b'Mortality Up in VHA Inpatients With COVID-19 Plus Hospital-Acquired InfectionsSeveral factors could account for the increased mortality among patients coinfected with bloodstream infections (BSI) and SARS-CoV-2 during the pandemic.For example, excessive focus on the diagnosis of COVID-19 infection might delay recognition and workup of coexisting or secondary processes. Also, isolation procedures and the need for personal protective equipment could have created logistical barriers, the authors suggested.By Mary Anne DunkinCLEVELANDPseudomonas aeruginosa (PA), anstudy period. They used multivariable logistic regres-opportunisticpathogencommonlyassociatedwithsion and modified Poisson analyses to determine the healthcare-associated infections, has a high mortalityassociation between COVID-19 and mortality among rate. The organisms high virulence and ability to rap- patients with PA-BSI. idly acquire resistance to antibiotics make PA infec- A majority of the 6,714 patients with PA-BSI were tions a treatment challenge.male, 70 years or older, white and non-Hispanic with In 2019, the national Centers for Disease Controlmultiple chronic comorbid medical conditions, includ-andPrevention(CDC)publishedencouragingdataing uncomplicated diabetes mellitus (43.1%), cancer indicating a 30% decrease in multidrug-resistant PAwithout metastases (42.1%), chronic pulmonary dis-between 2012 and 2017, but in 2020 rates had risenease (39.8%) and chronic renal disease (34.2%).again. In 2022, the CDC reported a 32% increase inThroughoutthestudyperiod,PAresistance ratesofmultidrugresistant(MDR)PAfrom2019ratesdecreased.Overall,30-dayall-causemor-to2020,largelyattributedtoantibioticoveruseintalitydecreasedamongcasepatientsduringthe patientswithCOVID-19.Inadditiontoobservedpre-COVID-19period,theresearchersreported higher rates of MDR PA, several studies have identi- inAntimicrobialStewardship&Healthcare fied a recent rise in bloodstream (PA-BSI) incidence,Epidemiology.Conversely,theyobservedan which is especially deadly. increasein30-daymortalityamongallcase-BecausePseudomonasaeruginosabloodstreampatients during the COVID-19 period (not stratified infection(PA-BSI)andCOVID-19areindepen- by COVID-19 coinfection status). dentlyassociatedwithhighmortality,researchersCase-patients identified in either period were simi-at Case Western Reserve University and Clevelandlar in terms of age, comorbidities and severity of ill-Clinic sought to understand the impact of COVID- ness.Case-patientswithCOVID-19coinfectionin 19coinfectionwithPA-BSI.UsingdatafromthetheCOVID-19periodhada30-daymortalityrate VHA Corporate Data Warehouse (CDW)a reposi- of 47.2%, whereas case-patients without COVID-19 tory for patient data recorded in the electronic healthduringtheCOVID-19periodandcase-patientsin record for all patients throughout the VHA system thepre-COVID-19periodhadsimilar,lowermor-they identified hospitalized patients with PA-BSI intalityratesofapproximately25%.Inadditionto pre-COVID-19 (January 2009 to December 2019)COVID-19 coinfection, predictors of higher mortal-and COVID-19 (January 2020 to June 2022) periodsity included a higher Charlson Comorbidity Index, and characterized trends in resistant, treatment overgreater disease severity as measured by the modified the study period.AcutePhysiologyandChronicHealthEvaluation Usingregistrydatatheresearcherscharacterized(mAPACHE) score and no targeted PA-BSI treatment trends in resistance, treatment and mortality over thewithin 48 hours. 23'