Association of COVID-19 coinfection with increased mortality among patients with Pseudomonas aeruginosa bloodstream infection in the Veterans Health Administration system

Leila S Hojat; Brigid M Wilson; Federico Perez; Maria F Mojica; Mendel E Singer; Robert A Bonomo; Lauren H Epstein

doi:10.1017/ash.2023.455

Association of COVID-19 coinfection with increased mortality among patients with Pseudomonas aeruginosa bloodstream infection in the Veterans Health Administration system

Antimicrob Steward Healthc Epidemiol. 2023 Dec 15;3(1):e237. doi: 10.1017/ash.2023.455. eCollection 2023.

Authors

Leila S Hojat^{1

2}, Brigid M Wilson^{1

3}, Federico Perez^{1

3

4}, Maria F Mojica^{4

5

6

7}, Mendel E Singer⁸, Robert A Bonomo^{1

3

4

5

7}, Lauren H Epstein⁹

Affiliations

¹ Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, OH, USA.
² Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
³ Geriatric Research Education and Clinical Center (GRECC), the VA Northeast Ohio Healthcare System, Cleveland, OH, USA.
⁴ Case Western Reserve University, Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA.
⁵ Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, USA.
⁶ Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia.
⁷ Departments of Pathology, Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
⁸ Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.
⁹ Infectious Diseases, US Department of Veterans Affairs Medical Center, Decatur, GA, USA.

Abstract

Objective: Pseudomonas aeruginosa bloodstream infection (PA-BSI) and COVID-19 are independently associated with high mortality. We sought to demonstrate the impact of COVID-19 coinfection on patients with PA-BSI.

Design: Retrospective cohort study.

Setting: Veterans Health Administration.

Patients: Hospitalized patients with PA-BSI in pre-COVID-19 (January 2009 to December 2019) and COVID-19 (January 2020 to June 2022) periods. Patients in the COVID-19 period were further stratified by the presence or absence of concomitant COVID-19 infection.

Methods: We characterized trends in resistance, treatment, and mortality over the study period. Multivariable logistic regression and modified Poisson analyses were used to determine the association between COVID-19 and mortality among patients with PA-BSI. Additional predictors included demographics, comorbidities, disease severity, antimicrobial susceptibility, and treatment.

Results: A total of 6,714 patients with PA-BSI were identified. Throughout the study period, PA resistance rates decreased. Mortality decreased during the pre-COVID-19 period and increased during the COVID-19 period. Mortality was not significantly different between pre-COVID-19 (24.5%, 95% confidence interval [CI] 23.3-28.6) and COVID-19 period/COVID-negative (26.0%, 95% CI 23.5-28.6) patients, but it was significantly higher in COVID-19 period/COVID-positive patients (47.2%, 35.3-59.3). In the modified Poisson analysis, COVID-19 coinfection was associated with higher mortality (relative risk 1.44, 95% CI 1.01-2.06). Higher Charlson Comorbidity Index, higher modified Acute Physiology and Chronic Health Evaluation score, and no targeted PA-BSI treatment within 48 h were also predictors of higher mortality.

Conclusions: Higher mortality was observed in patients with COVID-19 coinfection among patients with PA-BSI. Future studies should explore this relationship in other settings and investigate potential SARS-CoV-2 and PA synergy.