The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections
ABSTRACT The COVID-19 pandemic has likely influenced the epidemiology of bacterial infections through wide-ranging changes to clinical practices and infection control and prevention interventions. We sought to determine how the detection and incidence of bloodstream infections (BSIs) have been influ...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
American Society for Microbiology
2023-12-01
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| Series: | Microbiology Spectrum |
| Subjects: | |
| Online Access: | https://journals.asm.org/doi/10.1128/spectrum.02630-23 |
| _version_ | 1797393601828749312 |
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| author | Matt Driedger Nick Daneman Kevin Brown Wayne L. Gold Sarah C.J. Jorgensen Colleen Maxwell Kevin L. Schwartz Andrew M. Morris Deva Thiruchelvam Bradley Langford Elizabeth Leung Derek MacFadden |
| author_facet | Matt Driedger Nick Daneman Kevin Brown Wayne L. Gold Sarah C.J. Jorgensen Colleen Maxwell Kevin L. Schwartz Andrew M. Morris Deva Thiruchelvam Bradley Langford Elizabeth Leung Derek MacFadden |
| author_sort | Matt Driedger |
| collection | DOAJ |
| description | ABSTRACT The COVID-19 pandemic has likely influenced the epidemiology of bacterial infections through wide-ranging changes to clinical practices and infection control and prevention interventions. We sought to determine how the detection and incidence of bloodstream infections (BSIs) have been influenced by the pandemic. We performed a retrospective analysis of blood culture data in the province of Ontario, Canada, from 1 January 2017 to 31 December 2020. Outcomes included a weekly incidence of blood culture tests, BSIs, and contaminant results. Results were stratified by hospital, community, and long-term care (LTC) settings. An interrupted time series analysis using segmented regression models was used to determine changes in outcome incidence/prevalence during the pre- and peri-pandemic periods. Of the 14,083,853 individuals included, 129,329 (0.92%) developed a bloodstream infection. The blood culture ordering rate increased during the pandemic in the hospital setting only [Incidence rate ratio (IRR) 1.09, 95% confidence interval (CI) 1.01–1.19]. There was a decline in the incidence of community-acquired (IRR 0.95, 95% CI 0.91–0.99) and LTC-acquired (IRR 0.85, 95% CI 0.76–0.94) BSIs. Hospital-acquired BSIs were unchanged. The proportion of blood culture contaminants increased in the community (7% increase, P < 0.01) and LTC settings (14% increase, P < 0.05). There was decreased incidence of community-acquired Streptococcus pneumoniae (IRR 0.43, 95% CI 0.33–0.57) and Staphylococcus aureus (IRR 0.91, 95% CI 0.84–0.99) bacteremia. Pandemic-related changes in the performance of blood cultures and the epidemiology of BSIs have implications for current and future pandemic antimicrobial use, healthcare resource allocation, and hospital and laboratory policies. IMPORTANCE Bacterial infections are a significant cause of morbidity and mortality worldwide. In the wake of the COVID-19 pandemic, previous studies have demonstrated pandemic-related shifts in the epidemiology of bacterial bloodstream infections (BSIs) in the general population and in specific hospital systems. Our study uses a large, comprehensive data set stratified by setting [community, long-term care (LTC), and hospital] to uniquely demonstrate how the effect of the COVID-19 pandemic on BSIs and testing practices varies by healthcare setting. We showed that, while the number of false-positive blood culture results generally increased during the pandemic, this effect did not apply to hospitalized patients. We also found that many infections were likely under-recognized in patients in the community and in LTC, demonstrating the importance of maintaining healthcare for these groups during crises. Last, we found a decrease in infections caused by certain pathogens in the community, suggesting some secondary benefits of pandemic-related public health measures. |
| first_indexed | 2024-03-09T00:06:12Z |
| format | Article |
| id | doaj.art-5dd6ca0e7bd042199282e47d8b4c7f19 |
| institution | Directory Open Access Journal |
| issn | 2165-0497 |
| language | English |
| last_indexed | 2024-03-09T00:06:12Z |
| publishDate | 2023-12-01 |
| publisher | American Society for Microbiology |
| record_format | Article |
| series | Microbiology Spectrum |
| spelling | doaj.art-5dd6ca0e7bd042199282e47d8b4c7f192023-12-12T13:17:19ZengAmerican Society for MicrobiologyMicrobiology Spectrum2165-04972023-12-0111610.1128/spectrum.02630-23The impact of the COVID-19 pandemic on blood culture practices and bloodstream infectionsMatt Driedger0Nick Daneman1Kevin Brown2Wayne L. Gold3Sarah C.J. Jorgensen4Colleen Maxwell5Kevin L. Schwartz6Andrew M. Morris7Deva Thiruchelvam8Bradley Langford9Elizabeth Leung10Derek MacFadden11Department of Medicine, The University of Ottawa , Ottawa, Ontario, CanadaSunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, CanadaPublic Health Ontario , Toronto, Ontario, CanadaThe University Health Network , Toronto, Ontario, CanadaInstitute of Medical Science , Toronto, Ontario, CanadaUniversity of Waterloo , Waterloo, Ontario, CanadaICES , Toronto, Ontario, CanadaSinai Health System , Toronto, Ontario, CanadaICES , Toronto, Ontario, CanadaPublic Health Ontario , Toronto, Ontario, CanadaUnity Health Toronto , Toronto, Ontario, CanadaDepartment of Medicine, The University of Ottawa , Ottawa, Ontario, CanadaABSTRACT The COVID-19 pandemic has likely influenced the epidemiology of bacterial infections through wide-ranging changes to clinical practices and infection control and prevention interventions. We sought to determine how the detection and incidence of bloodstream infections (BSIs) have been influenced by the pandemic. We performed a retrospective analysis of blood culture data in the province of Ontario, Canada, from 1 January 2017 to 31 December 2020. Outcomes included a weekly incidence of blood culture tests, BSIs, and contaminant results. Results were stratified by hospital, community, and long-term care (LTC) settings. An interrupted time series analysis using segmented regression models was used to determine changes in outcome incidence/prevalence during the pre- and peri-pandemic periods. Of the 14,083,853 individuals included, 129,329 (0.92%) developed a bloodstream infection. The blood culture ordering rate increased during the pandemic in the hospital setting only [Incidence rate ratio (IRR) 1.09, 95% confidence interval (CI) 1.01–1.19]. There was a decline in the incidence of community-acquired (IRR 0.95, 95% CI 0.91–0.99) and LTC-acquired (IRR 0.85, 95% CI 0.76–0.94) BSIs. Hospital-acquired BSIs were unchanged. The proportion of blood culture contaminants increased in the community (7% increase, P < 0.01) and LTC settings (14% increase, P < 0.05). There was decreased incidence of community-acquired Streptococcus pneumoniae (IRR 0.43, 95% CI 0.33–0.57) and Staphylococcus aureus (IRR 0.91, 95% CI 0.84–0.99) bacteremia. Pandemic-related changes in the performance of blood cultures and the epidemiology of BSIs have implications for current and future pandemic antimicrobial use, healthcare resource allocation, and hospital and laboratory policies. IMPORTANCE Bacterial infections are a significant cause of morbidity and mortality worldwide. In the wake of the COVID-19 pandemic, previous studies have demonstrated pandemic-related shifts in the epidemiology of bacterial bloodstream infections (BSIs) in the general population and in specific hospital systems. Our study uses a large, comprehensive data set stratified by setting [community, long-term care (LTC), and hospital] to uniquely demonstrate how the effect of the COVID-19 pandemic on BSIs and testing practices varies by healthcare setting. We showed that, while the number of false-positive blood culture results generally increased during the pandemic, this effect did not apply to hospitalized patients. We also found that many infections were likely under-recognized in patients in the community and in LTC, demonstrating the importance of maintaining healthcare for these groups during crises. Last, we found a decrease in infections caused by certain pathogens in the community, suggesting some secondary benefits of pandemic-related public health measures.https://journals.asm.org/doi/10.1128/spectrum.02630-23bloodstream infectionspandemicCOVID-19blood culturesepidemiology |
| spellingShingle | Matt Driedger Nick Daneman Kevin Brown Wayne L. Gold Sarah C.J. Jorgensen Colleen Maxwell Kevin L. Schwartz Andrew M. Morris Deva Thiruchelvam Bradley Langford Elizabeth Leung Derek MacFadden The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections Microbiology Spectrum bloodstream infections pandemic COVID-19 blood cultures epidemiology |
| title | The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections |
| title_full | The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections |
| title_fullStr | The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections |
| title_full_unstemmed | The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections |
| title_short | The impact of the COVID-19 pandemic on blood culture practices and bloodstream infections |
| title_sort | impact of the covid 19 pandemic on blood culture practices and bloodstream infections |
| topic | bloodstream infections pandemic COVID-19 blood cultures epidemiology |
| url | https://journals.asm.org/doi/10.1128/spectrum.02630-23 |
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