Bacterial co-infection in patients with SARS-CoV-2 in the Kingdom of Bahrain

Table 1 Comparison patients’ demographic for total admitted patients with/without Bacterial or fungal coinfections

	Total admitted patients (COVID with clinical suspicion of sepsis)	Patients without coinfection (negative bacterial culture)	Patients with coinfection (positive bacterial culture)	P value
n (%)	1380	1119 (81.1)	261 (18.9)	< 0.0001
Male/female	0.92	0.87	1.13	> 0.05
Bahraini/non-Bahraini	2.80	2.70	3.10	> 0.05
Mean age (yr) ± SD	50.2 ± 18.1	48.4 ± 17.6	58.5 ± 18.7	< 0.0001
Death	159 (11.5%)	48 (4.30%)	111 (42.5%)	< 0.0001
Recurrences	5 (0.36%)	3 (0.27%)	2 (0.77%)	> 0.05

COVID: Corona virus disease; SD: Standard deviation.

Table 2 Comparison patients’ demographics and microbial profile for patients with gram-positive and gram-negative Bacteria and mixed infections

	Gram + ve coinfection	Gram-ve coinfection	Mixed coinfection	Candida	P value1	P value2	P value3
n (%)	136 (54)	115 (46)	82 (23.8)	115 (46)	> 0.05	< 0.0001	< 0.0001
Male/female	0.82	0.67	0.74	0.88	> 0.05	> 0.05	> 0.05
Bahraini/non-Bahraini	2.50	3.10	1.90	2.10	> 0.05	> 0.05	> 0.05
Mean age (yr) ± SD	57.7 ± 18.2	60 ± 18.2	64.3 ± 14.3	63.4 ± 16.4	> 0.05	< 0.01a	< 0.05
Death	39 (28.7%)	61 (53%)	62 (75.6%)	81 (70.4%)	< 0.0001	< 0.0001	< 0.01
HA infection	78 (57.3%)	86 (75%)	79 (96%)	97 (84.3%)	< 0.001	< 0.0001	< 0.0001

¹Comparison between gram + ve and gram-ve coinfection.

²Comparison between gram + ve and mixed coinfections.

³Comparison between gram-ve and mixed coinfections. HA: Hospital acquired; SD: Standard deviation.

Table 3 Microbiological profile in the admitted patients with confirmed coronavirus disease 2019 during the study period (472 isolates)

Type of the organism					Number	% of MDR
Gram Negative Isolates (164)	Klebsiella pneumoniae			Total	39	97.4
				ESBL	11
				CRE	27
	Pseudomonas aeruginosa			Total	38	26.3
				CRP	8
				MDR	2
	Acinetobacter baumannii (MDR)				36	100
	Escherichia coli			Total	28	68
				ESBL	11
				CRE	8
	Stenotrophomonas maltophilia				12	0
	Enterobacter cloacae			Total	2	100
				CRE	2
	Other				9	0
	Total G-ve isolates				164	59
	Total G-ve MDR strains				97
Gram positive isolates (164)	Coagulase negative Staphylococci (CoNS)	Staphylococcus hominis		Total	31	58
				MRCoNS	18
		Staphylococcus epidermidis		Total	25	78.6
				MRCoNS	22
		Staphylococcus heemolyticus		MRCoNS	18	100
		Staphylococcus capitis		Total	10	50
				MRCoNS	5
		Staphylococcus pettenkoferi		MRCoNS	1	100
		Total CoNS		Total	85	75.3
				MRCoNS	64
	Enterococcus faecium			Total	24	16.6
				VRE	3
				HLGR	1
	Enterococcus faecalis			Total	20	5.0
				HLGR	1
	Staphylococcus aureus			Total	15	53.3
				MRSA	8
	Others				20
	Total G + ve isolates				164	47
	Total G + ve MDR Strains				77
Fungal isolates(144)	Fungaemia		Candida galabrata		11
			Candida tropicalis		9
			Candida albicans		7
			Aspergillus fumigatus		3
			Candida parapsilosis		3
			Aspergillus niger		3
			Total		36
	Candida species				108
	Total fungal isolates				144
Total number of the microbial isolates					472	36.9
Total number of mdr bacterial strains					174

CRE: Carbapenem-resistant Enterobacteriaceae; ESBL: Extended spectrum beta-lactamase; HLGR: High level aminoglycoside resistance; MDR: Multidrug-resistant; MRCoNS: Methicillin-resistant coagulase-negative Staphylococci; MRSA: Methicillin-resistant Staphylococcus aureus; VRE: Vancomycin-resistant enterococci; Other gram-negative bacteria: Citrobacter freundii, Salmonella species, Pantoea species, Proteus mirabilis, Serratia marcescens, Elizabethkingia meningoseptica; Other gram-positive bacteria: Streptococcus agalactiae (Strep. Group B), Corynebacterium afermentans, Bacillus licheniformis, Leuconostoc mesenteroides, Staphylococcus caprae, Staphylococcus lugdunensis, Staphylococcus warneri, Streptococcus parasanguinis, Gemella sanguinis, Micrococcus luteus, Propionibacterium acnes, Rhodococcus erythropolis, Aerococcus viridans, Staphylococcus gallinarum.

Table 4 Comparison between the community and hospital acquired infections and their microbiologic profile from coronavirus disease 2019 confirmed patients (total isolates 472)

Character					HA infection	CA infection	P value
Patient number (total 261) 22 patients has both HA and CA					185 (70.8%)	98 (37.5%)	< 0.0001
Age					60.8 ± 16.8	54. ± 20.6	< 0.01
Male: Female					0.85	0.80	> 0.05
Bharani					137 (74%)	71 (72.4%)	> 0.05
Death					102 (55%)	23 (23.5%)	< 0.0001
Gram negative isolates (164)	Klebsiella pneumoniae			Total	30	9
				ESBL	11	0
				CRE	15	2
	Acinetobacter baumannii (MDR)				29	7
	Pseudomonas aeruginosa			Total	28	10
				CRP	6	2
				MDR	2	2
	Escherichia coli			Total	13	15
				ESBL	6	6
				CRE	5	2
	Stenotrophomonas maltophilia				11	1
	Enterobacter cloacae			Total	2	0
				CRE	1	0
	Others				8	1
	Total number of the G-ve isolates (164)				121 (73.8%)	43 (26.2%)	< 0.0001
	Number of G-ve resistant Strains				75 (62%)	21(48.8%)	> 0.05
	% from total Resistant strains (96)				78.1%	21.9%	< 0.0001
Gram positive isolates (164)	Coagulase negative Staphylococci (CoNS)	Staphylococcus epidermidis		Total	19	6
				MRCoNS	18	4
		Staphylococcus haemolyticus		MRCoNS	14	4
		Staphylococcus hominis		Total	12	19
				MRCoNS	6	13
		Staphylococcus capitis		Total	5	5
				MRCoNS	5	0
		Staphylococcus pettenkoferi		MRCoNS	1	0
		Total CoNS		Total	41 (40.6%)	31 (49.2%)	> 0.05
				MRCoNS	37 (90%)	21 (67.7%)	< 0.05
	Enterococcus faecium			Total	17	7
				VRE	2	1
				HLGR	1	0
	Enterococcus faecalis			Total	16	4
				HLGR	1	0
	Staphylococcus aureus			Total	8	8
				MRSA	3	5
	Others				9	10
	Total number of the G + ve isolates (164)				101 (61.6%)	63 (38.4%)	< 0.0001
	Number of G + ve resistant strains				51 (50.5%)	27 (42.9%)	> 0.05
	% from total Resistant strains (78)				65.4%	34.6%	< 0.0001
Fungal isolates (144)			Candida galabrata		11	0
			Candida albicans		7	0
			Candida tropicalis		9	0
			Candida parapsilosis		3	0
			Aspergillus fumigatus		3	0
			Aspergillus niger		3	0
			Total		36	0
	Candida species				95	13
	Total fungal isolates (144)				131 (91%)	13 (9%)	< 0.0001
Total microbial isolates (472)					353 (74.8%)	119 (25.2%)	< 0.0001
Total number of resistant bacterial strains					126 (35.7%)	48 (40.3%)	> 0.05
Percentage from total resistant bacterial strains (174)					72.4%	27.6%	< 0.0001

CA: Community Acquired; CRE: Carbapenem-resistant Enterobacteriaceae; ESBL: Extended spectrum beta-lactamase; HA: Hospital acquired; HLGR: High level aminoglycoside resistance; MDR: Multidrug-resistant; MRCoNS: Methicillin-resistant coagulase-negative Staphylococci; MRSA: Methicillin-resistant Staphylococcus aureus; VRE: Vancomycin-resistant enterococci; Other gram-negative bacteria: Citrobacter freundii, Salmonella species, Pantoea species, Proteus mirabilis, Serratia marcescens, Elizabethkingia meningoseptica; Other gram-positive bacteria: Streptococcus agalactiae (Strep. Group B), Corynebacterium afermentans, Bacillus licheniformis, Leuconostoc mesenteroides, Staphylococcus caprae, Staphylococcus lugdunensis, Staphylococcus warneri, Streptococcus parasanguinis, Gemella sanguinis, Micrococcus luteus, Propionibacterium acnes, Rhodococcus erythropolis, Aerococcus viridans, Staphylococcus gallinarum.