Merck & Co., Inc., Kenilworth, NJ, USA.
Becton, Dickinson and Company, Franklin Lakes, NJ, USA.
BMC Infect Dis. 2021 Feb 27;21(1):227. doi: 10.1186/s12879-021-05877-3.
Past respiratory viral epidemics suggest that bacterial infections impact clinical outcomes. There is minimal information on potential co-pathogens in patients with coronavirus disease-2019 (COVID-19) in the US. We analyzed pathogens, antimicrobial use, and healthcare utilization in hospitalized US patients with and without severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2).
This multicenter retrospective study included patients with > 1 day of inpatient admission and discharge/death between March 1 and May 31, 2020 at 241 US acute care hospitals in the BD Insights Research Database. We assessed microbiological testing data, antimicrobial utilization in admitted patients with ≥24 h of antimicrobial therapy, and length of stay (LOS).
A total of 141,621 patients were tested for SARS-CoV-2 (17,003 [12.0%] positive) and 449,339 patients were not tested. Most (> 90%) patients tested for SARS-CoV-2 had additional microbiologic testing performed compared with 41.9% of SARS-CoV-2-untested patients. Non-SARS-CoV-2 pathogen rates were 20.9% for SARS-CoV-2-positive patients compared with 21.3 and 27.9% for SARS-CoV-2-negative and -untested patients, respectively. Gram-negative bacteria were the most common pathogens (45.5, 44.1, and 43.5% for SARS-CoV-2-positive, -negative, and -untested patients). SARS-CoV-2-positive patients had higher rates of hospital-onset (versus admission-onset) non-SARS-CoV-2 pathogens compared with SARS-CoV-2-negative or -untested patients (42.4, 22.2, and 19.5%, respectively), more antimicrobial usage (68.0, 45.2, and 25.1% of patients), and longer hospital LOS (mean [standard deviation (SD)] of 8.6 [11.4], 5.1 [8.9], and 4.2 [8.0] days) and intensive care unit (ICU) LOS (mean [SD] of 7.8 [8.5], 3.6 [6.2], and 3.6 [5.9] days). For all groups, the presence of a non-SARS-CoV-2 pathogen was associated with increased hospital LOS (mean [SD] days for patients with versus without a non-SARS-CoV-2 pathogen: 13.7 [15.7] vs 7.3 [9.6] days for SARS-CoV-2-positive patients, 8.2 [11.5] vs 4.3 [7.9] days for SARS-CoV-2-negative patients, and 7.1 [11.0] vs 3.9 [7.4] days for SARS-CoV-2-untested patients).
Despite similar rates of non-SARS-CoV-2 pathogens in SARS-CoV-2-positive, -negative, and -untested patients, SARS-CoV-2 was associated with higher rates of hospital-onset infections, greater antimicrobial usage, and extended hospital and ICU LOS. This finding highlights the heavy burden of the COVID-19 pandemic on healthcare systems and suggests possible opportunities for diagnostic and antimicrobial stewardship.
过去的呼吸道病毒流行表明细菌感染会影响临床结果。在美国，关于 2019 年冠状病毒病（COVID-19）患者潜在共病原体的信息很少。我们分析了住院的美国 COVID-19 患者（有和没有严重急性呼吸综合征冠状病毒 2（SARS-CoV-2））的病原体、抗菌药物使用情况和医疗保健利用情况。
这项多中心回顾性研究纳入了 2020 年 3 月 1 日至 5 月 31 日期间在 241 家美国急性护理医院住院治疗至少 1 天且出院/死亡的患者。我们评估了微生物学检测数据、住院患者接受≥24 小时抗菌药物治疗的抗菌药物使用情况和住院时间（LOS）。
共有 141621 例患者接受了 SARS-CoV-2 检测（阳性 17003 例[12.0%]），449339 例患者未接受检测。与未接受 SARS-CoV-2 检测的患者相比，大多数（>90%）接受 SARS-CoV-2 检测的患者接受了额外的微生物学检测。SARS-CoV-2 阳性患者的非 SARS-CoV-2 病原体发生率为 20.9%，而 SARS-CoV-2 阴性和未检测患者的发生率分别为 21.3%和 27.9%。革兰氏阴性菌是最常见的病原体（SARS-CoV-2 阳性、阴性和未检测患者分别为 45.5%、44.1%和 43.5%）。与 SARS-CoV-2 阴性或未检测患者相比，SARS-CoV-2 阳性患者的医院获得性（而非入院时获得性）非 SARS-CoV-2 病原体发生率更高（分别为 42.4%、22.2%和 19.5%），抗菌药物使用更多（分别为 68.0%、45.2%和 25.1%的患者），住院 LOS 更长（平均[标准差（SD）]为 8.6[11.4]、5.1[8.9]和 4.2[8.0]天）和 ICU LOS 更长（平均[SD]分别为 7.8[8.5]、3.6[6.2]和 3.6[5.9]天）。对于所有组，非 SARS-CoV-2 病原体的存在与住院 LOS 增加相关（SARS-CoV-2 阳性患者中存在非 SARS-CoV-2 病原体与不存在非 SARS-CoV-2 病原体的患者相比，平均[SD]住院天数为 13.7[15.7] vs 7.3[9.6]天，SARS-CoV-2 阴性患者为 8.2[11.5] vs 4.3[7.9]天，SARS-CoV-2 未检测患者为 7.1[11.0] vs 3.9[7.4]天）。
尽管 SARS-CoV-2 阳性、阴性和未检测患者中非 SARS-CoV-2 病原体的发生率相似，但 SARS-CoV-2 与更高的医院获得性感染率、更多的抗菌药物使用以及更长的住院和 ICU LOS 相关。这一发现突显了 COVID-19 大流行对医疗保健系统的沉重负担，并表明可能有机会进行诊断和抗菌药物管理。
