Impact of common comorbidities on antimicrobial consumption and mortality amongst critically ill COVID-19 patients: A retrospective two center study in Saudi Arabia

Abstract: Clinical Infection in Practice 19 (2023) 100229 Contents lists available at ScienceDirect Clinical Infection in Practice journal homepage: www.sciencedirect.com/journal/clinical-infection-in-practice Practical clinical reviews Impact of common comorbidities on antimicrobial consumption and mortality amongst critically ill COVID-19 patients: A retrospective two center study in Saudi Arabia Nada AlQadheeb a, *, Hanine AlMubayedh b, Sarah AlBadrani b, Abdul Salam c, Mukhtar AlOmar a, Ahmed AlAswad d, Mohammed AlMualim d, Zahra AlQamariat e, Rasheed AlHubail f a Pharmacy Department, King Fahad Specialist Hospital, Eastern Province, Saudi Arabia College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Eastern Province, Saudi Arabia c Department of Biostatistics and Epidemiology, King Fahad Specialist Hospital, Eastern Province, Saudi Arabia d Critical Care Department, Qatif Central Hospital, Eastern Province, Saudi Arabia e Pharmacy Department, Dammam Medical Complex, Eastern Province, Saudi Arabia f Critical Care Department, Dammam Medical Complex, Eastern Province, Saudi Arabia b A R T I C L E I N F O A B S T R A C T Keywords: Mortality COVID-19 Comorbidities Intensive care unit Saudi Arabia Objectives: To determine the association between common comorbidities, ICU mortality and antimicrobial con­ sumption among critically ill COVID 19 patients in Saudi Arabia. Methods: A retrospective observational study of patients admitted to the ICU from March 1st, 2020, through August 31st, 2021. We excluded patients who stayed <24 h in the ICU and with no confirmed COVID-19 PCR testing. Results: Of the 976 screened ICU patients, 848 were included. While there was no difference in mortality between patients with and without comorbidities, those with at least one comorbidity had a higher severity of illness (p = 0.013). Compared to survivors, non-survivors were more likely to require mechanical ventilation and vasopressor support (P < 0.001). Almost all patients received at least one antimicrobial therapy. Predictors independently associated with ICU mortality were: older age (adjusted odds ratio [AOR], 1.03; 95% confidence interval [CI], 1.01–1.04), vancomycin use (AOR, 2.69; 95% [CI], 1.65–4.37), linezolid use (AOR, 2.65; 95% [CI], 1.65–4.04), sepsis or septic shock (AOR, 6.39; 95% [CI], 3.68–11.08), Acute Kidney Injury (AKI) (AOR, 2.51; 95% [CI], 1.61–3.92) and Acute Respiratory Distress Syndrome (ARDS) (AOR, 2.03; 95% [CI], 1.61–3.92). Conclusion: Older age, vancomycin and linezolid use, sepsis/septic shock, AKI, and ARDS were negative prog­ nostic factors in critically ill COVID-19 patients. More studies are needed to evaluate the outcomes of survived critically ill patients in relation to their vaccination status.