Characterization of Bacterial and Fungal Infections in Hospitalized Patients With Coronavirus Disease 2019 and Factors Associated With Health Care-Associated Infections

Abstract

Background Patients hospitalized with COVID-19 are at increased risk of healthcare-associated infections especially with prolonged hospital stays. We sought to identify incidence, antimicrobial susceptibilities, and outcomes associated with bacterial/fungal secondary infections in a large cohort of patients with COVID-19. Methods We evaluated adult patients diagnosed with COVID-19 between March 2 to May 31, 2020 and hospitalized >24 hours. Data extracted from medical records included diagnoses, vital signs, laboratory results, microbiological data, and antibiotic use. Microbiologically-confirmed bacterial and fungal pathogens from clinical cultures were evaluated to characterize community- and healthcare-associated infections, including describing temporal changes in predominant organisms on presentation and throughout hospitalization. Univariable and multivariable logistic regression analyses were performed to investigate risk factors for healthcare-associated infections. Results A total of 3,028 patients were included and accounted for 899 positive clinical cultures. Overall, 516 (17%) with positive cultures met criteria for infection. Community-associated co-infections were identified in 183 (6%) patients, whereas healthcare-associated infections occurred in 350 (12%) patients. 57% of healthcare-associated infections were caused by Gram-negative bacteria and 19% by fungi. Antibiotic resistance increased with longer hospital stays, with incremental increases in the proportion of vancomycin-resistance among enterococci and ceftriaxone- and carbapenem-resistance among Enterobacterales. ICU stay, invasive mechanical ventilation, and steroids were associated with healthcare-associated infections. Conclusions Healthcare-associated infections occur in a small proportion of patients hospitalized with COVID-19 and are most often caused by Gram-negative and fungal pathogens. Antibiotic resistance is more prevalent with prolonged hospital stays. Antimicrobial stewardship is imperative in this population to minimize unnecessary broad-spectrum antibiotics.

Mucormycosis in Indian COVID-19 Patients: Insight into Its Patho-Genesis, Clinical Manifestation, and Management Strategies

“…Mucormycosis symptoms vary depending on where the fungus develops in the body [14,20]. Symptoms of rhinocerebral mucormycosis include black sores on the nasal bridge, fever, one-sided face edema, headache, and nasal congestion, whereas the symptoms of cutaneous mucormycosis are swelling around the wound, pain, and excessive redness.…”

“…SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the virus behind the COVID-19 outbreak, is linked to a variety of bacterial and fungal infections [14]. In India and some other countries, mucormycosis has co-occurred extensively with COVID-19 and is considered to be an epidemic by the Indian government based on reports of the infection mainly affecting hospitalized COVID-19 patients, leading to prolonged morbidity and death.…”

“…Researchers have found that it chiefly affects immunocompromised patients admitted to the hospital when fungal spores enter a COVID-19-infected person through an airborne vector, affecting the sinuses and lungs, though rarely in persons who have strong immunity. Patients who have been treated for COVID-19 by using steroids and other drugs to cure inflammation are the most vulnerable to mucormycosis [14]. The erroneous administration of corticosteroids (i.e., Prednisone, Hydrocortisone, or Dexamethasone) is a contributing factor to mucormycosis infection in COVID-19 patients.…”

Overview on the Prevalence of Fungal Infections, Immune Response, and Microbiome Role in COVID-19 Patients

“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), has infected millions of patients worldwide, and placed an unprecedented stress on healthcare systems [ 1 , 2 , 3 , 4 ]. This disease has predisposed a relatively high number of patients to acute respiratory distress syndrome, and co-infections are a frequent complication [ 5 , 6 ], especially with prolonged hospital stays [ 7 ]. Changes in humans’ microbiota have been recently observed in COVID-19 patients [ 1 ], with patients often being colonized or infected by microorganisms responsible for secondary infections (co-infections or superinfections), often caused by bacteria and fungal pathogens [ 5 , 7 , 8 , 9 ].…”

“…This disease has predisposed a relatively high number of patients to acute respiratory distress syndrome, and co-infections are a frequent complication [ 5 , 6 ], especially with prolonged hospital stays [ 7 ]. Changes in humans’ microbiota have been recently observed in COVID-19 patients [ 1 ], with patients often being colonized or infected by microorganisms responsible for secondary infections (co-infections or superinfections), often caused by bacteria and fungal pathogens [ 5 , 7 , 8 , 9 ]. Indeed, several opportunistic infections following severe respiratory viral infections have been recognized in COVID-19 patients [ 2 ]—particularly, a higher incidence of fungal co-infections ( Figure 1 ) [ 10 , 11 , 12 ].…”