Clinico–Epidemio-Microbiological Exploratory Review Among COVID-19 Patients with Secondary Infection in Central India

Figures & data

Table 1 Baseline Demographic and Clinical Parameters of COVID-19 Patients with Secondary Infections

Variables	n (%)
Age (years), Mean±SD	53.7 ± 17.8
Male sex	63 (76.8%)
Co-morbidities
Diabetes Mellitus	45 (54.8%)
Hypertension	34 (41.4%)
Chronic Heart Disease	11 (13.4%)
Chronic Kidney Disease	8 (9.7%)
Type of Ward
High-priority admission	54 (65.8%)
Low-priority admission	28 (34.1%)
Presence of invasive device
Urinary catheter	60 (73.1%)
Central line	37 (45.1%)
Endotracheal tube	35 (42.6%)
Mechanical ventilation	35 (42.6%)
Non-invasive ventilation	15 (18.2%)
Laboratory investigations
Median TLC (IQR)	10.0 x10^3 (1.6–21.0 x10^3)
Neutrophil count (IQR)	88 (33–96)
MedianC- reactive protein mg/L (IQR)	67 (5–705)
Length of stay, days
Hospitalized, Median (IQR)	14 (2–52)
ICU stay, Median (IQR)	12 (1–40)
Overall mortality	54%
ICU mortality	48%

Abbreviations: SD, standard deviation; IQR, Inter quartile range; TLC, total leukocyte count; ICU, intensive care unit.

Table 2 Distribution of Isolates from Various Samples of COVID-19 Patients with Secondary Infection

Source/Organism Group	Total	High-Priority Area, n (%)	Low-Priority Area, n (%)
Blood Isolates, No. (%)
Total Number	46	34	12
Enterobacterales	10	8 (80)	2 (20)
Ceftriaxone-resistant	7 (70)	7 (70)	0 (0)
Carbapenem-resistant	6 (60)	6 (60)	0 (0)
Candida spp.	14	12	2
Fluconazole-resistant	2 (14.2)	1 (7.1)	1 (7.1)
Enterococcus spp.	8	7 (87.5)	1 (12.5)
VRE	3 (37.5)	3 (100)	0 (0)
Acinetobacter spp.	12	6 (50)	6 (50)
CRAB	5 (41.6)	4 (33.3)	1 (8.3)
Pseudomonas aeruginosa	1	1 (100)	0 (0)
MRSA	1	0 (0)	1 (100)
Urine Isolates, No. (%)
Total Number	17	7 (41.1)	10 (58.8)
Enterobacterales	9 (52.9)	2 (11.7)	7 (41.1)
Ceftriaxone -resistant	8 (88.8)	2 (22.2)	6 (66.6)
Carbapenem-resistant	4 (44.4)	1 (11.1)	3 (33.3)
Candida spp.	6 (35.2)	4 (66.6)	2 (33.3)
Fluconazole-resistant	0 (0)	0 (0)	0 (0)
Pseudomonas aeruginosa	2 (11.7)	1 (50)	1 (50)
Respiratory Isolates, No. (%)
Total Number	13	10 (76.9)	3 (23)
Enterobacterales	6 (46.1)	3 (23)	3 (23)
Ceftriaxone-resistant	5 (83.3)	3 (50)	2 (33.3)
Carbapenem-resistant	5 (83.3)	3 (50)	2 (33.3)
Acinetobacter species	6	6 (100)	0 (0)
CRAB	6 (100)	6 (100)	0 (0)
Pseudomonas aeruginosa	1	1 (100)	0 (0)
Pus Isolates, No. (%)
Total Number	6	3 (50)	3 (50)
Enterobacterales	4 (66.6)	3 (50)	1 (16.6)
Ceftriaxone-resistant	4 (66.6)	3 (50)	1 (16.6)
Carbapenem-resistant	4 (66.6)	3 (50)	1 (16.6)
Acinetobacter spp.	1 (16.6)	0 (0)	1 (100)
CRAB	1(16.6)	0 (0)	1 (100)
MSSA	1 (16.6)	0 (0)	1 (100)

Abbreviations: VRE, Vancomycin resistant Enterococci; CRAB, Carbapenem resistant Acinetobacter baumanii; MRSA, Methicillin resistant Staphylococcus aureus; MSSA, Methicillin susceptible Staphylococcus aureus.

Figure 1 Organisms isolated in different clinical samples among COVID-19 patients with secondary infection.

Table 3 Clinical and Laboratory Parameters of COVID-19 Patients Admitted in Different Areas

Variables	Low-Priority Area (N=28)	High-Priority Area (N=54)	p-value
Age	44.0 (33.8, 64.5)	59.5 (40.0, 65.0)	0.116
Male sex (%)	21 (75.0%)	42 (77.8%)	0.77
Co-morbidities
Diabetes Mellitus	15 (53.6%)	30 (55.6%)	0.864
Hypertension	9 (32.1%)	25 (46.3%)	0.217
Chronic Heart Disease	1 (3.6%)	10 (18.5%)	0.088
Chronic Kidney Disease	2 (7.1%)	6 (11.1%)	0.709
Presence of invasive devices
Urinary catheter	8 (28.6%)	52 (96.3%)	<0.001
Central line	5 (17.9%)	32 (59.3%)	<0.001
Mechanical ventilation	3 (10.7%)	32 (59.3%)	<0.001
Non-invasive ventilation	0 (0.0%)	15 (27.8%)	0.002
Isolation of MDRO	12 (42.9%)	33 (61.1%)	0.115
Clinical outcome
Discharged	22 (78.6%)	6 (11.1%)	<0.001
Expired	6 (21.4%)	48 (88.9%)	<0.001
Laboratory investigations
WBC (x10^3), Median (IQR)	9.4 (5.3–14.8)	10 (6.5–15.9)	0.56
CRP, Median (IQR)	25.0 (10.5, 57.0)	73.0 (32.0, 185.0)	0.023
LDH, Median (IQR)	572.0 (269, 695)	188.5 (51.8, 510)	0.099
Length of stay
Hospital stays (in days), Median (IQR)	11.0 (7–22)	16.0 (8–23)	0.466
ICU stay (in days)	1.0 (1.0, 1.0)	13.0 (7.0, 18.0)	0.095

Abbreviations: SD, standard deviation; IQR, Inter quartile range; MDRO, multi drug resistant organism; ICU, intensive care unit.

Table 4 Outcome Analysis of Survivors and Non-Survivors in COVID-19 Patients with Secondary Infections

Variables	Survivors (N = 28)	Non Survivors (N=54)	p-value
Age, Median (IQR)	43.0 (34.25–63.75)	60.0 (40.0–67.0)	0.07
Age, Median±SD	48.79 ±17.51	56.26 ±17.6	0.07
Type of admission
Low-priority area	22	6	<0.001
High-priority area	6	48	<0.001
Co-morbidities
Diabetes Mellitus	15	30	0.86
Hypertension	10	24	0.44
Chronic Heart Disease	1	10	0.08
Chronic Kidney Disease	1	7	0.25
Presence of invasive devices
Urinary catheter	7	58	<0.001
Central line	2	35	<0.001
Mechanical ventilation	3	32	<0.001
Non-invasive ventilation	1	14	0.013
MDRO	15	30	0.86

Abbreviations: IQR, inter quartile range; SD, standard deviation; MDRO, multi drug resistant organism.

Table 5 Incidence of Secondary Infections Rate (%) Among COVID-19 Patients in Various Countries

Author	Country	Incidence of Secondary Infections (%)	Mortality (%)
Current study	India	3.50%	60.90%
Garcia-Vidal et al, 2021^Citation16	Spain	4.70%	18.60%
Vijay et al, 2021^Citation17	India	3.60%	56.70%
Russell et al, 2021^Citation22	UK	70.60%	NA
Nasir et al, 2021^Citation27	Pakistan	72%	42%
Søgaard et al,2021^Citation28	Switzerland	8.30%	NA
Nassar et al, 2021^Citation29	Egypt	19.40%	24.40%
Langford et al, 2020^Citation7	Meta-analysis	14.30%	NA
Ripa et al, 2020^Citation8	Italy	4.40%	NA
Bardi et al, 2020^Citation23	Spain	40.70%	36% (ICU)
Li et al, 2020^Citation25	China	6.80%	49.00%
Mehta et al, 2020^Citation30	USA	30%	27%
Cai et al, 2020^Citation31	China	10.10%	NA
Sharov et al, 2020^Citation32	Russia	41.50%	8.16%

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