Clinical and microbiological characteristics of viral-bacterial pneumonia caused by Klebsiella pneumoniae in SARS-CoV-2 infected patients

The object of study was to investigate the clinical and laboratory characteristics, the outcomes of the disease, the susceptibility to antibiotics and to different combinations in the patients with pneumonia caused by K. pneumoniae associated and not associated with COVID-19.

We analysed 93 cases of pneumonia with K. pneumoniae detected in biological materials including 65 ones with COVID-19 and 28 ones without COVID-19.

In the both groups, the diseases of the circulatory system and metabolic disorders were the most common concomitant conditions. The laboratory data were not statistically different. The lethal outcomes were found reliably more often in the patients with COVID-19 (66 % vs 32 %).

 K. pneumoniae was detected predominantly after the tenth day of admission to the hospital (nosocomial strains). In the both groups, the majority of detected K. pneumoniae strains had a multiple resistance to antibiotics. The combinations of antibiotics with no colistin demonstrated a low efficacy, including those with carbapenems. A proportion of 40 (61.5 (48.6–73.3) %) K. pneumoniae samples isolated from patients with COVID-19 had carbopenemases detected.

The results of the study refer to the preferability of the colistin comprising the schemes of antibiotics for treatment  of pneumonia caused by K. pneumoniae associated and not associated with COVID-19.

1. COVID-19 Weekly Epidemiological Update Edition. World Health Organization (Edition 158 published September 1, 2023). Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20230901_weekly_epi_update_158.pdf?sfvrsn=b47cef7a_3&download=true (accessed 12.12.2023).

2. Wu H. Y., Chang P. H., Chen K. Y., Lin I. F., Hsih W. H., Tsai W. L., Chen J. A., Lee S. S. Coronavirus disease 2019 (COVID-19) associated bacterial coinfection: Incidence, diagnosis and treatment. Journal of Microbiology, Immunology and Infection, 2022, vol. 55, no. 6, pt. 1, pp. 985‒992. https://doi.org/10.1016/j.jmii.2022.09.006

3. Che Y. R., Norhayati M. N., Mohd A. Y. Bacterial coinfection and antibiotic resistance in hospitalized COVID-19 patients: a systematic review and meta-analysis. PeerJ, 2023, vol. 26, no. 11, p. e15265. https://doi.org/10.7717/peerj.15265

4. Aldali J. A., Aldali H. J., Aljohani R., Algahtani M., Meo S. A., Alharbi S. [еt al.]. Implications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected hospitalised patients with co-infections and clinical outcomes. Microorganisms, 2023, vol. 11, no. 8, art. 1921. https://doi.org/10.3390/microorganisms11081921

5. Chang R. Y., Nang S. C., Chan H. K., Li J. Novel antimicrobial agents for combating antibiotic-resistant bacteria. Advanced Drug Delivery Reviews, 2022, vol. 187, art. 114378. https://doi.org/10.1016/j.addr.2022.114378

6. Pitout J. D., Nordmann P., Poirel L. Carbapenemase-producing Klebsiella pneumoniae, a key pathogen set for global nosocomial dominance. Antimicrobial Agents and Chemotherapy, 2015, vol. 59, no. 10, pp. 5873‒5884. https://doi.org/10.1128/AAC.01019-15

7. Bychinin M. V., Antonov I. O., Klypa T. V., Mandel’ I. A., Minets A. I., Kolyshkina N. A., Golobokova Ya. B. Nosocomial infection in patients with severe and critical COVID-19. Obshchaya reanimatologiya [General reanimatology], 2022, vol. 18, no. 1, pp. 4‒10 (in Russian).

8. Antimicrobial resistance surveillance in Europe 2023 ‒ 2021 data. Stockholm: European Centre for Disease Prevention and Control and World Health Organization; 2023. Available at: https://www.ecdc.europa.eu/en/publications-data/antimicrobial-resistance-surveillance-europe-2023-2021-data (accessed 12.12.2023).

9. Antonova E. G., Zhil’tsov I. V., Stakhovich I. I. Antibacterial therapy of hospital infections caused by carbapenemaseproducing strains of K. pneumoniae. Vestnik Vitebskogo gosudarstvennogo meditsinskogo universiteta [Bulletin of Vitebsk State Medical University], 2022, vol. 21, no. 3, pp. 69‒76 (in Russian).

10. Tapal’skii D. V. Susceptibility to antibiotic combinations among nosocomial carbapenemase-producing Gramnegative bacteria isolated in Belarus. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya [Clinical microbiology and antimicrobial chemotherapy], 2018, vol. 20, no. 3, pp. 182‒191 (in Russian).

11. Breakpoint tables for interpretation of MICs and zone diameters. Version. 12.0.2022. The European Committee on Antimicrobial Susceptibility Testing. Available at: http://www.eucast.org (accessed 29.01.2023).

12. Wu G., Lu J., Liu D., He Y. Characteristics and risk factors of secondary bacterial infections in COVID-19 patients. Antimicrobial Stewardship and Healthcare Epidemiology, 2023, vol. 3, no. 1, p. e156. https://doi.org/10.1017/ash.2023.425

13. Tapal’skii D. V., Karpova E. V. Susceptibility to antibiotic combinations of Klebsiella pneumoniae and Acinetobacter baumannii strains isolated from COVID-19 patients. Problemy zdorov’ya i ekologii [Health and ecology issues], 2021, vol. 18, no. 4, pp. 33‒40 (in Russian).

14. Samoilova A. A., Kraeva L. A., Likhachev I. V., Rogacheva E. V., Mikhailov N. V., Egorova S. A., Shiling E. A. Phenotypical and genotypical assessment of resistance of carbapenemase producing. Immunopatologiya, allergologiya, infektologiya [Immunopathology, allergology, infectology], 2022, no. 1, pp. 25‒31 (in Russian).

15. Hallal F. R. O., Nordmann P., Dominguez P. M., Findlay J., Poirel L. Emergence of carbapenemase-producing hypervirulent Klebsiella pneumoniae in Switzerland. Antimicrobial Agents and Chemotherapy, 2023, vol. 67, no. 3, p. e0142422.