SCIENTIFIC INFORMATION

COVID 19 disease is caused by Severe Acute Respiratory Syndrome Related – Coronavirus 2 (SARS-CoV2), a new virus emergent in Wuhan China in December 2019 and the cause of the on- going pandemic. COVID 19 disease is associated with suppression of neutrophil, lymphocyte, macrophage and monocyte functions. This coupled with the use of immunomodulatory agents like corticosteroids and Interleukin 6 inhibitors further leads to immunosuppression eventually predisposing the patients to a variety of superinfections especially in those that are critically ill.

While these infections increase the cost of therapy, length of stay , morbidity and mortality, they also pose a threat to antimicrobial stewardship efforts due to the rampant and broad spectrum use of antimicrobial agents. A large scale multicentric study of hospitalized patients from India identified the predominance of Gram negative bacteria with high rates of resistance to antimicrobial agents like carbapenems causing secondary infections. These infections were associated with approximately 10% mortality. Similarly , fungal infections like invasive candidiasis, aspergillosis and mucormycosis were also reported in large numbers with high rates of mortality.

Microbiology has a very important role to play in the management of superinfections in COVID 19. It supports clinical management, infection prevention and control as well as antimicrobial stewardship programs. Blood cultures and site specific cultures remain the gold standard for detection of bacteria. Multiplex syndromic approach PCRs play an important role in the rapid diagnosis of atypical or non-cultivable organisms. Biomarkers like procalcitonin, galactomannan, Beta-D Glucan, antigen detection tests are also significant for diagnosis and prognosis of these infections. Serial procalcitonin estimation particularly has been particularly used to support antimicrobial stewardship activities like de-escalation of antimicrobial agents.

This talk will highlight the Indian perspective of superinfections, associated risk factors and the role of microbiology laboratories in managing these infections in bringing better patient outcomes.

Leong Hoe Nam is currently Infectious Diseases Physician at Mount Elizabeth Novena Hospital, Singapore. He graduated from National University of Singapore in 1996, and obtained his MRCP and M Med in 2001.
Dr Leong is involved in the management of complex infectious diseases such as tuberculosis, HIV and surgical complications, particularly in transplant patients and patients with multi-drug resistant microbial infections. He also has first-hand experience in managing infectious disease outbreaks including SARS and H1N1, and has published several papers in virology.

Murat Akova is Professor of Medicine with the Department of Infectious Diseases at Hacettepe University School of Medicine in Ankara, Turkey. He is President of the Turkish Febrile Neutropenia Society, and Past President of the European Society of Clinical Microbiology and Infectious Diseases and Turkish Clinical Research Association.
Professor Akova is also Editor-in-Chief for Infectious Diseases and Clinical Microbiology, Associate Editor for Frontiers in Medicine, and Scientific Committee Member for Clinical Microbiology and Infectious Diseases. His research interests are on antimicrobial resistance and infections in immunocompromised patients, and he has published extensively in numerous peer-reviewed journals and book chapters.

Chia-Ying Liu is Head of Physician Hospitalist Inpatient Division and Attending Physician of the Infectious Diseases Division at Far Eastern Memorial Hospital, Taiwan. Dr Liu is also Adjunct Lecturer at National Taiwan University College of Medicine and Assistant Professor at Far Eastern Memorial Hospital.

Dr Liu received his MD from National Taiwan University College of Medicine and MPH in Quantitative Methods from Harvard School of Public Health, USA. He has contributed to numerous publications in the field of infectious diseases, with a focus on nosocomial infection control and surveillance.