Antibiotic Resistance Fears Rise As Drugs Given Unnecessaril
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Microbiological characterisation of co-infections and secondary infections in patients with COVID-19 is lacking, and antimicrobial use is high. We aimed to describe microbiologically confirmed co-infections and secondary infections, and antimicrobial use, in patients admitted to hospital with COVID-19.

The study recruited patients from 260 hospitals in England, Scotland, and Wales. Patients with a confirmed or clinician-defined high likelihood of SARS-CoV-2 infection were eligible for inclusion in the ISARIC WHO CCP-UK study. The team excluded patients with a recorded negative SARS-CoV-2 test result and those without a recorded outcome at 28 days after admission. Demographic, clinical, laboratory, therapeutic, and outcome data were collected using a prespecified case report form.

Results:
They analysed data from 48902 patients admitted to hospital between Feb 6 and June 8, 2020. Microbiological investigations were recorded for 8649 patients, with clinically significant COVID-19-related respiratory or bloodstream culture results recorded for 1107 patients. 762 of 1080 infections were secondary, occurring more than 2 days after hospital admission.

Staphylococcus aureus and Haemophilus influenzae were the most common pathogens causing respiratory co-infections, with Enterobacteriaceae and S aureus most common in secondary respiratory infections. Bloodstream infections were most frequently caused by Escherichia coli and S aureus.

Among patients with available data, 13390 of 36145 had received antimicrobials in the community for this illness episode before hospital admission and 39258 of 46061 patients with inpatient antimicrobial data received one or more antimicrobials at some point during their admission. They identified frequent use of broad-spectrum agents and use of carbapenems rather than carbapenem-sparing alternatives.

Conclusion:

In patients admitted to hospital with COVID-19, microbiologically confirmed bacterial infections are rare, and more likely to be secondary infections. Gram-negative organisms and S aureus are the predominant pathogens. The frequency and nature of antimicrobial use are concerning, but tractable targets for stewardship interventions exist.

Source:
https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(21)00090-2/fulltext
Dr. T●●●●z H●●●●●●i and 2 other likes this1 share
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Dr. M●●●●●●d Q●●●●●●i
Dr. M●●●●●●d Q●●●●●●i General Medicine
What guides us to start and stop antibiotics in covid19 or any other secondary bacterial infections ? Or is it all clinical judgement & antibiotic stewardship (which is unlikely being followed anywhere - what is Antibiogram) What is the role of these biomarkers ( TLC DLC CRP quantitative & Procalcitonin) ? +- Imaging What should be the timing of the tests ? Respected seniors & colleagues kindly advise Thanks ... Read more
Jun 5, 2021Like1
Dr. M●●●●●●d Q●●●●●●i
Dr. M●●●●●●d Q●●●●●●i General Medicine
Rapid & comprehensive blood culture/sensitivity not done in remote areas and small cities Routine blood culture/sensitivity reports take 7 to 10 days
Jun 5, 2021Like