POST-ACUTE COVID-19 SYNDROME AND URINARY TRACT INFECTIONS
POST-ACUTE COVID-19 SYNDROME AND URINARY TRACT INFECTIONS

Summary/Abstract: The complications in the respiratory tract and cardiovascular events are the leading causes of death and morbidity among COVID-19 patients but it was shown that nearly all other systems might be involved including the urinary system. The post-acute COVID-19 syndrome is defined as the presence and/or persistence of symptoms 8– 12 weeks after the onset of COVID-19 unrelated to any other illness. The main pathophysiological mechanisms underlying the post-acute COVID-19 syndrome depend on the organ system involved, virus-specific pathophysiological alterations, immunological and inflammatory alterations, and other common post-infectious sequelae. Urinary tract infections (UTIs) that affect the kidneys, and cause fever, stones, sepsis, urinary obstruction, catheters, or immunocompromised patients are classified as complicated infections. The objective of this study was to assess complicated urinary tract infections in patients who recently recovered from COVID-19. It is an observational analysis of a case series of ten patients aged 22 to 71 years who had COVID- 19 one to six months before the urinary infection. Their radiographic images of the lungs had a finding suggesting sequelae of respiratory infection. Urine cultures were positive for Escherichia coli in 5 patients, Enterococcus spp. in 3 patients, and 2 patients had sterile findings but their urinalysis revealed the presence of leukocytes and bacteria. Six patients were febrile and two patients had clinical signs of urosepsis (systolic pressure<100mm/hg, tachypnea >22r/min, leukocytosis, and GSC<15) in two patients. All patients had elevated leukocyte counts and high CRP serum levels, confirming acute inflammation. D-dimers were elevated in most patients (n=9), which could signal active clotting issues—important in the context of infections and inflammatory processes. Serum creatine was elevated in 4 patients possibly indicating renal stress or dysfunction. Elevated serum urea levels in more than half of patients (n=6) indicate protein catabolism or decreased renal clearance. The study observed a higher incidence of patients with elevated serum glucose (n=9), which could be stress-induced hyperglycemia or underlying metabolic issues like diabetes. Treatment was dual antibiotic therapy with intravenous cephalosporin and ciprofloxacin (n=6), intravenous ertapenem and ciprofloxacin (n=3), and intravenous amikacin in one patient. The patients were discharged to home treatment after 5 days (n=1), 10 days (n=4), 15 days (n=3) and 20 days (n=2) respectively. The average hospital stay due to urinary infection was 13 (+/-10) days; male patients had a longer average hospital stay (20 days) compared to female patients (12.22 days). Patients with urinary catheters had a longer hospital stay (15 days) unlike the others (12.5 days), indicating more severe urinary issues or complications that might extend the hospital stay. Patients requiring intensive care (n=2) had a longer average hospital stay (17.5 days) compared to those who did not need intensive care (11.875 days), underscoring the impact of critical care needs on hospitalization length. This case series concludes that in a certain number of patients, depending on the patient's age, gender, and comorbidities, complicated urinary infections may occur after COVID-19. They should be recognized and treated in time in order not to escalate into a life-threatening condition such as urosepsis.

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