Table 4.
Epidemiology and outcomes of HOBSI before and during SARS-CoV-2 periods by SARS-CoV-2 testing status
| Characteristics | July 2019-February 2020 | March 2020-September 4, 2021 | |||
|---|---|---|---|---|---|
| Pre-SARS-CoV-2 | SARS-CoV-2 + | SARS-CoV-2- | SARS-CoV-2 not tested | Total | |
| 2771 | 1244 | 4028 | 1592 | 6864 | |
| Unadjusted BSI rate per 1000 admissions | 1.549 | 7.300c | 2.319c | 1.032c | 1.989c |
| Age: avg ± SD, (IQR; median) |
62.0 ± 16.1 (53–74; 64) |
63.4 ± 13.7a (54–73; 65) |
61.9 ± 16.1 (52–73; 64) |
62.4 ± 15.5 (53–74; 64) |
62.3 ± 15.6 (53–73; 64) |
| Males (%) | 59.2% (1640) | 62.0% (771) | 60.7% (2444) | 59.7% (950) | 60.7% (4165) |
| Prior 30-day admission (%) | 17.5% (484) | 9.8% (122)c | 18.3% (736) | 18.2% (289) | 16.7% (1147) |
| Prior 90-day admission (%) | 26.7% (741) | 14.1% (175)c | 31.2% (1255)c | 29.0% (462) | 27.6% (1892) |
| > 1 Underlying Conditionsd (%) | 91.5% (2535) | 98.7% (1228)c | 94.0% (3788)c | 90.8% (1446) | 94.1% (6462)c |
|
Time to HO Culture Collection: Avg ± SD (IQR; median) |
11.0 ± 13.1 (3–14; 7) |
17.5 ± 15.2c (8–22; 14) |
11.4 ± 15.4 (3–14; 7) |
11.4 ± 13.7 (3–14; 7) |
12.5 ± 15.1 (4–16; 8) |
| LOS (days): avg ± SD (IQR; median) |
25.5 ± 20.1 (12–32; 20) |
34.8 ± 25.2c (18–44; 28) |
26.7 ± 23.9a (12–34; 20) |
25.7 ± 24.5 (11–30; 19) |
28.0 ± 24.5c (13–35; 21) |
| % Ventilatede (%) | 21.5% (595) | 52.9% (658)c | 23.5% (947)a | 25.3% (403)b | 29.3% (2008)c |
| ICU admission (%) | 55.4% (1534) | 72.9% (907)c | 53.8% (2169) | 51.6% (821)a | 56.8% (3897) |
|
Overall LOS (days): avg ± SD (IQR; median) |
28.9 ± 22.0 (14–36; 23) |
37.1 ± 26.0c (20–46; 30) |
30.9 ± 26.1a (15–38; 24) |
30.4 ± 27.2 (14–36; 23) |
32.3 ± 26.4c (16–40; 25) |
|
ICU LOS (days): avg ± SD (IQR; median) |
12.3 ± 13.6 (3–16; 8) |
23.5 ± 18.3c (10.5–32; 20) |
13.6 ± 16.3 (3–18; 9) |
14.8 ± 15.9a (4–20; 10) |
16.1 ± 17.2c (4–22; 11) |
| Hospital mortality (%) | NA |
48.6% (377/775)c |
19.7% (486/2469) | NA | 26.7% (869/3252) |
aP < .05; bP < .01; cP < .001 bivariate correlations compared to the pre-SARS-CoV-2 period
dIncludes the following baseline conditions occurring within the first 3 days of hospital admissions as determined by the maximum value of surrogate laboratory results: renal insufficiency (serum creatinine [SCr] > 2.0 mg/dL [to convert to micromoles per liter, multiply by 88.4]); kidney failure (blood urea nitrogen > 100 and SCr > 3.0 mg/dL); suspected sepsis (lactic acid > 2.0 or > 4.0 mmol/L); suspected heart failure (brain-type natriuretic peptide [BNP] > 400 pg/mL [to convert to nanograms per liter, multiply by 1.0] or N-terminal pro BNP > 900 pg/mL); myocardial inflammation (doubling of troponin drawn within 6 h final value: troponin 0.4 ng/L [to convert to micrograms per liter, multiply by 1.0], troponin T15 ng/L [to convert to micrograms per liter, multiply by 1.0] in male patients, troponin T10 ng/L in female patients, troponin I > 0.04 ng/mL [to convert to micrograms per liter, multiply by 1.0]); liver dysfunction (any of the following: alanine aminotransferase > 60 U/L [to convert to microkatals per liter, multiply by 0.0167], aspartate aminotransferase > 80 U/L [to convert to microkatals per liter, multiply by 0.0167], serum albumin < 3.0 g/dL [to convert to grams per liter, multiply by 10], international normalized ratio > 2.0 [and not currently receiving warfarin, rivaroxaban, apixaban, edoxaban, or betrixaban]); cytokine stimulation (any of the following: fibrinogen < 250 mg/dL [to convert to grams per liter, multiply by 0.01], C-reactive protein > 7.0 mg/dL [to convert to milligrams per liter, multiply by 10], D-dimer [dimerized plasmin fragment D] > 1000 ng/mL [to convert to nanomoles per liter, multiply by 5.476], erythrocyte sedimentation rate > 30 mm/h, or triglycerides > 265 mg/dL [to convert to millimoles per liter, multiply by 0.0113])
eThe patient was (a) started on intravenous (IV)/IV push (IVP) sedation medications (propofol, lorazepam, midazolam, dexmedetomidine, or ketamine) or IV/IVP opioids (fentanyl, remifentanil, sufentanil, or hydromorphone) with a duration ≥ 24 h and (b) ≥ 2 arterial blood gas results collected ≥ 24 h apart (on the first day of sedation medication and a subsequent result 24 h later)