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Risk factors and outcomes associated with community-onset and hospital-acquired coinfection in patients hospitalized for coronavirus disease 2019 (COVID-19): A multihospital cohort study

Part of: SARS-CoV-2/COVID-19

Published online by Cambridge University Press:  26 July 2021

Lindsay A. Petty Open the ORCID record for Lindsay A. Petty [Opens in a new window] ,
Scott A. Flanders ,
Valerie M. Vaughn ,
David Ratz ,
Megan O’Malley ,
Anurag N. Malani ,
Laraine Washer ,
Tae Kim ,
Keith E. Kocher  and
Scott Kaatz
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Lindsay A. Petty*
Affiliation:
Division of Infectious Diseases, Internal Medicine, University of Michigan, Ann Arbor, Michigan
Scott A. Flanders
Affiliation:
Division of Hospital Medicine, Internal Medicine, University of Michigan, Ann Arbor, Michigan
Valerie M. Vaughn
Affiliation:
Division of General Internal Medicine, Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
David Ratz
Affiliation:
Division of Hospital Medicine, Internal Medicine, University of Michigan, Ann Arbor, Michigan
Megan O’Malley
Affiliation:
Division of Hospital Medicine, Internal Medicine, University of Michigan, Ann Arbor, Michigan
Anurag N. Malani
Affiliation:
Division of Infectious Diseases, Internal Medicine, St. Joseph Mercy Health System, Ann Arbor, Michigan
Laraine Washer
Affiliation:
Division of Infectious Diseases, Internal Medicine, University of Michigan, Ann Arbor, Michigan
Tae Kim
Affiliation:
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
Keith E. Kocher
Affiliation:
Emergency Medicine and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
Scott Kaatz
Affiliation:
Division of Hospital Medicine, Henry Ford Hospital, Detroit, Michigan
Tawny Czilok
Affiliation:
Division of Hospital Medicine, Internal Medicine, University of Michigan, Ann Arbor, Michigan
Elizabeth McLaughlin
Affiliation:
Division of Hospital Medicine, Internal Medicine, University of Michigan, Ann Arbor, Michigan
Hallie C. Prescott
Affiliation:
Division of Pulmonary and Critical Care, Internal Medicine, University of Michigan and VA Center for Clinical Management Research, Ann Arbor, Michigan
Vineet Chopra
Affiliation:
Division of Hospital Medicine, Internal Medicine, University of Michigan, Ann Arbor, Michigan
Tejal Gandhi*
Affiliation:
Division of Infectious Diseases, Internal Medicine, University of Michigan, Ann Arbor, Michigan
*
Author for correspondence: Lindsay A. Petty, E-mail: pettyl@med.umich.edu. Or Tejal N. Gandhi, E-mail: tgandhi@med.umich.edu
Author for correspondence: Lindsay A. Petty, E-mail: pettyl@med.umich.edu. Or Tejal N. Gandhi, E-mail: tgandhi@med.umich.edu
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Abstract

Background:

We sought to determine the incidence of community-onset and hospital-acquired coinfection in patients hospitalized with coronavirus disease 2019 (COVID-19) and to evaluate associated predictors and outcomes.

Methods:

In this multicenter retrospective cohort study of patients hospitalized for COVID-19 from March 2020 to August 2020 across 38 Michigan hospitals, we assessed prevalence, predictors, and outcomes of community-onset and hospital-acquired coinfections. In-hospital and 60-day mortality, readmission, discharge to long-term care facility (LTCF), and mechanical ventilation duration were assessed for patients with versus without coinfection.

Results:

Of 2,205 patients with COVID-19, 141 (6.4%) had a coinfection: 3.0% community onset and 3.4% hospital acquired. Of patients without coinfection, 64.9% received antibiotics. Community-onset coinfection predictors included admission from an LTCF (OR, 3.98; 95% CI, 2.34–6.76; P < .001) and admission to intensive care (OR, 4.34; 95% CI, 2.87–6.55; P < .001). Hospital-acquired coinfection predictors included fever (OR, 2.46; 95% CI, 1.15–5.27; P = .02) and advanced respiratory support (OR, 40.72; 95% CI, 13.49–122.93; P < .001). Patients with (vs without) community-onset coinfection had longer mechanical ventilation (OR, 3.31; 95% CI, 1.67–6.56; P = .001) and higher in-hospital mortality (OR, 1.90; 95% CI, 1.06–3.40; P = .03) and 60-day mortality (OR, 1.86; 95% CI, 1.05–3.29; P = .03). Patients with (vs without) hospital-acquired coinfection had higher discharge to LTCF (OR, 8.48; 95% CI, 3.30–21.76; P < .001), in-hospital mortality (OR, 4.17; 95% CI, 2.37–7.33; P ≤ .001), and 60-day mortality (OR, 3.66; 95% CI, 2.11–6.33; P ≤ .001).

Conclusion:

Despite community-onset and hospital-acquired coinfection being uncommon, most patients hospitalized with COVID-19 received antibiotics. Admission from LTCF and to ICU were associated with increased risk of community-onset coinfection. Future studies should prospectively validate predictors of COVID-19 coinfection to facilitate the reduction of antibiotic use.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 9 , September 2022 , pp. 1184 - 1193
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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