The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon

BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Ahmad Sleiman [verfasserIn] Pascal Abdelkhalek [verfasserIn] George Doumat [verfasserIn] Frida Atallah [verfasserIn] Lama Hamadeh [verfasserIn] Pamela Moussa [verfasserIn] Imad Bou Akl [verfasserIn] Ghassan Dbaibo [verfasserIn] George F. Araj [verfasserIn] Souha S. Kanj [verfasserIn] Rami Mahfouz [verfasserIn] Ghassan M. Matar [verfasserIn] Zeina A. Kanafani [verfasserIn] Antoine G. Abou Fayad [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Schlagwörter:	COVID-19 secondary bacterial infections carbapenem resistance colistin resistance NDM-5 NDM-7

Übergeordnetes Werk:	In: Frontiers in Medicine - Frontiers Media S.A., 2014, 10(2023)
Übergeordnetes Werk:	volume:10 ; year:2023

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.3389/fmed.2023.1001476

Katalog-ID:	DOAJ081255748

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520			\|a BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation.
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700	0		\|a Pascal Abdelkhalek \|e verfasserin \|4 aut
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700	0		\|a Pascal Abdelkhalek \|e verfasserin \|4 aut
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allfields	10.3389/fmed.2023.1001476 doi (DE-627)DOAJ081255748 (DE-599)DOAJ248db40e6edd408591ac6097d117784a DE-627 ger DE-627 rakwb eng R5-920 Ahmad Sleiman verfasserin aut The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation. COVID-19 secondary bacterial infections carbapenem resistance colistin resistance NDM-5 NDM-7 Medicine (General) Ahmad Sleiman verfasserin aut Ahmad Sleiman verfasserin aut Pascal Abdelkhalek verfasserin aut Pascal Abdelkhalek verfasserin aut Pascal Abdelkhalek verfasserin aut George Doumat verfasserin aut Frida Atallah verfasserin aut Lama Hamadeh verfasserin aut Lama Hamadeh verfasserin aut Pamela Moussa verfasserin aut Pamela Moussa verfasserin aut Pamela Moussa verfasserin aut Imad Bou Akl verfasserin aut Ghassan Dbaibo verfasserin aut George F. Araj verfasserin aut George F. Araj verfasserin aut Souha S. Kanj verfasserin aut Souha S. Kanj verfasserin aut Rami Mahfouz verfasserin aut Rami Mahfouz verfasserin aut Ghassan M. Matar verfasserin aut Ghassan M. Matar verfasserin aut Ghassan M. Matar verfasserin aut Zeina A. Kanafani verfasserin aut Zeina A. Kanafani verfasserin aut Antoine G. Abou Fayad verfasserin aut Antoine G. Abou Fayad verfasserin aut Antoine G. Abou Fayad verfasserin aut In Frontiers in Medicine Frontiers Media S.A., 2014 10(2023) (DE-627)789482991 (DE-600)2775999-4 2296858X nnns volume:10 year:2023 https://doi.org/10.3389/fmed.2023.1001476 kostenfrei https://doaj.org/article/248db40e6edd408591ac6097d117784a kostenfrei https://www.frontiersin.org/articles/10.3389/fmed.2023.1001476/full kostenfrei https://doaj.org/toc/2296-858X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2023
spelling	10.3389/fmed.2023.1001476 doi (DE-627)DOAJ081255748 (DE-599)DOAJ248db40e6edd408591ac6097d117784a DE-627 ger DE-627 rakwb eng R5-920 Ahmad Sleiman verfasserin aut The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation. COVID-19 secondary bacterial infections carbapenem resistance colistin resistance NDM-5 NDM-7 Medicine (General) Ahmad Sleiman verfasserin aut Ahmad Sleiman verfasserin aut Pascal Abdelkhalek verfasserin aut Pascal Abdelkhalek verfasserin aut Pascal Abdelkhalek verfasserin aut George Doumat verfasserin aut Frida Atallah verfasserin aut Lama Hamadeh verfasserin aut Lama Hamadeh verfasserin aut Pamela Moussa verfasserin aut Pamela Moussa verfasserin aut Pamela Moussa verfasserin aut Imad Bou Akl verfasserin aut Ghassan Dbaibo verfasserin aut George F. Araj verfasserin aut George F. Araj verfasserin aut Souha S. Kanj verfasserin aut Souha S. Kanj verfasserin aut Rami Mahfouz verfasserin aut Rami Mahfouz verfasserin aut Ghassan M. Matar verfasserin aut Ghassan M. Matar verfasserin aut Ghassan M. Matar verfasserin aut Zeina A. Kanafani verfasserin aut Zeina A. Kanafani verfasserin aut Antoine G. Abou Fayad verfasserin aut Antoine G. Abou Fayad verfasserin aut Antoine G. Abou Fayad verfasserin aut In Frontiers in Medicine Frontiers Media S.A., 2014 10(2023) (DE-627)789482991 (DE-600)2775999-4 2296858X nnns volume:10 year:2023 https://doi.org/10.3389/fmed.2023.1001476 kostenfrei https://doaj.org/article/248db40e6edd408591ac6097d117784a kostenfrei https://www.frontiersin.org/articles/10.3389/fmed.2023.1001476/full kostenfrei https://doaj.org/toc/2296-858X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2023
allfields_unstemmed	10.3389/fmed.2023.1001476 doi (DE-627)DOAJ081255748 (DE-599)DOAJ248db40e6edd408591ac6097d117784a DE-627 ger DE-627 rakwb eng R5-920 Ahmad Sleiman verfasserin aut The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation. COVID-19 secondary bacterial infections carbapenem resistance colistin resistance NDM-5 NDM-7 Medicine (General) Ahmad Sleiman verfasserin aut Ahmad Sleiman verfasserin aut Pascal Abdelkhalek verfasserin aut Pascal Abdelkhalek verfasserin aut Pascal Abdelkhalek verfasserin aut George Doumat verfasserin aut Frida Atallah verfasserin aut Lama Hamadeh verfasserin aut Lama Hamadeh verfasserin aut Pamela Moussa verfasserin aut Pamela Moussa verfasserin aut Pamela Moussa verfasserin aut Imad Bou Akl verfasserin aut Ghassan Dbaibo verfasserin aut George F. Araj verfasserin aut George F. Araj verfasserin aut Souha S. Kanj verfasserin aut Souha S. Kanj verfasserin aut Rami Mahfouz verfasserin aut Rami Mahfouz verfasserin aut Ghassan M. Matar verfasserin aut Ghassan M. Matar verfasserin aut Ghassan M. Matar verfasserin aut Zeina A. Kanafani verfasserin aut Zeina A. Kanafani verfasserin aut Antoine G. Abou Fayad verfasserin aut Antoine G. Abou Fayad verfasserin aut Antoine G. Abou Fayad verfasserin aut In Frontiers in Medicine Frontiers Media S.A., 2014 10(2023) (DE-627)789482991 (DE-600)2775999-4 2296858X nnns volume:10 year:2023 https://doi.org/10.3389/fmed.2023.1001476 kostenfrei https://doaj.org/article/248db40e6edd408591ac6097d117784a kostenfrei https://www.frontiersin.org/articles/10.3389/fmed.2023.1001476/full kostenfrei https://doaj.org/toc/2296-858X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2023
allfieldsGer	10.3389/fmed.2023.1001476 doi (DE-627)DOAJ081255748 (DE-599)DOAJ248db40e6edd408591ac6097d117784a DE-627 ger DE-627 rakwb eng R5-920 Ahmad Sleiman verfasserin aut The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation. COVID-19 secondary bacterial infections carbapenem resistance colistin resistance NDM-5 NDM-7 Medicine (General) Ahmad Sleiman verfasserin aut Ahmad Sleiman verfasserin aut Pascal Abdelkhalek verfasserin aut Pascal Abdelkhalek verfasserin aut Pascal Abdelkhalek verfasserin aut George Doumat verfasserin aut Frida Atallah verfasserin aut Lama Hamadeh verfasserin aut Lama Hamadeh verfasserin aut Pamela Moussa verfasserin aut Pamela Moussa verfasserin aut Pamela Moussa verfasserin aut Imad Bou Akl verfasserin aut Ghassan Dbaibo verfasserin aut George F. Araj verfasserin aut George F. Araj verfasserin aut Souha S. Kanj verfasserin aut Souha S. Kanj verfasserin aut Rami Mahfouz verfasserin aut Rami Mahfouz verfasserin aut Ghassan M. Matar verfasserin aut Ghassan M. Matar verfasserin aut Ghassan M. Matar verfasserin aut Zeina A. Kanafani verfasserin aut Zeina A. Kanafani verfasserin aut Antoine G. Abou Fayad verfasserin aut Antoine G. Abou Fayad verfasserin aut Antoine G. Abou Fayad verfasserin aut In Frontiers in Medicine Frontiers Media S.A., 2014 10(2023) (DE-627)789482991 (DE-600)2775999-4 2296858X nnns volume:10 year:2023 https://doi.org/10.3389/fmed.2023.1001476 kostenfrei https://doaj.org/article/248db40e6edd408591ac6097d117784a kostenfrei https://www.frontiersin.org/articles/10.3389/fmed.2023.1001476/full kostenfrei https://doaj.org/toc/2296-858X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2023
allfieldsSound	10.3389/fmed.2023.1001476 doi (DE-627)DOAJ081255748 (DE-599)DOAJ248db40e6edd408591ac6097d117784a DE-627 ger DE-627 rakwb eng R5-920 Ahmad Sleiman verfasserin aut The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation. COVID-19 secondary bacterial infections carbapenem resistance colistin resistance NDM-5 NDM-7 Medicine (General) Ahmad Sleiman verfasserin aut Ahmad Sleiman verfasserin aut Pascal Abdelkhalek verfasserin aut Pascal Abdelkhalek verfasserin aut Pascal Abdelkhalek verfasserin aut George Doumat verfasserin aut Frida Atallah verfasserin aut Lama Hamadeh verfasserin aut Lama Hamadeh verfasserin aut Pamela Moussa verfasserin aut Pamela Moussa verfasserin aut Pamela Moussa verfasserin aut Imad Bou Akl verfasserin aut Ghassan Dbaibo verfasserin aut George F. Araj verfasserin aut George F. Araj verfasserin aut Souha S. Kanj verfasserin aut Souha S. Kanj verfasserin aut Rami Mahfouz verfasserin aut Rami Mahfouz verfasserin aut Ghassan M. Matar verfasserin aut Ghassan M. Matar verfasserin aut Ghassan M. Matar verfasserin aut Zeina A. Kanafani verfasserin aut Zeina A. Kanafani verfasserin aut Antoine G. Abou Fayad verfasserin aut Antoine G. Abou Fayad verfasserin aut Antoine G. Abou Fayad verfasserin aut In Frontiers in Medicine Frontiers Media S.A., 2014 10(2023) (DE-627)789482991 (DE-600)2775999-4 2296858X nnns volume:10 year:2023 https://doi.org/10.3389/fmed.2023.1001476 kostenfrei https://doaj.org/article/248db40e6edd408591ac6097d117784a kostenfrei https://www.frontiersin.org/articles/10.3389/fmed.2023.1001476/full kostenfrei https://doaj.org/toc/2296-858X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2023
language	English
source	In Frontiers in Medicine 10(2023) volume:10 year:2023
sourceStr	In Frontiers in Medicine 10(2023) volume:10 year:2023
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	COVID-19 secondary bacterial infections carbapenem resistance colistin resistance NDM-5 NDM-7 Medicine (General)
isfreeaccess_bool	true
container_title	Frontiers in Medicine
authorswithroles_txt_mv	Ahmad Sleiman @@aut@@ Pascal Abdelkhalek @@aut@@ George Doumat @@aut@@ Frida Atallah @@aut@@ Lama Hamadeh @@aut@@ Pamela Moussa @@aut@@ Imad Bou Akl @@aut@@ Ghassan Dbaibo @@aut@@ George F. Araj @@aut@@ Souha S. Kanj @@aut@@ Rami Mahfouz @@aut@@ Ghassan M. Matar @@aut@@ Zeina A. Kanafani @@aut@@ Antoine G. Abou Fayad @@aut@@
publishDateDaySort_date	2023-01-01T00:00:00Z
hierarchy_top_id	789482991
id	DOAJ081255748
language_de	englisch
fullrecord	<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000naa a22002652 4500</leader><controlfield tag="001">DOAJ081255748</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230310211121.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230310s2023 xx \|\|\|\|\|o 00\| \|\|eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.3389/fmed.2023.1001476</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)DOAJ081255748</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)DOAJ248db40e6edd408591ac6097d117784a</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="050" ind1=" " ind2="0"><subfield code="a">R5-920</subfield></datafield><datafield tag="100" ind1="0" ind2=" "><subfield code="a">Ahmad Sleiman</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="4"><subfield code="a">The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2023</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">COVID-19</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">secondary bacterial infections</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">carbapenem resistance</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">colistin resistance</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">NDM-5</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">NDM-7</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Medicine (General)</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Ahmad Sleiman</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Ahmad Sleiman</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Pascal Abdelkhalek</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Pascal Abdelkhalek</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Pascal Abdelkhalek</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">George Doumat</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Frida Atallah</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Lama Hamadeh</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Lama Hamadeh</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Pamela Moussa</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Pamela Moussa</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Pamela Moussa</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Imad Bou Akl</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Ghassan Dbaibo</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">George F. 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callnumber-first	R - Medicine
author	Ahmad Sleiman
spellingShingle	Ahmad Sleiman misc R5-920 misc COVID-19 misc secondary bacterial infections misc carbapenem resistance misc colistin resistance misc NDM-5 misc NDM-7 misc Medicine (General) The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon
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topic_title	R5-920 The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon COVID-19 secondary bacterial infections carbapenem resistance colistin resistance NDM-5 NDM-7
topic	misc R5-920 misc COVID-19 misc secondary bacterial infections misc carbapenem resistance misc colistin resistance misc NDM-5 misc NDM-7 misc Medicine (General)
topic_unstemmed	misc R5-920 misc COVID-19 misc secondary bacterial infections misc carbapenem resistance misc colistin resistance misc NDM-5 misc NDM-7 misc Medicine (General)
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title	The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon
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title_full	The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon
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author_browse	Ahmad Sleiman Pascal Abdelkhalek George Doumat Frida Atallah Lama Hamadeh Pamela Moussa Imad Bou Akl Ghassan Dbaibo George F. Araj Souha S. Kanj Rami Mahfouz Ghassan M. Matar Zeina A. Kanafani Antoine G. Abou Fayad
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title_sort	under investigated facet of the covid-19 pandemic: molecular analysis of secondary bacterial infections at a covid dedicated intensive care unit within a tertiary care center in lebanon
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title_auth	The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon
abstract	BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation.
abstractGer	BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation.
abstract_unstemmed	BackgroundThe coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. Additionally, it is crucial to monitor and track AMR, post-COVID pandemic, in order to better understand the effect of this disease on AMR exacerbation.
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title_short	The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon
url	https://doi.org/10.3389/fmed.2023.1001476 https://doaj.org/article/248db40e6edd408591ac6097d117784a https://www.frontiersin.org/articles/10.3389/fmed.2023.1001476/full https://doaj.org/toc/2296-858X
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author2	Ahmad Sleiman Pascal Abdelkhalek George Doumat Frida Atallah Lama Hamadeh Pamela Moussa Imad Bou Akl Ghassan Dbaibo George F. Araj Souha S. Kanj Rami Mahfouz Ghassan M. Matar Zeina A. Kanafani Antoine G. Abou Fayad
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Secondary bacterial infections are associated with unfavorable outcomes in respiratory viral infections. This study aimed at determining the prevalence of secondary bacterial infections in COVID-19 patients admitted at a tertiary medical center in Lebanon.MethodologyFrom May till November, 2020, a total of 26 Gram-negative isolates were recovered from 16 patients during the course of their COVID-19 infection with Escherichia coli being the most prevalent. The isolates were assessed for their antimicrobial susceptibility by broth microdilution against 19 antimicrobial agents from different classes. Whole genome sequencing of 13 isolates allowed the mining of antimicrobial resistance (AMR) determinants as well as mobile genetic elements and sequence types (ST). Finally, broth microdilution with three different efflux pump inhibitors [theobromine, conessine and PheArg-β-naphthylamide (PAβN)] was done.ResultsAntimicrobial susceptibility testing showed that out of the 26 Gram-negative isolates, 1 (4%) was extensively drug resistant and 14 (54%) were multi-drug resistant (MDR). Whole genome sequencing results revealed a plethora of AMR determinants among the 13 sequenced isolates. Moreover, the 9 Enterobacterales and 4 Pseudomonas aeruginosa sequenced isolates belonged to 9 and 2 different ST, respectively. Using a variety of efflux pump inhibitors we demonstrated that only PAβN had a significant effect when combined with levofloxacin, and the latter regained its activity against two P. aeruginosa isolates.ConclusionThe identification of carbapenem and colistin resistant Gram-negative bacilli causing secondary bacterial infections in critical patients diagnosed with COVID-19 should be of high concern. 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The under investigated facet of the COVID-19 pandemic: Molecular analysis of secondary bacterial infections at a COVID dedicated intensive care unit within a tertiary care center in Lebanon

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