Secondary bacterial or fungal co-infections in COVID-19 patients have received inadequate attention from the public. For most, co-infections pose little to no risk according to reports that an estimated 8% of patients are found to experience this during hospital admission – a relatively low number compared to the global impact of the virus. However, once a patient enters a hospital for care or becomes ventilated while in the ICU, the risk for acquiring and spreading a deadly secondary bacterial or fungal infection drastically increases and patients have to battle for their life with not one, but two potentially fatal diseases.
Preliminary results from a study performed by the Karolinska Institutet in Stockholm, Sweden found that 25% of hospitalized COVID-19 patients in the ICU have a bacterial co-infection. Similarly, other studies have reported that patients hospitalized with COVID-19 have acquired a dangerous secondary bacterial infection, and 50% of patients who have died had such infections. Consequently, these infections become just as significant a threat as the virus itself once a patient enters the hospital. Hospitals have an inherent responsibility to not only slow the spread of COVID-19 but also to diligently diagnose and treat these secondary infections.
As doctors prioritize the identification and treatment of COVID-19, instances of patients ‘super spreading’ bacterial or fungal infections through hospitals reveal a dangerous gap in our healthcare system’s ability to quickly and precisely identify these other infectious diseases. To adequately evaluate COVID-positive individuals under their care and fill this gap, hospitals should be aware of the availability of rapid multiplex PCR diagnostic panels for lower respiratory tract infections such as pneumonia and deploy them as part of the diagnostic assessment of patients in whom bacterial or fungal infections are suspected.
The Need for Rapid yet Comprehensive Diagnostics
Hospitals are already in a fight against time when patients are admitted for COVID-19. Doctors have to quickly determine how long the patient has had the virus, what the impact is on their respiratory system and what other diseases they may be battling in order to create a strategic treatment plan customized to each patient. Complicating diagnosis and treatment even further, COVID-19 patients can be exposed to dangerous and sometimes drug-resistant bacterial and fungal co-infections during any step in the treatment process. From the use of ventilators to their close proximity to infected individuals being treated by the same staff, the risk is heightened the longer a patient’s stay.
Fast identification of specific pathogens and antibiotic resistance markers benefits hospitals in two specific ways – First, it provides a clearer view of a patient’s health for a more precise and customized treatment. In knowing which antibiotics a patient has developed a resistance to or understanding the select pathogen strain within a patient’s system, doctors can more strategically administer customized treatment and preserve limited antibiotic resources.
The second and most important benefit is enhanced infection control by minimizing the transmission risk, or “super spread” of bacterial and fungal infections, such as pneumonia, C. Auris, and more. Super spreading is not new, in fact, a study observing the SARS I outbreak in 2003 found that 76% of SARS-CoV infections were acquired in healthcare facilities, and hospitalized patients with bacterial co-infections were sources of super-spreading. In some cases, one single patient could infect more than 10 additional persons.
Historically, traditional microbiological culture has been the most reliable option for testing, offering a high degree of specificity with pathogens. These cultures, while effective, can take days or even weeks to return full results – time that doctors and patients alike do not have. During that time, empiric and preventative use of frontline antibiotics in these patients without any diagnostic insight can exacerbate the issue. To adequately treat COVID-positive individuals under their care, healthcare facilities should consider the use of rapid multiplex PCR diagnostic panels capable of detecting common AMR pathogens in order to provide earlier and more targeted antibiotic treatment insights in just a few hours instead of days.
Broader Diagnostics Help Create a Treatment Roadmap
Innovation in the diagnostics space for common COVID-19 secondary infections like pneumonia has proven to be effective. The available technologies have been able to quickly identify, with a high degree of sensitivity and specificity, a comprehensively broad range of pathogens and antibiotic resistance markers all in approximately five hours with only two minutes of hands-on time needed. Using this data, doctors are able to create an antibiotic treatment roadmap that is more effective for patients to reduce the risk before super spreading occurs.
As doctors create this roadmap, antibiotic use and stewardship must be delicately balanced with rapid testing and treatment. In cases without rapid diagnostic panels capable of identifying AMR markers, doctors have to decide whether or not to use broad-spectrum antibiotics as a preventative action to stop or slow the spread of infections in patients – a route chosen in up to 80% of all COVID-19 patients on ICUs.
This overuse has contributed to the growth of antibiotic-resistant “superbugs” which cause more than 2.8 million infections and 35,000 deaths in the United States each year. Advancements in available FDA-cleared rapid multiplex PCR diagnostic panels are encouraging antibiotic stewardship and guiding treatment to help determine if and when antibiotics are necessary. Doctors don’t need to delay treatment for diagnostic results or move forward with broad-spectrum antibiotics; they can identify and provide effective treatment on the same day. Additionally, with only a couple of minutes of hands-on time to perform such tests, more tests can be processed and more roadmaps for recovery can be created to stop the spread of drug-resistant co-infections.
Secondary co-infections in COVID-19 patients may carry a low risk outside the hospital, but once admitted, rapid diagnostics become the frontline defense to protect patients against these life-threatening diseases. With high levels of specificity for both pathogens and antibiotic resistance markers, and testing capabilities in mere hours instead of days, hospitals stand to benefit from incorporating rapid multiplex diagnostic panels into their care practices for hospitalized COVID-19 patients. Only in doing so, can they fill this gap in the care for secondary bacterial co-infections.
About Oliver Schacht
Oliver Schacht is the CEO of OpGen, Inc., a pioneering informatics and genomic analysis company providing complete solutions for patient, hospital, and network-wide infection prevention and treatment.