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Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience
Sonam Vijay1, Nitin Bansal1, Brijendra Kumar Rao2
1Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India.
Purpose:
Critically ill coronavirus disease 2019 (COVID-19) patients need hospitalization which increases their risk of acquiring secondary bacterial and fungal infections. The practice of empiric antimicrobial prescription, due to limited diagnostic capabilities of many hospitals, has the potential to escalate an already worrisome antimicrobial resistance (AMR) situation in India. This study reports the prevalence and profiles of secondary infections (SIs) and clinical outcomes in hospitalized COVID-19 patients in India.
Patients And Methods:
A retrospective study of secondary infections in patients admitted in intensive care units (ICUs) and wards of ten hospitals of the Indian Council of Medical Research (ICMR) AMR surveillance network, between June and August 2020, was undertaken. The demographic data, time of infection after admission, microbiological and antimicrobial resistance data of secondary infections, and clinical outcome data of the admitted COVID-19 patients were collated.
Results:
Out of 17,534 admitted patients, 3.6% of patients developed secondary bacterial or fungal infections. The mortality among patients who developed secondary infections was 56.7% against an overall mortality of 10.6% in total admitted COVID-19 patients. Gram-negative bacteria were isolated from 78% of patients. Klebsiella pneumoniae (29%) was the predominant pathogen, followed by Acinetobacter baumannii (21%). Thirty-five percent of patients reported polymicrobial infections, including fungal infections. High levels of carbapenem resistance was seen in A. baumannii (92.6%) followed by K. pneumoniae (72.8%).
Conclusion:
Predominance of Gram-negative pathogens in COVID-19 patients coupled with high rates of resistance to higher generation antimicrobials is an alarming finding. A high rate of mortality in patients with secondary infections warrants extra caution to improve the infection control practices and practice of antimicrobial stewardship interventions not only to save patient lives but also prevent selection of drug-resistant infections, to which the current situation is very conducive.
Insights
Hospitalized COVID-19 patients face a high risk of secondary bacterial and fungal infections, with Gram-negative bacteria like Klebsiella pneumoniae being common. High antimicrobial resistance rates in these infections contribute to increased mortality.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Critically ill COVID-19 patients are susceptible to secondary bacterial and fungal infections during hospitalization.
- Empirical antimicrobial use in India exacerbates antimicrobial resistance (AMR).
Purpose of the Study:
- To determine the prevalence and profiles of secondary infections (SIs) in hospitalized COVID-19 patients in India.
- To analyze the clinical outcomes associated with these secondary infections.
Main Methods:
- Retrospective study of 17,534 COVID-19 patients across ten ICMR AMR surveillance network hospitals (June-August 2020).
- Data collected included demographics, infection timing, microbiology, antimicrobial resistance, and clinical outcomes.
Main Results:
- 3.6% of patients developed secondary infections, with a significantly higher mortality rate (56.7%) compared to overall COVID-19 mortality (10.6%).
- Gram-negative bacteria were predominant (78%), with Klebsiella pneumoniae (29%) and Acinetobacter baumannii (21%) as leading pathogens.
- High carbapenem resistance rates were observed in A. baumannii (92.6%) and K. pneumoniae (72.8%).
Conclusions:
- The prevalence of Gram-negative pathogens and high antimicrobial resistance in COVID-19 patients is alarming.
- Increased mortality in patients with secondary infections necessitates improved infection control and antimicrobial stewardship to prevent drug-resistant infections.
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