Infecções bacterianas em pacientes com COVID-19 internados em UTI adulto: incidência e atuação farmacêutica

Kauanna  OLIVEIRA; Deisy  FILIPAK; Karina da Silva  AGUIAR; Marcela Bechara  CARNEIRO

doi:10.30968/rbfhss.2023.144.0967

Authors

Kauanna OLIVEIRA https://orcid.org/0009-0007-1353-2697
Deisy FILIPAK https://orcid.org/0009-0003-2645-9602
Karina da Silva AGUIAR https://orcid.org/0000-0001-6879-8037
Marcela Bechara CARNEIRO https://orcid.org/0000-0003-3323-6645

DOI:

https://doi.org/10.30968/rbfhss.2023.144.0967

Abstract

Objective: The present study aimed to determine the incidence of bacterial infection in patients infected with SARS-COV-2 admitted to intensive care units (ICUs) of an oncological hospital in southern Brazil and to demonstrate the role of the pharmacist in the management of antimicrobials. Methods: In this descriptive and retrospective observational study, all patients with COVID-19 confirmed by polymerase chain reaction (PCR) examination, admitted to adult ICUs at Erasto Gaertner Hospital from May 2020 to August 2021 were included, and demographic and clinical data were evaluated through medical records, in addition to the number and classification of pharmaceutical measures. Results: Of 192 patients hospitalized with COVID-19 in the ICU, 104 (54%) had an oncological diagnosis, 62 (60%) with solid cancer and 42 (40%) with hematological diagnosis. Regarding the length of hospital stay, the patients were hospitalized for an average of 9.5 days (SD:6.4), treated with invasive procedures. Of these, 44 (23%) had ventilator-associated pneumonia (VAP) and 32 (17%) patients developed a bloodstream infection (BSI). The most prevalent bacteria were Acinetobacter baumannii with a multiresistant profile and methicillin-sensitive Staphylococcus aureus. Sixty pharmaceutical measures were taken to manage the use of antimicrobials, the most prevalent being: addition, discontinuity, de-escalation, calculation and dose adjustment. With regard to clinical outcome, 147 (77%) of patients hospitalized with COVID-19 died. As for the co-infected patients, 36 (82%) of the patients with VAP and 28 (88%) with ICS died. Conclusions: The results obtained were consistent with the literature, in which the rates of co-infection and use of antimicrobials were high. In addition, pharmaceutical interventions demonstrate the importance of this professional in patient care and in the multidisciplinary team regarding the rational use of antimicrobials.

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References

Vaillancourt M, Jorth, P. The Unrecognized Threat of Secondary Bacterial Infections with COVID-19. mBio. 2020;11(4). DOI:10.1128/mBio.01806-20.

Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care. 2021;25(1):25.DOI: 10.1186/s13054-021-03460-5.

Brusselaers N, Vogelaers D, Blot S. The rising problem of antimicrobial resistance in the intensive care unit. Annals of In- tensive Care. 2011; 1(47). DOI: 10.1186/2110-5820-1-47.

Despotovic A, Milosevic B, Milosevic I, et al. Hospital-acquired infections in the adult intensive care unit-Epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality. Am J Infect Control. 2020; 48 (10).DOI: 10.1016/j.ajic.2020.01.009.

Vincent J, Rello J, Marshall J, et al. International Study of the Prevalence and Outcomes of Infection in Intensive Care Units. JAMA. 2009; 302(21).DOI: 10.1001/jama.2009.1754.

Fraimow H, Tsigrelis C. Antimicrobial resistance in the intensive care unit: mechanisms, epidemiology, and management of specific resistant pathogens. Crit Care Clin. 2011; 27(1). DOI:

European Centre for Disease Prevention and Control. Healthcare-associated infections acquired in intensive care units. In: ECDC. Annual epidemiological report for 2016. Stockholm: ECDC; 2018.

Umsheid CA, Mitchell M, Doshi J. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011; 32(2).

Gasperini B, Cherubini A, Lucarelli M, et al. Multidrug-Resistant Bacterial Infections in Geriatric Hospitalized Patients before and after the COVID-19 Outbreak: Results from a Retrospective Observational Study in Two Geriatric Wards. Antibiotics. 2021; 10(1):95. DOI:10.3390/antibiotics10010095.

Rawson T, Moore L, Zhu N, et al. Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing. Clin Infect Dis. 2020;71(9).DOI: 10.1093/cid/ciaa530.

Liu C, Zhao Y, Okwan-Duodu D. COVID-19 in cancer patients: risk, clinical features, and management. Cancer Biol Med. 2020;17(3). DOI: 10.20892/j.issn.2095-3941.2020.0289.

Satynarayana G, Enriquez KT, Sun T, et al. Coinfections in Patients With Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Study. Open Forum Infect Dis. 2022; 9(3). DOI: 10.1093/ofid/ofac037.

Garau J, Bassetti M. Role of pharmacists in antimicrobial stewardship programmes. Int J Clin Pharm. 2018;40(5).DOI: 10.1007/s11096-018-0675- z.

Guisado-Gil A, Infante-Domínguez C, Peñalva G, et al. Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections. Antibiotics (Basel).2020;9(11). DOI:10.3390/antibiotics9110816.

Parente D, Morton J. Role of the Pharmacist in Antimicrobial Stewardship. Med Clin North Am. 2018;102(5). DOI:10.1016/j.mcna.2018.05.009.

Ricieri MC, Barreto HAG, Pasquini-Netto H. PRAT tool: a harmonization of antimicrobial stewardship program interventions. Rev Ciênc Farm Básica Apl. 2021; 42 (735). DOI: 10.4322/2179-443X.073.

Bardi T, Pintado V, Gomez-rojo M, et al. Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome. Eur J Clin Microbiol Infect Dis. 2021;40(3). DOI:10.1007/s10096-020-04142-w.

Kreitmann L, Monard C, Dauwalder O, et al. Early bacterial co-infection in ARDS related to COVID-19. Intensive Care Med. 2020; 46(9). DOI: 10.1007/s00134-020-06165-5.

Lansbury L, Lim B, Baskaran V, et al. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81(2). DOI: 10.1016/j.jinf.2020.05.046.

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229). DOI: 10.1016/S0140-6736(20)30566-3.

Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223). DOI:10.1016/S0140- 6736(20)30211-7.

Langford BJ, So M, Raybardhan S, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta- analysis. Clin Microbiol Infect. 2020;26(12). DOI: 10.1016/j.cmi.2020.07.016.

Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8(5). DOI: 10.1016/S2213-2600(20)30079-5.

Gowri S, Kyle TE, Tianyi S, et al. Coinfections in Patients With Cancer and COVID-19: A COVID-19 and Cancer Con- sortium (CCC19) Study. Open Forum Infect Dis. 2022;9(3). DOI:10.1093/ofid/ofac037.

Gudiol C, Durà-miralles X, Aguilar-company J, et al. Co-infec- tions and superinfections complicating COVID-19 in cancer patients: A multicentre, international study. Journal of Infection.2021;83(3).DOI: 10.1016/j.jinf.2021.07.014.