Characterization of Secondary Bacterial Infections and Antibiotic Use in Mechanically Ventilated Patients With COVID-19 Induced Acute Respiratory Distress Syndrome

Abstract

Background: COVID-19 has a widely variable clinical syndrome that is difficult to distinguish from bacterial sepsis, leading to high rates of antibiotic use. Early studies indicate low rates of secondary bacterial infections (SBIs) but have included heterogeneous patient populations. Here, we catalogue all SBIs and antibiotic prescription practices in a population of mechanically ventilated patients with COVID-19 induced acute respiratory distress syndrome (ARDS). Methods: This was a retrospective cohort study of all patients with COVID-19 ARDS requiring mechanical ventilation from 3 Seattle, Washington hospitals in 2020. Data were obtained via electronic and manual review of the electronic medical record. We report the incidence and site of SBIs, mortality, and antibiotics per day using descriptive statistics. Results: We identified 126 patients with COVID-19 induced ARDS during the study period. Of these patients, 61% developed clinical infection confirmed by bacterial culture. Ventilator associated pneumonia was confirmed in 55% of patients, bacteremia in 20%, and urinary tract infection (UTI) in 17%. Staphylococcus aureus was the most commonly isolated bacterial species. A total of 97% of patients received antibiotics during their hospitalization, and patients received nearly one antibiotic per day during their hospital stay. Conclusions: Mechanically ventilated patients with COVID-19 induced ARDS are at high risk for secondary bacterial infections and have extensive antibiotic exposure.

Elevated Levels of Neutrophil Activated Proteins, Alpha-Defensins (DEFA1), Calprotectin (S100A8/A9) and Myeloperoxidase (MPO) Are Associated With Disease Severity in COVID-19 Patients

“…In our study, 53% of patients undergoing early intubation (0-3 days after hospitalization) developed secondary infection. This is in line with findings that mechanically ventilated COVID-19 patients are at high risk of developing secondary infection ( Risa et al., 2021 ).…”

Threat of Staphylococcus aureus Pneumonia in Severe COVID-19 Patients

“…COVID-19 has been spreading worldwide with unprecedented rapidity. The disease potentially induces various complications, of which secondary bacterial infections should be regarded as the most harmful events [ 1 ]. Among various bacterial etiologies, recent literature indicated S. aureus -associated infections to be of great importance.…”

“…Recent literature investigated the incidence of secondary bacterial infections in COVID-19 patients with mechanical ventilation due to acute respiratory distress syndrome [ 1 ]. Among 126 cases, 61% developed bacterial infections such as ventilator-associated pneumonia (VAP), blood stream infections, and urinary tract infections in its order, in which Staphylococcus aureus was the most common pathogen.…”

Methicillin-resistant Staphylococcus aureus lung infection in coronavirus disease 2019: how common?

“…Most cases of VABP in their study were caused by A. baumannii [ 42 ]. In a retrospective, multicenter study of 126 critically ill patients with COVID-19, of whom 77/126 had positive respiratory cultures (61%), Risa et al [ 19 ] observed 6/77 cases of S. aureus respiratory infection, of which 6 were caused MRSA. In a retrospective study of 178 critically ill patients with COVID-19 for a total of 230 lower respiratory tract specimens, there were 15/230 lower respiratory tract cultures positive for S. aureus (7%), and 6/15 were MRSA (40%).…”

“…Overall, methicillin-resistant S. aureus (MRSA) has been reported to cause up to 9% and 23% of CABP and HABP, respectively. However, the exact burden of MRSA lung infection in peculiar populations such as patients with COVID-19 remains somewhat elusive, possibly because of wide heterogeneity in methods and endpoints across studies (with many of them focused on other aspects and reporting only marginally on the epidemiology of causative agents of bacterial co-infection or superinfection), as well as in the approach to etiological diagnosis (e.g., different frequencies of collection of deep respiratory specimens for culture or molecular testing in COVID-19 patients with VABP) [1,2,4,[15][16][17][18][19][20][21][22].…”