Identifying risk factors for bacterial infections and drivers of antibiotic use in patients without bacterial infections during the COVID-19 pandemic in a low-middle-income country

Document Type

Article

Department

Medical College Pakistan; Medicine

Abstract

Background: Bacterial infections complicate COVID-19 and contribute to adverse outcomes. Despite low prevalence, antibiotics are frequently prescribed empirically, raising concerns for antimicrobial resistance. This study aimed to identify risk factors for bacterial infections in hospitalized COVID-19 patients and explore drivers of antibiotic use in those without infection.
Methods: We conducted a retrospective study at Aga Khan University Hospital, Karachi, including 5383 adults hospitalized with PCR- or antigen-confirmed COVID-19. Patients were classified by presence of bacterial infection, defined by positive cultures or procalcitonin > 5 ng/mL. Logistic regression identified predictors of bacterial infection, antibiotic use in patients without infection, and associations with clinical outcomes.
Results: Of 5383 patients, 796 (17.3%) had bacterial infections. Majority were older (median 63.5 vs 57 years) and male (69.2% vs 57.1%). Independent risk factors included severe illness (aOR 5.12, 95% CI: 4.35 - 6.03), malignancy (aOR 1.87, 95% CI: 1.33 - 2.62), chronic kidney disease (aOR 1.95, 95% CI: 1.56 - 2.44), older age (aOR 1.42, 95% CI: 1.20 - 1.69), and male sex (aOR 1.47, 95% CI: 1.24 - 1.74). Among patients without bacterial infections, 61% received antibiotics. Drivers included advanced age, male sex, comorbidities, and severe illness. Antibiotic use in this group was associated with increased mortality (10.4% vs .6%) and longer hospitalization (median 5 vs 2 days).
Conclusion: Bacterial infections in hospitalized COVID-19 patients were linked to severe illness, comorbidities, and male sex, resulting in excess mortality. Widespread antibiotic use in patients without infection was associated with worse outcomes, underscoring the urgent need for antimicrobial stewardship in low-middle-income countries.

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AKU Student

no

Publication (Name of Journal)

Antimicrobial stewardship & healthcare epidemiology : ASHE

DOI

10.1017/ash.2025.10211

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