The association of a positive respiratory or bloodstream culture on outcome in a large, single-center study of predominately rural Georgia patients admitted with COVID-19 in 2020

Abstract

In early 2020, Albany Georgia, located in a predominately rural part of Georgia, had the 4th highest per capita rate of COVID-19 infection in the United States. Many of these patients developed secondary infections or presented with concomitant infections, which were noted anecdotally to be associated with a worse outcome compared to those who did not develop secondary infections. We conducted a retrospective chart review of all patients admitted to Phoebe Putney Memorial Hospital in the calendar year 2020. We were primarily interested in the effect of respiratory and bloodstream culture positivity on the outcome. We recorded data for other variables potentially contributing to a bad outcome, including Charlson Comorbidity Index (CCI), Body Mass Index (BMI), age, sex, and race. Variables initially identified as significantly associated with bad outcomes (defined as either need for mechanical ventilation or death) were then analyzed by multinomial regression. During a 10-month period (March to December), 1,431 patients were admitted. Of these, 155 (10.8%) had a positive blood culture and 142 (9.9%) had a positive respiratory culture at any time during admission. Odds ratios (OR) for death or mechanical ventilation without death were 43.0 and 86.1, respectively, for a positive respiratory culture and 4.5 and 3.3, respectively, for a positive blood culture. Age > 70 and CCI also were associated with an increased risk of death, with OR of 2.0 and 1.3, respectively. In conclusion, in our large, single-center study of patients admitted with COVID-19 in the calendar year 2020, positive respiratory culture or a positive blood culture had the highest OR associated with the bad outcome of all the variables considered. Keywords: COVID-19, risk factors, inpatients.