Administrative claims may provide an understanding of the clinical and economic burden of novel coronavirus disease 2019 . However, their limited sensitivity in identifying conditions, such as sepsis, 1 suggests the need to assess whether billing codes reliably capture COVID-19 discharges.A new diagnosis code for COVID-19 (International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] code U07.1) was introduced on April 1, 2020, to facilitate billing and case monitoring. 2 For discharges prior to April 1, 2020, the Centers for Disease Control and Prevention advised coding for the clinical syndrome (eg, pneumonia) and "other coronavirus as the cause of diseases classified elsewhere" (ICD-10-CM code B97.29). 3 We examined the uptake in COVID-19-specific coding (ICD-10-CM code U07.1), the transition from legacy coding, and the accuracy of the COVID-19-specific code using severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing as the reference standard.Methods | The Premier Healthcare Database, an administrative all-payer repository that covers approximately 20% of all US hospitalizations from 48 states, was queried for inpatient discharges between January 1, 2020, and May 31, 2020, with COVID-19-specific coding or legacy coding. Only hospitals that reported data for every week during the study period were included. A descriptive analysis was performed by week to ex-

The effect of surges in COVID-19 caseload on COVID-19 survival rates is unclear, especially independent of temporal changes in survival. This retrospective cohort study used data from a large U.S. hospital database to study the association between caseload surges and risk-adjusted mortality in patients with COVID-19.

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Background Trimethoprim-sulfamethoxazole (TMP/SMX) is considered first-line therapy for Stenotrophomonas maltophilia infections based on observational data from small studies. Levofloxacin has emerged as a popular alternative due to tolerability concerns related to TMP/SMX. Data comparing levofloxacin to TMP/SMX as targeted therapy are lacking. Methods Unique adult inpatient encounters between January 1 st 2005 and December 31 st 2017 with growth of S. maltophilia in blood and/or lower respiratory cultures (including as part of polymicrobial growth) were identified in the Cerner Healthfacts™ database. Patients receiving targeted therapy with either levofloxacin or TMP/SMX and without other S. maltophilia-active agents were included. Propensity-scores were generated and overlap weighting was used to balance groups and simulate randomization followed by downstream weighted regression. The primary outcome was adjusted odds ratio (aOR) for in-hospital mortality or discharge to hospice. The secondary outcome was number of days from index S. maltophilia culture to hospital discharge. Results Among 1,581 patients with S. maltophilia infections, 758 received TMP/SMX and 823 received Levofloxacin. Levofloxacin displayed statistically similar mortality risk (aOR 0.76 [95% CI 0.58-1.01], p=0.06) compared to TMP/SMX. Levofloxacin (versus TMP/SMX) use was associated with a lower aOR of death in the prespecified subgroup of patients with LRTI (n=1,452) (aOR 0.73 [95%CI 0.54-0.98, p=0.03) and among those in whom the agent was initiated empirically (n=89) (aOR 0.16 (0.03-0.95, p=0.04). Compared to the TMP/SMX cohort, the levofloxacin cohort had fewer hospital days between index culture collection and discharge (weighted median[IQR] days 7 [4,13] vs. 9 [6,16]; p<0.0001). Conclusions Based on observational evidence, levofloxacin is a reasonable alternative to TMP/SMX in the treatment of bloodstream and lower respiratory tract infections caused by S. maltophilia.