Hospital-Acquired Bloodstream Infections in Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 Infection (Coronavirus Disease 2019): Association With Immunosuppressive Therapies

Abstract

Background Immunosuppressive therapies proposed for Coronavirus disease 2019 (COVID-19) management may predispose to secondary infections. We evaluated the association of immunosuppressive therapies with bloodstream-infections (BSIs) in hospitalized COVID-19 patients. Methods This was an institutional review board-approved retrospective, multicenter, cohort study of adults hospitalized with COVID-19 over a 5-month period. We obtained clinical, microbiologic and laboratory data from electronic medical records. Propensity-score-matching helped create balanced exposure groups. Demographic characteristics were compared across outcome groups (BSI/no BSI) using two-sample t-test and Chi-Square test for continuous and categorical variables respectively, while immunosuppressive therapy use was compared using McNemar’s test. Conditional logistic regression helped assess the association between immunosuppressive therapies and BSIs. Results 13,007 patients were originally included, with propensity-score-matching producing a sample of 6,520 patients. 3.74% and 3.97% were diagnosed with clinically significant BSIs in the original and propensity-score-matched populations respectively. COVID-19 patients with BSIs had significantly longer hospitalizations, higher intensive care unit admission and mortality rates compared to those without BSIs. On univariable analysis, combinations of corticosteroids/anakinra [odds-ratio (OR) 2.00, 95% confidence intervals (C.I.) 1.05-3.80, P value.0342] and corticosteroids/tocilizumab [OR 2.13, 95% C.I. 1.16–3.94, P value .0155] were significantly associated with BSIs. On multivariable analysis (adjusting for confounders), combination corticosteroids/tocilizumab were significantly associated with any BSI [OR 1.97, 95% C.I. 1.04–3.73, P value.0386] and with bacterial BSIs [OR 2.13, 95% C.I. 1.12–4.05, p-value 0.0217]. Conclusions Combination immunosuppressive therapies were significantly associated with BSI occurrence in COVID-19 patients; their use warrants increased BSI surveillance. Further studies are needed to establish their causative role.

The Impact of COVID-19 on the Profile of Hospital-Acquired Infections in Adult Intensive Care Units

“…Increased rates of HAIs in ICUs that treat COVID-19 patients are being reported in various countries and support our findings [4,34], likely as a result of the inability to fully comply with the standard practices of infection control during this unprecedented time [12,35,36]. Another risk for promoting resistance in patients hospitalized for COVID-19 is the use of immunosuppressive therapy, though studies are showing conflicting results regarding its contribution to resistance [37,38]. Serbia's national guideline for COVID-19 treatment (provided in Supplementary Table S3) emphasizes the absolute avoidance of antibiotic use precisely because of the risk of rising AMR.…”

Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

“…The 148 included studies were published between December, 2019, and May, 2021. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , ...…”

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

“…In a large cohort of 13,007 patients originally recruited followed by a propensity-score-matching cohort of 6520 patients, 3.74% and a 3.97% were diagnosed with clinically significant BSI, respectively. COVID-19 patients with BSI had significantly longer hospitalizations, more frequent ICU admission and higher mortality rates compared to those without BSI [ 42 ]. In our study, lack of vaccination for SARS-COV2 was not only correlated to severe pneumonia but also to an increased frequency of BSI, further hampering the patients’ outcome.…”