COVID-19 Patients Are More Susceptible to Health Care-Associated Infections

During the COVID-19 pandemic, health care-associated infections (HAIs) significantly increased.

Compared to 2019, HAIs in 2020 saw substantial highly incidence of central line–associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated adverse events, and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia; Clostridioides difficile (C diff) infections decreased modestly.

Follow-up inquiries found rates of HAIs have continued to increase throughout the COVID-19 pandemic. However, it is unclear whether this was due to increased strain on hospital resources or a heightened susceptibility of COVID-19 patients.

An original investigation, recently published in JAMA Network Open, sought to determine the incidence of HAIs among hospitalized patients with COVID-19 versus those without COVID-19.

The cross-sectional retrospective study included nearly 5 million patients in 182 community hospitals between 2020-2022. Of them, 313200 were hospitalized with COVID-19. The COVID-19 patients averaged 57 years of age and 56% female.

The HAI incidence per 100000 patient-days was definitively higher in COVID-19 patients than in patients hospitalized for non–COVID-19 reasons.

Data were obtained from January 1, 2019-March 31, 2022, and during this study period, the incidence of CLABSI was almost 4 times higher among the COVID-19 patients. CAUTI incidence was 2.7 times higher in the COVID-19 cohort, and MRSA was 3 times higher in these patients.

The most significant increase in HAI incidence occurred in quarter 3 of 2020, with CLABSI incidence per patient days 11.0 (versus 7.3 in Q3 of 2019). CAUTI incidence was highest in Q4 of 2021 (7.8 vs 6.8 in Q4 of 2019), and MRSA incidence was highest in Q3 of 2021 (5.2 vs 3.9 in Q3 of 2019).

Limiting their analyses to the non–COVID-19 patients, the investigators determined there was no CLABSI increase during the pandemic versus in 2019, and quarterly rates of CAUTI and MRSA were lower during the pandemic than in the 2019 comparator quarters.

This cross-sectional study found that among hospitalized patients without COVID-19, HAIs occurred at similar rates before and after the pandemic, despite additional hospital precautions to control infections. “The findings suggest that patients with COVID-19 may be more susceptible to HAIs and may require additional prevention measures,” the study authors concluded.