P-732. Clinical Outcomes in Adults Hospitalized with Viral Lower Respiratory Tract Disease with a Bacterial and/or Fungal Coinfection: A US Claims Data Base Study
Authors: Johnson Susan J , Maslova Ekaterina , Fageras Malin , Dalal Gopal , Syed Hashmath Ulla T A , Yehya Nadir 
Published: January 2025

Abstract

Background
Bacterial and fungal coinfections in people hospitalized for viral lower respiratory tract disease (LRTD) may worsen clinical outcomes. We describe US adults hospitalized with viral LRTD and diagnosed with bacterial/fungal coinfection in a large US claims database.Table 1:Clinical outcomes in patients with severe viral LRTD diagnosed with a bacterial or fungal coinfection

Methods
We included adults with a first hospitalization for viral LRTD (2015–2023) based on ICD codes using Optum’s de-identified Clinformatics® Data Mart Database. From this cohort, we identified patients with a bacterial or fungal coinfection using ICD codes. We descriptively analysed patient characteristics in the 12 months pre-hospitalization and clinical outcomes for the first 30 days from hospital admission.

Results
We identified 387,449 patients with severe viral LRTD (75% with coronavirus etiology), of which 67,517 (17%) also had a bacterial/fungal coinfection diagnosis. Mean (SD) age was 73 (14) years in these patients and 54% were women (similar to the overall viral LRTD cohort). Mean (SD) Charlson Comorbidity Index (CCI) was 4 (3), which was slightly higher than in the overall cohort (mean CCI [SD]: 3 [3]). Just over half (51%) had an intensive care unit (ICU) admission (overall cohort: 39%), and among these patients 91% received their coinfection diagnosis while in the ICU (Table). Outcomes including invasive mechanical ventilation (IMV)/extracorporeal membrane oxygenation (ECMO) and death were more frequent in patients with coinfections versus the overall cohort. Among patients receiving IMV/ECMO, 73% received their coinfection diagnosis on the day of the procedure (12% were diagnosed before; 15% were diagnosed after receiving IMV/ECMO). Length of stay was shorter among those diagnosed with a coinfection at ICU admission (vs those diagnosed before ICU admission or during/after an ICU stay). IMV/ECMO frequency was highest in those who were diagnosed with coinfection before their ICU admission; mortality was higher among those diagnosed during their ICU stay.

Conclusion
Patients with viral LRTD and bacterial/fungal coinfection had a higher frequency of severe clinical outcomes compared with the overall viral LRTD cohort, that could not be fully explained by a high ICU admission in this cohort. Coinfection may be an important consideration for high-risk patients even prior to ICU admission.

Disclosures
Susan J. Johnson, PhD, AstraZeneca: Employee|AstraZeneca: Stocks/Bonds (Public Company) Ekaterina Maslova, ScD, AstraZeneca: Employee of AstraZeneca|AstraZeneca: Stocks/Bonds (Private Company) Malin Fageras, PhD, AstraZeneca: Full time employee|AstraZeneca: Stocks/Bonds (Private Company) Gopal Dalal, PhD, AstraZeneca: Advisor/Consultant|AstraZeneca: Employee of ZS Associates India Pvt. Ltd. and contracted to AstraZeneca at time of study Hashmath Ulla T. A. Syed, PhD, AstraZeneca: Advisor/Consultant|AstraZeneca: Employee of ZS Associates India Pvt. Ltd. and contracted to AstraZeneca at time of study Nadir Yehya, MD, AstraZeneca: Advisor/Consultant