4CPS-123 Case-control study on the association between nosocomial bloodstream infections and glucocorticoids, tocilizumab, systemic antibiotics, mechanical ventilation and length of hospital stay in COVID-19 hospitalised patients

• Published in: European journal of hospital pharmacy. Science and practice Vol. 30; no. Suppl 1; p. A64
• Main Authors: Codina Jiménez, C, Marin, S, Álvarez, M, Terricabras, E, Estrada, L, Valls, E, García-Castiñeira, C, Bocos-Baelo, A, Quiñones, C
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 23-03-2023; BMJ Publishing Group LTD
• Subjects: Antibiotics; Catheters; Conflicts of interest; Coronaviruses; COVID-19; Infections; Length of stay; Section 4: Clinical pharmacy services; Severe acute respiratory syndrome coronavirus 2; Ventilation
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2023-eahp.134

Background and ImportanceHospitalised patients with COVID-19 are often exposed to immunosuppressive and anti-inflammatory drugs in addition to systemic antibiotic treatments. Nosocomial bloodstream infections (nBSI) have been associated with the need for mechanical ventilation or venous catheter insertion. However, there is current controversy regarding the influence of immunosuppressive, anti-inflammatory and antimicrobial drugs on nBSI occurrence.Aim and ObjectivesAssess the association between glucocorticoids, tocilizumab, systemic antibiotics and nonpharmacologic health interventions and the occurrence of nBSI in hospitalised patients with COVID-19.Material and MethodsCase–control study including cases of nBSI episodes in adult inpatients with SARS-CoV-2 pneumonia over a one-year period and controls without nBSI. Sociodemographic and clinical data were collected during hospitalisation. Bivariable analysis was performed. Numerical variables were compared using the Student’s t-test or the Mann-Whitney test and categorical variables using the χ2 or Fisher’s exact test. Variables with a p-value<0.1 in bivariable analysis were included in a multivariable logistic regression model to assess the factors independently associated with nBSI occurrence (p-value<0.05).Results50 cases with COVID-19 and 50 controls were included. Mean age was 63.0 ± 12.4(66% men, 2.3 ± 2.1 mean Charlson index and comparable between groups). nBSI episodes showed significantly higher length of hospital stay(LOS) (OR 1.173, 95% CI: 1.144-1.257, p<0.001), surgeries (OR 10.80, 95% CI: 1.310-88.5, p=0.008), need for mechanical ventilation(OR 8.10, 95% CI: 3.31-19.8, p<0.001) antibiotic and glucocorticoids therapy days (OR 1.166, 95% CI: 1.112-1.122, p=0.017 and OR 3.20, 95% CI: 1.325-7.287, p=0.010, respectively), and tocilizumab use (OR 9.33, 95% CI: 1.115-77.125, p=0.017). Non-significant higher number of chronic renal failure cases were present among nBSI episodes (p=0.1). Multivariate regression analyses showed mechanical ventilation (aOR 4.892, 95% CI: 1.206-19.845, p=0.026) and LOS (aOR 1.231, 95% CI: 1.104-1.371, p<0.001) as independent risk factors for nBSI when corrected for the presence of surgeries, central venous catheter, tocilizumab, chronic renal failure and the days of antibiotic and glucocorticoid treatment.Conclusion and RelevanceThis study found nBSI independently associated with mechanical ventilation and LOS and did not find an association between nBSI and the pharmacological interventions assessed. However, given the bivariate association between these pharmacological interventions and nBSI, and previous inconclusive literature on the effects of these treatments on bacterial and fungal infections occurrence, further investigation with a larger sample is required.1 ReferenceCodina-Jiménez C., et al. Risk factors for nosocomial bloodstream infections in COVID-19 affected patients: protocol for a case-control study. Eur J Hosp Pharm.2022Conflict of InterestNo conflict of interest