• Antibiotic Use and Bacterial Infection among Inpatients in the First Wave of COVID-19: a Retrospective Cohort Study of 64,691 Patients

      Baghdadi, Jonathan D; Coffey, K C; Adediran, Timileyin; Goodman, Katherine E; Pineles, Lisa; Magder, Larry S; O'Hara, Lyndsay M; Pineles, Beth L; Nadimpalli, Gita; Morgan, Daniel J; et al. (American Society for Microbiology, 2021-09-07)
      Hospitalized patients with SARS-CoV-2 infection (COVID-19) often receive antibiotics for suspected bacterial coinfection. We estimated the incidence of bacterial coinfection and secondary infection in COVID-19 using clinical diagnoses to determine how frequently antibiotics are administered when bacterial infection is absent. We performed a retrospective cohort study of inpatients with COVID-19 present on admission to hospitals in the Premier Healthcare Database between April and June 2020. Bacterial infections were defined using ICD-10-CM diagnosis codes and associated "present on admission" coding. Coinfections were defined by bacterial infection present on admission, while secondary infections were defined by bacterial infection that developed after admission. Coinfection and secondary infection were not mutually exclusive. A total of 18.5% of 64,961 COVID-19 patients (n = 12,040) presented with bacterial infection at admission, 3.8% (n = 2,506) developed secondary infection after admission, and 0.9% (n = 574) had both; 76.3% (n = 49,551) received an antibiotic while hospitalized, including 71% of patients who had no diagnosis of bacterial infection. Secondary bacterial infection occurred in 5.7% of patients receiving steroids in the first 2 days of hospitalization, 9.9% receiving tocilizumab in the first 2 days of hospitalization, and 10.3% of patients receiving both. After adjusting for patient and hospital characteristics, bacterial coinfection (adjusted relative risk [aRR], 1.15; 95% confidence interval [CI], 1.11 to 1.20) and secondary infection (aRR 1.93; 95% CI, 1.82 to 2.04) were both independently associated with increased mortality. Although 1 in 5 inpatients with COVID-19 presents with bacterial infection, secondary infections in the hospital are uncommon. Most inpatients with COVID-19 receive antibiotic therapy, including 71% of those not diagnosed with bacterial infection.
    • Coronavirus disease 2019 (COVID-19) research agenda for healthcare epidemiology.

      Mody, Lona; Akinboyo, Ibukunoluwa C; Babcock, Hilary M; Bischoff, Werner E; Cheng, Vincent Chi-Chung; Chiotos, Kathleen; Claeys, Kimberly C; Coffey, K C; Diekema, Daniel J; Donskey, Curtis J; et al. (Cambridge University Press, 2021-01-25)
      This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
    • Lessons learned - Outbreaks of COVID-19 in nursing homes

      Kim, Justin J; Coffey, K C; Morgan, Daniel J; Roghmann, Mary-Claire (Elsevier Ltd., 2020-07-31)
    • Preventing Transmission of SARS-CoV-2 During College Football Games

      Coffey, K C; Malani, Preeti; Morgan, Daniel J (American Medical Association, 2021-10-29)
    • Variation of National and International Guidelines on Respiratory Protection for Health Care Professionals During the COVID-19 Pandemic

      Birgand, Gabriel; Mutters, Nico T; Otter, Jonathan; Eichel, Vanessa M; Lepelletier, Didier; Morgan, Daniel J; Lucet, Jean-Christophe (American Medical Association, 2021-08-04)