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 Journal Article
| Authors: | Maki, K. R.; Steiger, S. N.; Su, Y.; Boumiza, A.; Tan, C. A.; Kerpelev, M.; Seo, S. K.; Cohen, N. |
| Article Title: | 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 |
| 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. © The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America. |
| Keywords: | adult; cancer chemotherapy; controlled study; aged; antibiotic agent; antibiotic therapy; retrospective studies; major clinical study; neutropenia; nonhuman; solid tumor; treatment duration; cancer patient; outcome assessment; antineoplastic agent; polymerase chain reaction; neoplasm; neoplasms; oxygen; cohort analysis; retrospective study; fever; antiinfective agent; anti-bacterial agents; disease severity; hematologic malignancy; escherichia coli; urinary tract infection; ciprofloxacin; patient compliance; hospital patient; bloodstream infection; methicillin resistant staphylococcus aureus; linezolid; vancomycin; doxycycline; new york; azithromycin; cotrimoxazole; levofloxacin; metronidazole; bacterial infection; streptococcus pneumoniae; bacterial infections; respiratory tract infection; skin infection; ceftriaxone; piperacillin plus tazobactam; artificial ventilation; pseudomonas aeruginosa; clindamycin; cefazolin; complication; cefepime; sultamicillin; pseudomonas; pandemic; stenotrophomonas maltophilia; ceftazidime; gastrointestinal infection; soft tissue infection; ampicillin; daptomycin; cefalexin; amoxicillin plus clavulanic acid; meropenem; klebsiella pneumoniae; coagulase negative staphylococcus; community acquired pneumonia; amikacin; serratia marcescens; carbapenem derivative; monobactam derivative; quinolone derivative; tetracycline derivative; medication compliance; coinfection; antimicrobial stewardship; cefadroxil; humans; human; male; female; article; tertiary care center; cefuroxime; avibactam plus ceftazidime; malignant neoplasm; ceftaroline; nitrofurantoin; pandemics; coronavirus disease 2019; covid-19; sars-cov-2; high flow nasal cannula therapy; nasopharyngeal swab; aminopenicillin; cefixime; ceftolozane plus tazobactam; achromobacter xylosoxidans; burkholderia cepacia; streptococcus anginosus |
| Journal Title: | Infection Control and Hospital Epidemiology |
| Volume: | 44 |
| Issue: | 3 |
| ISSN: | 0899-823X |
| Publisher: | The Society for Healthcare Epidemiology of America |
| Date Published: | 2023-03-01 |
| Start Page: | 413 |
| End Page: | 419 |
| Language: | English |
| DOI: | 10.1017/ice.2022.129 |
| PUBMED: | 35616016 |
| PROVIDER: | scopus |
| PMCID: | PMC9203359 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Nina Cohen -- Source: Scopus |
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