Title : Bacterial co-infection and secondary infection in Sars-Cov-2 (Covid- 19) adult patients in a national tertiary infectious disease hospital
Abstract:
Introduction: The SARS-CoV-2 virus, the main causative agent of COVID 19 infection was first detected in the province of Hubei in Wuhan China in December of 2019 and has overwhelmed the capacity of the government and hospitals to provide healthcare services to cater to the growing number of COVID-19 confirmed cases. In relation with the exponential growth of COVID-19 confirmed cases in the Philippines, there is need to fill the gap in knowledge regarding the use of antibiotics for the treatment of COVID-19. An understanding of bacterial co-infections and secondary infections, the causative pathogen and antimicrobial use is vital for treating patients with COVID-19. This information will help in optimizing empirical antimicrobial management strategies, ensure responsible use of antibiotics hence minimizing misuse and overuse. Furthermore, this knowledge will have a significant impact in antimicrobial stewardship.
General Objective: To describe microbiologically confirmed co-infections (upon admission) and secondary infections (during admission), and antimicrobial use, in patients admitted to a tertiary hospital with COVID 19.
Methodology: Retrospective research design was used in the study. Demographic data pertinent to this study were the following: age, past medical history, recent antibiotics use and pertinent physical examination. Any positive cultures from blood, sputum, or deep respiratory samples were considered COVID-19 related infections, while growth from other sample types were considered unrelated. Cultures that showed as mixed growth, colonizer or contaminant were excluded from all sample types.
Result: The most common clinical symptoms of COVID 19 patients with bacterial co-infection and secondary infection were cough (79.7%), fever (77%) and dyspnea (68.9%). Out of 74 patients 31.1% were given high flow nasal cannula oxygen support. Most of these patients had severe and critical COVID 19 infection in 32.4% and 47.3% respectively. Among the admitted patients the most common bacterial co-infection isolates were Klebsiella pneumoniae (26.9%), Acinetobacter baumannii, Staphylococcus aureus and Haemophilus parainfluenzae (11.5%) while for secondary infection Klebsiella pneumoniae (33.3%), Stenotrophomonas maltophilia (18.7%) and Pseudomonas aeruginosa (16.6%). The most common antibiotics administered upon admission were Ceftriaxone (51.4%) and Azithromycin (41.9%). Antibiotics prescribed 48 hours after admission were Meropenem (31.1%), Levofloxacin (28.4 %) and Piperacillin tazobactam (20.3%). Among patients included in this study 62.2 % were discharged improved.
Conclusion: The overall incidence of patients who tested positive with COVID-19 patients with bacterial co-infection and secondary infection from February 1, 2020 to December 31, 2021 is 3.35%. Out of 2210 patients who tested positive with COVID-19 from February 1, 2020 to December 31, 2021 only 74 (3.35 %) patients had bacterial co-infection and secondary infection.The most common bacterial isolates among COVID 19 patients with bacterial co-infection were Klebsiella pneumoniae (26.9%), Acinetobacter baumannii, Staphylococcus aureus and Haemophilus parainfluenzae (11.5%) while for secondary infection Klebsiella pneumoniae (33.3%), Stenotrophomonas maltophilia (18.7%) and Pseudomonas aeruginosa (16.6%). Antibiotic use in admitted COVID-19 patients were high regardless of low incidence of bacterial pneumonia during the first pandemic wave.
Audience take away:
- An understanding of bacterial co-infections and secondary infections, the causative pathogen and antimicrobial use is vital for treating patients with COVID-19.
- This information will help in optimizing empirical antimicrobial management strategies, ensure responsible use of antibiotics hence minimizing misuse and overuse.
- Furthermore, this knowledge will have a significant impact in antimicrobial stewardship
