ABSTRACT
Intro: Background: Obesity affects drug delivery and clearance owing to the patient's altered pharmacokinetics. In treating infection, this presents as a conundrum antibiotic dosing to achieve optimal antibiotic concentration at the same time avoiding drug toxicity. Particularly in the case of antimicrobial agents, underdosing may lead to antibiotic resistance. Method(s): Case description: We report a case of a morbidly obese (BMI=58) COVID-19 patient infected with carbapenem-sensitive multi-drug resistant (MDR) Enterobacter cloacae bacteremia, treated with ertapenem 1g twice daily and intravenous polymyxin E 9MU stat and 4.5MU twice daily for MDR Acinetobacter baumanii co-infection. He had infected huge grade IV sacral sore one month later in which intraoperative tissue culture grew phenotypically heterogeneous colonies of MDR Enterobacter cloacae with carbapenem-sensitive and carbapenem-intermediate-resistant non-carbapenemase producing colonies. He responded well clinically and biochemically with an increased dose of intravenous ciprofloxacin 800mg BD based on his actual body weight. He was discharged with oral ciprofloxacin 750mg BD for a total of six weeks. Finding(s): Discussion: Obesity is a public health crisis that has reached epidemic proportions. Obesity affects the volume distribution and renal clearance of many drugs including antibiotics. Obese patients are shown to have higher drug clearance than normal-weighted patients resulting in inadequate systemic exposure. This puts patients at risk of developing antibiotic resistant organisms. Our patient, weighing 162kg was given three different beta-lactam antibiotics to treat his infection including ertapenem in which a standard adult dose was given without body weight consideration. Possible underdosing contributed to the conversion of carbapenem susceptibility from sensitive to resistant strain. Conclusion(s): Obese individuals may need a larger ertapenem dose than their non-obese counterparts. Clinical and laboratory assessment may help in monitoring treatment response in this group of patients.Copyright © 2023
ABSTRACT
Intro The 2019 coronavirus disease (COVID-19) pandemic was caused by the virus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Unfortunately, admitted COVID-19 patients were also predisposed to bacterial infections, and this double pathology are feared to have worse outcome than either infection on its own. In this study, we aim to investigate the laboratory- confirmed bacterial infection in COVID-19 patients and the risk factors influencing it. Methods A retrospective study including 258 patients admitted to a COVID-19 tertiary centre between January 2020 to December 2021 was conducted. Cases were defined as patients who were positive for both RT-PCR for SARS-CoV-2 and bacterial cultures during the admission. Controls were defined as COVID-19 patients who did not have positive bacterial cultures. Findings Factors that were significantly associated with bacterial infection were: race (p=0.012), end stage renal failure (p=0.023), diabetes mellitus (p<0.001), hypertension (p<0.001), severity of disease (p<0.001), vasoactive agents administration (P<0.001), imaging findings in chest radiography (p<0.001) and history of antibiotic administration (p<0.001). Acinetobacter baumannii was the most frequently isolated organisms (20%, 27/134), followed by Klebsiella pneumoniae (13%, 18/134), coagulase negative Staphylococcus (12.7%, 17/134), Escherichia coli (11.1%, 15/134), Enterococcus faecalis (5.2%,7/134) and Enterococcus faecium (4.7%, 6/134). Discussion Patients in severe COVID-19 category, with underlying comorbidities, had history of vasoactive agents or antibiotics administration during admission, had either pneumonic changes or pulmonary embolism in their chest radiography are more prone for developing bacterial infection during their hospital stay. Gram negative organisms are the most commonly isolated organisms in COVID-19 patients. Conclusion Identifying risk factors for developing bacterial infection in COVID- 19 patients are essential for the clinicians to recognize, in order to initiate necessary treatments.
ABSTRACT
COVID-19 took the world by storm in early 2020 which rapidly escalated to a pandemic of unprecedented proportions. Containment of the outbreak requires a robust public health system of surveillance, contact tracing and laboratory preparedness. Technological advancement in molecular diagnosticshas helped identify patients in the initial stages of the outbreak. RT-PCR remains the gold standard in COVID-19 testing. However, as the pandemic continues, there is need for rapid and point of care tests (POCT) for mass screening and rapid decision making. Current serological tests and POCT have high sensitivity but need to be interpreted with caution. This review aims to discuss current laboratory tests available for the diagnosis of COVID-19.