Profiles of Deceased Patients with Coronavirus Disease 2019 (COVID-19) and Multidrug-Resistant Bacterial Coinfections at an Indonesian Tertiary Hospital
Introduction: Antibiotic use in coronavirus disease 2019 (COVID-19) patients reached 70% during the pandemic, potentially inducing the invasion of multidrug-resistant organisms (MDROs). This study analyzed patients who died from COVID-19 with MDRO coinfections at Dr. Soetomo General Academic Hospita...
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Faculty of Medicine, Universitas Airlangga
2025-07-01
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| Series: | Current Internal Medicine Research and Practice Surabaya Journal |
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| Online Access: | https://e-journal.unair.ac.id/CIMRJ/article/view/53649 |
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| author | Joedhistira Bayu Firmansyah Musofa Rusli Juniastuti Ratna Septyawati |
| author_facet | Joedhistira Bayu Firmansyah Musofa Rusli Juniastuti Ratna Septyawati |
| author_sort | Joedhistira Bayu Firmansyah |
| collection | DOAJ |
| description | Introduction: Antibiotic use in coronavirus disease 2019 (COVID-19) patients reached 70% during the pandemic, potentially inducing the invasion of multidrug-resistant organisms (MDROs). This study analyzed patients who died from COVID-19 with MDRO coinfections at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Methods: We conducted a retrospective descriptive study of 120 deceased COVID-19 inpatients from January to December 2021. The inclusion criteria required: (1) positive MDRO cultures from ≥2 specimens, and (2) resistance to ≥1 agent across ≥3 antimicrobial categories. Patients with incomplete records or no antibiotic therapy were excluded. The data were presented using descriptive statistics to characterize patient demographics, microbiological profiles, and antimicrobial resistance patterns.
Results: The patients were predominantly male (60%), aged 41–80 years (78.33%), and hospitalized for 8–30 days (53.44%). The microbiological examinations revealed blood cultures as the main specimen source (43.10%), followed by sputum (27.59%), urine (19.40%), pus (7.33%), and cerebrospinal fluid (2.59%). The prevalent isolates varied by specimen type: coagulase-negative staphylococci (51%) in blood, Pseudomonas spp. in pus (17.65%), Klebsiella spp. in sputum (26.69%), and Escherichia coli in urine (37.78%). The cerebrospinal fluid cultures showed an equal distribution of Gram-negative bacilli, Gram-positive bacilli, and Gram-positive cocci (33.33% each).
Conclusion: This study characterizes the profiles of fatal COVID-19 cases with MDRO coinfections, demonstrating a predominance of older male patients with prolonged hospitalization. The identified resistance patterns and pathogen distribution, notably coagulase-negative staphylococci in blood, highlight the importance of improved infection surveillance and antibiotic stewardship to minimize the risk of coinfection in the future.
Highlights:
1. While existing studies have examined multidrug-resistant organism (MDRO) coinfections in COVID-19 globally, this work offers a valuable standalone characterization of a high-risk subgroup in Indonesia, where resistance patterns arising from antimicrobial use during the pandemic created unique clinical challenges.
2. This study provides comprehensive data on the mortality of COVID-19 patients with MDRO coinfections at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, enhancing medical personnel's awareness of MDRO bacterial transmission and informing improvements in antibiotic stewardship programs within hospitals. |
| format | Article |
| id | doaj-art-41bf098324164a1a82b45255d6bc79f2 |
| institution | DOAJ |
| issn | 2721-544X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Faculty of Medicine, Universitas Airlangga |
| record_format | Article |
| series | Current Internal Medicine Research and Practice Surabaya Journal |
| spelling | doaj-art-41bf098324164a1a82b45255d6bc79f22025-08-20T03:03:16ZengFaculty of Medicine, Universitas AirlanggaCurrent Internal Medicine Research and Practice Surabaya Journal2721-544X2025-07-016211712410.20473/cimrj.v6i2.5364951811Profiles of Deceased Patients with Coronavirus Disease 2019 (COVID-19) and Multidrug-Resistant Bacterial Coinfections at an Indonesian Tertiary HospitalJoedhistira Bayu Firmansyah0https://orcid.org/0009-0009-0601-3818Musofa Rusli1https://orcid.org/0000-0002-4834-2259Juniastuti2https://orcid.org/0000-0002-1437-640XRatna Septyawati3Medical Study Program, Faculty of Medicine, Universitas Airlangga, SurabayaInfectious and Tropical Disease Division, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General Academic Hospital, SurabayaDepartment of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General Academic Hospital, SurabayaMedical Study Program, Faculty of Medicine, Universitas Jember, JemberIntroduction: Antibiotic use in coronavirus disease 2019 (COVID-19) patients reached 70% during the pandemic, potentially inducing the invasion of multidrug-resistant organisms (MDROs). This study analyzed patients who died from COVID-19 with MDRO coinfections at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Methods: We conducted a retrospective descriptive study of 120 deceased COVID-19 inpatients from January to December 2021. The inclusion criteria required: (1) positive MDRO cultures from ≥2 specimens, and (2) resistance to ≥1 agent across ≥3 antimicrobial categories. Patients with incomplete records or no antibiotic therapy were excluded. The data were presented using descriptive statistics to characterize patient demographics, microbiological profiles, and antimicrobial resistance patterns. Results: The patients were predominantly male (60%), aged 41–80 years (78.33%), and hospitalized for 8–30 days (53.44%). The microbiological examinations revealed blood cultures as the main specimen source (43.10%), followed by sputum (27.59%), urine (19.40%), pus (7.33%), and cerebrospinal fluid (2.59%). The prevalent isolates varied by specimen type: coagulase-negative staphylococci (51%) in blood, Pseudomonas spp. in pus (17.65%), Klebsiella spp. in sputum (26.69%), and Escherichia coli in urine (37.78%). The cerebrospinal fluid cultures showed an equal distribution of Gram-negative bacilli, Gram-positive bacilli, and Gram-positive cocci (33.33% each). Conclusion: This study characterizes the profiles of fatal COVID-19 cases with MDRO coinfections, demonstrating a predominance of older male patients with prolonged hospitalization. The identified resistance patterns and pathogen distribution, notably coagulase-negative staphylococci in blood, highlight the importance of improved infection surveillance and antibiotic stewardship to minimize the risk of coinfection in the future. Highlights: 1. While existing studies have examined multidrug-resistant organism (MDRO) coinfections in COVID-19 globally, this work offers a valuable standalone characterization of a high-risk subgroup in Indonesia, where resistance patterns arising from antimicrobial use during the pandemic created unique clinical challenges. 2. This study provides comprehensive data on the mortality of COVID-19 patients with MDRO coinfections at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, enhancing medical personnel's awareness of MDRO bacterial transmission and informing improvements in antibiotic stewardship programs within hospitals.https://e-journal.unair.ac.id/CIMRJ/article/view/53649coronavirus disease 2019 (covid-19)pneumoniarespiratory tract infectionmultidrug-resistant organisms (mdros)tropical disease |
| spellingShingle | Joedhistira Bayu Firmansyah Musofa Rusli Juniastuti Ratna Septyawati Profiles of Deceased Patients with Coronavirus Disease 2019 (COVID-19) and Multidrug-Resistant Bacterial Coinfections at an Indonesian Tertiary Hospital Current Internal Medicine Research and Practice Surabaya Journal coronavirus disease 2019 (covid-19) pneumonia respiratory tract infection multidrug-resistant organisms (mdros) tropical disease |
| title | Profiles of Deceased Patients with Coronavirus Disease 2019 (COVID-19) and Multidrug-Resistant Bacterial Coinfections at an Indonesian Tertiary Hospital |
| title_full | Profiles of Deceased Patients with Coronavirus Disease 2019 (COVID-19) and Multidrug-Resistant Bacterial Coinfections at an Indonesian Tertiary Hospital |
| title_fullStr | Profiles of Deceased Patients with Coronavirus Disease 2019 (COVID-19) and Multidrug-Resistant Bacterial Coinfections at an Indonesian Tertiary Hospital |
| title_full_unstemmed | Profiles of Deceased Patients with Coronavirus Disease 2019 (COVID-19) and Multidrug-Resistant Bacterial Coinfections at an Indonesian Tertiary Hospital |
| title_short | Profiles of Deceased Patients with Coronavirus Disease 2019 (COVID-19) and Multidrug-Resistant Bacterial Coinfections at an Indonesian Tertiary Hospital |
| title_sort | profiles of deceased patients with coronavirus disease 2019 covid 19 and multidrug resistant bacterial coinfections at an indonesian tertiary hospital |
| topic | coronavirus disease 2019 (covid-19) pneumonia respiratory tract infection multidrug-resistant organisms (mdros) tropical disease |
| url | https://e-journal.unair.ac.id/CIMRJ/article/view/53649 |
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