trimethoprim--sulfamethoxazole-drug-combination and Coronavirus-Infections

Topics: Anti-Bacterial Agents; Anti-HIV Agents; Asthma; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Diagnosis, Differential; DNA, Bacterial; Emtricitabine; Glucocorticoids; HIV Infections; Humans; Lung; Male; Middle Aged; Multiplex Polymerase Chain Reaction; Oxygen Inhalation Therapy; Pandemics; Pneumocystis carinii; Pneumonia, Pneumocystis; Pneumonia, Viral; Prednisolone; Raltegravir Potassium; Real-Time Polymerase Chain Reaction; RNA, Viral; SARS-CoV-2; Tenofovir; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Viral Load

Despite dramatic reductions in the rates of bacteremia and meningitis since the 1980s, febrile illness in children younger than 36 months continues to be a concern with potentially serious consequences. Factors that suggest serious infection include age younger than one month, poor arousability, petechial rash, delayed capillary refill, increased respiratory effort, and overall physician assessment. Urinary tract infections are the most common serious bacterial infection in children younger than three years, so evaluation for such infections should be performed in those with unexplained fever. Abnormal white blood cell counts have poor sensitivity for invasive bacterial infections; procalcitonin and C-reactive protein levels, when available, are more informative. Chest radiography is rarely recommended for children older than 28 days in the absence of localizing signs. Lumbar puncture is not recommended for children older than three months without localizing signs; it may also be considered for those from one to three months of age with abnormal laboratory test results. Protocols such as Step-by-Step, Laboratory Score, or the Rochester algorithms may be helpful in identifying low-risk patients. Rapid influenza testing and tests for coronavirus disease 2019 (COVID-19) may be of value when those diseases are circulating. When empiric treatment is appropriate, suggested antibiotics include ceftriaxone or cefotaxime for infants one to three months of age and ampicillin with gentamicin or with cefotaxime for neonates. For children three months to three years of age, azithromycin or amoxicillin is recommended if pneumonia is suspected; for urinary infections, suggested antibiotics are cefixime, amoxicillin/clavulanate, or trimethoprim/sulfamethoxazole. Choice of antibiotics should reflect local patterns of microbial resistance.

Topics: Algorithms; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Betacoronavirus; Blood Culture; C-Reactive Protein; Child, Preschool; Clinical Decision-Making; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Culture Techniques; Fever; Humans; Infant; Infant, Newborn; Influenza, Human; Leukocyte Count; Pandemics; Pneumonia, Bacterial; Pneumonia, Viral; Procalcitonin; Radiography, Thoracic; SARS-CoV-2; Spinal Puncture; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

BACKGROUND Although coronavirus disease 2019 (COVID-19) manifests primarily as a lung infection, its involvement in acute kidney injury (AKI) is gaining recognition and is associated with increased morbidity and mortality. Concurrent infection, which may require administration of a potentially nephrotoxic agent, can worsen AKI and lead to poor outcomes. Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus associated with nosocomial infections, especially in severely immunocompromised and debilitated patients. Trimethoprim/sulfamethoxazole combination (TMP/SMX) is considered the treatment of choice but can itself lead to AKI, posing a significant challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. CASE REPORT A 64-year-old male with end-stage renal disease and post renal transplant presented with severe respiratory symptoms of COVID-19 and was intubated upon admission. His renal functions were normal at the time of admission. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia requiring administration of TMP/SMX. However, TMP/SMX led to the development of AKI, which continued to worsen despite appropriate management including hemodialysis. This coincided with and most likely resulted in the patient's clinical deterioration and ultimate death. CONCLUSIONS The etiology of kidney disease involvement in patients with COVID-19 is still evolving and appears to be multifactorial. The condition can significantly worsen especially when nephrotoxic agents are given, probably due to a cumulative or synergistic effect. Great caution should be taken when administering nephrotoxic agents in the setting of COVID-19 as it can lead to adverse patient outcomes.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Betacoronavirus; Clinical Deterioration; Coinfection; Coronavirus Infections; COVID-19; Fatal Outcome; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Kidney Transplantation; Male; Middle Aged; Pandemics; Pneumonia, Bacterial; Pneumonia, Viral; SARS-CoV-2; Stenotrophomonas maltophilia; Transplant Recipients; Trimethoprim, Sulfamethoxazole Drug Combination