Superinfections in COVID-19 Patients: Role of Antimicrobials

The coronavirus pandemic is a global health crisis of recent times and the biggest threat we have faced after the Second World War. This viral infection (COVID-19) is not the only cause of deaths in this pandemic. A usual complication of viral infections is a secondary superimposed bacterial infection or a superinfection. Based on limited published data, the relatively high incidence of severe infection and mortality in COVID-19 patients is attributed to these infections. It is reasonable to anticipate that nearly half of the patients who have died from COVID-19 had superinfection. Patients who have severe form of the disease and those requiring prolonged stay in intensive care units (ICUs) are more prone to developing super added infection by nosocomial pathogens. The most common type of infection observed among COVID-19 patients is ventilator-associated pneumonia (VAP), followed by bacteremia with sepsis and urinary tract infections (UTIs). Antibiotics are commonly prescribed to keep these infections at bay which is promoting antimicrobial resistance (AMR). In developing countries like India, where there is well-established high burden of multidrug-resistant organisms in hospital settings, superinfections in COVID-19 patients can pose a biggest challenge in the treatment leading to increase mortality. There is a need of prospective studies, which should include clinical, microbiological, and epidemiological data on superinfections that can be used in forming effective antimicrobial stewardship strategies; which can have a crucial role in optimal antimicrobial prescribing.