Abstract
Hospital-acquired infections are emerging major concurrent conditions during the coronavirus disease (COVID-19) pandemic. We conducted a retrospective review of hospitalizations during March‒October 2020 of adults tested by reverse transcription PCR for severe acute respiratory syndrome coronavirus 2. We evaluated associations of COVID-19 diagnosis with risk for laboratory-confirmed bloodstream infections (LCBIs, primary outcome), time to LCBI, and risk for death by using logistic and competing risks regression with adjustment for relevant covariates. A total of 10,848 patients were included in the analysis: 918 (8.5%) were given a diagnosis of COVID-19, and 232 (2.1%) had LCBIs during their hospitalization. Of these patients, 58 (25%) were classified as having central line‒associated bloodstream infections. After adjusting for covariates, COVID-19‒positive status was associated with higher risk for LCBI and death. Reinforcement of infection control practices should be implemented in COVID-19 wards, and review of superiority and inferiority ranking methods by National Healthcare Safety Network criteria might be needed.
Highlights
COVID-19, coronavirus disease; MDA, organisms isolated during admission; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-sensitive S. aureus; MSS, multiple organisms isolated during bloodstream infection episode
Similar organisms were observed with cultures from COVID-19 patients meeting National Healthcare Safety Network (NHSN) definition for central line–associated bloodstream infection (CLABSI): Candida spp. 50.0% (n = 16), E. faecalis 25.0% (n = 8), and S. epidermis 12.5% (n = 4)
The organisms identified on blood culture from COVID-19–positive versus COVID-19–negative patients for laboratory-confirmed bloodstream infection (LCBI) and CLABSI were comparatively different, but because of low numbers, no statistical analysis was performed (Appendix Figure 2)
Summary
Time to LCBI (time from hospital admission to first positive blood culture per patient admission), and development of central line–associated bloodstream infection (CLABSI) evaluated by using the restricted cohort of patients who had a central venous catheter. In addition to COVID-19 infection status and outcomes (including organism identification), we abstracted information on demographics (age, sex, race, primary insurance provider), organisms isolated from blood cultures, chronic health conditions, Elixhauser comorbidity conditions [10], body mass index, severity of acute illness (sequential organ failure assessment score [SOFA] during hospital day 1) [11], renal replacement therapy (either intermittent or continuous), invasive mechanical ventilation, care in the ICU, prone positioning (including persons using mechanical ventilation), central venous catheters, urinary catheters, systemic corticosteroids, tocilizumab, and remdesivir.
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