15 Jan Rapid Test Identifies Secondary Pneumonia infections in COVID-19 Patients
MedicalResearch.com Interview with:
Dr Andrew Conway Morris
Wellcome Trust Clinical Research Career Development Fellow
University of Cambridge
Hon Consultant in Intensive Care Medicine
Addenbrookes Hospital, Cambridge
MedicalResearch.com: What is the background for this study?
Response: Patients with COVID-19 frequently need to come to the intensive care unit (ICU), where we use mechanical ventilation to support their lungs as they get over the intense inflammation caused by the virus. During the first wave of the virus we noted that a lot of our patients appeared to be developing secondary infections (infections they didn’t have when they came into the ICU).
We therefore rolled out a rapid diagnostic test for these secondary bacterial infections that we had developed previously, and this study reports the use of this diagnostic and also describes the types of bacteria seen. To see if the increase in secondary infections was due to COVID specifically, we compared them to patients who were managed in the same ICU but who did not have COVID.
MedicalResearch.com: What are the main findings? What type of bacteria are screened for?
Response: The main findings were that patients with COVID had twice the rate of secondary pneumonia compared to patients without COVID, and that this was not simply because they needed longer on a ventilator. We found that the bacteria identified were similar between patients with and without COVID-19, which suggests that standard ICU antibiotic protocols can be applied. However we did find an increase in fungal infections amongst patients with COVID, and suggest that doctors should be especially vigilant for these infections. Our diagnostic test covers 52 lung pathogens, including viral, bacterial and fungal organisms, it is designed to be used in a wide range of pneumonia presentations, including both ‘community-acquired’ pneumonia as well as ‘ventilator-associated pneumonia/secondary pneumonia’. We have previously shown that use of our diagnostic test could substantially reduce antibiotic exposure in ICU whilst ensuring treatments were appropriately targeted.
MedicalResearch.com: What should readers take away from your report?
Response: Patients who need ventilated for COVID are at high risk of secondary infection. Close attention should be paid to preventative strategies in ICU to limit this, and clinicians should be aware of secondary pneumonia developing. Standard approaches to treatment of secondary pneumonia are appropriate, although if these are not working it is important to rule out fungal infections. Our rapid diagnostic performed well, and allowed rapid return of results to clinicians.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further work is required to identify why patients with COVID have this heightened susceptibility to infection, and whether treatments which can restore immune cell antibacterial infection may be of benefit. The use of rapid diagnostics, such as the one we have developed, need to be evaluated in other ICUs to see if the effects and benefits we have seen can be replicated in other centres.
MedicalResearch.com: Is there anything else you would like to add?
Response: This work arose from a close collaboration between the NHS (Cambridge University Hospitals), University and Public Health England, combining the expertise of ICU consultants, microbiology researchers and diagnostic laboratory specialists. This is an important comparison of patients with and without COVID, and undertaking such comparisons is key to understanding how much of the effects of severe COVID are specific to this novel virus, and how much relates to the common complications seen in critical illness more generally.
We have no conflicts of interest, the work was funded by the NIHR Cambridge Biomedical Research Centre and I am funded by the Wellcome Trust.
Maes, M., Higginson, E., Pereira-Dias, J. et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care 25, 25 (2021). https://doi.org/10.1186/s13054-021-03460-5
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