DOI: 10.5061/dryad.sxksn0328
title: The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya

description: Background Data on the prevalence of bacterial co-infections among
 COVID-19 patients are limited, especially in our country. We aimed to
 assess the rate of bacterial co-infections in hospitalized COVID-19 and
 report the most common microorganisms involved and the antibiotic use in
 these patients. Methods This study is a cross sectional study with
 retrospective approach, among COVID-19 adult patients admitted to
 Universitas Airlangga Hospital Surabaya from 14 March-30 September 2020.
 The bacterial infection is defined based on clinical assessment,
 laboratory parameters, and microbiology results. Results Total of 218
 patients with moderate to critical ill and confirmed COVID-19 were
 included in this study. Bacterial infection was confirmed in 43 patients
 (19.7%). COVID-19 patients with bacterial infections had longer hospital
 length of stay (17.6 ± 6.62 vs 13.31±7.12), a higher proportion of
 respiratory failure, ICU treatment, and ventilator use. COVID-19 patients
 with bacterial infection had a worse prognosis than those without
 bacterial infection (p&lt;0.04). The empirical antibiotic was given to
 75,2% of the patients. Gram-negative bacterias were commonly found as
 causative agents in this study (n = 39; 70.37%). Conclusion COVID-19
 patients with bacterial infection have a longer length of stay and worse
 outcomes. Healthcare-associated infections during intensive care treatment
 for COVID-19 patients must be carefully prevented.
description: This study is a
 retrospective cohort study among COVID-19 adult patients admitted to
 Universitas Airlangga Hospital Surabaya. This hospital is an academic
 hospital and also a referral hospital for COVID-19 management in Surabaya,
 East Java Region. We included cases of moderate to critically ill COVID-19
 between 14 March-30 September 2020 that were admitted in the intensive
 care unit or high-care unit. COVID-19 diagnosis was made based on WHO
 guidelines and the Indonesian Ministry of Health guidelines. Confirmed
 COVID-19 patients were proven by oropharyngeal and nasopharyngeal swabs
 SARS-CoV-2 PCR. Bacterial infection was defined based on clinical
 assessment, laboratory parameters, and inflammatory parameters (CRP and
 procalcitonin). Bacterial co-infection of SARS-CoV-2 defines if the
 culture samples were taken at patient presentation to the hospital or
 &lt; 48 hours admission, while secondary bacterial infection defined
 if the culture samples were taken &gt; 48 hours of admission. The
 bacterial causative agents were extracted from data of microbiology, that
 were identified by Microbiology automated machine Vitek-2 compact, as a
 routine procedure in this hospital. This study was approved by the
 Ethical Committee of Universitas Airlangga Hospital
 (171/KEP/2020). <b>Data
 collection</b> Data was taken from medical
 records and microbiology reports from the laboratory. Incomplete medical
 records were excluded. Clinical characteristics were divided according to
 the severity of the disease. Moderate case definitions are: 1) clinically
 sign of pneumonia (fever, cough, dyspnea, tachypnea); 2) Oxygen saturation
 ³93% free air. Severe case definitions are if there were clinically sign
 of pneumonia, and one of the following: 1) respiration rate &gt;30
 times per minute, or 2) severe respiratory distress, or 3) oxygen
 saturation &lt; 93% free air. Critically ill cases defined if there
 were acute respiratory distress syndrome (ARDS), sepsis, and septic shock
 (25). Culture examination was performed when there was suspicion of
 bacterial infection or sepsis. The sample for culture was taken from
 blood, urine, and respiratory tract.