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Bloodstream infections in hospitalized adults with COVID-19: clinical characteristics and outcomes
Po-Hsuan Tseng1, Ling-Shan Syue2, Ching-Chi Lee3
1Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
Insights
Bloodstream infections (BSIs) in COVID-19 patients are linked to high mortality. Hospital-acquired BSIs pose a particular risk, underscoring the need for prompt diagnosis and targeted treatment.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Bloodstream infections (BSIs) are severe complications for hospitalized coronavirus disease 2019 (COVID-19) patients.
- BSIs can exacerbate clinical outcomes in COVID-19 patients.
Purpose of the Study:
- To evaluate the clinical characteristics and outcomes of COVID-19 patients with BSIs.
- To compare COVID-19 BSI patients with a matched cohort of non-COVID-19 BSI patients.
Main Methods:
- Retrospective cohort study at a tertiary medical center in southern Taiwan (January 2022–April 2023).
- Included adult patients hospitalized with concurrent COVID-19 and BSI.
- Propensity score matching (1:10) compared COVID-19 BSI patients with non-COVID-19 BSI patients (2017–2019).
Main Results:
- Among 104 COVID-19 patients with BSI, 26.0% died during hospitalization.
- Independent risk factors for mortality included male sex, diabetes mellitus, low Ct value at diagnosis, high Pitt bacteremia score, and hospital-onset BSI.
- Hospital-onset BSIs showed higher rates of resistant and polymicrobial infections. COVID-19 status was not independently associated with 30-day mortality after matching.
Conclusions:
- BSIs in COVID-19 patients are associated with significant in-hospital mortality.
- Hospital-acquired BSIs are particularly linked to increased mortality.
- Timely diagnosis, risk stratification, and targeted therapy are critical for managing BSIs in COVID-19 patients.
Background:
Bloodstream infections (BSIs) are serious complications in hospitalized coronavirus disease 2019 (COVID-19) patients and may have worsened clinical outcomes. We evaluated clinical characteristics and outcomes of COVID-19 patients with BSI and compared them to a matched non-COVID-19 BSI cohort.
Methods:
A retrospective cohort study was conducted at a tertiary medical center in southern Taiwan, and included adult patients hospitalized with concurrent COVID-19 and bloodstream infection (BSI) from January 2022 to April 2023. We compared survivors and non-survivors and assessed risk factors for in-hospital mortality. Propensity score matching (1:10) was used to compare COVID-19 BSI patients with non-COVID-19 BSI patients from 2017 to 2019.
Results:
Among 104 COVID-19 patients with BSI, 26.0 % died during hospitalization. Male sex (adjusted OR (aOR) 5.87, 95 % confidence interval (CI) 1.51-22.83, p = 0.011), diabetes mellitus (aOR 3.89, 95 % CI 1.07-14.21, p = 0.040), Ct value ≤ 20 at diagnosis (aOR 5.15, 95 % CI 1.06-24.98, p = 0.042), Pitt bacteremia score ≥4 (aOR 5.84, 95 % CI 1.48-23.01, p = 0.012), and hospital-onset BSI (aOR 19.45, 95 % CI 3.33-113.54, p < 0.001) were independently associated with mortality. Hospital-onset BSI cases had higher rates of resistant and polymicrobial infections. Compared to non-COVID-19 BSI patients, COVID-19 BSI cases had more primary BSI and higher inappropriate empirical therapy use, though COVID-19 status itself was not independently associated with 30-day mortality after matching.
Conclusions:
BSIs in COVID-19 patients are linked to high mortality, particularly in hospital-acquired infections. Timely diagnosis, risk stratification, and targeted therapy remain crucial.
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