COVID-19 Sepsis: Italian Researchers Warns Of Antimicrobial Drug Resistant Co-Infections In COVID-19 Patients
: Italian researchers in a case report published on a preprint server warns of bacterial or fungal infections that are drug resistant emerging in COVID-19 patients, often leading to treatment complications, sepsis and fatalities. https://www.preprints.org/manuscript/202008.0198/v1
The researchers said that although co-infections with bacteria or fungi may be a frequent complication of COVID-19, co-infections with Candida species in COVID-19 patients remain rare.
In the case report, the study team reported the 53-day clinical course of a complicated type-2 diabetes patient diagnosed with COVID-19, who developed bloodstream infections initially due to methicillin-resistant Staphylococcus aureus, secondly to multidrug-resistant Gram-negative bacteria, and lastly to a possibly fatal Candida glabrata. D
Development of FKS-associated pan-echinocandin resistance in the C. glabrata isolated from the patient after 13 days of caspofungin treatment aggravated the situation.
The patient subsequently died of septic shock shortly before the prospect of receiving potentially effective antifungal therapy.
This case emphasizes the importance of early diagnosis and monitoring for antimicrobial drug-resistant co-infections to reduce their unfavorable outcomes in COVID-19 patients.
Although sepsis may be a fatal complication of COVID-19, co-infection (also named super-infection) with bacteria or fungi may occur, albeit confined to the respiratory tract.
In two independent studies from Chinese hospitals, 96.4% and 16% of COVID-19 patients who died had secondary infections. This is consistent with a failed homeostasis between innate and adaptive responses or a pronounced immune suppression, which is partly dependent on the loss of lymphocytes, following SARS-CoV-2 infection. Diabetes is the most common comorbidity in COVID-19, with its late complications (e.g., ischemic heart disease) contributing to further increase COVID-19 severity.
Furthermore, diabetes increases not only the risk of infections but also of infection-related deaths. In this context, diabetes seems to alter the intestinal barrier function allowing gut microbiota members (e.g., Enterobacterales or Candida species) to reach the bloodstream and, then, to spread systemically.
In conclusion, the researchers say that this case highlights that bacterial and fungal co-infections, including those associated with antimicrobial resistance, in COVID-19 may be a further challenge for both clinicians and microbiologists. In waiting for epidemiological studies to evaluate their frequency and impact, it is imperative to be vigilant for these co-infections being complicating the outcome of COVID-19.
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