Clinico–Epidemio-Microbiological Exploratory Review Among COVID-19 Patients with Secondary Infection in Central India

Abstract

Purpose Secondary infections (SI) in COVID-19 have been documented from 3.6% to 72% in various studies with mortality ranging from 8.1% to 57.6%. There is a gap in knowledge for clinico–epidemio-microbilogical association among COVID-19 patients with concomitant SI. Patients and Methods This is a retrospective chart review, in central India. The study was undertaken for hospitalized adult patients during 1st June 2020 to 30th November 2020, with laboratory proven COVID-19 infection and secondary infection. Results Out of the total 2338 number of patients, only 265 (11.3%) patients were investigated for microbiological identification of SI. Male gender was predominant (76.8%) and the mean age was 53.7 ± 17.8 years. Only 3.5% (82/2338) of patients were having microbiologically confirmed (bacterial or fungal) SI. The overall mortality was 50.9% (54/82) with a differential mortality of 88.8% (48/54) in high-priority areas and 21.4% (6/28) in low-priority areas. Blood was the most commonly investigated sample (56%) followed by urine (20.7%) and respiratory secretion (15.8%). A. baumanii complex (20/82, 24.3%) was the most common bacteria isolated followed by K. pneumonia (12/82, 14.6%) and E. coli (11/82, 13.4%). Candida spp. (20/82, 24.3%) was the most common fungal pathogen isolated. Sixty percent (12/20) of Acinetobacter spp. were carbapenam-resistant and 70.3% of Enterobacterales were carbapenam-resistant. Fluconazole resistant Candid a spp. was isolated only in 10% (2/20) of cases. Diabetes was the most common co-morbidity 54.8% (45/82) followed by hypertension (41.4%) and chronic heart disease (13.4%). The negative predictors of secondary infections are urinary catheterization, placement of central line and mechanical ventilation (invasive and non-invasive). Conclusion There is an urgent need of better anti-microbial stewardship practices in India (institutional and extra institutional) for curtailment of secondary infection rates particularly among COVID-19 patients.

Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020–2021)

“…A systematic review and meta-analysis showed a high prevalence of antimicrobial resistance (AMR) in COVID-19 patients, with the most common microorganisms represented by MRSA, carbapenem-resistant A. baumannii, Klebsiella pneumonia e and Pseudomonas aeruginosa , and multi-drug resistant Candida auris ( 11 ). High rates of carbapenem resistance in Acinetobacter spp., K. pneumoniae and other Enterobacterales have also been reported in single studies where the above microorganisms represented the predominant causes of BSI in patients hospitalized with COVID-19 ( 12 , 13 ). Both prevalence of BSI and rates of resistance, however, displayed wide heterogeneity by hospital and geographical area ( 8 – 13 ).…”

“…With respect to fungal isolates, our results are consistent with those of Karuna et al, that describe a low rate of azole resistance in Candida spp. isolated from BSI ( 12 ).…”

“…(VRE), and Gram-negative organisms ( 3 ). Other studies reported a high prevalence of Acinetobacter baumannii in COVID-19 associated BSIs ( 8 , 12 , 13 ). A systematic review and meta-analysis showed a high prevalence of antimicrobial resistance (AMR) in COVID-19 patients, with the most common microorganisms represented by MRSA, carbapenem-resistant A. baumannii, Klebsiella pneumonia e and Pseudomonas aeruginosa , and multi-drug resistant Candida auris ( 11 ).…”