Abstract:
Introduction
The emergence of multidrug-resistant (MDR) ESKAPE pathogens in
severe COVID-19 patients poses a significant challenge in intensive
care units (ICUs). The study aims to assess the antibiotic resistance
profile of ESKAPE pathogens isolated from the respiratory tract of
critically ill COVID-19 patients and its impact on treatment efficacy
and patient outcomes.
Material and methods
Tracheal swab samples were collected from ICU patients diagnosed
with severe COVID-19. Following collection, swabs were immediately
transported to the microbiology laboratory, where they were
inoculated onto appropriate culture media and incubated under
standard conditions. Colonies suspected of being ESKAPE pathogens
were identified using Vitek 2 Compact, antimicrobial susceptibility
was determined based on the European Committee on Antimicrobial
Susceptibility Testing (EUCAST) guidelines. Results
Out of 227 isolates from the ESKAPE group, the distribution was: P.
aeruginosa – 28 (16.47%), A. baumannii – 125 (73.53%), E. faecium – 10 (5.88%), E. coli – 6 (3.53%), K. pneumonia – 38 (22.35%), S. aureus
– 20 (11.76%). Extensive Carbapenem Resistance: A. baumannii
exhibited 95.2% resistance to imipenem and 92.8% to meropenem.
K. pneumoniae showed 66.7% resistance to ceftriaxone and 18.9% to
meropenem. P. aeruginosa displayed 47.6% resistance to imipenem
and 50% to meropenem. Aminoglycoside Resistance: 95.3% of A.
baumannii isolates and 67.8% of P. Aeruginosa isolates were
resistant to tobramycin. 98.4% of A. baumannii isolates exhibited
resistance to amikacin, while 51.8% of P. aeruginosa were resistant
to gentamicin. Fluoroquinolone Resistance: A. baumannii showed
95.9% resistance to ciprofloxacin and 95.7% to levofloxacin. K.
pneumoniae exhibited 71.4% resistance to ciprofloxacin. Macrolide
and β-Lactam Resistance: K. pneumoniae and P. aeruginosa
demonstrated high resistance to cephalosporins (65-100%). S. aureus
had 44.4% resistance to ciprofloxacin and 33.3% to azithromycin.
Enterococcus faecium showed 100% resistance to vancomycin,
confirming the presence of VRE (Vancomycin-Resistant
Enterococcus) strains.
Conclusions
The widespread resistance to carbapenems, fluoroquinolones, and
aminoglycosides significantly limits treatment options, increasing the
risk of therapeutic failure, prolonged hospitalization, and high
mortality rates. These findings underscore the critical need for
infection control measures, targeted antimicrobial therapy, and
novel treatment strategies to combat MDR infections in COVID-19
ICUs.
