International Journal of General Medicine (Apr 2022)
A Retrospective Analysis of the Bacterial Infections, Antibiotic Use, and Mortality Predictors of COVID-19 Patients
Abstract
I Wayan Suranadi,1 I Made Agus Kresna Sucandra,1 Ni Nengah Dwi Fatmawati,2 Ayu Dilia Febriani Wisnawa3 1Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia; 2Department of Clinical Microbiology, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia; 3Faculty of Medicine, Udayana University, Denpasar, Bali, IndonesiaCorrespondence: I Wayan Suranadi, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University/Sanglah General Hospital, Denpasar, Bali, 80113, Indonesia, Tel +62 812 3846 3838, Email [email protected]: This study aimed to investigate the rate and profile of bacterial infections, mortality-associated predictors, and report the most common microorganisms and antibiotic use in coronavirus disease-19 (COVID-19) patients.Patients and Methods: This study used a retrospective approach to evaluate the bacterial culture, antibiotic use, comorbidities, imaging, and laboratory discoveries of patients with COVID-19 (hospitalized) confirmed by reverse transcription polymerase chain reaction (RT-PCR) between May and December 2020. We have selected 906 COVID-19 positive patients using a consecutive sampling technique and analyzed data using IBM SPSS-22 statistical software. Statistical analysis included univariate, bivariate, and multivariate analysis. It was carried out using multivariable logistic regression analysis to predict the mortality of COVID-19 patients.Results: A total of 410 patients, which involved 247 males with a mean age of 53.9 years were evaluated. Based on the results, the positive bacterial culture was detected in 18.3% of all patients who sent the culture sample test, representing bacterial infections. The Acinetobacter baumannii was the most commonly identified organism, while the proportion of patients treated with antibiotics was 83.4%. Furthermore, azithromycin was prescribed in the highest number of patients with approximately 44.3% of all antibiotics. The total mortality rate was 39.8% and its ratio was higher in COVID-19 patients with bacterial infections (65.3%, X2 = 25.1, P< 0.001). Patients mortality who used antibiotics were also higher compared to those who did not (89% vs 11%, P< 0.014). Age, length of hospitalization, bacterial infection, shortness of breath, neutrophil-to-lymphocyte ratio (NLR), and diabetes mellitus were also associated predictors to increased hospital mortality (adjusted OR (aOR) 0.382, P< 0.013; aOR 4.265, P< 0.001; aOR 3.720, P< 0.001; aOR 3.889, P< 0.001; aOR 6.839, P< 0.003; aOR 1.844, P< 0.030), respectively.Conclusion: This study discovered that there is high use of antibiotics amongst COVID-19 patients; however, the bacterial infection rates did not exceed one-fifth of the total patients. Furthermore, older age, bacterial infections, a longer length of hospitalization, diabetes mellitus, shortness of breath, and higher NLR have a significant impact on the mortality of COVID-19 patients.Keywords: antibiotics, bacterial infections, COVID-19, mortality
