Poor infection control practices in hospitals and irrational antibiotic prescription practices are triggering secondary infections in Covid-19 patients, leading to a higher mortality, according to a study coordinated by the Indian Council of Medical Research (ICMR).

The study, recently published in the journal Infection and Drug Resistance, found that out of 17,534 Covid-19 patients admitted in 10 hospitals across the country, 3.6 per cent developed secondary bacterial or fungal infection while in the hospital. The mortality among patients who developed secondary infections was as high as 56.7 per cent compared to an overall mortality of 10.6 per cent among hospitalised Covid 19 patients in general, the study said.

Apart from ICMR scientists Sonam Vijay and Nitin Bansal, medical scientists from major hospitals such as All India Institutes of Medical Sciences (AIIMS) at Delhi, Bhopal and Jodhpur, CMC Vellore, Apollo Hospitals Chennai and JIPMER Puducherry participated in the study.

Inter-patient transmission

The researchers observed that hand hygiene practices went for a toss during the pandemic because of the usage of PPE and, thus, there is risk of inter-patient transmission of infections in patients. “Hand hygiene practices are most affected during Covid-19 pandemic as health personnel use gloves as part of PPE and do not feel the need to follow hand hygiene, and there is a lack of concern for inter-patient transmission of infections in patients,” the study said.

With the fear of another wave around the corner, the study said there is a need to reinforce the principles of infection control and antibiotic stewardship. Together, both these interventions will lead to reduction in mortality and morbidity related not only to Covid-19 patients, but will also restrain development of drug-resistant pathogens/infections.

Over prescription

Fear of missing a secondary infection and lack of specific therapy for Covid-19 leads to over prescription of antibiotics which makes Covid patients more susceptible to fungal infection, said ICMR.

“Sending appropriate cultures, use of biomarkers such as procalcitonin and galactomannan and antibiotic time-out at 48 hours of prescription can help in reducing unnecessary antibiotic prescriptions.

Following these simple but effective measures can lead to reduced opportunities for antimicrobial prescriptions and reduce empirical prescriptions, leading to better outcomes for containment of antimicrobial resistance during this pandemic,” the report added.

According to the study, there is an urgent need to improve infection control practices in hospitals and rationalise antibiotic prescriptions. Prevalence of bacterial and fungal super-infections in hospitalised Indian patients with Covid-19 is low, but when such infections are present, they cause severe diseases with worst outcomes, as most super-infections are caused by drug-resistant pathogens.