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Diagnostic significance of secondary bacteremia in patients with COVID-19
Kensuke Nakagawara1, Hirofumi Kamata1, Shotaro Chubachi1
1Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Insights
Secondary bacterial infections, particularly bacteremia, significantly increase mortality in hospitalized COVID-19 patients. Early detection and management are crucial for improving outcomes in these vulnerable individuals.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Coronavirus disease 2019 (COVID-19) can lead to severe complications beyond respiratory issues.
- Secondary bacterial and fungal infections are increasingly recognized in hospitalized COVID-19 patients.
- Understanding the impact of non-respiratory infections on COVID-19 outcomes is critical for patient management.
Purpose of the Study:
- To investigate the incidence and types of non-respiratory bacterial and fungal secondary infections in COVID-19 patients.
- To identify causative organisms and assess their impact on clinical outcomes, including mortality.
- To determine the association between specific secondary pathogens and mortality risk in hospitalized COVID-19 cases.
Main Methods:
- Retrospective cohort study utilizing data from multiple centers in the Japan COVID-19 Taskforce (April 2020 - May 2021).
- Inclusion of hospitalized patients diagnosed with COVID-19.
- Collection and analysis of demographic, epidemiological, and microbiological data, focusing on non-respiratory bacterial infections.
Main Results:
- Non-respiratory bacterial infections occurred in 4.2% of 1914 COVID-19 patients; 3.1% were secondary infections.
- Bacteremia was the most frequent (55.9%), followed by urinary tract infections (27.1%). Staphylococcus epidermidis was a common cause of bacteremia.
- Patients with secondary bacterial infections had significantly higher mortality; bacteremia increased mortality risk 15.3-fold. Risk factors for nosocomial bacteremia included age, male sex, steroid use, and ICU admission.
Conclusions:
- Secondary bacteremia is a significant complication associated with poor prognosis in COVID-19 patients.
- An effective medical management strategy is essential, particularly for patients with predisposing factors.
- Further research into preventative and therapeutic interventions for secondary infections in COVID-19 is warranted.
Objectives:
We investigated the occurrence of non-respiratory bacterial and fungal secondary infections, causative organisms, impact on clinical outcomes, and association between the secondary pathogens and mortality in hospitalized patients with coronavirus disease 2019 (COVID-19).
Methods:
This was a retrospective cohort study that included data from inpatients with COVID-19 from multiple centers participating in the Japan COVID-19 Taskforce (April 2020 to May 2021). We obtained demographic, epidemiological, and microbiological data throughout the course of hospitalization and analyzed the cases of COVID-19 complicated by non-respiratory bacterial infections.
Results:
Of the 1914 patients included, non-respiratory bacterial infections with COVID-19 were diagnosed in 81 patients (4.2%). Of these, 59 (3.1%) were secondary infections. Bacteremia was the most frequent bacterial infection, occurring in 33 cases (55.9%), followed by urinary tract infections in 16 cases (27.1%). Staphylococcus epidermidis was the most common causative organism of bacteremia. Patients with COVID-19 with non-respiratory secondary bacterial infections had significantly higher mortality, and a multivariate logistic regression analysis demonstrated that those with bacteremia (aOdds Ratio = 15.3 [5.97-39.1]) were at higher risk of death. Multivariate logistic regression analysis showed that age, male sex, use of steroids to treat COVID-19, and intensive care unit admission increased the risk for nosocomial bacteremia.
Conclusions:
Secondary bacteremia is an important complication that may lead to poor prognosis in cases with COVID-19. An appropriate medical management strategy must be established, especially for patients with concomitant predisposing factors.
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