Blog / Focus: Infection Control

Antibiotic resistant co-infections: A silent killer in COVID-19 patients

By Oliver Schacht / Special to Healthcare Facilities Today
May 12, 2020

The COVID-19 pandemic in the U.S. is nearing its expected peak, yet the number of critical cases and the mortality rate continue to rise. People that suffer from pandemic viruses such as COVID-19 are more prone to secondary bacterial and fungal infections. A recent study found that an estimated one-in-seven hospitalized COVID-19 patients develop secondary infections, such as pneumonia, many of whom are already classified as high-risk.  Hospitals and healthcare facilities are making great strides to slow the curve and lower the transmission rate to protect patients from these threats. Effective treatment strategies that rely on innovative diagnostics to guide therapy decisions and antibiotic use are crucial in the management of these patients.

New WHO guidelines on the clinical management of COVID-19 point out that dual infections with other respiratory bacterial infections have been found in COVID-19 patients and the most common diagnosis in severe COVID-19 patients is severe pneumonia. As such, both the WHO and IDSA guidelines for managing COVID-19 recommend empiric treatment with antibiotics in this high-risk population. They further note that antibiotics should be deescalated as quickly as possible based on microbiology testing results and patients’ clinical status. With a pandemic on a scale of COVID-19, experts have predicted that the increased use of antibiotics during this time could advance a new challenge that the world is already familiar with – antibiotic resistant superbugs.  

Rapid diagnostics can and should be a critical component of any outbreak response, helping medical professionals better understand a patient’s infection and guide the appropriate use of antibiotic resources to prevent the rise of drug-resistant secondary infections. Combining these diagnostics with broader testing panels, hospitals and healthcare professionals will be able to help prevent the spread of COVID-19 and antibiotic resistance and thereby improve antibiotic stewardship.

Precise identification of co-infections

Co-infections are a common occurrence in hospitalized patients that are severely ill, elderly, and immunocompromised. In U.S. hospitals alone, the CDC estimates that hospital acquired infections (HAIs) account for 1.7 million infections and 99,000 deaths each year, with 15 percent of these infections being in the lungs. These patients, who are already in a higher risk group for COVID-19 also fear developing infectious diseases such as bacterial pneumonia, pneumocystis pneumonia (PCP), or sepsis.

To best treat patients and minimize transmission risks, healthcare professionals need to accurately diagnose a patient and know exactly what infections they’re up against. For example, it is extremely difficult to differentiate PCP from COVID-19 as they present many of the same clinical symptoms in high-risk patient populations. Furthermore, routine workup such as imaging technology and the microbiological detection of pneumocystis cysts or trophozoites in respiratory specimens are limited in their diagnostic effectiveness and can lead to a misdiagnosis, delay in accurate treatment and the continued spread of superbugs among hospitalized patients.

Knowing what an infection is not is just as important as knowing what it is to ensure fast and effective treatment. Hospitals need access to rapid diagnostic technologies with broader testing capabilities, beyond focusing exclusively on COVID-19 to more precisely hone in on what is causing a patient’s symptoms to better enable targeted appropriate antibiotic treatment. While many COVID-19 test kits are emerging, hospitals should also consider incorporating FDA-cleared rapid diagnostic testing panels that identify bacterial pathogens and antibiotic-resistance markers into their treatment and response efforts for patients in whom these diagnostic tools can be lifesaving. 

Stopping the spread of superbugs

Antibiotic-resistant superinfections, or “superbugs,” as we in the U.S. have come to know them, are a growing concern among COVID-19 patients. A recent study of SARS-CoV-2-infected adults admitted to Wuhan, China hospitals found that 10%-20% of patients developed superinfections during treatment.

As the WHO encourages hospitals to take faster action, an increase in drug-resistant secondary infections is expected to follow, making the treatment of these infections more difficult, potentially contributing further to the mortality of the COVID-19 pandemic, and creating another fast-spreading concern for healthcare facilities. The U.S. has not yet provided numbers of antibiotic prescription rates for COVID-19 but in China,  80%-100% of hospitalized patients with severe COVID-19 were treated with antibiotics.

This is on top of the already staggering statistics that the CDC published a few months ago noting that an estimated 3 million people in the U.S. get an antibiotic-resistance infection each year and every 15 minutes someone dies from antibiotic resistance causes.

Innovations in rapid molecular diagnostic panels have made it possible to test for bacterial infections and their associated antibiotic resistance in a matter of hours instead of days, empowering medical professionals to make informed decisions around patient treatment and antibiotic use. These technologies not only enhance antibiotic stewardship, they also lower the risk of super-spreading drug-resistant infections at a time when healthcare professionals already have enough to worry about with infection-control. Healthcare facilities can identify, isolate and treat patients with drug-resistant co-infections to prevent transmission and shorten time spent in the ICU.

Hospitals are trying to keep pace with COVID-19 and the resulting drug-resistant secondary bacterial infections. Rapid diagnostic panels with testing capabilities for a broader range of bacteria and antibiotic resistance markers can aid to effectively diagnose and treat hospitalized patients, and help guide effective treatment and antibiotic stewardship during a time where we need to act fast to stop the spread. 

Oliver Schacht is the CEO of OpGen, Inc.

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