ABSTRACT
Background. SARS-CoV-2 B.1.1.529 (Omicron) variant was first identified in November 2021 in South Africa and was notable for its increased transmissibility and rapid spread world wide. In the United States, this variant led to a surge inCOVID-19 cases by December 2021. As a result, we experienced a steep rise in cases among patients and employees at our institution starting December 22nd, 2021. Therefore, we compared the incidence and characteristics of hospital-onset COVID-19 (HO-COVID-19) in our cancer patients prior to and during the surge of the Omicron variant. Methods. We identified HO-COVID-19, as per the CDC definition, from our infection control surveillance database, and additional contact tracing information was reviewed to determine the possible sources of HO-COVID-19. Whole-genome sequencing studies were conducted randomly on nasopharyngeal swabs of patients and employees who had COVID-19 during the study period. Results. Twenty-six HO-COVID-19 infections were identified from the beginning of the pandemic (February 2020) through February 2022 (Table 1). Only 17 cases occurred over 22 months from the beginning of the pandemic through early December 2021 (Figure 1). These HO-COVID-19 occurred during the 3 COVID-19 surges that were epidemiologically attributed to the variants seen prior to Omicron. Among these 17 patients, 12 (70%) were symptomatic, 9 (53%) had a link to an infected employee, 7 (41%) died during their hospitalization (3 of the deaths were attributable to COVID-19), and 10 (59%) recovered and were discharged. Over 6 weeks (from December 22nd, 2021, through February 1st, 2022), 9 HO-COVID-19 were discovered during the Omicron variant surge (Figure 1). Six (67%) of these patients were symptomatic, 8 (89%) had a link to an infected employee, 2 (22%) died (1 death was attributed to COVID-19 ), and 7 (78%) recovered and were discharged. Conclusion. The Omicron variant surge led to marked increases in HO-COVID-19 despite the continuous adoption of enhanced infection control practices, testing on admission, and daily symptoms screening of patients and employees.
ABSTRACT
Background. Robust infection control (IC) measures were deployed across healthcare institutions at the start of the COVID-19 pandemic, resulting in increased use of personal protective equipment (PPE), enhanced contact precautions, and emphasis on hand hygiene. The impact of these IC measures on the rates of hospitalacquired infections (HAIs), such as multidrug-resistant organisms (MDROs), device-related infections (DRIs), Clostridium difficile infection (CDI), and respiratory viral infections (RVIs) is not known. Here, we aim to evaluate the effect of the enhanced IC practices on the occurrence of various HAIs in a comprehensive cancer center. Methods. We analyzed the monthly HAIs rates from September 2017 through March 2022, including data 42 months pre-pandemic (September 2016-February 2020) and 24 months during the pandemic (March 2020-August 2021). Reported HAIs were calculated using denominators of patient days for CDI and MDROs, per 1,000 admissions for RVIs, and catheter days for DRIs. The incidence rate ratios (IRR) were calculated for all HAIs. Results. When comparing pre-pandemic to the pandemic period, a significant increase in the overall incidence rate (IR) of MDROs from 0.56 to 0.67 per 1,000 patient days with an IRR of 1.19 (95% CI 1.02-1.39), a decrease in the IR of CLABSIs and a stable IR of CAUTIs and VAEs were observed (Table 1). A significant decrease was observed in the IR of CDI (IRR 0.65 (95% CI 0.55-0.78)). The total IR of hospital-acquired RVIs per 1,000 admissions (5.24 to 1.82;IRR 0.36;95% CI 0.30-0.44) decreased, as did each respiratory virus (Respiratory Syncytial Virus (0.51 to 0.15;IRR 0.30), Influenza (0.50 to 0.24;IRR 0.50), Parainfluenza (1.21- to 0.34;IRR 0.28), Rhinovirus (1.91 to 0.5;IRR 0.26), and Human Metapneumovirus (0.19 to 0.05;IRR 0.24) during their respective respiratory viral seasons (Figure 1). (Table Presented) Conclusion. Implementing strict IC measures during the COVID-19 pandemic in a cancer hospital led to a significant decrease in many HAIs and a reduction in nosocomial RVIs. However, whether these enhanced measures, such as masking at all times as part of patient care, are needed during the upcoming respiratory viral seasons is not known.
ABSTRACT
Background: The thrombotic risk associated with SARS-CoV- 2 (COVID-19) is well documented, although there is limited information on how additional prothrombotic risk factors impact persons who contract COVID-19. Certain estrogen containing contraceptives and hormone replacement therapies are also well known to increase the risk of thrombosis. It is unknown if the risks of these agents and concurrent COVID-19 infection are additive. Aim(s): To investigate the relationship between COVID-19 infection and concurrent exogenous estrogen on the rate of thrombotic events. Method(s): A retrospective analysis including all adult female patients diagnosed with COVID-19 between January 2020-2022 at our center also treated with hormone therapy. Female patients on hormone replacement therapy (HRT) for post-menopausal symptoms were included in this analysis. HRT was defined as any treatment consisting of an estrogen analog with or without a progesterone. Thrombotic events were defined as any venous thromboembolism (VTE), cerebrovascular accident (CVA), myocardia infarction (MI), or any arterial clot/embolic event. Events were included if they were recorded as current SNOMED/ICD codes in the same encounter as the diagnosis of COVID-19. Inpatients and outpatients were included in the analysis. Result(s): 92 patients were identified who were diagnosed with COVID-19 while on hormone therapy at the time of diagnosis. 18 of the patients were hospitalized. Mean age was 42 years and 59 years for all patients and hospitalized patients, respectively. The most common estrogen therapies were norethindrone-estradiol (38%) and conjugated estrogen (14.1%). There were 3 (3.2%) total thrombotic events which all occurred in hospitalized patients. 2 patients experienced VTE while 1 patient experienced a cerebrovascular event with arterial clot. Conclusion(s): This retrospective study demonstrates a low rate of thrombosis in patients treated with exogenous estrogen and with COVID-19. The rate of thrombosis in the outpatient setting was low while thrombotic events occurred in hospitalized older patients. Further studies are warranted to explore this association.