Delayed treatment of bacteremia during the COVID-19 pandemic

Abstract

ObjectivesCoronavirus 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.MethodsThis 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.ResultsWe 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.ConclusionsOur 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.

Clinical Characteristics Associated with Bacterial Bloodstream Coinfection in COVID-19

“…Some studies using these methods found that BSI as a whole increased in the pandemic, contamination rates increased with ICU bed surges, and any BSI increased mortality [ 18 , 22 , 43 ]. A large collection of patient data using these study methods could construct a laboratory algorithm model, similar to prediction models created for severe COVID-19 or mortality, to better predict bacterial coinfection in patients and ensure they are appropriately treated [ 44 – 48 ]. This algorithm could then be tested in a randomized controlled trial to overcome unmeasured confounders and evaluate whether patients in the algorithm arm received fewer antibiotics, with no increase in adverse events, and with appropriate COVID-19 bacterial coinfection care without delay in comparison to the control arm.…”

Diagnosing Bacterial Infection in the era of Pandemic: A Case Report

“…In the pandemic era, physicians may fall into “COVID blindness” [ 5 ], or being satisfied with the diagnostic label of “COVID-19 rule-out.” It is reported that this diagnostic bias leads to delayed treatment of bacteremia [ 6 ]. In this case, an appropriate evaluation was postponed until the result of the antigen rapid test was turned out, although the probability of COVID-19 was low.…”

The Impact of COVID-19 in Older People in Portugal: Results from the Survey of Health, Ageing and Retirement (SHARE)

“…No entanto, paradoxalmente, a maioria dos inquiridos não percecionou uma alteração do seu estado de saúde. Sendo certo que está descrito na literatura internacional 20,21 que o atraso no tratamento de diversas patologias, incluindo tratamentos urgentes, teve repercussão na mortalidade, esse impacto pode ser diferido no tempo e, portanto, não percecionado de forma imediata pela nossa amostra à data da resposta ao inquérito. de não ter sido possível aplicar completamente a escala europeia de depressão geriátrica (escala Euro-D), tal como em outras vagas, foram, ainda assim, mantidas as questões sobre tristeza/depressão, ansiedade e problemas de sono.…”