COVID-19 and bacterial superinfections: clinical and microbiological profiles, and determinants of mortality in a reference center in Quito, Ecuador

The massive prescription of antimicrobials accelerated the gen-eration of multi-resistant bacteria during the SARS-CoV-2 pandemic. This work aims to present the epidemiological, clinical, and microbiological profiles of a series of patients with bacterial superinfections hospitalized in a COVID-19 reference center. We conducted a retrospective observational study in adult COVID-19 patients hospitalized between January and December 2021 who pre-sented with bacterial superinfections. Mortality at discharge was the variable outcome. The median age of the 240 patients included in the study was 55 years, and the male sex predominated at 68.75%. The median stay of hospi-talization was 24 days. Superinfections occurred in 55% of patients with me-chanical ventilation. The most frequent bacteria were KPC-producing Klebsiella pneumoniaecomplex (24.17%), ESBL -producing Klebsiella pneumoniae com-plex (17.92%), and carbapenem-resistant Pseudomonas aeruginosa (13.75%). The most used empirical and targeted antibiotic schemes consisted of the asso-ciation of carbapenem, glycopeptides, and aminoglycosides (56.09 and 38.55%, respectively). In the multivariate analysis, older age (p= 0.006, OR 1.03, 95% CI: 1.01-1.06), central venous catheter-related bacteremia (CLBSI) (p= 0.028, OR 1.94, 95%CI: 1.07-3.49), and the use of colistin associated with other anti-biotics as targeted therapy (p: 0.028, OR 12, 95%CI: 1.30-110.52), were inde-pendent predictors of mortality. In this series, we found that in patients with COVID-19 and bacterial superinfection, age, CLBSI, and colistin use were in-dependent predictors of non-survival. The most frequently isolated microor-ganisms were ESBL - and KPC-producing enterobacterales and non-fermenting Gram-negative bacilli resistant to carbapenems.