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. 2021 May 24:14:1893-1903.
doi: 10.2147/IDR.S299774. eCollection 2021.

Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience

Sonam Vijay  1 , Nitin Bansal  1 , Brijendra Kumar Rao  2 , Balaji Veeraraghavan  3 , Camilla Rodrigues  4 , Chand Wattal  5 , Jagdish Prasad Goyal  6 , Karuna Tadepalli  7 , Purva Mathur  8 , Ramanathan Venkateswaran  9 , Ramasubramanian Venkatasubramanian  10 , Sagar Khadanga  11 , Sanjay Bhattacharya  12 , Sudipta Mukherjee  13 , Sujata Baveja  14 , Sujatha Sistla  15 , Samiran Panda  1 , Kamini Walia  1
Affiliations

Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience

Sonam Vijay et al. Infect Drug Resist. .

Abstract

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.

Keywords: COVID-19; antibiotics; antimicrobial resistance; hospital acquired infections; secondary infections.

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Conflict of interest statement

Dr Camilla Rodrigues reports personal fees from Pfizer, Sanofi, B Braun, Becton Dickinson, Biomerieux, Cipla and Glenmark, outside the submitted work. The authors declare that they have no other potential conflict of interests regarding this work.

Figures

Figure 1
Figure 1
Distribution of bacterial and fungal pathogens isolated from COVID-19 patients.
Figure 2
Figure 2
Susceptibility pattern (%) of Gram-negative bacteria isolated from COVID-19 patients. (A) Klebsiella pneumoniae. (B) Acinetobacter baumannii.
Figure 3
Figure 3
Depiction of antibiotics as per WHO Aware, Watch and Reserve (AWaRe) classification. (A) Total antibiotics usage in %. (B) Class of antibiotics usage in %.
Figure 4
Figure 4
Depiction of patient outcomes linked to secondary infections.
See this image and copyright information in PMC

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