Increasing Rates of Intensive Care Unit Bloodstream Infections During the Second COVID-19 Pandemic Wave, Particularly Primary Endogenous Enterococcus faecium, with High Crude Mortality and Associated with Introduction of Immunomodulatory Therapy
| Autor: | Lara Payne, Angelo Sousa, Helen Winslow, Luke B Snell, Themoula Charalampous, Helen Vollmer, Andrew Jones, Jerry Tam, Christian Buckingham, Jessica Irwin, Rahul Batra, Jonathan D. Edgeworth, Anita Milton, Duncan Wyncoll, Adela Alcolea-Medina |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19) biology business.industry Transmission (medicine) biology.organism_classification Intensive care unit law.invention chemistry.chemical_compound Tocilizumab chemistry Disease severity law Internal medicine Pandemic Medicine Infection control business Enterococcus faecium |
| Zdroj: | SSRN Electronic Journal. |
| ISSN: | 1556-5068 |
| DOI: | 10.2139/ssrn.3895049 |
| Popis: | Background: Reports indicate that COVID-19 patients have more bloodstream infections (BSI) on the intensive care unit (ICU) potentially due to lapses in infection control practice or other factors. Methods: Retrospective single-site study of ICU-BSIs in mechanically ventilated (MV) COVID-19 patients during the first pandemic year. Clinical, demographic and laboratory data including targeted pathogen genome sequencing was analysed during first (March 13th - May 31st 2020) and second (October 1st 2020 - March 15th 2021) pandemic waves. Findings: There were 305 MV-ICU patients in wave one and 440 in wave two with peak occupancy of 113 and 155 patients, respectively. The BSI rate was higher during both waves than pre-pandemic, but more in wave-two than wave-one, particularly during the first 28 days on ICU (14.1 vs. 9.4/1000 bed days; p=0.03) and with E. faecium (3.57 vs. 0.47/1000 bed days; p=0.0067). 22/28 (77%) of E. faecium BSIs had no microbiologically definable focus and the high wave-two rate could not be explained by transmission. Wave-two BSI-patients received more corticosteroids and tocilizumab and had higher crude hospital mortality compared with non-BSI patients (41% vs. 21% p |
| Databáze: | OpenAIRE |
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