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antimicrobialsraisesconcernsregarding theiruse Antibioticoveruseincreasestheriskofemergenceandtransmissionofmultidrug-resistantbacteriaInfectionswithmultidrug-resistantbacteriaaremoredifficult to treatandassociated withincreasedmorbidityandmortality(7)thenegativeimpactoftheuseofantibioticsandantimicrobialsingeneralisstillunknownwithcertainty,butasignificantincreaseinthelevelsofresistancetothemininfectionsassociatedwithhealthcareisestimatedInthisstudy,ourobjectivewastodescribetherateofinhospitalinfectionsandthesusceptibilitypatternsofthecausativeorganismsduringthecOVID-19pandemicinpatientsadmittedtotheIntensivecareUnit2METHODSANDMATERIALSAretrospectivedescriptivecohortstudywasconductedinatertiarymedicalcenterthatunderwenthospitalreconversionforcOVID-19care thereorganizationof thehospitalincluded theexpansionoftheIntensivecareUnit(IcU)Allconsecutivepatientsadmitted withconfirmedpolymerasechainreaction(Pcr)orawaitingsamplecollectionwithseverecOVID-19acquiredinthecommunitybetween themonthsofOctober 2020and January 2021 wereincludedDefinedas severeby thepresenceofanyof the followingrespiratoryrate≥30breathsperminute(Oxygensaturation)spO2<80%involvementof50%ormoreofthelungparenchymaasevidencedchestcomputedtomographyorcorads4and5criteriaOnclinicalpresentationdemographicslaboratoryresultsantibioticprescriptionuponadmissionanddurationdevelopmentandcharacteristicsofintrahospitalinfectionsanddischargestatus wereobtained from theelectronicmedicalrecordofeachoneofthepatientstheprimaryoutcomewasthedevelopmentofahealthcareassociatedinfection(HAI)ForeachcaseofHAIthecausativemicroorganismanditssusceptibilityorresistancepatternwererecordedsecondaryoutcomesincludeddeathduringhospitalizationandlengthof stay.Hospital-acquiredinfections wereidentifiedanddefinedaccording to the standardizedcriteriaof thenationalHealthsecuritynetwork(nHsn)FordetectionofSARS-Cov-2byPCRtocollect the sample fordetectionof sArs-cov-2anoropharyngealandnasopharyngeal swab wasperformedin whichcasesit waspossible todo soandnasopharyngeal swab forcases thatrequiredintubationprior tosamplecollection theywerestoredandtransportedinuniversaltransportmediumforvirusesandsenttothe statePublicHealthLaboratory for thedetectionof thepathogenthesameentitythatreportstheresultsaspositiveornegativeaccordingtothepresenceorabsenceofviralgeneticmaterial1INTRODUCCIÓNInDecember2019aseriesofnovelcoronavirus-relatedpneumoniacaseswerereportedinWuhanchinathediseasewasdesignedascoronavirusdisease2019(cOVID-19)byWorldHealthOrganization(WHO)(1)GeneticsequencingofthevirussuggeststhatitisabetacoronaviruscloselylinkedtothesArsvirus(2)bacterialcoinfectionswelldocumentedinotherrespiratory viralinfectionsnotablyinfuenzahavenot yetbeen thoroughlystudied forcOVID-19(3) Whileantibioticsareineffective for treatmentofcOVID-19theyareprescribedinpatientswithsuspectedordocumentedcOVID-19 fora varietyofreasons thisincludesdifficultyinrulingoutbacterialco-infectiononpresentationbutalsothepossibilityofbacterialsecondaryinfectionduringthecourseoftheillness(4)theprevalenceofbacterialinfectionrangedfrom14%to100%inintensivecareunit(IcU)patientsArecentmetaanalysis suggested thatonly7%ofcOVID-19patients wereexpectedtohavebacterialinfectionHowever,itshouldbenotedthatmostpatientsreceivedantibioticsbeforetheywerediagnosedwithbacterialinfection(5)Accordingtoexistingreports50%ofcOVID-19deathsexperienced secondarybacterialinfections(sbIs); thuspatients withsbIshaveahigherriskofmortality.sbIshadbecomethehiddenthreatlurkingbehindcOVID-19 theeffectiveantimicrobialregimenis stilloneof thekeymeasures for the successful treatmentofcOVID19(6)Ventilator-associatedpneumonia(VAP)isconsideredoneofthemostcommonhospital-acquiredinfectionsandtheleadinginfectiouscauseofmortalityinintensivecareunits(7)secondarybacterialpneumoniainapatientoninvasivemechanical ventilationhasapresentationsimilartothatofhospital-acquiredpneumoniabutwarrantsaggressiveuseofempiricbroad-spectrumantibioticswithcoverage forMeticillinresistantStaphilococcusaureus(MrsA)Pseudomonasaeruginosaandpossiblyothermultidrug-resistantorganismsinaccordancewiththeguidelines(8)themortalityismore significantin severecasescompared with thenonseveregroupduetothehighercoinfectionrateinseverepatientsFormoreseverelyillpatients theyaremorelikely toreceive treatment withinvasivecathetersresultinginincreasedsensitivitytosecondaryinfections withmultidrug-resistantpathogens suchas Acinetobacterbaumannii,Escherichiacoli,Pseudomonasaeruginosa,andEnterococcusspp.(9)Empiricantibiotictherapyshouldbede-escalatedonthebasisofmicrobiologyresultsandclinicaljudgmentregularlyreviewingthepossibilityofswitchingofintravenoustooralrouteofadministrationandprovide targeted treatmentbasedonmicrobiologicresultscarbapenemshavebeen thebackbone for the treatmentoftheseinfectionsbutthedevelopmentofstrainsresistanttothese124ANALESRANFwwwanalesranfcomResistencia alos antibióticoseninfecciones asociadas ala atencióndelasaludenlapandemiadeCOVID-19JorgeAAlmeidaVillegasJoséAGutiérrezGutiérrezetalAnRealAcadFarmVol88Nº2(2022)·pp123-130