Secondary infections after Covid 19 infection is dangerous and can lead to death. The study by the Indian Council of Medical Research published last week claimed that more than half of the Covid 19 patients who developed secondary infections and hospitals infections have died.
The study claimed that the mortality among patients who developed secondary infections was 56.7 per cent against an overall mortality of 10.6 per cent. The researchers studied 17,534 patients admitted in Intensive Care Units (ICUs) and wards of ten hospitals of the ICMR between June and August 2020.
SECONDARY INFECTIONS
The researchers found that 3.6 per cent of patients developed secondary bacterial or fungal infections. Gram negative bacteria were isolated from 78 per cent of patients, Klebsiella Pneumoniae was detected in 29 per cent, Acinetobacter baumannii in 21 per cent. 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%), the researchers said.
The researchers said that predominance of Gram-negative pathogens in COVID-19 patients coupled with high rates of resistance to higher generation antimicrobials was alarming. They pointed out that high rate of mortality in patients with secondary infections warranted extra caution to improve infection control practices and practice of antimicrobial stewardship interventions.
AIM
The study was aimed at understanding the etiology and antimicrobial resistance profile of secondary bacterial and fungal infections and subsequent clinical outcomes in hospitalized COVID-19 patients. The overarching aim is to use this evidence to guide the optimal antimicrobial use in COVID-19 patients, the researchers pointed out.
MORTALITY
The study showed that overall mortality among admitted Covid 19 patients was 11.6 per cent whereas mortality among Covid 19 patients with Secondary infection was 56.7 per cent. They also found that mortality was higher in critically ill patients (68 per cent) as compared to patients in wards (27.6 per cent).
The study said mortality following incidence of secondary infection was 55 per cent in male patients and 56 per cent in female patients. Out of the Covid 19 patients who died of secondary infection, 72 per cent had Gram-negative infections and 10.8 per cent had Gram-positive infections. Apart from this, eight per cent who died had mixed infections with Gram-positive and Gram-negative pathogens, four per cent had fungal pathogens with Gram-negative pathogens and six per cent had fungal infections. They also noted that mortality was very high among those infected with MDROs (60.5 per cent).
GENDER
Of the total reported secondary infections, three-quarters of infections were identified after 48 hours of hospitalization. This meant that Hospital Acquired Infections (HAIs) was the likely cause of secondary infections.
The analysis did not find any significant difference in males or female mortality. This showed that gender was not a risk factor for death in patients with Secondary Infections. However, studies from other countries said that male gender was a higher risk factor.
LIMITATIONS
The researchers noted that their study have several limitations. They maintained that further studies were needed in this respect. However, they claimed that their study was the first of its kind that gave the prevalence and spectrum of secondary bacterial and fungal infections among Covid 19 patients in India.
The study highlighted the need to improve infection control practices in hospitals and also rationalize antibiotic prescriptions.
DRUG RESISTANCE
The study also indicated growing drug resistance that had a major role to play in the patients developing secondary infections. Most of the secondary infections in the study were nosocomial in origin, and that too with highly drug-resistant pathogens. It highlighted poor infection control practices and irrational antibiotic prescription practices, the researchers said. “Our findings are important when defining the role of empiric antimicrobial therapy or stewardship strategies in hospitalized patients with COVID-19 to achieve better therapeutic outcomes,” the paper said.
IMPROVING INFECTION CONTROL
The ICMR study maintains that all out effort is needed to improve infection control practices (hand hygiene/ glove hygiene, device bundle compliance and air quality). This will help in reducing incidence of secondary infections, particularly those of nosocomial origin, the study said. “Strict practice of antimicrobial stewardship will help in reducing drug pressure, which is a key driver of drug resistance. This study provides an important lesson on the need to go back to the basics of diagnostic stewardship and practice culture-directed therapy using narrow-spectrum agents, from the “access” category of AWaRe classification,” the ICMR said.
The study also pointed out that high usage of broad-spectrum agents from the “watch“ and “reserve” categories would not only make drugs redundant but would also create highly drug-resistant bugs.
With fear of Covid 19 still around the corner, the study wants to reinforce the principles of infection control and antibiotic stewardship. “Together, both these interventions will lead to reduction in mortality and morbidity related to not only COVID-19 patients, but will also restrain development of drug resistant pathogens/infections,” the study said.
