Examining the influence of Covid-19 restrictions, a nurse strike, and SARS-CoV-2 coinfection on bacteremia mortality: A Danish population-based cohort study (2019–2022)

TL;DR

This study found that bacteremia mortality decreased during the pandemic's restrictions but increased with SARS-CoV-2 coinfection in Denmark.

Contribution

The study provides new evidence on how pandemic restrictions and SARS-CoV-2 coinfection influenced bacteremia mortality.

Findings

Bacteremia mortality was significantly lower during the COVID-19 restriction period.

SARS-CoV-2 coinfection was associated with higher bacteremia mortality.

The nurse strike's impact on mortality was inconclusive.

Abstract

Bacteremia is an acute severe infection with high mortality. Changes in healthcare services and coinfections with SARS-CoV-2 may have affected the mortality for bacteremia during the COVID-19 pandemic, which has been reported for other major diseases. In this study we examine the all-cause bacteremia mortality amidst the COVID-19 pandemic.

A population-based cohort study comprised of laboratory confirmed bacteremia episodes in the Capital Region, Denmark (March 2019–February 2022). Cox proportional hazards models were used to calculate hazard ratios (HR) and 95 % confidence intervals (CI) for all-cause bacteremia mortality associated with the Covid-19 restriction period, a strike period, and coinfection with SARS-CoV-2, adjusted for possible confounders.

A total of 14,912 bacteremia episodes were identified in 12,693 patients during the study period. The 30- and 90-day all-cause mortality were 19 % and 27 %, respectively. The fully adjusted HR for 30- and 90-day all-cause mortality associated with the Covid-19 restriction period were 0.91 (95 % CI, 0.84 to 0.99) and 0.90 (95 % CI, 0.84 to 0.96), respectively, compared to the remaining time period. The corresponding HRs associated with SARS-CoV-2 coinfection were 1.29 (95 % CI, 1.11 to 1.50) and 1.36 (95 % CI, 1.20 to 1.55) compared to patients without coinfection. The association between the national nurse strike and all-cause bacteremia mortality was inconclusive.

In this large population-based cohort study, a significant reduction in all-cause mortality for bacteremia was observed during the Covid-19 restriction period in Denmark, while coinfection with SARS-CoV-2 seem to be a substantial risk factor for all-cause bacteremia mortality.

•A Danish population-based cohort study of laboratory confirmed bacteremia.•The 30- and 90-day all-cause mortality were 19 % and 27 %, respectively.•The mortality was significantly lower during the Covid-19 restriction period.•The mortality was significantly higher in those with SARS-CoV-2 coinfection.

A Danish population-based cohort study of laboratory confirmed bacteremia.

The 30- and 90-day all-cause mortality were 19 % and 27 %, respectively.

The mortality was significantly lower during the Covid-19 restriction period.

The mortality was significantly higher in those with SARS-CoV-2 coinfection.