Bacterial coinfection and antimicrobial use among patients with COVID-19 infection in a referral center in the Philippines: A retrospective cohort study

Cybele L Abad; Joanne Carmela M Sandejas; Jonnel B Poblete; Anna Flor G Malundo; Maria Sonia S Salamat; Marissa M Alejandria

doi:10.1016/j.ijregi.2022.07.003

Bacterial coinfection and antimicrobial use among patients with COVID-19 infection in a referral center in the Philippines: A retrospective cohort study

IJID Reg. 2022 Sep:4:123-130. doi: 10.1016/j.ijregi.2022.07.003. Epub 2022 Jul 8.

Authors

Cybele L Abad¹, Joanne Carmela M Sandejas¹, Jonnel B Poblete², Anna Flor G Malundo¹, Maria Sonia S Salamat¹, Marissa M Alejandria¹

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, University of the Philippines Philippine General Hospital, UP-Manila, Philippines.
² Department of Medicine, University of the Philippines Philippine General Hospital, UP-Manila, Philippines.

Abstract

Objective: This study aimed to describe community-acquired bacterial coinfection (CAI) and antimicrobial use among COVID-19 patients.

Methods: Electronic records were retrospectively reviewed, and clinical data, laboratory data, antibiotic use, and outcomes of patients with and without CAI were compared.

Results: Of 1116 patients, 55.1% received antibiotics within 48 hours, but only 66 (5.9%) had documented CAI, mainly respiratory (40/66, 60.6%). Patients with CAI were more likely to present with myalgia (p = 0.02), nausea/vomiting (p = 0.014), altered sensorium (p = 0.007), have a qSOFA ≥ 2 (p = 0.016), or require vasopressor support (p < 0.0001). Patients with CAI also had higher median WBC count (10 vs 7.6 cells/mm³), and higher levels of procalcitonin (0.55 vs 0.13, p = 0.0003) and ferritin (872 vs 550, p = 0.028). Blood cultures were drawn for almost half of the patients (519, 46.5%) but were positive in only a few cases (30/519, 5.8%). Prescribing frequency was highest at the start and declined only slightly over time. The mortality of those with CAI (48.5%) was higher compared with those without CAI (14.3%).

Conclusion: Overall CAI rate was low (5.9%) and antimicrobial use disproportionately high (55.0%), varying little over time. The mortality rate of coinfected patients was high. Certain parameters can be used to better identify those with CAI and those who need blood cultures.

Keywords: Bacterial coinfection; COVID-19; antibiotic prescription.