Bacterial coinfection and antimicrobial use among patients with COVID-19 infection in a referral center in the Philippines: A retrospective cohort study

Abad, Cybele Lara; Sandejas, Joanne Carmela M.; Poblete, Jonnel B.; Malundo, Anna Flor G.; Salamat, Maria Sonia S.; Alejandria, Marissa M.

doi:10.1016/j.ijregi.2022.07.003

Cited by 2 publications

(5 citation statements)

References 30 publications

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“…The distribution of antibiotics used follows the Philippine Clinical Practice Guidelines on the management of community-acquired pneumonia ( 27 ) and the antibiogram of the hospital. This finding was similar to that of a retrospective cohort study done at a COVID-19 referral hospital in the Philippines by Abad et al ( 28 ) In contrast, a study from a German university hospital revealed that the most commonly used antibiotics were fluoroquinolones, carbapenems and third-generation cephalosporins; ( 6 ) however, this may be due to different antibiotic protocols in Europe.…”

Section: Discussionsupporting

confidence: 87%

Antimicrobial use in patients with confirmed COVID-19 infection: a cross-sectional study

Dominguez,

Domingo-Cereno,

Josue-Dominguez

2023

WPSAR

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Objective: The ongoing coronavirus disease (COVID-19) pandemic is exacerbating optimal antibiotic stewardship and the promotion of bacterial resistance due to the over-prescribing of antibiotics for patients with COVID-19. This study aimed to determine the prevalence of antibiotic therapy in patients with COVID-19 infection and explore the association of antibiotic prescribing with patients’ demographics and clinical characteristics. Methods: A retrospective analytical cross-sectional study was conducted at a tertiary hospital and training institution in Baguio City, the Philippines from March 2020 to March 2021. Univariate and multivariable logistic regression was used to compare COVID-19 patients who were prescribed antibiotics with those who were not. Results: Of the 157 patients hospitalized with COVID-19 infection, 90 (57.3%) received antibiotics, with only three (1.9%) having confirmed bacterial coinfection. Among those prescribed antibiotics, azithromycin was the most frequently prescribed antibiotic (43.3%), followed by ceftriaxone (33.1%), piperacillin-tazobactam (15.3%), ceftazidime (5.1%), moxifloxacin (1.3%), amikacin (0.6%), ampicillin and sulbactam (0.6%), cefuroxime (0.6%), metronidazole (0.6%) and penicillin (0.6%). Antibiotic use was associated with factors such as having bilateral infiltrates on chest X-ray, the severity of COVID-19 infection and high white blood cell counts. Discussion: Antibiotic use was high among patients with confirmed COVID-19 despite a low prevalence of confirmed bacterial coinfection. This may be due to the similarities in the clinical manifestations of both viral and bacterial infections. Judicious use of antibiotics in the treatment of COVID-19, as well as other viral infections (for example, influenza), is required to prevent antibiotic resistance in accordance with the principles of antimicrobial stewardship.

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Section: Discussionsupporting

confidence: 87%

Antimicrobial use in patients with confirmed COVID-19 infection: a cross-sectional study

Dominguez,

Domingo-Cereno,

Josue-Dominguez

2023

WPSAR

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“…The most commonly prescribed antibiotics were ceftriaxone, piperacillin + an enzyme inhibitor, azithromycin, and meropenem, followed by various other antibiotics in smaller percentages. In a study from the Philippines, [ 5 ] involving 1156 COVID-19 patients, within the initial 2 days of hospitalization, 55.1% received antibiotics, yet only 5.9% had documented community-acquired bacterial infection. Consistent with these findings, a review indicated that 72.1% of hospitalized COVID-19 patients received antibiotics [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Antimicrobial therapy was primarily guided by inflammatory markers like CRP, PCT, and WBC, as these markers were more frequently observed in patients with primary co-infections compared to those without [ 1 ]. Ferritin and LDH levels were elevated in individuals with community-acquired infections compared to those without [ 5 ]. Positive blood cultures were observed in a limited number of cases [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Ferritin and LDH levels were elevated in individuals with community-acquired infections compared to those without [ 5 ]. Positive blood cultures were observed in a limited number of cases [ 5 ]. The decision to initiate antimicrobial treatment was influenced by elevated leukocyte counts, heightened CRP levels, intensive care unit (ICU) admission, and the need for oxygen supplementation.…”

Section: Introductionmentioning

confidence: 99%

“…These factors were considered in the context of potential concurrent bacterial co-infection [ 4 ]. Conversely, the general incidence of nosocomial bacterial co-infections (occurring 48 h after admission) was primarily linked to ICU admission, followed by an extended hospital stay and a higher mortality rate [ 1 , 2 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial Use during the SARS-CoV-2 Pandemic in a Greek Tertiary University Hospital

Biros,

Filippas-Ntekouan,

Limperatou

et al. 2024

Microorganisms

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In cases of SARS-CoV-2 hospitalization, despite low bacterial co-infection rates, antimicrobial use may be disproportionately high. Our aim was to quantify such usage in COVID-19 patients and identify factors linked to increased antibiotic use. We retrospectively studied patients with SARS-CoV-2 infection who were hospitalized at our institution during the pandemic. In the initial two waves of the pandemic, antimicrobial use was notably high (89% in the first wave and 92% in the second), but it decreased in subsequent waves. Elevated procalcitonin (>0.5 μg/mL) and C-reactive protein (>100 mg/L) levels were linked to antibiotic usage, while prior vaccination reduced antibiotic incidence. Antimicrobial use decreased in the pandemic, suggesting enhanced comprehension of SARS-CoV-2′s natural course. Additionally, it was correlated with heightened SARS-CoV-2 severity, elevated procalcitonin, and C-reactive protein levels.

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Bacterial coinfection and antimicrobial use among patients with COVID-19 infection in a referral center in the Philippines: A retrospective cohort study

Cited by 2 publications

References 30 publications

Antimicrobial use in patients with confirmed COVID-19 infection: a cross-sectional study

Antimicrobial use in patients with confirmed COVID-19 infection: a cross-sectional study

Antimicrobial Use during the SARS-CoV-2 Pandemic in a Greek Tertiary University Hospital

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