Abstract
Antimicrobial resistance (AMR) is an emerging public health problem in modern times and the current COVID-19 pandemic has further exaggerated this problem. Due to bacterial co-infection in COVID-19 cases, an irrational consumption of antibiotics has occurred during the pandemic. This study aimed to observe the COVID-19 patients hospitalized from 1 March 2019 to 31 December 2020 and to evaluate the AMR pattern of bacterial agents isolated. This was a single-center study comprising 494 bacterial isolates (blood and urine) that were obtained from patients with SARS-CoV-2 admitted to the ICU and investigated in the Department of Microbiology of a tertiary care hospital in Delhi, India. Out of the total bacterial isolates, 55.46% were gram negative and 44.53% were gram positive pathogens. Of the blood samples processed, the most common isolates were CoNS (Coagulase Negative Staphylococcus) and Staphylococcus aureus. Amongst the urinary isolates, most common pathogens were Escherichia coli and Staphylococcus aureus. A total of 60% MRSA was observed in urine and blood isolates. Up to 40% increase in AMR was observed amongst these isolates obtained during COVID-19 period compared to pre-COVID-19 times. The overuse of antibiotics gave abundant opportunity for the bacterial pathogens to gradually develop mechanisms and to acquire resistance. Since the dynamics of SARS-COV-2 are unpredictable, a compromise on hospital antibiotic policy may ultimately escalate the burden of drug resistant pathogens in hospitals. A shortage of trained staff during COVID-19 pandemic renders it impossible to maintain these records in places where the entire hospital staff is struggling to save lives. This study highlights the extensive rise in the use of antibiotics for respiratory illness due to COVID-19 compared to antibiotic use prior to COVID-19 in ICUs. The regular prescription audit followed by a constant surveillance of hospital infection control practices by the dedicated teams and training of clinicians can improve the quality of medications in the long run and help to fight the menace of AMR.
Highlights
IntroductionThe dynamics of COVID-19 disease and its treatment has been changing throughout the course of pandemic with new research guidelines constantly being added
Viral agents causing severe disease are frequently associated with immunosuppression, predisposing patients to secondary infections that can further complicate the course of the disease by increasing the morbidity and mortality
We aimed to evaluate the Antimicrobial resistance (AMR) pattern of bacterial agents isolated from clinical samples submitted to Microbiology laboratory from the patients with COVID-19 illness, to evaluate those admitted to a tertiary care center during the pandemic and compared the anti-microbial susceptibility profile of bacterial agents isolated in the previous year for strengthening the antimicrobial stewardship protocols during the disaster
Summary
The dynamics of COVID-19 disease and its treatment has been changing throughout the course of pandemic with new research guidelines constantly being added. Steroids are the mainstay in the management of COVID-19 illness, in hypoxemic patients. The development of sepsis with raised CRP is generally considered to be a domain of bacteria associated infection but, during this pandemic, viral sepsis emerged as a new entity that is relatively less suspected and undiagnosed, with a remarkable high risk of multiple organ failure [1]. Viral agents causing severe disease are frequently associated with immunosuppression, predisposing patients to secondary infections that can further complicate the course of the disease by increasing the morbidity and mortality. Overlapping clinical features, radiological findings and laboratory parameters renders it difficult to distinguish severe COVID-19 infection from secondary bacterial or fungal involvement
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