Hanna John J, Most Zachary M, Cooper Lauren N, Wakene Abdi D, Radunsky Alexander P, Lehmann Christoph U, Perl Trish M, Medford Richard J
Information Services, ECU Health, Greenville, NC, USA.
Division of Infectious Diseases, Department of Internal Medicine, East Carolina University, Greenville, NC, USA.
Antimicrob Steward Healthc Epidemiol. 2024 Sep 23;4(1):e142. doi: 10.1017/ash.2024.424. eCollection 2024.
The interplay between SARS-CoV-2 and contemporaneous bacterial or fungal culture growth may have crucial implications for clinical outcomes of hospitalized patients. This study aimed to quantify the effect of microbiological culture positivity on mortality among hospitalized patients with SARS-CoV-2.
In this retrospective cohort study, we included adult hospitalized patients from OPTUM COVID-19 specific data set, who tested positive for SARS-CoV-2 within 14 days of hospitalization between 01/20/2020 and 01/20/2022. We examined outcomes of individuals with organisms growing on cultures from the bloodstream infections (BSIs), urinary tract, and respiratory tract, and a composite of the three sites. We used propensity score matching on covariates included demographics, comorbidities, and hospitalization clinical parameters. In a sensitivity analysis, we included same covariates but excluded critical care variables such as length of stay, intensive care unit stays, mechanical ventilation, and extracorporeal membrane oxygenation.
The cohort included 104,560 SARS-CoV-2 positive adult hospitalized patients across the United States. The unadjusted mortality odds increased significantly with BSIs (98.7%) and with growth on respiratory cultures (RC) (176.6%), but not with growth on urinary cultures (UC). Adjusted analyses showed that BSIs and positive RC independently contribute to mortality, even after accounting for critical care variables.
In SARS-CoV-2-positive hospitalized patients, positive bacterial and fungal microbiological cultures, especially BSIs and RC, are associated with an increased risk of mortality even after accounting for critical care variables associated with disease severity. These findings underscore the importance of stringent infection control and the effective management of secondary infections to improve patient outcomes.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）与同期细菌或真菌培养生长之间的相互作用可能对住院患者的临床结局产生关键影响。本研究旨在量化微生物培养阳性对SARS-CoV-2住院患者死亡率的影响。
在这项回顾性队列研究中，我们纳入了来自OPTUM COVID-19特定数据集的成年住院患者，这些患者在2020年1月20日至2022年1月20日住院的14天内SARS-CoV-2检测呈阳性。我们检查了血液感染（BSIs）、泌尿道和呼吸道培养物中有微生物生长的个体的结局，以及这三个部位的综合情况。我们对包括人口统计学、合并症和住院临床参数在内的协变量进行倾向评分匹配。在敏感性分析中，我们纳入了相同的协变量，但排除了诸如住院时间、重症监护病房停留时间、机械通气和体外膜肺氧合等重症监护变量。
该队列包括美国104,560名SARS-CoV-2阳性成年住院患者。未经调整的死亡几率在BSIs（98.7%）和呼吸道培养物（RC）生长时显著增加，但在泌尿道培养物（UC）生长时未增加。调整分析表明，即使在考虑了重症监护变量后，BSIs和阳性RC也独立导致死亡。
在SARS-CoV-2阳性住院患者中，即使在考虑了与疾病严重程度相关的重症监护变量后，阳性细菌和真菌微生物培养，尤其是BSIs和RC，也与死亡风险增加相关。这些发现强调了严格感染控制和有效管理继发性感染以改善患者结局的重要性。
