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

Kwon, Jennie H.; Nickel, Katelin B.; Reske, Kimberly A.; Stwalley, Dustin; Dubberke, Erik R.; Lyons, Patrick G.; Michelson, Andrew P.; McMullen, Kathleen M.; Sahrmann, John M.; Gandra, Sumanth; Olsen, Margaret A.; Burnham, Jason P.

doi:10.1016/j.jhin.2022.11.020

Cited by 9 publications

(5 citation statements)

References 23 publications

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“…BSI incidence was also numerically lower, but did not reach statistical significance, probably due to the small numbers. COVID-19 status remained the only significant factor associated with HAI development in multivariable analysis, which is in line with data from other studies including concurrent non-COVID-19 patients [ 27 ]. Whereas the increased HAI risk in COVID-19 patients is intuitive for pulmonary HAI, it is less clear for the similar tendency in BSI.…”

Section: Discussionsupporting

confidence: 90%

Healthcare‑associated infections in intensive care unit patients with and without COVID-19: a single center prospective surveillance study

Bloch,

Rüfenacht,

Ludwinek

et al. 2023

Antimicrob Resist Infect Control

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Background The coronavirus disease 2019 (COVID-19) pandemic led to a global increase in healthcare-associated infections (HAI) among intensive care unit (ICU) patients. Whether this increase is directly attributable to COVID-19 or whether the pandemic indirectly (via staff shortages or breaches in infection prevention measures) led to this increase, remains unclear. The objectives of this study were to assess HAI incidence and to identify independent risk factors for HAI in COVID-19 and non-COVID-19 ICU patients. Methods We established a monocentric prospective HAI surveillance in the medical ICU of our tertiary care center from September 1st 2021 until August 31st 2022, during circulation of the SARS-CoV-2 delta and omicron variants. We consecutively included patients ≥ 18 years of age with an ICU length of stay of > 2 calendar days. HAI were defined according to the European Centre for Disease Prevention and Control definitions. HAI rate was calculated per 1,000 patient-days or device-days; risk ratios (RR) and corresponding 95% confidence intervals (CI) for COVID-19 versus non-COVID-19 patients were calculated. We used multivariable Cox regression to identify independent risk factors for HAI. As a proxy for institutional COVID-19 burden, weekly COVID-19 density (i.e. percentage of COVID-19 patients among all ICU patients) was included in the model as time-dependent co-variable. Results We included 254 patients, 64 (25.1%) COVID-19 and 190 (74.9%) non-COVID-19 patients; 83 HAI in 72 patients were recorded, thereof 45 ventilator-associated lower respiratory tract infections (VA-LRTI) (54.2%) and 18 blood stream infections (BSI) (21.6%). HAI incidence rate was 49.1/1,000 patient-days in COVID-19 and 22.5/1,000 patient-days in non-COVID-19 patients (RR 2.2, 95%-CI 1.4–3.4). This result was mainly due to different VA-LRTI rates (40.3 vs. 11.7/1,000 ventilator days, p < 0.001), whereas BSI rates were not statistically different (9.4 vs. 5.6/1,000 patient days, p = 0.27). Multivariable analysis identified COVID-19 as main risk factor for HAI development, whereas age, mechanical ventilation and COVID-19 density were not significant. Conclusions These data from the fourth and fifth wave of the pandemic show a higher HAI incidence in COVID-19 than in non-COVID-19 ICU patients, mainly due to an increase in pulmonary infections. A diagnosis of COVID-19 was independently associated with HAI development, whereas institutional COVID-19 burden was not.

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Section: Discussionsupporting

confidence: 90%

Healthcare‑associated infections in intensive care unit patients with and without COVID-19: a single center prospective surveillance study

Bloch,

Rüfenacht,

Ludwinek

et al. 2023

Antimicrob Resist Infect Control

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“…Other identified risk factors for hospital-acquired infections were chronic comorbidities, intensive care unit stay, hospital type, and extremes of BMI. 44 The combination of these risk factors may explain the high incidence of nosocomial infection in this study. Other complications were less common in children.…”

Section: Discussionmentioning

confidence: 77%

Clinical and Laboratory Profile, Management and Outcome of Pediatric SARS-CoV-2 Infection Admitted at the Philippine General Hospital

Reyes-Pagcatipunan, MD,

Isada, MD,

Delos Reyes, MD

2024

Acta Med Philipp

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Background. The Philippines has recorded over 470,000 COVID-19 cases in children, with over 1,500 deathsduring the same period. Although a Philippine online pediatric COVID-19 registry exists, this only relies on passive surveillance. Objectives. This study determined the clinical and laboratory profile, risk factors for severe COVID-19, and mortality, management, and outcome of pediatric SARS-CoV-2 patients admitted at the Philippine General Hospital (PGH) from April 2020 to June 2022 to fill in knowledge gaps on the epidemiology of COVID-19 infection in children. Methods. This was a retrospective cohort study of pediatric COVID-19 cases admitted at the PGH, a designatedCOVID referral center during the study period. Demographic and clinical profile, risk factors, comorbidities, laboratory and radiologic findings, management, and outcomes across different disease severity states were gathered by chart review and the data were analyzed using STATA 17. Results. There were 448 pediatric patients admitted and diagnosed with COVID-19 during the study period. Most patients belonged to the 1-5-year age group (25.9%), had no known exposure to a COVID-19 case (65.4%), were mild cases (37.3%%), and did not receive any dose of the COVID-19 vaccine (96.7%). The most common presenting symptoms across all disease categories were fever (44.4%), cough (28.6%), and shortness of breath (26.6%). Multisystem inflammatory syndrome in children (MIS-C) presented with fever (100%) and rash (53.9%). The risk factors for severe disease were the presence of a congenital anomaly lung disease, and elevated procalcitonin. Most patients with MIS-C were previously well with no comorbidities. Laboratory findings which were markedly elevated among severe and critical cases were ESR, CRP, D-dimer, LDH, and IL-6. Ferritin, procalcitonin (PCT) and IL-6 were elevated only in severe to critical COVID-19 cases and remained within normal for the other disease categories. As to treatment, asymptomatic, mild, and moderate cases were given supportive medications (zinc, vitamin D, and vitamin C), while investigational drugs particularly corticosteroids, IVIG, and remdesivir, were used in severe cases. Antibiotics were given to 71.7% of patients at the outset.As to the outcomes, 89% recovered, while 8.9% died. The case fatality rate from COVID-19 infection was at2.2%. Conclusion. Admitted pediatric COVID-19 cases are generally mild but admission is due to underlying illnessor comorbidities. Those with severe to critical cases have underlying comorbidities and had either progression or complications due to COVID disease. D-dimer, LDH, IL-6, ferritin and procalcitonin were elevated among severe and critical cases which can be utilized as inflammatory markers.

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“…COVID-19 is considered as a risk factor for hospital-acquired infection [17]. Our study analyzed the status of COVID-19 RT-qrtPCR in patients with positive BACTEC results.…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 pandemic on bloodstream infections in pediatrics and alteration in antimicrobial resistance phenotypes, 2020-2022

Fallah,

Karimi,

Azimi

et al. 2024

Preprint

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Background: Alteration in the etiology of bloodstream infection (BSI) and antimicrobial resistance (AMR) following the COVID-19 pandemic is not well known in children. This study aimed to investigate these changes during 2 years in Tehran, Iran. Methods Children under 18 years old with suspected bacteremia/fungemia who had positive BACTEC blood cultures were included. Characterization of the isolates, antimicrobial susceptibility testing, and detection of multidrug-resistant (MDR) phenotypes were done based on standard protocols. Statistical analysis was done to measure the correlation of COVID-19 infection with BSI and AMR. Results Out of 13,345 COVID-19 tests and 4,194 BACTEC blood culture requests, bacteremia/fungemia were confirmed in 10.34% of the patients who requested both tests simultaneously. The COVID-19 infection was confirmed in 25.3% of the patients with bacteremia/fungemia. The infection with Gram-negative bacteria, Gram-positive bacteria (GPB), and fungi was detected in 59.3%, 32.3%, and 8.31% of the cases, respectively. Pseudomonasspp. (21.3%), Klebsiella spp. (20.2%), CNS (15.8%), Acinetobacterspp. (9.6%), S. aureus (8%), and Enterococcus spp. (5%) were among the common isolates. In the case of BSI with GPB, a significant difference was measured among different hospital wards (p-value= 0.01). Moreover, a negative correlation was shown between the CNS bacteremia and COVID-19 infection (p-value= 0.029). Candida spp. and non-Candidayeasts were detected in 6.7% and 13.4% of the cases, respectively. Results of antibiotic susceptibility testing showed the highest frequency of resistance to azithromycin and oxacillin among CNS, azithromycin, tetracycline, and oxacillin among S. aureus, and tetracycline and trimethoprim/sulfamethoxazole among Enterococcus. Methicillin-resistance phenotype in the S. aureus (MRSA) and coagulase-negative Staphylococcusspp. (MR-CNS) was detected in 40% and 61.5% of the strains, respectively and the Enterococci were resistant to vancomycin in 33.3% of the isolates. Conclusion A decline in the trend of BSI by GPB and an increase in AMR was shown in children during the COVID-19 pandemic. The rise in antibiotic resistance could be described by the overuse of antibiotics in COVID-19 patients, while the difference in types of medical interventions may explain the difference in the etiology of BSI among the hospital wards.

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

Cited by 9 publications

References 23 publications

Healthcare‑associated infections in intensive care unit patients with and without COVID-19: a single center prospective surveillance study

Healthcare‑associated infections in intensive care unit patients with and without COVID-19: a single center prospective surveillance study

Clinical and Laboratory Profile, Management and Outcome of Pediatric SARS-CoV-2 Infection Admitted at the Philippine General Hospital

The impact of COVID-19 pandemic on bloodstream infections in pediatrics and alteration in antimicrobial resistance phenotypes, 2020-2022

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