Infections in G6PD-Deficient Hospitalized Patients—Prevalence, Risk Factors, and Related Mortality

Abstract

G6PD deficiency is a genetic disease that weakens the immune system and renders affected individuals susceptible to infections. In the Sultanate of Oman resides a high number of recorded G6PD cases due to widespread consanguineous marriage, which may reach 25% of the population. We studied the infection patterns and risk factors for mortality to provide antimicrobial stewardship recommendations for these patients. After obtaining ethical approval, a registry of recorded cases was consulted retrospectively to include G6PD-deficient adult patients admitted to Suhar hospital over 5 years with microbiologically confirmed infections. Patient demographics, health-related information, infection causes, treatment, and clinical outcomes were studied. Data were analyzed to describe infection patterns and risk factors. Several variables, including underlying comorbidities and hospitalization details, such as length of stay, admission to critical care unit, blood transfusion, or exposure to an invasive procedure, were statistically associated with the acquisition of multidrug-resistant and hospital-acquired infections. Meanwhile, these infections were associated with a high mortality rate (28%), significantly associated with the patient’s health status and earlier exposure to antimicrobial treatment due to previous bacterial infection. The high prevalence of G6PD deficiency among the Omani population should alert practitioners to take early action when dealing with such cases during infection that requires hospitalization. Strict infection control measures, Gram-negative empiric coverage, hospital discharge as early as possible, and potent targeted antimicrobial therapy in this patient population can ameliorate the treatment outcomes and should be emphasized by the antimicrobial stewardship team.

Persistent Headaches in an Avid Hiker: A Case of Chronic Coccidioidal Meningitis

“…Our patient presented with a known G6PD deficiency in correspondence to additional potential undiagnosed immunodeficiencies, which ultimately could have served as a significant risk factor for disseminated coccidioidomycosis in the form of CM. G6PD deficiency can lead to reduced nicotinamide adenine dinucleotide phosphate oxidase activity in phagocytes, resulting in immunodeficiency, and can lead to bacterial, viral, and fungal infections [ 24 , 25 ].…”

Severe G6PD deficiency leads to recurrent infections and defects in ROS production: Case report and literature review

“…Cases with severe G6PD deficiency and infections have rarely been reported; however, this figure may be an underestimate. A recently published study focused on infection in hospitalized patients with G6PD deficiency ( Alrahmany et al, 2022 ). Only 620 of 3,334 registered G6PD-deficient patients did not have any microbiological cultures or hospitalization details.…”

Infections in Glucose-6-Phosphate Dehydrogenase G6PD-Deficient Patients; Predictors for Infection-Related Mortalities and Treatment Outcomes

“…The G6PD enzyme stimulates the reduction in nicotinamide adenine dinucleotide phosphate (NADP) in the pentose phosphate pathway (PPP) to generate NADPH; the latter is a substrate for NADPH oxidase responsible for regenerating the antioxidant glutathione that protects the blood cells against oxidative stress. The deficiency of G6PD leads to premature loss of cell integrity under the stress of sulfa-containing drugs, certain foods, and systemic infections, which explains why many studies suggested G6PD deficiency to be a significant predictor of hospitalization and severe infections [ 3 , 4 , 6 , 7 ].…”

“…Several studies identified a slew of life-threatening infections in G6PD-deficient patients, with bacteremia, respiratory, cerebrospinal, and urinary tract infections being the most common. Gram-negative bacteria were the predominant cause of these infections, followed by Gram-positive bacteria and, to a lesser extent, a variety of fungi and viruses [ 7 , 8 , 9 ].…”

“…In our community—due to the high prevalence of consanguineous marriage—a large number of G6PD enzyme deficiency cases is registered, which may reach 25% in males and 10% in females, providing a unique opportunity to study these cases in depth that may not be possible in other societies [ 10 ]. In a previous study by the same research group, we monitored the pattern of infection in an adequate number of G6PD patients, allowing us to vividly describe the causes and risk factors for nosocomial infections and infections with multi-drug resistant (MDR) bacteria [ 7 ]. Therefore, we found it useful to track the predictors that may be associated with high mortality rates in the same patient population that primarily suffers from an inferior immune response.…”