Secondary infections, including fungal, causing COVID-19 death spike: ICMR study
Secondary infections among hospitalized COVID-19 patients are linked to the increased risk of fatality, an Indian Council of Medical Research (ICMR) study has found. These secondary infections, which were fungal or bacterial in nature, were caused by poor infection control practices at health facilities and the irrational use of antibiotics that makes pathogens highly drug-resistant, the study said. Here are more details.
Study monitored over 17,000 hospitalized patients last year
The retrospective study, published in the Dovepress journal this week, looked into 17,534 COVID-19 patients admitted in intensive care units (ICUs) and wards of 10 hospitals of the ICMR AMR surveillance network between June and August 2020. Among these patients, 3.6% had developed secondary infections, and 56.7% among them died. Comparatively, the overall mortality among all 17,534 patients was 10.6%, the study said.
91% hospitalized patients had bacterial infections
The study found that 91.4% (585 out of 640) of hospitalized COVID-19 patients had bacterial infections. Meanwhile, 5.4% (35 out of 640) of patients had only fungal infections. "Mixed infection with more than one organism isolated from different or same site was seen in 34.8% (223/640) of patients. Both bacterial and fungal organisms were reported in 8.43% (54/640) of patients," the study added.
'Blood, respiratory sites most common sites of secondary infection'
"Blood and respiratory sites were the most common sites of secondary infection in COVID-19 patients. Gram-negative pathogens were predominant in respiratory infections, with a significant proportion of Gram-positive pathogens isolated from bloodstream infections," the study mentioned.
'Gram-negative bacteria isolated from 78% of patients'
The study stated, "Gram-negative bacteria were isolated from 78% of patients. Klebsiella pneumoniae (29%) was the predominant pathogen, followed by Acinetobacter baumannii (21%)." Both pathogens are known to cause pneumonia. Further, the study added, "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%)."
Study also monitored antibiotic resistance
Antibiotic resistance is the phenomenon wherein pathogens develop immunity against the drugs designed to kill them. The excessive use of antibiotics is a leading cause of antibiotic resistance. The study analyzed antibiotics prescribed against the WHO's Access, Watch, and Reserve (AWaRe) classification. "Access" covers a wide range of common pathogens, "watch" has a higher resistance potential, while the "reserve" group is a last resort.
'Irrational antibiotic use may be adding fuel to fire'
The study found that 52.36% of antibiotics prescribed were from the "watch" category, followed by "reserve" (22.05%) and "access" (16.49%). This, the study said, "may be further adding 'fuel to the fire' of the already alarming antimicrobial resistance levels in India."
'10% of patients received antifungals without any evidence of infection'
The study mentioned, "We found that 10% of patients (70/640) received antifungals without any evidence of fungal infection, warranting a focused intervention around rational use of antifungals." "As most of the secondary infections in our study were nosocomial (originating in a hospital) in origin, and that too with highly drug-resistant pathogens, it highlighted poor infection control practices and irrational antibiotic prescription practices," it added.