Clinicians should adhere to standard best practices for preventing and empirically treating secondary infections in patients hospitalized with COVID-19, according to study results published in the Annals of the American Thoracic Society.1
Initial reports of patients hospitalized with COVID-19 indicate that 10% to 33% develop bacterial pneumonia and 2% to 6% develop bloodstream infection (BSI). However, few studies have reported patient characteristics or the effect of intensive care unit (ICU) admission on secondary infections. Therefore, researchers conducted a descriptive study to identify the prevalence, microbiology, and outcomes of secondary pneumonias and BSIs in patients hospitalized with COVID-19 at 4 academic hospitals in Atlanta, Georgia from February 15 to May 16, 2020.1
Among 774 patients hospitalized with COVID-19, nearly one-third required mechanical ventilation, of whom 27% had positive respiratory cultures and 2% had ventilator-associated pneumonia. A total of 36 patients (5%) developed BSI, and 50% died. Secondary infections were associated with traditional risk factors for health care-associated infections, including indwelling medical devices, and predominantly in the ICU.
Only 3 nonintubated patients had microbiologic evidence of bacterial pneumonia, while intubated patients had a high proportion of cultures positive for Staphylococcus. aureus, Pseudomonas aeruginosa, and Klebsiella spp. These results suggest that hospitalization and intubation are more important than are COVID-19-specific effects in conferring susceptibility to specific pathogens.
Bloodstream infections in our cohort were also largely related to risk factors and pathogens associated with hospitalization, with the majority (66.7%) being ICU-onset and nearly half (47.2%) were central line-associated BSIs.
“Our analysis adds to this previous literature by demonstrating that the risk factors for these infections (intubation and central lines, respectively) and causative pathogens reflect healthcare delivery and not a COVID-19-specific effect,” the study authors wrote.
Adelman MW, Bhamidipati DR, Hernandez-Romieu AC, et al; on behalf of the Emory COVID-19 Quality and Clinical Research Collaborative. Secondary bacterial pneumonias and bloodstream infections in patients hospitalized with COVID-19. Ann Am Thorac Soc. Published online April 6, 2021. doi:10.1513/AnnalsATS.202009-1093RL