Abstract
BACKGROUND: We examined community- and hospital-acquired bloodstream infections (BSIs) in coronavirus disease 2019 (COVID-19) and non-COVID-19 patients across 2 epidemic waves.
METHODS: We analyzed blood cultures of patients presenting to a London hospital group between January 2020 and February 2021. We reported BSI incidence, changes in sampling, case mix, healthcare capacity, and COVID-19 variants.
RESULTS: We identified 1047 BSIs from 34 044 blood cultures, including 653 (62.4%) community-acquired and 394 (37.6%) hospital-acquired. Important pattern changes were seen. Community-acquired Escherichia coli BSIs remained below prepandemic level during COVID-19 waves, but peaked following lockdown easing in May 2020, deviating from the historical trend of peaking in August. The hospital-acquired BSI rate was 100.4 per 100 000 patient-days across the pandemic, increasing to 132.3 during the first wave and 190.9 during the second, with significant increase in elective inpatients. Patients with a hospital-acquired BSI, including those without COVID-19, experienced 20.2 excess days of hospital stay and 26.7% higher mortality, higher than reported in prepandemic literature. In intensive care, the BSI rate was 421.0 per 100 000 intensive care unit patient-days during the second wave, compared to 101.3 pre-COVID-19. The BSI incidence in those infected with the severe acute respiratory syndrome coronavirus 2 Alpha variant was similar to that seen with earlier variants.
CONCLUSIONS: The pandemic have impacted the patterns of community- and hospital-acquired BSIs, in COVID-19 and non-COVID-19 patients. Factors driving the patterns are complex. Infection surveillance needs to consider key aspects of pandemic response and changes in healthcare practice.
| Original language | English |
|---|---|
| Pages (from-to) | E1082-E1091 |
| Journal | Clinical Infectious Diseases |
| Volume | 75 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 1 Oct 2021 |
Bibliographical note
Funding information: This work was supported by the World Health Organization (WHO); the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with PHE, in collaboration with Imperial Healthcare Partners, University of Cambridge, and University of Warwick; the Department of Health and Social Care, which funded the Centre for Antimicrobial Optimisation at Imperial College London; and the NIHR Imperial Biomedical Research Centre, which developed and funded the iCARE high-performance analytics environment to provide data used in this research. A. H. is an NIHR Senior Investigator. P. A. is supported by the NIHR Applied Research Collaboration Northwest London and Telstra Health UK. F. D. receives funding from the Medical Research Council Clinical Academic Research Partnership Scheme.Potential conflicts of interest. A. H. reports participation on WHO Health Emergencies Program Ad-Hoc Advisory Panel of Infection Prevention and Control Experts for Preparedness, Readiness and Response to COVID-19 (current); Scientific Advisory Group for Emergencies Coronavirus Response working group on nosocomial transmission (current); serving as board member for Wellcome-Surveillance and Epidemiology of Drug-resistant Infections Consortium (2017–2020); serving as committee member of Scientific Steering Committee on Antimicrobial Resistance organized by Academy of Medical Sciences, supported by the Yusuf and Farida Hamied Foundation (2018–2019); serving as expert advisory board group member (2017–2018) for De-linking Reimbursement of Antimicrobials from Volumes Sold: Implications for National Institute for Health and Care Excellence (NICE) Appraisal (contributor to report entitled “Framework for value assessment of new antimicrobials—implications of alternative funding arrangements for NICE Appraisal,” published in September 2018); and serving as executive committee member and president of the International Society for Infectious Diseases (current). R. H. reports honoraria editing for the Journal of Antimicrobial Chemotherapy. T. M. R. reports personal consultancy fees (2020) from Sandoz and personal consultancy fees (2021) and personal educational honoraria from bioMérieux. M. G. reports payment or honoraria from Pfizer and Sanofi. J. O. reports consulting payments from Gama Healthcare Ltd and Pfizer Ltd; payment or honoraria for giving talks from Antimicrobial Stewardship Progamme, Diversey and Clean Hospitals; and academic fees from Imperial College London and Nursing Times. All other authors report no potential conflicts.
Open Access: This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact [email protected]
Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
Citation: Nina J Zhu, Timothy M Rawson, Siddharth Mookerjee, James R Price, Frances Davies, Jonathan Otter, Paul Aylin, Russell Hope, Mark Gilchrist, Yeeshika Shersing, Alison Holmes, Changing Patterns of Bloodstream Infections in the Community and Acute Care Across 2 Coronavirus Disease 2019 Epidemic Waves: A Retrospective Analysis Using Data Linkage, Clinical Infectious Diseases, Volume 75, Issue 1, 1 July 2022, Pages e1082–e1091,
DOI: https://doi.org/10.1093/cid/ciab869
Keywords
- SARS-CoV-2
- antimicrobial resistance
- bacteremia
- healthcare-Associated infection
