Secondary Bloodstream Infections in COVID-19 Patients

Investigators reported detailed microbiology, risk factors, and outcomes of secondary bloodstream infections in patients with severe COVID-19.

Patients with COVID-19 and secondary bloodstream infections (sBSI) had more severe initial presentation, prolonged hospital course and worse clinical outcomes, according to a study published in Clinical Infectious Diseases.

In this multicenter case-control study, investigators aimed to address the lack of detailed microbiology, risk factors, and outcomes of sBSI in COIVD-19 patients. Of the 375 hospitalized patients with COVID-19, 128 cases of sBSI were identified.

Blood culture was usually drawn upon admission and 69 (53.9%) were positive for sBSI. The median time from admission to first positive culture was 6 days (interquartile range [IQR], 1-13). Among the first set of positive cultures, 117 (91.4%) were bacterial and 7 (5.5%) were fungal. Staphylococcus epidermidis, methicillin-sensitive Staphylococcus aureus (MSSA), Enterococcus faecalis, Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA), Candida albicans, and Candida glabrata were the most common pathogens from the first set of positives.

Data results showed that sBSI patients were less likely to have cough (45.3% vs 65.2%; P =.0002) and fever (54.7% vs 66.8%; P =.02) as a presenting symptom compared to patients without sBSI. However, altered mental status was more common (23.4% vs 11.7%; P =.003).

Several treatment outcomes were more common in sBSI patients, including septic shock requiring vasopressors (55.5% vs 14.2%; P <.001), use of antimicrobial therapy (99.2% vs 70.5%; P <.001), and use of systemic glucocorticoids (32% vs 17.8%; P =.002) compared to patients without sBSI. Patients with sBSI had significantly longer median length of stay in hospital (18.5 days vs 7 days; P <.001), were more likely to require intensive care unit admission (71.1% vs 35.6%; P <.001), and have longer median intensive care unit stays (17 days vs 6.5 days; P <.001) compared to patients without sBSI; death in hospital was also more likely for this patient population (53.1% vs 32.8%; P =.0001).

Limitations of the study included lack of data collected on other types of secondary infections or causes of mortality, and lack of standardized care across facilities. There could also be misclassification between contaminant vs pathogens since sources of sBSI were determined using correlation to other positive body site cultures with the same organism.

“Hospitalized adult patients with severe COVID-19 with sBSI had a more severe initial presentation, prolonged hospital care, and worse clinical outcomes,” investigators concluded.


Bhatt PJ, Shiau S, Brunetti L, et al. Risk factors and outcomes of hospitalized patients with severe COVID-19 and secondary bloodstream infections: A multicenter, case-control study. Clin Infect Dis. Published online November 20, 2020. doi:10.1093/cid/ciaa1748.