Profile of co-infections & secondary infections in COVID-19 patients at a dedicated COVID-19 facility of a tertiary care Indian hospital: Implication on antimicrobial resistance

Abstract

Background The COVID-19 pandemic has raised concerns over secondary infections because it has limited treatment options and empiric antimicrobial treatment poses serious risks of aggravating antimicrobial resistance (AMR). Studies have shown that COVID-19 patients are predisposed to develop secondary infections. This study was conducted to ascertain the prevalence and profiles of co- & secondary infections in patients at the COVID-19 facility in North India. Methods We studied the profile of pathogens isolated from 290 clinical samples. Bacterial and fungal pathogens were identified, and antimicrobial susceptibility was determined by the Vitek2® system. Additionally, respiratory samples were tested for any viral/atypical bacterial co-infections and the presence of AMR genes by FilmArray test. The clinical and outcome data of these patients were also recorded for demographic and outcome measures analyses. Results A total of 151 (13%) patients had secondary infections, and most got infected within the first 14 days of hospital admission. Patients aged >50 years developed severe symptoms (p = 0.0004) and/or had a fatal outcome (p = 0.0005). In-hospital mortality was 33%. K.pneumoniae (33.3%) was the predominant pathogen, followed by A. baumannii (27.1%). The overall resistance was up to 84%.Majority of the organisms were multidrug-resistant (MDR) harbouring MDR genes. Conclusion A high rate of secondary infections with resistant pathogens in COVID-19 patients highlights the importance of antimicrobial stewardship programs focussing on supporting the optimal selection of empiric treatment and rapid-de-escalation, based on culture reports.

Clinical Profile of Bloodstream Infections in Covid-19 Patients: A Retrospective Cohort Study

“…In addition, apart from BSIs respiratory specimen were also analyzed which could be contaminants or colonizers. Another report by Khurana et al showed 13% prevalence of secondary infections [20]. Contrary to previous studies, Lai et al described the prevalence of BSIs up to 50% among non-survivors severe Covid-19 pneumonia patients [21].…”

Identification of bacterial co-detections in COVID-19 critically Ill patients by BioFire® FilmArray® pneumonia panel: a systematic review and meta-analysis

“…The literature search resulted in 155 studies meeting our search criteria (Supplementary Figure 1). Excluded studies were comprised of 12 duplicates studies, 96 non-PN/PN plus Panel studies, 18 review articles or position statements, 17 non-clinical or non-human studies, two commentaries, three non-SARS-CoV-2 study, and one study due to insufficient data for evaluating incidence of co-detections related to PN Panel [Khurana et al, 2021] . After removing duplicate and non-applicable studies, seven studies with 558 patients were included for the systematic review and meta-analyses ( Table 1 , Supplementary Table 2) [ Camelena et al, 2021 , Kolenda et al, 2020 , Verroken et al, 2020 , Kreitmann et al, 2020 , Contou et al, 2020 , Foschi et al, 2021 , Maataoui et al, 2021 ].…”

Boswellic acids/Boswellia serrata extract as a potential COVID-19 therapeutic agent in the elderly

“…Because lymphocytes play an important role in the immune defense function against infection, patients with COVID-19 are highly susceptible to bacterial and fungal secondary infections causing a high mortality rate in patients with COVID-19 (Bhatt et al 2021 ). About 3.6–13% of patients with COVID-19 developed a secondary bacterial or fungal infection and the mortality rate among these patients was about 33.3–56.7% (Khurana et al 2021 ; Vijay et al 2021 ). Also, it has been verified that major anaerobic pathogens Tannerella forsythia and Porphyromonas gingivalis in periodontitis are associated with a higher risk of developing a severe secondary infection in patients with COVID-19 (Aquino-Martinez et al 2021 ; Marouf et al 2021 ; Şehirli et al 2021 ), and importantly that patients with COVID-19 have a high probability of suffering from an invasive fungal infection such as mucormycosis, cryptococcosis, aspergillosis, or candidiasis as secondary infection (Song et al 2020 ).…”