Describing the impact of COVID-19 hospitalization in invasive Staphylococcus aureus epidemiology including racial/ethnic disparities in iSA incidence, six Emerging Infections Program sites, 2020 Open Access
Resler, Sydney (Spring 2023)
Abstract
Background: Invasive Staphylococcus aureus (iSA) infections are frequently associated with healthcare exposures, including recent hospitalization. At various times during the COVID-19 pandemic, a large percent of overall U.S. hospitalizations has been due to COVID-19; therefore, the pandemic may have altered iSA epidemiology. Previous studies described increases in hospital-onset iSA infections during the COVID-19 pandemic, but potential healthcare-related risk factors during COVID-19-associated hospitalization (for example: ICU admission, mechanical ventilation) leading to iSA infection have not been explored. There are also well-documented racial and ethnic disparities in both infections separately, but disparities in persons with COVID-19-associated hospitalizations that later develop iSA are not yet explored. Methods: Emerging Infections Program surveillance data was used (iSA and COVID-NET) in an overlapping catchment area for March 1, 2020, through December 31, 2020. Odds ratios were calculated for demographics, healthcare, and clinical risk factors to inform a multivariate logistic regression comparing iSA cases with and without a prior COVID-19-associated hospitalization. Additionally, odds ratios were calculated for demographics, healthcare, and clinical risk factors comparing persons with COVID-19-associated hospitalizations with and without subsequent iSA infection. Rates and rate ratios of iSA by racial/ethnic group were calculated for 2019 and 2020, as well as health disparity measures, to see how the pandemic impacted racial/ethnic disparities in iSA infection. Results: iSA cases with a prior COVID-19-associated hospitalization were more likely to be older, have underlying conditions, die, and be discharged to a LTCF than iSA cases without a prior COVID-19- associated hospitalization. Multivariate regression showed that Black race, Hispanic ethnicity, being ≥65 years old, recent long-term care facility (LTCF) stay, recent long-term acute care hospitalization, and a central venous catheter were associated with iSA cases that had a prior COVID-19-associated hospitalization. Persons with COVID-19-associated hospitalizations that developed iSA were more likely to have underlying conditions, critical care such as ICU admission, die, and be discharged to a LTCF than persons with COVID-19-associated hospitalizations that did not develop iSA. Racial/ethnic disparities in iSA rates appeared to widen during the pandemic. Conclusions: Racial/ethnic differences exist between iSA cases with and without a prior COVID-19- associated hospitalization. Further research is necessary to explore these findings.
Table of Contents
Introduction...............................1
Background................................2
Methods.....................................4
Results.......................................7
Discussion.................................12
References.................................17
Appendix: Figures and Tables.....21
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