The microbiology lab at the Ernakulam General Hospital has been working to help diagnose secondary infections in COVID patients, and determine patterns of drug-resistance.
Out of a total of 438 samples collected from COVID hospitals, 39 samples were found to be carbapenem (a class of antibiotics) resistant, which means that these infections were sensitive only to antibiotics used as a last resort, such as colistin. A total of 11 fungal infections were also diagnosed in the samples sent to the lab from September 2020 till April this year.
The lab has been receiving samples from patients at COVID care centres to diagnose infections, said Dr. Sivaprasad P.S., district nodal officer for the antimicrobial resistance (AMR) programme. From PVS Hospital, a tertiary care facility for COVID patients, 186 blood cultures were received at the lab. Of these, 33 blood cultures were found to be positive. A positive blood culture indicates an infection. Samples were also collected from the Palluruthy and Fort Kochi taluk hospitals, and the District Hospital at Aluva.
Cultures of blood, pus, urine, sputum, or cerebrospinal fluid are sent to the lab. Depending on the sensitivity pattern of the culture, precise antibiotics can be prescribed, since unwarranted use can lead to resistance, Dr. Sivaprasad said.
Sepsis management and AMR surveillance in the district function on a unique ‘hub-and-spoke’ model, with the GH lab being the ‘hub’ that collects and tests samples from 15 government hospitals that are the ‘spokes’, thus avoiding the need for separate, expensive laboratories at each of these hospitals.
The lab receives 40 to 50 samples daily, and COVID hospitals have also begun sending suspected mucormycosis samples, Dr. Sivaprasad said. COVID patients can develop secondary infections and early identification of these is crucial, he said.
Severe COVID patients admitted in ICUs could be on immunosuppressants that make them vulnerable to bacterial super-infections, said Dr. Aravind R., head of the Infectious Disease Department, Government Medical College, Thiruvananthapuram. Infection control measures are likely to have taken a hit since there has been a surge in cases, and there are chances of bacterial infections. “High-end antibiotics might be prescribed to cover for lapses in infection control. This could drive up drug-resistant infections. This is what is happening across the world, and Kerala might not be any exception to this,” he said.
The use of antibiotics should be culture-guided, Dr. Aravind said. But in the COVID scenario, labs are overwhelmed, and antibiotics are administered without taking a culture. Broad-spectrum antibiotics could kill useful bacteria that keep fungal growth in check. Misuse of antibiotics could then lead to invasive fungal infections, he said.
The District Medical Officer had issued an order in April indicating that the district microbiology lab for the AMR programme at the General Hospital may receive samples from COVID treatment centres and work round-the-clock for “better results in COVID treatment outcome.”
