Bloodstream infection profile of COVID-19 patients in intensive care unit of a tertiary care hospital in Western India

Abstract

Background: This study was aimed to determine the pervasiveness, comorbidity and associated risk factors, clinical significance and etiological pathogens of secondary bloodstream infections (BSIs) in COVID-19 patients to start the empirical antimicrobial therapy for positive clinical outcomes. Materials and Methods: The study was conducted in a tertiary care hospital in Western India during the COVID-19 global pandemic wave (April 2020 to December 2021). COVID-19 status was confirmed by reverse-transcription polymerase chain reaction (RT-PCR). Central line-associated bloodstream infection (CLABSI) was defined according to the NHSN (National Healthcare Safety Network) 2020 criteria. Results: Of the 1152 patients admitted to the COVID-19 ICU, 193 (16.7%) developed BSIs, of which 7 (3.6%) had candidemia and 186(96.3%) had bacteremia. A substantial majority of patients had acute respiratory distress syndrome (ARDS) 81(41.9%), while chronic obstructive pulmonary disease (COPD) was present in 46 (23.8%) patients. The most frequent isolates were Klebsiella pneumoniae (52/147, 35.3%) Acinetobacter baumannii (29/147, 19.7%) and E. coli (18/147, 12.2%). Of the total pathogens causing BSI, 128 (66.32%) were multidrug-resistant organisms (MDRO). Methicillin-resistant S. aureus (MRSA) were 19/46 (41.3%) while Enterococcus faecalis were 12/46 (26%). Conclusion: Appropriate initiation of antibiotic stewardship programmes and strict compliance with the prevention of infections and spread of antibiotic resistance is necessary to contain the transmission of MDROs. A damaging impact on disease management can be expected in seriously ill COVID-19 patients with BSIs caused by MDROs.