b'u FromPage 23Whilethemortalityrateamongcase-patients Rich DatabaseincreasedduringtheCOVID-19periodcomparedThe new study, the first to examine the impact of the to the pre-COVID-19 period, the COVID-19 periodCOVID-19 pandemic on outcomes for patients with itself did not appear to be associated with increasedPA-BSI,waspossiblebecauseoftheVHACDW, mortalityindependentofCOVID-19coinfection,which serves as a rich database for this study, cap-the authors wrote. This remained true even whenturing data from over 150 medical centers through-isolatingthelate-pre-COVID-19periodcorre- out the continental United States and Puerto Rico and sponding to the 3 years immediately preceding thespanning a period of almost 20 years, they wrote. COVID-19periodwiththelowestobservedmor- Moreover, the VHA data regarding resistance trends tality rate of the entire study period. These resultsgenerally align with CDC data in that rates of MDR suggest that COVID-19 coinfection may account forPA infection were observed to decrease in the last the increased PA-BSI mortality observed during thedecade until 2020 when an increase was observed.COVID-19 period. The authors said their findings laid the groundwork The authors said several factors could account forfor many potential future studies. The relationship theincreasedmortalityamongpatientscoinfectedbetween COVID-19 and PA should be explored in withBSIandCOVID-19.Forexample,excessivemore detail to determine whether characteristics of focus on the diagnosis of COVID-19 infection mighteither pathogen enhance the infectivity of the other delay recognition and workup of coexisting or second- orworksynergisticallyagainstthehostimmune ary processes, thereby delaying initiation of appropri- response,andinclusionofobservationsofpatients ate treatment. Logistical barriers could affect man- with COVID-19 with and without PA-BSI could be agement and subsequent outcomes in patients withhelpful to this end, they wrote. More features related COVID-19relatedtoisolationproceduresandtheto the COVID-19 period would also be worthwhile to need for personal protective equipment.Additionally,investigate, such as impact of staffing, hospital vol-circumstancesattheinstitutionallevelrelatedtoume, and resources on PA-BSI-associated outcomes.the pandemic period, such as nursing- or provider- 1 to-patient ratio, hospital volume and availability ofHojat LS, Wilson BM, Perez F, Mojica MF, Singer ME, Bonomo RA, Epstein LH. Association of COVID-19 coinfection with increased infectious diseases expertise could impact outcomesmortality among patients with Pseudomonas aeruginosa bloodstream on an individual level. Finally, the interaction of theinfection in the Veterans Health Administration system. Antimicrob two infectious processes could lead to a synergisticSteward Healthc Epidemiol. 2023 Dec 15;3(1):e237. doi: 10.1017/or additive effect on infectivity and the host response.ash.2023.455. PMID: 38156202; PMCID: PMC10753479.Figure 3. Figure indicates the proportion of PA-BSI cases in the VHA system meeting the primary end point of mortality at 30 days during each year of the study period. Mortality decreased across the pre-COVID-19 period to a low of 20.6% and increased during the COVID-19 period, peaking at 30.8% in 2022 through June 30. PA-BSI, Pseudomonas aeruginosa bloodstream infection; VHA, Veterans Health Administration.Source: Association of COVID-19 coinfection with increased mortality among patients with Pseudomonas aeruginosa bloodstream infection in the Veterans Health Administration system. Antimicrob Steward Healthc Epidemiol. 2023 Dec 15;3(1):e237. doi: 10.1017/ash.2023.455. PMID: 38156202; PMCID: PMC10753479.24'