A study published in Infection Control & Hospital Epidemiology reported “widespread” use of empirical antibiotics for patients with COVID-19 at a New York hospital, and that coinfections among COVID-19 patients were uncommon.
“Antibiotic use was through the roof, but it was not justified by the relatively small number of patients who ended up getting these infections,” Priya Nori, MD, director of the antimicrobial stewardship program at Montefiore Health System and Albert Einstein College of Medicine and assistant professor in Albert Einstein College of Medicine’s Department of Medicine, told Healio. “However, if you take a closer look at who got the infections, it was the most vulnerable patients — the ICU patients, intubated patients, patients with multiple invasive devices and patients who were staying in the hospital the longest — with the poorest outcomes, in that more than half of those patients ended up dying.”
Nori and colleagues performed a retrospective observational study of 4,267 patients with COVID-19 to determine clinical outcomes, antimicrobial use and resistance. They included patients with a positive SARS-CoV-2 test result and blood or respiratory culture that had a positive PCR result and microbiology result within 30 days of admission. They excluded blood cultures that tested positive for skin flora and did not grow in multiple culture or on different dates. They also excluded respiratory cultures that tested positive for yeast, mixed bacterial species and normal oral or respiratory flora.
The researchers identified 152 (3.6%) patients with bacterial or fungal coinfections. Of the 152 patients, 32% were Hispanic, 39% were non-Hispanic Black and 75% were white. The mortality rate among the coinfection group was 57%. Around three-quarters (74%) of these patients were intubated, whereas 51% with bacteremia had central venous catheters. Additionally, 79% of patients were given preceding antibiotics.
Among the 112 isolates identified from the 91 patients with positive respiratory cultures, the most common organisms were Staphylococcus aureus (44%), Pseudomonas aeruginosa (16%), Klebsiella species (10%), Enterobacter species (8%) and Escherichia coli (4%). Of the 112 isolates, 17 were multidrug resistant, which was defined as having resistance to one or more agent across three different classes of antibiotics.
Nori noted that the researchers saw an “unexpected amount” of multidrug resistance in patients with secondary infections.
“In the beginning, it was all about disease transmission, incubation, precautions and airborne vs. droplets — there was really no obvious role for antibiotic stewardship,” Nori said. “What happened was the antibiotic stewards were diverted to roles including assisting with experimental treatment protocols, helping with clinical trials and diagnostic testing — anything but antibiotics.”
“We felt morally responsible for putting our story out there in the event that even five patients benefited,” she concluded.