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Risk Factors and Outcomes Associated with Community-Onset and Hospital-Acquired Co-infection in Patients Hospitalized for COVID-19: A Multi-Hospital Cohort Study.

Petty LA, Flanders SA, Vaughn VM, Ratz D, O'Malley M, Malani AN, Washer L, Kim T, Kocher KE, Kaatz S, Czilok T, McLaughlin E, Prescott HC, Chopra V, Gandhi T. Risk Factors and Outcomes Associated with Community-Onset and Hospital-Acquired Co-infection in Patients Hospitalized for COVID-19: A Multi-Hospital Cohort Study. Infection control and hospital epidemiology. 2021 Jul 26; 1-28.

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BACKGROUND: We sought to determine the incidence of community-onset and hospital-acquired co-infection in patients hospitalized with COVID-19 and evaluate associated predictors and outcomes. METHODS: Multicenter retrospective cohort study of patients hospitalized for COVID-19, 3/2020 to 8/2020, across 38 Michigan hospitals assessed for prevalence, predictors, and outcomes of community-onset or hospital-acquired co-infection. In-hospital and 60-day mortality, readmission, discharge to long-term care facility (LTCF), and mechanical ventilation duration, were assessed for patients with vs. without co-infection. RESULTS: Of 2205 patients with COVID-19, 6.4% (N = 141) had a co-infection (3.0% community-onset, 3.4% hospital-acquired). 64.9% of patients without co-infection received antibiotics. Community-onset co-infection predictors include admission from LTCF (OR 3.98, 95% CI 2.34-6.76, p < 0.001) and admission to intensive care (OR 4.34, 95% CI 2.87-6.55, p < 0.001). Hospital-acquired co-infection predictors include fever (OR 2.46, 95% CI 1.15-5.27, p = 0.02) and advanced respiratory support (OR 40.72, 95% CI 13.49-122.93, p < 0.001). Patients with (vs. without) community-onset co-infection had longer mechanical ventilation (OR 3.31, 95% CI 1.67-6.56, p = 0.001) and higher in-hospital (OR 1.90, 95% CI 1.06-3.40 p = 0.03) and 60-day mortality (OR 1.86, 95% CI 1.05-3.29 p = 0.03). Patients with (vs. without) hospital-acquired co-infection had higher discharge to LTCF (OR 8.48, 95%CI 3.30-21.76 p < 0.001), in-hospital (OR 4.17, 95% CI 2.37-7.33, p = < .001) and 60-day mortality (OR 3.66, 95% CI 2.11-6.33, p = < .001). CONCLUSION: Despite community-onset and hospital-acquired co-infection being uncommon, most patients hospitalized with COVID-19 received antibiotics. Admission from LTCF and to ICU were associated with increased risk of community-onset co-infection. Future work should prospectively validate predictors of COVID-19 co-infection to facilitate antibiotic reduction.

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