Title : Prevalence of secondary bacterial pneumonia co-infection in SARS-CoV-2 infected patients, their treatment and outcome: A hospital-based study
Abstract:
Introduction: Viral pulmonary infections have caused high morbidities worldwide since the advent of outbreaks of SARS-CoV, H1N1 influenza, MERS-CoV and the more recent SARS-CoV-2 virus discovered in China in 2019. This novel virus has caused a global pandemic in the year 2020 with increased mortality worldwide. In the treatment of these viral infections, the initial focus of the clinical management was to treat the primary viral infection, however little emphasis has been given on the secondary bacterial infection that could ensue in the course. Like some viral respiratory diseases, SARS-CoV-2 infection predisposes the patient to a bacterial infection. The primary objective of this study was to determine the prevalence of secondary bacterial pneumonia co-infection on patients with SARS-CoV-2 infection, their demographic profile, treatment and outcome.
Methodology: This was a single-center retrospective analysis conducted over a period of one year from March 2020 and December 2021 in a secondary hospital in Iloilo City, Philippines. The sample population included 153 patients admitted with confirmed SARS-CoV 2 infection using RTPCR testing. All statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 26.
Results: The mean age of participants was 51.33 ± 16.9 years and majority are of the male population. 76.5% of patients have confirmed bacterial pneumonia co-infection. Those with bacterial pneumonia co-infection have significantly increased incidence of cough, fever, shortness of breath, difficulty of breathing and lower oxygen saturations (p<0.05). Patients with Diabetes Mellitus (40.2%, p<0.05) have significantly higher incidence of bacterial pneumonia and Hypertension, Bronchial Asthma and Coronary Artery Disease were among the common comorbidities. Lactate dehydrogenase (LDH), C-reactive protein (CRP), D-dimer and Ferritin levels were significantly higher in patients with bacterial pneumonia co-infection. The predominant agent identified was Klebsiella pneumoniae (14.4%), followed by Candida albicans (4.8%) and Staphylococcus haemolyticus (4.8%). Empiric antibiotic treatment at the time of admission was significantly increased in both with bacteria pneumonia and without bacterial pneumonia at 95.7% and 72.2% respectively (p<0.05). In terms of treatment, 97 (85.9%) of patients with bacterial pneumonia co-infection were admitted at the regular ward while 20 (17.1%) were admitted at the Intensive Care Unti and were significantly higher (p<0.05) than those without bacterial pneumonia co-infection. Patients with bacterial pneumonia co-infection have increased risk of intubation (5.1%,p<0.05), critical care admission (17.1%, p<0.05) and higher mortality of 4.3% (p<0.05).
Conclusion: In patients with SARS-CoV-2 infection and bacterial pneumonia co-infection they have significantly lower oxygen saturation, higher levels of inflammatory markers, higher incidence of gram-negative bacteria, higher use of oxygen support indicating a more debilitating disease with higher mortality rate. The initiation of oxygen support, glucocorticoids, antibiotics and anti-viral therapy have decreased mortality. The empiric use of antibiotics was high even in patients with no bacterial pneumonia co-infection. The study would like to highlight the rampant use of antibiotics and to urge clinicians to improve efforts on antimicrobial stewardship and judicious use of antibiotics.
