COVID-19 Clinical Care: Rutgers University Clinical Study Shows Secondary Bloodstream Infections Linked With COVID-19 Severity
COVID-19 Clinical Care
: A new study by medical scientists from Rutgers University shows that hospitalized COVID-19 patients who had secondary blood infections typically developed disease severity and were significantly sicker upon hospital admission, had longer hospital stays and poorer outcomes.
This is the first study to date to assess the microbiology, risk factors and outcomes in hospitalized patients with severe COVID-19 and secondary bloodstream infections (sBSI).
The study team performed a multicenter case-control study including all hospitalized patients diagnosed with severe COVID-19 and blood cultures drawn from 1 March 2020 to 7 May 2020 at 3 academic medical centers in New Jersey. Data collection included demographics, clinical and microbiologic variables, and patient outcomes. Risk factors and outcomes were compared between cases (sBSI) and controls (no sBSI).
A total of 375 hospitalized patients were included. There were 128 sBSIs during the hospitalization. For the first set of positive blood cultures, 117 (91.4%) were bacterial and 7 (5.5%) were fungal. Those with sBSI were more likely to have altered mental status, lower mean percentage oxygen saturation on room air, have septic shock, and be admitted to the intensive care unit compared with controls. In-hospital mortality was higher in those with an sBSI versus controls (53.1% vs 32.8%, P
Co-lead author Dr Pinki Bhatt, an assistant professor at Rutgers Robert Wood Johnson Medical School's Division of Allergy, Immunology and Infectious Disease told Thailand Medical News, "These patients were more likely to have altered mental status, lower percent oxygen saturation, septic shock and to be admitted to the i
ntensive care unit compared to those without bloodstream infections."
The study team also found that patients who needed more advanced types of supplemental oxygen upon hospital admission had higher odds of secondary bloodstream infections.
Importantly the in-hospital mortality rate for these patients was more than 50 percent, but the study reported these deaths were associated with, not caused by, the condition.
The study findings were published in the peer reviewed journal: Clinical Infectious Diseases. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1748/5995838
The study team said that infections in COVID-19 patients may have contributed to the severity of illness or it may reflect other underlying physiological and immunological complications of COVID-19.
The research findings showed that the most common cause of secondary blood stream infections was unknown or not determined followed by central-line associated bloodstream infection as the most common presumed source.
The research also found that 80 percent of all the patients in the study received antimicrobials at some point during hospitalization, including those who did not have bloodstream infections.
Dr Bhatt added, "This likely reflects clinicians' inclination to administer antimicrobials given the limited information on the natural course of this novel disease.”
Dr Bhatt noted that further studies are needed to better understand when to suspect and treat empirically for secondary bloodstream infections in severe COVID-19.
Co-author Dr Navaneeth Narayanan, a clinical associate professor at Rutgers Ernest Mario School of Pharmacy added, "Antimicrobial stewardship remains crucial during this unprecedented time. Given the scale of the pandemic, indiscriminate antimicrobial use will inevitably lead to widespread complications such as adverse drug reactions, antimicrobial resistance and Clostridium difficile infections."
The study team concluded, “We observed that hospitalized adult patients with severe COVID-19 and sBSI had a more severe initial presentation, prolonged hospital course, and worse clinical outcomes. To maintain antimicrobial stewardship principles, further prospective studies are necessary to better characterize risk factors and prediction modeling to better understand when to suspect and empirically treat for sBSIs in severe COVID-19.”
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