The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya

Abstract

Background: Data on the prevalence of bacterial co-infections among COVID-19 patients are limited, especially in our country, Indonesia. We aimed to assess the rate of bacterial co-infections in hospitalized COVID-19 patients and report the most common microorganisms involved and the antibiotic use in these patients. Methods: This study is a retrospective cohort study, among COVID-19 adult patients admitted to Universitas Airlangga Hospital Surabaya from 14 March-30 September 2020. The bacterial infection is defined based on clinical assessment, laboratory parameters, and microbiology results. Results: A total of 218 patients with moderate to critical illness and confirmed COVID-19 were included in this study. Bacterial infection was confirmed in 43 patients (19.7%). COVID-19 patients with bacterial infections had longer hospital length of stay (17.6 ± 6.62 vs 13.31±7.12), a higher proportion of respiratory failure, intensive care treatment, and ventilator use. COVID-19 patients with bacterial infection had a worse prognosis than those without bacterial infection (p<0.04). The empirical antibiotic was given to 75.2% of the patients. Gram-negative bacteria were commonly found as causative agents in this study (n = 39; 70.37%). Conclusion: COVID-19 patients with bacterial infection have a longer length of stay and worse outcomes. Healthcare-associated infections during intensive care treatment for COVID-19 patients must be carefully prevented.

Clinical use of antiviral, antibiotic and immunomodulatory drugs in hospitalized COVID-19 patients: a retrospective study in Bandung, Indonesia

“…This proportion is higher than that reported in the United Kingdom (UK) (85.2%), 26 Netherland (60.1%), 10 and Surabaya Indonesia (75.3%). 27 In fact, microbiological testing showed that the bacterial infection and co-infection among hospitalized COVID-19 patients was infrequent. 10 Several studies reported 1.25 % of 925 patients, 10 19.7% of 218 patients, 27 1107 of 48902 patients were confirmed bacterial co-infection.…”

“…27 In fact, microbiological testing showed that the bacterial infection and co-infection among hospitalized COVID-19 patients was infrequent. 10 Several studies reported 1.25 % of 925 patients, 10 19.7% of 218 patients, 27 1107 of 48902 patients were confirmed bacterial co-infection. In COVID-19 patients in the UK, the most frequent etiology of respiratory co-infection was Staphylococcus aureus and Haemophilus influenza, of secondary respiratory infection was Enterobacteriaceae and S aureus, and in bloodstream infection was Escherichia coli and S aureus.…”

“…26 In the Indonesian setting, Gram-negative was the common causative agents of bacterial infection in COVID-19 patients. 27 These findings suggested that the choice for empirical antimicrobial should be treated for Gram-negative bacteria and S aureus until the results of culture available.…”

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

“…In Indonesia, the information of incidence and prevalence of bacterial infections in COVID-19 patients has not been widely reported (Prasetyoputri, 2021). However, based on a retrospective study at the Airlangga University Hospital, Surabaya conducted by Asmarawati et al (2021), it was stated that there 19.7% of moderate and critically ill patients had bacterial infections. Those bacterial infections impacted the increase of hospitalization length, high risk of respiratory failure, use of ventilators, and ICU admission.…”

“…5). The antibiotics used are quinolones (moxifloxacin and levofloxacin), cephalosporin (ceftazidime, cefotaxime, ceftriaxone, cefuroxime, and cefoperazone-sulbactam), a carbapenem (meropenem), and levofloxacin (Asmarawati et al, 2021).…”