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Risk Factors for Multi-Drug Resistance (MDR) Infections in COVID-19 Patients with Secondary Bacterial Infections

ACTA MEDICA INDONESIANA · Vol. 58 No. 3 (2026)

ISSN
2338-2732, 0125-9326
Published
2026-09-28
Publisher
The Indonesian Society of Internal Medicine
Language
eng
License
creativecommons.org/licenses/by/4.0

Abstract

Background: The COVID-19 pandemic has significantly affected global health, contributing to an increase in secondary bacterial infections caused by multidrug-resistant (MDR) pathogens, thereby increasing morbidity and mortality. This study aims to evaluate the risk factors of MDR bacterial infections in affected COVID-19 patients. Methods: This retrospective cohort study analyzed medical records, as well as clinical and epidemiological data of COVID-19 patients with secondary bacterial infections hospitalized in Cipto Mangunkusumo General Hospital during 2020 – 2021. During the procedures, only patients with positive microbial culture results were included. Bivariate and multivariate analyses were carried out to evaluate risk factors of MDR bacterial infections. Results: A total of 3203 medical records of COVID-19 patients were assessed, and 192 subjects were enrolled. The results showed that the most common secondary infection and pathogen were pneumonia and Acinetobacter baumanii, respectively. In addition, the most common MDR pathogen was A.baumanii. In the multivariate log-binomial analysis, the risk factors associated with MDR bacterial infections in COVID-19 were female gender (RR 1,194;CI95% 1,024 – 1,393 p 0,020), comorbidity (RR 1,181;CI95% 1,006 – 1,385, p 0,041), prior antibiotic use (RR 1.718; CI95% 1,127 – 2,620 p 0,012), and history of invasive procedure (RR 1,979;CI95% 1,423 – 2.753 p <0,001). Conclusion: Comorbidities, female gender, prior antibiotic use, and a history of invasive procedures were risk factors for secondary bacterial infections with an MDR pathogen in hospitalized COVID-19 patients.

Keywords

Collaboration network of the authors

40 authors · 332 co-authorship links · showing the 40 most connected

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  • University of Indonesia
  • Affiliation unknown
  • Different organisations
  • Same organisation
  • Affiliation unknown
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Co-authorOrganisationJoint articles
Hamzah ShatriAffiliation unknown24
Leonard NainggolanAffiliation unknown23
Sharifah ShakinahAffiliation unknown14
Siti SetiatiAffiliation unknown12
Rudi PutrantoAffiliation unknown11
Adeline PasaribuAffiliation unknown10
Evy YunihastutiAffiliation unknown10
Sukamto KoesnoeAffiliation unknown9
Murdani AbdullahAffiliation unknown9
Anshari Saifuddin HasibuanAffiliation unknown8
Randy AdiwinataAffiliation unknown8
Chyntia Olivia Maurine JasirwanAffiliation unknown8
Suzy MariaAffiliation unknown7
Iris RengganisAffiliation unknown7
Irsan HasanAffiliation unknown7
Eka GinanjarAffiliation unknown7
Muhadi MuhadiAffiliation unknown6
Andhika RachmanAffiliation unknown6
Pringgodigdo NugrohoAffiliation unknown6
Juferdy KurniawanAffiliation unknown6
Lugyanti SukrismanAffiliation unknown5
Adityo SusiloAffiliation unknown5
Rudy HidayatAffiliation unknown5
Dyah PurnamasariAffiliation unknown5
Soekamto KoesnoeAffiliation unknown5
Imam SubektiAffiliation unknown5
Arif MansjoerAffiliation unknown5
Mira YuliantiAffiliation unknown4
Em YunirUniversity of Indonesia4
Ika Prasetya WijayaAffiliation unknown3
Kuntjoro HarimurtiAffiliation unknown3

Affiliations come from OpenAlex; journal OAI-PMH metadata carries none. Authors without an OpenAlex ID are matched by name, which can merge or split people.

Metadata source: OAI-PMH (metadata jurnal) http://www.actamedindones.org/index.php/ijim/oai, first harvested 8 Nov 2026, last seen 8 Nov 2026.
Original metadata (oai_dc) 
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	<dc:title xml:lang="en-US">Risk Factors for Multi-Drug Resistance (MDR) Infections in COVID-19 Patients with Secondary Bacterial Infections</dc:title>
	<dc:creator>Lie, Khie Chen</dc:creator>
	<dc:creator>Rianto, Rezky Ananda</dc:creator>
	<dc:creator>Sinto, Robert</dc:creator>
	<dc:creator>Rumende, Cleopas Martin</dc:creator>
	<dc:creator>Sakinah, Sharifah</dc:creator>
	<dc:creator>Nelwan, Erni Juwita</dc:creator>
	<dc:creator>Nasution, Sally Aman</dc:creator>
	<dc:creator>Rinaldi, Ikhwan</dc:creator>
	<dc:creator>Widhani, Alvina</dc:creator>
	<dc:subject xml:lang="en-US">COVID-19</dc:subject>
	<dc:subject xml:lang="en-US">secondary bacterial infection</dc:subject>
	<dc:subject xml:lang="en-US">MDR bacterial infection</dc:subject>
	<dc:description xml:lang="en-US">Background: The COVID-19 pandemic has significantly affected global health, contributing to an increase in secondary bacterial infections caused by multidrug-resistant (MDR) pathogens, thereby increasing morbidity and mortality. This study aims to evaluate the risk factors of MDR bacterial infections in affected COVID-19 patients. Methods: This retrospective cohort study analyzed medical records, as well as clinical and epidemiological data of COVID-19 patients with secondary bacterial infections hospitalized in Cipto Mangunkusumo General Hospital during 2020 – 2021. During the procedures, only patients with positive microbial culture results were included. Bivariate and multivariate analyses were carried out to evaluate risk factors of MDR bacterial infections. Results: A total of 3203 medical records of COVID-19 patients were assessed, and 192 subjects were enrolled. The results showed that the most common secondary infection and pathogen were pneumonia and Acinetobacter baumanii, respectively. In addition, the most common MDR pathogen was A.baumanii. In the multivariate log-binomial analysis, the risk factors associated with MDR bacterial infections in COVID-19 were female gender (RR 1,194;CI95% 1,024 – 1,393 p 0,020), comorbidity (RR 1,181;CI95% 1,006 – 1,385, p 0,041), prior antibiotic use (RR 1.718; CI95% 1,127 – 2,620 p 0,012), and history of invasive procedure (RR 1,979;CI95% 1,423 – 2.753 p &amp;lt;0,001). Conclusion: Comorbidities, female gender, prior antibiotic use, and a history of invasive procedures were risk factors for secondary bacterial infections with an MDR pathogen in hospitalized COVID-19 patients.</dc:description>
	<dc:publisher xml:lang="en-US">The Indonesian Society of Internal Medicine</dc:publisher>
	<dc:date>2026-09-28</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>http://www.actamedindones.org/index.php/ijim/article/view/2810</dc:identifier>
	<dc:source xml:lang="en-US">Acta Medica Indonesiana; Vol. 58 No. 3 (2026): Acta Medica Indonesiana; 369</dc:source>
	<dc:source>2338-2732</dc:source>
	<dc:source>0125-9326</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>http://www.actamedindones.org/index.php/ijim/article/view/2810/886</dc:relation>
	<dc:rights xml:lang="en-US">Copyright (c) 2026 khie chen Lie, Rezky Ananda Rianto, Robert Sinto, Cleopas Martin Rumende, Sharifah Sakinah, Erni Juwita Nelwan, Sally Aman Nasution, Ikhwan Rinaldi, Alvina Widhani</dc:rights>
	<dc:rights xml:lang="en-US">https://creativecommons.org/licenses/by/4.0</dc:rights>
</oai_dc:dc>