ABSTRACT
Purpose: This study aimed to identify probable cases of nosocomial Coronavirus Disease 2019 (COVID-19) among hospitalized solid organ transplant (SOT) recipients. Methods: All hospitalized SOT recipients diagnosed with COVID-19 by polymerase chain reaction (PCR) from March 11, 2020 to August 24, 2020 were evaluated. Potential nosocomial cases included admissions where the first positive PCR occurred on hospital day 3 or later (intra-admission) or within 14 days of a previous hospital discharge (inter-admission). Two infectious disease specialists independently adjudicated all potential cases into four categories (definitely community-acquired, likely community-acquired, likely hospital-acquired, and definitely hospital-acquired) using systematic chart review of symptom onset, radiographic findings, and community risk factors. Discrepancies were resolved by a third investigator. Results: Of 132 hospitalized SOT recipients diagnosed with COVID-19, nosocomial infections were apparent in 19 (14%;Figure 1). Intra-admission cases (n=11, 4 likely hospital-acquired and 7 definitely hospital-acquired) were diagnosed a median (IQR) of 43 (8 to 53) days after admission. Inter-admission cases (n=8, all likely hospitalacquired) had 5 (3 to 10) days of hospital care in the 14 days preceding diagnosis. The proportion of COVID-19 infections classified as nosocomial varied by time from most recent transplant until diagnosis (P<0.001) and transplant type (P<0.001;Table 1). Probable nosocomial infections peaked in June and gradually declined. Conclusions: Despite infection control measures to sequester SOT recipients and their nurses on dedicated transplant floors and provide patients and healthcare workers with screening, COVID-19 may have been acquired during healthcare interactions in 14% of hospitalized SOT recipients diagnosed with COVID-19. Vaccination against COVID-19 for front-line healthcare workers is important for protection of SOT recipients.
ABSTRACT
Purpose: This study compared death and non-favorable discharge following a hospital admission for Coronavirus Disease 2019 (COVID-19) management for patients with a history of solid organ transplant (SOT) vs without (control). Methods: All non-pregnant adults who tested positive with symptomatic or asymptomatic COVID-19 and were admitted at a multihospital health-system from March 17, 2020 through August 24, 2020 were eligible for the study. Patients were excluded if their first positive COVID-19 test occurred >7 days before admission (potentially resolved) or >7 days after admission (potentially nosocomial). Patients not taking immunosuppression immediately prior to COVID-19 diagnosis were excluded from the SOT group. Outcomes included death at 60 days after admission and non-favorable discharge (death or hospice). To adjust for confounding due to differences in baseline demographics, a propensity score was calculated using age, sex, race, body mass index, hypertension, diabetes mellitus, chronic kidney disease, underlying liver disease, month of hospital admission, and area deprivation index (a surrogate for socioeconomic status). The matched cohort was generated using 1:1 nearest neighbor matching without replacement. Outcomes were analyzed using logistic regression that accounted for matching. Results: Among 4,562 included patients (108 SOT recipients and 4,454 controls), 60-day death occurred in 17% SOT vs 10% control (P=0.033) and non-favorable discharge in 18% SOT vs 9% control (P=0.004). Among 214 matched patients (107 SOT recipients, 107 controls), 60-day death occurred in 17% SOT vs 9% control (OR=2.0, 95%CI=0.9 to 4.4, P=0.106) and non-favorable discharge in 18% SOT vs 9% control (OR=2.1, 95%CI=1.0 to 4.6, P=0.063). As expected, propensity matching reduced confounding due to differences in baseline characteristics (Table 1). Transplanted organs included kidney (n=64), liver (n=13), lung (n=12), history of >1 organ (n=13), and heart (n=5). Conclusions: Recipients of SOT had a greater risk of 60-day death and non-favorable discharge among hospitalized patients with COVID-19 using unadjusted analysis. Preliminary data from the propensity matched analysis reported similar magnitudes of association but did not find statistical significance. A larger study may be needed to clarify whether immune-suppressed SOT recipients have greater risk of death or non-favorable discharge from COVID-19. (Table Presented) .