Incidence, Risk Factors and Impact on Clinical Outcomes of Bloodstream Infections in Patients Hospitalised with COVID-19: A Prospective Cohort Study

Abstract

With the aim of describing the burden and epidemiology of community-acquired/healthcare-associated and hospital-acquired bloodstream infections (CA/HCA-BSIs and HA-BSIs) in patients hospitalised with COVID-19, and evaluating the risk factors for BSIs and their relative impact on mortality, an observational cohort study was performed on patients hospitalised with COVID-19 at San Paolo Hospital in Milan, Italy from 24 February to 30 November 2020. Among 1351 consecutive patients hospitalised with COVID-19, 18 (1.3%) had CA/HCA-BSI and 51 (3.8%) HA-BSI for a total of 82 episodes of BSI. The overall incidence of HA-BSI was 3.3/1000 patient-days (95% CI 2.4–4.2). Patients with HA-BSI had a longer hospital stay compared to CA/HCA-BSI and no-BSI groups (27 (IQR 21–35) vs. 12 (7–29) vs. 9 (5–17) median-days, p < 0.001) but a similar in-hospital mortality (31% vs. 33% vs. 25%, p = 0.421). BSI was not associated with an increased risk of mortality (CA/HCA-BSI vs. non-BSI aOR 1.27 95% CI 0.41–3.90, p = 0.681; HA-BSI vs. non-BSI aOR 1.29 95% CI 0.65–2.54, p = 0.463). Upon multivariate analysis, NIMV/CPAP (aOR 2.09, 95% CI 1.06–4.12, p = 0.034), IMV (aOR 5.13, 95% CI 2.08–12.65, p < 0.001) and corticosteroid treatment (aOR 2.11, 95% CI 1.06–4.19, p = 0.032) were confirmed as independent factors associated with HA-BSI. Development of HA-BSI did not significantly affect mortality. Patients treated with corticosteroid therapy had double the risk of developing BSI.

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 , ...…”

Bacterial and Fungal Co-Infections and Superinfections in a Cohort of COVID-19 Patients: Real-Life Data from an Italian Third Level Hospital

“…Cona et al [ 28 ] studied incidence, risk factors and outcome of patients with BSI and COVID-19, showing that the most common cause of BSI in a cohort of COVID-19 patients was Staphylococcus aureus and that CA-BSI were as frequent as HA-BSI32.…”

“…They also reported that the presence of BSI increased the length of the hospital stay [ 28 ]. Similarly, our data showed that any kind of bacterial superinfection, with particular reference to HAIs, significantly increased the length of hospital stay.…”

“…To fight the inflammatory syndrome, many immunomodulant agents are used, such as corticosteroids, anti-interleukin-1 (IL-1), anti-interleukin-6 (IL-6), and inhibitors of the JAK-STAT pathway [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. The use of immune suppressive drugs, combined with the natural immune suppression caused by the virus, can lead to a surge of secondary bacterial and fungal infections [ 8 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ].…”

Epidemiology of Candidemia and Fluconazole Resistance in an ICU before and during the COVID-19 Pandemic Era

“…Severe forms are complicated by hypoxemic acute respiratory failure requiring intensive care unit (ICU) admission [ 3 , 4 ]. In these patients, secondary infections, both bacterial and fungal, have been increasingly reported [ 5 , 6 , 7 , 8 , 9 ], resulting in the widespread use of antibiotics for the empirical treatment of suspected as well as of microbiologically confirmed infections, hence contributing to an increase in multidrug-resistant bacteria and fungi and increased costs of care [ 10 ].…”