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Increased rates of secondary bacterial infections, including Enterococcus bacteremia, in patients hospitalized with coronavirus disease 2019 (COVID-19)

Published online by Cambridge University Press:  06 September 2021

Catherine DeVoe
Affiliation:
Division of Infectious Diseases, University of California, San Francisco, California
Mark R. Segal
Affiliation:
Department of Epidemiology and Biostatistics, University of California, San Francisco, California
Lusha Wang
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, University of California, San Francisco, California
Kim Stanley
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, University of California, San Francisco, California
Sharline Madera
Affiliation:
Division of Infectious Diseases, University of California, San Francisco, California
Joe Fan
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, University of California, San Francisco, California
Jonathan Schouest
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, University of California, San Francisco, California
Renee Graham-Ojo
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, University of California, San Francisco, California
Amy Nichols
Affiliation:
Department of Hospital Epidemiology and Infection Prevention, University of California, San Francisco, California
Priya A. Prasad
Affiliation:
Division of Hospital Medicine, University of California, San Francisco, California
Rajani Ghale
Affiliation:
Department of Pulmonary and Critical Care Medicine, University of California, San Francisco, California
Christina Love
Affiliation:
Division of Infectious Diseases, University of California, San Francisco, California
Yumiko Abe-Jones
Affiliation:
Division of Hospital Medicine, University of California, San Francisco, California
Kirsten N. Kangelaris
Affiliation:
Division of Hospital Medicine, University of California, San Francisco, California
Sarah L. Patterson
Affiliation:
Division of Rheumatology, University of California, San Francisco, California
Deborah S. Yokoe
Affiliation:
Division of Infectious Diseases, University of California, San Francisco, California Department of Hospital Epidemiology and Infection Prevention, University of California, San Francisco, California
Charles R. Langelier*
Affiliation:
Division of Infectious Diseases, University of California, San Francisco, California Department of Hospital Epidemiology and Infection Prevention, University of California, San Francisco, California Chan Zuckerberg Biohub, San Francisco, California
*
Author for correspondence: Charles Langelier, E-mail: chaz.langelier@ucsf.edu

Abstract

Objective:

We compared the rates of hospital-onset secondary bacterial infections in patients with coronavirus disease 2019 (COVID-19) with rates in patients with influenza and controls, and we investigated reports of increased incidence of Enterococcus infections in patients with COVID-19.

Design:

Retrospective cohort study.

Setting:

An academic quaternary-care hospital in San Francisco, California.

Patients:

Patients admitted between October 1, 2019, and October 1, 2020, with a positive SARS-CoV-2 PCR (N = 314) or influenza PCR (N = 82) within 2 weeks of admission were compared with inpatients without positive SARS-CoV-2 or influenza tests during the study period (N = 14,332).

Methods:

National Healthcare Safety Network definitions were used to identify infection-related ventilator-associated complications (IVACs), probable ventilator-associated pneumonia (PVAP), bloodstream infections (BSIs), and catheter-associated urinary tract infections (CAUTIs). A multiple logistic regression model was used to control for likely confounders.

Results:

COVID-19 patients had significantly higher rates of IVAC and PVAP compared to controls, with adjusted odds ratios of 4.7 (95% confidence interval [CI], 1.7–13.9) and 10.4 (95 % CI, 2.1–52.1), respectively. COVID-19 patients had higher incidence of BSI due to Enterococcus but not BSI generally, and whole-genome sequencing of Enterococcus isolates demonstrated that nosocomial transmission did not explain the increased rate. Subanalyses of patients admitted to the intensive care unit and patients who required mechanical ventilation revealed similar findings.

Conclusions:

COVID-19 is associated with an increased risk of IVAC, PVAP, and Enterococcus BSI compared with hospitalized controls, which is not fully explained by factors such as immunosuppressive treatments and duration of mechanical ventilation. The mechanism underlying increased rates of Enterococcus BSI in COVID-19 patients requires further investigation.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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