Secondary bacterial, fungal infections in hospitalised COVID-19 patients increase risk of worse outcomes, finds study
According to researchers, antimicrobial measures in hospitals and healthcare centres with COVID-19 wards need to be amped up as half of these secondary infections originated at the hospital, more than 48 hours from the time of hospital admission
The COVID-19 infection can cause a number of complications like hypoxia, acute respiratory distress syndrome (ARDS), thromboembolic disease, cytokine storm, multiorgan failure, and, in some cases, secondary bloodstream infections. Secondary bloodstream infections or SBIs are ones that emerge in the wake of an already existing infection. The presence of one infection often creates a conducive environment for other microbes to grow, which leads to SBIs.
A new study published in the journal Clinical Infectious Diseases reveals that the presence of such SBIs when you have COVID-19 can lead to severe disease and worse health outcomes. The study, conducted by researchers based at Rutgers University, suggests that SBIs often occur in people with influenza and other viral respiratory illnesses. This is because these viral infections alter the epithelial surfaces of the lungs and respiratory tracts, and modulate the immune responses in such a way that it results in severe inflammation and the contracting of secondary infections.
Secondary infections in COVID-19 patients
The researchers explain that even though data about SBIs in COVID-19 patients is limited, the fact remains that the infection caused by SARS-CoV-2 leads to immune dysregulation, which can predispose patients to secondary and bacterial infections.
To throw better light on how the development of secondary infections affects the survival and recovery of hospitalised COVID-19 patients, the researchers conducted a multicentre case-control study that included 375 hospitalised patients with severe COVID-19 infection. Their blood cultures were drawn at the time of hospitalisation between March and May 2020 in three medical centres in New Jersey.
Of these 375 patients, the researchers found that 128 developed SBIs during hospitalisation. Around 117 (91.4 percent) of the SBIs were bacterial and 7 (5.5 percent) were fungal. Around 50.8 percent of these SBIs were acquired nosocomially, meaning that they originated in the hospital, more than 48 hours from the time of hospital admission.
The risk factors and health outcomes of these patients with SBIs were compared with those of the other hospitalised COVID-19 patients. The researchers’ analysis revealed that those with SBIs were more likely to have an altered mental status or confusion, lower mean percentage oxygen saturation at room temperature, and septic shock. They were also more likely to be admitted to the intensive care unit.
Effects of secondary infections
The researchers also noted that these patients with SBIs were less likely to have cough and fever as presenting symptoms of COVID-19 at the time of hospitalisation but had a much higher percentage of intubations and oxygen support requirements while being hospitalised. About 23.8 percent of these patients had to be intubated as compared to only 8.1 percent of SBI-free COVID-19 patients. The in-hospital mortality rate of patients with SBIs was 53.1 percent, while it was 32.8 percent for those without SBIs.
The study thus concluded that severe COVID-19 patients who developed nosocomial SBIs had prolonged hospital stays and worse clinical outcomes than COVID-19 patients without SBIs. This shows that antimicrobial measures in hospitals and healthcare centres with COVID-19 wards need to be amped up. The researchers also recommend further study into these nosocomial SBIs associated with COVID-19 to better prevent and treat them.
For more information, read our article on Infections.
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