Is empirical antibiotic treatment required in COVID-19 patients? What lessons have we learnt over the past 1 year?
DOI:
https://doi.org/10.18203/2320-6012.ijrms20221788Keywords:
COVID-19, Ceftriaxone sulbactam disodium EDTAAbstract
Background: Secondary bacterial infections manifest during or after a viral infection(s) and can lead to negative outcomes and sometimes fatal clinical complications. The choice for an empiric antibiotic therapy requires a broad spectrum of activity against pathogens including beta-lactamase producing pathogens. Ceftriaxone+sulbactam+disodium EDTA is one of the antibiotic combinations used to prevent secondary infections. The objective was to evaluate rate of secondary bacterial infections in patients receiving empirical antibiotic therapy through retrospective analysis of data from a tertiary care center.
Methods: A single center, retrospective analysis of data from hospital of COVID-19 patients treated in the ICU or wards was conducted. Patients who received empirical antibiotic therapy including ceftriaxone+sulbactam+disodium EDTA were included in the study.
Results: 99 patients (mena age 75±9.89 years) were included in the retrospective analysis. Diabetes and hypertension were the most common comorbidities in the patients. The total WBC count was raised (12.36±9.01). All the biological markers were raised. 45% patients had abnormalities in chest X-ray. The mean CT severity index was 13.81±5.64. Bacterial superinfection was observed only in 1 patient.
Conclusions: Bacterial co infections and secondary bacterial infections are a major risk factor for adverse COVID-19 outcomes. The use of appropriate prophylactic antibiotics such as ceftriaxone+sulbactam+disodium EDTA has significantly reduced the prevalence of secondary bacterial infections in patients with severe COVID.
References
Manohar P, Loh B, Athira S, Nachimuthu R, Hua X, Welburn SC, et al. Front. Microbiol: secondary bacterial infections during pulmonary viral disease: phage therapeutics as alternatives to antibiotics? Front Microbiol. 2020;11:1434.
Umerska A, Strandh M, Cassisa V, Matougui V, Eveillard M, Saulnier P. Synergistic effect of combinations containing EDTA and the antimicrobial peptide AA230, an arenicin-3 derivative, on gram-negative bacteria. Biomolecules. 2018;8(4):122.
Wu P, Hao X, Lau EHY, Wong JY, Leung KSM, Wu JT, et al. Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 January 2020. Euro Surveill. 2020;25(3):2000044.
Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;588(7836):6.
Zhang H, Zhang Y, Wu J, Li Y, Zhou X, Li X, et al. Risks and features of secondary infections in severe and critical ill COVID-19 patients. Emerg Microbes Infect. 2020;9(1):1958-64.
Cox MJ, Loman N, Bogaert D, O'Grady J. Co-infections: potentially lethal and unexplored in COVID-19. Lancet Microbe. 2020;1(1):11.
Chaudhary M, Mir MA, Ayub SG, Protocol 06 Group. Safety and efficacy of a novel drug elores (ceftriaxone+sulbactam+disodium edetate) in the management of multi-drug resistant bacterial infections in tertiary care centers: a post-marketing surveillance study. Braz J Infect Dis. 2017;21(4):408-17.
Patil UN, Jambulingappa KL. A combination strategy of ceftriaxone, sulbactam and disodium edetate for the treatment of multi-drug resistant (MDR) septicaemia: a retrospective, observational study in indian tertiary care hospital. J Clin Diagn Res. 2015;9(11):29-32.
Patil UN, Jambulingappa KL. A combination strategy of ceftriaxone, sulbactam and disodium edetate for the treatment of multi-drug resistant (MDR) septicaemia: a retrospective, observational study in indian tertiary care hospital. J Clin Diagn Res. 2015;9(11):29-32.
Patel NB, Jain G, Chandrakar S, Walikar BN. Ventilator-associated pneumonia due to carbapenem-resistant Providencia rettgeri. BMJ Case Rep. 2021;14(7):243908.
Mahendra M, Jayaraj BS, Lokesh KS, Chaya SK, Veerapaneni VV, Limaye S, et al. Antibiotic prescription, organisms and its resistance pattern in patients admitted to respiratory ICU with respiratory infection in Mysuru. Indian J Crit Care Med. 2018;22(4):223-30.
Amudhan MS, Sekar U, Kamalanathan A, Balaraman S. bla(IMP) and bla(VIM) mediated carbapenem resistance in Pseudomonas and Acinetobacter species in India. J Infect Dev Ctries. 2012;6(11):757-62.
