RISK FACTORS INFLUENCING BACTERIAL INFECTION IN COVID-19 PATIENTS IN HOSPITAL SUNGAI BULOH

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.