Hospital patients with COVID-19 at increased risk for antibiotic-resistant infections
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Patients with COVID-19 had a higher risk for hospital-onset antibiotic-resistant infections compared with patients with influenza-like illness before the pandemic, according to a study published in Clinical Infectious Diseases.
“Given the frequent use of antibiotics among hospitalized patients with a diagnosis of COVID-19, our objective was to estimate the frequency of bacterial and fungal coinfections among these patients, estimate the frequency of certain antibiotic-resistant infections typically associated with health care for these patients, and compare the frequency of certain antibiotic-resistant infections to a cohort of patients hospitalized with influenza-like illness (ILI) before the pandemic in order to address which risk factors may be contribution to antibiotic-resistant infections in COVID-19 patients,” CDC epidemiologist James Baggs, PhD, told Healio.
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Baggs and colleagues conducted a retrospective study using adult and pediatric inpatient discharge data from U.S. hospitals included in the Premier Healthcare Database Special COVID-19 Release. These records included diagnostic and procedure codes, demographic information, admission and discharge dates and facility characteristics.
They used the data to split inpatients into COVID-19 and ILI cohorts and identified patients with at least one microbiology specimen collected between 3 days before admission and 3 days after discharge. The study included 142,426 inpatients diagnosed with ILI from January to June 2019 and 206,465 diagnosed with COVID-19 from January 2020 to June 2021.
The researchers retrospectively calculated the proportions of inpatients with a positive bacterial or fungal culture among inpatients with ILI and COVID-19. To best determine antibiotic resistance rates, they limited specimens to MRSA, extended-spectrum beta-lactamases (ESBLs), carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Acinetobacter, (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA).
Overall, the study showed that inpatients with COVID-19 had longer lengths of stay than inpatients with ILI (8.3 vs. 6.1 days), as well as higher odds of spending at least 1 day in a critical care unit (48.3% vs. 46.4%) and having at least 1 day of invasive mechanical ventilation (13% vs. 10.2%).
According to the study, the proportion of inpatients with a bacterial or fungal culture obtained was similar for the COVID-19 and ILI cohorts — 56.2% and 60.4%, respectively — but the percent of discharges with a positive culture categorized as community onset was lower among inpatients with COVID-19 compared with inpatients with ILI (7% vs. 10.4%). The percentage of discharges with a positive culture categorized as hospital onset was higher among inpatients with COVID-19 (4.1% vs. 2.4%).
The most common organisms among inpatients in either group were similar. However, researchers found that community-onset infection rates of MRSA, ESBL, CRE, VRE, CRAB and CRPA were lower, whereas hospital-onset infection rates were higher among inpatients with COVID-19 compared with those with ILI across all pathogens.
“Hospitals should continue to focus on infection control and antibiotic stewardship to prevent health care-associated infections among COVID-19 inpatients,” Baggs said. “Empiric antibiotic therapy should not be used to treat COVID-19 patients as the frequency of bacterial and fungal infections at admission for COVID-19 patients is low.”
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