Volume 12, Issue 1 (3-2024)                   JoMMID 2024, 12(1): 76-83 | Back to browse issues page

Ethics code: TMCHRC/Surg/2021/IEC Protocol -1/012

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Prabil A, Gandhi M, Vemuri V R. Retrospective Assessment of Secondary Bacterial and Fungal Infections in COVID-19 Patients at a Tertiary Care Hospital in Navi Mumbai. JoMMID 2024; 12 (1) :76-83
URL: http://jommid.pasteur.ac.ir/article-1-598-en.html
Retrospective Assessment of Secondary Bacterial and Fungal Infections in COVID-19 Patients at a Tertiary Care Hospital in Navi Mumbai
Anila Prabil * , Murtaza Gandhi , Veena Rani Vemuri
Department of Microbiology, Terna Medical College, Nerul, Navi Mumbai, Maharashtra, India
Abstract:   (712 Views)
Introduction: Secondary bacterial and fungal infections are a significant concern in COVID-19 patients, particularly those critically ill and requiring intensive care. This retrospective study investigated the prevalence and spectrum of secondary infections among COVID-19 patients admitted to the intensive care unit (ICU) at a tertiary care hospital in Navi Mumbai. Additionally, we explored the association between secondary infections and patient comorbidities. Methods: We performed a single-center, retrospective cohort study of 3234 COVID-19 patients admitted to a tertiary care hospital in Navi Mumbai, India, between August 2020 and August 2021. Microbiological data from various clinical specimens, including blood, sputum, bronchoalveolar lavage (BAL) fluid, urine, and tissue cultures, were retrospectively analyzed. Patient demographics and comorbidities were extracted from medical records. We employed descriptive statistics and Pearson's Chi-square test for data analysis to identify associations between secondary infections and patient characteristics. Results: Among the 3234 COVID-19 patients, 195 (6.02%) presented with clinical features suggestive of secondary infections. Microbiological analysis confirmed secondary infections in 98 patients (3.03%), with a culture positivity rate of 50.3%. Among bacterial isolates, Klebsiella pneumoniae was the most prevalent (43.28%), followed by Acinetobacter baumannii (25.37%). Aspergillus spp. emerged as the dominant fungal pathogen. Notably, Escherichia coli isolation was significantly associated with various specimen types (P < 0.001). However, no significant correlation was found between secondary infection rates and patient comorbidities. Conclusion: Gram-negative bacteria, specifically K. pneumoniae and A. baumannii, were the primary pathogens responsible for secondary infections in our cohort of critically ill COVID-19 patients admitted to the ICU. These findings underscore the importance of ongoing surveillance and monitoring of secondary infection trends, including fungal pathogens, to inform and optimize management strategies in this high-risk population.
Keywords: Tertiary care hospital, Secondary infection, Retrospective, Intensive care unit, Klebsiella pneumoniae, Acinetobacter baumannii, Aspergillus spp., Antimicrobial resistance
Full-Text [PDF 1103 kb]   (175 Downloads)    
Type of Study: Original article | Subject: Other
Received: 2023/09/16 | Accepted: 2024/05/21 | Published: 2024/06/8
References
1. Ghanshani R, Gupta R, Gupta B, Kalra S, Khedar R, Sood S. Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India. Lung India. 2015; 32 (5): 441-8. [DOI:10.4103/0970-2113.164155] [PMID] []
2. Jha P, Deshmukh Y, Tumbe C, Suraweera W, Bhowmick A, Sharma S, et al. COVID mortality in India: National survey data and health facility deaths. Science. 2022; 375 (6581): 667-71. [DOI:10.1126/science.abm5154] [PMID] []
3. Tendulkar P, Pandey P, Panda PK, Bhadoria AS, Kulshreshtha P, Mishra M, et al. Comparative Study Between the First and Second Wave of COVID-19 Deaths in India: A Single Center Study. Cureus. 2023; 15 (4): e37472. [DOI:10.7759/cureus.37472]
4. Boorgula SY, Yelamanchili S, Kottapalli P, Naga MD. An update on secondary bacterial and fungal infections and their antimicrobial resistance pattern (Amr) in COVID-19 confirmed patients. J Lab Physicians. 2022; 14 (3): 260-4. [DOI:10.1055/s-0041-1741438] [PMID] []
5. Karuna T, Garg R, Kumar S, Singh G, Prasad L, KrishenPandita K, et al. Clinico-Epidemio-Microbiological Exploratory Review Among COVID-19 Patients with Secondary Infection in Central India. Infect Drug Resist. 2022; 15: 1667-76. [DOI:10.2147/IDR.S355742] [PMID] []
6. Song G, Liang G, Liu W. Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from china. Mycopathologia. 2020; 185 (4): 599-606. [DOI:10.1007/s11046-020-00462-9] [PMID] []
7. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395 (10223): 507-13. [DOI:10.1016/S0140-6736(20)30211-7] [PMID]
8. Bhat KA, Madi D, Bhat S, Mary T, ShenoyMulki S, Kotian H. Profile of Secondary Bacterial and Fungal Infections in Hospitalized COVID-19 Patients in a Tertiary Care Centre. Infect Drug Resist. 2022; 15: 5705-14. [DOI:10.2147/IDR.S378221] [PMID] []
9. Zhu X, Ge Y, Wu T, Zhao K, Chen Y, Wu B, et al. Co-infection with respiratory pathogens among COVID-2019 cases. Virus Res. 2020; 285: 198005. [DOI:10.1016/j.virusres.2020.198005] [PMID] []
10. Kozel TR, Wickes B. Fungal diagnostics. Cold Spring HarbPerspect Med. 2014; 4 (4): a019299. [DOI:10.1101/cshperspect.a019299] [PMID] []
11. Chindamporn A, Chakrabarti A, Li R, Sun PL, Tan BH, Chua M, et al. Survey of laboratory practices for diagnosis of fungal infection in seven Asian countries: An Asia Fungal Working Group (Afwg) initiative. Med Mycol. 2018; 56 (4): 416-25. [DOI:10.1093/mmy/myx066] [PMID]
12. Roncon L, Zuin M, Rigatelli G, Zuliani G. Diabetic patients with COVID-19 infection are at higher risk of ICU admission and poor short-term outcome. J ClinVirol. 2020; 127: 104354. [DOI:10.1016/j.jcv.2020.104354] [PMID] []
13. Varshini KM, Ganesan V, Charles J. Secondary bacterial and fungal infections in COVID-19 patients. Int J Antimicrob Agents. 2021; 58: 21003526. [DOI:10.1016/j.ijantimicag.2021.106421.81] []
14. White PL, Dhillon R, Hughes H, Wise MP, Backx M. COVID-19 and fungal infection: the need for a strategic approach. Lancet Microbe. 2020; 1 (5): e196. [DOI:10.1016/S2666-5247(20)30127-0] [PMID]
15. Vaughn VM, Gandhi TN, Petty LA, Patel PK, Prescott HC, Malani AN, et al. Empiric antibacterial therapy and community-onset bacterial co-infection in patients hospitalized with coronavirus disease 2019 (COVID-19): a multi-hospital cohort study. Clin Infect Dis. 2021; 72 (10): 533-41. [DOI:10.1093/cid/ciaa1239] [PMID] []
16. Rattani S, Farooqi J, Jabeen G, Chandio S, Kash Q, Khan A, et al. Evaluation of semi-quantitative compared to quantitative cultures of tracheal aspirates for the yield of culturable respiratory pathogens - a cross-sectional study. BMC Pulm Med. 2020; 20 (1): 284. [DOI:10.1186/s12890-020-01311-7] [PMID] []
17. Indian Council of Medical Research. Standard Operating Procedures for Bacteriology Antimicrobial Resistance Surveillance and Research Network.2015; 01-160.
18. World Health Organization. Laboratory testing for coronavirus disease (COVID-19) in suspected human cases; WHO Interim guidance; 2020.
19. Valones MA, Guimarães RL, Brandão LA, de Souza PR, de Albuquerque Tavares Carvalho A, Crovela S. Principles and applications of polymerase chain reaction in medical diagnostic fields: a review. Braz J Microbiol. 2009; 40 (1): 1-11. [DOI:10.1590/S1517-83822009000100001] [PMID] []
20. Kyosei Y, Yamura S, Namba M, Yoshimura T, Watabe S, Ito E. Antigen tests for COVID-19. Biophys Physicobiol. 2021; 18: 28-39. [DOI:10.2142/biophysico.bppb-v18.004] [PMID] []
21. Cheesbrough, M. (2005). District Laboratory Practice in Tropical Countries, Part 1 (2nd ed., pp. 105-115). Cambridge University Press. [DOI:10.1017/CBO9780511581304]
22. Bauer AW, Kirby WMM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J ClinPathol. 1966; 45 (4): 493-6. [DOI:10.1093/ajcp/45.4_ts.493]
23. Indian Council of Medical Research. (2019). Standard Operating Procedures for Fungal Identification and Detection of Antifungal Resistance Antimicrobial Resistance Surveillance and Research Network (pp. 01-114).
24. Zhang H, Zhang Y, Wu J, Li Y, Zhou X, Li X, et al. Risks and features of secondary infections in severe and critical ill COVID-19 patients. Emerg Microbes Infect. 2020; 9 (1): 1958-64. [DOI:10.1080/22221751.2020.1812437] [PMID] []
25. Raffaelli F, Tanzarella ES, De Pascale G, Tumbarello M. Invasive Respiratory Fungal Infections in COVID-19 Critically Ill Patients. J Fungi (Basel). 2022; 8 (4): 415. [DOI:10.3390/jof8040415] [PMID] []
26. Langford BJ, So M, Simeonova M, Leung V, Lo J, Kan T, et al. Antimicrobial resistance in patients with COVID-19: A systematic review and meta-analysis. Lancet Microbe. 2023; 4 (3): 179-91. [DOI:10.1016/S2666-5247(22)00355-X] [PMID]
27. Sonam V,Bansal N,Rao BK,Veeraraghavan B,Rodrigues C,Wattal C, et al. Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience. Infect Drug Resist. 2021; 14: 1893-1903. [DOI:10.2147/IDR.S299774] [PMID] []
28. Khurana S, Singh P, Sharad N, Kiro VV, Rastogi N, Lathwal A, et al. Profile of co-infections & secondary infections in COVID-19 patients at a dedicated COVID-19 facility of a tertiary care Indian hospital: Implication on antimicrobial resistance. Indian J Med Microbiol. 2021; 39 (2): 147-53. [DOI:10.1016/j.ijmmb.2020.10.014] [PMID] []
29. Qiao LD, Chen S, Yang Y, Zhang K, Zheng B, Guo HF, et al. Characteristics of urinary tract infection pathogens and their in vitro susceptibility to antimicrobial agents in China: data from a multicenter study. BMJ Open. 2013; 3 (12): 004152. [DOI:10.1136/bmjopen-2013-004152] [PMID] []
30. Asokan GV, Ramadhan T, Ahmed E, Sanad H. WHO Global Priority Pathogens List: A Bibliometric Analysis of Medline-PubMed for Knowledge Mobilization to Infection Prevention and Control Practices in Bahrain. Oman Med J. 2019; 34 (3): 184-93. [DOI:10.5001/omj.2019.37] [PMID] []
31. Bongomin F, Gago S, Oladele R, Denning D. Global and multi-national prevalence of fungal diseases-estimate precision. J Fungi (Basel). 2017; 3 (4): 57. [DOI:10.3390/jof3040057] [PMID] []
32. Low CY, Rotstein C. Emerging fungal infections in immunocompromised patients. F1000 Med Rep. 2011; 3: 14. [DOI:10.3410/M3-14] [PMID] []
Add your comments about this article : Your username or Email:
CAPTCHA
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.