Prevalence of Empiric Antibacterial Therapy, Community-Acquired Bacterial Superinfection, and Antibiotic-Associated Adverse Reactions among Patients with COVID-19 Pneumonia Admitted in Makati Medical Center from March 2020 to March 2021.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus which was first discovered in Wuhan, China. Being a viral illness, antibacterial agents theoretically have no role in patients with pure COVID-19 infection. However, like any viral illness, concomitant bacterial infection may occur. The dilemma of starting an antibacterial agent in a COVID-19 patient remains a debate since the use of antibacterial agents may pose a risk of developing antibiotic-associated adverse events such as the emergence of drug-resistant pathogens and other antibiotic-associated drug toxicity. The primary objective of the study is to determine the amount of empiric antibacterial prescription done by physicians among admitted patients with COVID-19 infection as well as the trend of antibiotic prescription by physicians during the past 12 months of the COVID-19 pandemic. The secondary objective was to determine and quantify antibiotic-associated adverse effects. MATERIALS AND METHODS: This is a retrospective cohort study wherein charts of patients admitted for COVID-19 last March 2020 to March 2021 were reviewed and analyzed. Empiric antibiotic prescription during the first 48 hours of admission was noted as well as the proportion of concomitant bacterial infections. Development of antibiotic-associated adverse events such as the development of the multidrug-resistant organism and fungal infections, Clostridiodes difficile and/or gastrointestinal side effects, and hypersensitivity reactions were also noted. RESULTS: Results showed that among the 895 patients with COVID-19 admitted, 533 (59.6%) patients were started antibiotics during the first 48 hours of admission. Among those patients who are started with antibacterial therapy during the first 48 hours of admission, 60 (15.3%) patients had bacterial coinfection. The prevalence of antibiotic-associated adverse events was 46.9%, the most common of which was gastrointestinal reactions. The overall mortality rate of the patients given antibiotics was 18.8%. The median length of hospital stay was 11 days. CONCLUSION: Community-acquired bacterial infections in COVID-19 patients admitted during the study period were low while empiric antibiotic prescription was high especially during the first few months of the pandemic, especially during the surge. Antibiotic-related adverse effects were high. There was a noted decreasing trend of antibiotic prescription during the latter part of the pandemic when new developments in COVID-19 treatment were discovered. All in all, routine antibacterial prescription in patients with COVID-19 is not recommended given the real-world data in this study.

High TB burden and low notification rates in the Philippines: The 2016 national TB prevalence survey.

SETTING: The 3rd national tuberculosis (TB) survey in the Philippines in 2007 reported a significant decline in the prevalence of TB. Since then, more significant investments for TB control have been made, yet TB burden estimates from routine surveillance data remain relatively stable. OBJECTIVE: To estimate the prevalence of bacteriologically confirmed pulmonary TB in the Philippines amongst individuals aged ≥15 years in 2016. DESIGN: In March-December 2016, we conducted a population-based survey with stratified, multi-stage cluster sampling of residents in 106 clusters aged ≥15 years. Survey participants were screened for TB by symptom-based interview and digital chest X-ray. Those with cough ≥2 weeks and/or haemoptysis and/or chest X-ray suggestive of TB were requested to submit 2 sputum specimens for Xpert MTB/RIF, direct sputum smear microscopy using LED fluorescent microscopy, and mycobacterial solid culture (Ogawa method). Bacteriologically confirmed pulmonary TB was defined as MTB culture positive and/or Xpert positive. RESULTS: There were 46,689 individuals interviewed, and 41,444 (88.8%) consented to a chest X-ray. There were 18,597 (39.8%) eligible for sputum examination and 16,242 (87.3%) submitted at least one specimen. Out of 16,058 sputum-eligible participants, 183 (1.1%) were smear-positive. There were 466 bacteriologically confirmed TB cases: 238 (51.1%) Xpert positive, 69 (14.8%) culture positive, and 159 (34.1%) positive by both Xpert and culture. The estimated TB prevalence per 100,000 population aged ≥15 years was 434 (95% CI: 350-518) for smear-positive TB, and 1,159 (95% CI: 1,016-1,301) for bacteriologically confirmed TB. CONCLUSION: This nationally representative survey found that the TB burden in the Philippines in 2016 was higher than estimated from routine TB surveillance data. There was no evidence of a decline in smear and culture positive TB from the 2007 survey despite significant investments in TB control. New strategies for case-finding and patient-centered care must be intensified and expanded.

Clonal relatedness is a predictor of spontaneous multidrug efflux pump gene overexpression in Staphylococcus aureus.

Increased expression of genes encoding multidrug resistance efflux pumps (MDR-EPs) contributes to antimicrobial agent and biocide resistance in Staphylococcus aureus. Previously identified associations between norA overexpression and spa type t002 meticillin-resistant S. aureus (MRSA), and a similar yet weaker association between mepA overexpression and type t008 meticillin-susceptible S. aureus (MSSA), in clinical isolates are suggestive of clonal dissemination. It is also possible that related strains are prone to mutations resulting in overexpression of specific MDR-EP genes. Exposure of non-MDR-EP-overexpressing clinical isolates to biocides and dyes can select for MDR-EP-overexpressing mutants. spa types t002 and t008 isolates are predominated by multilocus sequencing typing sequence types (STs) 5 and 8, respectively. In this study, non-MDR-EP gene-overexpressing clinical isolates (MRSA and MSSA) representing ST5 and ST8 were subjected to single exposures of ethidium bromide (EtBr) to select for EtBr-resistant mutants. Measurements of active EtBr transport among mutants were used to demonstrate an efflux-proficient phenotype. Using quantitative reverse-transcription PCR, it was found that EtBr-resistant mutants of ST5 and ST8 parental strains predominantly overexpressed mepA (100%) and mdeA (83%), respectively, regardless of meticillin sensitivity. Associations between clonal lineage and MDR-EP gene overexpression differed from those previously observed and suggest the latter is due to clonal spread of efflux-proficient strains. The predilection of in vitro-selected mutants of related strains to overexpress the same MDR-EP gene indicates the presence of a consistent mutational process.