Understanding secondary bloodstream infections in COVID patients: Insights from Karachi, Pakistan
DOI:
https://doi.org/10.61529/idjp.v33i2.288Abstract
Background: Nosocomial Bloodstream infection (BSI) in COVID patients is an emerging clinical concern for physicians. It can lead to sepsis resulting in rise in morbidity and mortality. In this study, we aimed to assess the prevalence of BSI in COVID patients admitted to Indus Hospital and Health Network in Karachi, Pakistan.
Material and Methods: This retrospective study included the Reverse-transcriptase polymerase chain reaction (RT-PCR) confirmed COVID patients from March 2020 to December 2021. Data of all the patients (n=961) was obtained from electronic medical record of the hospital which included information regarding demographics, BSI, Central line-associated blood stream infections (CLABSI), frequency of pathogens, antimicrobial resistance pattern and clinical outcome.
Results: Our data showed that 217 (22.6%) patients developed BSI from which 44.2% had CLABSI. BSI was higher in males than females (61.8% vs 38.2%) and most patients were 51-64 years of age (n=66, 30.41%). Infections with Gram-negative bacteria were predominant (46.7%), followed by Gram-positive bacteria (17.9%) and yeasts (7.2%). Among the isolates, Acinetobacter spp. were the most commonly identified pathogen (17%). Regarding multi drug-resistant organisms, Carbapenem-resistant Acinetobacter baumanii (CRAB) was the most frequently isolated (n=37), followed by Methicillin-resistant S. aureus (MRSA) (n=16), Carbapenem-resistant E. coli (CRE) (n=10), Carbapenem-resistant Klebsiella spp. (CRE) (n=8), Vancomycin-resistant Enterococcus (VRE) (n=8) and multi drug-resistant Pseudomonas spp. (n=3). The mortality among CLABSI in different age groups ranged from 80% to 100% while in BSI ranged from 52.38% to 92.3%.
Conclusion: In order to prevent nosocomial infections from spreading and enhance the prognosis of hospitalized COVID patients, early detection of secondary infections and adherence to appropriate infection control measures are essential.
Keywords: Bloodstream infections, BSI, COVID-19, CLABSI, Multidrug resistance
References
Eastin C, Eastin T, Guan W, Ni Z, Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2019;58(4):711–2.
DOI: http://dx.doi.org/10.1056/NEJMoa2002032
Lupia T, Scabini S, Pinna SM, Di Perri G, De Rosa FG, Corcione S. 2019 novel coronavirus (2019-nCoV) outbreak: A new challenge. J Glob Antimicrob Resist. 2020; 21: 22–7.
DOI: http://dx.doi.org/10.1016/j.jgar.2020.02.021
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: Summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA. 2020; 323(13): 1239–42.
DOI: http://dx.doi.org/10.1001/jama.2020.2648
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229): 1054–62.
DOI: http://dx.doi.org/10.1016/S0140-6736(20)30566-3
Luyt CE, Sahnoun T, Gautier M, Vidal P, Burrel S, Pineton de Chambrun M, et al. Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: A retrospective cohort study. Ann Intensive Care. 2020; 10(1): 158.
DOI: http://dx.doi.org/10.1186/s13613-020-00775-4
Rouzé A, Martin-Loeches I, Povoa P, Makris D, Artigas A, Bouchereau M, et al. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: A European multicenter cohort study. Intensive Care Med. 2021; 47(2): 188–98. DOI: http://dx.doi.org/10.1007/s00134-020-06323-9
Buetti N, Ruckly S, de Montmollin E, Reignier J, Terzi N, Cohen Y, et al. COVID-19 increased the risk of ICU-acquired bloodstream infections: a case-cohort study from the multicentric OUTCOMEREA network. Intensive Care Med. 2021; 47(2): 180–7.
DOI: http://dx.doi.org/10.1007/s00134-021-06346-w
McCullers JA. The co-pathogenesis of influenza viruses with bacteria in the lung. Nat Rev Microbiol. 2014; 12(4): 252–62. DOI: http://dx.doi.org/10.1038/nrmicro3231
Metzger DW, Sun K. Immune dysfunction and bacterial coinfections following influenza. J Immunol. 2013; 191(5): 2047–52.
DOI: http://dx.doi.org/10.4049/jimmunol.1301152
Morris DE, Cleary DW, Clarke SC. Secondary bacterial infections associated with influenza pandemics. Front Microbiol. 2017; 8: 1041.
DOI: http://dx.doi.org/10.3389/fmicb.2017.01041
Chang JC. TTP-like syndrome: Novel concept and molecular pathogenesis of endotheliopathy-associated vascular microthrombotic disease. Thromb J. 2018;16(1). DOI: http://dx.doi.org/10.1186/s12959-018-0174-4
Dempfle CE. Coagulopathy of sepsis. Thromb Haemost. 2004; 91(2): 213-24.
Gauer RL. Early recognition and management of sepsis in adults: the first six hours. Am Fam Physician. 2013; 88(1): 44–53.
Sepulveda J, Westblade LF, Whittier S, Satlin MJ, Greendyke WG, Aaron JG, et al. Bacteremia and blood culture utilization during COVID-19 surge in New York City. J Clin Microbiol. 2020; 58(8).
DOI: http://dx.doi.org/10.1128/JCM.00875-20
Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020; 109(102433): 102433. DOI: http://dx.doi.org/10.1016/j.jaut.2020.102433
Giacobbe DR, Battaglini D, Ball L, Brunetti I, Bruzzone B, Codda G, et al. Bloodstream infections in critically ill patients with COVID-19. Eur J Clin Invest. 2020;50(10):e13319.
DOI: http://dx.doi.org/10.1111/eci.13319
Prowle JR, Echeverri JE, Ligabo EV, Sherry N, Taori GC, Crozier TM, et al. Acquired bloodstream infection in the intensive care unit: Incidence and attributable mortality. Crit Care. 2011; 15(2): R100.
DOI: http://dx.doi.org/10.1186/cc10114
Pasquini Z, Barocci I, Brescini L, Candelaresi B, Castelletti S, Iencinella V, et al. Bloodstream infections in the COVID-19 era: Results from an Italian multi-center study. Int J Infect Dis. 2021; 111: 31–6.
DOI: http://dx.doi.org/10.1016/j.ijid.2021.07.065
Kang M, Conrad Z, Thomas E, Arocha D, Trivedi J. Central-line associated bloodstream infection (CLABSI) in patients hospitalized with COVID-19. Antimicrob Steward Healthc Epidemiol. 2022;2(S1): s32–s32.
DOI: http://dx.doi.org/10.1017/ash.2022.116
Palanisamy N, Vihari N, Meena DS, Kumar D, Midha N, Tak V, et al. Clinical profile of bloodstream infections in COVID-19 patients: A retrospective cohort study. BMC Infect Dis. 2021; 21(1): 933.
DOI: http://dx.doi.org/10.1186/s12879-021-06647-x
Vijay S, 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: 1893–903.
DOI: http://dx.doi.org/10.2147/idr.s299774
Temperoni C, Caiazzo L, Barchiesi F. High prevalence of antibiotic resistance among opportunistic pathogens isolated from patients with COVID-19 under mechanical ventilation: Results of a single-center study. Antibiotics (Basel). 2021; 10(9): 1080.
DOI: http://dx.doi.org/10.3390/antibiotics10091080
Montrucchio G, Corcione S, Lupia T, Shbaklo N, Olivieri C, Poggioli M, et al. The burden of carbapenem-resistant Acinetobacter baumannii in ICU COVID-19 patients: A regional experience. J Clin Med. 2022; 11(17): 5208.
DOI: http://dx.doi.org/10.3390/jcm11175208
Kurt AF, Mete B, Urkmez S, Demirkiran O, Dumanli GY, Bozbay S, et al. Incidence, risk factors, and prognosis of bloodstream infections in COVID-19 patients in intensive care: A single-center observational study. J Intensive Care Med. 2022; 37(10): 1353–62.
DOI: http://dx.doi.org/10.1177/08850666221103495
Bhargava A, Riederer K, Sharma M, Fukushima EA, Johnson L, Saravolatz L. High rate of multidrug-resistant organisms (MDROs) among COVID-19 patients presenting with bacteremia upon hospital admission. Am J Infect Control. 2021; 49(11): 1441–2.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Dr. Fareeha Adnan, Dr. Nazia Khursheed, Dr. Adeel Zafar Nagra, Mrs. Nida Ghori , Dr. Qurat ul Ain Zahid, Moiz Khan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
