Hospital-Acquired Bloodstream Infections in Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 Infection (Coronavirus Disease 2019): Association With Immunosuppressive Therapies
| Autor: | Bruce Farber, Thomas Chen, Angela Kim, Ilan Berlinrut, Pranisha Gautam-Goyal, Negin Niknam, Akshay Khatri, Prashant Malhotra, Thien-Ly Doan, David Hirschwerk, Stephanie Izard, Sarah Flannery, Michael I. Oppenheim, Marcia Epstein |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Secondary infection immunosuppressive therapy 030204 cardiovascular system & hematology Major Articles law.invention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Tocilizumab law Internal medicine medicine 030212 general & internal medicine bacteremia Fungemia fungemia SARS-CoV-2 business.industry Mortality rate Medical record COVID-19 medicine.disease Intensive care unit AcademicSubjects/MED00290 Infectious Diseases Oncology chemistry Bacteremia business Cohort study |
| Zdroj: | Open Forum Infectious Diseases |
| ISSN: | 2328-8957 |
| DOI: | 10.1093/ofid/ofab339 |
| Popis: | Background Immunosuppressive therapies proposed for Coronavirus disease 2019 (COVID-19) management may predispose to secondary infections. We evaluated the association of immunosuppressive therapies with bloodstream-infections (BSIs) in hospitalized COVID-19 patients. Methods This was an institutional review board-approved retrospective, multicenter, cohort study of adults hospitalized with COVID-19 over a 5-month period. We obtained clinical, microbiologic and laboratory data from electronic medical records. Propensity-score-matching helped create balanced exposure groups. Demographic characteristics were compared across outcome groups (BSI/no BSI) using two-sample t-test and Chi-Square test for continuous and categorical variables respectively, while immunosuppressive therapy use was compared using McNemar’s test. Conditional logistic regression helped assess the association between immunosuppressive therapies and BSIs. Results 13,007 patients were originally included, with propensity-score-matching producing a sample of 6,520 patients. 3.74% and 3.97% were diagnosed with clinically significant BSIs in the original and propensity-score-matched populations respectively. COVID-19 patients with BSIs had significantly longer hospitalizations, higher intensive care unit admission and mortality rates compared to those without BSIs. On univariable analysis, combinations of corticosteroids/anakinra [odds-ratio (OR) 2.00, 95% confidence intervals (C.I.) 1.05-3.80, P value.0342] and corticosteroids/tocilizumab [OR 2.13, 95% C.I. 1.16–3.94, P value .0155] were significantly associated with BSIs. On multivariable analysis (adjusting for confounders), combination corticosteroids/tocilizumab were significantly associated with any BSI [OR 1.97, 95% C.I. 1.04–3.73, P value.0386] and with bacterial BSIs [OR 2.13, 95% C.I. 1.12–4.05, p-value 0.0217]. Conclusions Combination immunosuppressive therapies were significantly associated with BSI occurrence in COVID-19 patients; their use warrants increased BSI surveillance. Further studies are needed to establish their causative role. Immunosuppressive therapies predispose to secondary infections. We retrospectively evaluated the association of immunosuppressive therapies with bloodstream infection (BSI) incidence in hospitalized adults with COVID-19, using propensity score matching and multivariable logistic regression. Combination corticosteroid-tocilizumab therapy was significantly associated with BSIs. |
| Databáze: | OpenAIRE |
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