53 - Incidence of Bloodstream Infections and Outcomes in Patients with Severe COVID-19 Pneumonia

Background: Coronavirus disease 19 (COVID-19) leading to acute respiratory distress syndrome is associated with need for intensive care (IC), mechanical ventilation (MV), and prolonged recovery. These patients are thus predisposed to blood stream infections which can worsen outcomes. This risk may be aggravated by adjunctive therapies.

Methods: We reviewed the medical records of all adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (requiring high-flow O₂). Patients who received MV or died within 24h were excluded. Patients were followed until death or hospital discharge. We reviewed positive blood cultures (PBC) for pathogenic microorganisms, and calculated the incidence of bacteremia, rates of infective endocarditis (IE), and impact on mortality. Microbes isolated only once and belonging to groups defined as commensal skin microbiota were labelled as contaminants. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on bacteremia.

Results: A total of 469 patients with severe COVID-19 pneumonia were included (Table 1). Of these, 199 (42.4%) required IC and 172 (36.7%) MV. Median length of stay was 13 days (8-22) and 94 (20.0%) had PBC. Of these, 43 were considered true pathogens (bacteremia), with predominance of E. faecalis and S. epidermidis, and 51 were considered contaminants (Table 2). The incidence of bacteremia (43/469, 9.2%) was 5.1 per 1000 patient-days (95%CI 3.8-6.4). An echocardiogram was performed in 21 patients, 1 had an aortic valve vegetation (IE) by methicillin sensitive S. aureus. Bacteremia rates were nonsignificantly higher with steroids (5.9 vs 3.7 per 1000 patient-days; P=0.057). Use of tocilizumab was not associated with bacteremia (5.8 vs 4.8 per 1000 patient-days; P=0.28). Mortality was nonsignificantly higher in patients with (15/43, 34.9%) vs. without (108/426, 25.4%) bacteremia (P=0.20). Length of stay was the strongest predictor of bacteremia, with risk increasing by 7% (95%CI 6%-9%, P< 0.001) per additional day.Cohort Characteristics of Patients with Severe COVID-19 Pneumonia on High-Flow O2 (N= 469)
All Microorganisms Isolated from Blood Cultures


Conclusion: The incidence of bacteremia was relatively low and IE was uncommon in this study of severe COVID-19 patients. Risk of bacteremia increased with longer hospital stay and with steroids use, but not with tocilizumab.

Presenting Author(s)

• 

  Aikaterini Papamanoli, MD

  Infectious Diseases Fellow
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• JY

  Jeanwoo Yoo, MD

  Medical Resident
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AM

  Azad Mojahedi, MD

  Attending Physician
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• RJ

  Robin Jacob, MD

  Medical Resident
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• PG

  Prabhjot Grewal, MD

  Medical Resident
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SD

  Simrat Dhaliwal, BS

  Medical Student
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AC

  Alexandra Coritsidis, BS

  Medical Student
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JN

  Jacquelyn Nakamura, BS

  Medical Students
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JF

  Jenny Fung, BS

  Medical Student
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JH

  Jessica Hotelling, MD

  Medical Resident
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SR

  Sahil Rawal, BS

  medical Student
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• NK

  Nikitha Karkala, BS

  Medical Student
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• ST

  Stella T. Tsui, BS

  Medical Student
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JA

  Joshua Abata, BS

  Medical Student
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• GP

  George Psevdos, MD

  Chief of Infectious Disease
  Northport VA
  North Port, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AK

  Andreas Kalogeropoulos, MD, MPH, PhD

  Associate Professor of Medicine (Cardiology)
  Stony Brook University Hospital
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• LM

  Luis Marcos, MD, MPH

  Associate Professor of Medicine, ID fellowship program director
  Stony Brook University
  Stony Brook, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.