Co-infections among COVID-19 Patients in Ugandan Intensive Care Units (preprint)

ABSTRACT

Background: The pandemic of COVID-19 has led to an upsurge of critically ill patients requiring advanced life support. Bacteria and fungi have been isolated as etiological agents for co-infections among COVID-19 patients in the intensive care unit (ICU). Co-infection has been associated with worse outcomes among COVID-19 patients in ICUs. The aim of this study was to determine the prevalence of co-infections and their antimicrobial susceptibility patterns among COVID-19 patients admitted to intensive care units in Uganda.    Materials and Methods: A multi-center cross-sectional retrospective survey was carried out in Intensive Care Units (ICUs) in Mulago national referral hospital, UMC Victoria and TMR international hospital in Uganda. The records of 216 hospitalized ICU COVID-19 patients were purposively sampled using a standardized data abstraction tool. The collected data were double entered in Epi-data version 3.1 and exported to Stata version 17.0 for statistical analysis. Results: The prevalence of co-infections (bacterial and fungal) was 111(51.39%) with respiratory tract infections 57(51.35%) being the most prevalent. Staphylococcus aureus 23(28.75%), Citrobacter freudii 19(23.75%), Pseudomonas aureginosa 15(18.75%) and Klebsiella pneumoniae 10(12.50%) were the most frequently isolated bacterial species. The prevalence of multidrug resistant bacterial species was 75.95%. About 07/8(8.75%) of the bacterial species were extended spectrum beta lactamase or AmpC beta lactamase producers. Some of ESBL producers demonstrated susceptibility to Augmentin, Amikacin and trimethoprim.  Augmentin 33/54(61.11%) and ceftriaxone 4/44(9.09%) had the highest and lowest overall antibiotic susceptibility respectively.  About 31/111(27.93%) of the organisms were Candida albicans. The fungal species isolated had good overall susceptibility to most commonly used antifungal agents in the study setting. Conclusion: This study found a high prevalence of co-infections (bacterial and fungal). Respiratory tract infection was the most prevalent. There was an overwhelming burden of multidrug resistant infections with some extended spectrum drug resistant organisms isolated among COVID-19 patients admitted in the Ugandan ICUs. There is need for establishment of stronger policy measures in regards to antibiotic stewardship, antimicrobial surveillance and infection control to inform empirical antibiotic therapy and mitigate the spread MDR bacteria and antibiotic drug resistance among COVID-19 patients.