Background Previous viral pandemics have shown that secondary bacterial infections result in higher morbidity and mortality, with Staphylococcus aureus as the primary causative pathogen. The impact of secondary S. aureus bacteremia on mortality in patients infected with SARS-CoV-2 remains unknown. Methods This was a retrospective, observational case series of patients with COVID-19 disease who developed secondary S. aureus bacteremia across two New York City hospitals. The primary endpoint was to describe 14-day and 30-day hospital mortality rates of patients infected with COVID-19 and S. aureus bacteremia. Secondary endpoints included predictors of 14-day and 30-day hospital mortality in patients infected with COVID-19 and S. aureus bacteremia. Results A total of 42 hospitalized patients for COVID-19 with secondary S. aureus bacteremia were identified. Of these patients, 23 (54.8 %) and 28 (66.7%) died at 14 days and 30 days, respectively, from their first positive blood culture. Multivariate analysis identified hospital-onset bacteremia (≥4 days from date of admission) and age as significant predictors of 14-day hospital mortality, and Pitt bacteremia score as a significant predictor of 30-day hospital mortality (odds ratio [OR] 11.9 [95% confidence interval [CI] 2.03-114.7], p=0.01; (OR 1.10 [95% CI 1.03-1.20], p=0.02); and (OR 1.56 [95% CI 1.19-2.18], p=0.003), respectively. Conclusions Bacteremia with S. aureus is associated with high mortality rates in patients hospitalized with COVID-19 infection. Further investigation is warranted to understand the impact of COVID-19 and secondary S. aureus bacteremia.
BackgroundThe global pandemic caused by severe acute respiratory syndrome coronavirus 2 resulted in a large burden of critically ill patients, a population with an increased risk of both developing and dying from secondary infections. We investigated the clinical characteristics, risk factors, and outcomes associated with developing bloodstream infections (BSIs) among those admitted to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) during the peak of the first surge in New York City, before the standardization of treatment regimens limited the ability to analyze differences.MethodsWe performed a retrospective case-control study including all patients 18 years or older who were admitted to the ICU because of COVID-19 in April 2020 in New York City. Demographic characteristics, risk factors, and outcomes were analyzed between cases, those who developed BSI during ICU admission, and matched controls who did not develop BSI, using a logistic regression.ResultsThirty-two cases and 64 controls, all with COVID-19, were matched on sex, age, and the length of ICU stay before BSI. Cases who developed BSI had higher odds of longer corticosteroid use and a preexisting diagnosis of hypertension at the time of hospital admission than controls without BSI.ConclusionsWe found a positive association between the duration of corticosteroids and the development of BSI. Considering immunosuppression is now the cornerstone of guidelines for COVID-19 treatment, further studies are needed to evaluate risks and mitigation strategies for these therapies.
Background The impact of COVID-19 on the health care system in New York City (NYC) cannot be overstated. The first documented cases of COVID-19 in Queens NYC occurred in early March of 2020. The total number of patients with proven or suspected COVID-19 at Elmhurst Hospital peaked in early April. A dramatic increase in the use of antimicrobials occurred in April, and correlated with the increased number of intubated COVID-19 patients at Elmhurst Hospital. Methods Antimicrobial Stewardship Committee activities and meetings had been suspended for the months of March and April due to the increased clinical demands associated with the COVID-19 outbreak. In preparation for the May meeting, a retrospective analysis of antimicrobial use for March and April of 2020 was performed. Results The analysis revealed a 30% increase in the use of antimicrobials. The average total days of antimicrobials per 1000 patient days (TDA/TPD) was 445 for January through March of 2020. In April, this number climbed to 580. TDA/TPD increased from 57 to 90 (58%) for vancomycin, 25 to 35 (40%) for meropenem, and 31 to 89 (187%) for cefepime. The number of intervention by the Antibiotic Stewardship team remained low during this time period. Total Days of Antimicrobials per 1000 Patient Days (TDA/TPD) Conclusion A dramatic increase in the use of antimicrobials correlated with an increase in the number of intubated patients at Elmhurst Hospital during a COVID-19 outbreak. It is likely that the frequent appearance of fever and leukocytosis in intubated patients with COVID-19 prompted an increase in empiric antimicrobial use. The 48 hour time outs and prospective review of antimicrobial use may be necessary to maintain stewardship efforts during the COVID-19 epidemic. Further review of antibiotic usage in critically ill COVID-19 patients is needed to help define stewardship practices as we go forward in this pandemic. Disclosures All Authors: No reported disclosures
Highlights Capnocytophaga sputigena is a rare pathogen with diverse clinical presentations. We report a case of catheter-related C. sputigena bloodstream infection. C. sputigena clinical isolates can form biofilms in vitro. Biofilm development by Capnocytophaga species may potentiate disease pathogenesis.
Background Candidemia is a rare but serious complication of SARS-CoV-2 hospitalization. Combining non-culture and culture-based diagnostics allows earlier identification of candidemia. Given higher reported incidence during COVID-19 surges, we investigated the use of (1-3)-β-D-glucan (BDG) assay at our institution in those who did and did not develop candidemia. Methods Retrospective study of adults admitted to The Mount Sinai Hospital between March 15-June 30 2020 for SARS-CoV-2 infection, with either ≥1 BDG assay or positive fungal blood culture. Data was collected with the electronic medical record and Vigilanz. A BDG value ≥ 80 was used as a positivity cutoff. Differences in mortality were assessed by univariate logistic regression using R (version 4.0.0). Statistical significance was measured by P value < .05. Results There were 75 patients with ≥1 BDG assay resulted and 28 patients with candidemia, with an overlap of 9 between the cohorts. Among the 75 who had BDG assay, 23 resulted positive and 52 negative. Nine of 75 patients developed candidemia. Of the 23 with a positive assay, 5 developed candidemia and 18 did not. Seventeen of the 18 had blood cultures drawn within 7 days +/- of BDG assay. Four patients with candidemia had persistently negative BDG; 2 had cultures collected within 7 days +/- of BDG assay. With a cut-off of >80, the negative predictive value (NPV) was 0.92. When the cut-off increased to >200, NPV was 0.97 and positive predictive value (PPV) was 0.42. Average antifungal days in patients with negative BDG was 2.6 vs. 4.2 in those with a positive. Mortality was 74% in those with ≥1 positive BDG vs. 50% in those with persistently negative BDGs. There was a trend towards higher odds of death in those with positive BDG (OR = 2.83, 95% CI: 1.00-8.90, p < 0.06). Conclusion There was substantial use of BDG to diagnose candidemia at the peak of the COVID-19 pandemic. Blood cultures were often drawn at time of suspected candidemia but not routinely. When cultures and BDG were drawn together, BDG had a high NPV but low PPV. High NPV of BDG likely contributed to discontinuation of empiric antifungals. The candidemic COVID-19 patients had high mortality, so further investigation of algorithms for the timely diagnosis of candidemia are needed to optimize use of antifungals while improving mortality rates. Disclosures All Authors: No reported disclosures
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