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      Predictors and Outcomes of HAIs in COVID-19 Patients

      research-article
      Author(s): a , * , b , b , a , c , d , e , e , a , f , g
      Publication date (Electronic):
      Journal: International Journal of Infectious Diseases
      Publisher: Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
      Keywords: HAI, Healthcare Associated Infections, CVL, central venous line, CI, Confidence Interval, OR, Odds Ratio, AWS, Amazon Web Services, ICD10CM, International classification of disease 10thClinical Modification, CPT, Current Procedural Terminology, VAP, Ventilator Associated Pneumonia, CLABSI, central line associated blood stream infection, CAUTI, Catheter associated urinary tract infection, SIC, Sepsis Induced Coagulopathy, ICU, Intensive care unit, FiO2, Fraction of inspired oxygen, CMS, Center for Medicare and Medicaid Services, AKI, Acute Kidney Injury, COVID 19, Secondary infections, Tocilizumab, Hydroxychloroquine

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          Highlights

          • •

            Of 1565 patient, 140 (8.9%) separate HAIs from 73 different organisms developed in 59 (3.7%) patients.

          • •

            Tocilizumab, steroids and hydroxychloroquine are associated with higher rate of HAIs.

          • •

            HAIs are not associated with increased risk of death.

          Abstract

          Introduction

          Healthcare Associated infections (HAI) after a viral illness are important source of morbidity and mortality, this has not been studied well in hospitalized COVID-19 patients.

          Methods

          We included all COVID-19 positive adult patients (≥18 years) hospitalized between March 1, 2020 to August 5th, 2020. We used CDC definitions of HAI in the acute care setting. Outcomes studied were rates and types of infections and in hospital mortality.. We constructed several multivariable logistic regression models to examine characteristics associated with development of HAI.

          Results

          Of 1565 patients, 140 separate HAIs from 73 different organisms developed in 59 (3.7%) patients. Of these, 23 were gram positive, 39 were gram negative and 11 were fungal. Patient developing HAI did not have higher odds of death (OR 0.85,95%CI 0.40-1.81, p = 0.69). HAIs were associated with use of tocilizumab (OR 5.04, 95%CI 2.4-10.6, p < 0.001), steroids (OR 3.8, 95%CI 1.4-10, p = 0.007), hydroxychloroquine(OR 3.0, 95%CI 1.0-8.8, p = 0.05) and acute kidney injury requiring hemodialysis (OR 3.7, 95%CI 1.1-12.8, p = 0.04).

          Conclusions

          HAI are common in hospitalized covid-19 patients. Tocilizumab and steroids were associated with increased risk of HAIs.

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          Most cited references29

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Fei Zhou, Ting Yu, Ronghui Du … (2020)
          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

            Nanshan Chen, Min Zhou, Xuan Dong … (2022)
            Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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              Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review

              W. Joost Wiersinga, Andrew Rhodes, Allen Cheng … (2020)
              The coronavirus disease 2019 (COVID-19) pandemic, due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease. This review discusses current evidence regarding the pathophysiology, transmission, diagnosis, and management of COVID-19.
              Article 0 comments Cited 2403 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Infect Dis
                Journal ID (iso-abbrev): Int J Infect Dis
                Title: International Journal of Infectious Diseases
                Publisher: Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
                ISSN (Print): 1201-9712
                ISSN (Electronic): 1878-3511
                Publication date PMC-release: 15 November 2020
                Publication date (Electronic): 15 November 2020
                Affiliations
                [a ]Department of Pulmonary & Critical Care, Northeast Georgia Health System, Gainesville, GA 30501
                [b ]Department of Internal Medicine, Northeast Georgia Health System, Gainesville, GA 30501
                [c ]Department of Internal Medicine, Apex hospital, Varanasi 221004
                [d ]Division of Cardiovascular Critical Care, Department of Cardiovascular and Thoracic surgery, West Virginia University, WV, 26506
                [e ]IPC global, 4080 McGinnis Ferry Road, Building 100, Suite 103, Alpharetta, GA 30005
                [f ]Division of pulmonary & Critical Care, Medical College of Wisconsin, Milwaukee 53226
                [g ]Division of Hematology/Oncology, Georgia Cancer Center, Augusta University, Augusta, GA 30909
                Author notes
                [* ]Corresponding author.
                Article
                Publisher Item ID: S1201-9712(20)32447-4
                DOI: 10.1016/j.ijid.2020.11.135
                PMC ID: 7666872
                PubMed ID: 33207271
                SO-VID: 92868465-d999-4baf-ac8b-caf9a32e660e
                Copyright © © 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 13 September 2020
                Date revision received : 6 November 2020
                Date accepted : 8 November 2020
                Categories
                Subject: Article

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: hai, healthcare associated infections,cvl, central venous line,ci, confidence interval,or, odds ratio,aws, amazon web services,icd10cm, international classification of disease 10thclinical modification,cpt, current procedural terminology,vap, ventilator associated pneumonia,clabsi, central line associated blood stream infection,cauti, catheter associated urinary tract infection,sic, sepsis induced coagulopathy,icu, intensive care unit,fio2, fraction of inspired oxygen,cms, center for medicare and medicaid services,aki, acute kidney injury,covid 19,secondary infections,tocilizumab,hydroxychloroquine
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: hai, healthcare associated infections, cvl, central venous line, ci, confidence interval, or, odds ratio, aws, amazon web services, icd10cm, international classification of disease 10thclinical modification, cpt, current procedural terminology, vap, ventilator associated pneumonia, clabsi, central line associated blood stream infection, cauti, catheter associated urinary tract infection, sic, sepsis induced coagulopathy, icu, intensive care unit, fio2, fraction of inspired oxygen, cms, center for medicare and medicaid services, aki, acute kidney injury, covid 19, secondary infections, tocilizumab, hydroxychloroquine

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