Title : The rising trend of gram-negative bacterial infections in the post-Covid era and military conflict in Ukraine
Abstract:
Introduction: Since early 2022, Ukraine has faced unprecedented challenges due to the ongoing war following Russia's aggression. At the same time, the country, like the rest of the world, continues to confront the aftermath of the COVID-19 pandemic, which has exacerbated various health issues. Notably, there has been nearly a two-fold increase in bacterial and viral infections between 2022 and 2023. Of particular concern is the rising incidence of Gram-negative bacterial infections, increasingly caused by multidrug-resistant (MDR) strains. The most vulnerable populations include individuals with a history of severe COVID-19 or post-COVID complications, which weaken immune defenses and heighten susceptibility to secondary infections.
Materials and Methods: This study was conducted in the infectious diseases department and the bacteriological laboratory of a regional hospital in Dnipro, Ukraine, following EUCAST standards. We collected a total of 103 biological samples (sputum, wound exudate, blood, and urine) from hospitalized patients to assess antimicrobial susceptibility. Additionally, a clinical case of a COVID-19 patient with severe bacterial complications was analyzed, focusing on microbiological findings and the selection of targeted antimicrobial therapy.
Results: Among the isolated bacterial pathogens from various biological samples (including blood, feces, urine, sputum, bronchial lavage, and wound exudate), over 30% were non-fermenting, multidrug-resistant organisms. The predominant pathogens included Escherichia coli (30%), Salmonella enteritidis (18%), Acinetobacter spp. (16%), Klebsiella pneumoniae (21%), and Pseudomonas aeruginosa (7%). Despite the availability of treatment options, most isolates demonstrated extensive antibiotic resistance, posing significant therapeutic challenges. This is exemplified by the following clinical case: A 32-year-old woman was hospitalized on day 8 of her COVID-19 pneumonia (confirmed by CT), presenting with an SpO? of 90% and moderate respiratory failure. Prior to admission, she had received ceftriaxone. In the hospital, her treatment included remdesivir, dexamethasone, anticoagulants, levofloxacin, and supplemental oxygen. On day 5, her condition worsened due to worsening hypoxia, necessitating admission to the ICU and escalation to meropenem. Subsequent sputum cultures identified MDR Klebsiella pneumoniae and Pseudomonas aeruginosa. Given the resistance profile, her therapy was adjusted to a combination of ceftazidime/avibactam and aztreonam every 8 hours intravenously. The patient showed gradual improvement, requiring reduced oxygen support, and was discharged after three weeks for continued care under a thoracic surgeon and family physician.
Conclusions: The surge in bacterial infections following COVID-19 has led to increased antibiotic use, contributing to the rise of antimicrobial resistance. The combination of ongoing military conflict and the persistent healthcare burdens of COVID-19 exacerbates these challenges. This situation necessitates strategic interventions in infection control, antimicrobial stewardship, and healthcare resource allocation
