Secondary infections modify the overall course of hospitalized patients with COVID-19: a retrospective study from a network of hospitals across North India

Incidence of secondary bacterial infections and risk factors for in-hospital mortality among coronavirus disease 2019 subjects admitted to secondary care hospital: A single-center cross-sectional retrospective study

Background

This study aims to determine the prevalence of secondary bacterial infections (SBIs) in hospitalized coronavirus disease 2019 (COVID-19) subjects and evaluate their antibiotic susceptibility. The study also sought to identify risk factors for the outcome of SBIs in COVID-19 subjects.

Methods

This single-center cross-sectional retrospective study was carried out at Sohar Hospital in Oman. The study examined hospitalized COVID-19 subjects diagnosed with SBIs during March 2020-December 2022. The relevant subjects' data were extracted from hospital electronic health records and analyzed using STATA version 14. The Chi-square test or Fisher's exact test was employed for analyzing categorical variables, and P < 0.05 was deemed statistically significant.

Results

The research encompassed a total of 817 bacteria recovered from various clinical samples of 421 subjects. The older individuals (39.4%) and men (65.6%) experienced bacterial infections more frequently, with bloodstream and respiratory infections being the most common. Gram-negative bacilli (GNB) were responsible for a higher proportion (85.6%) of infections, with Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae being the most common pathogens. Subjects who underwent mechanical ventilation, received corticosteroid therapy, and who had underlying comorbidities, such as diabetes and chronic renal disease, were found to have higher mortality rates. Neutrophilia, elevated C-reactive protein, lymphocytopenia, decreased serum albumin level, sepsis, and pneumonia were found to be independent contributors to mortality.

Conclusions

SBI is common among COVID-19-hospitalized subjects. GNB were primarily linked to SBI. The severity and the likelihood of SBI increased in subjects undergoing medical interventions and immunosuppressive therapy.

Factors predicting mortality among patients with COVID-19 associated hospital acquired pneumonia: insights from a tertiary care center

Hospital acquired pneumonia (HAP) is a severe and dangerous complication in patients admitted with COVID-19, causing significant morbidity and mortality globally. However, the early detection and subsequent management of high-risk cases may prevent disease progression and improve clinical outcomes. This study was undertaken in order to identify predictors of mortality in COVID-19 associated HAP. A retrospective study was performed on all patients who were admitted to a tertiary care center with COVID-19 associated HAP from July 2020 till November 2020. Data was collected on relevant demographic, clinical and laboratory parameters to determine their association with in-hospital mortality; 1574 files were reviewed, out of which 162 were included in the final study. The mean age of subjects was 59.4±13.8 and a majority were male (78.4%). There were 71 (48.3%) mortalities in the study sample. Klebsiella pneumoniae (31.5%) and Pseudomonas aeruginosa (30.2%) were the most common organisms overall. Clinically significant growth of Aspergillus sp. was observed in 41 (29.0%) of patients. On univariate analysis, several factors were found to be associated with mortality, including male gender (p=0.04), D-dimers >1.3 mg/L (p<0.001), ferritin >1000 µg/mL (p<0.001), LDH >500I.U/mL (p<0.001) and procalcitonin >2.0 µg/mL (p<0.001). On multivariate analysis, ferritin >1000ng/mL, initial site of care in Special Care Units or Intensive Care Units, developing respiratory failure and developing acute kidney injury were factors independently associated with mortality in our patient sample. These results indicate that serum ferritin levels may be a potentially useful biomarker in the management of COVID-19 associated HAP.

Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU

Purpose

Secondary infections have been observed among coronavirus disease 2019 (COVID-19) patients, especially in the intensive care unit (ICU) setting, which is associated with worse clinical outcomes. The current study aimed to investigate the incidence, common pathogens, and outcome of bacterial and fungal secondary infections among ICU patients with COVID-19.

Methods

A retrospective chart review of all patients admitted to the ICU at King Fahd Hospital of the University in Saudi Arabia. All adult patients aged ≥18 admitted in the ICU for ≥48 hours with positive COVID-19 reverse transcription-polymerase chain reaction test during the period between March 2020 till September 2021 were included.

Results

Out of 314 critically ill patients, 133 (42.4%) developed secondary infections. The incidence of secondary bacterial infection was 32.5% with Pseudomonas aeruginosa (n = 34), Acinetobacter baumannii (n = 33), and Klebsiella pneumoniae (n = 17) being the predominant pathogens, while secondary fungal infection was 25.2% mainly caused by Candida albicans (n = 43). Invasive mechanical ventilation was significantly associated with the development of secondary bacterial infections (odds ratio [OR] = 17.702, 95% confidence interval [CI] 7.842–39.961, p < 0.001) and secondary fungal infections (OR = 12.914, 95% CI 5.406–30.849, p < 0.001). Mortality among patients with secondary infections was 69.2% (n = 92). Secondary infections were associated with longer hospital and ICU stays with a median of 25 days (interquartile range [IQR] 17–42) and 19 days (IQR 13–32), respectively.

Conclusion

Bacterial and fungal secondary infections are common among COVID-19 patients admitted to the ICU with a predominance of gram-negative bacteria and Candida species. The development of secondary infections was significantly associated with invasive mechanical ventilation. Poor clinical outcomes have been observed, demonstrated with a prolonged hospital and ICU stays and higher mortality.