Prevalence of secondary blood stream infections in patients with SARS- CoV-2 infection in a tertiary care hospital in Sri Lanka: A retrospective analysis

Introduction: Secondary infections are an important cause of morbidity and mortality related to SARS-CoV-2 infection. Early administration of effective antimicrobials improves patient outcome of such infections. In the present study, we investigated secondary blood stream infections (BSI) among COVID-19 patients in Colombo North Teaching Hospital, Sri Lanka (CNTH). Methods: This is a descriptive study, performed to analyse blood culture positive events retrospectively in patients hospitalized with COVID-19 in our institution from 1st June 2021 to 30th November 2021. Results: Of a total 434 blood cultures received from SARS-COV-2 positive patients, the overall blood culture positivity rate was 25.3 % (110/434) of which 11.7% (51/434) were clinically relevant bacteraemias. The contamination rate was 13.7% (59/434). Of the 60 isolates from clinically relevant bacteraemias, 60% (36/60) were Gram negative organisms, 31.7% (19/60) were Gram positive organisms and 8.3% (5/60) were Candida spp. The most prevalent isolates were Enterococcus spp. (20%; 12/60) and Acinetobacter spp. (15%; 9/60). Higher rates of multi drug resistance were observed among Gram negative isolates. The proportion of 3rd generation cephalosporins and ciprofloxacin resistance among enterobacterales was 81.3% and carbapenem resistance among Acinetobacter spp. was 77.8%. A primary focus of infection could be identified in only 18 blood stream infections (BSI). Conclusion: A high rate of significant BSIs was detected in this patient cohort. Blood culture contamination rate among COVID-19 patients was higher than the usual rates in the institution. A high number of bacteraemias due to Enterococcus spp. and Acinetobacter spp. were noted and overall antibiotic resistance among Gram negative organisms was high.