Abstract
Objective: To describe empirical antimicrobial prescription on admission in patients with severe COVID-19, the prevalence of Hospital-Acquired Infections, and the susceptibility patterns of the causing organisms. Methods: In this prospective cohort study in a tertiary care center in Mexico City, we included consecutive patients admitted with severe COVID-19 between March 20th and June 10th and evaluated empirical antimicrobial prescription and the occurrence of HAI. Results: 794 patients with severe COVID-19 were admitted during the study period. Empiric antibiotic treatment was started in 92% of patients (731/794); the most frequent regimes were amoxicillin-clavulanate plus atypical coverage in 341 (46.6%) and ceftriaxone plus atypical coverage in 213 (29.1%). We identified 110 HAI episodes in 74/656 patients (11.3%). Ventilator-associated pneumonia (VAP) was the most frequent HAI, in 56/110 (50.9%), followed by bloodstream infections (BSI), in 32/110 (29.1%). The most frequent cause of VAP were Enterobacteriaceae in 48/69 (69.6%), followed by non-fermenter gram-negative bacilli in 18/69 (26.1%). The most frequent cause of BSI was coagulase negative staphylococci, in 14/35 (40.0%), followed by Enterobacter complex in 7/35 (20%). Death occurred in 30/74 (40.5%) patients with one or more HAI episodes and in 193/584 (33.0%) patients without any HAI episode (p < 0.05). Conclusion: A high frequency of empiric antibiotic treatment in patients admitted with COVID-19 was seen. VAP and BSI were the most frequent hospital-acquired infections, due to Enterobacteriaceae and coagulase negative staphylococci, respectively.
Highlights
Bacterial coinfections are a major cause of morbidity and mortality among patients with viral infections of the respiratory tract such as severe influenza, with reported rates ranging from 2% to 65%
In this study we aimed to describe the pattern of antimicrobial prescription on admission in patients with severe COVID-19, the rate of hospital-acquired infections and the susceptibility patterns of the causing organisms during the first months of the pandemic
Sixty-one percent (489/794) were male, the median age was 52 years (IQR 43–62), the median body mass index (BMI) was 29.7 kg/m2 and obesity was seen in 46.1% of patients (364/794)
Summary
Bacterial coinfections are a major cause of morbidity and mortality among patients with viral infections of the respiratory tract such as severe influenza, with reported rates ranging from 2% to 65%. Most commonly, bacteria such as Streptococcus pneumoniae and Staphylococcus aureus account for 35% and 28% of infections, respectively [1,2]. COVID-19, despite a low (3.5–8%) prevalence of bacterial coinfections on admission [5,6,7] These factors include the difficulty to obtain respiratory samples, a breakdown in surveillance and antimicrobial stewardship programs and the absence of evidence-based antiviral treatments [5,7]. The pandemic is a challenge to antimicrobial stewardship programs, several antimicrobial stewardship recommendations include obtaining microbiological samples on admission, early discontinuation or de-escalation once bacterial infection is ruled out and enforcing the proper treatment duration [8,9]
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