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COVID-19 Insights & Analytics Issue 7
Incidence of Infection and Antimicrobial Usage

Dec 16, 2020

Overview

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The COVID-19 Insights & Analytics newsletter is designed to provide you with a summary to quantify national trends that may help in COVID-19 response planning. The included data, analytics and dashboards are generated utilizing BD HealthSight™ Infection Advisor Analytics and are derived from electronic patient data from 338 participating U.S. hospitals initiated on March 1, 2020 through November 23, 2020 unless otherwise indicated.

Introduction

Previous respiratory viral epidemics have been associated with increased rates of co-infections (“super infections”) with other additional viral, bacterial or fungal infections1. We evaluated antimicrobial use and culture source for US hospitalized COVID-19 tested patients from 246 hospitals between March 1 – May 31, 2020.

Executive Summary

  • Cultures were performed at a very high rate in both COVID-19+ (97.2%) and COVID-19- (91.9%) vs the COVID-19 non-tested group (41%)
  • The culture positive rate for another pathogen was similar for COVID-19+ (20.9%) and COVID-19- (21.4%) patients
  • Antimicrobials were prescribed at a higher rate in COVID-19+ (68%) than COVID-19- (46%) and non-tested patients (25.9%)
  • Co-infection in COVID-19+ patients with another respiratory virus (e.g. influenza, RSV or metapnuemovirus) does occur, but was relatively low at 2.2% in this data set.
  • High rates of antimicrobial use among COVID-19+ may be due to high level of concern with potential bacterial superinfection. However, it may also be indicative of potential overuse of antimicrobials.

Figure 1: Patient characteristics by COVID-19 testing status

Commentary for Figure 1

Patients who were tested for COVID-19 were also cultured for other pathogens at 97% (COVID-19+) and 92% (COVID-19 -) rate compared to just 41% for those not tested for COVID-19

Figure 2: Source and pathogen distribution by COVID-19 testing status

Commentary for Figure 2

Observations per graph:

  • Additional diagnostic tests: COVID-19+ patients who had other cultures taken later in the hospital course (i.e. 2 days after admission) had a higher culture positive rate at 44% compared to COVID-19 negative (23%) and COVID-19 not-tested patients (20%)
  • Respiratory cultures for another pathogen were positive at a higher rate in COVID-19+ patients (24%) than in those that were COVID-19- (15%) or not tested at all (14%)
  • Overall gram negative rod culture positive rates were similar in all groups (COVID-19+,COVID-19-, and those not tested for COVID), which was approximately 45%
  • Pseudomonas and Candida culture positive rates were higher in COVID-19+ patients compared to COVID-19- or not tested at all
  • Co-infection in COVID-19+ patients with another respiratory virus (e.g. influenza, RSV or metapnuemovirus) was relatively low at 2%

Figure 3: Antimicrobial use by COVID-19 testing status

Commentary for Figure 3

  • COVID-19+ patients received more antibiotics (68%) than COVID-19- (46%) or those not tested for COVID-19 (26%)
  • Extended spectrum 3rd/4th generation cephalosporins, macrolides and tetracycline antibiotics were used at higher rates in COVID-19+ patients than COVID-19– patients and those who were not tested for COVID-19.

Figure 4: Resource utilization by COVID-19 testing status

Commentary for Figure 4

  • COVID-19+ patients had longer LOS (hospital length of stay) than COVID-19- and patients never tested for COVID-19.
  • COVID-19+ patients who had another culture positive had a longer LOS (13.6 days) compared to COVID-19– patients (8.3 days) and those who were never tested for COVID-19 (7.3 days) and also had another culture positive.
  • COVID-19+ patients in general had longer LOS in and out of the ICU than their COVID-19- counterparts and those who were never tested for COVID-19.

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