Increased rates of secondary bacterial infections, including Enterococcus bacteremia, in patients hospitalized with coronavirus disease 2019 (COVID-19). (6th October 2022)

• Record Type: Journal Article
• Authors: DeVoe, Catherine; Segal, Mark R.; Wang, Lusha; Stanley, Kim; Madera, Sharline; Fan, Joe; Schouest, Jonathan; Graham-Ojo, Renee; Nichols, Amy; Prasad, Priya A.; Ghale, Rajani; Love, Christina; Abe-Jones, Yumiko; Kangelaris, Kirsten N.; Patterson, Sarah L.; Yokoe, Deborah S.; Langelier, Charles R.
• Is Part Of: Infection control and hospital epidemiology. Volume 43:Number 10(2022)
• Page Start: 1416
• Page End: 1423
• Publication Date: 2022-10-06
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2021.391
• Languages: English
• ISSNs: 0899-823X

Abstract

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.