Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: a descriptive analysis of the Eurobact II study
Authors: Buetti Niccolò , Tabah Alexis , Loiodice Ambre , Ruckly Stéphane , Aslan Abdullah Tarik , Montrucchio Giorgia , Cortegiani Andrea , Saltoglu Nese , Kayaaslan Bircan , Aksoy Firdevs , Murat Akova , Akdoğan Özlem , Saracoglu Kemal Tolga , Erdogan Cem , Leone Marc , Ferrer Ricard , Paiva José-Artur , Hayashi Yoshiro , Ramanan Mahesh , Conway Morris Andrew , Barbier François , Timsit Jean-François ,   the Eurobact 2 study group, Lipman Jeffrey , Litton Edward , Palermo Anna Maria , Yap Timothy , Eroglu Ege , Hosokawa Koji , Yoshida Hideki , Fujitani Shigeki , Zand Farid , Mahmoodpoor Ata , Tabatabaei Seyed Mohammad Nasirodin , Elrabi Omar , Almekhlafi Ghaleb A. , Vidal Gabriela , Aparicio Marta , Alonzo Irene , Namendys-Silva Silvio A. , Hermosillo Mariana , Castillo Roberto Alejandro , De Bus Liesbet , De Waele Jan , Hollevoet Isabelle , De Schryver Nicolas , Serck Nicolas , Kovacevic Pedja , Zlojutro Biljana , Ruppe Etienne , Montravers Philippe , Dulac Thierry , Castanera Jérémy , Massri Alexandre , Guesdon Charlotte , Garcon Pierre , Duprey Matthieu , Philippart François , Tran Marc , Bruel Cédric , Kalfon Pierre , Badre Gaëtan , Demeret Sophie , Le Guennec Loïc , Bassetti Matteo , Giacobbe Daniele , Sales Gabriele , Daroui Ivan , Lodi Giovanni , Ippolito Mariachiara , Bellina Davide , Di Guardo Andrea , Rocco Monica , Fiorelli Silvia , Mikstacki Adam , Peichota Mariusz , Pietraszek-Grzywaczewska Iwona , Póvoa Pedro , Krystopchuk Andriy , Teresa Ana , de Figueiredo António Manuel Pereira , Botelho Isabel , Costa Vasco , Cunha Rui Pedro , Gritsan Alexey , Belskiy Vladislav , Furman Mikhail , Martinez Maria , Casares Vanessa , Arnillas Maria Pilar Gracia , Bermudez Rosana Munoz , Ubeda Alejandro , Salgado Maria , Maseda Emilio , De La Rica Alejandro Suarez , Blasco-Navalpotro Miguel Angel , Gallego Alberto Orejas , Prazak Josef , Pagani J. L. , Abed-Maillard S. , Iskit Arzu Topeli , Mehtap Selcuk , Ceyhun Solakoğlu , Kalem Ayşe Kaya , Kurt Ibrahim , Telli Murat , Ozturk Barcin , Baykam Nurcan , Karaali Ridvan , Koksal Iftihar , Bilir Yeliz , Guzeldag Seda , Ersoz Gulden , Evik Guliz , Bayindir Yasar , Ersoy Yasemin , Ercole Ari , Raj Ashok , Zormpa Artemis , Tinaslanidis George , Khade Reena , Roshdy Ashraf , Kannan Santhana , Antrolikar Supriya , Marsden Nicholas , Attwood Ben , Patel Jamie , Gurjar Mohan , Dsilva Carol , Chandran Jagadish , Sanousi Bashir El , Saidahmed Elfayadh , Hamid Hytham K. S. 
Published: October 2022

Abstract
Background
The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 and non-COVID-19 critically ill patients.

Methods
We used data from the Eurobact II study, a prospective observational multicontinental cohort study on HABSI treated in ICU. For the current analysis, we selected centers that included both COVID-19 and non-COVID-19 critically ill patients. We performed descriptive statistics between COVID-19 and non-COVID-19 in terms of patients’ characteristics, source of infection and microorganism distribution. We studied the association between COVID-19 status and mortality using multivariable fragility Cox models.

Results
A total of 53 centers from 19 countries over the 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%) COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between hospital admission and HABSI was similar between both groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%, p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%) HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio (HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49–2.45).

Conclusions
We showed that the epidemiology of HABSI differed between COVID-19 and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients. COVID-19 patients with HABSI had elevated risk of mortality.
Trial registration ClinicalTrials.org number NCT03937245. Registered 3 May 2019.