QUANTITY AND QUALITY OF ANTIBIOTIC USE IN COVID-19 PATIENTS WITH SECONDARY BACTERIAL INFECTIONS IN THE INTENSIVE CARE UNIT OF A TYPE A HOSPITAL IN BANDUNG

• Main Author: Ratna Rejeki, Tri
• Format: Theses
• Language: Indonesia
• Online Access: https://digilib.itb.ac.id/gdl/view/76466
• Institution: Institut Teknologi Bandung

COVID-19 patients may develop secondary infections during hospital treatment. Virus infections in the respiratory tract can lead to secondary bacterial infections that can increase morbidity and mortality. Secondary infection data in COVID-19 patients in Indonesia is still limited, while the empirical use of antibiotics in COVID-19 patients is high. High antibiotic use in COVID-19 patients can increase bacterial resistance to antibiotics. The aim of this study was to identify bacterial patterns and antibiotic sensitivity, analyze the quantity of antibiotic use in COVID19 patients with and without secondary bacterial infection, analyze the quality of the use of antibiotics in patients with secondary bacterial infection, and analyze factors related to the clinical outcome of COVID-19 patients with secondary bacterial infections. This study is descriptive-analytical with a cross-sectional method using retrospective data from type A hospitals in Bandung from March 2020–February 2022. The study subjects consisted of 302 COVID-19 patients in the intensive care unit, with inclusion criteria of 116 people with secondary bacterial infections and 186 people without secondary bacterial infections. The subjects are divided into two periods: period 1 (March 2020–February 2021) and period 2 (March 2021–February 2022). Quantitative analysis of antibiotics used the ATC/DDD method and the DU 90% segment, and qualitative analysis of antibiotics used the Gyssens method. The results of the study showed that 38.41% of subjects had a secondary bacterial infection. Most secondary bacterial infections are caused by gram-negative bacteria identified in sputum, namely Acinetobacter baumannii (56.03%), Klebsiella pneumoniae (38.79%), and Pseudomonas aeruginosa (9.48%). The gram-positive bacteria identified are Staphylococcus haemolyticus (11.21%), Staphylococcus hominis (3.45%), and Streptococcus mitis (2,59%). Antibiotics with the highest sensitivity to gram-negative bacteria in the subject are amikacin and tigecycline. As for gram-positive bacteria in subjects such as vancomycin, linezolid, tetracycline, and tigecycline. Quantitative analysis showed that most antibiotics in subjects with secondary bacterial infection were levofloxacin at 35.23 DDD/100 patient-days in period 1 and 26.01 DDD/100 patient-days in period 2 (p<0,001). In subjects without secondary bacterial infection, the most common antibiotic was levofloxacin, with 21.46 DDD/100 patient-days in period 1 and 19.15 DDD/100 patient-days in period 2 (p=0.005). In subjects with secondary bacterial infections, DU 90% segment in period 1 are levofloxacin, meropenem, amikacin, ceftriaxone, and vancomycin. While in period 2, these are levofloxacin, meropenem, ceftriaxone, amikacin, and tigecycline. The results of qualitative analysis on subjects with secondary bacterial infections in period 1 showed that 82.28% of appropriate use of antibiotics and 17,72% of inappropriate use of antibiotics consisted of 13.61% category IIIa, 4.19% category IVa, and 0.52% category IIa. In the second period, 84.9% of the appropriate use of antibiotics and 15.1% of the inappropriate use of antibiotics consisted of 11.80% category IIIa, 2.36% category IVa, and 0.94% category IIa. There was no significant difference between the two periods. Secondary bacterial infections in this study were mostly caused by gram-negative bacteria. The amount of antibiotic use improved in the second period and was statistically significant, while the quality of the use of antibiotics improved but was not statistically significant. The quality of antibiotic use has no significant effect on clinical outcomes. The clinical outcomes of COVID-19 patients with secondary bacterial infection are related to age, history of smoking, COPD, ventilator use, and hypertensive heart disease.