Background: In the COVID-19 pandemic from 2019 to date, we confront secondary bacterial and viral infections in SARS-CoV2 infected patients, especially hospitalized patients. Coagulase-negative staphylococci, are commensals of the human body and can lead to infections in immunocompromised patients. The antimicrobial resistance is increasingly reported in coagulase-negative staphylococci, especially in Staphylococcus epidermidis . One of the most critical problems is resistance to linezolid in S. epidermidis , observed in Europe since 2014. The aim of this study was to evaluation of bacterial Co-infections and determination of antimicrobial resistance pattern of co-infection isolated strains in North Khorasan, Iran, in the last six-month period. MethodsAfter microbiological evaluation of pulmonary samples of hospitalized intubated patients with signs of bacterial pneumonia, we found co-infection in 11 of 185 patients with S. epidermidis, S. aureus, and Acinetobacter baumani, respectively. Interestingly seven of nine S. epidermidis isolates were linezolid resistant. For identification of the isolates at the species level, we used phenotypic methods and also the Polymerase Chain Reaction (PCR) for the atlE gene. Selected isolates were characterized by determining their antimicrobial resistance patterns and using molecular methods including SCCmec typing, detection of ica, mecA, vanA, and cfr genes . ResultsAll isolates were resistant to methicillin, and Seven isolates were resistant to linezolid. It should be noted that all nine isolates were positive for the ica gene. Nine of 11 isolated have belonged to the SCCmec I, and two belonged to the SCCmec IV. It should be noted that all patients had the underlying disease and six patients died.ConclusionThe increasing linezolid resistance in bacterial strains becomes a real threat for patients, and monitoring such infections combined with surveillance and infection prevention programs is very important to decrease the number of linezolid-resistant staphylococcal strains.
The Emergence of Linezolid-resistant Staphylococcus Epidermidis in the COVID-19 Hospitalized Intubated Patients in North Khorasan, Iran (preprint)