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Review
. 2021 Apr;39(2):147-153.
doi: 10.1016/j.ijmmb.2020.10.014. Epub 2020 Nov 2.

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

Surbhi Khurana  1 , Parul Singh  2 , Neha Sharad  3 , Vandana V Kiro  4 , Neha Rastogi  5 , Amit Lathwal  6 , Rajesh Malhotra  7 , Anjan Trikha  8 , Purva Mathur  9
Affiliations
Review

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

Surbhi Khurana et al. Indian J Med Microbiol. 2021 Apr.

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.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; COVID-19; Film array; Secondary infections.

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Figures

Fig. 1
Fig. 1
Distribution of secondary infections in COVID-19 patients.
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