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J Infect Chemother
. 2023 Jan 19;S1341-321X(23)00014-4.
doi: 10.1016/j.jiac.2023.01.006. Online ahead of print.
Diagnostic significance of secondary bacteremia in patients with COVID-19
Kensuke Nakagawara 1 , Hirofumi Kamata 2 , Shotaro Chubachi 1 , Ho Namkoong 3 , Hiromu Tanaka 1 , Ho Lee 1 , Shiro Otake 1 , Takahiro Fukushima 1 , Tatsuya Kusumoto 1 , Atsuho Morita 1 , Shuhei Azekawa 1 , Mayuko Watase 1 , Takanori Asakura 4 , Katsunori Masaki 1 , Makoto Ishii 5 , Akifumi Endo 6 , Ryuji Koike 6 , Hiroyasu Ishikura 7 , Tohru Takata 8 , Yasushi Matsushita 9 , Norihiro Harada 10 , Hiroyuki Kokutou 11 , Takashi Yoshiyama 11 , Kensuke Kataoka 12 , Yoshikazu Mutoh 13 , Masayoshi Miyawaki 14 , Soichiro Ueda 14 , Hiroshi Ono 15 , Takuya Ono 16 , Tomohisa Shoko 16 , Hiroyuki Muranaka 17 , Kodai Kawamura 17 , Nobuaki Mori 18 , Takao Mochimaru 19 , Mototaka Fukui 20 , Yusuke Chihara 20 , Yoji Nagasaki 21 , Masaki Okamoto 21 , Masaru Amishima 22 , Toshio Odani 23 , Mayuko Tani 24 , Koichi Nishi 24 , Yuya Shirai 25 , Ryuya Edahiro 25 , Akira Ando 26 , Naozumi Hashimoto 26 , Shinji Ogura 27 , Yuichiro Kitagawa 27 , Toshiyuki Kita 27 , Takashi Kagaya 28 , Yasuhiro Kimura 29 , Naoki Miyazawa 29 , Tomoya Tsuchida 30 , Shigeki Fujitani 31 , Koji Murakami 32 , Hirohito Sano 32 , Yuki Sato 33 , Yoshinori Tanino 33 , Ryo Otsuki 34 , Shuko Mashimo 34 , Mizuki Kuramochi 35 , Yasuo Hosoda 35 , Yoshinori Hasegawa 36 , Tetsuya Ueda 36 , Yotaro Takaku 37 , Takashi Ishiguro 37 , Akiko Fujiwara 38 , Naota Kuwahara 38 , Hideya Kitamura 39 , Eri Hagiwara 39 , Yasushi Nakamori 40 , Fukuki Saito 40 , Yuta Kono 41 , Shinji Abe 41 , Tomoo Ishii 42 , Takehiko Ohba 43 , Yu Kusaka 43 , Hiroko Watanabe 44 , Makoto Masuda 45 , Hiroki Watanabe 45 , Yoshifumi Kimizuka 46 , Akihiko Kawana 46 , Yu Kasamatsu 47 , Satoru Hashimoto 48 , Yukinori Okada 49 , Tomomi Takano 50 , Kazuhiko Katayama 51 , Masumi Ai 52 , Atsushi Kumanogoh 25 , Toshiro Sato 53 , Katsushi Tokunaga 54 , Seiya Imoto 55 , Yuko Kitagawa 56 , Akinori Kimura 57 , Satoru Miyano 58 , Naoki Hasegawa 3 , Seishi Ogawa 59 , Takanori Kanai 60 , Koichi Fukunaga 1 ; Japan COVID-19 Task Force
Affiliations
PMID: 36682606 DOI: 10.1016/j.jiac.2023.01.006
Abstract
Objectives: We investigated the occurrence of non-respiratory bacterial and fungal secondary infections, causative organisms, impact on clinical outcomes, and association between the secondary pathogens and mortality in hospitalized patients with coronavirus disease 2019 (COVID-19).
Methods: This was a retrospective cohort study that included data from inpatients with COVID-19 from multiple centers participating in the Japan COVID-19 Taskforce (April 2020 to May 2021). We obtained demographic, epidemiological, and microbiological data throughout the course of hospitalization and analyzed the cases of COVID-19 complicated by non-respiratory bacterial infections.
Results: Of the 1914 patients included, non-respiratory bacterial infections with COVID-19 were diagnosed in 81 patients (4.2%). Of these, 59 (3.1%) were secondary infections. Bacteremia was the most frequent bacterial infection, occurring in 33 cases (55.9%), followed by urinary tract infections in 16 cases (27.1%). Staphylococcus epidermidis was the most common causative organism of bacteremia. Patients with COVID-19 with non-respiratory secondary bacterial infections had significantly higher mortality, and a multivariate logistic regression analysis demonstrated that those with bacteremia (aOdds Ratio = 15.3 [5.97-39.1]) were at higher risk of death. Multivariate logistic regression analysis showed that age, male sex, use of steroids to treat COVID-19, and intensive care unit admission increased the risk for nosocomial bacteremia.
Conclusions: Secondary bacteremia is an important complication that may lead to poor prognosis in cases with COVID-19. An appropriate medical management strategy must be established, especially for patients with concomitant predisposing factors.
Keywords: Bacteremia; Fungemia; Mortality; SARS-CoV-2 infection; Secondary infection.