CC BY-NC-ND 4.0 · J Lab Physicians 2022; 14(03): 260-264
DOI: 10.1055/s-0041-1741438
Original Article

An Update on Secondary Bacterial and Fungal Infections and Their Antimicrobial Resistance Pattern (AMR) in COVID-19 Confirmed Patients

Sushma Yadav Boorgula
1   Department of Microbiology, AIG Hospitals, Hyderabad, Telangana, India
Sadhana Yelamanchili
1   Department of Microbiology, AIG Hospitals, Hyderabad, Telangana, India
Pragathi Kottapalli
1   Department of Microbiology, AIG Hospitals, Hyderabad, Telangana, India
Mohini D. Naga
1   Department of Microbiology, AIG Hospitals, Hyderabad, Telangana, India
› Author Affiliations


Introduction Since coronavirus disease 2019 (COVID-19) has limited treatment options, concern has been raised over secondary infections and antimicrobial resistance (AMR) patterns. It has been observed that patients who were infected with COVID-19 were predisposed to develop secondary infections. The purpose of the study is to ascertain the prevalence of the bacterial and fungal coinfections in COVID-19 patients, and also to assess the AMR patterns in the obtained isolates.

Methods We have studied 200 clinical samples obtained from 122 COVID-19 positive patients. Pathogens were identified using Vitek 2 system. The demographic and clinical patterns were also observed.

Results A total of 122 patients developed secondary infections. Patients aged more than 40 years were majorly affected (p-value < 0.0001). Respiratory samples (n = 96) were predominant. Klebsiella pneumoniae (n = 68) was the most common pathogen isolated followed by Acinetobacter baumannii (n = 54) and an overall 6% rise in the Carbapenem resistance was observed in the isolates.

Conclusion To contain the secondary infections in COVID-19 patients, it is imperative to adhere to antimicrobial stewardship program and timely revise the empirical antibiotic policy.

Publication History

Article published online:
10 January 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Zhu N, Zhang D, Wang W. et al; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382 (08) 727-733
  • 2 Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054-1062
  • 3 Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: challenges for global health governance. JAMA 2020; 323 (08) 709-710
  • 4 Huttner BD, Catho G, Pano-Pardo JR, Pulcini C, Schouten J. COVID-19: don't neglect antimicrobial stewardship principles!. Clin Microbiol Infect 2020; 26 (07) 808-810
  • 5 Cox MJ, Loman N, Bogaert D, O'Grady J. Co-infections: potentially lethal and unexplored in COVID-19. Lancet Microbe 2020; 1 (01) e11
  • 6 Parohan M, Yaghoubi S, Seraji A, Javanbakht MH, Sarraf P, Djalali M. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies. Aging Male 2020; 23 (05) 1416-1424
  • 7 Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis 2005; 41 (7, Suppl 7): S504-S512
  • 8 Weiss P, Murdoch DR. Clinical course and mortality risk of severe COVID-19. Lancet 2020; 395 (10229): 1014-1015
  • 9 Ejaz H, Alsrhani A, Zafar A. et al. COVID-19 and comorbidities: deleterious impact on infected patients. J Infect Public Health 2020; 13 (12) 1833-1839
  • 10 Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect 2020; 81 (02) 266-275
  • 11 Nori P, Cowman K, Chen V. et al. Bacterial and fungal coinfections in COVID-19 patients hospitalized during the New York City pandemic surge. Infect Control Hosp Epidemiol 2021; 42 (01) 84-88
  • 12 Zhang H, Zhang Y, Wu J. et al. Risks and features of secondary infections in severe and critical ill COVID-19 patients. Emerg Microbes Infect 2020; 9 (01) 1958-1964
  • 13 Chen N, Zhou M, Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507-513
  • 14 Khurana S, Singh P, Sharad N. et al. Profile of co-infections & secondary infections in COVID-19 patients at a dedicated COVID-19 facility of a tertiary care Indian hospital: implication on antimicrobial resistance. Indian J Med Microbiol 2021; 39 (02) 147-153