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Delayed treatment of bacteremia during the COVID-19 pandemic
Taiju Miyagami1, Yuki Uehara1,2, Taku Harada3,4
1Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
Insights
The COVID-19 pandemic caused delays in bacteremia diagnosis and treatment. Increased use of CT scans for COVID-19 exclusion prolonged antimicrobial administration times in 2020 compared to 2019.
Area of Science:
- Infectious Diseases
- Medical Diagnostics
- Public Health Emergencies
Background:
- The COVID-19 pandemic led to a phenomenon known as "COVID-19 blindness," where excessive focus on the disease potentially delayed diagnoses of other conditions.
- Bacteremia, a serious bloodstream infection, requires timely diagnosis and treatment to prevent severe outcomes.
Purpose of the Study:
- To compare clinical measures for bacteremia patients during the COVID-19 pandemic (2020) versus the pre-pandemic period (2019).
- To investigate if the pandemic influenced the timeliness of bacteremia diagnosis and treatment.
Main Methods:
- A retrospective observational study comparing patients with bacteremia admitted to two hospitals.
- Data collected from March 1 to May 31, 2020 (pandemic period) and March 1 to May 31, 2019 (pre-pandemic period).
- Primary outcome: time from patient consultation to antimicrobial administration.
Main Results:
- Patients in 2020 experienced significantly longer times from consultation to antimicrobial administration (222 min) compared to 2019 (139 min).
- The frequency of chest computed tomography (CT) scans was higher in 2020 (96.6%) than in 2019 (73.1%).
- No significant difference was found in the time to blood culture or chest CT preceding blood culture.
Conclusions:
- The focus on excluding COVID-19, particularly with CT scans, contributed to delays in diagnosing and treating bacteremia during the pandemic.
- Healthcare providers should be vigilant about "COVID-19 blindness" and maintain objective patient evaluations to ensure timely management of other critical conditions.
Objectives:
Coronavirus disease (COVID-19) blindness, that is, the excessive consideration of the disease in diagnosis, has reportedly led to delayed diagnosis of some diseases. We compared several clinical measures between patients admitted for bacteremia during the two months of the COVID-19 pandemic and those admitted during the same period in 2019. We hypothesized that the pandemic has led to delayed treatment of bacteremia.
Methods:
This retrospective observational study compared several measures undertaken for patients who visited the emergency unit in two hospitals between March 1 and May 31, 2020, during the COVID-19 pandemic and whose blood cultures tested positive for bacteremia with those for corresponding patients treated during the same period in 2019. The primary measure was time from consultation to blood culture/antimicrobials.
Results:
We included 29 eligible patients from 2020 and 26 from 2019. In 2020, the time from consultation to antimicrobial administration was significantly longer than in 2019 (mean [range], 222 [145-309] min vs. 139 [102-179] min, p=0.002). The frequency of chest computed tomography (CT) was significantly higher in 2020 (96.6 vs. 73.1%, p=0.021). Significant differences were not observed in the time to blood culture or chest CT preceding the blood culture between the two periods.
Conclusions:
Our findings suggested that due to the COVID-19 epidemic/pandemic, focusing on the exclusion of its infection using CT scans leads to an overall delay in the diagnosis and treatment of bacteremia. Medical providers must be aware of COVID-19 blindness and evaluate patients objectively based on rational criteria and take appropriate action.
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