Risk Factors and Outcomes of Hospitalized Patients With Severe Coronavirus Disease 2019 (COVID-19) and Secondary Bloodstream Infections: A Multicenter Case-Control Study

Abstract

Background Coronavirus disease 2019 (COVID-19) has become a global pandemic. Clinical characteristics regarding secondary infections in patients with COVID-19 have been reported, but detailed microbiology, risk factors, and outcomes of secondary bloodstream infections (sBSIs) in patients with severe COVID-19 have not been well described. Methods We performed a multicenter case-control study including all hospitalized patients diagnosed with severe COVID-19 and blood cultures drawn from 1 March 2020 to 7 May 2020 at 3 academic medical centers in New Jersey. Data collection included demographics, clinical and microbiologic variables, and patient outcomes. Risk factors and outcomes were compared between cases (sBSI) and controls (no sBSI). Results A total of 375 hospitalized patients were included. There were 128 sBSIs during the hospitalization. For the first set of positive blood cultures, 117 (91.4%) were bacterial and 7 (5.5%) were fungal. Those with sBSI were more likely to have altered mental status, lower mean percentage oxygen saturation on room air, have septic shock, and be admitted to the intensive care unit compared with controls. In-hospital mortality was higher in those with an sBSI versus controls (53.1% vs 32.8%, P = .0001). Conclusions We observed that hospitalized adult patients with severe COVID-19 and sBSI had a more severe initial presentation, prolonged hospital course, and worse clinical outcomes. To maintain antimicrobial stewardship principles, further prospective studies are necessary to better characterize risk factors and prediction modeling to better understand when to suspect and empirically treat for sBSIs in severe COVID-19.

COVID-19 increased the risk of ICU-acquired bloodstream infections: a case–cohort study from the multicentric OUTCOMEREA network

“…To our knowledge, to date, this issue remains under-investigated. A large multi-centric cohort study including only COVID-19 highlighted that the most common presumed source was unknown or not reported [ 30 ]. Moreover, the role of bacterial translocation should further be evaluated: a recent monocentric Italian study showed an increased risk for enterococcal BSI among COVID-19 patient, thus suggesting an enteric involvement in patients with severe COVID-19 [ 31 ].…”

Clinical features and risk factors for community-onset bloodstream infections among coronavirus disease 2019 (COVID-19) patients

“…In our study, the prevalence of COBSI was 8.6%, which was higher than previously reported rates of 1.6%-2.5%. 1,3,4 Previous studies did not report nursing home admissions. In our study, 30% of COVID-19 patients were admitted from the nursing homes.…”

Diagnosis, clinical characteristics, and outcomes of COVID-19 patients from a large healthcare system in northern New Jersey

“…Despite Northern NJ being an early epicenter (March, 2020) in the US for COVID-19, which rapidly engulfed the entire state, there has been a paucity of research on the epidemiology of this disease in the NJ population. At the time of writing, only three studies were published to fill this gap, with one describing the clinical features in a minority patient population, one investigating the impact of COVID-19 on mothers, infants and staff in a delivery service in NJ, and one focusing on the secondary bloodstream infections in severe COVID-19 patients 14 – 16 . Contributing to this growing knowledge base, our study describes the clinical characteristics and outcomes in a large hospitalized patient series in our hospital network covering Northern NJ, during the early phase of the COVID-19 pandemic.…”