Risk of Subsequent Lower Respiratory Tract Infection (LRTI) After Hospitalization for COVID-19 LRTI and Non-COVID-19 LRTI: a Retrospective Cohort Study

Overview

Journal Pneumonia (Nathan)

Publisher Biomed Central

Date 2023 Oct 4

PMID 37794443

Authors

Katia J Bruxvoort

Heidi Fischer

Joseph A Lewnard

Vennis X Hong

Magdalena Pomichowski

Lindsay R Grant

Luis Jodar

Bradford D Gessner

Sara Y Tartof

Affiliations

Soon will be listed here.

Abstract

Background: Respiratory pathogens, including SARS-CoV-2, can cause pulmonary structural damage and physiologic impairment, which may increase the risk of subsequent lower respiratory tract infections (LRTI). Prior hospitalization for any reason is a risk factor for LRTI, but data on the risk of subsequent new-onset LRTI following hospitalization for COVID-19 LRTI or non-COVID-19 LRTI are needed to inform strategies for immunizations targeting respiratory pathogens.

Methods: We conducted a retrospective cohort study at Kaiser Permanente Southern California (KPSC) among adults hospitalized from 3/1/2020 to 5/31/2022, excluding labor and delivery. We categorized individuals into 3 mutually exclusive baseline exposure groups: those hospitalized for COVID-19 LRTI, those hospitalized for non-COVID-19 LRTI, and those hospitalized for all other causes without LRTI or COVID-19 ("non-LRTI"). Following hospital discharge, patients were followed up for new-onset LRTI, beginning 30 antibiotic-free days after hospital discharge until 8/31/2022. We used multivariable cause-specific Cox regression with time-varying covariates to estimate hazard ratios (HR) of new-onset LRTI comparing those hospitalized for COVID-19 LRTI or non-COVID-19 LRTI to those hospitalized for non-LRTI, adjusting for demographic and clinical characteristics.

Results: The study included 22,417 individuals hospitalized for COVID-19 LRTI, 12,795 individuals hospitalized for non-COVID-19 LRTI, and 176,788 individuals hospitalized for non-LRTI. Individuals hospitalized for non-COVID-19 LRTI were older and had more comorbidities than those hospitalized for COVID-19 LRTI or non-LRTI. Incidence rates per 1,000 person-years (95% CI) of new-onset LRTI were 52.5 (51.4-53.6) among individuals hospitalized for COVID-19 LRTI, 253.5 (243.7-263.6) among those hospitalized for non-COVID-19 LRTI, and 52.5 (51.4-53.6) among those hospitalized for non-LRTI. The adjusted hazard of new-onset LRTI during follow-up was 20% higher among individuals hospitalized for COVID-19 LRTI (HR 1.20 [95% CI: 1.12-1.28]) and 301% higher among individuals hospitalized for non-COVID-19 LRTI (HR 3.01 [95% CI: 2.87-3.15]) compared to those hospitalized for non-LRTI.

Conclusion: The risk of new-onset LRTI following hospital discharge was high, particularly among those hospitalized for non-COVID-19 LRTI, but also for COVID-19 LRTI. These data suggest that immunizations targeting respiratory pathogens, including COVID-19, should be considered for adults hospitalized for LRTI prior to hospital discharge.

References

Grant L, Slack M, Yan Q, Trzcinski K, Barratt J, Sobczyk E . The epidemiologic and biologic basis for classifying older age as a high-risk, immunocompromising condition for pneumococcal vaccine policy. Expert Rev Vaccines. 2021; 20(6):691-705. DOI: 10.1080/14760584.2021.1921579. View

Ramirez J, Wiemken T, Peyrani P, Arnold F, Kelley R, Mattingly W . Adults Hospitalized With Pneumonia in the United States: Incidence, Epidemiology, and Mortality. Clin Infect Dis. 2017; 65(11):1806-1812. DOI: 10.1093/cid/cix647. View

Pelton S, Shea K, Weycker D, Farkouh R, Strutton D, Edelsberg J . Rethinking risk for pneumococcal disease in adults: the role of risk stacking. Open Forum Infect Dis. 2015; 2(1):ofv020. PMC: 4438900. DOI: 10.1093/ofid/ofv020. View

Pelton S, Bornheimer R, Doroff R, Shea K, Sato R, Weycker D . Decline in Pneumococcal Disease Attenuated in Older Adults and Those With Comorbidities Following Universal Childhood PCV13 Immunization. Clin Infect Dis. 2018; 68(11):1831-1838. PMC: 6522679. DOI: 10.1093/cid/ciy800. View

Kobayashi M, Farrar J, Gierke R, Britton A, Childs L, Leidner A . Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022; 71(4):109-117. PMC: 9351524. DOI: 10.15585/mmwr.mm7104a1. View

Almirall J, Serra-Prat M, Bolibar I, Balasso V . Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies. Respiration. 2017; 94(3):299-311. DOI: 10.1159/000479089. View

Fedson D, Baldwin J . Previous hospital care as a risk factor for pneumonia. Implications for immunization with pneumococcal vaccine. JAMA. 1982; 248(16):1989-95. View

Aul D, Gates D, Draper D, Dunleavy D, Ruickbie D, Meredith D . Complications after discharge with COVID-19 infection and risk factors associated with development of post-COVID pulmonary fibrosis. Respir Med. 2021; 188:106602. PMC: 8425673. DOI: 10.1016/j.rmed.2021.106602. View

Bellan M, Soddu D, Balbo P, Baricich A, Zeppegno P, Avanzi G . Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge. JAMA Netw Open. 2021; 4(1):e2036142. PMC: 7841464. DOI: 10.1001/jamanetworkopen.2020.36142. View

10.

Fraser E . Persistent pulmonary disease after acute covid-19. BMJ. 2021; 373:n1565. DOI: 10.1136/bmj.n1565. View

11.

Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo P, Cuapio A . More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021; 11(1):16144. PMC: 8352980. DOI: 10.1038/s41598-021-95565-8. View

12.

Torres-Castro R, Vasconcello-Castillo L, Alsina-Restoy X, Solis-Navarro L, Burgos F, Puppo H . Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis. Pulmonology. 2020; 27(4):328-337. PMC: 7687368. DOI: 10.1016/j.pulmoe.2020.10.013. View

13.

Wu X, Liu X, Zhou Y, Yu H, Li R, Zhan Q . 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respir Med. 2021; 9(7):747-754. PMC: 8099316. DOI: 10.1016/S2213-2600(21)00174-0. View

14.

Murthy N, Wodi A, Bernstein H, Ault K . Recommended Adult Immunization Schedule, United States, 2022. Ann Intern Med. 2022; 175(3):432-443. DOI: 10.7326/M22-0036. View

15.

Mbaeyi S, Oliver S, Collins J, Godfrey M, Goswami N, Hadler S . The Advisory Committee on Immunization Practices' Interim Recommendations for Additional Primary and Booster Doses of COVID-19 Vaccines - United States, 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(44):1545-1552. PMC: 8568093. DOI: 10.15585/mmwr.mm7044e2. View

16.

Koebnick C, Langer-Gould A, Gould M, Chao C, Iyer R, Smith N . Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data. Perm J. 2012; 16(3):37-41. PMC: 3442759. DOI: 10.7812/TPP/12-031. View

17.

Gilbert T, Neuburger J, Kraindler J, Keeble E, Smith P, Ariti C . Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet. 2018; 391(10132):1775-1782. PMC: 5946808. DOI: 10.1016/S0140-6736(18)30668-8. View

18.

Matanock A, Lee G, Gierke R, Kobayashi M, Leidner A, Pilishvili T . Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019; 68(46):1069-1075. PMC: 6871896. DOI: 10.15585/mmwr.mm6846a5. View

19.

Lewnard J, Bruxvoort K, Fischer H, Hong V, Grant L, Jodar L . Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Medically Attended Lower Respiratory Tract Infection and Pneumonia Among Older Adults. Clin Infect Dis. 2021; 75(5):832-841. DOI: 10.1093/cid/ciab1051. View

20.

Eurich D, Marrie T, Minhas-Sandhu J, Majumdar S . Ten-Year Mortality after Community-acquired Pneumonia. A Prospective Cohort. Am J Respir Crit Care Med. 2015; 192(5):597-604. DOI: 10.1164/rccm.201501-0140OC. View