Low prevalence of bloodstream infection and high blood culture contamination rates in patients with COVID-19

Yu, David C.; Ininbergs, Karolina; Hedman, Karolina; Giske, Christian G.; Strålin, Kristoffer; Özenci, Volkan

doi:10.1371/journal.pone.0242533

Cited by 46 publications

(56 citation statements)

References 15 publications

(19 reference statements)

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“…17 However, a study performed in Sweden detected a clinically relevant microbial growth in blood cultures in 6.5% of COVID-19-affected patients, which was significantly lower compared with 10.8% in the 2020 control group without COVID-19 (p<0.0001) and 10.4% in the 2019 control group without COVID-19 (p<0.0001). 48 These data coincide with a study conducted in the USA which found that the blood culture positivity rate was significantly lower for patients who tested positive for SARS-CoV-2 when compared with those who did not and to those who were not tested (3.8%, 8.0% and 7.1%, respectively; p<0.001). 49 A rapid systematic review of 24 studies (3338 hospitalised paediatric and adult COVID-19 affected patients), that aimed to assess the available literature on the prevalence of bacterial infections in COVID-19 affected patients, showed that 3.5% (95% CI 0.4% to 6.7%) and 14.3% (95% CI 9.6% to 18.9%) of these patients suffered a bacterial co-infection or secondary infection, respectively, and that this was more common in those patients who were critically ill (8.1%, 95% CI 2.3% to 13.8%).…”

Section: Discussionsupporting

confidence: 87%

Risk factors for nosocomial bloodstream infections in COVID-19 affected patients: protocol for a case–control study

et al. 2021

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Background Nosocomial bloodstream infection (nBSI) is an important clinical concern among COVID-19 hospitalised patients. It can cause sepsis and septic shock leading to high morbidity, mortality, and the emergence of antibiotic resistance. The aim of this case-control study is to identify the risk factors associated with the nBSI development in COVID-19 hospitalised patients and its incidence. Methods and analysis A retrospective case-control study will be performed. Cases will include nBSI episodes of adult patients (≥18 years) admitted to Hospital Universitari Germans Trias i Pujol, Barcelona, Spain, from April to December 2020 with a diagnosis of SARS-CoV-2 pneumonia. Patients transferred from other hospitals will be excluded. Controls will include hospitalisation episodes of COVID-19 patients without nBSI. We will recruit a minimum of 74 nBSI episodes (cases) and 74 controls (according to sample size calculation). We will collect data on sociodemographics, clinical status at admission, hospital admission, in-hospital mortality, and exposure data (use of antivirals, glucocorticoids or immunomodulatory agents, length of hospitalisation, and use of medical devices such as intravenous catheters). A bivariate and a subsequent multivariate regression analysis will be performed to assess the independent effect of the associated risk factors after adjusting for confounders. The nBSI incidence rate will be estimated according to the number of nBSI episodes in admitted COVID-19 patients among the total person-month of follow-up. Ethics and dissemination The protocol of this study was approved by the Ethical Committee for Drug Investigation of the Hospital Universitari Germans Trias i Pujol. The results of this case-control study will be published in a peer reviewed journal.

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Section: Discussionsupporting

confidence: 87%

Risk factors for nosocomial bloodstream infections in COVID-19 affected patients: protocol for a case–control study

et al. 2021

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“…9,10,[14][15][16][17][18]20,23,[27][28][29][30][31][32][33] , Streptococcus spp. 9,10,[15][16][17][18]20,23,27,29,34 , Escherichia coli 9,14,16,27,28,30,31,33,34 , Klebsiella spp. 9,10,12,15,16,18,22,24,27,28,31 , Enterococcus spp.…”

Section: Resultsmentioning

confidence: 99%

A rapid review of the overuse of antibiotics during the COVID-19 pandemic: lessons learned and recommendations for the future

2021

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The coronavirus disease 2019 (COVID-19) pandemic has had severe implications on healthcare systems and the patients affected by this infectious disease. To improve outcomes for patients with COVID-19 and limit future antimicrobial resistance, there is continued urgency to improve our understanding of the rates and causative agents of secondary bacterial infections in patients with COVID‑19, and recognise whether antibiotics are being overused in patients prior to and following COVID-19 diagnosis. This article presents the results of a rapid review comparing reported rates of secondary bacterial infections with rates of antibiotic use in patients with COVID-19 predominantly in a hospital setting, within the context of treatment guidelines and recommendations. The review revealed rates of antibiotic use in patients with COVID-19 of 37–100%, far outweighing rates of secondary bacterial infections which were typically below 20%. There was a lack of consistent reporting of causative microorganisms of secondary infections, and the distinction between bacterially- and virally-induced sepsis was rarely made. Early in the pandemic, healthcare agencies published treatment guidelines recognising the importance of antimicrobial stewardship. However, many are yet to provide updated guidance detailing the most appropriate antibiotics to treat patients with concurrent COVID-19 and secondary bacterial infections in a way which limits the emergence of drug-resistant infections and does not negatively impact patient outcomes. Without significant improvements to the testing and reporting of causative organisms and corresponding updates to antimicrobial treatment guidelines, there is a risk of worsened clinical outcomes and increased burden on healthcare systems from antimicrobial resistance during the remainder of the COVID-19 pandemic and beyond.

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“…Furthermore, late infections with gram-positive bacteria were more common in COVID-19 compared to influenza patients. Of note, a large multi-center study from Sweden comparing bacterial growth in 15,103 blood cultures from COVID-19 patients with non-infected controls also found that the rate of infections with gram-positive bacteria was significantly higher in patients with COVID-19 (66% vs. 50%, p < 0.0001) 13 .…”

Section: Discussionmentioning

confidence: 96%

Secondary bacterial infection in COVID-19 patients is a stronger predictor for death compared to influenza patients

Shafran

Ben‐Zvi

et al. 2021

Sci Rep

162

121

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Secondary bacterial infections are a potentially fatal complication of influenza infection. We aimed to define the impact of secondary bacterial infections on the clinical course and mortality in coronavirus disease 2019 (COVID-19) patients by comparison with influenza patients. COVID-19 (n = 642) and influenza (n = 742) patients, admitted to a large tertiary center in Israel and for whom blood or sputum culture had been taken were selected for this study. Bacterial culture results, clinical parameters, and death rates were compared. COVID-19 patients had higher rates of bacterial infections than influenza patients (12.6% vs. 8.7%). Notably, the time from admission to bacterial growth was longer in COVID-19 compared to influenza patients (4 (1–8) vs. 1 (1–3) days). Late infections (> 48 h after admission) with gram-positive bacteria were more common in COVID-19 patients (28% vs. 9.5%). Secondary infection was associated with a higher risk of death in both patient groups 2.7-fold (1.22–5.83) for COVID-19, and 3.09-fold (1.11–7.38) for Influenza). The association with death remained significant upon adjustment to age and clinical parameters in COVID-19 but not in influenza infection. Secondary bacterial infection is a notable complication associated with worse outcomes in COVID-19 than influenza patients. Careful surveillance and prompt antibiotic treatment may benefit selected patients.

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Low prevalence of bloodstream infection and high blood culture contamination rates in patients with COVID-19

Cited by 46 publications

References 15 publications

Risk factors for nosocomial bloodstream infections in COVID-19 affected patients: protocol for a case–control study

Risk factors for nosocomial bloodstream infections in COVID-19 affected patients: protocol for a case–control study

A rapid review of the overuse of antibiotics during the COVID-19 pandemic: lessons learned and recommendations for the future

Secondary bacterial infection in COVID-19 patients is a stronger predictor for death compared to influenza patients

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