Risk Factors for Bacterial Infections in Patients With Moderate to Severe COVID-19: a Case Control Study

Abstract

ObjectiveBacterial infections are known to complicate respiratory viral infections and are associated with adverse outcomes in COVID-19 patients. A case control study was conducted to determine risk factors for bacterial infections where cases were defined as moderate to severe/critical COVID-19 patients with bacterial infection and those without were included as controls. Logistic regression analysis was performed. ResultsOut of a total of 50 cases and 50 controls, greater proportion of cases had severe or critical disease at presentation as compared to control i.e 80% vs 30% (p<0.001). Hospital acquired pneumonia (72%) and Gram negative organisms (82%) were predominant. Overall antibiotic utilization was 82% and was 64% in patients who had no evidence of bacterial infection. The median length of stay was significantly longer among cases compared to controls (12.5 versus 7.5 days) (p=0.001). The overall mortality was 30%, with comparatively higher proportion of deaths among cases (42% versus 18%) (p=0.009). Severe or critical COVID-19 at presentation (AOR: 4.42 times; 95% CI; 1.63-11.9) and use of steroids (AOR: 4.60; 95% CI 1.24-17.05) were independently associated with risk of bacterial infections. These findings have implications for antibiotic stewardship as antibiotics can be reserved for those at higher risk for bacterial superinfections.

Antibiotic Use and Associated Risk Factors for Antibiotic Prescribing in COVID-19 Hospitalized Patients

“…These findings are similar to the results of previous studies, suggesting the need for strategies to help clinicians judiciously prescribe antibiotics in patients with COVID-19. [1][2][3][4][5][8][9][10]20 Previous studies conducted in the United States have shown that concomitant community acquired bacterial infections in COVID-19 patients are low based on microbiological data within the first 48 hours of admission. 4,5 In our study, we found only slightly higher rates of microbiologically confirmed infections than in other US studies, despite the fact that we reported all microbiologic data throughout hospitalization.…”

“…Despite bacterial co-infection being reported in 1-8% of patients, rates of antibiotic prescribing have ranged from 57-95% in hospitalized patients. [1][2][3][4][5][6][7][8][9][10][11] Additionally, there are reports of increased consumption of antibiotics during the COVID-19 pandemic. 6,7,12,13 Over-prescribing of antibiotics may increase the risk of adverse events, nosocomial infection, and antibiotic resistance resulting in multidrug resistant bacteria.…”

Bacterial infections in COVID-19 patients and their possible treatments. A review

“…The majority of the patients who died were infected with Gram-negative bacteria such as Acinetobacter sp. and P. aeruginosa (Nasir et al, 2021).…”

“…Each year, the number of patients infected with antibiotic-resistant bacteria grows, leading to the death of patients caused by resistant bacterial infections (Michael et al, 2014;Thongkrachang et al, 2016). Bacterial co-infections are commonly identified in viral respiratory infections and lead to the severe disease and mortality, as seen in influenza and H1N1 outbreak in 1918 and 2009, respectively (Feldman & Anderson, 2021;Nasir et al, 2021;Rice et al, 2012;Taubenberger & Morens, 2020). In addition, these infections able to suppress the host's immune system, raise antibiotics treatment sensitivity, and worsen the disease severity (Xin- Xu & Xiao-Nong, 2013).…”

“…In several reports, the majority of COVID-19 patients admitted to hospitals are treated with broad-spectrum antibiotics with unknown efficacy. For example, Nasir et al (2021) reported 82% of antibiotic utilization, of which 62% were given to patients without a clear indication of bacterial infections. This phenomenon can potentially cause increased antimicrobial resistance rates (d'Humieres et al, 2021;Nasir et al, 2021;Sharifipour et al, 2020;Sieswerda et al, 2021).…”