Prevalence of Bacterial co-infections and super infections in cancer patients hospitalized with COVID-19 in ICU: a retrospective cohort study

ABSTRACT

Background:Bacterial co-pathogens are commonly identified in viral respiratory tract infections such as influenza and are an im- portant cause of morbidity and mortality, necessitating timely diagnosis and antibacterial therapy1-3. The prevalence, incidence and characteristics of bacterial infection in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS -CoV-2) is not well understood and has been raised as an important knowledge gap. Methods:This observational study was performed in the department of Microbiology, Tata memorial Hospital, Mumbai. All cancer patients admitted in ICU with COVID-19 for ≥48 hours between April 2020 to July 2020 were included in the study. Results:A total of 9595 cancer patients were tested for SARS Coronavirus 2 between April 2020 to July 2020 in the department of Microbiology, Tata Memorial Hospital, Mumbai. Out of these 2380 (24.80%) were COVID- 19 positive. 30 (1.26%) of the patients tested positive for COVID 19 required ICU admission. Squamous cell carcinona (3), Pancreatic Cancer (3) and Breast Cancer (3) were most com- monly involved cancer types. 20/30 of these patients had bacterial super infections while 10/30 had co infections. NDBAL 22 (31.88%) constituted the major source of infection, followed by BILE 10 (14.49%), PUS, PUS SWAB & WOUND SWAB 9 (13.04%). Most common- ly isolated organisms was E. coli 20 (23.25%), followed by Pseudomonas aeruginosa 19 (22.09%), Acinetobacter spp. 15 (17.44%) and Klebseilla pneumoniae 14(16.27%) respec- tively. E. coli & K. pneumoniae were most commonly sensitive to Amikacin (63.63%) and Tigecycline (57.57%). Ps. aeruginosa was moderately sensitive to commonly used antibi- otics like Piperacillin – tazobactum, Ceftazidime, Cefoperazone sulbactam (42.85%) and Ciprofloxacin, Tobramycin (38.09%) [Formula presented] Conclusions:Understanding the proportion of COVID-19 patients with acute respiratory bacterial co-infection, and the culprit pathogens, is crucial for treating patients with COVID- 19 and to help ensure responsible use of antibiotics and to minimize negative consequenc- es of overuse.