Risk Factors and Outcomes of Hospitalized Patients With Severe Coronavirus Disease 2019 (COVID-19) and Secondary Bloodstream Infections: A Multicenter Case-Control Study
Risk Factors and Outcomes of Hospitalized Patients With Severe Coronavirus Disease 2019 (COVID-19) and Secondary Bloodstream Infections: A Multicenter Case-Control Study
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DOI：
10.1093/cid/ciaa1748
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发表时间：
2021-06-15
影响因子：
11.8
通讯作者：
Narayanan, Navaneeth
中科院分区：
文献类型：
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作者：
Bhatt, Pinki J.;Shiau, Stephanie;Narayanan, Navaneeth
背景2019冠状病毒病（COVID-19）已成为全球大流行病。关于COVID-19患者继发感染的临床特征已有报道，但严重COVID-19患者继发性血流感染（sBSI）的详细微生物学、风险因素和结局尚未得到很好的描述。我们进行了一项多中心病例对照研究，纳入了2020年3月1日至2020年5月7日期间在新泽西3个学术医疗中心诊断为严重COVID-19的所有住院患者和血液培养。数据收集包括人口统计学、临床和微生物学变量以及患者结局。比较sBSI组和对照组的危险因素和预后。共纳入375例住院患者。在住院期间有128例sBSI。在第一组阳性血培养中，117例（91.4%）为细菌，7例（5.5%）为真菌。与对照组相比，sBSI患者更容易出现精神状态改变、室内空气平均血氧饱和度降低、感染性休克和入住重症监护室。sBSI患者的住院死亡率高于对照组（53.1%vs 32.8%，P = 0.0001）。我们观察到，患有严重COVID-19和sBSI的住院成人患者的初始表现更严重，住院时间更长，临床结局更差。为了维持抗菌药物管理原则，有必要进行进一步的前瞻性研究，以更好地描述风险因素和预测模型，从而更好地了解在严重COVID-19中何时怀疑和经验性治疗sBSI。
Background. Coronavirus disease 2019 (COVID-19) has become a global pandemic. Clinical characteristics regarding secondary infections in patients with COVID-19 have been reported, but detailed microbiology, risk factors, and outcomes of secondary bloodstream infections (sBSIs) in patients with severe COVID-19 have not been well described.Methods. We performed a multicenter case-control study including all hospitalized patients diagnosed with severe COVID-19 and blood cultures drawn from 1 March 2020 to 7 May 2020 at 3 academic medical centers in New Jersey. Data collection included demographics, clinical and microbiologic variables, and patient outcomes. Risk factors and outcomes were compared between cases (sBSI) and controls (no sBSI).Results. A total of 375 hospitalized patients were included. There were 128 sBSIs during the hospitalization. For the first set of positive blood cultures, 117 (91.4%) were bacterial and 7 (5.5%) were fungal. Those with sBSI were more likely to have altered mental status, lower mean percentage oxygen saturation on room air, have septic shock, and be admitted to the intensive care unit compared with controls. In-hospital mortality was higher in those with an sBSI versus controls (53.1% vs 32.8%, P = .0001).Conclusions. We observed that hospitalized adult patients with severe COVID-19 and sBSI had a more severe initial presentation, prolonged hospital course, and worse clinical outcomes. To maintain antimicrobial stewardship principles, further prospective studies are necessary to better characterize risk factors and prediction modeling to better understand when to suspect and empirically treat for sBSIs in severe COVID-19.