PGY2 Infectious Diseases Pharmacy Residency

Multicenter evaluation of superinfection occurrence and impact on clinical outcomes in patients with COVID-19

Taryn A. Eubank, PharmD; William L. Musick, PharmD, BCIDP; Katherine K. Perez, PharmD, BCIDP; Charles E. Janak, PharmD, BCPS; Keving W. Garey, PharmD, MS

PURPOSE The coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread globally in late 2019. We sought to evaluate the overall bacterial and fungal superinfection rate within our COVID-19 population, effect on 28-day mortality, and patient characteristics that correlate with a higher risk of a superinfection.

METHODS

Hospitalized, adult patients with laboratory confirmed and symptomatic COVID-19 disease admitted between March 12, 2020 and May 31, 2020 within the Houston Methodist Hospital System including a large, 900-bed, quaternarycare hospital and five community hospitals in the greater Houston, Texas, metro area were eligible for inclusion in this study. Follow-up continued through June 28, 2020. Outcomes of this analysis include overall bacterial and fungal superinfection occurrence rate within 28 days of admission, patient characteristics that correlate with a higher risk of a superinfection, and the effect on 28-day mortality.

RESULTS

A total of 404 patients were included in the study analyses of which 56 (13.9%) had a clinically significant superinfection within 28-days from admission. Mortality at 28 days was significantly higher in patients with superinfections (12.1% vs 5.8%, p ≤ 0.001). Risk of superinfection was significantly higher among patients of Black ethnicity, those with chronic kidney disease, ICU status at admission, receipt of tocilizumab, and/or lymphocytopenia.

CONCLUSION

In conclusion, our retrospective cohort study reports a superinfection rate of 13.9%. Presence of a superinfection significantly increases the likelihood of mortality within 28days from admission. These results can aid in de-escalation of empirical antimicrobial therapies in patients that are low risk of a superinfection as the overall occurrence of superinfection is relatively low.

PGY2 INFECTIOUS DISEASES PHARMACY RESIDENCY

Taryn A. Eubank, PharmD

Taryn earned her BS in Biochemistry and Molecular Biology in 2015 and PharmD in 2019 from Harding University in Searcy, AR. She completed her PGY1 at Houston Methodist Hospital. Following completion of PGY2, Taryn will complete an Infectious Diseases Research Fellowship and Training Program in Antimicrobial Resistance through the Gulf Coast Consortium for Antimicrobial Resistance in Houston, Texas. Primary project preceptor: William L. Musick, PharmD, BCIDP

Presented at 2020 Virtual Vizient Pharmacy Network, 4th Annual Texas Medical Center Antimicrobial Resistance and Stewardship Conference, and Midwest Pharmacy Residency Conference