An Overview of the Impact of Bacterial Infections and the Associated Mortality Predictors in Patients with COVID-19 Admitted to a Tertiary Center from Eastern Europe

Amalia-Stefana Timpau; Radu-Stefan Miftode; Irina-Iuliana Costache; Antoniu Octavian Petris; Ionela-Larisa Miftode; Liliana Gheorghe; Razvan Timpau; Ioana Diandra Miftode; Cristian Sorin Prepeliuc; Ioana Coman; Dana-Teodora Anton-Paduraru; Cristina Tuchilus; Egidia Gabriela Miftode

doi:10.3390/antibiotics12010144

An Overview of the Impact of Bacterial Infections and the Associated Mortality Predictors in Patients with COVID-19 Admitted to a Tertiary Center from Eastern Europe

Antibiotics (Basel). 2023 Jan 11;12(1):144. doi: 10.3390/antibiotics12010144.

Affiliations

¹ Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania.
² Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania.
³ Department of Radiology, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania.
⁴ Radiology Department, St. Spiridon Clinical Hospital, 700115 Iasi, Romania.
⁵ St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania.
⁶ Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania.
⁷ Department of Preventive Medicine and Interdisciplinarity (Microbiology), Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania.

Abstract

1.

Background: Literature data on bacterial infections and their impact on the mortality rates of COVID-19 patients from Romania are scarce, while worldwide reports are contrasting. 2.

Materials and methods: We conducted a unicentric retrospective observational study that included 280 patients with SARS-CoV-2 infection, on whom we performed various microbiological determinations. Based on the administration or not of the antibiotic treatment, we divided the patients into two groups. First, we sought to investigate the rates and predictors of bacterial infections, the causative microbial strains, and the prescribed antibiotic treatment. Secondly, the study aimed to identify the risk factors associated with in-hospital death and evaluate the biomarkers' performance for predicting short-term mortality. 3.

Results: Bacterial co-infections or secondary infections were confirmed in 23 (8.2%) patients. Acinetobacter baumannii was the pathogen responsible for most of the confirmed bacterial infections. Almost three quarters of the patients (72.8%) received empiric antibiotic therapy. Multivariate logistic regression has shown leukocytosis and intensive care unit admission as risk factors for bacterial infections and C-reactive protein, together with the length of hospital stay, as mortality predictors. The ROC curves revealed an acceptable performance for the erythrocyte sedimentation rate (AUC: 0.781), and C-reactive protein (AUC: 0.797), but a poor performance for fibrinogen (AUC: 0.664) in predicting fatal events. 4.

Conclusions: This study highlighted the somewhat paradoxical association of a low rate of confirmed infections with a high rate of empiric antibiotic therapy. A thorough assessment of the risk factors for bacterial infections, in addition to the acknowledgment of various mortality predictors, is crucial for identifying high-risk patients, thus allowing a timely therapeutic intervention, with a direct impact on improving patients' prognosis.

Keywords: COVID-19; antibiotherapy; bacterial infections; mortality predictors.

Grants and funding

This research received no external funding.