EC Clinical and Medical Case Reports

Background and Objectives: The COVID-19 pandemic had affected multiple aspects of health. Injudicious use of antibiotics had led to the development of drug resistance and hospital acquired infections (HAI). Hence, we mapped this study to evaluate the incidences of HAI among COVID and non-COVID ICU patients.

Methods: In this cross-sectional study, we included adult patients of either gender, who tested positive for SARS-CoV-2 by RT-PCR and were admitted to the ICU irrespective of their COVID-19 status. Relevant clinical and microbiological data were retrieved from the case sheets of the participants. All clinical specimens were processed according to standard microbiological procedures. Isolates were identified using VITEK-2 automated identification systems. Antimicrobial susceptibility testing (AST) was performed to determine the susceptibility profile of isolates against commonly used antibiotics. R software (version 4.4.1) was leveraged for the data analysis.

Results: 1355 (36.9%) of 3672 patients were eligible as per our study criteria. Of them, 719 (53.1%) were females. The median age of the study population was 53.5 (47.0-62.0) years [COVID: 55.8 (47.0-65.0) years; non-COVID: 51.5 (46.0-58.5) years; p < 0.001]. The median duration of ICU stay of the study population was 17.0 (14.0-21.0) days [COVID: 16.0 (13.0-20.0) days; non-COVID: 18.0 (15.0-22.0) days; p < 0.001]. The median value of serum procalcitonin level of the study population was 1.29 (0.71-2.07) ng/ml [COVID: 1.38 (0.71-3.01) ng/ml; non-COVID: 1.17 (0.71-1.32) ng/ml; p = 0.02]. 958 of 1355 (70.7%) patients [COVID: 572 of 839 (68.2%); non-COVID: 386 of 516 (74.8%); p < 0.001] had no pathogenic organisms in the AST. The most organisms found among COVID patients were Acinetobacter baumannii (74, 9%) and Klebsiella pneumoniae (68, 8%). The most organisms found among non-COVID patients were Pseudomonas aeruginosa (46, 9%) and Acinetobacter baumannii (28, 5%).

Conclusion: The COVID-19 ICU patients in our study were older, had higher PCT levels, and shorter ICU stays contrasted to non-COVID ICU patients. The AST findings revealed the predominance of multidrug-resistant Gram-negative pathogens. Tigecycline and meropenem remain the most effective antimicrobials for multiple pathogens. However, resistance against aminoglycosides, fluoroquinolones, and carbapenems mandate rational prescribing measures and strengthening of antimicrobial stewardship programs.

 Keywords: COVID-19 Infection; Hospital-Acquired Infection; Bacterial Co-Infection; ICU; Comparative Analysis

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