Abstract
Objective: Bacterial co-pathogens are common in various viral respiratory tract infections, leading to increased disease severity and mortality. Still, they are understudied during large outbreaks and pandemics. This study was conducted to highlight the overall burden of these infections in COVID-19 patients admitted to our tertiary care hospital, along with their antibiotic susceptibility patterns.Material and methods: During the six-month study period, clinical samples (blood samples, respiratory samples, and sterile body fluids, including cerebrospinal fluid [CSF]) of COVID-19 patients with suspected bacterial coinfections (at presentation) or secondary infections (after 48 hours of hospitalization) were received and processed for the same.Results: Clinical samples of 814 COVID-19 patients were received for bacterial culture and susceptibility. Out of the total patient sample, 75% had already received empirical antibiotics before the samples were sent for analysis. Overall, 17.9% of cultures were positive for bacterial infections. Out of the total patients with bacterial infection, 74% (108/146) of patients had secondary bacterial infections (after 48 hours of hospitalization) and 26% (38/146) had bacterial coinfections (at the time of admission). Out of the 143 total isolates obtained, the majority (86%) were gram-negative organisms, of which Acinetobacter species was the commonest organism (35.6%), followed by Klebsiella pneumoniae (18.1%). The majority (50.7%) of the pathogenic organisms reported were multidrug resistant.Conclusion: The overall rate of secondary bacterial infections (SBIs) in our study was lower (7.9%) than reported by other studies. A rational approach would be to adhere to the practice of initiating culture-based guidance for antibiotics and to restrict unnecessary empirical antimicrobial therapy.
Highlights
The coronavirus disease 2019 (COVID-19), first identified in December 2019 in Wuhan, China, is a highly pathogenic and transmissible infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1]
A rational approach would be to adhere to the practice of initiating culturebased guidance for antibiotics and to restrict unnecessary empirical antimicrobial therapy
We see that the overall rate of bacterial infections in COVID-19 patients in our study was lower than that in previous studies
Summary
The coronavirus disease 2019 (COVID-19), first identified in December 2019 in Wuhan, China, is a highly pathogenic and transmissible infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1]. Despite the proven importance of secondary bacterial infections (SBIs) affecting the severity of viral respiratory diseases, they are still understudied during large outbreaks of viral respiratory infections.[3,4] There remains a knowledge gap in the nature, frequency, and antimicrobial profiles of secondary bacterial pathogens in the current COVID-19 pandemic.[5,6] Due to this knowledge gap and paucity of literature, the majority of patients tend to receive unnecessary empirical antibiotics, with no adherence to the antimicrobial stewardship guidelines. Almost half of COVID-19 deaths are associated with SBIs or coinfections.[7] Extrapolating from the concerns of increased mortality seen due to bacterial superinfections during previous influenza pandemics, various guidelines on the empirical use of antibiotics in COVID-19 patients have been advocated.[8,9,10] with the current scenario, the problem of increasing antimicrobial resistance will likely outlive COVID-19, and unnecessary use of antibiotics in the treatment of this pandemic virus should be reduced. A growing number of reports have suggested that antimicrobial stewardship has suffered and that even fundamental principles have been overlooked during the pandemic.[11]
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