ABSTRACT
New York City was the epicenter of COVID-19 infections within the United States in the spring of 20201. Our public, hospital-based hemodialysis (HD) unit is located in Bronx County, which had the highest rates of infections and deaths due to COVID-19.2 We retrospectively investigated the prevalence of COVID-19 in our HD unit and the effectiveness of expanded infection control measures implemented during the surge. Charts were reviewed for all 61 patients receiving maintenance HD between March 1-July 15, 2020. 4 HD patients and 2 HD healthcare providers (HCP) developed symptoms from COVID-19 infection between March 17-23, followed by another 5 patients and 2 HCP. HD patients underwent SARS-CoV-2 PCR nasal swab, regardless of symptoms, allowing detection of 4 asymptomatic COVID-19 cases. Positive cases were cohorted. Patients were screened for fever and COVID-19 symptoms before each HD, advised to wear face masks and practice hand hygiene. 5 patients were hospitalized with COVID-19 within 14 days of the screening period with no additional cases detected afterwards. During the surge, patients requiring bedside HD increased exponentially so HD frequency or treatment hours were reduced for some patients and 20 were temporarily transferred to other units. In May, all 32 HCP were tested for COVID-19 antibody with 18.8% (5 with and 1 without symptoms) testing positive. In June, 51 HD patients were tested for antibodies with detection of 6 additional asymptomatic individuals who had been SARS-CoV-2 PCR negative. In total, 26 patients (42.6%) tested positive for COVID-19, of which 42.3% were asymptomatic, and with 1 death. Early identification and isolation of both symptomatic and asymptomatic patients by universal screening along with stringent infection control measures limited the spread of COVID-19 infection in our unit.
ABSTRACT
Background. Comparative data on bloodstream infections (BSI) in hospitalized patients with and without SARS-CoV2 positive test is lacking. Methods. A retrospective observational study comparing (BSI) with and without COVID-19 infection was performed was performed from Jan1- May 1, 2020. Patient demographics, clinical microbiological characteristics of infections, therapeutic interventions and outcomes was compared between the two groups. Results. Of 155 patients with BSI, 104 were SARS-CoV2 PCR negative (N) while 51 were positive (Table 1). Majority of SARS-CoV2 positives (P) had ARDS (58.8%), required mechanical ventilation (73%), inotropic support (55%), therapeutic anticoagulation (28%), proning (35%), Rectal tube (43%), Tocilizumab (18%), and steroids (43%) (Table 2). BSI was higher in N with HIV (16.3% vs 3.9% p=0.027). Duration of antibiotic therapy (DOT) prior to BSI was significantly longer in P (15 days vs. 5 days, p < 0.0001) (table 2). In-hospital mortality was significantly higher among P with BSI (49% vs. 21% p < 0.0001). 185 BSI events were observed during the study period with 117 in N patients and 68 in P. Primary BSI was predominant (76%) in N while secondary BSI (65%) was common in P of which 50% were CLABSI. Median time from admission to positive culture was 0.86 days in N compared to 12.4 in P (p = 0.001). Majority of BSI in P were monomicrobial (88%) and hospital acquired (71%) when compared to N (p< 0.001). Enterococcus spp (28%), Candida spp(12%), MRSA (10%) and E.coli (10%) were predominant microbes in P compared to Streptococcus grp (16%), MSSA (14%), MRSA (13%) and E.coli (12%) in N (figure 1). Mortality from BSI was associated with COVID-19 infection (OR 2.403, p = 0.038), DM (OR 2.335, p = 0.032), Charlson comorbidity index >3 (OR 1.236, p = 0.004), and mechanical ventilation (OR 11.398, p < 0.001) on multivariate analysis. Conclusion. Increased events of hospital acquired, secondary BSI (CLABSI) due to Enterococcus was observed in adult P compared to N. These patients were critically ill, developed BSI in the second week of hospitalization, had longer DOT prior to positive cultures and worse outcomes. Breakdown of infection control measures and inappropriate antimicrobial use during the surge could be contributory.
ABSTRACT
Background. There is a paucity of data of bloodstream infections (BSI) before and during the COVID-19 pandemic. The aim of our study was to compare the incidence and characteristics of blood stream infections (BSI) in hospitalized patients before and during the surge of COVID-19 pandemic in a community hospital in South Bronx. Methods. This is a retrospective observational comparative study of adult hospitalized patients with BSI admitted before (Jan 1-Feb 28, 2020) and during COVID-19 surge (Mar 1- May 1,2020). The incidence of BSI, patient demographics, clinical and microbiological characteristics of infections including treatment and outcomes were compared. Results. Of the 155 patients with BSI, 64 were before COVID and 91 were during the COVID surge (Table 1). Incidence of BSI was 5.84 before COVID and 6.57 during surge (p = 0.004). Majority of patients during COVID period had ARDS (39.6%), required mechanical ventilation (57%), inotropic support (46.2%), therapeutic anticoagulation (24.2%), proning (22%), rectal tube (28.6%), Tocilizumab (9.9%), and steroids (30.8%) in comparison to pre-COVID (Table 2). Days of antibiotic therapy prior to BSI was 5 days before COVID and 7 during COVID. Mortality was higher among patients with BSI admitted during COVID surge (41.8% vs. 14.1% p < 0.0001). Of 185 BSI events, 71 were Pre-COVID and 114 during surge. Primary BSI were predominant (72%) before COVID contrary to secondary BSI (46%) (CLABSI) during COVID. Time from admission to positive culture was 2.5 days during COVID compared to 0.9 pre-COVID. Majority of BSI during COVID period were monomicrobial (93%) and hospital acquired (50%) (p=0.001). Enterococcus (20.2%), E.coli (13.2%), and MSSA (12.3%) were predominant microbes causing BSI during COVID vs. MRSA (15.5%), Streptococci (15.5%), and S. pneumoniae (14.1%) before COVID (Figure 1). In multivariate logistic regression, Enterococcal coinfection was associated with COVID positivity (OR 2.685, p = 0.038), mechanical ventilation (OR 8.739, p = 0.002), and presence of COPD/Asthma (OR 2.823, p = 0.035). Conclusion. Higher incidence of secondary BSI (CLABSI) due to Enterococcus spp. was observed during the surge of COVID-19 infection in the South Bronx. Breakdown of infection control measures during the COVID-19 pandemic could have been contributory.