Increased risk of Enterococcal Bacteremia in critically ill patients with COVID-19 during pandemic surges.

Abstract

Objective: Identify incidence of enterococcal bacteremia and associated risk factors in ICU patients with SARS-CoV-2 infection.

Design: Retrospective cohort study.

Setting: Veterans Affairs Medical Center, Oklahoma City, Oklahoma.

Patients: Adult ICU patients with SARS-CoV-2 and positive blood cultures for Enterococcus species between March 1, 2020 and February 28, 2022.

Methods: Durations of hospitalization, ICU stay, ventilation, site and duration of central line, receipt of steroids, tocilizumab, and antimicrobials were gathered by chart review. Patient location during a surge of bacteremia was noted and strains were identified by multilocus sequencing typing (MLST).

Results: There were 70 episodes of enterococcal bacteremia in ICU patients with COVID-19 during a 2-year period. Patients had a median age of 72 years and 97% were male. Onset of bacteremia was 12 and 14 days after mechanical ventilation and central line placement, respectively. The median number of days to bacteremia diagnosis was 13 from admission to the ICU and 90-day mortality was 66.7% among patients admitted October to December of 2020. A large proportion of ICU patients developed enterococcal bacteremia during a COVID-19 surge (P < .00001) and an increased incidence of enterococcal bacteremia was seen September 2020-February 2021 (P < .0001) in hospitalized patients. A total of 5 unique Enterococcal strains among 13 bacteremia episodes were identified in patients with ICU beds in close proximity.

Conclusions: A high incidence of enterococcal bacteremia was observed in critically ill patients with SARS-CoV-2, especially during surges. Contributing factors may include environmental contamination, patient colonization, nonadherence to infection control practices, resource limitations, ICU design and use of mechanical ventilation, central lines and immunosuppressants. MLST can be used to identify clusters to address these contributing factors.