Multidrug-resistant bacterial and fungal superinfections in SARS-CoV-2 critically ill patients. Pharmacokinetic-pharmacodynamic analysis to optimize antibiotic treatment

By project TITTAN

Published on 13 July 2022

Spain

País Vasco

About this good practice

Several studies from different countries have shown the risk of COVID-19 patients of suffering bacterial and fungal superinfections. At the beginning of the pandemic (between March 4 and March 31) in the Intensive Care Units (ICU) of the OSI Araba, 12.5% of COVID-19 patients suffered a superinfection by Pseudomonas aeruginosa, Enterococcus faecium, Haemophilus influenzae or methicillin-resistant Staphylococcus aureus. These superinfections, often due to resistant microorganisms, increase the morbidity and mortality of these patients. In this context, it is essential to evaluate whether empirical treatments with broad-spectrum antibiotics have developed changes in nosocomial colonization and / or infection in patients admitted to the ICU, and to monitor the appearance of multidrug-resistant strains in response to antibiotic pressure. Our objective is to follow the resistance trend of bacteria and fungi to antimicrobials after the COVID-19 pandemic, and to evaluate, by pharmacokinetic / pharmacodynamic (PK/PD) analysis the adequacy of the antimicrobial dosing used to treat COVID-19 patients admitted to the ICU with bacterial and fungal superinfections. This strategy is very useful to optimize the dosage regimens and to improve the morbidity and mortality of the patients, which allows for the design of the antibiotic policy in the ICU considering the current pandemic situation.

Resources needed

Such as a I+D+i project the budget used was 38.335 €

Evidence of success

This activity evidenced the genetic diversity of the microorganisms that are within the hospital. Likewise, it corroborates the wide distribution of resistance genes, virulence and mobile genetic elements. We have shown an increase in multidrug resistance phenotypes among the different bacterial populations, mainly in the genes encoding Extended spectrum beta-lactamases, with the consequent risk of resistance dissemination and loss of therapeutic options.

Potential for learning or transfer

This good practices could also be implemented by other hospital units. They could be interested in the analysis of genetic diversity of the microorganisms already present in the spaces around the COVID19 patients. This requires to access to the next generation sequencing instruments.