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Risk Factors and Outcomes of Hospitalized Patients With Severe Coronavirus Disease 2019 (COVID-19) and Secondary
Pinki J Bhatt1,2, Stephanie Shiau3, Luigi Brunetti2
1Division of Allergy/Immunology and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Insights
Secondary bloodstream infections (sBSIs) in severe COVID-19 patients are linked to worse outcomes. Bacterial and fungal sBSIs occurred in 128 patients, increasing mortality risk and ICU admission.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Coronavirus disease 2019 (COVID-19) is a global pandemic.
- Secondary bloodstream infections (sBSIs) in severe COVID-19 patients require further investigation.
- Limited data exists on the microbiology, risk factors, and outcomes of sBSIs in severe COVID-19.
Purpose of the Study:
- To describe the microbiology, risk factors, and outcomes of secondary bloodstream infections (sBSIs) in hospitalized patients with severe COVID-19.
- To compare characteristics and outcomes between severe COVID-19 patients with and without sBSIs.
Main Methods:
- Multicenter case-control study.
- Inclusion of hospitalized patients with severe COVID-19 and blood cultures drawn between March 1 and May 7, 2020.
- Comparison of demographics, clinical and microbiologic variables, and outcomes between sBSI cases and controls.
Main Results:
- 128 secondary bloodstream infections (sBSIs) were identified among 375 severe COVID-19 patients.
- Bacterial infections predominated (91.4%), followed by fungal infections (5.5%).
- Patients with sBSIs had more severe presentations, higher ICU admission rates, and significantly increased in-hospital mortality (53.1% vs. 32.8%).
Conclusions:
- Hospitalized adults with severe COVID-19 and sBSIs experience more severe illness and worse outcomes.
- Further prospective studies are needed to identify risk factors and develop predictive models for sBSIs.
- Antimicrobial stewardship principles should guide the empirical treatment decisions for sBSIs in severe COVID-19.
Background:
Coronavirus disease 2019 (COVID-19) has become a global pandemic. Clinical characteristics regarding secondary infections in patients with COVID-19 have been reported, but detailed microbiology, risk factors, and outcomes of secondary bloodstream infections (sBSIs) in patients with severe COVID-19 have not been well described.
Methods:
We performed a multicenter case-control study including all hospitalized patients diagnosed with severe COVID-19 and blood cultures drawn from 1 March 2020 to 7 May 2020 at 3 academic medical centers in New Jersey. Data collection included demographics, clinical and microbiologic variables, and patient outcomes. Risk factors and outcomes were compared between cases (sBSI) and controls (no sBSI).
Results:
A total of 375 hospitalized patients were included. There were 128 sBSIs during the hospitalization. For the first set of positive blood cultures, 117 (91.4%) were bacterial and 7 (5.5%) were fungal. Those with sBSI were more likely to have altered mental status, lower mean percentage oxygen saturation on room air, have septic shock, and be admitted to the intensive care unit compared with controls. In-hospital mortality was higher in those with an sBSI versus controls (53.1% vs 32.8%, P = .0001).
Conclusions:
We observed that hospitalized adult patients with severe COVID-19 and sBSI had a more severe initial presentation, prolonged hospital course, and worse clinical outcomes. To maintain antimicrobial stewardship principles, further prospective studies are necessary to better characterize risk factors and prediction modeling to better understand when to suspect and empirically treat for sBSIs in severe COVID-19.
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