Bloodstream Infections in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Abstract

Background: Little is known about the occurrence of bloodstream infections in hospitalized patients with COVID-19 and the related clinical consequences. The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of BSIs among hospitalized patients with COVID-19 and mortality of this patient population. Methods: A systematic search was performed on PubMed, EMBASE, and Web of Science from inception to 19 April 2021. The primary outcome was the occurrence of BSIs among hospitalized patients with COVID-19. The secondary outcome was mortality at the longest available follow-up. Results: Forty-six studies met the inclusion criteria, with a total of 42,694 patients evaluated. The estimated occurrence of BSIs was 7.3% (95% CI 4.7–1.1%) among hospitalized patients with COVID-19, with a mortality rate of 41% (95% CI 30%–52.8%). The subgroup analysis conducted on patients admitted to ICU provided an estimated occurrence of 29.6% (95% CI 21.7%–38.8%). A higher occurrence of BSI was observed in patients with COVID-19, in comparison with patients without COVID-19 (OR 2.77; 95% CI 1.53–5.02; p < 0.001). Conclusions: Our analysis estimated the occurrence of BSIs among hospitalized patients with COVID-19 at around 7%. A four-times higher occurrence was estimated among patients admitted to ICU.

Bloodstream Infections in a COVID-19 Non-ICU Department: Microbial Epidemiology, Resistance Profiles and Comparative Analysis of Risk Factors and Patients’ Outcome

“…In our cohort, the mean incidence of BSI (2.015 per 100 admissions) was lower than the reported rates in COVID-19 wards outside the ICU [11,21]. However, our results confirmed previous reports of higher BSI incidence in COVID-19 vs. non-COVID-19 patients [11].…”

“…The novelty of our study is a clear incorporation of a COVID-19 population outside the ICU environment. The incidence of BSI in COVID-19 patients and their outcome has been studied mostly in ICU or in mixed populations of both ICU and medical wards [ 11 ]. Furthermore, epidemiology of bacterial and fungal pathogens in BSI of patients with COVID-19 was mostly described in ICU departments with endemicity of multidrug antimicrobial resistance, but not in non-ICU COVID-19 settings [ 20 ].…”

“…Moreover, a high risk for secondary fungal infections among COVID-19 patients has been described [ 9 ]. Bloodstream infections are a significant subset of infections following acute SARS-CoV-2 pneumonia and a driver for sepsis and in-hospital mortality [ 10 , 11 ]. Current data suggest that diagnosis and subsequent prompt treatment of BSI might be delayed due to a focalized effort for controlling the primary infection (SARS-CoV-2 pneumonia) [ 12 ].…”

Bloodstream infections in hospitalized patients before and during the COVID-19 surge in a community hospital in the South Bronx

“…Our results highlight the higher incidence of BSI during the COVID-19 surge compared to pre-COVID-19 period at NYC public hospital. The increased BSI during the COVID-19 surge in our hospital was higher than the pooled estimated BSI occurrence published in a systematic review (Ippolito et al 2021), due to our higher burden of critically ill patients requiring mechanical ventilation, pressors, steroids, proning etc. Empiric antibiotics were used in almost all patients due to paucity of information about COVID-19 resulting in higher DOT.…”

Laboratory Biomarkers for Diagnosis and Prognosis in COVID-19

“…Patients with severe COVID-19 are highly susceptible to superimposed bacterial, fungal, and viral infections, including ventilator-associated pneumonia and bloodstream infection, among others ( 29 , 30 ). As for systemic biomarkers of infection, procalcitonin is a predictor of disease severity ( 31 ), and can be useful to guide antimicrobial stewardship ( 32 , 33 ).…”