Empirical antibiotic therapy in COVID-19 ICU pulmonary coinfections

Abstract

Introduction: The rapid emergence and global spread of COVID-19 have underscored the critical need for understanding patient characteristics, clinical outcomes, and the microbiological landscape within intensive care settings. The study aims to identify the most common microbes causing pulmonary coinfections in COVID-19 ICU patients and to determine the optimal empirical antimicrobial treatment for this patient population. Material and methods: In the following single-center retrospective cohort study, we collected medical data on 201 patients admitted to the ICU due to COVID-19. Further, we identified the primary causative pathogens of pulmonary coinfection. The study outcomes were death or ICU discharge. Results: The study analyzed 201 COVID-19 patients in the ICU, revealing a balanced distribution between those with (52%) and without (48%) pulmonary infections. In our cohort, the mean BMI was 33.0. The subgroup with pulmonary coinfections did not show statistically significant differences in the prevalence of diabetes and hypertension compared to those without such coinfections. Patients with pulmonary infections exhibited more severe respiratory compromise, necessitating increased mechanical ventilation and extended ICU stays. Pathogen isolation highlighted Staphylococcus aureus, Enterobacter cloacae, and Enterococcus faecalis as predominant, with a notable shift towards resistant strains like Klebsiella pneumoniae ESBL and Acinetobacter baumannii MDR post-48 hours of admission. Antibiotic susceptibility testing underscored the effectiveness of specific agents against MSSA, while revealing variable resistance patterns among Enterobacter cloacae and Enterococcus faecalis, particularly against Daptomycin and Levofloxacin. The most commonly used antibiotics were ceftriaxone and levofloxacin. Conclusions: The number of used antibiotics, including broad-spectrum, increased the occurrence of multi-drug resistant bacteria.