MDR Pathogens Organisms as Risk Factor of Mortality in Secondary Pulmonary Bacterial Infections Among COVID-19 Patients: Observational Studies in Two Referral Hospitals in West Java, Indonesia

Abstract

Purpose The coronavirus disease (COVID-19) outbreak has created a global health crisis. Secondary pulmonary bacterial infection is a COVID-19 complication, increasing morbidity and mortality. This study aimed to determine the pathogens, antibiotic susceptibility patterns, and risk factors for mortality in hospitalized COVID-19 patients. Patients and Methods This retrospective study used secondary data from patients’ electronic medical records at Hasan Sadikin General Hospital and Santo Borromeus Hospital between March 2020 and March 2021. Overall, 2230 hospitalized COVID-19 patients were screened, and 182 of them who were hospitalized ≥48 hours with a procalcitonin level of ≥0.25 ng/mL were enrolled. Culture examination was performed on sputum samples to determine pathogen and antibiotic susceptibilities. Univariate and multivariate analyses were used to determine mortality-related risk factors in hospitalized COVID-19 patients. Results The prevalence of secondary pulmonary bacterial infections in COVID-19 patients was 8.2%, with 161/182 pathogen growth from sputum samples. Mainly gram-negative bacteria (64.8%) were present, including Acinetobacter baumannii (31.9%), Klebsiella pneumoniae (19.8%), and Pseudomonas aeruginosa (8.8%). High rate of multidrug-resistant (MDR) pathogens was found among isolate (45.9%), ie carbapenem-resistance A. baumannii (CR-Ab) was 84.2%, extended-spectrum β-lactamase (ESBL) among K. pneumoniae was 61.1%. Secondary infection of MDR pathogens was associated with a higher risk of mortality (AOR 5.63, p = 0.001). Other associated factors were age ≥60 years, ventilator use, and female gender. Conclusion Gram-negative bacteria are the predominant pathogens causing secondary pulmonary bacterial infection in COVID-19 patients, implying nosocomial infection. High resistance to first-line antimicrobial drugs was observed in Gram-negative bacteria and Gram-positive bacteria. High rate of MDR pathogens was found among isolate and was associated with a significant risk of mortality.

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

“…1,21,26 Additionally, the presence of these bacteria is related to a history of prolonged antibiotic use or treatment failure. 21,27 The practice of frequent and prolonged use of antibiotics, particularly fluoroquinolone and third-generation cephalosporin, in Indonesian hospital settings has been identified and reported in the previous studies. 28 Therefore, our study notes the limited choice of antibiotics that can be used empirically as an early treatment for bacterial infections in COVID-19.…”

“…During the COVID-19, the use of personal protective equipment for health workers has caused cross-contamination among hospitalized patient and affect to the nosocomial infection. 27 …”

Consumption of Antibiotics in Primary Care Setting before and during COVID-19 Pandemic in Republic of Srpska, Bosnia and Herzegovina

“…Indirectly, the results of this study lead to the conclusion that the increased consumption of antibiotics did not reduce the COVID-19 mortality rate in RS. Incorrect use of antibiotics increases antibiotic resistance, which can affect the further increase in mortality of COVID-19 patients, especially due to bacterial superinfections caused by multi-resistant bacteria [ 34 ].…”

Altered infective competence of the human gut microbiome in COVID-19

“…In particular, bacterial co-infections in hospitalised and intensive care unit patients with COVID-19 are associated with prolonged ventilation and an increased mortality rate [14,17–19]. Furthermore, hospital-acquired infections with multi drug resistant (MDR) pathogens are also linked with increased mortality in COVID-19 patients [20,21]. These reports collectively suggest a clear shift in COVID-19 patients with respect to an increased abundance of pathogens and potential for harm.…”