COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation
Abstract Background Recent single-center reports have suggested that community-acquired bacteremic co-infection in the context of Coronavirus disease 2019 (COVID-19) may be an important driver of mortality; however, these reports have not been validated with a multicenter, demographically diverse, c...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-01-01
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| Series: | Critical Care |
| Online Access: | https://doi.org/10.1186/s13054-023-04312-0 |
| _version_ | 1811175788012109824 |
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| author | Michael John Patton Carlos J. Orihuela Kevin S. Harrod Mohammad A. N. Bhuiyan Paari Dominic Christopher G. Kevil Daniel Fort Vincent X. Liu Maha Farhat Jonathan L. Koff Charitharth V. Lal Anuj Gaggar Robert P. Richter Nathaniel Erdmann Matthew Might Amit Gaggar |
| author_facet | Michael John Patton Carlos J. Orihuela Kevin S. Harrod Mohammad A. N. Bhuiyan Paari Dominic Christopher G. Kevil Daniel Fort Vincent X. Liu Maha Farhat Jonathan L. Koff Charitharth V. Lal Anuj Gaggar Robert P. Richter Nathaniel Erdmann Matthew Might Amit Gaggar |
| author_sort | Michael John Patton |
| collection | DOAJ |
| description | Abstract Background Recent single-center reports have suggested that community-acquired bacteremic co-infection in the context of Coronavirus disease 2019 (COVID-19) may be an important driver of mortality; however, these reports have not been validated with a multicenter, demographically diverse, cohort study with data spanning the pandemic. Methods In this multicenter, retrospective cohort study, inpatient encounters were assessed for COVID-19 with community-acquired bacteremic co-infection using 48-h post-admission blood cultures and grouped by: (1) confirmed co-infection [recovery of bacterial pathogen], (2) suspected co-infection [negative culture with ≥ 2 antimicrobials administered], and (3) no evidence of co-infection [no culture]. The primary outcomes were in-hospital mortality, ICU admission, and mechanical ventilation. COVID-19 bacterial co-infection risk factors and impact on primary outcomes were determined using multivariate logistic regressions and expressed as adjusted odds ratios with 95% confidence intervals (Cohort, OR 95% CI, Wald test p value). Results The studied cohorts included 13,781 COVID-19 inpatient encounters from 2020 to 2022 in the University of Alabama at Birmingham (UAB, n = 4075) and Ochsner Louisiana State University Health—Shreveport (OLHS, n = 9706) cohorts with confirmed (2.5%), suspected (46%), or no community-acquired bacterial co-infection (51.5%) and a comparison cohort consisting of 99,170 inpatient encounters from 2010 to 2019 (UAB pre-COVID-19 pandemic cohort). Significantly increased likelihood of COVID-19 bacterial co-infection was observed in patients with elevated ≥ 15 neutrophil-to-lymphocyte ratio (UAB: 1.95 [1.21–3.07]; OLHS: 3.65 [2.66–5.05], p < 0.001 for both) within 48-h of hospital admission. Bacterial co-infection was found to confer the greatest increased risk for in-hospital mortality (UAB: 3.07 [2.42–5.46]; OLHS: 4.05 [2.29–6.97], p < 0.001 for both), ICU admission (UAB: 4.47 [2.87–7.09], OLHS: 2.65 [2.00–3.48], p < 0.001 for both), and mechanical ventilation (UAB: 3.84 [2.21–6.12]; OLHS: 2.75 [1.87–3.92], p < 0.001 for both) across both cohorts, as compared to other risk factors for severe disease. Observed mortality in COVID-19 bacterial co-infection (24%) dramatically exceeds the mortality rate associated with community-acquired bacteremia in pre-COVID-19 pandemic inpatients (5.9%) and was consistent across alpha, delta, and omicron SARS-CoV-2 variants. Conclusions Elevated neutrophil-to-lymphocyte ratio is a prognostic indicator of COVID-19 bacterial co-infection within 48-h of admission. Community-acquired bacterial co-infection, as defined by blood culture-positive results, confers greater increased risk of in-hospital mortality, ICU admission, and mechanical ventilation than previously described risk factors (advanced age, select comorbidities, male sex) for COVID-19 mortality, and is independent of SARS-CoV-2 variant. |
| first_indexed | 2024-04-10T19:42:40Z |
| format | Article |
| id | doaj.art-08100dfe0b7b44c1ad101bf1bafeb813 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-10T19:42:40Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-08100dfe0b7b44c1ad101bf1bafeb8132023-01-29T12:13:35ZengBMCCritical Care1364-85352023-01-0127111210.1186/s13054-023-04312-0COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilationMichael John Patton0Carlos J. Orihuela1Kevin S. Harrod2Mohammad A. N. Bhuiyan3Paari Dominic4Christopher G. Kevil5Daniel Fort6Vincent X. Liu7Maha Farhat8Jonathan L. Koff9Charitharth V. Lal10Anuj Gaggar11Robert P. Richter12Nathaniel Erdmann13Matthew Might14Amit Gaggar15Medical Scientist Training Program, Heersink School of Medicine, University of Alabama at BirminghamDepartment of Microbiology, University of Alabama at BirminghamDepartment of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at BirminghamDepartment of Internal Medicine, Division of Clinical Informatics, Louisiana State University Health Sciences Center at ShreveportDepartment of Medicine, Division of Cardiovascular Sciences, University of IowaDepartments of Pathology, Molecular and Cellular Physiology, and Cellular Biology and Anatomy, Louisiana State University Health Sciences Center at ShreveportOchsner Health SystemKaiser Permanente Division of ResearchHarvard University Medical SchoolDepartment of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Yale UniversityDepartment of Pediatrics, Neonatology Division, University of Alabama at BirminghamArriveBioDepartment of Pediatrics, Division of Pediatric Critical Care, University of Alabama at BirminghamDepartment of Medicine, Division of Infectious Diseases, University of Alabama at BirminghamHugh Kaul Precision Medicine Institute, University of Alabama at BirminghamDepartment of Medicine, Pulmonary, Allergy, and Critical Care Medicine Division, University of Alabama at BirminghamAbstract Background Recent single-center reports have suggested that community-acquired bacteremic co-infection in the context of Coronavirus disease 2019 (COVID-19) may be an important driver of mortality; however, these reports have not been validated with a multicenter, demographically diverse, cohort study with data spanning the pandemic. Methods In this multicenter, retrospective cohort study, inpatient encounters were assessed for COVID-19 with community-acquired bacteremic co-infection using 48-h post-admission blood cultures and grouped by: (1) confirmed co-infection [recovery of bacterial pathogen], (2) suspected co-infection [negative culture with ≥ 2 antimicrobials administered], and (3) no evidence of co-infection [no culture]. The primary outcomes were in-hospital mortality, ICU admission, and mechanical ventilation. COVID-19 bacterial co-infection risk factors and impact on primary outcomes were determined using multivariate logistic regressions and expressed as adjusted odds ratios with 95% confidence intervals (Cohort, OR 95% CI, Wald test p value). Results The studied cohorts included 13,781 COVID-19 inpatient encounters from 2020 to 2022 in the University of Alabama at Birmingham (UAB, n = 4075) and Ochsner Louisiana State University Health—Shreveport (OLHS, n = 9706) cohorts with confirmed (2.5%), suspected (46%), or no community-acquired bacterial co-infection (51.5%) and a comparison cohort consisting of 99,170 inpatient encounters from 2010 to 2019 (UAB pre-COVID-19 pandemic cohort). Significantly increased likelihood of COVID-19 bacterial co-infection was observed in patients with elevated ≥ 15 neutrophil-to-lymphocyte ratio (UAB: 1.95 [1.21–3.07]; OLHS: 3.65 [2.66–5.05], p < 0.001 for both) within 48-h of hospital admission. Bacterial co-infection was found to confer the greatest increased risk for in-hospital mortality (UAB: 3.07 [2.42–5.46]; OLHS: 4.05 [2.29–6.97], p < 0.001 for both), ICU admission (UAB: 4.47 [2.87–7.09], OLHS: 2.65 [2.00–3.48], p < 0.001 for both), and mechanical ventilation (UAB: 3.84 [2.21–6.12]; OLHS: 2.75 [1.87–3.92], p < 0.001 for both) across both cohorts, as compared to other risk factors for severe disease. Observed mortality in COVID-19 bacterial co-infection (24%) dramatically exceeds the mortality rate associated with community-acquired bacteremia in pre-COVID-19 pandemic inpatients (5.9%) and was consistent across alpha, delta, and omicron SARS-CoV-2 variants. Conclusions Elevated neutrophil-to-lymphocyte ratio is a prognostic indicator of COVID-19 bacterial co-infection within 48-h of admission. Community-acquired bacterial co-infection, as defined by blood culture-positive results, confers greater increased risk of in-hospital mortality, ICU admission, and mechanical ventilation than previously described risk factors (advanced age, select comorbidities, male sex) for COVID-19 mortality, and is independent of SARS-CoV-2 variant.https://doi.org/10.1186/s13054-023-04312-0 |
| spellingShingle | Michael John Patton Carlos J. Orihuela Kevin S. Harrod Mohammad A. N. Bhuiyan Paari Dominic Christopher G. Kevil Daniel Fort Vincent X. Liu Maha Farhat Jonathan L. Koff Charitharth V. Lal Anuj Gaggar Robert P. Richter Nathaniel Erdmann Matthew Might Amit Gaggar COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation Critical Care |
| title | COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation |
| title_full | COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation |
| title_fullStr | COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation |
| title_full_unstemmed | COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation |
| title_short | COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation |
| title_sort | covid 19 bacteremic co infection is a major risk factor for mortality icu admission and mechanical ventilation |
| url | https://doi.org/10.1186/s13054-023-04312-0 |
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