Antimicrobials in COVID-19 Patients in ICU is one of our sessions at the #C19marathon this Saturday - let's have a look at some of the current literature ahead of the session.
Due to the high amounts of multi-drug resistant organisms, superimposed infections are problematic in C19 patients - via immune dysregulation and mechanical ventilation. karger.com/Article/FullTe… 
There are many studies that have referenced multiple organisms with varying mortalities and abx-use profiles: karger.com/Article/FullTe…
NICE (May, 2020) treatment guidance for severe hospital-acquired pneumonia in COVID-19 patients includes broad-spectrum antibiotics such as piperacillin-tazobactam, ceftazidime and levofloxacin. Vancomycin, teicoplanin and linezolid if MRSA is suspected. karger.com/Article/FullTe…
Usual difficulties with CRP/PCT as biomarkers in infection - but meta-analysis suggests risk of severe COVID-19 infx to be 5x more in patients with raised PCT - these patients with raised PCT on admission had a greater risk of secondary bacterial infection karger.com/Article/FullTe…
And indeed, we have seen unrestricted broad-spectrum abx use across the board. jidc.org/index.php/jour…
In 197 C19 patients in ICU, 44.7% = at least 1 bacterial infx (pneumonia (39.1%) and bloodstream infx (15,7%).) Unusual findings include frequent suspicion of bacterial translocations originating from GI tract as well as bacterial persistence in the lungs. journals.plos.org/plosone/articl…
Unsurprisingly, there is a loud call for detailed antimicrobial stewardship and clinical algorithms to rationalise prescribing: link.springer.com/article/10.100…
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