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T Karuna,1 Rahul Garg,2 Shweta Kumar,2 Gyanendra Singh,3 Lakshmi Prasad,4 Kawal Krishen Pandita,4 Abhijit Pakhare,3 Saurabh Saigal,5 Alkesh Kumar Khurana,6 Rajnish Joshi,2 Kamini Walia,7 Sagar Khadanga2 1Department of Microbiology, AIIMS, Bhopal, Madhya Pradesh, India; 2Department of General Medicine, AIIMS, Bhopal, Madhya Pradesh, India; 3Department of Community and Family Medicine, AIIMS, Bhopal, Madhya Pradesh, India; 4Department of Hospital Administration, AIIMS, Bhopal, Madhya Pradesh, India; 5Department of Critical Care, AIIMS, Bhopal, Madhya Pradesh, India; 6Department of Pulmonary Medicine & TB, AIIMS, Bhopal, Madhya Pradesh, India; 7Indian Council of Medical Research, New Delhi, IndiaCorrespondence: Sagar Khadanga, Department of General Medicine, AIIMS, Bhopal, Madhya Pradesh, India, Email drsagarkhadanga@gmail.comPurpose: Secondary infections (SI) in COVID-19 have been documented from 3.6% to 72% in various studies with mortality ranging from 8.1% to 57.6%. There is a gap in knowledge for clinicoâepidemio-microbilogical association among COVID-19 patients with concomitant SI.Patients and Methods: This is a retrospective chart review, in central India. The study was undertaken for hospitalized adult patients during 1st June 2020 to 30th November 2020, with laboratory proven COVID-19 infection and secondary infection.Results: Out of the total 2338 number of patients, only 265 (11.3%) patients were investigated for microbiological identification of SI. Male gender was predominant (76.8%) and the mean age was 53.7 ± 17.8 years. Only 3.5% (82/2338) of patients were having microbiologically confirmed (bacterial or fungal) SI. The overall mortality was 50.9% (54/82) with a differential mortality of 88.8% (48/54) in high-priority areas and 21.4% (6/28) in low-priority areas. Blood was the most commonly investigated sample (56%) followed by urine (20.7%) and respiratory secretion (15.8%). A. baumanii complex (20/82, 24.3%) was the most common bacteria isolated followed by K. pneumonia (12/82, 14.6%) and E. coli (11/82, 13.4%). Candida spp. (20/82, 24.3%) was the most common fungal pathogen isolated. Sixty percent (12/20) of Acinetobacter spp. were carbapenam-resistant and 70.3% of Enterobacterales were carbapenam-resistant. Fluconazole resistant Candida spp. was isolated only in 10% (2/20) of cases. Diabetes was the most common co-morbidity 54.8% (45/82) followed by hypertension (41.4%) and chronic heart disease (13.4%). The negative predictors of secondary infections are urinary catheterization, placement of central line and mechanical ventilation (invasive and non-invasive).Conclusion: There is an urgent need of better anti-microbial stewardship practices in India (institutional and extra institutional) for curtailment of secondary infection rates particularly among COVID-19 patients.Keywords: COVID-19, secondary infection, anti-microbial stewardship practice, mortality, predictor |
