P442 Bacterial and fungal infection in COVID-19 diagnosed cases in a tertiary care ICU setting in the wake of second wave in Kolkata, India

Abstract

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMFungal and bacterial infections increase the mortality rate of COVID-19-positive patients. In addition to the risk factors that we cannot change, invasive procedures should be avoided, constant blood sugar regulation should be applied, and unnecessary antibiotics use should be avoided. To investigate the incidence of bacterial and fungal infection of hospitalized patients intensive care units with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in this retrospective observational study in a tertiary care hospital in Kolkata in the wake of second-wave in India. A retrospective study of hospitalized patients with confirmed SARS-CoV-2 by PCR was analyzed study in a tertiary care hospital in Kolkata in the wake of second-wave from February 2021 to October 2021. The records of 327 patients hospitalized in ICU with the diagnosis of COVID-19 were investigated from electronic health records and hospitalization files. The demographic characteristics (age, gender), the number of ICU hospitalization days and mortality rates, APACHE II scores, accompanying diseases, antibiotic-steroid treatments taken during hospitalization, and microbiological results (blood, urine, tracheal aspirate samples) of the patients were recorded. Blood cultures, respiratory samples, pneumococcal or Legionella urinary antigens, and respiratory viral PCR panels were obtained from COVID-19 patients, respectively. The average APACHE II score of the patients was 28 ± 6. A positive blood culture was identified in 60 patients (7.1%), of which 39 were classified as contaminants. Bacteremia resulting from respiratory infection was confirmed in two cases (one each community-acquired Klebsiella pneumoniae and ventilator-associated Enterobacter cloacae). Line-related bacteremia was identified in six patients (three Candida, two Enterococcus spp., and one Pseudomonas aeruginosa). All other community-acquired bacteremias (n = 16) were attributed to non-respiratory infections. Zero concomitant pneumococcal, Legionella or influenza infection was detected. A low yield of positive respiratory cultures was identified; Staphylococcus aureus was the most common respiratory pathogen isolated in community-acquired coinfection (4/24; 16.7%), with pseudomonas and yeast identified in late-onset infection. Invasive fungal infections (n = 3) were attributed to line-related infections. Opportunistic fungal infection was detected in 58 patients (17.37%) of 327 patients monitored in ICU with a COVID-19-positive diagnosis. Candida albicans was the opportunistic fungal agent isolated from most blood samples taken from COVID-19-positive patients. The mortality rate of COVID-19-positive patients with candidemia was 80%. While 2/3 patients (66.6%) for whom fungi were grown from their tracheal aspirate died, one patient (33.3%) was transferred to the ward. Prolonged mechanical ventilation support was associated with the development of nosocomial candidemia and bacteremia. Parallel to the developments in the field of diagnosis and treatment, an increase in the incidence of fungal infections and the number of patients who are in the risk group for the development of opportunistic fungal infections have been observed in recent years. Among the hospitalized patients, those most at risk in terms of fungal infections are intensive care unit (ICU) patients. The rate of Candida infections amongst critical care patients is very and may pose severe mortality if not diagnosed, treated, and handled effectively, and promptly.