A Retrospective Analysis of the Bacterial Infections, Antibiotic Use, and Mortality Predictors of COVID-19 Patients

I Wayan Suranadi; I Made Agus Kresna Sucandra; Ni Nengah Dwi Fatmawati; Ayu Dilia Febriani Wisnawa

doi:10.2147/IJGM.S351180

A Retrospective Analysis of the Bacterial Infections, Antibiotic Use, and Mortality Predictors of COVID-19 Patients

Int J Gen Med. 2022 Apr 1:15:3591-3603. doi: 10.2147/IJGM.S351180. eCollection 2022.

Authors

I Wayan Suranadi¹, I Made Agus Kresna Sucandra¹, Ni Nengah Dwi Fatmawati², Ayu Dilia Febriani Wisnawa³

Affiliations

¹ Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.
² Department of Clinical Microbiology, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.
³ Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.

Abstract

Purpose: 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: COVID-19; antibiotics; bacterial infections; mortality.