When a COVID-19 patient enters a hospital for care, the virus itself is not the only risk to their health. Upon admission, an individual’s chances of acquiring a deadly secondary bacterial infection or drug-resistant pathogen skyrocket. Among general patient populations, it’s estimated that only 8% of patients present with a co-infection at the time of admission, but the longer a patient stays in an intensive care unit (ICU) or undergoes ventilation, the more vulnerable they are to contracting other infectious diseases. In fact, initial data from a study of COVID-19 patients in the ICU performed by Sweden’s Karolinska Institutet revealed a sharp increase compared to infection rates at admission – bacterial co-infections were found in 25% of these individuals.
Doctors and healthcare administrators need to be aware of the risk bacterial and fungal co-infections pose to their COVID-19 patients that are hospitalised and the safety of their facilities as a whole. Not only are they deadly – secondary bacterial infections were co-indicated in 50% of fatalities in hospitalized COVID-19 patients – they are highly-infectious and can spread rapidly between individuals, particularly if the infection is left undetected or improperly treated in the original patient. Traditional microbiological culture testing, while effective and reliable for diagnosing patients under normal circumstances, is not an adequate solution during an outbreak situation when doctors cannot afford to wait days for results.
The COVID-19 pandemic has highlighted the need for a comprehensive and fast solution to close this care gap and provide the best possible outcomes for patients. This might seem like a tall order, particularly at a time when most hospitals are prioritising virus treatment first and foremost. However, readily available diagnostic panels offer a quick and reliable solution that can be ramped up for use during a fast-moving outbreak as well as incorporated into a facility’s everyday procedures and best practices. These platforms require just minutes of hands-on time and deliver results in a couple of hours. By running patient samples through rapid multiplex PCR panels whenever a bacterial or fungal infection is suspected, healthcare workers can identify secondary infections, gain valuable treatment insights and slow the spread of drug-resistant pathogens among COVID-19 patients.
Beware the 'super spreaders'
During the SARS I outbreak in 2003,76% of infections were acquired in healthcare facilities. Hospitalised patients who were found to have co-infections, includingKlebsiella pneumoniae, Acinetobacter baumannii andEscherichia coli, were often the culprits of this super spread. By some estimates, a single patient could be responsible for infecting at least 10 additional individuals. In fact, during a single outbreak of 206 individuals in Singapore,two co-infected patients were found to have caused 30% of probable SARS cases.
We’re always learning from past outbreaks and facilities around the world have stepped up their infection control practices in the face of the COVID-19 pandemic. However, hospital settings will always be vulnerable to viral and bacterial transmission, particularly when an ICU is at capacity and infected individuals are all being treated by the same staff. This risk goes beyond the original COVID-19 virus – a patient’s likelihood of exposure to bacterial pneumonia, a fungal infection withCandida aurisand other common nosocomial pathogens is compounded by widespread use of invasive medical devices, such as ventilators.
Faster results yield better outcomes and lower transmission rates
It is impossible to effectively treat a patient without a complete picture of their condition. COVID-19 can present itself in a number of ways, some which can be mistaken for other diseases. When faced with a SARS CoV2-positive individual, doctors must determine when they were exposed and infected, gauge what impact the virus may have already had on their respiratory system and identify any preexisting conditions. For this reason alone, broader diagnostics should be utilised upon admission to help understand the scope of the patient’s condition. But it’s not enough to determine if the individual is CoV2-positive; other infections or underlying causes must be revealed as quickly as possible so doctors can craft a comprehensive and effective treatment plan. Diagnostic testing should not be a one-time occurrence, either. Testing should be performed throughout a patient’s stay to monitor for any infections or antimicrobial-resistant (AMR) pathogens they might acquire during treatment.
When a patient is found to have contracted a drug-resistant bacterial infection, every hour counts – for that patient and for everyone they come into contact with. By deploying fast and comprehensive diagnostic panels for specific bacterial and fungal pathogens and antibiotic resistance markers, a facility can spot threats faster and act on them to lower its transmission risk. These platforms deliver sample-to-answer results within a rapid timeframe that commonly-used microbiological culture methods cannot match – with some panels, complete results can be available in just five hours, compared to several days for traditional methods. If a facility is running all its patient samples through a rapid multiplex diagnostic panel, healthcare professionals can know sooner which patients under their care have deadly bacterial or fungal infections and act accordingly to isolate those individuals and slow the spread.
The right drug for the right bug
Rapid diagnostic panels encourage doctors to wait for a complete diagnosis before proceeding with treatment. Antibiotic stewardship should be at the forefront of healthcare professionals’ and administrators’ minds, even during a fast-moving pandemic situation like COVID-19. In up to 80% of ICU COVID cases, antibiotics are administered preventatively in an effort to treat potential infectious diseases, particularly when rapid diagnostic panels aren’t available. However, using broad spectrum antibiotics to treat for diseases that a patient may not have can contribute to, and compound, the problem of the growth of multidrug resistant superbugs, responsible for34,000 deaths and 2.8 million infections annually in the US.
Rather than treating a patient empirically with a course of antibiotics during the days and hours it takes for results to come in and potentially exacerbating a drug-resistant pathogen, healthcare professional should look to multiplex PCR diagnostic panels to take the guesswork out of treatment. What’s more, these tests only require a few minutes of hands-on time, meaning more tests can be run each day. By receiving quick and comprehensive results for more patients undergoing care, doctors can deliver same-day treatment is catered to each patient’s results and medical history. This treatment plan encourages more strategic use of both broad-spectrum and reserve antibiotics at a time when preserving antibiotic resources is crucial. This approach will likely also help improve individual patient outcomes across the board while lowering a facility’s risk of a secondary superbug outbreak.
Patients being admitted to the hospital for COVID-19 treatment should not have to grapple with a second deadly disease at the same time. While secondary co-infections aren’t considered a risk for patients outside the hospital, they can strike when a hospitalised patient is most vulnerable and silently spread to others in the same facility. As doctors race against the clock to diagnose and treat these individuals, rapid diagnostic panels can offer a crucial assist. By providing a high level of sensitivity and specificity and delivering results on most common pathogens and drug-resistant strains in a fraction of the time, rapid multiplex PCR panels have emerged as a crucial missing link during COVID care. By introducing these platforms into their facilities, doctors can gain a more complete understanding of a patient’s condition and act faster and more confidently when treating COVID-19 patients.
Oliver Schacht is chief executive of informatics and genomic analysis company OpGen Inc