الفهرس 
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Abstract
Corona virus disease 2019 novel coronavirus (COVID-19) is described as a pandemic causing hundreds of deaths globally. The severity of respiratory diseases is exacerbated by co-infections in massive pandemics, however, they are not thoroughly studied. The first report about co-infections in this COVID-19 pandemic showed that 50 percent of deaths were due to secondary bacterial infections.Understanding the proportion of COVID-19 patients with acute respiratory bacterial co-infection, and the culprit pathogens, is crucial for treating patients with COVID-19 and to help ensure responsible use of antibiotics and to minimize negative consequences of overuse.
This study was trying to know to what extent the association of microbial infection with COVID-19 infection and how can this affect the outcome, the clinical features and predictors of mortality between hospitalized COVID‐19 patients.
This Cross sectional hospital based study was performed in Microbiology unit, Clinical Pathology Department at Assiut University Hospital during the period from June 2020 to June 2021.Demographic data including age, sex and comorbidities were recorded, laboratory investigations. sputum culture and blood cultures were done according to SOPs of microbiology laboratory. Blood cultures were inoculated into BacT/ALERT PF culture bottles then incubated in the BACT/ ALERT 3D system (BioMerieux , France) for up to 7 days for negative result. Identification of isolated organism and antimicrobial susceptibility testing are done according to manufacturer instructions, by VITEK 2 Compact.
Based on the outcome of studied group; the patients were subdivided into groups either survivors (n= 60 patients) or non-survivors (n= 40 patients). In our study the mean age of non survivors was significantly higher than the survivors comorbid DM, chest disease, Inetrleukin-6 and C-reactive protein were higher in non survivors and all of them predict mortality.
The present study showed that 66 (66%) patients had positive bacterial growth in sputum culture while 44 (44%) patients had no bacterial growth. The microbial infections and MDRO was higher in non survivors respectively and the presence of gram negative bacteria in sputum and presence of MDRO predict mortality. It was noticed that MDR was detected in majority (80%) of non-survivors while MDR, ESBL and MRS were found in 11 (18.3%), 5 (8.3%) and 3 (5%) patients, respectively.
Based on the current study, risk factors for morality among patients with COVID-19 infection in ICU were older age, diabetes mellitus, chest diseases, and CRP, IL-6, gram negative bacteria in sputum culture and presence of MDRO