Superinfections in COVID-19 Patients: Role of Antimicrobials

Abstract

The coronavirus pandemic is a global health crisis of recent times and the biggest threat we have faced after the Second World War. This viral infection (COVID-19) is not the only cause of deaths in this pandemic. A usual complication of viral infections is a secondary superimposed bacterial infection or a superinfection. Based on limited published data, the relatively high incidence of severe infection and mortality in COVID-19 patients is attributed to these infections. It is reasonable to anticipate that nearly half of the patients who have died from COVID-19 had superinfection. Patients who have severe form of the disease and those requiring prolonged stay in intensive care units (ICUs) are more prone to developing super added infection by nosocomial pathogens. The most common type of infection observed among COVID-19 patients is ventilator-associated pneumonia (VAP), followed by bacteremia with sepsis and urinary tract infections (UTIs). Antibiotics are commonly prescribed to keep these infections at bay which is promoting antimicrobial resistance (AMR). In developing countries like India, where there is well-established high burden of multidrug-resistant organisms in hospital settings, superinfections in COVID-19 patients can pose a biggest challenge in the treatment leading to increase mortality. There is a need of prospective studies, which should include clinical, microbiological, and epidemiological data on superinfections that can be used in forming effective antimicrobial stewardship strategies; which can have a crucial role in optimal antimicrobial prescribing.

Pandoraea pnomenusa Superinfection in a Patient with SARS-CoV-2 Pneumonia: First Case in the Literature

“…This high salt concentration leads to the inhibition of antimicrobial peptides, including human β-defensins, and a subsequent increased infection susceptibility [ 17 ]. Additionally, two other mechanisms predispose to acquiring superinfections: hypermethylation of the interferon 1 gene, which leads to a decrease in interferon 1 concentrations in the airways [ 18 ], and the synthesis of pro-inflammatory cytokines, which are harmful to host cells [ 19 ]. This cytokine release syndrome, exhaustion of the immune system, and lung damage in patients with SARS-CoV-2 infection might lead to a state of immunosuppression, increasing susceptibility to superinfection by unusual microorganisms such as P. pnomenusa .…”

Community-Acquired, Post-COVID-19, Methicillin-Resistant Staphylococcus aureus Pneumonia and Empyema

“…Such secondary infections increase their risk of sepsis, and it follows that they are then treated with antimicrobials, which may enhance nosocomial infections by multidrug-resistant organisms. This has also been demonstrated in urban India where secondary infections in COVID-19 patients with antibiotic-resistant bacteria have been the country’s biggest challenge at mitigating mortality [ 7 ].…”

Bacterial Infections in Coronavirus Disease 2019

“…Inappropriate antibiotic use may reduce their availability and may also result in Clostridioides difficile infection as well as antimicrobial resistance, especially when broad-spectrum antibiotics are used [13]. Prospective studies on superinfection are required, with clinical, microbiological, and epidemiological data that may be used to develop successful antimicrobial stewardship strategies, which can play a critical role in antimicrobial prescription [32].…”