Patients with COVID-19 and secondary bloodstream infections tend to be sicker on admission
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Adult patients hospitalized with severe COVID-19 and secondary bloodstream infections had a more severe initial presentation, prolonged hospital stay and worse clinical outcomes, according to a recent study.
“Anecdotally, when I was taking care of or consulted on patients infected with COVID-19, we found that a large proportion of them had a coinfection with a secondary bloodstream infection (sBSI),” Pinki J. Bhatt, MD, assistant professor in the division of infectious diseases at Rutgers Robert Wood Johnson Medical School and adjunct assistant professor at Rutgers Ernest Mario School of Pharmacy, told Healio. “Thus, this prompted us to see how common it was at three of our hospitals in New Jersey, as well as look into risk factors and outcomes in those with COVID-19 and a concurrent blood stream infection.”
Bhatt and colleagues performed a case-control study of all hospitalized patients diagnosed with severe COVID-19 with blood cultures drawn between March 1 and May 7, 2020, at three academic medical centers in New Jersey. According to the study, risk factors and outcomes were compared between patients with sBSI and controls with no sBSI.
In total, 375 hospitalized patients were included in the study. The researchers found that there were 128 sBSIs during hospitalization. Among the first set of positive blood cultures, 117 (91.4%) were bacterial and seven (5.5%) were fungal. The researchers observed that hospitalized adult patients with severe COVID-19 and sBSI had a more severe initial presentation, prolonged hospital stay (17 days vs. 6.5 days; P < .001) and worse clinical outcomes. They also found that patients with sBSI were more likely to have altered mental status (15.7), lower mean percent oxygen saturation on room air (82.5% vs 86.1%), have septic shock and be admitted to the ICU (71.1% vs 35.6%; P < .001) compared with the controls. Additionally, the study demonstrated that in-hospital mortality was higher among patients with an sBSI compared with the controls (53.1% vs 32.8%; P = .0001).
“Patients with COVID-19 and sBSI are certainly sicker with a higher in-hospital mortality compared to those with COVID-19 but without sBSI. We noticed that all of our patients were on antimicrobials at some point, whether or not they had a sBSI. We feel it’s important to maintain antimicrobial stewardship principles during this unprecedented time. However, further prospective studies are necessary to better characterize risk factors and prediction modeling to understand when to suspect and empirically treat for sBSI in severe COVID-19.”
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