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Yossadania A, Hayati Z, Harapan H, Saputra I, Mudatsir, Diah M, Ramadhana IF. Quantity of antibiotic use and its association with clinical outcomes in COVID-19 patients: A snapshot from a provincial referral hospital in Indonesia. NARRA J 2023; 3:e272. [PMID: 38450336 PMCID: PMC10914064 DOI: 10.52225/narra.v3i3.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/25/2023] [Indexed: 03/08/2024]
Abstract
Irrational antibiotic use in Indonesia is considered high, yet there are still lacks reliable information regarding the issue. The quantity of antibiotic use studies, in particular during coronavirus disease 2019 (COVID-19) pandemic, was not well reported. The aim of this study was to evaluate antibiotic use in COVID-19 patients at a province referral hospital in Aceh, Indonesia, Dr Zainoel Abidin Hospital, and to assess the association between antibiotic use and COVID-19 clinical outcomes. The defined daily dose (DDD) method was used and expressed in DDDs per 100 patient-days as in hospital setting. The data were obtained from inpatient confirmed COVID-19 patients between March 2020 and December 2021. A logistic regression was used to determine the association between patients' characteristics and antibiotic usage with clinical outcomes. A total of 361 treated COVID-19 patients were included using a random sampling technique and analyzed. Out of 361 patients, 89.2% of them were treated with antibiotic(s). All the antibiotics were given empirically except for cefazoline (5.5%) that was used as prophylaxis to obstetric patients who underwent the c-section. Azithromycin was the most prescribed antibiotic and levofloxacin had the highest DDD. Our data suggested that there was no association between antibiotic use and clinical outcomes of COVID-19 patients (p=0.128). Having sepsis and another pulmonary disease however were associated with mortality of COVID-19 patients with adjusted odds ratio (aOR) 14.14; 95%CI 2.94-67.90, p=0.001 and aOR 8.64; 95%CI 3.30-22.63, p<0.001, respectively. In addition, patients older than 60-year-old had a higher chance to an unfavorable outcome compared to those younger than 30-year-old, aOR: 7.61; 95%CI: 1.07-53.94. In conclusion, the use of antibiotics is prevalent among COVID-19 and it is not directly associated with clinical outcomes.
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Affiliation(s)
- Asyriva Yossadania
- Departement of Public Health, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Zinatul Hayati
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Prevention and Control Antimicrobial Resistance Committee, Dr Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Harapan Harapan
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Tropical Disease Center, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Indonesia
- Tsunami & Disaster Mitigation Research Centre (TDMRC), Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Irwan Saputra
- Departement of Public Health, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Mudatsir
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Muhammad Diah
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Ika F. Ramadhana
- Prevention and Control Antimicrobial Resistance Committee, Dr Zainoel Abidin Hospital, Banda Aceh, Indonesia
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Binkhamis K, Alhaider AS, Sayed AK, Almufleh YK, Alarify GA, Alawlah NY. Prevalence of secondary infections and association with mortality rates of hospitalized COVID-19 patients. Ann Saudi Med 2023; 43:243-253. [PMID: 37554024 DOI: 10.5144/0256-4947.2023.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND ICU and other patients hospitalized with corona-virus disease 2019 (COVID-19) are more susceptible to secondary infections. Undetected secondary infections tend to have a severe clinical impact, associated with prolonged hospitalization and higher rates of inpatient mortality. OBJECTIVES Estimate the prevalence of secondary infections, determine the frequency of microbial species detected at different body sites, and measure the association between secondary infections and outcomes among hospitalized COVID-19 patients. DESIGN Cross-sectional analytical study. SETTING Tertiary care center in Riyadh PATIENTS AND METHODS: Data were collected through retrospective chart review of hospitalized COVID-19 patients >18 years old from March 2020 until May 2022 at King Saud University Medical City (27 months). Rates of secondary infections among hospitalized COVID-19 patients were described and data on clinical outcomes (intensive care admission, invasive management procedures and mortality) was collected. MAIN OUTCOME MEASURES Features and rates of infection and mortality. SAMPLE SIZE 260 RESULTS: In total, 24.2% of the study population had secondary infections. However, only 68.8% of patients had secondary infection testing, from which 35.2% had a confirmed secondary infection. These patients had a significantly higher prevalence of diabetes mellitus (P<.0001) and cardiovascular diseases (P=.001). The odds of ICU admissions (63.3%) among secondarily infected patients was 8.4 times higher compared to patients with only COVID-19 infection (17.3%). Secondarily infected patients were more likely to receive invasive procedures (OR=5.068) and had a longer duration of hospital stay compared to COVID-19 only patients. Overall mortality was 16.2%, with a predominantly higher proportion among those secondarily infected (47.6% vs 6.1%) (OR=14.015). Bacteria were the most commonly isolated organisms, primarily from blood (23.3%), followed by fungal isolates, which were mostly detected in urine (17.2%). The most detected organism was Candida albicans (17.2%), followed by Escherichia coli (9.2%), Klebsiella pneumoniae (9.2%) and Pseudomonas aeruginosa (9.2%). CONCLUSION Secondary infections were prevalent among hospitalized COVID-19 patients. Secondarily infected patients had longer hospital stay, higher odds of ICU admission, mortality, and invasive procedures. LIMITATION Single-center study, retrospective design and small sample size. CONFLICT OF INTEREST None.
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Affiliation(s)
- Khalifa Binkhamis
- From the Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- From the King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Alanoud S Alhaider
- From the College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayah K Sayed
- From the College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yara K Almufleh
- From the College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghadah A Alarify
- From the College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Norah Y Alawlah
- From the College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Recommendations and guidelines for the diagnosis and management of Coronavirus Disease-19 (COVID-19) associated bacterial and fungal infections in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:207-235. [PMID: 36586743 PMCID: PMC9767873 DOI: 10.1016/j.jmii.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
Coronavirus disease-19 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2 that has rapidly evolved into a pandemic to cause over 600 million infections and more than 6.6 million deaths up to Nov 25, 2022. COVID-19 carries a high mortality rate in severe cases. Co-infections and secondary infections with other micro-organisms, such as bacterial and fungus, further increases the mortality and complicates the diagnosis and management of COVID-19. The current guideline provides guidance to physicians for the management and treatment of patients with COVID-19 associated bacterial and fungal infections, including COVID-19 associated bacterial infections (CABI), pulmonary aspergillosis (CAPA), candidiasis (CAC) and mucormycosis (CAM). Recommendations were drafted by the 7th Guidelines Recommendations for Evidence-based Antimicrobial agents use Taiwan (GREAT) working group after review of the current evidence, using the grading of recommendations assessment, development, and evaluation (GRADE) methodology. A nationwide expert panel reviewed the recommendations in March 2022, and the guideline was endorsed by the Infectious Diseases Society of Taiwan (IDST). This guideline includes the epidemiology, diagnostic methods and treatment recommendations for COVID-19 associated infections. The aim of this guideline is to provide guidance to physicians who are involved in the medical care for patients with COVID-19 during the ongoing COVID-19 pandemic.
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Langford BJ, So M, Simeonova M, Leung V, Lo J, Kan T, Raybardhan S, Sapin ME, Mponponsuo K, Farrell A, Leung E, Soucy JPR, Cassini A, MacFadden D, Daneman N, Bertagnolio S. Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis. THE LANCET. MICROBE 2023; 4:e179-e191. [PMID: 36736332 PMCID: PMC9889096 DOI: 10.1016/s2666-5247(22)00355-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/08/2022] [Accepted: 11/24/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Frequent use of antibiotics in patients with COVID-19 threatens to exacerbate antimicrobial resistance. We aimed to establish the prevalence and predictors of bacterial infections and antimicrobial resistance in patients with COVID-19. METHODS We did a systematic review and meta-analysis of studies of bacterial co-infections (identified within ≤48 h of presentation) and secondary infections (>48 h after presentation) in outpatients or hospitalised patients with COVID-19. We searched the WHO COVID-19 Research Database to identify cohort studies, case series, case-control trials, and randomised controlled trials with populations of at least 50 patients published in any language between Jan 1, 2019, and Dec 1, 2021. Reviews, editorials, letters, pre-prints, and conference proceedings were excluded, as were studies in which bacterial infection was not microbiologically confirmed (or confirmed via nasopharyngeal swab only). We screened titles and abstracts of papers identified by our search, and then assessed the full text of potentially relevant articles. We reported the pooled prevalence of bacterial infections and antimicrobial resistance by doing a random-effects meta-analysis and meta-regression. Our primary outcomes were the prevalence of bacterial co-infection and secondary infection, and the prevalence of antibiotic-resistant pathogens among patients with laboratory-confirmed COVID-19 and bacterial infections. The study protocol was registered with PROSPERO (CRD42021297344). FINDINGS We included 148 studies of 362 976 patients, which were done between December, 2019, and May, 2021. The prevalence of bacterial co-infection was 5·3% (95% CI 3·8-7·4), whereas the prevalence of secondary bacterial infection was 18·4% (14·0-23·7). 42 (28%) studies included comprehensive data for the prevalence of antimicrobial resistance among bacterial infections. Among people with bacterial infections, the proportion of infections that were resistant to antimicrobials was 60·8% (95% CI 38·6-79·3), and the proportion of isolates that were resistant was 37·5% (26·9-49·5). Heterogeneity in the reported prevalence of antimicrobial resistance in organisms was substantial (I2=95%). INTERPRETATION Although infrequently assessed, antimicrobial resistance is highly prevalent in patients with COVID-19 and bacterial infections. Future research and surveillance assessing the effect of COVID-19 on antimicrobial resistance at the patient and population level are urgently needed. FUNDING WHO.
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Affiliation(s)
- Bradley J Langford
- Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Miranda So
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada
| | | | - Valerie Leung
- Public Health Ontario, Toronto, ON, Canada; Toronto East Health Network, Toronto, ON, Canada
| | - Jennifer Lo
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tiffany Kan
- North York General Hospital, Toronto, ON, Canada
| | | | - Mia E Sapin
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kwadwo Mponponsuo
- University of Calgary, Calgary, AB, Canada; Alberta Health Services, Calgary, AB, Canada
| | | | - Elizabeth Leung
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Unity Health Toronto, Toronto, ON, UK
| | - Jean-Paul R Soucy
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Derek MacFadden
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital, Ottawa, ON, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Wu HY, Chang PH, Chen KY, Lin IF, Hsih WH, Tsai WL, Chen JA, Lee SSJ. Coronavirus disease 2019 (COVID-19) associated bacterial coinfection: Incidence, diagnosis and treatment. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:985-992. [PMID: 36243668 PMCID: PMC9536868 DOI: 10.1016/j.jmii.2022.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/25/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
Coronavirus disease 2019 (COVID-19) emerged as a pandemic that spread rapidly around the world, causing nearly 500 billion infections and more than 6 million deaths to date. During the first wave of the pandemic, empirical antibiotics was prescribed in over 70% of hospitalized COVID-19 patients. However, research now shows a low incidence rate of bacterial coinfection in hospitalized COVID-19 patients, between 2.5% and 5.1%. The rate of secondary infections was 3.7% in overall, but can be as high as 41.9% in the intensive care units. Over-prescription of antibiotics to treat COVID-19 patients fueled the ongoing antimicrobial resistance globally. Diagnosis of bacterial coinfection is challenging due to indistinguishable clinical presentations with overlapping lower respiratory tract symptoms such as fever, cough and dyspnea. Other diagnostic methods include conventional culture, diagnostic syndromic testing, serology test and biomarkers. COVID-19 patients with bacterial coinfection or secondary infection have a higher in-hospital mortality and longer length of stay, timely and appropriate antibiotic use aided by accurate diagnosis is crucial to improve patient outcome and prevent antimicrobial resistance.
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Affiliation(s)
- Huan-Yi Wu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Peng-Hao Chang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuan-Yu Chen
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - I-Fan Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wen-Hsin Hsih
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wan-Lin Tsai
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jiun-An Chen
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Susan Shin-Jung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan,Corresponding author. 386, Ta-Chung 1st Rd., Kaohsiung 813, Taiwan. Fax: +886 -7 -3468292
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Mirzaie F, Teymori F, Shahcheragh S, Dobaradaran S, Arfaeinia H, Kafaei R, Sahebi S, Farjadfard S, Ramavandi B. Occurrence and distribution of azithromycin in wastewater treatment plants, seawater, and sediments of the northern part of the Persian Gulf around Bushehr port: A comparison with Pre-COVID 19 pandemic. CHEMOSPHERE 2022; 307:135996. [PMID: 35970214 PMCID: PMC9372055 DOI: 10.1016/j.chemosphere.2022.135996] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
One of the environmental effects of COVID 19 is the contamination of ecosystems with antibiotics due to their high consumption to treat this disease. Many years ago, the distribution of antibiotics including azithromycin (Azi) in wastewater treatment plants in Bushehr city, seawater, and sediment of the Persian Gulf has been investigated. As Azi has been prescribed to COVID 19 patients, contamination of the environment with this drug can also be assumed. Thus, we decided to examine this hypothesis by repeating our previous study during COVID 19 period. We collected wastewater samples from influent, effluent, and different units of three wastewater treatment plants (WWTPs) including one municipal WWTP (Plant A) and two hospital-WWTPs (Plant B and C). Seawater and adjusted sediments were gathered from 8 stations located in the Persian Gulf in two seasons to evaluate the special and temporal variation. The results showed a huge growth of Azi pollution in all studied matrixes. The mean Azi values in the influent of Plant A, B, and C were 145 ng/L, 110 ng/L, and 896 ng/L, which represented an 9, 6, and 48-time increase compared with those obtained in 2017 (before COVID 19). The Azi removal efficiency had a different behavior compared to before COVID 19. The mean concentration of Azi in seawater and sediment samples was 9 ng/L and 6 ng/g, which was 3 and 4-fold higher than the previous study. Opposed to our former study, the Azi amount in the aqueous phase was less subjected to temporal seasonal variations. Our observations indicated the wide distribution of Azi in the environment and a future threat of intense growth of antibiotic resistance in ecosystems.
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Affiliation(s)
- Farzad Mirzaie
- Environmental Laboratory, Department of Chemical Engineering, Shiraz University, Shiraz, Iran
| | - Fatemeh Teymori
- Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Sina Dobaradaran
- Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran; Environmental Health Engineering Department, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Hosein Arfaeinia
- Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran; Environmental Health Engineering Department, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Raheleh Kafaei
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Soleyman Sahebi
- Center of Excellence for Membrane Research and Technology, School of Chemical, Petroleum and Gas Engineering, Iran University of Science and Technology (IUST), Narmak, Tehran, Iran
| | - Sima Farjadfard
- Environmental Health Engineering Department, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Bahman Ramavandi
- Systems Environmental Health and Energy Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran; Environmental Health Engineering Department, Faculty of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran.
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Alshaikh FS, Godman B, Sindi ON, Seaton RA, Kurdi A. Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis. PLoS One 2022; 17:e0272375. [PMID: 35913964 PMCID: PMC9342726 DOI: 10.1371/journal.pone.0272375] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background Evidence around prevalence of bacterial coinfection and pattern of antibiotic use in COVID-19 is controversial although high prevalence rates of bacterial coinfection have been reported in previous similar global viral respiratory pandemics. Early data on the prevalence of antibiotic prescribing in COVID-19 indicates conflicting low and high prevalence of antibiotic prescribing which challenges antimicrobial stewardship programmes and increases risk of antimicrobial resistance (AMR). Aim To determine current prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patients. Data source OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021. Study eligibility English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting. Participants Adults (aged ≥ 18 years) with RT-PCR confirmed diagnosis of COVID-19, regardless of study setting. Methods Systematic review and meta-analysis. Proportion (prevalence) data was pooled using random effects meta-analysis approach; and stratified based on region and study design. Results A total of 1058 studies were screened, of which 22, hospital-based studies were eligible, compromising 76,176 of COVID-19 patients. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26–10.31) and 61.77% (CI 50.95–70.90), respectively. Sub-group analysis by region demonstrated that bacterial co-infection was more prevalent in North American studies (7.89%, 95% CI 3.30–14.18). Conclusion Prevalence of bacterial coinfection in COVID-19 is low, yet prevalence of antibiotic prescribing is high, indicating the need for targeted COVID-19 antimicrobial stewardship initiatives to reduce the global threat of AMR.
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Affiliation(s)
- Faisal Salman Alshaikh
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, United Kingdom
- Pharmaceutical Services, Bahrain Defence Force Military Hospital, Riffa, Kingdom of Bahrain
- * E-mail: (FSA); (BG)
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, United Kingdom
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- * E-mail: (FSA); (BG)
| | - Oula Nawaf Sindi
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, United Kingdom
- Pharmaceutical Sciences Department, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
| | - R. Andrew Seaton
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Glasgow, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, United Kingdom
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Center of Research and Strategic Studies, Lebanese French University, Erbil, Kurdistan Region Government, Iraq
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Kurdistan Region Government, Iraq
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Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients. J Infect 2022; 85:374-381. [PMID: 35781017 PMCID: PMC9245395 DOI: 10.1016/j.jinf.2022.06.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 01/08/2023]
Abstract
Background : Procalcitonin (PCT) and C-Reactive Protein (CRP) are useful biomarkers to differentiate bacterial from viral or fungal infections, although the association between them and co-infection or mortality in COVID-19 remains unclear. Methods : The study represents a retrospective cohort study of patients admitted for COVID-19 pneumonia to 84 ICUs from ten countries between (March 2020-January 2021). Primary outcome was to determine whether PCT or CRP at admission could predict community-acquired bacterial respiratory co-infection (BC) and its added clinical value by determining the best discriminating cut-off values. Secondary outcome was to investigate its association with mortality. To evaluate the main outcome, a binary logistic regression was performed. The area under the curve evaluated diagnostic performance for BC prediction. Results : 4635 patients were included, 7.6% fulfilled BC diagnosis. PCT (0.25[IQR 0.1-0.7] versus 0.20[IQR 0.1-0.5]ng/mL, p<0.001) and CRP (14.8[IQR 8.2-23.8] versus 13.3 [7-21.7]mg/dL, p=0.01) were higher in BC group. Neither PCT nor CRP were independently associated with BC and both had a poor ability to predict BC (AUC for PCT 0.56, for CRP 0.54). Baseline values of PCT<0.3ng/mL, could be helpful to rule out BC (negative predictive value 91.1%) and PCT≥0.50ng/mL was associated with ICU mortality (OR 1.5,p<0.001). Conclusions : These biomarkers at ICU admission led to a poor ability to predict BC among patients with COVID-19 pneumonia. Baseline values of PCT<0.3ng/mL may be useful to rule out BC, providing clinicians a valuable tool to guide antibiotic stewardship and allowing the unjustified overuse of antibiotics observed during the pandemic, additionally PCT≥0.50ng/mL might predict worsening outcomes.
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9
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Kurra N, Woodard PI, Gandrakota N, Gandhi H, Polisetty SR, Ang SP, Patel KP, Chitimalla V, Ali Baig MM, Samudrala G. Opportunistic Infections in COVID-19: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e23687. [PMID: 35505698 PMCID: PMC9055976 DOI: 10.7759/cureus.23687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/31/2022] [Indexed: 02/06/2023] Open
Abstract
The prevalence, incidence, and characteristics of bacterial infections in patients infected with severe acute respiratory syndrome coronavirus 2 are not well understood and have been raised as an important knowledge gap. Therefore, our study focused on the most common opportunistic infections/secondary infections/superinfections in coronavirus disease 2019 (COVID-19) patients. This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eligible studies were identified using PubMed/Medline since inception to June 25, 2021. Studies meeting the inclusion criteria were selected. Statistical analysis was conducted in Review Manager 5.4.1. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported as inverse variance and the corresponding 95% confidence interval. We screened 701 articles comprising 22 cohort studies which were included for analysis. The pooled prevalence of opportunistic infections/secondary infections/superinfections was 16% in COVID-19 patients. The highest prevalence of secondary infections was observed among viruses at 33%, followed by bacteria at 16%, fungi at 6%, and 25% among the miscellaneous group/wrong outcome. Opportunistic infections are more prevalent in critically ill patients. The isolated pathogens included Epstein-Barr virus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, Hemophilus influenza, and invasive pulmonary aspergillosis. Large-scale studies are required to better identify opportunistic/secondary/superinfections in COVID-19 patients.
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Affiliation(s)
- Nithin Kurra
- Department of Neurology, University of Nebraska Medical Center, Omaha, USA
| | | | | | - Heli Gandhi
- Medicine and Surgery, Manipal Academy of Higher Education, Manipal, IND
| | | | - Song Peng Ang
- Medicine and Surgery, International Medical University, Kuala Lumpur, MYS
| | - Kinjalben P Patel
- Medicine and Surgery, Smt. B. K. Shah Medical Institute & Research Centre, Vadodara, IND
| | - Vishwaj Chitimalla
- Medicine and Surgery, Shri B M Patil Medical College Hospital and Research Centre, Bijapur Lingayat District Educational (BLDE) University, Vijayapura, IND
| | - Mirza M Ali Baig
- Department of Anaesthesiology, Dow University of Health Sciences, Karachi, PAK
| | - Gayathri Samudrala
- Obstetrics and Gynecology, National Board of Examinations, New Delhi, IND.,Medicine and Surgery, Dr. N. T. Ramarao University of Health Sciences, Vijayawada, IND
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Mohamad IN, Wong CKW, Chew CC, Leong EL, Lee BH, Moh CK, Chenasammy K, Lim SCL, Ker HB. The landscape of antibiotic usage among COVID-19 patients in the early phase of pandemic: a Malaysian national perspective. J Pharm Policy Pract 2022; 15:4. [PMID: 35016728 PMCID: PMC8749115 DOI: 10.1186/s40545-022-00404-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/05/2022] [Indexed: 01/08/2023] Open
Abstract
Background During the early phase of the COVID-19 pandemic, antibiotic usage among COVID-19 patients was noted to be high in many countries. The objective of this study was to determine the prevalence of antibiotic usage and factors affecting antibiotic usage among COVID-19 patients during the early phase of the COVID-19 pandemic in Malaysia. Methods This was a cross-sectional study that involved reviewing medical records of COVID-19 Malaysian patients aged 12 and above who were diagnosed with COVID-19 and received treatment in 18 COVID-19 hospitals from February to April 2020. A minimum sample of 375 patients was required. A binary logistic regression analysis was performed to determine factors associated with antibiotic usage. Variables with p < 0.05 were considered statistically significant. Results A total of 4043 cases were included for analysis. The majority of the patients (87.6%) were non-smokers, male (65.0%), and had at least one comorbidity (37.0%). The median age was 35 years (IQR: 38). The prevalence of antibiotic usage was 17.1%, with 5.5% of them being prescribed with two or more types of antibiotics. The most frequent antibiotics prescribed were amoxicillin/clavulanic acid (37.8%), ceftriaxone (12.3%), piperacillin/tazobactam (13.3%), azithromycin (8.3%), and meropenem (7.0%). Male patients (adjusted OR 1.53), who had a comorbidity (adjusted OR 1.36), associated with more severe stage of COVID-19 (adjusted OR 6.50–37.06), out-of-normal range inflammatory blood parameters for neutrophils, lymphocytes, and C-reactive protein (adjusted OR 2.04–3.93), corticosteroid use (adjusted OR 3.05), and ICU/HDU admission (adjusted OR 2.73) had higher odds of antibiotic use. Conclusions The prevalence of antibiotic usage in the early phase of the COVID-19 pandemic was low, with amoxicillin/clavulanic acid as the most common antibiotic of choice. The study showed that clinicians rationalized antibiotic usage based on clinical assessment, supported by relevant laboratory parameters.
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Affiliation(s)
| | - Calvin Ke-Wen Wong
- Medical Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - E-Li Leong
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia.
| | - Biing-Horng Lee
- Medical Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Cheng-Keat Moh
- Medical Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Komalah Chenasammy
- Medical Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Steven Chee-Loon Lim
- Infectious Diseases Unit, Medical Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Hong-Bee Ker
- Infectious Diseases Unit, Medical Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
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11
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Muflihah H, Bhekti Rahimah S, Widiyanto T, Mahwati Y, Parumasivam T, Sastramihardja HS. Clinical use of antiviral, antibiotic and immunomodulatory drugs in hospitalized COVID-19 patients: a retrospective study in Bandung, Indonesia. F1000Res 2021. [DOI: 10.12688/f1000research.73606.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Evidence of highly effective repurposed drugs for coronavirus disease 2019 (COVID-19) is insufficient. However, empirical therapy using antiviral, antibiotic and immunomodulatory drugs is massive. Studies evaluating the clinical use of these drugs in Indonesia are sparse. Methods: We performed a retrospective study using medical records of hospitalized COVID-19 patients from July 2020 to March 2021 in Bandung, Indonesia. Data were collected at relevant timelines: age, sex, comorbid condition, peripheral oxygen saturation (SpO2), and hematology at admission; antiviral, antibiotic, and immunomodulator treatment during hospitalization; length of stay hospitalization (LOS) and death at discharge. Clinical use of the drug regimens included dose, frequency, and duration of therapy. The main outcome of hospitalization care was LOS and death. Results: Out of 249 patients, 43.3% had a comorbid condition, 74.7% had non-severe COVID-19 (SpO2 ≥ 90%), and almost all received antiviral or antibiotic agents. Remdesivir was the most frequent drug composing various antiviral regimens. Patients receiving a combination of remdesivir and favipiravir had lower SpO2 compared to those receiving oseltamivir (p=0.01). The short LOS was associated with remdesivir alone (p=0.03), the combination of favipiravir and oseltamivir (p=0.01), and the combination of intravenous levofloxacin and ceftriaxone (p<0.0001). Immunomodulatory drugs (methylprednisolone, dexamethasone, tocilizumab) were used in 47.1% of patients with low SpO2 (p=0.001). Its use was associated with prolonged LOS (p=0.0043). The increased risk of death in patients treated with the combination of remdesivir and favipiravir (OR 4.1;95%CI 1.4-12.2), and immunomodulatory drugs (OR 6.2; 95%CI 1.7-23.3) was confounded by the baseline characteristics of older age, comorbid condition, SpO2 level, and low lymphocyte number. Conclusions: Some treatment regimens were associated with short LOS, but there were drug regimens which might increase the risk of death. Further study should control the clinical conditions of COVID-19 patients at admission to confirm the outcome of death following drug therapy.
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12
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Asmarawati TP, Rosyid AN, Suryantoro SD, Mahdi BA, Windradi C, Wulaningrum PA, Arifianto MV, Bramantono B, Triyono EA, Rusli M, Rachman BE, Marfiani E, Endraswari PD, Hadi U, Kuntaman K, Nasronudin N. The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya. F1000Res 2021; 10:113. [PMID: 33868645 PMCID: PMC8030114 DOI: 10.12688/f1000research.31645.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Data on the prevalence of bacterial co-infections among COVID-19 patients are limited, especially in our country, Indonesia. We aimed to assess the rate of bacterial co-infections in hospitalized COVID-19 patients and report the most common microorganisms involved and the antibiotic use in these patients. Methods: This study is a retrospective cohort study,among COVID-19 adult patients admitted to Universitas Airlangga Hospital Surabaya from 14 March-30 September 2020. The bacterial infection is defined based on clinical assessment, laboratory parameters, and microbiology results. Results: A total of 218 patients with moderate to critical illness and confirmed COVID-19 were included in this study. Bacterial infection was confirmed in 43 patients (19.7%). COVID-19 patients with bacterial infections had longer hospital length of stay (17.6 6.62 vs 13.317.12), a higher proportion of respiratory failure, intensive care treatment, and ventilator use. COVID-19 patients with bacterial infection had a worse prognosis than those without bacterial infection (p<0.04). The empirical antibiotic was given to 75.2% of the patients. Gram-negative bacteria were commonly found as causative agents in this study (n = 39; 70.37%). Conclusion: COVID-19 patients with bacterial infection have a longer length of stay and worse outcomes. Healthcare-associated infections during intensive care treatment for COVID-19 patients must be carefully prevented.
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Affiliation(s)
- Tri Pudy Asmarawati
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Alfian Nur Rosyid
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Department of Pulmonology and Respiratory Medicine,, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60115, Indonesia
| | - Satriyo Dwi Suryantoro
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
| | - Bagus Aulia Mahdi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia
| | - Choirina Windradi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia
| | - Prastuti Asta Wulaningrum
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Department of Pulmonology and Respiratory Medicine,, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60115, Indonesia
| | - Muhammad Vitanata Arifianto
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Bramantono Bramantono
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Erwin Astha Triyono
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Musofa Rusli
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Brian Eka Rachman
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Erika Marfiani
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Pepy Dwi Endraswari
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia.,Department of Clinical Microbiology, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60286, Indonesia
| | - Usman Hadi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Kuntaman Kuntaman
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia.,Department of Clinical Microbiology, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60286, Indonesia
| | - Nasronudin Nasronudin
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
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