Patients who tested positive for SARS-CoV-2 infection placed a greater burden on health care systems than patients who tested negative for COVID-19. These findings, from a multicenter, retrospective analysis, were published in BMC Infectious Diseases.

Researchers analyzed data from 241 medical facilities in the United States included in the Becton, Dickinson Insights Research Database. The data included information about 590,960 patients who were admitted as inpatients and spent more than 1 day at a hospital between March 1 and May 31 2020. Hospital utilization was assessed on the basis of SARS-CoV-2 status.

A total of 449,339 patients (76.1%) were not tested for SARS-CoV-2, and 17,003 patients (12.0%) tested positive for COVID-19. Male patients constituted a greater proportion of those who tested positive for SARS-CoV-2 (53.1%) vs patients who tested negative (46.5%) or patients who were untested (44.5%,). The mean age of patients who were SARS-CoV-2-postive was 61.7 years (SD, 18), while the mean ages of patients who tested negative or were untested were 58.5 years (SD, 20.9) and 48.7 years (SD, 27.3), respectively.

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Study authors identified non-SARS-CoV-2 pathogens more commonly among COVID-19-negative patients (37.2%) than among positive (34.3%) or untested (34.1%), patients. However, the total number of non-SARS-CoV-2 pathogens was higher among COVID-19- positive patients, indicating a high rate of multiple concurrent infections. Hospital-acquired infections were more common among patients with COVID-19 (42.4%) than negative (22.2%) or untested (19.5%) patients.

Most patients who were SARS-CoV-2-positive (68.0%) used antimicrobial agents compared with less than half of COVID-19-negative (45.2%) or untested (25.1%) inpatients. Among those treated with antibiotics, the average duration of treatment was 6.1 days (SD, 5.2) among patients with SARS-CoV-2, 4.8 days (SD, 4.5) among patients who tested negative for the virus, and 4.1 days (SD, 3.9) among untested patients.

Patients with SARS-CoV-2 stayed in the intensive care unit for an average of 7.8 days (SD, 8.5), which was longer than patients without COVID-19 who stayed for 3.8 days (SD, 6.2), or untested patients who stayed for 3.6 days (SD, 5.9). Hospital stays increased to 17.5 days (SD, 16.1) among patients who had multiple non-SARS-CoV-2 pathogens and concurrent COVID-19.

This study may have been limited by institutional variation in testing modalities and practices.

These data indicated SARS-CoV-2-positive patients were more likely to be infected with pathogens during hospitalization and to carry multiple infections. COVID-19 infections increased antimicrobial treatment duration and hospital stay. Altogether, these findings indicated SARS-CoV-2 placed a considerable burden on the operation of the healthcare system.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.


Puzniak L, Finelli L, Yu K C, et al. A multicenter analysis of the clinical microbiology and antimicrobial usage in hospitalized patients in the US with or without COVID-19. BMC Infect Dis. 2021;21(1):227. doi:10.1186/s12879-021-05877-3