Abstract
ObjectivesThe effect of the use of immunomodulatory drugs on the risk of developing hospital-acquired bloodstream infection (BSI) in patients with COVID-19 has not been specifically assessed. We aim to identify risk factors for, and outcomes of, BSI among hospitalized patients with severe COVID-19 pneumonia. MethodsWe performed a severity matched case–control study (1:1 ratio) nested in a large multicentre prospective cohort of hospitalized adults with COVID-19. Cases with BSI were identified from the cohort database. Controls were matched for age, sex and acute respiratory distress syndrome. A Cox proportional hazard ratio model was performed. ResultsOf 2005 patients, 100 (4.98%) presented 142 episodes of BSI, mainly caused by coagulase-negative staphylococci, Enterococcus faecalis and Pseudomonas aeruginosa. Polymicrobial infection accounted for 23 episodes. The median time from admission to the first episode of BSI was 15 days (IQR 9–20), and the most frequent source was catheter-related infection. The characteristics of patients with and without BSI were similar, including the use of tocilizumab, corticosteroids, and combinations. In the multivariate analysis, the use of these immunomodulatory drugs was not associated with an increased risk of BSI. A Cox proportional hazard ratio (HR) model showed that after adjusting for the time factor, BSI was associated with a higher in-hospital mortality risk (HR 2.59; 1.65–4.07; p < 0.001). DiscussionHospital-acquired BSI in patients with severe COVID-19 pneumonia was uncommon and the use of immunomodulatory drugs was not associated with its development. When adjusting for the time factor, BSI was associated with a higher mortality risk.
Highlights
To date, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has caused more than 116 million cases and more than 2.5 million deaths worldwide [1]
The shortage of staff and critical care resources [6], the proliferation of newly created critical care units with less experienced personnel, the increase in the healthcare workerepatient ratio [7], and the difficulty of conducting adequate antimicrobial stewardship programs may have facilitated the development of hospital-acquired infections, including bloodstream infections (BSIs)
Most episodes (87.3%) occurred in the intensive care unit (ICU), and 30.98% developed in newly created critical care units
Summary
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has caused more than 116 million cases and more than 2.5 million deaths worldwide [1]. After a decade of austerity in the public health system, and with as many as 3 164 983 cases and 71 727 confirmed deaths up to 9 March 2021, Spain has been badly hit by the COVID-19 pandemic [2,3]. In this setting, various therapeutic strategies have been implemented. These approaches include immunomodulatory drugs such as corticosteroids and monoclonal antibodies, which may potentially increase the risk of infectious complications. The shortage of staff and critical care resources [6], the proliferation of newly created critical care units with less experienced personnel, the increase in the healthcare workerepatient ratio [7], and the difficulty of conducting adequate antimicrobial stewardship programs may have facilitated the development of hospital-acquired infections, including bloodstream infections (BSIs)
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