ABSTRACT
Background. Concerns about antibiotic resistance are exacerbated in COVID-19 patients due to frequent antibiotic use, increase in mechanical ventilation and reusable equipment, conservation of PPE, and strain on hospital staff. We described cases with co-infection of carbapenem-resistant organisms (CRO) and SARS-CoV-2 and compared rates in the Massachusetts population. Methods. All providers and hospitals are required to report CROs and SARS-CoV-2 to the Massachusetts Virtual Epidemiologic Network (MAVEN). We selected cases with both a positive SARS-CoV-2 test and a laboratory confirmed CRO from January through July 2020. We classified by which result occurred first and described demographic and clinical characteristics. We standardized the CRO case definition by excluding CR-Pseudomonas aeruginosa and calculated rates per 100,000 to assess the impact of SARS-CoV-2 on the population-based frequency of CROs. Analyses were conducted in SAS 9.4. Results. 28 confirmed cases of SARS-CoV-2 infection were also diagnosed with a CRO. They were an average age of 71.8, 60.7% male, 67.9% white, and 64.3% were in congregate care prior to their diagnoses. Mortality was 5/28 (17.9%). The 23 (82.1%) with a positive SARS-CoV-2 result first were all hospitalized at least once compared to 40% in the CRO first group (p=0.003). 11 (47.8%) of the SARS-CoV-2 first were already admitted when they tested CRO positive;7 (30.4%) were admitted for the CRO separately from COVID-19 treatment. None of the CRO first group were admitted for CRO infection. Average length of stay for the SARS-CoV-2 first group was higher than the CRO first group (62.3 days vs 11.0 days;p=0.049). Cases positive for CRO first were all infected with CR-Escherichia coli whereas those positive for SARS-CoV-2 first were infected with CRAB, CRPA, or a CRE (Klebsiella oxytoca or Klebsiella pneumoniae) (p< 0.0001). The rate of CRO/COVID coinfection was 0.203 per 100,000 population;the rates for January through July of CRO alone were 2.5 per 100,000 in 2020 and 2.4 per 100,000 in 2019. Conclusion. Characteristics of individuals co-infected with CRO and SARSCoV-2 differed by which diagnosis was made first;however, the SARS-CoV-2 pandemic did not impact the CRO population rate during the time frame studied.
ABSTRACT
During the ongoing coronavirus disease 2019 (COVID-19) crisis, data on risks of immunomodulatory biologics have been limited, causing uncertainty for patients and providers whether to continue biologic therapy for chronic skin disease. We aimed to investigate if patients treated with biologics were at an increased risk for COVID-19 infection and all-cause mortality once infected. We performed a retrospective study of 7,361 patients prescribed biologics and 74,910 matched controls, cross-referenced with the Massachusetts Department of Public Health COVID-19 infection and all-cause mortality data through June 19, 2020. We included patients in the Mass General Brigham system with at least 1 prescription for a biologic between July 1, 2019 and February 29, 2020. Multivariable logistic regression was used on matched data to calculate the odds ratio (OR) for COVID-19 infection between patients on biologics and controls, adjusting for age, gender, race, Charlson Comorbidity Index (CCI) severity grade, median income, and local infection rate. Multivariate Poisson regression was performed on COVID-19 positive patients to compare all-cause mortality, adjusting for gender, CCI severity, income, and local COVID-19 rate. 7,361 patients treated with biologics and 74,910 matched controls were included in the analysis (mean age, 50.6 years;56.0% women, 84.5% white;mean age adjusted CCI 2.8). There were 87 (1.2%) infections and 7 deaths (8.0%) in patients treated with biologics and 1063 (1.4%) infections and 71 deaths (6.7%) in the control group. Patients treated with immunosuppressive biologics were not at increased risk of COVID-19 diagnosis (OR 0.88, 95% CI 0.71-1.09, p=0.25) or subsequent mortality (OR 1.38, 95% CI 0.62-3.07, p=0.43). Given an absence of evidence that patients treated with biologics are more susceptible to COVID-19, patients should be encouraged to continue their therapy to prevent disease progression during this pandemic.
ABSTRACT
Importance: It is unclear if systemic immunosuppression for chronic conditions modifies patients’ risk of contracting COVID-19, leading to uncertainty among patients and dermatologists treating immune-mediated skin conditions during the pandemic. Methods: We partnered with the Massachusetts Department of Public Health to identify COVID-19 positivity and mortality for patients treated at the Mass General Brigham who were prescribed a systemic immunosuppressant from 07/01/19-02/29/20. We excluded biologics, steroids, and antirheumatic drugs from the analysis. Patients were compared with exact matched controls using a multivariable logistic regression for infection and multivariable Poisson regression for mortality, adjusting for demographics, comorbidity score, and local infection rate. Results: The most common medications identified were Methotrexate (23.5%), Mesalamine (19.2%), Paclitaxel (8.3%), Mycophenolate (7.8%), Hydroxyurea (6.0%), and Tacrolimus (5.3%). 218 of 14,865 (1.5%) patients prescribed systemic immunosuppressants and 1,368 of 80,318 (1.7%) controls were identified as COVID-19 positive. Of these, 26 (0.2%) patients prescribed immunosuppressants and 162 (0.2%) controls died after diagnosis. Patients prescribed immunosuppressants were not more likely to have a COVID-19 diagnosis (OR 0.91, 95% CI 0.79-1.05, p=0.22) or die after diagnosis (OR 0.95, 95% CI 0.62-1.44, p=0.80) after adjusting for demographics, comorbidity score, and local infection rate. Conclusions and Relevance: We found no evidence that systemic immunosuppression preceding the COVID-19 pandemic increased risk of contracting COVID-19 or risk of mortality among COVID-19 positive patients.