Antibiotic Use and Fatal Outcomes among Critically Ill Patients with COVID-19 in Tacna, Peru

Abstract

Overuse of antibiotics during the Coronavirus Disease 2019 (COVID-19) pandemic could increase the selection of extensively resistant bacteria (XDR). However, it is unknown what impact they could have on the evolution of patients, particularly critically ill patients. This study aimed to evaluate the characteristics and impact of ICU-acquired infections in patients with COVID-19. A retrospective cohort study was conducted, evaluating all patients with critical COVID-19 admitted to the intensive care unit (ICU) of a hospital in Southern Peru from 28 March 2020 to 1 March 2021. Of the 124 patients evaluated, 50 (40.32%) developed a healthcare-associated infection (HAI), which occurred at a median of 8 days (IQR 6–17) after ICU admission. The proportion of patients with HAI that required ceftriaxone was significantly higher; the same was true for the use of dexamethasone. Forty bacteria isolations (80%) were classified as XDR to antibiotics, with the most common organisms being Acinetobacter baumannii (54%) and Pseudomonas aeruginosa (22%); 33% (41/124) died at the ICU during the follow-up. In the adjusted analysis, healthcare-associated infection was associated with an increased risk of mortality (aHR= 2.7; 95% CI: 1.33–5.60) and of developing acute renal failure (aRR = 3.1; 95% CI: 1.42–6.72). The incidence of healthcare infection mainly by XDR pathogens is high in critically ill patients with COVID-19 and is associated with an increased risk of complications or death.

Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

“…The 148 included studies were published between December, 2019, and May, 2021. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , ...…”

Risk factors for hospital-acquired infection during the SARS-CoV-2 pandemic

“…Recently, more studies have been published on secondary bacterial infections in hospitalized patients with COVID-19. [4] , [5] , [6] , [7] , [8] , [9] However, the studies are often small, 6 , 8 and/or have limited patient populations (intensive care unit [ICU] only), 5 , 6 , 8 or are lacking historical or concurrent controls. There have been large studies of data reported to the National Healthcare Safety Network (NHSN) that show higher rates of central line-associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and ventilator-associated events (VAEs), but relatively stable Clostridioides difficile infection (CDI) rates during the pandemic, but these studies lack patient level data to correlate particular patient-level risk factors with the development of infections during hospitalization.…”

Association between the Use of Antibiotics and the Development of Acute Renal Injury in Patients Hospitalized for COVID-19 in a Hospital in the Peruvian Amazon

“…As previously described [ 33 , 34 , 35 , 36 ], the inappropriate use of antibiotics for COVID-19 has been associated with multiple negative outcomes and consequences. The current study concludes that the development of AKI among hospitalized patients was associated with vancomycin administration.…”

“…This is consistent with that reported by Lima et al, who estimated that the risk of developing AKI is three times higher in patients who received antibiotic therapy compared to those who did not (RR: 3.03; 95% CI: 1.64–5.62) [ 28 ]. In addition, recent studies have reported that in Latin America, particularly in Peru, 99% of hospitalized patients with COVID-19 received antibiotics unjustifiably [ 35 , 36 ]. In their study, Mousavi Movahed SM et al reported that antibiotics and acute kidney injury were significantly associated with severity and death in patients hospitalized for COVID-19 [ 37 ].…”