Pathophysiology of Methicillin-Resistant Staphylococcus aureus Superinfection in COVID-19 Patients

Gul Habib; Khalid Mahmood; Haji Gul; Muhammad Tariq; Qurat Ul Ain; Azam Hayat; Mujaddad Ur Rehman

doi:10.3390/pathophysiology29030032

Pathophysiology of Methicillin-Resistant Staphylococcus aureus Superinfection in COVID-19 Patients

Pathophysiology. 2022 Jul 27;29(3):405-413. doi: 10.3390/pathophysiology29030032.

Authors

Gul Habib¹, Khalid Mahmood², Haji Gul³, Muhammad Tariq⁴, Qurat Ul Ain¹, Azam Hayat¹, Mujaddad Ur Rehman¹

Affiliations

¹ Department of Microbiology, Abbottabad University of Science and Technology, Havelian, Abbottabad 22010, Pakistan.
² National Institute of Virology, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75850, Pakistan.
³ College of Animal Science and Technology, Anhui Agricultural University, Hefei 230036, China.
⁴ Institute of Paramedical Sciences, Khyber Medical University, Peshawar 25000, Pakistan.

Abstract

The global spread of the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has infected humans in all age groups, deteriorated host immune responses, and caused millions of deaths. The reasons for individuals succumbing to COVID-19 were not only the SARS-CoV-2 infection but also associated bacterial infections. Antibiotics were largely used to prevent bacterial infections during COVID-19 illness, and many bacteria became resistant to conventional antibiotics. Although COVID-19 was considered the main culprit behind the millions of deaths, bacterial coinfections and superinfections were the major factors that increased the mortality rate in hospitalized patients. In the present study, we assessed the pathophysiology of methicillin-resistant Staphylococcus aureus (MRSA) superinfection in COVID-19 patients in Pakistan. A total of 3492 COVID-19 hospitalized patients were screened among which 224 strain were resistant to methicillin; 110 strains were tazobactam-resistant; 53 strains were ciprofloxacin-resistant; 23 strains were gentamicin-resistant; 11 strains were azithromycin-resistant; 3 strains were vancomycin-resistant. A high frequency of MRSA was detected in patients aged ≥50 with a prevalence of 7.33%, followed by patients aged >65 with a prevalence of 5.48% and a 5.10% prevalence in patients aged <50. In addition, pneumonia was detected in the COVID-19-associated MRSA (COVID-MRSA) that showed decreased levels of lymphocytes and albumin and increased the mortality rate from 2.3% to 25.23%. Collectively, an MRSA superinfection was associated with increased mortality in COVID-19 after 12 to 18 days of hospitalization. The study assessed the prevalence of MRSA, mortality rate, pneumonia, and the emergence of antibiotic resistance as the main outcomes. The study summarized that COVID-MRSA aggravated the treatment and recovery of patients and suggested testing MRSA as critical for hospitalized patients.

Keywords: COVID-19; MRSA; antibiotic resistance; mecA; pneumonia.

Grants and funding

The study was partially funded by the Office of Research Innovation and Commercialization, Abbottabad University of Science and Technology (Grant no: AUST/ORIC/2021/375).