Abstract
BackgroundCOVID-19 pneumonia can be indistinguishable from other infectious respiratory etiologies, so providers are challenged with deciding whether empiric antibiotics should be prescribed to hospitalized patients with SARS-CoV-2. This study aimed to evaluate predictors of respiratory bacterial co-infections (RBCI) in hospitalized patients with COVID-19. MethodsRetrospective study evaluating COVID-19 inpatients from Feb 1, 2020 to Sept 30, 2020 at a tertiary academic medical center. Patients with RBCI were matched with three COVID-19 inpatients lacking RBCI admitted within 7 days of each other. The primary objectives of this study were to determine the prevalence of and identify variables associated with RBCI in COVID-19 inpatients. Secondary outcomes included length of stay and mortality. Data collected included demographics; inflammatory markers; bacterial culture/antigen results; antibiotic exposure; and COVID-19 severity. Wilcoxon rank sum, Chi Square tests, or Fisher’s exact tests were utilized as appropriate. A multivariable logistic regression (MLR) model was conducted to identify covariates associated with RBCI.ResultsSeven hundred thirty-five patients were hospitalized with COVID-19 during the study period. Of these, 82 (11.2%) had RBCI. Fifty-seven of these patients met inclusion criteria and were matched to three patients lacking RBCI (N = 228 patients). Patients with RBCI were more likely to receive antibiotics [57 (100%) vs. 130 (76%), p < 0.0001] and for a longer cumulative duration [19 (13-33) vs. 8 (4-13) days, p < 0.0001] compared to patients lacking RBCI. The MLR model revealed risk factors of RBCI to be admission from SNF/LTAC/NH (AOR 6.8, 95% CI 2.6-18.2), severe COVID-19 (AOR 3.03, 95% CI 0.78-11.9), and leukocytosis (AOR 3.03, 95% CI 0.99-1.16). ConclusionAlthough RBCI is rare in COVID-19 inpatients, antibiotic use is common. COVID-19 inpatients may be more likely to have RBCI if they are admitted from a SNF/LTAC/NH, have severe COVID-19, or present with leukocytosis. Early and prompt recognition of RBCI predictors in COVID-19 inpatients may facilitate timely antimicrobial therapy while improving antimicrobial stewardship among patients at low risk for co-infection.Disclosures All Authors: No reported disclosures
Highlights
COVID-19, caused by the novel SARS-CoV-2 virus, was first identified in Wuhan, China, in December 2019 and declared a worldwide pandemic by the World Health Organization (WHO) in March 2020
Patients with respiratory bacterial co-infection were matched with three hospitalized COVID-19 patients lacking respiratory co-infection who were admitted within 7 days of each other
Twenty-five patients with respiratory bacterial coinfection were excluded for the following reasons: colonization (n = 8), non-index COVID-19 admission (n = 8), inmate (n = 6), pregnancy (n = 1), and other (n = 2)
Summary
COVID-19, caused by the novel SARS-CoV-2 virus, was first identified in Wuhan, China, in December 2019 and declared a worldwide pandemic by the World Health Organization (WHO) in March 2020. SARS-CoV-2 infects cells that express angiotensin-converting enzyme (ACE) receptors. A variety of organ systems may be impacted, but patients predominantly present with respiratory symptoms including shortness of breath, cough, and fever (Mclachlan, 2020). Due to the lack of distinguishing characteristics of COVID-19 pneumonia from other infectious respiratory etiologies, providers are challenged with deciding whether empiric anti bacterials are warranted (Use of chest imaging, 2020). All authors have NO affiliation with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript
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