Covid-19 patients with secondary bloodstream infections at 50% higher risk of in-hospital death

Covid-19 patients with a secondary blood infection are more likely to be sicker, require longer hospital stays as well as have a higher risk of dying in the hospital, reveals a new study.

By: Longjam Dineshwori | | Published: December 23, 2020 4:19 pm

Antimicrobial use during hospitalization suspected to be the cause of bloodstream infections in COVID-19 patients.

Certain medical conditions like heart disease, cancer, chronic kidney disease, diabetes, and obesity are known to increase the risk of serious illness from COVID-19. Existing data also shows that the novel coronavirus can cause lasting harm to the lungs and other organs, leading to serious medical complications. In yet another discovery, researchers have found secondary bloodstream infections in severe Covid-19 patients. Also Read - Coronavirus: WHO issues new advisory for COVID-19 patients

Covid-19 patients with a secondary bloodstream infection are more likely to be sicker, require longer hospital stays as well as have a higher risk of dying in the hospital, revealed a new study published in the journal Clinical Infectious Diseases. Also Read - India’s Covaxin can neutralize UK variant of COVID-19, finds new study

According to the researchers, the in-hospital mortality rate for Covid-19 patients with a secondary bloodstream infection was more than 50 per cent compared to those without bloodstream infections. Also Read - COVID-19 vaccination FAQs: All you need to know before you get the jab

What is a bloodstream infection?

As defined by the International Society for Infectious Diseases, a bloodstream infection (BSI) is the presence of one or more positive blood cultures associated with systemic signs of infection such as fevers, chills, and/or hypotension. Most bloodstream infections are related to invasive procedures or devices such as the placement of a central venous catheter.

For example, a central line-associated bloodstream infection (CLABSI) occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line. Also known as a central venous catheter, a central line is a tube that doctors often place in a large vein in the neck, chest, or groin to give medication or fluids or to collect blood for medical tests.

BSIs can be divided into primary and secondary. Primary BSIs are infections that do not result from an infection at another body site while secondary BSIs develop from a detectable area of infection such as the urine or a surgical wound. For example, a urinary tract infection with subsequent bacteremia, the presence of bacteria in the bloodstream, is a secondary BSI.

Secondary bloodstream infections seen in Covid-19 patients

Researchers at Rutgers Robert Wood Johnson Medical School in New Jersey, US analysed 375 patients diagnosed with severe Covid-19 from March to May 2020. Of these, 128 cases had secondary bloodstream infections, 92 per cent of which were bacterial infections.

The Covid-19 patients with secondary bloodstream infections were more likely to have altered mental status, lower per cent oxygen saturation, septic shock and to be admitted to the intensive care unit compared to those without bloodstream infections, said Pinki Bhatt, Assistant Professor at Rutgers Robert Wood Johnson Medical School and co-lead author of the study.

Those who needed more advanced types of supplemental oxygen upon hospital admission had higher odds of secondary bloodstream infections. In addition, the in-hospital mortality rate for Covid-19 patients with secondary bloodstream infections was found to be more than 50 per cent compared to those without bloodstream infections, the researchers wrote. However, the study noted that these deaths were associated with, not caused by, the condition.

The researchers theorised that secondary bloodstream infections in Covid-19 patients may have contributed to the severity of the illness or it may reflect other underlying physiological and immunological complications of Covid-19.

Cause of secondary bloodstream infections

The study indicated that the most common cause of secondary bloodstream infections was unknown or not determined, but a central-line associated bloodstream infection is presumed as the most common source.

It was found that 80 percent of all the patients in the study received antimicrobials at some point during hospitalization, including those who did not have bloodstream infections.

“This likely reflects clinicians’ inclination to administer antimicrobials given the limited information on the natural course of this novel disease,” Bhatt said.

Further studies are needed to better understand when to suspect and treat empirically for secondary bloodstream infections in severe COVID-19, she added.

Co-author Navaneeth Narayanan, a clinical associate professor at Rutgers Ernest Mario School of Pharmacy, also pointed out that indiscriminate antimicrobial use will inevitably lead to widespread complications such as adverse drug reactions, antimicrobial resistance and Clostridium difficile infections.

Published : December 23, 2020 4:19 pm

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