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Bacterial infections and antibiotic utilization varies by coronavirus disease 19 (COVID-19) severity in hospitalized cancer patients: Analysis from the first phase of the pandemic

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

Published online by Cambridge University Press:  26 May 2022

Kayla R. Maki ,
Samantha N. Steiger ,
Yiqi Su ,
Aida Boumiza ,
Carrie A. Tan ,
Marina Kerpelev ,
Susan K. Seo Open the ORCID record for Susan K. Seo [Opens in a new window]  and
Nina Cohen
Kayla R. Maki
Affiliation:
Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
Samantha N. Steiger
Affiliation:
Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
Yiqi Su
Affiliation:
Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
Aida Boumiza
Affiliation:
Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
Carrie A. Tan
Affiliation:
Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
Marina Kerpelev
Affiliation:
Information Systems, Memorial Sloan Kettering Cancer Center, New York, New York
Susan K. Seo
Affiliation:
Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Weill Cornell Medical College, New York, New York
Nina Cohen*
Affiliation:
Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
*
Author for correspondence: Nina Cohen, PharmD, E-mail: cohenn@mskcc.org
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Abstract

Objective:

To characterize bacterial infections and antibiotic utilization in hospitalized cancer patients with coronavirus disease 2019 (COVID-19).

Design:

Retrospective cohort study.

Setting:

Tertiary cancer center in New York City.

Patients:

Hospitalized cancer patients ≥18 years with COVID-19 between March 1, 2020, and May 31, 2020.

Methods:

Patients were classified with mild COVID-19 (ie, with room air), moderate COVID-19 (ie, using nasal cannula oxygen), or severe COVID-19 (ie, using high-flow oxygen or mechanical ventilation). The primary outcome was bacterial infection rate within 30 days of COVID-19 onset. Secondary outcomes included the proportion of patients receiving antibiotics and antibiotic length of therapy (LOT).

Results:

Of 358 study patients, 133 had mild COVID-19, 97 had moderate COVID-19, and 128 had severe COVID-19. Of 358 patients, 234 (65%) had a solid tumor. Also, 200 patients (56%) had 245 bacterial infections, of which 67 (27%) were microbiologically confirmed. The proportion of patients with bacterial infection increased with COVID-19 severity: mild (n = 47, 35%) versus moderate (n = 49, 51%) versus severe (n = 104, 81%) (P < .0001). Also, 274 (77%) received antibiotics for a median of 4 days. The median antibiotic LOTs were 7 days with 1 infection and 20 days with multiple infections (P < .0001). Antibiotic durations were 1 day for patients with mild COVID-19, 4 days for patients with moderate COVID-19, and 8 days for patients with severe COVID-19 (P < .0001).

Conclusions:

Hospitalized cancer patients with COVID-19 had a high rate of bacterial infection. As COVID-19 severity increased, the proportion of patients diagnosed with bacterial infection and given antibiotics increased. In mild COVID-19 cases, antibiotic LOT was short, suggesting that empiric antibiotics can be safely avoided or discontinued in this group.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 3 , March 2023 , pp. 413 - 419
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. These data were presented in a poster at the 2020 American Society of Health System Pharmacists Midyear Meeting on December 6–10, 2020, held virtually. Poster number RP-554, on December 10, 2020.

a

Authors of equal contribution.

References

Wang, D, Hu, B, Hu, C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061–1069.10.1001/jama.2020.1585CrossRefGoogle ScholarPubMed
Yu, J, Ouyang, W, Chua, MLK, Xie, C. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol 2020;6:1108–1110.10.1001/jamaoncol.2020.0980CrossRefGoogle Scholar
Liang, W, Guan, W, Chen, R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020;21:335–337.10.1016/S1470-2045(20)30096-6CrossRefGoogle ScholarPubMed
Robilotti, EV, Babady, NE, Mead, PA, et al. Determinants of COVID-19 disease severity in patients with cancer. Nat Med 2020;26:1218–1223.10.1038/s41591-020-0979-0CrossRefGoogle ScholarPubMed
Jee, J, Foote, MB, Lumish, M, et al. Chemotherapy and COVID-19 outcomes in patients with cancer. J Clin Oncol 2020;38:3538–3546.10.1200/JCO.20.01307CrossRefGoogle ScholarPubMed
Nori, P, Cowman, K, Chen, V, et al. Bacterial and fungal coinfections in COVID-19 patients hospitalized during the New York City pandemic surge. Infect Control Hosp Epidemiol 2021;42:84–88.10.1017/ice.2020.368CrossRefGoogle ScholarPubMed
Rawson, TM, Moore, LSP, Zhu, N, et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis 2020;71:2459–2468.Google ScholarPubMed
Russell, CD, Fairfield, CJ, Drake, TM, et al. Coinfections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study. Lancet Microbe 2021;2:e354–e365.10.1016/S2666-5247(21)00090-2CrossRefGoogle ScholarPubMed
Garcia-Vidal, C, Sanjuan, G, Moreno-Garcia, E, et al. Incidence of coinfections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect 2021;27:83–88.10.1016/j.cmi.2020.07.041CrossRefGoogle ScholarPubMed
American Hospital Formulary Service. AHFS Pharmacologic-Therapeutic Classification System. Oregon government website. https://www.oregon.gov/obnm/Documents/Formulary%20Information/AHFSClassificationwithDrugs2019.pdf. Accessed November 11, 2021.Google Scholar
Bloodstream infection event (central-line–associated bloodstream infection and non–central-line–associated bloodstream infection). Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf. Accessed November 2, 2021.Google Scholar
Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.10.1086/651706CrossRefGoogle Scholar
Freifeld, AG, Bow, EJ, Sepkowitz, KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52:e56–e93.10.1093/cid/cir073CrossRefGoogle ScholarPubMed
Gupta, K, Hooton, TM, Naber, KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103–e120.CrossRefGoogle Scholar
Kalil, AC, Metersky, ML, Klompas, M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;63:e61–e111.10.1093/cid/ciw353CrossRefGoogle Scholar
Mandell, LA, Wunderink, RG, Anzueto, A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 suppl 2:S27–S72.10.1086/511159CrossRefGoogle Scholar
Shane, AL, Mody, RK, Crump, JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis 2017;65:e45–e80.10.1093/cid/cix669CrossRefGoogle Scholar
Solomkin, JS, Mazuski, JE, Bradley, JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010;50:133–164.10.1086/649554CrossRefGoogle ScholarPubMed
Stevens, DL, Bisno, AL, Chambers, HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014;59:e10–e52.10.1093/cid/ciu296CrossRefGoogle ScholarPubMed
Antimicrobial stewardship programs (ASPs) metrics examples. Public Health Ontario website. https://www.publichealthontario.ca/-/media/documents/A/2017/asp-metrics-examples.pdf. Accessed November 2, 2021.Google Scholar
Arentz, M, Yim, E, Klaff, L, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 2020;323:1612–1614.10.1001/jama.2020.4326CrossRefGoogle ScholarPubMed
Cheng, LS, Chau, SK, Tso, EY, et al. Bacterial coinfections and antibiotic prescribing practice in adults with COVID-19: experience from a single hospital cluster. Ther Adv Infect Dis 2020;7:2049936120978095.Google ScholarPubMed
Goyal, P, Choi, JJ, Pinheiro, LC, et al. Clinical characteristics of COVID-19 in New York City. N Engl J Med 2020;382:2372–2374.10.1056/NEJMc2010419CrossRefGoogle ScholarPubMed
Vaughn, VM, Gandhi, TN, Petty, LA, et al. Empiric antibacterial therapy and community-onset bacterial coinfection in patients hospitalized with coronavirus disease 2019 (COVID-19): a multihospital cohort study. Clin Infect Dis 2021;72:e533–e541.10.1093/cid/ciaa1239CrossRefGoogle Scholar
Gudiol, C, Dura-Miralles, X, Aguilar-Company, J, et al. Coinfections and superinfections complicating COVID-19 in cancer patients: a multicentre, international study. J Infect 2021;83:306–313.10.1016/j.jinf.2021.07.014CrossRefGoogle ScholarPubMed
Metlay, JP, Waterer, GW. Treatment of community-acquired pneumonia during the coronavirus disease 2019 (COVID-19) pandemic. Ann Intern Med 2020;173:304–305.10.7326/M20-2189CrossRefGoogle ScholarPubMed
Jain, S, Self, WH, Wunderink, RG, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med 2015;373:415–427.10.1056/NEJMoa1500245CrossRefGoogle Scholar
Metlay, JP, Waterer, GW, Long, AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019;200:e45–e67.CrossRefGoogle ScholarPubMed
Rowe, HM, Meliopoulos, VA, Iverson, A, Bomme, P, Schultz-Cherry, S, Rosch, JW. Direct interactions with influenza promote bacterial adherence during respiratory infections. Nat Microbiol 2019;4:1328–1336.10.1038/s41564-019-0447-0CrossRefGoogle ScholarPubMed
Shah, NS, Greenberg, JA, McNulty, MC, et al. Bacterial and viral coinfections complicating severe influenza: incidence and impact among 507 US patients, 2013–2014. J Clin Virol 2016;80:12–19.10.1016/j.jcv.2016.04.008CrossRefGoogle Scholar
Du, Y, Tu, L, Zhu, P, et al. Clinical features of 85 fatal cases of COVID-19 from Wuhan: a retrospective observational study. Am J Respir Crit Care Med 2020;201:1372–1379.10.1164/rccm.202003-0543OCCrossRefGoogle ScholarPubMed
Cong, W, Poudel, AN, Alhusein, N, Wang, H, Yao, G, Lambert, H. Antimicrobial use in COVID-19 patients in the first phase of the SARS-CoV-2 pandemic: a scoping review. Antibiotics (Basel) 2021;10:745.CrossRefGoogle ScholarPubMed
Pettit, NN, Nguyen, CT, Lew, AK, et al. Reducing the use of empiric antibiotic therapy in COVID-19 on hospital admission. BMC Infect Dis 2021;21:516.10.1186/s12879-021-06219-zCrossRefGoogle ScholarPubMed
Evans, TJ, Davidson, HC, Low, JM, Basarab, M, Arnold, A. Antibiotic usage and stewardship in patients with COVID-19: too much antibiotic in uncharted waters? J Infect Prev 2021;22:119–125.10.1177/1757177420976813CrossRefGoogle ScholarPubMed
Lucien, MAB, Canarie, MF, Kilgore, PE, et al. Antibiotics and antimicrobial resistance in the COVID-19 era: perspective from resource-limited settings. Int J Infect Dis 2021;104:250–254.10.1016/j.ijid.2020.12.087CrossRefGoogle ScholarPubMed
Martin, AJ, Shulder, S, Dobrzynski, D, Quartuccio, K, Pillinger, KE. Antibiotic use and associated risk factors for antibiotic prescribing in COVID-19 hospitalized patients. J Pharm Pract 2021. doi: 10.1177/08971900211030248.Google ScholarPubMed
Andrews, A, Budd, EL, Hendrick, A, et al. Surveillance of antibacterial usage during the COVID-19 pandemic in England, 2020. Antibiotics (Basel) 2021;10:841.CrossRefGoogle ScholarPubMed
Bork, JT, Leekha, S, Claeys, K, et al. Change in hospital antibiotic use and acquisition of multidrug-resistant gram-negative organisms after the onset of coronavirus disease 2019. Infect Control Hosp Epidemiol 2021;42:1115–1117.10.1017/ice.2020.1360CrossRefGoogle Scholar
Dieringer, TD, Furukawa, D, Graber, CJ, et al. Inpatient antibiotic utilization in the Veterans’ Health Administration during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2021;42:751–753.10.1017/ice.2020.1277CrossRefGoogle ScholarPubMed
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