Abstract
BackgroundWe investigated for change in blood stream infections (BSI) with Enterobacterales, coagulase negative staphylococci (CoNS), Streptococcus pneumoniae, and Staphylococcus aureus during the first UK wave of SARS-CoV-2 across five London hospitals.MethodsA retrospective multicentre ecological analysis was undertaken evaluating all blood cultures taken from adults from 01 April 2017 to 30 April 2020 across five acute hospitals in London. Linear trend analysis and ARIMA models allowing for seasonality were used to look for significant variation.ResultsOne hundred nineteen thousand five hundred eighty-four blood cultures were included. At the height of the UK SARS-CoV-2 first wave in April 2020, Enterobacterales bacteraemias were at an historic low across two London trusts (63/3814, 1.65%), whilst all CoNS BSI were at an historic high (173/3814, 4.25%). This differed significantly for both Enterobacterales (p = 0.013), CoNS central line associated BSIs (CLABSI) (p < 0.01) and CoNS non-CLABSI (p < 0.01), when compared with prior periods, even allowing for seasonal variation. S. pneumoniae (p = 0.631) and S. aureus (p = 0.617) BSI did not vary significant throughout the study period.ConclusionsSignificantly fewer than expected Enterobacterales BSI occurred during the UK peak of the COVID-19 pandemic; identifying potential causes, including potential unintended consequences of national self-isolation public health messaging, is essential. High rates of CoNS BSI, with evidence of increased CLABSI, but also likely contamination associated with increased use of personal protective equipment, may result in inappropriate antimicrobial use and indicates a clear area for intervention during further waves.
Highlights
We investigated for change in blood stream infections (BSI) with Enterobacterales, coagulase negative staphylococci (CoNS), Streptococcus pneumoniae, and Staphylococcus aureus during the first United Kingdom (UK) wave of SARS-CoV-2 across five London hospitals
We investigated the incidence of BSIs during the initial months of the COVID-19 pandemic, focusing on Enterobacterales and CoNS, against variations in rates across the preceding 3 years
The autoregressive integrated moving average (ARIMA) model, constructed to allow for any seasonality, is represented in Fig. 3a-d and demonstrates historic observed BSI (April 2017–December 2019) and Discussion In our multi-centre BSI ecological analysis we find during the period of COVID-19 social distancing and selfisolation a significant reduction in Enterobacterales BSIs verified across two different statistical models
Summary
We investigated for change in blood stream infections (BSI) with Enterobacterales, coagulase negative staphylococci (CoNS), Streptococcus pneumoniae, and Staphylococcus aureus during the first UK wave of SARS-CoV-2 across five London hospitals. Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) began in December 2019 in China. In the UK, social distancing and self-quarantine measures were subsequently implemented, aimed at slowing transmission. In an attempt to prevent overwhelming hospital capacity, those with high temperature and/or new continuous cough (i.e. symptoms consistent with COVID-19, and other infections) were advised to stay home and seek advice online or via a national telephone service [1]. Extensive self-isolation practices and decreased utilisation of healthcare services has potentially impacted on direct care for both COVID-19 and non-COVID-19 clinical presentations
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