{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:14:06Z","timestamp":1791756846355,"version":"4.3.4"},"reference-count":37,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T00:00:00Z","timestamp":1666915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Bacterial co-infection in COVID-19 patients significantly contributes to the worsening of the prognosis based on morbidity and mortality. Information on the co-infection profile in such patients could help to optimize treatment. The purpose of this study was to describe bacterial co-infections associated with microbiological, clinical, and laboratory data to reduce or avoid a secondary infection. A retrospective cohort study was conducted at Sant\u2019Anna and San Sebastiano Hospital from January 2020 to December 2021. Bacterial co-infection was detected in 14.3% of the COVID-19-positive patients. The laboratory findings on admission showed significant alterations in the median D-dimer, C-reactive protein, interleukin-6, and lactate dehydrogenase values compared to normal values. All inflammatory markers were significantly elevated. The most common pathogens isolated from blood cultures were E. faecalis and S. aureus. Instead, the high prevalence of respiratory tract infections in the COVID-19 patients was caused by P. aeruginosa (41%). In our study, 220 (82.4%) of the COVID-19 patients received antimicrobial treatment. Aminoglycosides and \u03b2-lactams\/\u03b2-lactamase inhibitors showed the highest resistance rates. Our results showed that older age, underlying conditions, and abnormal laboratory parameters can be risk factors for co-infection in COVID-19 patients. The antibiotic susceptibility profile of bacterial pathogen infection provides evidence on the importance, for the clinicians, to rationalize and individualize antibiotic usage.<\/jats:p>","DOI":"10.3390\/pathogens11111250","type":"journal-article","created":{"date-parts":[[2022,10,30]],"date-time":"2022-10-30T09:01:42Z","timestamp":1667120502000},"page":"1250","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Profile of Co-Infection Prevalence and Antibiotics Use among COVID-19 Patients"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4164-8578","authenticated-orcid":false,"given":"Rita","family":"Greco","sequence":"first","affiliation":[{"name":"UOSD Microbiology\u2014AORN Sant\u2019Anna and San Sebastiano, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Panetta","sequence":"additional","affiliation":[{"name":"UOSD Microbiology\u2014AORN Sant\u2019Anna and San Sebastiano, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0369-1009","authenticated-orcid":false,"given":"Maria Teresa","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"UOSD Microbiology\u2014AORN Sant\u2019Anna and San Sebastiano, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Durante","sequence":"additional","affiliation":[{"name":"UOSD Microbiology\u2014AORN Sant\u2019Anna and San Sebastiano, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Di Caprio","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Clinic, AORN Sant\u2019Anna and San Sebastiano, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8772-0136","authenticated-orcid":false,"given":"Paolo","family":"Maggi","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Clinic, AORN Sant\u2019Anna and San Sebastiano, 81100 Caserta, Italy"},{"name":"Department of Infectious Disease, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"10484","DOI":"10.1073\/pnas.2004978117","article-title":"Spread and dynamics of the COVID-19 epidemic in Italy: Effects of emergency containment measures","volume":"117","author":"Gatto","year":"2020","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41479-021-00083-w","article-title":"The role of co-infections and secondary infections in patients with COVID-19","volume":"13","author":"Feldman","year":"2021","journal-title":"Pneumonia (Nathan Qld.)"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/MCP.0000000000000666","article-title":"Viral respiratory infections: A cause of community-acquired pneumonia or a predisposing factor?","volume":"26","author":"Arnold","year":"2020","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1007\/s15010-021-01602-z","article-title":"State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia","volume":"49","author":"Chong","year":"2021","journal-title":"Infection"},{"key":"ref_5","first-page":"359","article-title":"Unit of Antibiotic Resistance and Special Pathogens; Unit of Antibiotic Resistance and Special Pathogens of the Department of Infectious Diseases, Istituto Superiore di Sanit\u00e0, Rome. Bacterial coinfections in COVID-19: An underestimated adversary","volume":"56","author":"Fattorini","year":"2020","journal-title":"Ann. Ist. Super. Sanita"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jinf.2020.05.046","article-title":"Co-Infections in People with COVID-19: A Systematic Review and Meta-Analysis","volume":"81","author":"Lansbury","year":"2020","journal-title":"J. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1111\/irv.12824","article-title":"Influenza and COVID-19: What does co-existence mean?","volume":"15","author":"Chotpitayasunondh","year":"2021","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/j.ajic.2020.06.192","article-title":"Could the COVID-19 pandemic aggravate antimicrobial resistance?","volume":"48","author":"Rossato","year":"2020","journal-title":"Am. J. Infect. Control."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1080\/07853890.2020.1840620","article-title":"Disparities in case frequency and mortality of coronavirus disease 2019 (COVID-19) among various states in the United States","volume":"53","author":"Loomba","year":"2021","journal-title":"Ann. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s12098-020-03263-6","article-title":"A Review of Coronavirus Disease-2019 (COVID-19)","volume":"87","author":"Singhal","year":"2020","journal-title":"Indian J. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1111\/all.14657","article-title":"Risk factors for severe and critically ill COVID-19 patients: A review","volume":"76","author":"Gao","year":"2021","journal-title":"Allergy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.jinf.2020.06.039","article-title":"Laboratory characteristics of patients infected with the novel SARS-CoV-2 virus","volume":"81","author":"Skevaki","year":"2020","journal-title":"J. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4381","DOI":"10.1007\/s00330-020-06801-0","article-title":"Chest CT manifestations of new coronavirus disease 2019 (COVID-19): A pictorial review","volume":"30","author":"Ye","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"173644","DOI":"10.1016\/j.ejphar.2020.173644","article-title":"Treatment for COVID-19: An overview","volume":"889","author":"Stasi","year":"2020","journal-title":"Eur. J. Pharmacol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3386","DOI":"10.1093\/jac\/dkaa326","article-title":"Antibiotic use in patients with COVID-19: A \u2018snapshot\u2019 Infectious Diseases International Research Initiative (ID-IRI) survey","volume":"75","author":"Nadrah","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1093\/jac\/dkaa194","article-title":"COVID-19 and the potential long-term impact on antimicrobial resistance","volume":"75","author":"Rawson","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_18","first-page":"2459","article-title":"Bacterial and Fungal Coinfection in Individuals with Coronavirus: A Rapid Review to Support COVID-19 Antimicrobial Prescribing","volume":"71","author":"Rawson","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2657","DOI":"10.1002\/jmv.26125","article-title":"Influenza and COVID-19 coinfection: Report of six cases and review of the literature","volume":"92","author":"Ozaras","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"7777","DOI":"10.1007\/s00253-020-10814-6","article-title":"The microbial coinfection in COVID-19","volume":"104","author":"Chen","year":"2020","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.cmi.2020.12.018","article-title":"Antibiotic prescribing in patients with COVID-19: Rapid review and meta-analysis","volume":"27","author":"Langford","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e533","DOI":"10.1093\/cid\/ciaa1239","article-title":"Empiric Antibacterial Therapy and Community-onset Bacterial Coinfection in Patients Hospitalized With Coronavirus Disease 2019 (COVID-19): A Multi-hospital Cohort Study","volume":"72","author":"Vaughn","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"108293","DOI":"10.1016\/j.diabres.2020.108293","article-title":"Risk factors for mortality among COVID-19 patients","volume":"166","author":"Albitar","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Arastehfar, A., Carvalho, A., Nguyen, M.H., Hedayati, M.T., Netea, M.G., Perlin, D.S., and Hoenigl, M. (2020). COVID-19-Associated Candidiasis (CAC): An Underestimated Complication in the Absence of Immunological Predispositions?. J. Fungi, 6.","DOI":"10.3390\/jof6040211"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.cmi.2020.07.016","article-title":"Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis","volume":"26","author":"Langford","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1001\/jama.2009.1754","article-title":"International study of the prevalence and outcomes of infection in intensive care units","volume":"302","author":"Vincent","year":"2009","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1007\/s42399-020-00363-4","article-title":"Comorbidity and its Impact on Patients with COVID-19","volume":"2","author":"Sanyaolu","year":"2020","journal-title":"SN Compr. Clin. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jhin.2021.04.001","article-title":"Fungal and bacterial coinfections increase mortality of severely ill COVID-19 patients","volume":"113","author":"Silva","year":"2021","journal-title":"J. Hosp. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1080\/10408363.2020.1770685","article-title":"Biomarkers associated with COVID-19 disease progression","volume":"57","author":"Ponti","year":"2020","journal-title":"Crit. Rev. Clin. Lab. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.cmi.2020.07.041","article-title":"Incidence of co-infections and superinfections in hospitalized patients with COVID-19: A retrospective cohort study","volume":"27","author":"Sanjuan","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1177\/00045632211022380","article-title":"Elevated procalcitonin concentrations in severe Covid-19 may not reflect bacterial co-infection","volume":"58","author":"Heer","year":"2021","journal-title":"Ann. Clin. Biochem."},{"key":"ref_33","first-page":"158","article-title":"Bacterial\/fungal infection in hospitalized patients with COVID-19 in a tertiary hospital in the Community of Castilla y Le\u00f3n, Spain","volume":"40","year":"2020","journal-title":"Enferm. Infect. Microbiol. Clin."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Segala, F.V., Bavaro, D.F., Di Gennaro, F., Salvati, F., Marotta, C., Saracino, A., Murri, R., and Fantoni, M. (2021). Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review. Viruses, 13.","DOI":"10.3390\/v13112110"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Musuuza, J.S., Watson, L., Parmasad, V., Putman-Buehler, N., Christensen, L., and Safdar, N. (2021). Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0251170"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s40545-022-00404-4","article-title":"The landscape of antibiotic usage among COVID-19 patients in the early phase of pandemic: A Malaysian national perspective","volume":"15","author":"Mohamad","year":"2022","journal-title":"J. Pharm. Policy Pract."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.jmii.2020.03.034","article-title":"Treatment options for COVID-19: The reality and challenges","volume":"53","author":"Jean","year":"2020","journal-title":"J. Microbiol. Immunol. Infect."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/11\/1250\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:04:55Z","timestamp":1760144695000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/11\/1250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,28]]},"references-count":37,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["pathogens11111250"],"URL":"https:\/\/doi.org\/10.3390\/pathogens11111250","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,28]]}}}