Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA.
Long Island Jewish Medical Center-Northshore University Hospital, Manhasset, NY, 11030, USA.
Eur J Clin Microbiol Infect Dis. 2023 Oct;42(10):1173-1181. doi: 10.1007/s10096-023-04655-0. Epub 2023 Aug 19.
To identify the predictors of morbidity and mortality in matched COVID-19 positive and negative patients who were septic with Gram positive or Gram negative infections.
We conducted a retrospective review, from March to October 2020, of matched septic patients at five Hackensack Meridian Health hospitals who had bacteremia with Staphylococcus aureus, Klebsiella pneumoniae or Escherichia coli with and without COVID-19. We extracted patient demographics, comorbidities and clinical outcomes data using ICD-10 codes. Bacterial isolates were compared by whole genome sequencing analysis. Multivariate logistic regression was used to analyze independent predictors of morbidity and mortality.
A total of 208 patients were grouped by positive bloodstream infection (BSI) with COVID-19 (n = 104) and without COVID-19 (n = 104). Most patients were over age 50 (90% vs. 89%) and Caucasian (78% vs. 86%). Inpatient mortality was higher in patients with COVID-19 for both GP (35% vs. 8%, p < 0.05) and GN (28% vs. 10%, p < 0.05) BSIs. Patients with Gram positive (GP) BSIs had a significant increase in mortality risk (OR 4.5, CI 1.4-14.5, p < 0.05) in contrast to those with Gram negative (GN) infections (OR 0.4, CI 0.4-4.0, p = 0.4).
Concurrent COVID-19 infection is associated with a significant increase in morbidity and mortality in patients with GP and GN BSIs. Patients with S. aureus BSIs with COVID-19 are more likely to develop shock and respiratory failure and have higher rates and odds of mortality than those without COVID-19. These findings provide an essential insight into the care of these patients, especially those co-infected with Staphylococcus aureus.
确定患有革兰氏阳性或革兰氏阴性感染性败血症且 COVID-19 阳性和阴性患者的发病率和死亡率的预测因素。
我们进行了一项回顾性研究，研究对象为 2020 年 3 月至 10 月在哈肯萨克子午线健康系统五家医院接受治疗的患有败血症且伴有金黄色葡萄球菌、肺炎克雷伯菌或大肠杆菌菌血症的匹配性败血症患者，这些患者有无 COVID-19 感染。我们使用 ICD-10 代码提取患者人口统计学、合并症和临床结局数据。通过全基因组测序分析比较细菌分离株。采用多变量逻辑回归分析发病率和死亡率的独立预测因素。
根据是否有 COVID-19 阳性血流感染（BSI）将 208 名患者分为阳性组（n=104）和阴性组（n=104）。大多数患者年龄在 50 岁以上（90%对 89%），为白种人（78%对 86%）。在 COVID-19 阳性患者中，革兰氏阳性（GP）和革兰氏阴性（GN）BSI 的住院死亡率均较高（分别为 35%对 8%，p<0.05；分别为 28%对 10%，p<0.05）。与患有革兰氏阴性（GN）感染的患者相比，患有革兰氏阳性（GP）BSI 的患者的死亡率风险显著增加（比值比 4.5，95%置信区间 1.4-14.5，p<0.05）。
在患有 GP 和 GN BSI 的患者中，同时感染 COVID-19 与发病率和死亡率的显著增加相关。与无 COVID-19 感染的患者相比，感染 COVID-19 的金黄色葡萄球菌 BSI 患者更有可能出现休克和呼吸衰竭，死亡率更高，几率更大。这些发现为这些患者的护理提供了重要的见解，特别是那些与金黄色葡萄球菌共同感染的患者。
