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Published on: March 3, 2023
Antimicrobial Resistance Patterns and Antibiotic Use during Hospital Conversion in the COVID-19 Pandemic
Bernardo A Martinez-Guerra1, Maria F Gonzalez-Lara2, Nereyda A de-Leon-Cividanes1
1Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 14080 Mexico City, Mexico.
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.
Insights
Empiric antibiotic use was high in severe COVID-19 patients. Ventilator-associated pneumonia and bloodstream infections were common hospital-acquired infections, often caused by specific bacteria.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Antimicrobial Stewardship
Background:
- Severe COVID-19 patients frequently receive empiric antimicrobial therapy upon admission.
- Understanding hospital-acquired infections (HAIs) and their causative organisms is crucial for patient outcomes.
Purpose of the Study:
- To document the empirical antimicrobial prescribing practices for severe COVID-19 patients.
- To determine the incidence of hospital-acquired infections (HAIs) in this population.
- To analyze the antimicrobial susceptibility patterns of pathogens causing HAIs.
Main Methods:
- Prospective cohort study conducted in a tertiary care center.
- Inclusion of consecutive patients admitted with severe COVID-19.
- Evaluation of empirical antimicrobial prescriptions and HAI occurrence.
Main Results:
- 92% of severe COVID-19 patients received empiric antibiotics.
- Ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) were the most common HAIs (11.3% incidence).
- Enterobacteriaceae and coagulase-negative staphylococci were leading causes of VAP and BSI, respectively. Higher mortality was observed in patients with HAIs.
Conclusions:
- High rates of empiric antibiotic use in severe COVID-19 patients.
- VAP and BSI are significant HAIs in this cohort, driven by specific bacterial pathogens.
- Antimicrobial stewardship and infection control measures are critical.
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