{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T08:05:48Z","timestamp":1771661148055,"version":"3.50.1"},"reference-count":59,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T00:00:00Z","timestamp":1650931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008809","name":"University of Hail","doi-asserted-by":"publisher","award":["RG191293"],"award-info":[{"award-number":["RG191293"]}],"id":[{"id":"10.13039\/501100008809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Bacterial co-infections may aggravate COVID-19 disease, and therefore being cognizant of other pathogens is imperative. We studied the types, frequency, antibiogram, case fatality rates (CFR), and clinical profiles of co-infecting-pathogens in 301 COVID-19 patients. Co-infection was 36% (n = 109), while CFR was 31.2% compared to 9.9% in non-co-infected patients (z-value = 3.1). Four bacterial species dominated, namely, multidrug-resistant Klebsiella pneumoniae (37%, n = 48), extremely drug-resistant Acinetobacter baumannii (26%, n = 34), multidrug-resistant Eschericia. coli (18.6%, n = 24), and extremely drug-resistant Pseudomonas aeruginosa (8.5%, n = 11), in addition to other bacterial species (9.3%, n = 12). Increased co-infection of K. pneumoniae and A. baumannii was associated with increased death rates of 29% (n = 14) and 32% (n = 11), respectively. Klebsiella pneumoniae was equally frequent in respiratory and urinary tract infections (UTI), while E. coli mostly caused UTI (67%), and A. baumannii and P. aeruginosa dominated respiratory infections (38% and 45%, respectively). Co-infections correlated with advance in age: seniors \u2265 50 years (71%), young adults 21\u201349 years (25.6%), and children 0\u201320 years (3%). These findings have significant clinical implications in the successful COVID-19 therapies, particularly in geriatric management. Future studies would reveal insights into the potential selective mechanism(s) of Gram-negative bacterial co-infection in COVID-19 patients.<\/jats:p>","DOI":"10.3390\/ijerph19095270","type":"journal-article","created":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T11:45:55Z","timestamp":1650973555000},"page":"5270","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["COVID-19 Clinical Profiles and Fatality Rates in Hospitalized Patients Reveal Case Aggravation and Selective Co-Infection by Limited Gram-Negative Bacteria"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3749-6754","authenticated-orcid":false,"given":"Kamaleldin","family":"Said","sequence":"first","affiliation":[{"name":"Department of Pathology, College of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"},{"name":"Genomics, Bioinformatics and Systems Biology, Carleton University, 1125 Colonel-By Dr, Ottawa, ON K1S 5B6, Canada"},{"name":"ASC, McGill University, 21111 Lakeshore Rd, Montreal, QC H9X 3L9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Alsolami","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Safia","family":"Moussa","sequence":"additional","affiliation":[{"name":"Department of Microbiology, King Salman Specialist Hospital, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fayez","family":"Alfouzan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, King Salman Specialist Hospital, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelhafiz","family":"Bashir","sequence":"additional","affiliation":[{"name":"Department of Physiology, College of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Musleh","family":"Rashidi","sequence":"additional","affiliation":[{"name":"Ministry of Health, Hail Region, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rana","family":"Aborans","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taha","family":"Taha","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7585-2166","authenticated-orcid":false,"given":"Husam","family":"Almansour","sequence":"additional","affiliation":[{"name":"Health Management Department, College of Public Health and Health Informatics, University of Ha\u2019il, Ha\u2019il 81481, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mashari","family":"Alazmi","sequence":"additional","affiliation":[{"name":"College of Computer Science and Engineering, University of Ha\u2019il, Ha\u2019il 81481, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amal","family":"Al-Otaibi","sequence":"additional","affiliation":[{"name":"Department of Pathology, College of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luluh","family":"Aljaloud","sequence":"additional","affiliation":[{"name":"Department of 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