Antibiotic Resistance in COVID-19 with Bacterial Infection: Laboratory-Based Surveillance Study at Single Tertiary Hospital in Indonesia

Abstract

Purpose Coronavirus disease 2019 (COVID-19) is a new pandemic affecting the respiratory system and caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In addition to the increased use of antibiotics, the length of stay of hospitalized patients affects the risk of bacterial infections among the COVID-19 patients. However, this pandemic has interrupted antibiotic surveillance activity and led to an information gap about the prevalence and characteristics of bacterial infection. This study aims to describe the antibiotic resistance in COVID-19 patients with culture-proven bacterial infection using a laboratory-based surveillance approach. Patients and Methods A retrospective study with a cross-sectional design was conducted on adult patients that confirmed positive for COVID-19 according to the International Classification of Diseases 10th Revision (ICD-10). From March 2020 to October 2021, data were obtained from the hospital information system and merged with the culture and antibiotic susceptibility test from laboratory information system at Hasan Sadikin General Hospital. The outcome is the prevalence percentage of resistance to selected antibiotics in patients with COVID-19. The resistance percentage is considered high when equal to or more than 20%. Results There was 2786 adult patient confirmed for COVID-19 according to the ICD-10, and 26.3% (n = 733) of them submitted clinical specimen for culture. The prevalence of bacterial infection among COVID-19 patients was 16.4%, predominating Gram-negative bacteria (GNB). The respiratory specimen dominated the positive growth culture. The GNB were predominantly discovered among the respiratory and non-respiratory specimens. High range resistance to ampicillin-sulbactam (24–100%), ceftriaxone (22–81%), cefotaxime (22–73%) and ciprofloxacin (20–86%) are observed among the GNB. Conclusion There is high resistance to fluoroquinolone and cephalosporins in identified isolate, commonly used as the first-line empirical treatment for respiratory and non-respiratory infection in Indonesia. The continuous antibiotic surveillance is mandatory and crucial to prevent the long-term effects of the COVID-19 pandemic, particularly bacterial infection.

Bacterial profiles and their antibiotic resistance background in superinfections caused by multidrug‐resistant bacteria among COVID‐19 ICU patients from southwest Iran

“…Similar results were observed by Sahu et al 38 from India. In contrast to the current study, in a previous report from Indonesia, 41 S. aureus isolates showed low resistance rates (below 25%) against all antibiotic categories. Moreover, in our research, the majority of Gram‐negative isolates showed high resistance rates (75.0%–100.0%) against all tested antibiotics including carbapenems and third‐generation cephalosporins.…”

“…In line with our results, Bazaid et al 36 from Saudi Arabia showed high resistance rates of A. baumannii and K. pneumoniae toward all antibiotics except colistin. Also, in a study from Indonesia, 41 high resistance to third‐generation cephalosporins (cefotaxime and ceftriaxone) in A. baumannii and E. coli and carbapenem in A. baumannii was found. These various results may be due to the differences in the prescribing antibiotic regime in each region or country, presence or absence of surveillance of antimicrobial consumption, and studied population.…”

The Diagnostic Value of Kinetics of NLR to Identify Secondary Pulmonary Bacterial Infection Among COVID-19 Patients at Single Tertiary Hospital in Indonesia

“…Pathogens, ie Acinetobacter baumannii (34/114, 29.8%), Klebsiella pneumoniae (25/114, 21.9%), Pseudomonas aeruginosa (8/114, 7.0%), and Stenotrophomonas maltophilia (8/114, 7.0%) were commonly identified and well known as the etiology of bacterial pneumonia. 32 The presence of MDR pathogens was 36.8% among GNB and Gram-Positive Bacterial (GPB). However, the presence of fungal infection was low (7.0%), compared with overall identified bacterial (GNB, GPB), as shown in Table 2 .…”

“…as the etiology of bacterial pneumonia. 32 The presence of MDR pathogens was 36.8% among GNB and Gram-Positive Bacterial (GPB). However, the presence of fungal infection was low (7.0%), compared with overall identified bacterial (GNB, GPB), as shown in Table 2.…”

Microbial Landscape and Antibiotic-Susceptibility Profiles of Microorganisms in Patients with Bacterial Pneumonia: A Comparative Cross-Sectional Study of COVID-19 and Non-COVID-19 Cases in Aktobe, Kazakhstan

“…In contrast to our findings, Zeshan et al [ 48 ] reported that isolated strains of K. pneumoniae in 88%, P. aeruginosa in 75%, and S. aureus in 45% of cases were resistant to ciprofloxacin. Other researchers also noted that there is high resistance to fluoroquinolone and cephalosporins among the gram-negative bacteria isolated from the COVID-19 patients [ 41 , 49 ]. This may be a reflection of the widespread use of these medications for empirical therapy.…”