PreprintArticleVersion 1Preserved in Portico This version is not peer-reviewed
A Sequent of Gram-Negative Co-Infectome Induced Severe Res-Piratory Distress Syndrome Are Potential Subtle Aggravators As-Sociated to SARS-CoV-2 Evolution of Virulence
Alsolami, A.; Alshammari, K.F.; Alshammari, F.; Alhallabi, S.A.; Alafnan, S.F.; Moussa, S.; Bashir, A.I.; Alshurtan, K.S.; Aboras, R.; Sogaier, E.K.A.; Alnajib, A.A.M.; Said, K.B. A Sequent of Gram-Negative Co-Infectome Induced Severe Res-Piratory Distress Syndrome Are Potential Subtle Aggravators As-Sociated to SARS-CoV-2 Evolution of Virulence. Preprints2023, 2023061341. https://doi.org/10.20944/preprints202306.1341.v1
APA Style
Alsolami, A., Alshammari, K.F., Alshammari, F., Alhallabi, S.A., Alafnan, S.F., Moussa, S., Bashir, A.I., Alshurtan, K.S., Aboras, R., Sogaier, E.K.A., Alnajib, A.A.M., & Said, K.B. (2023). A Sequent of Gram-Negative Co-Infectome Induced Severe Res-Piratory Distress Syndrome Are Potential Subtle Aggravators As-Sociated to SARS-CoV-2 Evolution of Virulence. Preprints. https://doi.org/10.20944/preprints202306.1341.v1
Chicago/Turabian Style
Alsolami, A., Alfatih A. M. Alnajib and Kamaleldin B. Said. 2023 "A Sequent of Gram-Negative Co-Infectome Induced Severe Res-Piratory Distress Syndrome Are Potential Subtle Aggravators As-Sociated to SARS-CoV-2 Evolution of Virulence" Preprints. https://doi.org/10.20944/preprints202306.1341.v1
Abstract
The severe respiratory distress syndrome (SRDS) has been a significant clinical issue in modern respiratory medicine. Its role in COVID-19 pandemic is not well defined. Outside-the-hospital SRDS is usually community-acquired septic pneumonia; however, in-hospitals incidences are complicated by co-infections. While SRDS is genetically selected in European and African origins, these are not clear in Middle East, particularly in COVID-19 backgrounds. There is a severe paucity in high quality data on correlations between COVID-19, ARDS, co-infectome, and patient demographics. We have conducted a comprehensive investigation on 298 patients for associations of SRDS, coinfections, and patient demographics on COVID-19 patients’ outcomes. Of these, 9.4% (n=28) had SRDS, and the rest (90.6%) had not. 54% of those with SRDS died while 84% survived; SRDS fatality was highly significant (Chi-square test P-value = 0.00000246). Irrespective of gender, the age of patients was significantly associated with SRDS (72.9 +/-8.9) compared to those without it (56.2 +/-15.1). However, there was no significant difference neither in the age of admitted patients before COVID-19 (58.5 +/-15.3) and during COVID-19 (57.2 +/-15.5) nor in the gender and COVID-19 fatality (Fisher Exact test 2-sided 1.000, 1-sided .546) ruling out that SRDS age-specificity were selected by virus susceptibility. A 100% of SRDS patients without bacterial co-infections survived while only 25% of those with co- infectome did not; this association was highly significant (P value= 0.00041). Co-infections alone without underlying SRDS was also associated with high fatality among patients (P value= 0.00000000076). Almost all COVID-19 patients without co-infectome (99.2%) survived while 28% of those with bacterial co-infection died. The major bacterial pathogens that potentially predisposed to SRDS, were Acinetobacter baumannii, and Escherichia coli either alone or in a mixed infection with Klebsiella pneumoniae were predominant species identified during SRDS attack. Thus, Gram-negative co-infectome potentially induced fatal SRDS aggravating COVID-19 outcome. These findings have significant clinical implications in specific differential diagnosis of SRDS syndromes for subsequent empiric therapy and patient management strategies. Future vertical investigation for similar mechanisms of cytokine-induced SRDS by Gram negative pathogens is imperative since hypervirulent strains are rapidly circulating in the region. The study is limited by a single center study confined to Ha’il hospitals; large scale investigation in major national hospitals would gain more insights.
Keywords
SRDS; Co-infections; COVID-19 fatality; co-evolution of virulence
Subject
Public Health and Healthcare, Public Health and Health Services
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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