The Impact of Secondary Bacterial Infections in COVID‐19 Patients on Mortality and the Immune Response in the State of Arizona

Abstract

The literature on COVID‐19 has focused primarily on urban centers and suggest an increased risk of mortality in COVID‐19 patients coinfected with bacteria compared to those solely infected with COVID‐19. In patients screened or admitted to suburban and rural hospitals in Arizona, mortality increased with co‐infection. The impact of bacterial coinfections on the immune response was studied by comparing white blood cell (WBC) and lymphocyte counts as well as the relationship between duration of steroid use and mortality in coinfected COVID‐19 patients investigated.MethodsA chart review of 677 SARS‐CoV‐2 patients was conducted at during December 2020 to March 2021. Patients solely infected with COVID‐19 (COVID‐19 patients) were compared to patients with concurrent bacterial or fungal infections (coinfected patients). Parameters included admission duration, ICU duration, mortality, WBC, lymphocytes, and duration of steroid use. WBC and lymphocytes were compared amongst COVID‐19 and coinfected patients that survived or that expired during their hospital stay. COVID‐19 positive patients not admitted to hospital were used as controls.ResultsThe admitted and ICU duration of coinfected patients was significantly (p < 0.05) higher (12.93 vs 10.92 days) than COVID‐19 patients (6.39 vs 4.38 days), as was mortality rate (22.5% vs 9.8%). WBC was higher (9.4x103) in coinfected patients than COVID‐19 alone (7.9x103). Lymphocytes were lower (2.03x103) in coinfected patients compared to COVID‐19 alone (2.41x103). A significant difference in WBC was seen between expired COVID‐19 patients (10.1x103), expired coinfected patients (10.01x103) and COVID‐19 non‐admitted patients (6.44x103). Lymphocytes were lower in surviving coinfected patients (I.96x103) and expired COVID‐19 patients (I.61x103) than COVID‐19 non‐admitted patients (7.33x 103). Expired coinfected patients were treated with steroids for a longer average duration (9.22 days) when compared to expired COVID‐19 (6.77 days).ConclusionThe presence of other bacterial infections increased hospitalization and mortality rate of patients admitted to a suburban hospital with COVID‐19 infection. Patients with co‐infections needed longer steroid treatment, had higher WBCs but lower lymphocytes. Thus, co‐infection presents significant challenges for treatment of patients with a diagnosis of COVID‐19.