Bacterial co-infections, secondary infections and antimicrobial use among hospitalized COVID-19 patients in the sixth wave in Pakistan : findings and implications

Ul Mustafa, Zia and Batool, Arfa and Ibrar, Hadia and Salman, Muhammad and Habib Khan, Yusra and Malhi, Tauqeer Hussain and Meyer, Johanna C. and Godman, Brian and Moore, Catrin E. (2024) Bacterial co-infections, secondary infections and antimicrobial use among hospitalized COVID-19 patients in the sixth wave in Pakistan : findings and implications. Expert Review of Anti-infective Therapy, 22 (4). pp. 229-240. ISSN 1744-8336 (https://doi.org/10.1080/14787210.2023.2299387)

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Abstract

Introduction: Previous studies in Pakistan have shown considerable over prescribing of antibiotics in patients hospitalized with COVID-19 despite very low prevalence of bacterial infections. Irrational use of antibiotics will worsen antimicrobial resistance (AMR). Methods: Retrospective analysis of medical records of patients in the COVID-19 wards of three tertiary care hospitals to assess antibiotic use during the sixth COVID-19 wave. Results: A total of 284 patients were included, most were male (66.9%), aged 30–50 years (50.7%) with diabetes mellitus the most common comorbidity. The most common symptoms at presentation were cough (47.9%) and arthralgia-myalgia (41.5%). Around 3% were asymptomatic, 34.9% had mild, 30.3% moderate, and 23.6% had severe disease, with 8.1% critical. Chest X-ray abnormalities were seen in 43.3% of patients and 37% had elevated white cell counts, with 35.2% having elevated C-reactive protein levels. Around 91% COVID-19 patients were prescribed antibiotics during their hospital stay, with only a few with proven bacterial co-infections or secondary bacterial infections. Most antibiotics were from the ‘Watch’ category (90.8%) followed by the ‘Reserve’ category (4.8%), similar to previous COVID-19 waves. Conclusion: There continued to be excessive antibiotics use among hospitalized COVID-19 patients in Pakistan. Urgent measures are needed to address inappropriate prescribing including greater prescribing of Access antibiotics where pertinent.

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