Epidemiology, Clinical Characteristics, Risk Factors and In-Hospital Mortality Of Bloodstream Infections During the COVID-19 Pandemic In Shenzhen: A Population-Based Cohort Analysis

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic is still ongoing. Limited data exist on the epidemiology of bloodstream infections (BSIs) in developing countries based on large populations during the COVID-19 pandemic. We aimed to describe the epidemiological and microbiological characteristics, in-hospital mortality and potential risk factors for patients with BSI.

Methods: We carried out a multicenter retrospective cohort study at 58 Chinese hospitals between 2020 and 2022 based on a hospital-based surveillance system. Baseline characteristics, including patient- and hospital-level characteristics and outcomes, were compared between groups. Multivariate logistic regression models were used to estimate the risk factors for BSI, polymicrobial infection and in-hospital mortality.

Findings: A total of 326662 patients were included, of whom 6758 had BSIs and 319904 did not have BSIs, and the in-hospital mortality rate was significantly higher in the BSI group (5.25%) than in the non-BSI group (0.67%). The incidence of BSI was seasonal and showed a small peak from July to September. Risk factors for BSI were admission to the hospital that are primary-grade, traditional Chinese medicine (TCM), private, and was located in an urban area and had 1500 or more beds, female, older age, a longer hospital stay, ICU admission, and surgery or invasive procedures. Patients who were admitted to the hospital in urban areas, male, older, have longer hospital stays, admitted to the ICU, have invasive procedures, with hospital acquired BSI were at higher risks for poly-microbial infection. Admission to a TCM hospital, male, older age, ICU admission, invasive procedures, hospital acquired BSI, and polymicrobial infection were significant risk factors for in-hospital mortality among patients with BSI, and patients who had surgery had a reduced mortality risk compared to their counterparts.

Interpretation: Patient- and hospital-level factors contributed to the risk of BSI, polymicrobial infection and in-hospital mortality, which indicated that targeted infection control programs should be emphasized during the COVID-19 pandemic in the future.

Funding: This work was supported by grants from the Sanming Project of Medicine in Shenzhen (SZSM20162011), and Shenzhen Second People’s Hospital Clinical Research Fund of Guangdong Province High-level Hospital Construction Projects (20203357014, 2023xgyj3357001, 2023yjlcyj022).

Declaration of Interest: All the authors declare no competing interests.

Ethical Approval: This study was approved by the Declaration of Helsinki and approved by the Shenzhen Second People’s Hospital and First Affiliated Hospital of Shenzhen University Health Science Center (20220519001-MC01). The requirement for informed consent was waived for this analysis of data from the Surveillance System of Hospital Infection in Shenzhen. Findings were reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) recommendations for reporting observational studies.

Keywords: Bloodstream infection, epidemiology, clinical characteristics, risk factors, outcomes