Curriculum Vitae

Name : Lie Khie Chen

Birth : Jakarta
Graduates
MD : FKUI 1994
Internist : FKUI 2003
Consultant : FKUI 2006
PhD : FKUI 2014
Position:
Medical Staff Department of Internal Medicine
Division of Tropical Medicine and Infectious Diseases
Faculty of Medicine University of Indonesia
Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Member of National Committee Antimicrobial Control Resistance
Program, Ministry of Health, Republic of Indonesia.
Chairman of Working Group of Antimicrobial Control Resistance Program
Department of Internal Medicine
Dr. Cipto Mengunkusumo Hospital, Jakarta, Indonesia.
Antibiotic Treatment in ICU Critical
Covid-19 Patients

Khie Chen

Division of Tropical Medicine and Infectious Diseases

Departement of Internal Medicine
Faculty of Medicine University of Indonesia
Dr. Cipto Mangunkusumo Hospital
JAKARTA
Case
• Female 49 y.o, confirmed Covid-
19 with comorbid di abetes
mellitus and hypertension
• Admitting due to fever and
shortness of breath since 6 days
ago.
• BW 90 kg heigh 155 cm.
Hemodynamic stable. Sp02 82%
room air, and after receiving 8L 02
with NRBM Sp02 95%.
• Lab : Hb 14.1 WBC 5.6 PLT 195
Cr 0,7 CRP>200 PCT 0.33
D-dimer 1160 alb 3.4
Case
• As the clinical condition was
getting worse, the patient was
intubated and using ventilator
• Favipiravir, dexametason,
antibiotics (Mero + Levo), ivig
and heparin was given.
• The condition was getting better
and patient showed response to
the treatment.
• After 10 days of admission,
patient had fever, and
hemodynamic remain unstable.
Blood culture was performed and
antibiotic was escalated to
Tygacicline and Meropenem high
dose (2g tid prolonged infusion)
 Case
• • Sputum culture show no bacterial
growing, Candida albicans
colonization grown.
• Blood culture show K.pneumonia
resistant to all antibiotics except
Amikacin (Sensitive) [Tygaciline,
Meropenem : Intermediate]
• Tygaciline was stop and Amikacin
given combine with meropenem
and Fluconazole.
• The condition was improve and
antibiotics was stop after 12 days
of treatment.
Secondary infection in Covid-19
• Why patients with severe Covid-19 prone to
secondary bacterial infections ?
• What is the different between co and secondary
infections?
• What is the pathogen related to co and
secondary infections?
• What is the risk factor being infected with
MDRO?
Dysregulated Immune Response in Covid-19 leads to
cytokine storm and Immune-suppression
Susceptibility to secondary Bacterial secondary infection
due to Influenza infection

iai. asm.org. 2015 vol 83:10

Clinical Course of Covid 19 infections
Risk factor associated -with mortality
• Age
• Comorbidity
• Severity
• Secondary infections
• Organ dysfunctions
 Antibiotic options for Covid-19

• Co-infections • Secondary infections

– Community acquired – Hospital acquired
– MDR less possible – MDR more possible
– Community associated – Hospital associated
bacterial bacterial
– Respiratory viral – Fungal : PCP,
– Atypical pathogen Aspergillus, Candida
– CMV
 Classification of Microorganism
Producing Carbapenemases

Schofeild CB, The Anarchy of Antibiotic Resistance : Mechanism of Bacterial Resistance,2010

In-vitro antibiotic synergistic study to MDRO
In-vitro antibiotic synergistic study to MDRO
Combination Treatment for KPC
Combination treatment for MDR Acinetobacter
Optimizing Carbapenem Usage for Carbapenemase
Producing K. pneumonia

Petrosillo N, Expert Rev Anti Infect Ther. 2013;11(2):159-177.

Petrosillo N, Expert Rev Anti Infect Ther. 2013;11(2):159-177.
Petrosillo N, Expert Rev Anti Infect Ther. 2013;11(2):159-177.
Petrosillo N, Expert Rev Anti Infect Ther. 2013;11(2):159-177.
 Polymixin/Colistin

◼ Polymixin E (Colistin), Polymixin E

◼ Praparation : Colismethate : pro drug of Colistin, Polimyxin
Oral form can’t be used for systemic treatment as
can’t be absorb in GI
▪ Indication : Definit treatment of MDR/XDR Pseudomonas
aeruginosa and Acinetobacter baumanii
in combination with Group 2 Carbapenem, PIPTAZO,
Fosfomycin or Aminoglycoside
▪ Dosage : 0.75-1.25 mg/kg (7,500-12,500 U/kg) iv drip q 12 h

◼
 Fosfomycin
◼ Spectrum : Gram positive, Gram negative
in vitro sensitive for ESBL,
MDR Pseudomonas and Acinetobacter baumanii
◼ Indication : UTI (oral) dose 3 g single dose
Dose : 2x2g iv drip
High dose 16-24g daily
salvage treatment for MDR Pseudomonas/ Acinetobacter
infection in combination Carbapenem/Polymixin
Treatment for ESBL and Carbapenemase producing
Klebsiella pneumonia
New Agents against MDR Pseudomonas
aeruginosa and Acinetobacter baumanii
 Summary
• Co and secondary infections are not common in Covid-19, but it
increased the morbidity and mortality
• In severe and critical Covid-19 risk of secondary infection and
MDRO infection increased due to immune suppressed condition,
prolong ICU stay, using ventilator and other instrumentation.
• Adequate antimicrobial treatment were suggested in severe and
critical Covid-19, along with performing appropriate microbiological
diagnostic and biomarker, identifying specific pathogen and
evaluating used of empirical antibiotics.
• Empirical treatment for MDRO should be considered in critical,
unstable hemodynamic Covid-19 with progressive secondary
bacterial infections un-responsed to broad-spectrum antibiotics.
• Treatment MDRO should be based on definite culture results, using
monotherapy (MDR) or combination (in XDR) therapy with
optimizing the PKPD.