Generic placeholder image

Infectious Disorders - Drug Targets

Author(s): Subhashree Samantaray, Priyabrat Karan, Anuradha Sharma*, Vijayalakshmi Nag, Naveen Dutt, Mahendra Kumar Garg, Pradeep Kumar Bhatia and Sanjeev Misra

DOI: 10.2174/1871526522666220418093450

DownloadDownload PDF Flyer Cite As
Prevalence, Presentation and Outcome of Secondary Bloodstream Infections among COVID-19 Patients

Article ID: e180422203723 Pages: 8

  • * (Excluding Mailing and Handling)

Abstract

Background: The higher mortality rate in COVID-19 patients is still a concern. Though some studies mention that elderly patients with co-morbidities are at higher risk of mortality, some others report uneventful outcomes in young patients even without co-morbidities. Secondary bacterial and fungal infections, especially with nosocomial pathogens are known to be associated with worse outcome in the ongoing pandemic as well as in the previous viral outbreaks. In such a scenario, the outcome of hospitalized COVID-19 patients can be improved by timely identification of secondary infections using appropriate biomarkers and by following appropriate infection control measures to prevent the spread of nosocomial pathogens.

Objective: The study aims to find out the prevalence of bloodstream infections (BSI) among hospitalized COVID-19 patients and to analyze their laboratory markers and outcome by comparing them with those without BSI.

Methods: In this descriptive cross-sectional study, the prevalence of secondary BSI was determined among the hospitalized COVID-19 patients by including 388 blood culture bottles collected from 293 patients, which were received in the microbiology lab within the study period.

Results: The overall prevalence of BSI in COVID-19 patients was 39.5% (116/293), out of which 35.5% (104/293) infections were bacterial, and 4.1% (12/293) were fungal, while 8.9% (26/293) patients grew contaminants, and 51.5% (151/293) were sterile. Common causative agents of secondary BSI were found to be MDR Klebsiella pneumoniae (10.9%) and Acinetobacter baumannii (8.8%) followed by Candida species (4.1%). Patients with co-morbidities like diabetes, hypertension and COPD were at higher risk of developing BSI with significantly higher levels of sepsis markers such as Creactive protein (CRP), procalcitonin, ferritin and Interleukin-6 (IL-6). The mortality rate was significantly higher (60.2%) in patients with BSI compared to the group of patients without BSI.

Conclusion: Our findings suggest the necessity of early diagnosis of the secondary infections using appropriate biomarkers and following proper infection control measures to prevent the spread of the nosocomial infections and improve the outcome of hospitalized COVID-19 patients.

Keywords: COVID-19, Secondary bloodstream infections, sepsis markers, hospital infection control, predisposing factors, outcome.

Graphical Abstract

[1]
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 2020; 323(13): 1239-42.
[http://dx.doi.org/10.1001/jama.2020.2648] [PMID: 32091533]
[2]
Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. HLH Across Speciality Collaboration UK. COVID-19: Consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395(10229): 1033-4.
[http://dx.doi.org/10.1016/S0140-6736(20)30628-0] [PMID: 32192578]
[3]
Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19: An overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. Pediatr Infect Dis J 2020; 39(5): 355-68.
[http://dx.doi.org/10.1097/INF.0000000000002660] [PMID: 32310621]
[4]
Jamilloux Y, Henry T, Belot A, et al. Should we stimulate or suppress immune responses in COVID-19? Cytokine and anti-cytokine interventions. Autoimmun Rev 2020; 19(7): 102567.
[http://dx.doi.org/10.1016/j.autrev.2020.102567] [PMID: 32376392]
[5]
Reinhart K, Daniels R, Kissoon N, Machado FR, Schachter RD, Finfer S. Recognizing sepsis as a global health priority-a WHO resolution. N Engl J Med 2017; 377(5): 414-7.
[http://dx.doi.org/10.1056/NEJMp1707170] [PMID: 28658587]
[6]
McArdle AJ, Turkova A, Cunnington AJ. When do co-infections matter? Curr Opin Infect Dis 2018; 31(3): 209-15.
[http://dx.doi.org/10.1097/QCO.0000000000000447] [PMID: 29698255]
[7]
Paget C, Trottein F. Mechanisms of bacterial superinfection post-influenza: A role for unconventional T cells. Front Immunol 2019; 10: 336.
[http://dx.doi.org/10.3389/fimmu.2019.00336] [PMID: 30881357]
[8]
Phua J, Ngerng W, See K, et al. Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Crit Care 2013; 17(5): R202.
[http://dx.doi.org/10.1186/cc12896] [PMID: 24028771]
[9]
Carter B, Collins JT, Barlow-Pay F, et al. COPE Study Collaborators Nosocomial COVID-19 infection: Examining the risk of mortality. The COPE-nosocomial study (COVID in older people). J Hosp Infect 2020; 106(2): 376-84.
[http://dx.doi.org/10.1016/j.jhin.2020.07.013] [PMID: 32702463]
[10]
Jabarpour M, Dehghan M, Afsharipour G, et al. The impact of COVID-19 outbreak on nosocomial infection rate: A case of Iran. Can J Infect Dis Med Microbiol 2021; 2021: 6650920.
[http://dx.doi.org/10.1155/2021/6650920] [PMID: 33680220]
[11]
Zhou Q, Gao Y, Wang X, et al. COVID-19 Evidence and Recommendations Working Group Nosocomial infections among patients with COVID-19, SARS and MERS: a rapid review and meta-analysis. Ann Transl Med 2020; 8(10): 629.
[http://dx.doi.org/10.21037/atm-20-3324] [PMID: 32566566]
[12]
Lu D, Wang H, Yu R, Yang H, Zhao Y. Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. J Hosp Infect 2020; 104(4): 454-5.
[http://dx.doi.org/10.1016/j.jhin.2020.02.018] [PMID: 32114056]
[13]
National Healthcare Safety Network (NHSN). Patient safety component manual 2021. Available from: https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf (Accessed on Juen 25, 2021).
[14]
Ripa M, Galli L, Poli A, et al. COVID-BioB study group Secondary infections in patients hospitalized with COVID-19: Incidence and predictive factors. Clin Microbiol Infect 2021; 27(3): 451-7.
[http://dx.doi.org/10.1016/j.cmi.2020.10.021] [PMID: 33223114]
[15]
Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18(3): 268-81.
[http://dx.doi.org/10.1111/j.1469-0691.2011.03570.x] [PMID: 21793988]
[16]
Dargère S, Cormier H, Verdon R. Contaminants in blood cultures: Importance, implications, interpretation and prevention. Clin Microbiol Infect 2018; 24(9): 964-9.
[http://dx.doi.org/10.1016/j.cmi.2018.03.030] [PMID: 29621616]
[17]
Hughes S, Troise O, Donaldson H, Mughal N, Moore LSP. Bacterial and fungal coinfection among hospitalized patients with COVID-19: A retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect 2020; 26(10): 1395-9.
[http://dx.doi.org/10.1016/j.cmi.2020.06.025] [PMID: 32603803]
[18]
Yu Y, Xu D, Fu S, et al. Patients with COVID-19 in 19 ICUs in Wuhan, China: A cross-sectional study. Crit Care 2020; 24(1): 219.
[http://dx.doi.org/10.1186/s13054-020-02939-x] [PMID: 32410714]
[19]
Clancy CJ, Nguyen MH. Coronavirus Disease 2019, superinfections, and antimicrobial development: What can we expect? Clin Infect Dis 2020; 71(10): 2736-43.
[http://dx.doi.org/10.1093/cid/ciaa524] [PMID: 32361747]
[20]
Engsbro AL, Israelsen SB, Pedersen M, et al. Predominance of hospital-acquired bloodstream infection in patients with Covid-19 pneumonia. Infect Dis (Lond) 2020; 52(12): 919-22.
[http://dx.doi.org/10.1080/23744235.2020.1802062] [PMID: 32779951]
[21]
Li J, Wang J, Yang Y, et al. Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: A retrospective analysis. Antimicrob Resist Infect Control 2020; 9(1): 153.
[http://dx.doi.org/10.1186/s13756-020-00819-1] [PMID: 32962731]
[22]
Bhatt PJ, Shiau S, Brunetti L, et al. Risk factors and outcomes of hospitalized patients with severe coronavirus disease 2019 (COVID-19) and secondary bloodstream infections: A multicenter case-control study. Clin Infect Dis 2021; 72(12): e995-e1003.
[http://dx.doi.org/10.1093/cid/ciaa1748] [PMID: 33216875]
[23]
Getahun H, Smith I, Trivedi K, Paulin S, Balkhy HH. Tackling antimicrobial resistance in the COVID-19 pandemic. Bull World Health Organ 2020; 98(7): 442-442A.
[http://dx.doi.org/10.2471/BLT.20.268573] [PMID: 32742026]
[24]
Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: A global multifaceted phenomenon. Pathog Glob Health 2015; 109(7): 309-18.
[http://dx.doi.org/10.1179/2047773215Y.0000000030] [PMID: 26343252]
[25]
Cataldo MA, Tetaj N, Selleri M, et al. INMICOVID-19 Co-infection Group Incidence of bacterial and fungal bloodstream infections in COVID-19 patients in intensive care: An alarming “collateral effect”. J Glob Antimicrob Resist 2020; 23: 290-1.
[http://dx.doi.org/10.1016/j.jgar.2020.10.004] [PMID: 33130024]
[26]
Odabasi Z, Cinel I. Consideration of severe coronavirus disease 2019 as viral sepsis and potential use of immune checkpoint inhibitors. Crit Care Explor 2020; 2(6): e0141.
[http://dx.doi.org/10.1097/CCE.0000000000000141] [PMID: 32696004]
[27]
Liu D, Wang Q, Zhang H, et al. Viral sepsis is a complication in patients with novel corona virus disease (COVID-19). Med Drug Discov 2020; 8: 100057.
[http://dx.doi.org/10.1016/j.medidd.2020.100057] [PMID: 32838292]
[28]
Bennett JE, Dolin ER, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia: Elsevier/Saunders 2019.
[29]
Hall KK, Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006; 19(4): 788-802.
[http://dx.doi.org/10.1128/CMR.00062-05] [PMID: 17041144]
[30]
Yu D, Ininbergs K, Hedman K, Giske CG, Strålin K, Özenci V. Low prevalence of bloodstream infection and high blood culture contamination rates in patients with COVID-19. PLoS One 2020; 15(11): e0242533.
[http://dx.doi.org/10.1371/journal.pone.0242533] [PMID: 33226995]
[31]
Guidelines for the provision of intensive care services V2. The faculty of intensive care medicine. Available from: https://www.ficm.ac.uk/standards-research-revalidation/guidelines-provision-intensive-care-services-v2 (accessed on December 13, 2020).