Secondary infections modify the overall course of hospitalized patients with COVID-19: a retrospective study from a network of hospitals across North India

Budhiraja, Sandeep; Tarai, Bansidhar; Jain, Dinesh Kumar; Aggarwal, Mona; Indrayan, Abhaya; Das, Poonam; Mishra, R S; Bali, Supriya; Mahajan, Manish; Kirtani, Jay; Tickoo, Rommel; Soni, P.; Nangia, Vivek; Lall, Ajay C.; Kishore, Nevin; Jain, Ashish; Singh, Omender; Singh, Namrita; Kumar, Ashok; Saxena, Prashant; Dewan, Arun; Aggarwal, Ritesh; Mehra, Mukesh; Jain, Meenakshi; Nakra, Vimal; Sharma, B D; Pandey, Praveen; Singh, YP; Arora, Vijay K.; Jain, Somya; Chhabra, Ranjana; Tuli, Preeti; Boobna, Vandana; Joshi, Alok; Aggarwal, Manoj; Gupta, Rajiv; Aneja, Pankaj; Dhall, Sanjay S.; Arora, Vineet M.; Chugh, Inder Mohan; Garg, Sandeep; Mittal, Vikas; Gupta, Ajay Kumar; Jyoti, Bikram; Sharma, Puneet; Bhasin, Pooja; Jain, Shakti; Singhal, R. K.; Bhasin, Atul; Vardani, Anil; Pal, Vivek; Pande, Deepak Gargi; Gulati, Tribhuvan; Nayar, Sandeep; Kalra, Sunny; Garg, Manish; Pande, Rajesh; Bag, Pradyut; Gupta, Arpit; Sharma, Jitin; Handoo, Anil; Burman, Purabi; Choudhary, Pooja; Gupta, Ashish; Gupta, Puneet; Joshi, Sharad; Tayal, Nitesh; Gupta, Manish; Khanna, Anita; Kishore, Sachin; Sahay, Shailesh Chandra; Dang, Rajiv; Mishra, Neelima; Sekhri, Sunil; Srivastava, Rajneesh Chandra; Agrawal, Mitali Bharat; Mathur, Mohit; Banwari, Akash; Khetarpal, Sumit; Pandove, Sachin; Bhasin, Deepak K.; Singh, Harpal; Midha, Devender; Bhutani, Anjali; Kaur, Manpreet; Singh, Amarjit; Sharma, Shalini; Singla, Komal; Gupta, Pooja; Sagar, Vinay; Dixit, Ambrish; Bajpai, Rashmi; Chachra, Vaibhav; Tyagi, Puneet; Saxena, SK; Uniyal, Bhupesh; Belwal, Shantanu; Aier, Imliwati; Singhal, Mini; Khaduri, Ankit

doi:10.1016/j.ijregi.2022.02.008

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…In China, a higher incidence of secondary infections (57.89%) was identified among critically ill and severe critically ill patients diagnosed with COVID-19. 13 Nevertheless, a relatively lower incidence was observed in England 14 and North India 15 (30.3% and 22.6%, respectively). These variations in the literature could be attributed to the different sample size across studies and the disparity between populations.…”

Section: Discussionmentioning

confidence: 94%

Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU

Alshrefy¹,

Alwohaibi²,

Alhazzaa³

et al. 2022

IJGM

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Purpose Secondary infections have been observed among coronavirus disease 2019 (COVID-19) patients, especially in the intensive care unit (ICU) setting, which is associated with worse clinical outcomes. The current study aimed to investigate the incidence, common pathogens, and outcome of bacterial and fungal secondary infections among ICU patients with COVID-19. Methods A retrospective chart review of all patients admitted to the ICU at King Fahd Hospital of the University in Saudi Arabia. All adult patients aged ≥18 admitted in the ICU for ≥48 hours with positive COVID-19 reverse transcription-polymerase chain reaction test during the period between March 2020 till September 2021 were included. Results Out of 314 critically ill patients, 133 (42.4%) developed secondary infections. The incidence of secondary bacterial infection was 32.5% with Pseudomonas aeruginosa (n = 34), Acinetobacter baumannii (n = 33), and Klebsiella pneumoniae (n = 17) being the predominant pathogens, while secondary fungal infection was 25.2% mainly caused by Candida albicans (n = 43). Invasive mechanical ventilation was significantly associated with the development of secondary bacterial infections (odds ratio [OR] = 17.702, 95% confidence interval [CI] 7.842–39.961, p < 0.001) and secondary fungal infections (OR = 12.914, 95% CI 5.406–30.849, p < 0.001). Mortality among patients with secondary infections was 69.2% (n = 92). Secondary infections were associated with longer hospital and ICU stays with a median of 25 days (interquartile range [IQR] 17–42) and 19 days (IQR 13–32), respectively. Conclusion Bacterial and fungal secondary infections are common among COVID-19 patients admitted to the ICU with a predominance of gram-negative bacteria and Candida species. The development of secondary infections was significantly associated with invasive mechanical ventilation. Poor clinical outcomes have been observed, demonstrated with a prolonged hospital and ICU stays and higher mortality.

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Section: Discussionmentioning

confidence: 94%

Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU

Alshrefy¹,

Alwohaibi²,

Alhazzaa³

et al. 2022

IJGM

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“…In a study from North India, out of 19,852 COVID-19 patients, secondary bacterial infections were diagnosed in 1940 (9.8%) cases with bloodstream infections, UTI, soft tissue infection, and pneumonia; and 319 isolates were E. coli and 396 isolates were Klebsiella pneumonia. Among the overall bacterial isolates, 76.9% were ESBL and 47.1% CRE with an overall mortality of 40.3% [16]. Another study published in 2021 found that among COVID-19 patients who developed bacterial infections, over 70% of the bacteria were multidrug-resistant.…”

Section: Extended-spectrum Beta Lactamase Producing Enterobacterales ...mentioning

confidence: 99%

“…In a COVID-19 study from a chain of hospitals in North India by Budhiraja et al reports 9.8% of secondary bacterial infections out of 19,852 COVID-19 patients, including bloodstream infections, UTIs, soft tissue infections, and pneumonia. Acinetobacter baumannii was isolated in 215 cases, with 68% being CRAB, contributing to a 40.3% mortality rate associated with co-bacterial infections in COVID-19 cases [16]. Examining a tertiary care hospital in North India, a comparison of carbapenem resistance rates between August-October 2019 and early 2021 revealed an overall increase from 23% (pre-COVID) to 41% (COVID period) in bacteria like Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa [17].…”

Section: Carbapenem-resistant Acinetobacter Baumannii (Crab)mentioning

confidence: 99%

“…A study by Budhiraja et al reports out of 19,852 COVID-19 patients, secondary bacterial infections were diagnosed in 1940 (9.8%) cases (bloodstream infections, UTI, soft tissue infection, and pneumonia) with 207 isolates of Pseudomonas aeruginosa with 43% resistant to Carbapenem with an overall mortality of 40.3% [16]. Another study by Yuan et al reports 22.4% of co-infections of Pseudomonas aeruginosa in COVID-19 cases from China [13].…”

Section: Multi Drug Resistant (Mdr) Pseudomonas Aeruginosamentioning

confidence: 99%

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The Silent Pandemic by Super Pathogens during the COVID-19 Pandemic

Das,

Gladston,

Silvanose

2023

Preprint

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Post-COVID-19 bacterial infections are a significant threat to global health, mainly due to the overuse and misuse of antibiotics. The review highlights the importance of using antibiotics judiciously and following appropriate guidelines and recommendations. The article also examines the potential indirect contribution of steroids to antibiotic resistance through immune suppression in severe cases of COVID-19. Anti-microbial resistance (AMR) is one of the leading causes of death worldwide that continues as a silent pandemic caused by the major AMR superbug includes Carbapenem-resistant Acinetobacter baumannii (CRAB), Methicillin-resistant Staphylococcus aureus (MRSA), Carbapenem-resistant Enterobacterales (CRE), Extended-spectrum Beta Lactamase producing Enterobacterales (ESBL) which is resistant to cephalosporin and Multidrug-resistant (MDR) Pseudomonas aeruginosa. Ongoing surveillance and monitoring of antibiotic use and resistance helped to minimize the risk of antibiotic resistance and shrink it from pandemic to endemic.

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Enterococcal Infections: A Comparative Analysis between the Pandemic and the Pre-pandemic Period

Sharad,

Srivastava,

Kiro

et al. 2024

COVID

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Introduction: During the COVID-19 pandemic, higher Enterococcus bloodstream infections (BSI) rates have been reported. To establish whether these infections actually increased, we compared the incidence of Enterococcal infections before (September 2019 to February 2020) and during the pandemic (April 2020 to March 2022). Materials and Methods: This retrospective observational study was conducted at a tertiary care center converted into a COVID-19 facility. All clinical samples received in our laboratory during the study period were included. Results: In the six months preceding the pandemic, 2,243 samples were positive for bacterial growth; of the isolated organisms, 100 were Enterococcus species. During the pandemic, 39 out of 996 positive samples were Enterococcus. E. faecium was the most common isolate, 79/99 and 37/39. BSI was the most common overall infection (554/996; 55.6%) compared to the period before it (287/2243; 12.79%). Enterococcus species accounted for 30 out of 554 (5.41%) BSI in COVID-19 patients and 21/287 in the period before it (7.31%). Ten out of 39 (25.64%) isolates were vancomycin-resistant compared to the pre-COVID-19 period (9/21; 42.8%). There was an increase in antimicrobial resistance in the pandemic, except for linezolid and high-level aminoglycoside. Conclusion: Although we noted a higher percentage of BSIs, Enterococci were isolated from a lesser rate of COVID-19 patients from our center compared to pre-pandemic times. The plausible reasons for this could be the protective gut microbiota in the Indian population, and no increase in Enterococcus species in the environment of patients.

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Secondary infections modify the overall course of hospitalized patients with COVID-19: a retrospective study from a network of hospitals across North India

Cited by 5 publications

References 20 publications

Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU

Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU

The Silent Pandemic by Super Pathogens during the COVID-19 Pandemic

Enterococcal Infections: A Comparative Analysis between the Pandemic and the Pre-pandemic Period

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