Understanding secondary bloodstream infections in COVID patients: Insights from Karachi, Pakistan

Background: Nosocomial Bloodstream infection (BSI) in COVID patients is an emerging clinical concern for physicians. It can lead to sepsis resulting in rise in morbidity and mortality. In this study, we aimed to assess the prevalence of BSI in COVID patients admitted to Indus Hospital and Health Network in Karachi, Pakistan. Material and Methods: This retrospective study included the Reverse-transcriptase polymerase chain reaction (RT-PCR) confirmed COVID patients from March 2020 to December 2021. Data of all the patients (n=961) was obtained from electronic medical record of the hospital which included information regarding demographics, BSI, Central line-associated blood stream infections (CLABSI), frequency of pathogens, antimicrobial resistance pattern and clinical outcome. Results: Our data showed that 217 (22.6%) patients developed BSI from which 44.2% had CLABSI. BSI was higher in males than females (61.8% vs 38.2%) and most patients were 51-64 years of age (n=66, 30.41%). Infections with Gram-negative bacteria were predominant (46.7%), followed by Gram-positive bacteria (17.9%) and yeasts (7.2%). Among the isolates, Acinetobacter spp. were the most commonly identified pathogen (17%). Regarding multi drug-resistant organisms, Carbapenem-resistant Acinetobacter baumanii (CRAB) was the most frequently isolated (n=37), followed by Methicillin-resistant S. aureus (MRSA) (n=16), Carbapenem-resistant E. coli (CRE) (n=10), Carbapenem-resistant Klebsiella spp. (CRE) (n=8), Vancomycin-resistant Enterococcus (VRE) (n=8) and multi drug-resistant Pseudomonas spp. (n=3). The mortality among CLABSI in different age groups ranged from 80% to 100% while in BSI ranged from 52.38% to 92.3%. Conclusion: In order to prevent nosocomial infections from spreading and enhance the prognosis of hospitalized COVID patients, early detection of secondary infections and adherence to appropriate infection control measures are essential. Keywords: Bloodstream infections, BSI, COVID-19, CLABSI, Multidrug resistance