04.08.2020

COVID-19: risks caused by secondary infections

The potential risk caused by legionella and gram-negative germs

As the number of coronavirus cases continues to increase worldwide, a study suggests secondary infections pose a risk for COVID-19 patients. The observance and monitoring of the gram-negative microbe limits in drinking water in hospitals can play an important role in the containment of this potential for risk.

More than 18 million infected persons and over 680,000 deaths worldwide – these are the latest COVID-19 figures. This coronavirus-based disease, caused by the SARS-CoV-2 pathogen, initially broke out in December 2019 in Wuhan, China. The Robert Koch Institute has published a SARS-CoV-2 overview which states that about 14 percent of the verified infected persons show to have a severe and 5 percent a critical disease progression.

Mortality rate of 50 percent caused by secondary infection
The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in Switzerland describes in their ESGLI Guidance for Managing Legionella in Hospital Water Systems during the COVID-19 Pandemic a study from China (Zhou et al., 2020), which was published in The Lancet in March 2020. The study, a retrospective of cohorts with 191 patients, determined that 15 percent of COVID-19 patients had shown to have a secondary infection (28 of 191). Based on the overall mortality rate, 50 percent of the patients died due to a secondary infection.

Recommendations for infection prevention
The death rate for legionella infections acquired in clinics can increase to over 25 percent, while the number of infections acquired outside the clinical environment in Europe can lie at below 10 percent. To protect patients and personnel from infections acquired by waterborne pathogens such as legionella or Pseudomonas aeruginosa, it is essential, according to ESGLI, the ESCMID Study Group for Legionella Infections, that not only patients be examined for a potential COVID-19 infection, but also the water-bearing systems in hospitals on a regular basis in terms of their microbiological contamination. The adherence to valid water safety plans plays an important role in this case. The use of terminal filters should be considered when in doubt about the water quality. ESGLI concludes that the potential for risk caused by legionella and other gram-negative microbes is obviously underrated.

Over the last few years, a number of scientists have been concerned with the efficiency and effectiveness of point-of-use water filters for the reduction of nosocomial infections in hospitals. In the brochure Importance of water and gram-negative microbes in hygiene, we have compiled extensive information on the evidence of terminal sterile filters.

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