Clinical Characteristics Associated with Bacterial Bloodstream Coinfection in COVID-19

Nicholas Rebold; Sara Alosaimy; Taylor Morrisette; Dana Holger; Abdalhamid M Lagnf; Iman Ansari; Ana C Belza; Laura Cheaney; Huzaifa Hussain; Shelbye R Herbin; Jacinda Abdul-Mutakabbir; Caitlin Carron; Avnish Sandhu; Teena Chopra; Michael J Rybak

doi:10.1007/s40121-022-00636-6

Clinical Characteristics Associated with Bacterial Bloodstream Coinfection in COVID-19

Infect Dis Ther. 2022 Jun;11(3):1281-1296. doi: 10.1007/s40121-022-00636-6. Epub 2022 May 11.

Authors

Nicholas Rebold^{1

2}, Sara Alosaimy^{3

4}, Taylor Morrisette^{3

4

5

6}, Dana Holger^{3

4}, Abdalhamid M Lagnf^{3

4}, Iman Ansari³, Ana C Belza³, Laura Cheaney³, Huzaifa Hussain³, Shelbye R Herbin^{7

8}, Jacinda Abdul-Mutakabbir^{3

4

9

10}, Caitlin Carron³, Avnish Sandhu^{3

7

11}, Teena Chopra^{3

7

11}, Michael J Rybak^{12

13

14

15}

Affiliations

¹ Wayne State University, Detroit, MI, USA. Nicholas.rebold@wayne.edu.
² Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA. Nicholas.rebold@wayne.edu.
³ Wayne State University, Detroit, MI, USA.
⁴ Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
⁵ Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina College of Pharmacy, Charleston, SC, USA.
⁶ Department of Pharmacy Services, Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston, SC, USA.
⁷ Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA.
⁸ Department of Pharmacy, Henry Ford Wyandotte Hospital, Henry Ford Health System, Wyandotte, MI, USA.
⁹ Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, USA.
¹⁰ Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA.
¹¹ Department of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA.
¹² Wayne State University, Detroit, MI, USA. m.rybak@wayne.edu.
¹³ Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA. m.rybak@wayne.edu.
¹⁴ Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA. m.rybak@wayne.edu.
¹⁵ Department of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA. m.rybak@wayne.edu.

Abstract

Introduction: Inappropriate antibiotic use in COVID-19 is often due to treatment of presumed bacterial coinfection. Predictive factors to distinguish COVID-19 from COVID-19 with bacterial coinfection or bloodstream infection are limited.

Methods: We conducted a retrospective cohort study of 595 COVID-19 patients admitted between March 8, 2020, and April 4, 2020, to describe factors associated with a bacterial bloodstream coinfection (BSI). The primary outcome was any characteristic associated with BSI in COVID-19, with secondary outcomes including 30-day mortality and days of antibiotic therapy (DOT) by antibiotic consumption (DOT/1000 patient-days). Variables of interest were compared between true BSI (n = 25) and all other COVID-19 cases (n = 570). A secondary comparison was performed between positive blood cultures with true BSI (n = 25) and contaminants (n = 33) on antibiotic use.

Results: Fever (> 38 °C) (as a COVID-19 symptom) was not different between true BSI (n = 25) and all other COVID-19 patients (n = 570) (p = 0.93), although it was different as a reason for emergency department (ED) admission (p = 0.01). Neurological symptoms (ED reason or COVID-19 symptom) were significantly higher in the true BSI group (p < 0.01, p < 0.01) and were independently associated with true BSI (ED reason: OR = 3.27, p < 0.01; COVID-19 symptom: OR = 2.69, p = 0.03) on multivariate logistic regression. High (15-19.9 × 10⁹/L) white blood cell (WBC) count at admission was also higher in the true BSI group (p < 0.01) and was independently associated with true BSI (OR = 2.56, p = 0.06) though was not statistically significant. Thirty-day mortality was higher among true BSI (p < 0.01). Antibiotic consumption (DOT/1000 patient-days) between true BSI and contaminants was not different (p = 0.34). True bloodstream coinfection was 4.2% (25/595) over the 28-day period.

Conclusion: True BSI in COVID-19 was associated with neurological symptoms and nonsignificant higher WBC, and led to overall higher 30-day mortality and worse patient outcomes.

Keywords: Bacterial coinfection; Blood culture; Bloodstream infection; COVID-19; Risk factors.

Abstract

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