Antimicrobial Resistance Patterns and Antibiotic Use during Hospital Conversion in the COVID-19 Pandemic

Abstract

Objective: To describe empirical antimicrobial prescription on admission in patients with severe COVID-19, the prevalence of Hospital-Acquired Infections, and the susceptibility patterns of the causing organisms. Methods: In this prospective cohort study in a tertiary care center in Mexico City, we included consecutive patients admitted with severe COVID-19 between March 20th and June 10th and evaluated empirical antimicrobial prescription and the occurrence of HAI. Results: 794 patients with severe COVID-19 were admitted during the study period. Empiric antibiotic treatment was started in 92% of patients (731/794); the most frequent regimes were amoxicillin-clavulanate plus atypical coverage in 341 (46.6%) and ceftriaxone plus atypical coverage in 213 (29.1%). We identified 110 HAI episodes in 74/656 patients (11.3%). Ventilator-associated pneumonia (VAP) was the most frequent HAI, in 56/110 (50.9%), followed by bloodstream infections (BSI), in 32/110 (29.1%). The most frequent cause of VAP were Enterobacteriaceae in 48/69 (69.6%), followed by non-fermenter gram-negative bacilli in 18/69 (26.1%). The most frequent cause of BSI was coagulase negative staphylococci, in 14/35 (40.0%), followed by Enterobacter complex in 7/35 (20%). Death occurred in 30/74 (40.5%) patients with one or more HAI episodes and in 193/584 (33.0%) patients without any HAI episode (p < 0.05). Conclusion: A high frequency of empiric antibiotic treatment in patients admitted with COVID-19 was seen. VAP and BSI were the most frequent hospital-acquired infections, due to Enterobacteriaceae and coagulase negative staphylococci, respectively.

Fighting Antibiotic Resistance in Hospital-Acquired Infections: Current State and Emerging Technologies in Disease Prevention, Diagnostics and Therapy

“…Therefore, from the start of the pandemic, doctors treating COVID-19 patients have been prone to prescribe antibiotics empirically on admission to hospital (Abelenda-Alonso et al, 2020). As such, up to 56-92% of hospitalized COVID-19 patients were given antibiotics throughout the course of treatment, although only around 6-15% of them actually suffered bacterial co-infection (Li et al, 2020;Vaughn et al, 2020;Martinez-Guerra et al, 2021). A retrospective study from the Wuhan Union Hospital revealed that the majority of patients with secondary bacterial infections had acquired antimicrobial resistant strains (carbapenem-resistant K. pneumoniae, A. baumannii; methicillin-resistant S. aureus) (Li et al, 2020).…”

An Assessment of the Impact of Coronavirus Disease (COVID-19) Pandemic on National Antimicrobial Consumption in Jordan

“…Effective diagnostic specimens for conducting mass testing and for accurate diagnosis of COVID-19 is critical and deemed necessary [14]. The inappropriate use of antibiotics during the COVID-19 pandemic may further worsen the situation in relation to antimicrobial resistance [15][16][17]. An assessment to determine changes in antimicrobial consumption due the COVID-19 outbreak is needed.…”

Bacteremia in Critically Ill Patients with SARS-CoV 2 Infection

“…The presence of a positive blood culture was reported in 13.2% (n=17) of the patients, greater than other studies, like in Engsbro, et al, were the presence of blood stream infections was demonstrated in 5.3% of their critically III patients (n=12) [6]; in Yu and cols that reported the presence of a positive blood culture in 6.5% of their patients; and Martinez-Guerra and cols. [7] they observed the presence of a blood stream infections on 29.1% of their population (n=32) being a coagulase negative staphylococci the most frequent cause in 40%, followed by Enterobacter complex in 20% with a 14.3% of AmpC producers pathogens, 2.9% Extended spectrum beta lactamases and 2.9% Pseudomonas aeruginosa multidrug resistant, nevertheless this last studies does not make difference between mild, moderate or critically III patients [7,8].…”