COVID-19 Tanılı Hastalarda Koenfeksiyonlar ve Antimikrobiyal Direnç

Giriş: SARS CoV-2’nin, diğer solunum yolu patojenleri ile koenfeksiyonu, hastalığın seyrini kötüleştirir. COVID-19'un başarılı tedavisi için, antimikrobiyal tedavi uygulanmaktadır. Uygunsuz antimikrobiyal kullanımı, dirençli patojenlerin artmasına, yeni direnç paternlerinin ortaya çıkmasına, tedavisi güç, mortalitesi yüksek enfeksiyonlara neden olur. COVID-19 hastalarında daha iyi terapötik sonuçlar elde etmek için ampirik antimikrobiyal tedavi stratejilerinin belirlenmesine katkı sağlamak amacıyla kendi merkezimizdeki koenfeksiyonlar analiz edildi. Yöntem: Nazofaringeal sürüntü örnekleri RT-PZR test yöntemi kullanılarak COVID-19 virüsü yönünden, solunum yolu örnekleri (balgam, bronkoalveolar lavaj, trakeal aspirat) de rutin bakteri/mantar kültürleri yönünden test edildi. İzolatların tanımlanması ve antibiyotik duyarlılığı için Vitek 2 Compact (Biomerieux, Fransa) cihazı kullanıldı. Bulgular: COVID-19 testi pozitif olan hastalar arasında 15/1093 vakada (%1.4) bakteriyel ve/veya fungal koenfeksiyon görüldü. Bunlar 10 gram-negatif bakteri (%55.6), 2 gram-pozitif bakteri (%11.1), 6 maya mantarı (%33.3) olarak, sırası ile: Aeromonas hydrophila/caviae (n=2), Burkholderia cepacia (n=2), Pseudomonas aeruginosa (n=2), Acinetobacter baumannii (n=2), Achromobacter xylosoxidans (n=1), Serratia marcescens (n=1) ve Staphylococcus aureus (n=2) olarak tanımlandı. Candida albicans (n=2), Candida glabrata (n=2) ve Candida kefyr (n=2) de solunum yolu örneklerinde üreyen fungal patojenler olarak tanımlandı. Burkholderia cepacia, Pseudomonas aeruginosa, Acinetobacter baumannii izolatları Çok ilaca dirençli olarak bulundu. İki Acinetobacter baumannii türü hariç hiçbir izolatta karbapenem direncine rastalanmadı. En yüksek direnç gentamisin (%83.3) ve siprofloksasine (%83.3) karşı bulundu. Daha düşük oranlarda olmak üzere; trimetoprim/sulfametoxazole (%66.7), piperasillin/tazobactam (%66.7) ve amikasin’e (%40) direç tespit edildi. Bakterilerin hiçbirinde kolistine direnç görülmedi. Gram pozitif bakteriler vankomisin, linezolid ve tigesikline duyarlı olarak bulundu. Her iki Staphylococcus aureus’ta metisilin direnci tespit edildi. Sonuç: Çalışmamızda COVID-19 tanısı almış ve eş zamanlı solunum yolu örnekleri kültürü yapılan hastalardaki bakteriyel/fungal koenfeksiyonları inceledik. Düşük koenfeksiyon sıklığına rağmen izole edilen mikroorganizmalar yüksek antimikrobiyal direnç paternine sahipti. Bu sonuçlara göre, artan antimikrobiyal direnç oranlarının önüne geçmek için her merkez ciddi bir antimikrobiyal yönetim programı uygulamalıdır. Enfeksiyon kontrolü yöntemlerine uyulması ve geniş spektrumlu antimikrobiyallerin uygunsuz kullanılmasından kaçınılması; dirençli patojenlerin artmasına, yeni direnç paternlerinin ortaya çıkmasına, tedavisi güç, mortalitesi yüksek enfeksiyonlara ve yeni salgınlara engel olacaktır. Ülkemizde COVID-19’lu hastalarda bakteriyel/fungal koenfeksiyonlarının prevalansı ve profili henüz çok iyi anlaşılmamıştır. Çalışmamızın, COVID-19 hastalarında optimal antimikrobiyal kullanımını yönlendirmekte fayda sağlayacağını düşünmekteyiz

Anahtar Kelimeler:

SARS-CoV-2, koenfeksi̇yon, COVID-19

Co-infections and Antimicrobial Resistance in Patients Diagnosed with COVID-19

Objective: Co-infection of SARS CoV-2 with other respiratory pathogens worsens the course of the disease. For the successful treatment of COVID-19, antimicrobial therapy is applied. Inappropriate antimicrobial use causes an increase in resistant pathogens, the emergence of new resistance patterns, and infections that are difficult to treat and have high mortality. Co-infections in our own center were analyzed to contribute to the determination of empirical antimicrobial treatment strategies to achieve beter therapeutic results in COVID-19 patients. Methods: Nasopharyngeal swab samples were tested for COVID-19 virus using the RT-PCR test method, and respiratory tract samples (sputum, bronchoalveolar lavage, tracheal aspirate) were tested for routine bacterial/fungal cultures. Vitek 2 Compact (Biomerieux, France) device was used for the identification and antibiotic susceptibility of the isolates. Results: Among patients who tested positive for COVID-19, 15/1093 cases (1.4%) showed bacterial and/or fungal coinfection. These were 10 gram-negative bacteria (55.6%), 2 gram-positive bacteria (11.1%), 6 yeasts (33.3%), respectively: Aeromonas hydrophila/caviae (n 2), Burkholderia cepacia (n=2), It was defined as Pseudomonas aeruginosa (n = 2), Acinetobacter baumannii (n=2), Achromobacter xylosoxidans (n=1), Serratia marcescens (n=1) and Staphylococcus aureus (n = 2). Candida albicans (n=2), Candida glabrata (n=2) and Candida kefyr (n=2) were also identified as fungal pathogens grown in respiratory tract samples. Burkholderia cepaciave, Pseudomonas aeruginosa, Acinetobacter baumannii isolates were found to be Multidrug Resistant. Carbapenem resistance was not found in any isolates except for two Acinetobacter baumannii species. The highest resistance was found against gentamicin (83.3%) and ciprofloxacin (83.3%). At lower rates; resistance to trimethoprim/sulfamethoxazole (66.7%), piperacillin/tazobactam (66.7%) and amikacin (40%) was detected. No resistance to colistin was observed in any of the bacteria. Gram positive bacteria were found susceptible to vancomycin, linezolid and tigecycline. Methicillin resistance was detected in both Staphylococcus aureus. Conclusion: In our study, we examined bacterial/fungal co-infections in patients diagnosed with COVID-19 and simultaneously cultured respiratory tract samples. Despite the low frequency of coinfection, the isolated microorganisms had a high antimicrobial resistance pattern. According to these results, each center should implement a serious antimicrobial management program to preventin creasing antimicrobial resistance rates. Compliance with infection control methods and avoidance of inappropriate use of broad-spectrum antimicrobials; It will prevent the increase of resistant pathogens, the emergence of new resistance patterns, infections that are difficult to treat and have high mortality, and new epidemics. The prevalence and profile of bacterial/fungal co-infections in patients with COVID-19 in our country are not yet well understood. We think that our study will be beneficial in guiding the optimal antimicrobial use in patients with COVID-19.

Keywords:

SARS-CoV-2, koenfeksi̇yon, COVID-19,

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