Vijay Sonam, Bansal Nitin, Rao Brijendra Kumar, Veeraraghavan Balaji, Rodrigues Camilla, Wattal Chand, Goyal Jagdish Prasad, Tadepalli Karuna, Mathur Purva, Venkateswaran Ramanathan, Venkatasubramanian Ramasubramanian, Khadanga Sagar, Bhattacharya Sanjay, Mukherjee Sudipta, Baveja Sujata, Sistla Sujatha, Panda Samiran, Walia Kamini
Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India.
Institute of Critical Medicine, Sir Ganga Ram Hospital, New Delhi, India.
Infect Drug Resist. 2021 May 24;14:1893-1903. doi: 10.2147/IDR.S299774. eCollection 2021.
Critically ill coronavirus disease 2019 (COVID-19) patients need hospitalization which increases their risk of acquiring secondary bacterial and fungal infections. The practice of empiric antimicrobial prescription, due to limited diagnostic capabilities of many hospitals, has the potential to escalate an already worrisome antimicrobial resistance (AMR) situation in India. This study reports the prevalence and profiles of secondary infections (SIs) and clinical outcomes in hospitalized COVID-19 patients in India.
A retrospective study of secondary infections in patients admitted in intensive care units (ICUs) and wards of ten hospitals of the Indian Council of Medical Research (ICMR) AMR surveillance network, between June and August 2020, was undertaken. The demographic data, time of infection after admission, microbiological and antimicrobial resistance data of secondary infections, and clinical outcome data of the admitted COVID-19 patients were collated.
Out of 17,534 admitted patients, 3.6% of patients developed secondary bacterial or fungal infections. The mortality among patients who developed secondary infections was 56.7% against an overall mortality of 10.6% in total admitted COVID-19 patients. Gram-negative bacteria were isolated from 78% of patients. (29%) was the predominant pathogen, followed by (21%). Thirty-five percent of patients reported polymicrobial infections, including fungal infections. High levels of carbapenem resistance was seen in (92.6%) followed by (72.8%).
Predominance of Gram-negative pathogens in COVID-19 patients coupled with high rates of resistance to higher generation antimicrobials is an alarming finding. A high rate of mortality in patients with secondary infections warrants extra caution to improve the infection control practices and practice of antimicrobial stewardship interventions not only to save patient lives but also prevent selection of drug-resistant infections, to which the current situation is very conducive.
2019年冠状病毒病（COVID-19）重症患者需要住院治疗，这增加了他们获得继发性细菌和真菌感染的风险。由于许多医院诊断能力有限，经验性抗菌药物处方的做法有可能使印度本已令人担忧的抗菌药物耐药性（AMR）情况进一步恶化。本研究报告了印度住院COVID-19患者继发性感染（SIs）的患病率、特征及临床结局。
对2020年6月至8月期间在印度医学研究理事会（ICMR）AMR监测网络的10家医院的重症监护病房（ICU）和病房收治的患者的继发性感染进行了回顾性研究。整理了COVID-19住院患者的人口统计学数据、入院后感染时间、继发性感染的微生物学和抗菌药物耐药性数据以及临床结局数据。
在17534名入院患者中，3.6%的患者发生了继发性细菌或真菌感染。发生继发性感染的患者死亡率为56.7%，而COVID-19住院患者的总体死亡率为10.6%。78%的患者分离出革兰氏阴性菌。（29%）是主要病原体，其次是（21%）。35%的患者报告有多重微生物感染，包括真菌感染。（92.6%）对碳青霉烯类药物的耐药率较高其次是（72.8%）。
COVID-19患者中革兰氏阴性病原体占主导地位，以及对新一代抗菌药物的高耐药率是一个令人担忧的发现。继发性感染患者的高死亡率值得格外谨慎，以改善感染控制措施和抗菌药物管理干预措施的实施，这不仅是为了挽救患者生命，也是为了防止选择耐药性感染，目前的情况非常有利于耐药性感染的发生。
