Impact of COVID-19 pandemic on hospital onset bloodstream infections (HOBSI) at a large health system

Abstract

Background The COVID-19 pandemic has had a considerable impact leading to increases in healthcare-associated infections, particularly bloodstream infections (BSI). Methods We evaluated the impact of COVID-19 in 69 US hospitals on BSIs before and during the pandemic. Events associated with 5 pathogens ( Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa , and Candida sp .) were stratified by community onset (CO) if ≤ 3 days from admission or hospital onset (HO) if >3 days after admission. We compared pre-pandemic CO and HO rates with pandemic periods and the rates of BSI for those with and without COVID-19. Results COVID-19 patients were less likely to be admitted with COBSI compared to others (10.85 vs. 22.35 per 10,000 patient days; p<0.0001). There was a significant increase between pre-pandemic and pandemic HOBSI rates (2.78 vs. 3.56 per 10,000 patient days; p<0.0001). Also, COVID-19 infected patients were 3.5 times more likely to develop HOBSI compared to those without COVID-19 infection (9.64 vs. 2.74 per 10,000 patient-days; p<0.0001). Conclusions The COVID-19 pandemic period was associated with substantial increases in HOBSI and largely attributed to COVID-19 infected patients. Future research should evaluate whether such measures would be beneficial to incorporate in evaluating infection prevention trends.

Risk factors for hospital-acquired infection during the SARS-CoV-2 pandemic

“…Patients with COVID-19 had higher risk for an HAI (urine, blood, or respiratory), consistent with prior literature. 4 , 7 , 18 As is consistent with national trends in decreased rates of HAIs over time prior to the pandemic, year of admission was associated with decreased hazard ratios for HAI as the study period progressed. A recent study showed that again in 2021, HAI rates increased, though because of data limitations, the authors were unable to correlate HAI rates with COVID-19.…”

Epidemiology and outcomes of culture-positive bloodstream pathogens prior to and during the SARS-CoV-2 pandemic: a multicenter evaluation

“…In our study, C albicans was the third most common pathogen and seen in 10.5% of SARS-CoV-2-positive patients but were not observed as a top 5 pathogen among SARS-CoV-2-negative patients or in the pre-pandemic period (Table 3). A significant 35% increase in HOBSI risk associated with Candida species during the pandemic period has also been observed in a study of 69 US hospitals [30], possibly driven by risk factors frequently present in critically ill patients with COVID-19, including the use of mechanical ventilation, indwelling devices, glucocorticoids, and broad-spectrum antibiotic therapy [31][32][33]. Our results also showed a significantly longer time for culture collection in HOBSI pathogens in SARS-CoV-2-positive patients (14 days median) compared to SARS-CoV-2-negative patients, patients not tested, and the pre-pandemic period (median 7 days for all 3 groups).…”

Implementation of a hospital antimicrobial stewardship program to improve vancomycin use in Cyprus: Challenges and opportunity

“…A possible explanation might include an increase in both blood culture contamination and catheter-related bloodstream infections. Contributory factors for the increased blood culture contamination could be the higher burden of workload for the care of the patients with COVID-19 and wearing personal protective equipment (PPE) that might have made the procedure of blood cultures more difficult than those without, as described elsewhere [ [16] , [17] , [18] , [19] ]. The increase in blood stream infections during the COVID-19 pandemic might be related to the extended length of stay [ 20 ].…”