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The impact of COVID on bacterial sepsis

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose

To identify the predictors of morbidity and mortality in matched COVID-19 positive and negative patients who were septic with Gram positive or Gram negative infections.

Methods

We conducted a retrospective review, from March to October 2020, of matched septic patients at five Hackensack Meridian Health hospitals who had bacteremia with Staphylococcus aureus, Klebsiella pneumoniae or Escherichia coli with and without COVID-19. We extracted patient demographics, comorbidities and clinical outcomes data using ICD-10 codes. Bacterial isolates were compared by whole genome sequencing analysis. Multivariate logistic regression was used to analyze independent predictors of morbidity and mortality.

Results

A total of 208 patients were grouped by positive bloodstream infection (BSI) with COVID-19 (n = 104) and without COVID-19 (n = 104). Most patients were over age 50 (90% vs. 89%) and Caucasian (78% vs. 86%). Inpatient mortality was higher in patients with COVID-19 for both GP (35% vs. 8%, p < 0.05) and GN (28% vs. 10%, p < 0.05) BSIs. Patients with Gram positive (GP) BSIs had a significant increase in mortality risk (OR 4.5, CI 1.4–14.5, p < 0.05) in contrast to those with Gram negative (GN) infections (OR 0.4, CI 0.4–4.0, p = 0.4).

Conclusion

Concurrent COVID-19 infection is associated with a significant increase in morbidity and mortality in patients with GP and GN BSIs. Patients with S. aureus BSIs with COVID-19 are more likely to develop shock and respiratory failure and have higher rates and odds of mortality than those without COVID-19. These findings provide an essential insight into the care of these patients, especially those co-infected with Staphylococcus aureus.

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Data availability

The datasets in this paper will be made available from the corresponding authors upon requests.

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Acknowledgements

We are grateful to the effort of the Microbiology Laboratory at Jersey Shore University Medical Center in supporting this study.

Funding

This work was funded by Merck’s Investigator Studies Program (MISP) SARS CoV-2/COVID-19 award MISP 60453 to B.N.K. and M.K. (“Drug resistance profiles of bacterial and fungal isolates from super-infections in hospitalized COVID-19 patients”).

Author information

Authors and Affiliations

  1. Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA

    Sophia Dar & Daniel Erickson

  2. Long Island Jewish Medical Center-Northshore University Hospital, Manhasset, NY, 11030, USA

    Sophia Dar

  3. Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA

    Claudia Manca, Tara Lozy, Elena Shashkina, Milena Kordalewska, Jose R. Mediavilla, Liang Chen & Barry N. Kreiswirth

  4. Jersey Shore University Medical Center, Neptune, NJ, 07753, USA

    Albert Rojtman

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  1. Sophia Dar
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Contributions

The corresponding author (B. Kreiswirth) and Drs. Rojtman and Kordalewska were involved in the research design, overseeing the study and editing the manuscript. The two co-first authors (Dar and Erickson) collected and analyzed the data in collaboration with Dr. Manca and prepared the initial draft of the manuscript. Dr. Lozy provided guidance in the statistical analysis. The other authors generated the laboratory data including the preparation, sequencing, and analysis of the strains.

Corresponding author

Correspondence to Barry N. Kreiswirth.

Ethics declarations

Ethics approval

This study was approved on 11/1/2021 by Hackensack Meridian Health Institutional Review Board (IRB) under protocol Pro2021-0519.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

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Sophia Dar and Daniel Erickson are co-first authors.

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Dar, S., Erickson, D., Manca, C. et al. The impact of COVID on bacterial sepsis. Eur J Clin Microbiol Infect Dis 42, 1173–1181 (2023). https://doi.org/10.1007/s10096-023-04655-0

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