Background

Data on the prevalence of bacterial co-infections among COVID-19 patients are limited, especially in our country. We aimed to assess the rate of bacterial co-infections in hospitalized COVID-19 and report the most common microorganisms involved and the antibiotic use in these patients.

Methods

This study is a cross sectional study with retrospective approach, 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

Total of 218 patients with moderate to critical ill 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 13.31±7.12), a higher proportion of respiratory failure, ICU 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 bacterias 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.

This study is a retrospective cohort study among COVID-19 adult patients admitted to Universitas Airlangga Hospital Surabaya. This hospital is an academic hospital and also a referral hospital for COVID-19 management in Surabaya, East Java Region. We included cases of moderate to critically ill COVID-19 between 14 March-30 September 2020 that were admitted in the intensive care unit or high-care unit. COVID-19 diagnosis was made based on WHO guidelines and the Indonesian Ministry of Health guidelines. Confirmed COVID-19 patients were proven by oropharyngeal and nasopharyngeal swabs SARS-CoV-2 PCR. Bacterial infection was defined based on clinical assessment, laboratory parameters, and inflammatory parameters (CRP and procalcitonin). Bacterial co-infection of SARS-CoV-2 defines if the culture samples were taken at patient presentation to the hospital or < 48 hours admission, while secondary bacterial infection defined if the culture samples were taken > 48 hours of admission. The bacterial causative agents were extracted from data of microbiology, that were identified by Microbiology automated machine Vitek-2 compact, as a routine procedure in this hospital.

This study was approved by the Ethical Committee of Universitas Airlangga Hospital (171/KEP/2020).

Data collection

Data was taken from medical records and microbiology reports from the laboratory. Incomplete medical records were excluded. Clinical characteristics were divided according to the severity of the disease. Moderate case definitions are: 1) clinically sign of pneumonia (fever, cough, dyspnea, tachypnea); 2) Oxygen saturation ³93% free air. Severe case definitions are if there were clinically sign of pneumonia, and one of the following: 1) respiration rate >30 times per minute, or 2) severe respiratory distress, or 3) oxygen saturation < 93% free air. Critically ill cases defined if there were acute respiratory distress syndrome (ARDS), sepsis, and septic shock (25). Culture examination was performed when there was suspicion of bacterial infection or sepsis. The sample for culture was taken from blood, urine, and respiratory tract.