Characterization of Secondary Bacterial Infections and Antibiotic Use in Mechanically Ventilated Patients With COVID-19 Induced Acute Respiratory Distress Syndrome

Erik Risa,Nicholas J Johnson,Nandita S Mani,James Town,Chloe Bryson-Cahn,David Roach,Jehan Z Budak,Christopher Hebert,Jeannie D Chan

doi:10.1177/08850666211021745

Abstract

Background:COVID-19 has a widely variable clinical syndrome that is difficult to distinguish from bacterial sepsis, leading to high rates of antibiotic use. Early studies indicate low rates of secondary bacterial infections (SBIs) but have included heterogeneous patient populations. Here, we catalogue all SBIs and antibiotic prescription practices in a population of mechanically ventilated patients with COVID-19 induced acute respiratory distress syndrome (ARDS).Methods:This was a retrospective cohort study of all patients with COVID-19 ARDS requiring mechanical ventilation from 3 Seattle, Washington hospitals in 2020. Data were obtained via electronic and manual review of the electronic medical record. We report the incidence and site of SBIs, mortality, and antibiotics per day using descriptive statistics.Results:We identified 126 patients with COVID-19 induced ARDS during the study period. Of these patients, 61% developed clinical infection confirmed by bacterial culture. Ventilator associated pneumonia was confirmed in 55% of patients, bacteremia in 20%, and urinary tract infection (UTI) in 17%. Staphylococcus aureus was the most commonly isolated bacterial species. A total of 97% of patients received antibiotics during their hospitalization, and patients received nearly one antibiotic per day during their hospital stay.Conclusions:Mechanically ventilated patients with COVID-19 induced ARDS are at high risk for secondary bacterial infections and have extensive antibiotic exposure.

Highlights

The SARS-CoV-2 pandemic has led to a global surge in the utilization of intensive care and mechanical ventilation.[1]
Given the recent emergence of SARS-CoV-2, the characterization and extent of secondary bacterial infections (SBIs) in critically ill patients with COVID-19 has not been as thoroughly documented in the literature, leading to antimicrobial stewardship guidelines in patients with COVID-19 that rely on emerging evidence.[4,5]
Over the course of the study period, 208 SARS-CoV-2 patients with COVID-19 were admitted to the intensive care unit (ICU) and required mechanical ventilation

Summary

Introduction

The SARS-CoV-2 pandemic has led to a global surge in the utilization of intensive care and mechanical ventilation.[1]. COVID-19 has a widely variable clinical syndrome that is difficult to distinguish from bacterial sepsis, leading to high rates of antibiotic use. Studies indicate low rates of secondary bacterial infections (SBIs) but have included heterogeneous patient populations. We catalogue all SBIs and antibiotic prescription practices in a population of mechanically ventilated patients with COVID-19 induced acute respiratory distress syndrome (ARDS). Methods: This was a retrospective cohort study of all patients with COVID-19 ARDS requiring mechanical ventilation from 3 Seattle, Washington hospitals in 2020. Results: We identified 126 patients with COVID-19 induced ARDS during the study period. Of these patients, 61% developed clinical infection confirmed by bacterial culture. Conclusions: Mechanically ventilated patients with COVID-19 induced ARDS are at high risk for secondary bacterial infections and have extensive antibiotic exposure

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