Bacteremia and Blood Culture Utilization during COVID-19 Surge in New York City
Bacteremia and Blood Culture Utilization during COVID-19 Surge in New York City
复制标题
DOI：
10.1128/jcm.00875-20
复制
发表时间：
2020-08-01
影响因子：
9.4
通讯作者：
Green, Daniel A.
中科院分区：
文献类型：
--
作者：
Sepulveda, Jorge;Westblade, Lars F.;Green, Daniel A.
2020 年 3 月，纽约市医院就诊的 2019 冠状病毒病 (COVID-19) 患者激增，导致血培养利用率急剧增加，超出了自动化血培养仪器的容量。我们试图评估 COVID-19 大流行期间血培养的利用和诊断率，以确定菌血症的患病率和常见病因，并为缓解血培养过度利用的诊断方法提供信息。我们对纽约市多中心医院网络的 28,011 名患者的 88,201 份血培养物进行了回顾性队列分析，以评估 COVID-19 中的订单量、阳性率、阳性时间和阳性培养物的病因。 2020年3月下半月订单量较上半月增长34.8%。 COVID-19 患者的菌血症发生率 (3.8%) 显着低于 COVID-19 阴性患者 (8.0%) 和未检测患者 (7.1%) (I) < 0.001）。 COVID-19 患者体内有很高比例的反映皮肤共生微生物群的微生物，排除这些微生物后，菌血症率可降低至 1.6%。超过 98% 的阳性培养物在培养 4 天内被检测到。对于 COVID-19 患者来说，血流感染非常罕见，这支持在缺乏细菌合并感染的令人信服的证据的情况下明智地使用血培养物。与订购提供者进行清晰的沟通对于防止患者激增期间过度使用血培养物是必要的，实验室应考虑将潜伏期从 5 天缩短到 4 天（如有必要），以释放额外的能力。
A surge of patients with coronavirus disease 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase in blood culture utilization, which overwhelmed the capacity of automated blood culture instruments. We sought to evaluate the utilization and diagnostic yield of blood cultures during the COVID-19 pandemic to determine prevalence and common etiologies of bacteremia and to inform a diagnostic approach to relieve blood culture overutilization. We performed a retrospective cohort analysis of 88,201 blood cultures from 28,011 patients at a multicenter network of hospitals within New York City to evaluate order volume, positivity rate, time to positivity, and etiologies of positive cultures in COVID-19. Ordering volume increased by 34.8% in the second half of March 2020 compared to the level in the first half of the month. The rate of bacteremia was significantly lower among COVID-19 patients (3.8%) than among COVID-19-negative patients (8.0%) and those not tested (7.1%) (I) < 0.001). COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, which, when excluded, reduced the bacteremia rate to 1.6%. More than 98% of all positive cultures were detected within 4 days of incubation. Bloodstream infections are very rare for COVID-19 patients, which supports the judicious use of blood cultures in the absence of compelling evidence for bacterial coinfection. Clear communication with ordering providers is necessary to prevent overutilization of blood cultures during patient surges, and laboratories should consider shortening the incubation period from 5 days to 4 days, if necessary, to free additional capacity.