Antibiotic Use and Fatal Outcomes among Critically Ill

Patients with COVID-19 in Tacna, Peru

pubmed.ncbi.nlm.nih.gov/34439009

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Abstract
Overuse of antibiotics during the Coronavirus Disease 2019 (COVID-19) pandemic could
increase the selection of extensively resistant bacteria (XDR). However, it is unknown what
impact they could have on the evolution of patients, particularly critically ill patients. This
study aimed to evaluate the characteristics and impact of ICU-acquired infections in patients
with COVID-19. A retrospective cohort study was conducted, evaluating all patients with
critical COVID-19 admitted to the intensive care unit (ICU) of a hospital in Southern Peru
from 28 March 2020 to 1 March 2021. Of the 124 patients evaluated, 50 (40.32%) developed
a healthcare-associated infection (HAI), which occurred at a median of 8 days (IQR 6-17)
after ICU admission. The proportion of patients with HAI that required ceftriaxone was
significantly higher; the same was true for the use of dexamethasone. Forty bacteria
isolations (80%) were classified as XDR to antibiotics, with the most common organisms
being Acinetobacter baumannii (54%) and Pseudomonas aeruginosa (22%); 33% (41/124)
died at the ICU during the follow-up. In the adjusted analysis, healthcare-associated
infection was associated with an increased risk of mortality (aHR= 2.7; 95% CI: 1.33-5.60)
and of developing acute renal failure (aRR = 3.1; 95% CI: 1.42-6.72). The incidence of
healthcare infection mainly by XDR pathogens is high in critically ill patients with COVID-19
and is associated with an increased risk of complications or death.

Keywords: COVID-19; Peru; SARS-CoV-2; anti-bacterial agents; bacterial; cross-infection;

drug resistance; hospital mortality; infections; mortality.

Conflict of interest statement

Rodriguez-Morales is a medical advisor at Abbott Diagnostics for Latin America, outside the
submitted work. The rest of the authors declare no conflict of interest.

Figures
Figure 1

Sample selection flow chart.

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Figure 2

Kaplan–Meier survival curves according to…

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References

1.
1. Zu Z.Y., Jiang M.D., Xu P.P., Chen W., Ni Q.Q., Lu G.M., Zhang L.J. Coronavirus
Disease 2019 (COVID-19): A Perspective from China. Radiology. 2020;296:E15–
E25. doi: 10.1148/radiol.2020200490. - DOI - PMC - PubMed
2.
1. Yang X., Yu Y., Xu J., Shu H., Xia J., Liu H., Wu Y., Zhang L., Yu Z., Fang M., et
al. Clinical course and outcomes of critically ill patients with SARS-CoV-2
pneumonia in Wuhan, China: A single-centered, retrospective, observational
study. Lancet Respir. Med. 2020;8:475–481. doi: 10.1016/S2213-
2600(20)30079-5. - DOI - PMC - PubMed
3.
1. Giacobbe D.R., Battaglini D., Enrile E.M., Dentone C., Vena A., Robba C., Ball L.,
Bartoletti M., Coloretti I., Di Bella S., et al. Incidence and Prognosis of Ventilator-
Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter
Study. J. Clin. Med. 2021;10:555. doi: 10.3390/jcm10040555. - DOI - PMC -
PubMed
4.
1. Martinez-Guerra B.A., Gonzalez-Lara M.F., de-Leon-Cividanes N.A., Tamez-
Torres K.M., Roman-Montes C.M., Rajme-Lopez S., Villalobos-Zapata G.I.,
Lopez-Garcia N.I., Martínez-Gamboa A., Sifuentes-Osornio J., et al. Antimicrobial
Resistance Patterns and Antibiotic Use during Hospital Conversion in the
COVID-19 Pandemic. Antibiot. Basel. 2021;10:182. doi:
10.3390/antibiotics10020182. - DOI - PMC - PubMed
5.
1. Álvarez-Moreno C., Valderrama-Beltrán S., Rodriguez-Morales A.J. Implications
of Antibiotic Use during the COVID-19 Pandemic: The Example of Associated
Antimicrobial Resistance in Latin America. Antibiotics. 2021;10:328. doi:
10.3390/antibiotics10030328. - DOI - PMC - PubMed

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