Brief report
Bacteremia during COVID-19 pandemic in a tertiary hospital in Spain
Bacteriemia durante la pandemia de COVID-19 en un hospital terciario de España
Saray Mormeneo Bayo
, María Pilar Palacián Ruíz, Miguel Moreno Hijazo, María Cruz Villuendas Usón
Corresponding author
Servicio de Microbiología, Hospital Universitario Miguel Servet Zaragoza, Spain
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Corresponding data from the same period in 2018 and 2019 were collected to establish a seasonal historic baseline of blood culture ordering.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Laboratory methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Blood cultures were incubated on BD BACTEC™ FX during 5 days. When a positive blood culture was detected, a Gram stain and identification by mass spectrometry (MALDI-TOF MS) (MaldiBiotyper® Bruker Daltonics) of the subculture was performed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Samples used for the determination of COVID-19 consisted mainly in nasopharyngeal swabs. For RNA targeting, VIASURE (CerTest, BIOTEC, Spain), Allplex™ (Seegen, Korea) and COBAS 6800tm (Roche, Switzerland) were used mainly.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Blood withdrawals were grouped into three groups, depending on the year of extraction (2018, 2019, or 2020). The origin of withdrawals was also taken into account, grouping them into four categories (medical wards, surgical wards, ICUs and emergency departments). Further analysis was done in the specific case of the Emergency Department, where the number of patients admitted during the years 2018, 2019, and 2020 was accounted.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Blood culture contamination was defined as the presence of one or more of the following organisms found in only one blood culture set and only one of a series of two or three blood culture sets: coagulase-negative staphylococci, <span class="elsevierStyleItalic">Micrococcus</span> spp., <span class="elsevierStyleItalic">viridans</span> group streptococci, <span class="elsevierStyleItalic">Propionibacterium acnes</span>, <span class="elsevierStyleItalic">Corynebacterium</span> spp. and <span class="elsevierStyleItalic">Bacillus</span> spp.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally, a review of clinical data in COVID-positive and COVID-negative patients with bacteremia was done.</p><p id="par0050" class="elsevierStylePara elsevierViewall">All data analysis was performed with IBM SPSS 19. Differences in continuous data between groups were assessed by one-way analysis of variance (ANOVA), whereas categorical data were analyzed by Pearson's <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span> analysis.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Number of blood cultures sets</span><p id="par0055" class="elsevierStylePara elsevierViewall">The number of blood cultures processed during the study period was 5313 in 2020, 6876 in 2019 and 6541 in 2018, representing 22.7% and 18.8% of decrease, respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.173). <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the number of blood cultures processed by month from 4th March to 21st June during 2018, 2019 and 2020.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">With regard to requesting services, the adult Emergency Department showed a decrease in the number of blood cultures sets of 35.5% and 12.3% compared to 2019 and 2018, respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.044). In surgical wards the decrease was 35% and 36.4% (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.054), and in medical wards the decrease was 20% and 28.3% (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.091). On the other hand, the increase in the intensive care units were 10.5% and 3.2% compared to 2019 and 2018 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.738) and in Children's Emergency Department the increase was 32.4% and 35.8% (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.021).</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the specific case of adult Emergency Department, the number of patients who went to this department was 24980 in 2020, 43580 in 2019 and 41656 in 2018, representing a decrease of 42.7% and 40%, respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">COVID positivity rate</span><p id="par0070" class="elsevierStylePara elsevierViewall">During the study period, 2923 patients tested positive (9.1%) for COVID and 29314 patients tested negative (90.9%). The highest peak of positivity was reached the week from March 23rd to March 29th (39.5% of positivity).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Blood culture positivity rate and etiologies of bacteremia during COVID period</span><p id="par0075" class="elsevierStylePara elsevierViewall">During the period of study, there were 282 cases of bacteremia belonging to 258 patients, accounting for a positivity rate of 10.7%. Among COVID-positive patients, 44 had bacteremia (positivity rate 12.5%), and among non-COVID patients 170 had bacteremia (positivity rate 10.2%) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001); 68 bacteremia cases occurred in untested SARS-CoV-2 RT-PCR (positivity rate 13.3%).</p><p id="par0080" class="elsevierStylePara elsevierViewall">Among patients with positive blood cultures, COVID patients had a significantly higher proportion of nosocomial bacteremia (95.5%) than non-COVID-19 patients (30.5%) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) being catheter-related bacteremia the main origin. Furthermore, while in most of bacteremia cases in COVID patients the requesting service was the ICU (70.5%), in the non-COVID patients it was the Emergency Department (45.3%). In fact, community-acquired bacteremia was the main origin in non-COVID patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). In relation to one month mortality rate, no significant difference was found (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.101).</p><p id="par0085" class="elsevierStylePara elsevierViewall">The most common etiology of bacteremia, source, outcome and requesting service are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Blood culture contamination rate and contaminant organisms during COVID period</span><p id="par0090" class="elsevierStylePara elsevierViewall">There were 322 isolates considered contaminants belonging to 261 patients. The contamination rate was 12.3% in COVID-positive, 5.7% in COVID-negative patients, and 4.5% in untested patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p><p id="par0095" class="elsevierStylePara elsevierViewall">The most common causes of contamination were coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span> species, among both COVID-19 patients (86.7%) and non COVID-19 patients (65.7%).</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">During the study period, an important decrease in the number of blood cultures was observed in our laboratory. This phenomenon could be explained by the decrease in the number of patients who went to the Emergency Department, as well as the decrease in scheduled surgeries caused by the pandemic. The single exception was ICUs and Children's Emergency Department, which showed a marked increase when compared to previous years.</p><p id="par0105" class="elsevierStylePara elsevierViewall">One of the measures that was carried out during the pandemic was to replace the face-to-face consultations by telephone consultations in primary care centres. It is possible that in patients with fever, medical care was focused on whether the patient had COVID, recommending isolation at the slightest suspicion and possibly forgetting other causes of fever, such as bacteremia. Besides, fear of contracting COVID-19 could also lead patients to stay longer at home. This would explain the decrease in the number of patients that went to the Emergency Department, the largest source of blood culture sets, and consequently the lesser number of blood withdrawals.</p><p id="par0110" class="elsevierStylePara elsevierViewall">When comparing our results to previous literature, we found very few data. A research was performed in New York City<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a>; however, a very different situation was described, with a dramatic increase in the use of blood cultures, which overwhelmed the capacity of their automated blood culture instruments, which was translated into the incubation period, having to be reduced from 5 days to 4 days. In our case, due to the decrease in the number of blood cultures received, it was not necessary to decrease the incubation time.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding the etiology of bacteremia, a different trend was observed between COVID-positive and non-COVID patients. COVID-positive patients had bacteremia caused mainly by healthcare-associated organsims, such as coagulase-negative <span class="elsevierStyleItalic">Staphylococcus</span> species and <span class="elsevierStyleItalic">Candida</span> spp; by contrast, non-COVID patients had bacteremia caused more frequently by community-acquired pathogens. Again, this is different from the aforementioned New York City study<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> and the UK study,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> where, among COVID-positive patients with true bacteremia, the distribution of clinically important organisms was similar to patients without COVID. The exception to this was <span class="elsevierStyleItalic">Candida</span> spp, which was notably isolated in both groups of patients. Although the results suggest a higher rate of candidemia than during previous years, this affirmation would require further study, as the short time of study accounts for a small sample relative to the low annual incidence.</p><p id="par0120" class="elsevierStylePara elsevierViewall">It can also be concluded, along with the New York research,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> that the bacterial infection rate - bacteremia in our case- is low, but the pandemic may have led, as an undesired consequence, to a limited care in some patients in a process as relevant as sepsis.</p><p id="par0125" class="elsevierStylePara elsevierViewall">A high proportion of blood culture contamination was identified, especially in COVID-positive patients. It could be explained by unfamiliarity of additional personal protective equipment worn by healthcare workers taking blood cultures.</p><p id="par0130" class="elsevierStylePara elsevierViewall">It is worth mentioning, however, that the high number of blood cultures in the New York study<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> (over 88,000 patient cultures) was also one of its major strengths. In comparison, our study is much smaller with only 5313 cultures, which allows for a worse generalizability. The multicentre analysis from a wide geographic catchment area was also mentioned as another strength, in contrast to ours, which consisted of a single hospital.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Sepsis is a time-dependent disease, and prognosis may improve if early diagnosis and appropriate treatment are achieved.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> All of this makes us rethink whether during the epidemic the anamnesis of the patients was correct, not focusing entirely on COVID-19 but instead paying attention to other diseases such as bacteremia.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical approval</span><p id="par0140" class="elsevierStylePara elsevierViewall">Institutional ethical review board approval was not required.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Informed consent</span><p id="par0145" class="elsevierStylePara elsevierViewall">This analysis does not contain patient data; therefore, informed consent was not required.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1695791" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1502038" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1695790" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1502037" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Laboratory methods" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Number of blood cultures sets" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "COVID positivity rate" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Blood culture positivity rate and etiologies of bacteremia during COVID period" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Blood culture contamination rate and contaminant organisms during COVID period" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Ethical approval" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Informed consent" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-10-23" "fechaAceptado" => "2021-01-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1502038" "palabras" => array:3 [ 0 => "COVID-19" 1 => "Bacteremia" 2 => "Blood culture" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1502037" "palabras" => array:3 [ 0 => "COVID-19" 1 => "Bacteriemia" 2 => "Hemocultivo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The reasons for the decrease in blood cultures were investigated and the rate and aetiology of bacteremia and contaminated blood cultures collected from COVID and non-COVID patients were assessed.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective analysis in a tertiary hospital in Spain during the COVID period from 4th March 2020 to 21st June 2020.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The number of blood cultures processed was 5313, representing 22.7% and 18.8% of decrease compared to the same months of 2019 and 2018, respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.173). The rate of bacteremia was 1.2% higher among COVID-patients than among non-COVID patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). COVID patients had a higher proportion of nosocomial bacteremia (95.5%) than non-COVID patients (30.5%) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). In COVID-positive patients, the contamination rate was 12.3% <span class="elsevierStyleItalic">vs</span> 5.7% in non-COVID patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There was a decrease in the number of blood cultures collected during the COVID period compared to previous years. Bacteremia in COVID patients was mainly nosocomial and catheter-related.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Investigar la causa de la disminución de los hemocultivos recibidos y evaluar la tasa y la etiología de la bacteriemia y la contaminación de los hemocultivos extraídos en pacientes con COVID-19 y sin COVID-19.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo en un hospital de tercer nivel en España durante el periodo de COVID-19 del 4 de marzo al 21 de junio de 2020.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se procesaron 5.313 hemocultivos, representando una disminución del 22,7 y 18,8% respecto de los mismos meses de 2019 y 2018 (p = 0,173). La tasa de bacteriemia fue 1,2% superior en pacientes con COVID-19 (p < 0,001). Los pacientes positivos en COVID-19 tenían una mayor proporción de bacteriemia nosocomial (95,5%) que los pacientes sin COVID-19 (30,5%) (p < 0,001). En pacientes positivos en COVID-19, la tasa de contaminación fue del 12,3 <span class="elsevierStyleItalic">vs</span>. 5,7% en pacientes sin COVID-19 (p < 0,001).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Durante el periodo de COVID-19 disminuyó el número de hemocultivos recibidos, en comparación con años anteriores. La bacteriemia en pacientes con COVID-19 fue principalmente nosocomial y se asoció con el catéter.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 924 "Ancho" => 1512 "Tamanyo" => 62355 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Number of blood cultures processed from March 4th to June 21st, during 2018, 2019 and 2020.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CA, community-acquired; HA, hospital-acquired; HCAIs, Health care-associated infection.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SARS-CoV-2 result \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median age \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Etiology (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Microbiological source \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Community- and hospital-acquired \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Petitioner \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86% males14% females \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">S. epidermidis</span> (38.7%)<span class="elsevierStyleItalic">E. faecalis</span> (11.4%)<span class="elsevierStyleItalic">S. aureus</span> (11.4%)<span class="elsevierStyleItalic">P. aeruginosa</span> (9.1%)<span class="elsevierStyleItalic">C. albicans</span> (9.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Catheter (45.5%)Unknown (27.3%)Respiratory (15.9%)Urinary (4.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HA (95.5%)CA (4.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharge (63.6%)Death (36.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ICU (70.5%)Internal Medicine (15.9%)Hematology (6.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67% males33% females \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">E. coli</span> (29.4%)<span class="elsevierStyleItalic">E. faecium</span> (10%)<span class="elsevierStyleItalic">K. pneumonia</span> (9.4%)<span class="elsevierStyleItalic">S. aureus</span> (8.8%)<span class="elsevierStyleItalic">S. epidermidis</span> (7%)<span class="elsevierStyleItalic">P. aeruginosa</span> (5.8%)<span class="elsevierStyleItalic">E. faecalis</span> (4.1%)<span class="elsevierStyleItalic">C. albicans</span> (3.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown (59.4%)Urinary (19.4%)Catheter (9.4%)Abdominal (2.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CA (62.3%)HA (30.5%)HCAIs (7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharge (75.8%)Death (24.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Emergency Department (adults) (45.3%)Surgery Ward (11.2%)ICU (7.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2882743.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Characteristics of bacteremias in COVID-positive and COVID-negative patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Redacción médica. 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Aaron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.00875-20" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2020" "volumen" => "58" "paginaInicial" => "e00875" "paginaFinal" => "e920" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32404482" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Hughes" 1 => "O. Troise" 2 => "H. Donaldson" 3 => "N. Mughal" 4 => "L.S.P. Moore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cmi.2020.06.025" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2020" "volumen" => "26" "paginaInicial" => "1395" "paginaFinal" => "1399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32603803" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current aspects in sepsis approach. Turning things around" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. Candel" 1 => "M. Borges Sá" 2 => "S. Belda" 3 => "G. Bou" 4 => "J.L. Del Pozo" 5 => "O. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 0 | 8 |
| 2024 October | 22 | 1 | 23 |
| 2024 September | 32 | 1 | 33 |
| 2024 August | 33 | 5 | 38 |
| 2024 July | 28 | 7 | 35 |
| 2024 June | 17 | 0 | 17 |
| 2024 May | 25 | 2 | 27 |
| 2024 April | 17 | 1 | 18 |
| 2024 March | 16 | 6 | 22 |
| 2024 February | 17 | 1 | 18 |
| 2024 January | 17 | 3 | 20 |
| 2023 December | 19 | 5 | 24 |
| 2023 November | 28 | 2 | 30 |
| 2023 October | 32 | 6 | 38 |
| 2023 September | 22 | 0 | 22 |
| 2023 August | 12 | 0 | 12 |
| 2023 July | 19 | 1 | 20 |
| 2023 June | 19 | 3 | 22 |
| 2023 May | 39 | 0 | 39 |
| 2023 April | 26 | 9 | 35 |
| 2023 March | 47 | 7 | 54 |
| 2023 February | 19 | 4 | 23 |
| 2023 January | 9 | 3 | 12 |
| 2022 December | 15 | 5 | 20 |
| 2022 November | 15 | 7 | 22 |
| 2022 October | 21 | 5 | 26 |
| 2022 September | 9 | 0 | 9 |
| 2022 August | 2 | 0 | 2 |
| 2022 July | 3 | 0 | 3 |
| 2022 June | 3 | 0 | 3 |
| 2022 May | 10 | 0 | 10 |
| 2022 April | 5 | 0 | 5 |
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