Abstract
Data on the prevalence of bacterial co-infections and secondary infection among adults with COVID-19 admitted to the intensive care unit (ICU) are rare. We aimed to determine the frequency of secondary bacterial infection, antibiotic use, and clinical characteristics in patients admitted to the ICU with severe SARS-CoV-2 pneumonia. This was a retrospective cohort study of adults with severe COVID-19 admitted to two ICUs from March 6 to September 7, 2020 in an academic medical center in Isfahan, Iran. To detect COVID-19, reverse transcription real-time polymerase chain reaction was performed and also typical pattern of CT scan was used for the diagnosis of COVID-19. Data collection included the age, gender, main symptoms, history of underlying disease, demographics, hospital stay, outcomes, and antibiotic regimen of the patient. Antimicrobial susceptibility testing was carried out according to the CLSI guidelines. During the study period, 553 patients were referred to the both ICUs for COVID-19 with severe pneumonia. Secondary bacterial infection was detected in 65 (11.9%) patients. The median age was 69.4 (range 21–95) years; 42 (63.6%) were men. Notably, 100% (n = 65) of the patients with superinfection were prescribed empirical antibiotics before first positive culture, predominantly meropenem (86.2%) with a median duration of 12 (range 2–32) days and levofloxacin (73.8%) with a median duration of nine (range 2–24) days. Most prevalent causative agents for secondary bacterial infection were Klebsiella pneumoniae (n = 44) and Acinetobacter baumannii (n = 33). Most patients with secondary bacterial infection showed extensive drug-resistance. The mortality among patients who acquired superinfections was 83% against an overall mortality of 38.1% in total admitted COVID-19 patients. We found a high prevalence of carbapenem-resistant Gram-negative bacilli in COVID-19 patients admitted to our ICUs, with a high proportion of K. pneumoniae followed by A. baumannii. These findings emphasize the importance of implementation of strict infection control measures and highlight the role of antimicrobial stewardship during a pandemic.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), which causes coronavirus disease 2019 (COVID-19), was first identified in December 2019 in Wuhan, China, and is currently circulating worldwide
We aimed to assess the rate of secondary bacterial infections, their antibiotic resistance, antibiotic therapies and clinical characteristics applied among patients admitted to our hospital for severe SARS-CoV-2 pneumonia in Isfahan, Iran
We conducted a single-center retrospective study including all adult (≥18 years old) patients admitted to two COVID-19 intensive care unit (ICU) from March 6 to September 7, 2020 in an academic hospital with approximately 220 beds, located in in Isfahan, Iran, for acute respiratory failure related to SARS-CoV-2 pneumonia
Summary
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), which causes coronavirus disease 2019 (COVID-19), was first identified in December 2019 in Wuhan, China, and is currently circulating worldwide. Many studies of COVID-19 patients admitted to the ICU note the empiric use of antibiotics in a majority of patients, which can lead to increases in the prevalence of multidrug-resistant (MDR) bacteria (Contou et al, 2020; Sharifipour et al, 2020; Baskaran et al, 2021). COVID-19 pneumonia is associated with high rates of admission to the ICU and in-hospital mortality (Contou et al, 2020). We aimed to assess the rate of secondary bacterial infections, their antibiotic resistance, antibiotic therapies and clinical characteristics applied among patients admitted to our hospital for severe SARS-CoV-2 pneumonia in Isfahan, Iran
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