ABSTRACT
World Health Organization (WHO) recommends prompt initiation, even within one hour of initial assessment, in patients with suspected or confirmed severe Covid-19. After so much experience with Covid-19 patients, the authors of the present study feel that it is time to highlight the motto for antibiotic stewardship "the right drug at the right time and the right dose for the right bug for the right duration"10 and to challenge the use of empirical antibiotic therapy, with particular concern about the detrimental consequences of unnecessary or inappropriate use of antibiotics. Study patients During the study period, a total of 183 consecutive patients were admitted to the ICUs of the two centers due to severe Covid-19 infection, as diagnosed by the criteria recommended in the Interim Guidance of the WHO1.Inclusion criteria were empirical use of antibiotics, an ICU admission of at least 48 hours for Covid-19, and age beyond 18 years. Data collection and definitions Demographic, clinical and laboratory data of the patients as well as data on empirical antimicrobial use were retrieved from the hospital registry system and infection visit charts.
ABSTRACT
INTRODUCTION: We sought to evaluate secondary infections (SIs) in patients admitted to the intensive care unit (ICU) for COVID-19 with respect to incidence, causative pathogens, and clinical outcomes. METHODOLOGY: In this two-centre retrospective study, we analysed 146 patients (96 males, 50 females; median age, 64 years) admitted to the ICU with COVID-19 between March 26 and December 31, 2020. Inclusion criteria were an ICU admission for at least 48 hours and age beyond 18 years. Patients with and without SIs were compared and the impacts of SIs and carbapenem resistance on mortality were analysed. RESULTS: During ICU admission, 84 episodes of SIs developed in 58 patients (39.7%). A total of 104 isolates were recovered, with Gram-negative bacteria most frequent accounting for 74%. At least one carbapenem-resistant pathogen (n = 61) was recovered in 41 patients (70.1%). In multivariate analysis, the use of ECMO and an elevated procalcitonin level were significantly associated with the development of SIs. The mortality rate and the incidence of carbapenem resistance did not differ significantly in COVID-19 patients with and without SIs (p = 0.059 and p = 0.083, respectively). CONCLUSIONS: The incidences of SIs and carbapenem resistance among COVID-19 patients were alarming, emphasizing stricter infection control measures in the ICU setting.
Subject(s)
COVID-19 , Coinfection , Adolescent , COVID-19/epidemiology , Carbapenems/pharmacology , Female , Humans , Intensive Care Units , Male , Middle Aged , Retrospective StudiesABSTRACT
A 55-year-old man who underwent bicaval orthotopic heart transplantation nine months earlier presented with complaints of diarrhea and oliguria. Laboratory findings showed pancytopenia and an elevated creatinine level. Cyclosporine and mycophenolate mofetil were discontinued, and the patient received only everolimus. As he was immunosuppressed and had atypical symptoms during the COVID-19 pandemic, reverse transcriptase-polymerase chain reaction testing was performed, which yielded a positive result. Treatment with hydroxychloroquine and favipiravir were initiated. Although the patient suffered from acute renal failure, his condition showed an improvement after hydration plus a five-day antiviral treatment and, then, treatment was stopped. His COVID-19 test was negative after 10 days of follow-up and treatment, and he was discharged with cyclosporin and mycophenolate mofetil.