Bacterial superinfection in pregnant women with severe COVID-19: Prevalence, resistance patterns and outcomes

IF 4.8 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2026-04-01 Epub Date: 2026-02-18 DOI:10.1016/j.jiph.2026.103184

Mojtaba Akbari , Mohammad Shirzadi , Fatemeh Yazdani , Samaneh Pourajam , Majid Hosseinzadeh , Armita akbari , Mansour Siavash , Hamid Solgi

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引用次数: 0

Abstract

Background

Pregnant women with severe COVID-19 are at high risk for intensive care unit (ICU) admission and adverse maternal outcomes. Evidence on the burden and impact of bacterial infections in this group is limited.

Methods

We conducted a single-center retrospective cohort study of pregnant women with confirmed COVID-19 admitted for ≥ 48 h to the ICU of a referral maternity hospital in Isfahan, Iran, between June and December 2021. Clinical, demographic, microbiological, and outcome data were retrieved from electronic medical records. Bacterial isolates were identified and tested for antimicrobial susceptibility according to CLSI guidelines. Logistic regression was performed to determine factors independently associated with in-hospital mortality.

Results

Of 527 pregnant women hospitalized with COVID-19, 71 required ICU admission and were included in the analysis. Bacterial infections were detected in 8 patients (11.3 %), most frequently caused by multidrug-resistant (MDR) Klebsiella pneumoniae. Compared with non-infected patients, women with bacterial superinfections had significantly longer hospital stays (22.4 vs. 10.2 days, p < 0.001) and ICU stays (16.8 vs. 5.2 days, p < 0.001), higher rates of invasive mechanical ventilation (50.0 % vs. 9.5 %, p = 0.002), and increased mortality (37.5 % vs. 9.5 %, p = 0.025). Univariate analyses identified bacterial superinfection, MDR pathogens, carbapenem/vancomycin use, lower admission SpO₂, and carbapenem-resistant K. pneumoniae as predictors of death. In multivariate analysis, only bacterial superinfection (aOR = 13.35, 95 % CI: 1.05–170.06) and lower oxygen saturation at admission (aOR = 1.21 per 1 % decrease, 95 % CI: 1.06–1.38) remained independent predictors of mortality.

Conclusion

Bacterial superinfections, especially with multidrug-resistant pathogens, are relatively common in ICU-hospitalized pregnant women with COVID-19 and strongly linked to worse outcomes, including higher mortality. Early detection, infection control, and rational antibiotic use are essential to improve survival.

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重症COVID-19孕妇的细菌重复感染：患病率、耐药性模式和结果

背景：重症COVID-19孕妇进入重症监护病房（ICU）和不良孕产妇结局的风险很高。关于这一群体中细菌感染的负担和影响的证据有限。方法：我们对2021年6月至12月在伊朗伊斯法罕一家转诊妇产医院ICU住院≥ 48 h的确诊COVID-19孕妇进行了一项单中心回顾性队列研究。临床、人口统计学、微生物学和结局数据从电子病历中检索。根据CLSI指南鉴定分离的细菌并进行抗菌药物敏感性试验。采用Logistic回归确定与院内死亡率独立相关的因素。结果：527例因COVID-19住院的孕妇中，71例需要ICU住院，并纳入分析。8例患者（11.3 %）检出细菌感染，最常见的是多药耐药肺炎克雷伯菌。与未感染的患者相比，细菌超感染的女性住院时间明显更长（22.4天对10.2天，p ）。结论：细菌超感染，特别是多药耐药病原体，在icu住院的COVID-19孕妇中相对常见，并且与较差的结局密切相关，包括较高的死亡率。早期发现、感染控制和合理使用抗生素对提高生存率至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.