Risk Factors for Mortality in Adult COVID-19 Patients Who Develop Bloodstream Infections Mostly Caused by Antimicrobial-Resistant Organisms: Analysis at a Large Teaching Hospital in Italy

• Published in: Journal of clinical medicine 2021-04, Vol.10 (8), p.1752
• Main Authors: Posteraro, Brunella, De Angelis, Giulia, Menchinelli, Giulia, D'Inzeo, Tiziana, Fiori, Barbara, De Maio, Flavio, Cortazzo, Venere, Sanguinetti, Maurizio, Spanu, Teresa
• Format: Article
• Language: English
• Subjects: Antibiotics; Antifungal agents; Antimicrobial agents; Clinical medicine; Coronaviruses; COVID-19; Drugs; Infections; Laboratories; Medical records; Mortality; Pathogens; Patients; Regression analysis; Risk factors; Sepsis; Severe acute respiratory syndrome coronavirus 2; Teaching hospitals
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm10081752

The aim of this study was to characterize COVID-19 (SARS-CoV-2-infected) patients who develop bloodstream infection (BSI) and to assess risk factors associated with in-hospital mortality. We conducted a retrospective observational study of adult patients admitted for ≥48 h to a large Central Italy hospital for COVID-19 (1 March to 31 May 2020) who had or had not survived at discharge. We included only patients having blood cultures drawn or other inclusion criteria satisfied. Kaplan-Meier survival or Cox regression analyses were performed of 293 COVID-19 patients studied, 46 patients (15.7%) had a hospital-acquired clinically relevant BSI secondary to SARS-CoV-2 infection, accounting for 58 episodes (49 monomicrobial and 9 polymicrobial) in total. Twelve episodes (20.7%) occurred at day 3 of hospital admission. Sixty-nine species were isolated, including (32.8%), Enterobacterales (20.7%), (17.2%), (13.8%) and (10.3%). Of 69 isolates, 27 (39.1%) were multidrug-resistant organisms. Twelve (54.5%) of 22 patients for whom empirical antimicrobial therapy was inappropriate were infected by a multidrug-resistant organism. Of 46 patients, 26 (56.5%) survived and 20 (43.5%) died. Exploring variables for association with in-hospital mortality identified > 75-year age (HR 2.97, 95% CI 1.15-7.68, = 0.02), septic shock (HR 6.55, 95% CI 2.36-18.23, < 0.001) and BSI onset ≤ 3 days (HR 4.68, 95% CI 1.40-15.63, = 0.01) as risk factors independently associated with death. In our hospital, mortality among COVID-19 patients with BSI was high. While continued vigilance against these infections is essential, identification of risk factors for mortality may help to reduce fatal outcomes in patients with COVID-19.