Too HAI: Increased HAI diagnoses among hospitalized patients with COVID-19

Reviewed by Cindy Noyes, MD, University of Vermont Medical Center

A retrospective, cross sectional analysis demonstrated higher rates of health care associated infections (HAI) in hospitalized patients with COVID compared to those admitted with other conditions. Incidence of central line associated blood stream infection (CLABSI), catheter associated urinary tract infection (CAUTI), methicillin resistant staphylococcus bacteremia and Clostridioides difficile colitis (CDC) was determined in more than 5 million hospitalizations among 182 hospitals in 21 states from Jan 1, 2019 through March 31, 2022.  Mean case mix index (CMI) and length of stay (LOS) for patients with COVID was higher than those without (CMI 2.29 vs 1.63; LOS 8.2 vs 4.7 days).  HAIs among hospitalized patients with COVID were consistently higher than those without COVID, with CLABSI incidence the greatest at 3.7-fold higher. CAUTI and MRSA bacteremia were also increased, 2.7 and 3-fold higher, respectively, in the patients with COVID-19 versus those without.  The only HAI for which there was no difference was CDC.  The rates for the above HAIs in patients without COVID approximated the pre-COVID baseline, further suggesting that excess HAIs occurred in patients admitted with COVID and not in those hospitalized for other reasons.  Possible explanations suggested included: increase in LOS in patients with COVID, altered workflows in care of patients with COVID, COVID infection or treatment raising the risk of HAI. 

Sands K, et al.  Health care-associated infections among hospitalized patients with COVID-19, March 202-March 2022.  JAMA Network Open.  2023; 6(4): e238059.

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