Secondary infections modify the overall course of hospitalized patients with COVID-19: a retrospective study from a network of hospitals across North India.
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Budhiraja Sandeep, Tarai Bansidhar, Jain Dinesh, Aggarwal Mona, Indrayan Abhaya, Das Poonam, Mishra Ram Shankar, Bali Supriya, Mahajan Monica, Kirtani Jay, Tickoo Rommel, Soni Pankaj, Nangia Vivek, Lall Ajay, Kishore Nevin, Jain Ashish, Singh Omender, Singh Namrita, Kumar Ashok, Saxena Prashant, Dewan Arun, Aggarwal Ritesh, Mehra Mukesh, Jain Meenakshi, Nakra Vimal, Sharma Bhagwan Das, Pandey Praveen Kumar, Singh Yogendra Pal, Arora Vijay, Jain Suchitra, Chhabra Ranjana, Tuli Preeti, Boobna Vandana, Joshi Alok, Aggarwal Manoj, Gupta Rajiv, Aneja Pankaj, Dhall Sanjay, Arora Vineet, Chugh Inder Mohan, Garg Sandeep, Mittal Vikas, Gupta Ajay, Jyoti Bikram, Sharma Puneet, Bhasin Pooja, Jain Shakti, Singhal Rajinder Kumar, Bhasin Atul, Vardani Anil, Pal Vivek, Pande Deepak Gargi, Gulati Tribhuvan, Nayar Sandeep, Kalra Sunny, Garg Manish, Pande Rajesh, Bag Pradyut, Gupta Arpit, Sharma Jitin, Handoo Anil, Burman Purabi, Gupta Ajay Kumar, Choudhary Pankaj Nand, Gupta Ashish, Gupta Puneet, Joshi Sharad, Tayal Nitesh, Gupta Manish, Khanna Anita, Kishore Sachin, Sahay Shailesh, Dang Rajiv, Mishra Neelima, Sekhri Sunil, Srivastava Rajneesh Chandra, Agrawal Mitali Bharat, Mathur Mohit, Banwari Akash, Khetarpal Sumit, Pandove Sachin, Bhasin Deepak, Singh Harpal, Midha Devender, Bhutani Anjali, Kaur Manpreet, Singh Amarjit, Sharma Shalini, Singla Komal, Gupta Pooja, Sagar Vinay, Dixit Ambrish, Bajpai Rashmi, Chachra Vaibhav, Tyagi Puneet, Saxena Sanjay, Uniyal Bhupesh, Belwal Shantanu, Aier Imliwati, Singhal Mini, Khaduri Ankit
Аннотация
METHODS: In this retrospective, multicentre study, the data of all patients who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on reverse transcriptase polymerase chain reaction (RT-PCR), admitted to hospital between March 2020 and July 2021, were accessed from the electronic health records of a network of 10 hospitals across five states in North India.
RESULTS: Of 19,852 patients testing positive for SARS-CoV-2 on RT-PCR and admitted to the study hospitals during the study period, 1940 (9.8%) patients developed secondary infections (SIs). Patients with SIs were, on average, 8 years older than patients without SIs (median age 62.6 vs 54.3 years; P<0.001). The risk of SIs was significantly (P<0.001) associated with age, severity of disease at admission, diabetes, admission to the intensive care unit (ICU), and ventilator use. The most common site of infection was urine (41.7%), followed by blood (30.8%) and sputum/bronchoalveolar lavage/endotracheal fluid (24.8%); the least common was pus/wound discharge (2.6%). Gram-negative bacilli (GNB) were the most common organisms (63.2%), followed by Gram-positive cocci (GPC) (19.6%) and fungi (17.3%). Most patients with SIs were on multiple antimicrobials. The most commonly used antibiotics against GNB were beta-lactam/beta-lactamase inhibitors (76.9%), carbapenems (57.7%), cephalosporins (53.9%), and antibiotics against carbapenem-resistant Enterobacteriaceae (47.1%). Empirical use of antibiotics against GPC was seen in 58.9% of patients with SIs, and empirical use of antifungals was observed in 56.9% of patients with SIs. The average length of hospital stay for patients with SIs was almost twice as long as that of patients without SIs (median 13 vs 7 days). Overall mortality among patients with SIs (40.3%) was more than eight times higher than that among patients without SIs (4.6%). Only 1.2% of patients with SIs with mild COVID-19 at admission died, compared with 17.5% of those with moderate COVID-19 at admission and 58.5% of those with severe COVID-19 at admission (P<0.001). The mortality rate was highest in patients with bloodstream infections (49.8%), followed by those with hospital-acquired pneumonia (47.9%), urinary tract infections (29.4%), and skin and soft tissue infections (29.4%). The mortality rate in patients with diabetes with SIs was 45.2%, compared with 34.3% in those without diabetes (P<0.001).
CONCLUSIONS: SIs complicate the course of patients hospitalized with COVID-19. These patients tend to have a much longer hospital stay, a higher requirement for oxygen and ICU care, and a significantly higher mortality rate compared with those without SIs. The groups most vulnerable to SIs are patients with more severe COVID-19, elderly patients and patients with diabetes. Judicious empirical use of combination antimicrobials in these groups of vulnerable patients can save lives. It is desirable to have region- or country-specific guidelines for appropriate use of antibiotics and antifungals to prevent their overuse.