Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience

Vijay, Sonam; Bansal, N.K.; Rao, Brijendra Kumar; Veeraraghavan, Balaji; Rodrigues, Camilla; Wattal, Chand; Goyal, Jagdish Prasad; Karuna, Tadepalli; Mathur, Purva; Ramesh, Venkateswaran; Ramasubramanian, V; Khadanga, Sagar; Bhattacharya, Sanjay; Mukherjee, Sudipta Kumer; Baveja, Sujata; Sistla, Sarath Chandra; Panda, Samiran; Walia, Kāmini

doi:10.2147/idr.s299774

Cited by 111 publications

(125 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Interestingly, we found a 100% mortality rate in severe COVID-19 pneumonia patients with BSIs. Previous studies have reported 21–68% mortality in this group of patients [ 4 , 5 , 16 , 19 ]. The disparity in mortality rate could be due to various factors, first of all the severity of the COVID-19 illness and the need for ICU admission.…”

Section: Discussionmentioning

confidence: 66%

See 1 more Smart Citation

Clinical profile of bloodstream infections in COVID-19 patients: a retrospective cohort study

et al. 2021

View full text Add to dashboard Cite

Background Bloodstream infections (BSIs) are an emerging cause of significant morbidity and mortality in severe Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence, clinical profile and outcome of BSIs in critically ill COVID-19 patients. Methods This was a single-centre retrospective study conducted at a tertiary care hospital in Western India. All patients (age > 18 years) with reverse-transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 admitted in the intensive care unit (ICU) were included. Hospital electronic records were searched for demographic data, time of bloodstream infection since admission, clinical profile, antimicrobial resistance pattern and clinical outcome of all patients who developed BSIs. Results Out of 750 patients admitted in COVID ICU, 8.5% developed secondary BSIs. All severe COVID-19 patients who developed BSIs succumbed to illness. A significant proportion of BSIs were Gram-negative pathogens (53/64, 82.8%). Acinetobacter baumannii was the commonest isolate, followed by Klebsiella pneumoniae (32.8% and 21.9%, respectively). Multidrug-resistance organisms (MDRO) were found in 57.8% of the cases. The majority of MDRO belonged to K. pneumoniae and Enterococcus groups. The proportion of Gram-negative bacteria resistant to carbapenems was 47.2% (25/53). On multivariate analysis, raised total leukocyte counts, mechanical ventilation and presence of comorbidities were significantly associated with the incidence of BSIs. Conclusion We found a significant prevalence of Acinetobacter baumannii in COVID-19 associated BSIs. The presence of comorbidities raised leukocyte counts and mechanical ventilation should alarm clinicians for possible BSIs. The timely initiation of empirical antibiotics and rapid de-escalation is vital to improve the outcome. At the same time, strict compliance of infection control practices should be accomplished to reduce the occurrence of MDRO.

show abstract

Section: Discussionmentioning

confidence: 66%

“…In this study, we found the overall prevalence of BSIs in ICU patients to be 8.5%. A recent study from India found the prevalence of secondary infections to be 3.6% [ 16 ]. However, in their report, both hospital-acquired and community-acquired cases were taken.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile of bloodstream infections in COVID-19 patients: a retrospective cohort study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Furthermore, the inability to demarcate viral and bacterial associated respiratory complications; poor turnaround time of culture reports and the severity of manifestation among patients were the few underlying factors, which prompted clinicians to start pre-emptive antibiotic. Studies have reported 3.1–3.5% of bacterial co-infection in COVID-19 patients, while 15% secondary bacterial infections after hospitalization are reported under AMR surveillance in India, although mortality was as high as 56.7% in these patients compared to 10.6% in total COVID-19 patients [ 22 ]. Secondary infections in admitted patients are known to be associated with negative health outcomes and worsening of the clinical prognosis.…”

Section: Discussionmentioning

confidence: 99%

Paradigm Shift in Antimicrobial Resistance Pattern of Bacterial Isolates during the COVID-19 Pandemic

et al. 2021

View full text Add to dashboard Cite

Antimicrobial resistance (AMR) is an emerging public health problem in modern times and the current COVID-19 pandemic has further exaggerated this problem. Due to bacterial co-infection in COVID-19 cases, an irrational consumption of antibiotics has occurred during the pandemic. This study aimed to observe the COVID-19 patients hospitalized from 1 March 2019 to 31 December 2020 and to evaluate the AMR pattern of bacterial agents isolated. This was a single-center study comprising 494 bacterial isolates (blood and urine) that were obtained from patients with SARS-CoV-2 admitted to the ICU and investigated in the Department of Microbiology of a tertiary care hospital in Delhi, India. Out of the total bacterial isolates, 55.46% were gram negative and 44.53% were gram positive pathogens. Of the blood samples processed, the most common isolates were CoNS (Coagulase Negative Staphylococcus) and Staphylococcus aureus. Amongst the urinary isolates, most common pathogens were Escherichia coli and Staphylococcus aureus. A total of 60% MRSA was observed in urine and blood isolates. Up to 40% increase in AMR was observed amongst these isolates obtained during COVID-19 period compared to pre-COVID-19 times. The overuse of antibiotics gave abundant opportunity for the bacterial pathogens to gradually develop mechanisms and to acquire resistance. Since the dynamics of SARS-COV-2 are unpredictable, a compromise on hospital antibiotic policy may ultimately escalate the burden of drug resistant pathogens in hospitals. A shortage of trained staff during COVID-19 pandemic renders it impossible to maintain these records in places where the entire hospital staff is struggling to save lives. This study highlights the extensive rise in the use of antibiotics for respiratory illness due to COVID-19 compared to antibiotic use prior to COVID-19 in ICUs. The regular prescription audit followed by a constant surveillance of hospital infection control practices by the dedicated teams and training of clinicians can improve the quality of medications in the long run and help to fight the menace of AMR.

show abstract

“…These were associated with diabetes, uncontrolled blood sugars due to steroid use and high ferritin levels. A reterospective study by Vijay et al [15] of secondary infection in COVID-19 cases admitted in 10 hospitals of India between June and August 2020 showed, that 3.6% cases developed secondary bacterial/fungal infection and of which 56.7% died, i.e. very high rate of mortality in cases with secondary infection.…”

Section: Discussionmentioning

confidence: 99%

Differentials in the characteristics of COVID-19 cases in Wave-1 and Wave-2 admitted to a network of hospitals in North India

Budhiraja

Indrayan

Aggarwal

et al. 2021

Preprint

View full text Add to dashboard Cite

Second wave of COVID 19 pandemic in India came with unexpected quick speed and intensity, creating an acute shortage of beds, ventilators, and oxygen at the peak of occurrence. This may have been partly caused by emergence of new variant delta. Clinical experience with the cases admitted to hospitals suggested that it is not merely a steep rise in cases but also possibly the case profile is different. This study was taken up to investigate the differentials in the characteristics of the cases admitted in the second wave versus those admitted in the first wave. Records of a total of 14398 cases admitted in the first wave (2020) to our network of hospitals in north India and 5454 cases admitted in the second wave (2021) were retrieved, making it the largest study of this kind in India. Their demographic profile, clinical features, management, and outcome was studied. Age sex distribution of the cases in the second wave was not much different from those admitted in the first wave but the patients with comorbidities and those with greater severity had larger share. Level of inflammatory markers was more adverse. More patients needed oxygen and invasive ventilation. ICU admission rate remained nearly the same. On the positive side, readmissions were lower, and the duration of hospitalization was slightly less. Usage of drugs like remdesivir and IVIG was higher while that of favipiravir and tocilizumab was lower. Steroid and anticoagulant use remained high and almost same during the two waves. More patients had secondary bacterial and fungal infections in Wave 2. Mortality increased by almost 40% in Wave 2, particularly in the younger patients of age less than 45 years. Higher mortality was observed in those admitted in wards, ICU, with or without ventilator support and those who received convalescent plasma. No significant demographic differences in the cases in these two waves, indicates the role of other factors such as delta variant and late admissions in higher severity and more deaths. Comorbidity and higher secondary bacterial and fungal infections may have contributed to increased mortality.

show abstract

Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience

Cited by 111 publications

References 20 publications

Clinical profile of bloodstream infections in COVID-19 patients: a retrospective cohort study

Clinical profile of bloodstream infections in COVID-19 patients: a retrospective cohort study

Paradigm Shift in Antimicrobial Resistance Pattern of Bacterial Isolates during the COVID-19 Pandemic

Differentials in the characteristics of COVID-19 cases in Wave-1 and Wave-2 admitted to a network of hospitals in North India

Contact Info

Product

Resources

About