Infection and Drug Resistance (May 2021)

Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience

  • Vijay S,
  • Bansal N,
  • Rao BK,
  • Veeraraghavan B,
  • Rodrigues C,
  • Wattal C,
  • Goyal JP,
  • Tadepalli K,
  • Mathur P,
  • Venkateswaran R,
  • Venkatasubramanian R,
  • Khadanga S,
  • Bhattacharya S,
  • Mukherjee S,
  • Baveja S,
  • Sistla S,
  • Panda S,
  • Walia K

Journal volume & issue
Vol. Volume 14
pp. 1893 – 1903

Abstract

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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 Walia1 1Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India; 2Institute of Critical Medicine, Sir Ganga Ram Hospital, New Delhi, India; 3Department of Clinical Microbiology, Christian Medical College, Vellore, India; 4Department of Microbiology, PD Hinduja Hospital, Mumbai, Maharashtra, India; 5Department of Clinical Microbiology, Sir Ganga Ram Hospital, New Delhi, India; 6Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India; 7Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India; 8Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India; 9Department of Medicine, JIPMER, Pondicherry, India; 10Department of Infectious Diseases, Apollo Hospital, Chennai, Tamil Nadu, India; 11Department of Medicine, All India Institute of Medical Sciences, Bhopal, India; 12Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India; 13Department of Critical Care Medicine, Tata Medical Center, Kolkata, West Bengal, India; 14Department of Microbiology, Lokmanya Tilak Municipal General Hospital, Mumbai, India; 15Department of Microbiology, JIPMER, Pondicherry, IndiaCorrespondence: Kamini WaliaDivision of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, IndiaEmail [email protected]: 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, secondary infections, antimicrobial resistance, hospital acquired infections, antibiotics

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