Title : Prevailing Microorganisms in Confirmed COVID 19 patients admitted to the Medical ICU of a Tertiary Hospital in the Philippines
Abstract:
One of the main problems encountered in the hospital setting is the increasing antimicrobial resistance due to overuse of antibiotics for viral infection. With the recent SARS COV2 pandemic and previous data showing a correlation of viral infection predisposing patients to bacterial infection resulting in an increase in morbidity and mortality rates, more so in the critically ill, it has been the practice to give empiric antibiotics to cover for bacterial coinfection in COVID-19 confirmed patients despite insufficient evidence. The difficulty to ascertain the cause being solely viral from concomitant bacterial infection due to similarities in clinical, laboratory, and imaging presentation, including the increased risk of these patients (use of a ventilator, catheters, venous access, and prolonged hospital stay) has led to more aggressive use of antibiotics. The CDC defined superinfection as an infection following a previous infection while a coinfection is an infection concurrent with the initial infection. There are conflicting and limited data regarding the burden of coinfection and superinfection with COVID 19. Initial data suggests that superinfection was common, especially in those with comorbidities and more severe cases. However, current data indicate that bacterial coinfection is relatively infrequent and recommends against the use of empiric antibiotics unless an objective finding makes bacterial superinfection more likely. A total of 88 patients were included in the study. The study population included patients aged 18 years old and above who were admitted to the intensive care unit which turned out positive for COVID 19, detected using RT-PCR and with chest radiograph findings of infiltrates suggesting pneumonia Considering their risk for multi-drug resistance, all patients were started on broad-spectrum antibiotics. Sputum culture and Blood culture were requested. Another specimen for culture was sent as deemed necessary by the infectious disease consultant. We found that the most common prevailing microorganisms in critical COVID 19 patients seen at our ICU are Staphylococcus epidermidis (11%), Klebsiella pneumoniae (7%), Pseudomonas aeruginosa (6%), and Stenotrophomonas maltophilia (6%). The more common fungal pathogens isolated were Candida tropicalis (14%) and Candida albicans (13%). The majority of the growth was collected from the respiratory specimen (44%). Of all the cultures collected and submitted per patient, 40% had no growth. Other accounted infection includes catheter associated urinary tract infection (12%), catheter related blood stream infection (10%) and bacteremia (0.06%). The early antibiotic administration may have affected the results of the culture samples rendering some organisms not detectable. Our findings indicate that severe COVID 19 is associated with a high risk of bacterial infection as a complication and significantly worsened prognosis.
This study has the following objectives and significance:
• Examine the occurrence of coinfection and superinfection in COVID 19 patients and their clinical outcomes, which could therefore translate into early identification and treatment action
• Identify the prevailing microorganism affecting critically ill COVID 19 patients. This, together with the hospital's existing antibiogram data, will guide the clinicians in treating their patients and uphold antimicrobial stewardship to prevent further increase in microbial resistance.
• Identify the predisposing factors contributing to bacterial co-infection and superinfection in these populations.
