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TELLİ DİZMAN G, METAN G, AYAZ CEYLAN ÇM, ALTUNAY H, UZUN M, GÜRSOY G, TAŞ Z, KARAHAN G, AHMADOVA F, SARICAOĞLU T, ÇALIŞKAN ZC, ALP A, SÖNMEZER MÇ, İNKAYA AÇ, Ahmet Görkem ER, ÖZYAVUZ ALP Ş, UYAROĞLU OA, DURUSU TANRIÖVER M, ÇALIK BAŞARAN N, DURHAN G, DEMİRKAZIK F, UZUN Ö, AKOVA M, ÜNAL S. A COVID-19 first evaluation clinic at a university hospital in Turkey. Turk J Med Sci 2022; 52:1-10. [PMID: 34493032 PMCID: PMC10734817 DOI: 10.3906/sag-2104-152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 02/22/2022] [Accepted: 09/07/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We aimed to analyze the usefulness of such a reserved area for the admission of the patients' symptoms suggesting COVID-19 and compare the demographic and clinical characteristics of the patients with COVID-19 and without COVID-19 who were admitted to C1 during the first month of the COVID-19 outbreak in our hospital. METHODS A new area was set up in Hacettepe University Adult Hospital to limit the contact of COVID-19 suspicious patients with other patients, which was named as COVID-19 First Evaluation Outpatient Clinic (C1). C1 had eight isolation rooms and two sampling rooms for SARS-CoV-2 polymerase-chain-reaction (PCR). All rooms were negative-pressurized. Patients who had symptoms that were compatible with COVID-19 were referred to C1 from pretriage areas. All staff received training for the appropriate use of personal protective equipment and were visited daily by the Infection Prevention and Control team. RESULTS One hundred and ninety-eight (29.4%) of 673 patients who were admitted to C1were diagnosed with COVID-19 between March 20, 2020, and April 19, 2020. SARS-CoV-2 PCR was positive in 142 out of 673 patients. Chest computerized tomography (CT) was performed in 421 patients and COVID-19 was diagnosed in 56 of them based on CT findings despite negative PCR. Four hundred and ninety-three patients were tested for other viral and bacterial infections with multiplex real-time reverse-transcriptase PCR (RTPCR). Blood tests that included complete blood count, renal and liver functions, d-dimer levels, ferritin, C- reactive protein, and procalcitonin were performed in 593 patients. Only one out of 44 healthcare workers who worked at C1 was infected by SARS-CoV-2. DISCUSSION Early diagnosis of infected patients and ensuring adequate isolation are very important to control the spread of COVID-19. The purpose of setting up the COVID-19 first evaluation outpatient clinic was to prevent the overcrowding of ER due to mild or moderate infections, ensure appropriate distancing and isolation, and enable emergency services to serve for real emergencies. A wellplanned outpatient care area and teamwork including internal medicine, microbiology, and radiology specialists under the supervision of infectious diseases specialists allowed adequate management of the mild-to-moderate patients with suspicion of COVID-19.
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Affiliation(s)
- Gülçin TELLİ DİZMAN
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Gökhan METAN
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | | | - Hayriye ALTUNAY
- Department of Infectious Diseases, Siirt Training and Research Hospital, Siirt,
Turkey
| | - Mertcan UZUN
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Gamze GÜRSOY
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Zahit TAŞ
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Gizem KARAHAN
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Farida AHMADOVA
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Tuğba SARICAOĞLU
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Zeynep Cansu ÇALIŞKAN
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Alpaslan ALP
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University Ankara,
Turkey
| | - Meliha Çağla SÖNMEZER
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Ahmet Çağkan İNKAYA
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - ER Ahmet Görkem
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Şehnaz ÖZYAVUZ ALP
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Oğuz Abdullah UYAROĞLU
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Mine DURUSU TANRIÖVER
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Nursel ÇALIK BAŞARAN
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Gamze DURHAN
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Figen DEMİRKAZIK
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Ömrüm UZUN
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Murat AKOVA
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Serhat ÜNAL
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
- Infection Control Committee, Hospitals of Faculty of Medicine, Hacettepe University, Ankara,
Turkey
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Amer YS, Titi MA, Godah MW, Wahabi HA, Hneiny L, Abouelkheir MM, Hamad MH, ElGohary GM, Hamouda MB, Ouertatani H, Velasquez-Salazar P, Acosta-Reyes J, Alhabib SM, Esmaeil SA, Fedorowicz Z, Zhang A, Chen Z, Liptrott SJ, Frungillo N, Jamal AA, Almustanyir SA, Dieyi NU, Powell J, Hon KJ, Alzeidan R, Azzo M, Zambrano-Rico S, Ramirez-Jaramillo P, Florez ID. International alliance and AGREE-ment of 71 clinical practice guidelines on the management of critical care patients with COVID-19: a living systematic review. J Clin Epidemiol 2022; 142:333-370. [PMID: 34785346 PMCID: PMC8590623 DOI: 10.1016/j.jclinepi.2021.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/10/2021] [Accepted: 11/06/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to systematically identify and critically assess the clinical practice guidelines (CPGs) for the management of critically ill patients with COVID-19 with the AGREE II instrument. STUDY DESIGN AND SETTING We searched Medline, CINAHL, EMBASE, CNKI, CBM, WanFang, and grey literature from November 2019 - November 2020. We did not apply language restrictions. One reviewer independently screened the retrieved titles and abstracts, and a second reviewer confirmed the decisions. Full texts were assessed independently and in duplicate. Disagreements were resolved by consensus. We included any guideline that provided recommendations on the management of critically ill patients with COVID-19. Data extraction was performed independently and in duplicate by two reviewers. We descriptively summarized CPGs characteristics. We assessed the quality with the AGREE II instrument and we summarized relevant therapeutic interventions. RESULTS We retrieved 3,907 records and 71 CPGs were included. Means (Standard Deviations) of the scores for the 6 domains of the AGREE II instrument were 65%(SD19.56%), 39%(SD19.64%), 27%(SD19.48%), 70%(SD15.74%), 26%(SD18.49%), 42%(SD34.91) for the scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence domains, respectively. Most of the CPGs showed a low overall quality (less than 40%). CONCLUSION Future CPGs for COVID-19 need to rely, for their development, on standard evidence-based methods and tools.
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Affiliation(s)
- Yasser S. Amer
- Pediatrics Department and Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia,Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt
| | - Maher A. Titi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Patient Safety Unit, Quality Management Department King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammad W. Godah
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hayfaa A. Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Layal Hneiny
- Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon
| | | | - Muddathir H. Hamad
- Division of Neurology, Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ghada Metwally ElGohary
- Internal Medicine and Clinical Hematology, Faculty of Medicine, Ain Shams University, Cairo, Egypt,University Oncology Center, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Ben Hamouda
- Clinical Practice Guidelines Unit, INEAS l instance Nationale de l'évaluation et de l'accréditation en santé 7 Rue Ahmed Rami le belvedere 1001 Tunis-TUNISIA
| | - Hella Ouertatani
- Clinical Pathways Unit, National Authority for Assessment and Accreditation in Healthcare (INEAS), Tunis, Tunisia
| | - Pamela Velasquez-Salazar
- Unidad de Evidencia y Deliberación para la toma de Decisiones (UNED), Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | - Jorge Acosta-Reyes
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia
| | - Samia M. Alhabib
- National Center for Evidence-Based Health Practice, Saudi Health Council, Riyadh, Saudi Arabia,King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Samia Ahmed Esmaeil
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
| | - Zbys Fedorowicz
- Veritas Health Sciences Consultancy Ltd., Huntingdon, United Kingdom
| | - Ailing Zhang
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Chen
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Niccolò Frungillo
- Oncology Unit, ASST Fatebenefratelli-Sacco, PO Fateberefratelli, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Amr A. Jamal
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Newman Ugochukwu Dieyi
- Division of Community Health and Humanities, Memorial University, St. John's Newfoundland and Labrador, Canada
| | - John Powell
- National Institute for Health and Care Excellence, London, UK,Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Katrina J. Hon
- Division of Community Health and Humanities, Memorial University, St. John's Newfoundland and Labrador, Canada,Neuroscience, Mind, Brain, and Behavior, Harvard University, MA, USA
| | - Rasmieh Alzeidan
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Majduldeen Azzo
- Pediatrics Emergency Department, The International Medical Center, Hail Street, 21451, Jeddah, Saudi Arabia
| | | | | | - Ivan D. Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia,School of Rehabilitation Science, McMaster University, Hamilton, Canada,Corresponding author: Tel.: +57 4 219 2480
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Ng TM, Ong SWX, Loo AYX, Tan SH, Tay HL, Yap MY, Lye DC, Lee TH, Young BE. Antibiotic Therapy in the Treatment of COVID-19 Pneumonia: Who and When? Antibiotics (Basel) 2022; 11:antibiotics11020184. [PMID: 35203787 PMCID: PMC8868256 DOI: 10.3390/antibiotics11020184] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 01/07/2023] Open
Abstract
Background: COVID-19 imposes challenges in antibiotic decision-making due to similarities between bacterial pneumonia and moderate to severe COVID-19. We evaluated the effects of antibiotic therapy on the clinical outcomes of COVID-19 pneumonia patients and diagnostic accuracy of key inflammatory markers to inform antibiotic decision-making. Methods: An observational cohort study was conducted in patients hospitalised with COVID-19 at the National Centre for Infectious Diseases and Tan Tock Seng Hospital, Singapore, from January to April 2020. Patients were defined as receiving empiric antibiotic treatment for COVID-19 if started within 3 days of diagnosis. Results: Of 717 patients included, 86 (12.0%) were treated with antibiotics and 26 (3.6%) had documented bacterial infections. Among 278 patients with COVID-19 pneumonia, those treated with antibiotics had more diarrhoea (26, 34.7% vs. 24, 11.8%, p < 0.01), while subsequent admissions to the intensive care unit were not lower (6, 8.0% vs. 10, 4.9% p = 0.384). Antibiotic treatment was not independently associated with lower 30-day (adjusted odds ratio, aOR 19.528, 95% confidence interval, CI 1.039–367.021) or in-hospital mortality (aOR 3.870, 95% CI 0.433–34.625) rates after adjusting for age, co-morbidities and severity of COVID-19 illness. Compared to white cell count and procalcitonin level, the C-reactive protein level had the best diagnostic accuracy for documented bacterial infections (area under the curve, AUC of 0.822). However, the sensitivity and specificity were less than 90%. Conclusion: Empiric antibiotic use in those presenting with COVID-19 pneumonia did not prevent deterioration or mortality. More studies are needed to evaluate strategies to diagnose bacterial co-infections in these patients.
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Affiliation(s)
- Tat Ming Ng
- Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (T.M.N.); (A.Y.X.L.); (S.H.T.); (H.L.T.); (M.Y.Y.)
| | - Sean W. X. Ong
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore; (S.W.X.O.); (D.C.L.); (T.H.L.)
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Audrey Y. X. Loo
- Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (T.M.N.); (A.Y.X.L.); (S.H.T.); (H.L.T.); (M.Y.Y.)
| | - Sock Hoon Tan
- Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (T.M.N.); (A.Y.X.L.); (S.H.T.); (H.L.T.); (M.Y.Y.)
| | - Hui Lin Tay
- Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (T.M.N.); (A.Y.X.L.); (S.H.T.); (H.L.T.); (M.Y.Y.)
| | - Min Yi Yap
- Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (T.M.N.); (A.Y.X.L.); (S.H.T.); (H.L.T.); (M.Y.Y.)
| | - David C. Lye
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore; (S.W.X.O.); (D.C.L.); (T.H.L.)
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Tau Hong Lee
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore; (S.W.X.O.); (D.C.L.); (T.H.L.)
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Barnaby E. Young
- Department of Infectious Diseases, National Centre for Infectious Diseases, 16 Jln Tan Tock Seng, Singapore 308442, Singapore; (S.W.X.O.); (D.C.L.); (T.H.L.)
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Correspondence: ; Tel.: +65-8133-4132
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Falcone M, Tiseo G, Arcari G, Leonildi A, Giordano C, Tempini S, Bibbolino G, Mozzo R, Barnini S, Carattoli A, Menichetti F. Spread of hypervirulent multidrug-resistant ST147 Klebsiella pneumoniae in patients with severe COVID-19: an observational study from Italy, 2020-21. J Antimicrob Chemother 2022; 77:1140-1145. [PMID: 35040981 PMCID: PMC9383231 DOI: 10.1093/jac/dkab495] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives To report an outbreak of hypervirulent Klebsiella pneumoniae (hvKp) in COVID-19 patients. Methods Prospective, observational study including consecutive COVID-19 patients with hvKp infections admitted to the University Hospital of Pisa (Italy). Clinical data and outcome of patients were collected. All patients were followed-up to 30 days from the diagnosis of infection. Mortality within 30 days of the diagnosis of hvKp infection was reported. The hypermucoviscous phenotype was determined by the ‘string test’. Molecular typing was performed on three strains collected during different periods of the outbreak. The strains underwent whole genome sequencing using the Illumina MiSeq instrument. The complete circular assemblies were also obtained for the chromosome and a large plasmid using the Unicycler tool. Results From November 2020 to March 2021, hvKp has been isolated from 36 COVID-19 patients: 29/36 (80.6%) had infections (15 bloodstream infections, 8 ventilator-associated pneumonias and 6 complicated urinary tract infections), while 7/36 (19.4%) had colonization (3 urine, 2 rectal and 2 skin). The isolates belonged to ST147 and their plasmid carried three replicons of the IncFIB (Mar), IncR and IncHI1B types and several resistance genes, including the rmpADC genes encoding enhancers of capsular synthesis. The hvKp isolates displayed an ESBL phenotype, with resistance to piperacillin/tazobactam and ceftolozane/tazobactam and susceptibility only to meropenem and ceftazidime/avibactam. The majority of patients were treated with meropenem alone or in combination with fosfomycin. Thirty-day mortality was 48.3% (14/29). Conclusions ST147 ESBL-producing hvKp is associated with high mortality in COVID-19 patients. Strict microbiological surveillance and infection control measures are needed in this population.
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Affiliation(s)
- Marco Falcone
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Tiseo
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Arcari
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Cesira Giordano
- Microbiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Sara Tempini
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Bibbolino
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Roberto Mozzo
- Anaesthesia and Critical Care for General and Transplantation Surgery, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy
| | - Simona Barnini
- Microbiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Francesco Menichetti
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Abdelhadi A, Kassem A. Candida Pneumonia with Lung Abscess as a Complication of Severe COVID-19 Pneumonia. Int Med Case Rep J 2022; 14:853-861. [PMID: 34992473 PMCID: PMC8711636 DOI: 10.2147/imcrj.s342054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
A South Asian male patient in his mid-forties presented with symptoms of severe 2019-nCoV (COVID-19) and recent brain infarction. Subsequently, he was found to have evidence of sepsis, underlying undetected diabetes mellitus (DM) and oral candida mucositis, possibly leading to the rare occurrence of direct spread to the lung, manifesting as a necrotizing candida lung abscess. We describe the diagnosis, clinical course, and management of the unique complication in this case that occurred during his admission, hospitalization, and eventual successful discharge from the hospital. This case highlights the importance of early identification and treatment of suspected COVID-19 infection based on clinical and radiological assessments before the confirmation of COVID-19 by real-time polymerase chain reaction (rtPCR) test result, especially in patients with hyperglycemia. It also indicates the complications that can occur due to COVID-19 such as arteriovenous manifestations and the rare occurrence of pulmonary candida lung abscess. Early detection and prompt management by interdisciplinary teams in the emergency room, followed by close monitoring of complications in the intensive care unit (ICU), can lead to successful outcomes in severe/critical COVID-19 infection.
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Affiliation(s)
- Adel Abdelhadi
- Department of Critical Care Medicine, Saqr Hospital, MOH, Ras Al-Khaimah, Ras Al-Khaimah, United Arab Emirates
| | - Abeer Kassem
- Department of Pulmonary Medicine, IBHOA Hospital, MOH, Ras Al-Khaimah, Ras Al-Khaimah, United Arab Emirates
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Mustafa ZU, Kow CS, Salman M, Kanwal M, Riaz MB, Parveen S, Hasan SS. Pattern of medication utilization in hospitalized patients with COVID-19 in three District Headquarters Hospitals in the Punjab province of Pakistan. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100101. [PMID: 34977851 PMCID: PMC8715623 DOI: 10.1016/j.rcsop.2021.100101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose In Pakistan, a wide range of repurposed drugs are recommended to manage hospitalized patients with COVID-19. Therefore, the current study was conducted to evaluate the pattern of utilization of repurposed drugs and other potential therapeutic options among hospitalized patients with COVID-19 in Pakistan. Methods This retrospective, multicenter, descriptive study enrolled consecutive hospitalized patients with COVID-19 who were admitted between March 1, 2021, and April 30, 2021, from three District Headquarter Hospitals in the Punjab province of Pakistan. We described patient and clinical characteristics and medications, stratified by COVID-19 severity during hospitalization: mild, moderate, and severe. In addition, an analytical study of drug utilization was conducted. Findings A total of 444 hospitalized patients with COVID-19 were included. Remdesvir, corticosteroids, antibiotics, and antithrombotics were administered to 45.0%, 93.9%, 84.9%, and 60.1% of patients, respectively. Specifically, dexamethasone was the most commonly used corticosteroid among the included patients (n = 405; 91.2%), irrespective of their clinical severity. Only 60.1% of patients hospitalized with COVID-19 in our cohort received antithrombotic therapy, and the prevalence of use was especially low (27.8%) in patients with mild illness. Of 444 patientsscreened, 399 (89.9%) patients had been discharged, and 45 patients (10.1%) died. Implications We provided an important glimpse into the utilization patterns of several medications of interest for the treatment of COVID-19 in Pakistan, which had not been entirely evidence-based, especially concerning systemic corticosteroids and antibiotics.
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Affiliation(s)
- Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Pakistan
| | - Chia Siang Kow
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.,School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Muhammad Salman
- Department of Pharmacy, The University of the Lahore, Lahore 54000, Pakistan
| | - Mahpara Kanwal
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Okara South City, Pakistan
| | - Muhammad Bilal Riaz
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Chakwal, Pakistan
| | - Samina Parveen
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Chakwal, Pakistan
| | - Syed Shahzad Hasan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom.,School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, Australia
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Yogo A, Yamamoto S, Iwamoto N, Aoki K, Motobayashi H, Tochitani K, Shimizu T. Non-typhoidal Salmonella Bacteremia in COVID-19 with Recrudescence of Fever After Corticosteroid Discontinuation: A case report. IDCases 2022; 27:e01415. [PMID: 35096529 PMCID: PMC8779851 DOI: 10.1016/j.idcr.2022.e01415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 11/27/2022] Open
Abstract
Secondary bacterial infections occur in COVID-19 patients treated with corticosteroid. Rebound phenomenon is observed after the cessation of steroid treatment. Non-typhoidal Salmonella bacteremia is associated with immunosuppressive conditions. Blood cultures distinguish between secondary infections and rebound phenomena.
It is challenging for clinicians to determine the cause of occurrence of fever in COVID-19 patients after corticosteroid discontinuation. Blood cultures help us distinguish between secondary infections and rebound phenomena. We report a case of non-typhoidal Salmonella bacteremia in a 34-year-old male COVID-19 patient who developed fever after discontinuing corticosteroids.
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Peghin M, Vena A, Graziano E, Giacobbe DR, Tascini C, Bassetti M. Improving management and antimicrobial stewardship for bacterial and fungal infections in hospitalized patients with COVID-19. Ther Adv Infect Dis 2022; 9:20499361221095732. [PMID: 35591884 PMCID: PMC9112312 DOI: 10.1177/20499361221095732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 03/14/2022] [Indexed: 12/27/2022] Open
Abstract
SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection is being
one of the most significant challenges of health care systems worldwide.
Bacterial and fungal infections in hospitalized patients with coronavirus
disease 2019 (COVID-19) are uncommon but consumption of antibiotics and
antifungals has increased dramatically during the ongoing pandemic resulting in
increased selective pressure for global antimicrobial resistance. Nosocomial
bacterial superinfections appear to be more frequent than community-acquired
coinfections, particularly among patients admitted to the intensive care unit
(ICU) and those receiving immunosuppressive treatment. Fungal infections
associated with COVID-19 might be missed or misdiagnosed. Existing and new
antimicrobial stewardship (AMS) programmes can be utilized directly in COVID-19
pandemic and are urgently needed to contain the high rates of misdiagnosis and
antimicrobial prescription. The aim of this review is to describe the role of
bacterial and fungal infections and possible strategies of AMS to use in daily
practice for optimal management of COVID-19.
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Affiliation(s)
- Maddalena Peghin
- Clinica di Malattie Infettive, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Presidio Ospedaliero Universitario Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia 15, 33010 Udine, Italy
| | - Antonio Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Elena Graziano
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | | | - Carlo Tascini
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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Silva ARO, Salgado DR, Lopes LPN, Castanheira D, Emmerick ICM, Lima EC. Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital. Front Pharmacol 2021; 12:778386. [PMID: 34955847 PMCID: PMC8703131 DOI: 10.3389/fphar.2021.778386] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Microbial drug resistance is one of the biggest public health problems. Antibiotic consumption is an essential factor for the emergence and spread of multiresistant bacteria. Therefore, we aimed to analyze the antibiotics consumption in the Intensive Care Unit (ICU), identifying trends in the antibiotics use profile and microbiological isolates throughout the COVID-19 pandemic. Methods: We performed this retrospective observational study in intensive care units of a Brazilian tertiary hospital from January 2019 to December 2020. The primary outcome was antimicrobial consumption in the ICU, measured by defined daily doses (DDDs) per 100 bed-days. As a secondary outcome, bacterial infections (microbiological isolates) were calculated in the same fashion. Outcomes trends were analyzed using Joinpoint regression models, considering constant variance (homoscedasticity) and first-order autocorrelation assumptions. A monthly percent change (MPC) was estimated for each analyzed segment. Results: Seven thousand and nine hundred fifty-three patients had data available on prescribed and received medications and were included in the analyses. Overall, the use of antibiotics increased over time in the ICU. The reserve group (World Health Organization Classification) had an increasing trend (MPC = 7.24) from February to April 2020. The azithromycin consumption (J01FA) increased rapidly, with a MPC of 5.21 from January to April 2020. Polymyxin B showed a relevant increase from March to June 2020 (MPC = 6.93). The peak of the antibiotic consumption of Reserve group did not overlap with the peak of the pathogenic agents they are intended to treat. Conclusion: Overall antimicrobial consumption in ICU has increased in the context of the COVID-19 pandemic. The peaks in the antimicrobial's use were not associated with the rise of the pathogenic agents they intended to treat, indicating an empirical use, which is especially concerning in the context of treating multidrug-resistant (MDR) infections. This fact may contribute to the depletion of the therapeutic arsenal for MDR treatment.
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Affiliation(s)
| | - Diamantino Ribeiro Salgado
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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60
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Zou H, Yang Y, Dai H, Xiong Y, Wang JQ, Lin L, Chen ZS. Recent Updates in Experimental Research and Clinical Evaluation on Drugs for COVID-19 Treatment. Front Pharmacol 2021; 12:732403. [PMID: 34880750 PMCID: PMC8646041 DOI: 10.3389/fphar.2021.732403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/13/2021] [Indexed: 12/17/2022] Open
Abstract
Since the outbreak of corona virus disease 2019 (COVID-19) in Wuhan (China) in December 2019, the epidemic has rapidly spread to many countries around the world, posing a huge threat to global public health. In response to the pandemic, a number of clinical studies have been initiated to evaluate the effect of various treatments against COVID-19, combining medical strategies and clinical trial data from around the globe. Herein, we summarize the clinical evaluation about the drugs mentioned in this review for COVID-19 treatment. This review discusses the recent data regarding the efficacy of various treatments in COVID-19 patients, to control and prevent the outbreak.
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Affiliation(s)
| | - Yuqi Yang
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, United States
| | - Huiqiang Dai
- Cell Research Center, Shenzhen Bolun Institute of Biotechnology, Shenzhen, China
| | - Yunchuang Xiong
- Cell Research Center, Shenzhen Bolun Institute of Biotechnology, Shenzhen, China
| | - Jing-Quan Wang
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, United States
| | - Lusheng Lin
- Cell Research Center, Shenzhen Bolun Institute of Biotechnology, Shenzhen, China
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, United States
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Detection of bacteria via multiplex PCR in respiratory samples of critically ill COVID-19 patients with suspected HAP/VAP in the ICU. Wien Klin Wochenschr 2021; 134:385-390. [PMID: 34882256 PMCID: PMC8656439 DOI: 10.1007/s00508-021-01990-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/16/2021] [Indexed: 01/28/2023]
Abstract
Background Critically ill Coronavirus disease 2019 (COVID-19) patients have high rates of bacterial superinfection. Multiplex polymerase chain reaction panels may be able to provide useful information about the incidence and spectrum of bacteria causing superinfections. Methods In this retrospective observational study we included all COVID-19 positive patients admitted to our intensive care unit with suspected hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) in whom the BioFire® Pneumonia Panel (PP) was performed from tracheal aspirate or bronchoalveolar lavage fluid for diagnostic purposes. The aim of our study was to analyze the spectrum of pathogens detected with the PP. Results In this study 60 patients with a median age of 62.5 years were included. Suspected VAP was the most frequent (48/60, 80%) indication for performing the PP. Tracheal aspirate was the predominant sample type (50/60, 83.3%). The PP led to a negative, monomicrobial and polymicrobial result in 36.7%, 35% and 28.3% of the patients, respectively. The three most detected bacteria were Staphylococcus aureus (13/60, 21.7%), Klebsiella pneumoniae (12/60, 20%) and Haemophilus influenzae (9/60, 15%). Neither atypical bacteria nor resistance genes were detected. Microbiological culture of respiratory specimens was performed in 36 (60%) patients concomitantly. The PP and microbiological culture yielded a non-concordant, partial concordant and completely concordant result in 13.9% (5/36), 30.6% (11/36) and 55.6% (20/36) of the analyzed samples, respectively. Conclusion In critically ill COVID-19 patients with suspected HAP/VAP results of the PP and microbiological culture methods were largely consistent. In our cohort, S. aureus and K. pneumoniae were the most frequently detected organisms. A higher diagnostic yield may be achieved if both methods are combined.
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Grinbaum RS, Kiffer CRV. Bacterial infections in COVID-19 patients: a review. Rev Assoc Med Bras (1992) 2021; 67:1863-1868. [PMID: 34909963 DOI: 10.1590/1806-9282.20210812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/28/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Renato Satovschi Grinbaum
- Hospital e Maternidade São Luiz São Caetano - São Caetano do Sul (SP), Brazil.,Universidade Cidade de São Paulo - São Paulo (SP), Brazil.,Universidade Municipal de São Caetano do Sul - São Caetano do Sul (SP), Brazil
| | - Carlos Roberto Veiga Kiffer
- Hospital e Maternidade São Luiz São Caetano - São Caetano do Sul (SP), Brazil.,Universidade Federal de São Paulo, Laboratório Especial de Microbiologia Clínica, Escola Paulista de Medicina - São Paulo (SP), Brazil
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Langford BJ, So M, Leung V, Raybardhan S, Lo J, Kan T, Leung F, Westwood D, Daneman N, MacFadden DR, Soucy JPR. Predictors and microbiology of respiratory and bloodstream bacterial infection in patients with COVID-19: living rapid review update and meta-regression. Clin Microbiol Infect 2021; 28:491-501. [PMID: 34843962 PMCID: PMC8619885 DOI: 10.1016/j.cmi.2021.11.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/27/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022]
Abstract
Background The prevalence of bacterial infection in patients with COVID-19 is low, however, empiric antibiotic use is high. Risk stratification may be needed to minimize unnecessary empiric antibiotic use. Objective To identify risk factors and microbiology associated with respiratory and bloodstream bacterial infection in patients with COVID-19. Data sources We searched MEDLINE, OVID Epub and EMBASE for published literature up to 5 February 2021. Study eligibility criteria Studies including at least 50 patients with COVID-19 in any healthcare setting. Methods We used a validated ten-item risk of bias tool for disease prevalence. The main outcome of interest was the proportion of COVID-19 patients with bloodstream and/or respiratory bacterial co-infection and secondary infection. We performed meta-regression to identify study population factors associated with bacterial infection including healthcare setting, age, comorbidities and COVID-19 medication. Results Out of 33 345 studies screened, 171 were included in the final analysis. Bacterial infection data were available from 171 262 patients. The prevalence of co-infection was 5.1% (95% CI 3.6–7.1%) and secondary infection was 13.1% (95% CI 9.8–17.2%). There was a higher odds of bacterial infection in studies with a higher proportion of patients in the intensive care unit (ICU) (adjusted OR 18.8, 95% CI 6.5–54.8). Female sex was associated with a lower odds of secondary infection (adjusted OR 0.73, 95% CI 0.55–0.97) but not co-infection (adjusted OR 1.05, 95% CI 0.80–1.37). The most common organisms isolated included Staphylococcus aureus, coagulase-negative staphylococci and Klebsiella species. Conclusions While the odds of respiratory and bloodstream bacterial infection are low in patients with COVID-19, meta-regression revealed potential risk factors for infection, including ICU setting and mechanical ventilation. The risk for secondary infection is substantially greater than the risk for co-infection in patients with COVID-19. Understanding predictors of co-infection and secondary infection may help to support improved antibiotic stewardship in patients with COVID-19.
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Affiliation(s)
- Bradley J Langford
- Public Health Ontario, ON, Canada; Hotel Dieu Shaver Health and Rehabilitation Centre, ON, Canada.
| | - Miranda So
- Sinai Health-University Health Network Antimicrobial Stewardship Program, University Health Network, Toronto, Canada; University of Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada
| | - Valerie Leung
- Public Health Ontario, ON, Canada; Toronto East Health Network, Michael Garron Hospital, ON Canada
| | | | - Jennifer Lo
- Sunnybrook Health Sciences Centre, ON, Canada
| | - Tiffany Kan
- Toronto East Health Network, Michael Garron Hospital, ON Canada
| | | | | | - Nick Daneman
- Public Health Ontario, ON, Canada; University of Toronto, ON, Canada; Sunnybrook Health Sciences Centre, ON, Canada; Sunnybrook Research Institute, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), ON Canada
| | | | - Jean-Paul R Soucy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, ON, Canada
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Borges MASB, Guilarde AO, Tomich LGMDM, Turchi MD. Clinical practice in COVID-19: The most frequently asked questions to infectious diseases specialists. Braz J Infect Dis 2021; 25:101648. [PMID: 34793712 PMCID: PMC8572702 DOI: 10.1016/j.bjid.2021.101648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/28/2021] [Accepted: 10/17/2021] [Indexed: 12/15/2022] Open
Abstract
Since the emergence of the disease caused by the severe respiratory syndrome coronavirus 2 (SARS-CoV-2) - COVID-19 - in late December 2019, a vast number of publications on the subject appeared in peer-reviewed journals and preprints. Despite the significant amount of available information, infectious disease physicians are requested to solve questions from colleagues, patients, and relatives on a daily basis. Here, we aim to describe the evidence supporting the answers for frequently asked questions, based on a literature review. We created a web-based questionnaire which was distributed to a group of 70 infectious disease specialists and medical residents, asking what questions and issues they most frequently faced. The 10 most frequent questions guided the topics for a narrative review. We provide evidence and consensus-based information on subjects such as infection and transmission, isolation, management of COVID-19 confirmed cases, reinfection, clinical-therapeutic management, vaccination, and antibodies post-infection/vaccination. Correctly clarifying doubts and providing clear information to physicians, patients, and family members helps to better manage COVID-19 in the community and the hospital settings.
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Affiliation(s)
- Moara Alves Santa Bárbara Borges
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil; Serviço de Infectologia, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, GO, Brazil.
| | - Adriana Oliveira Guilarde
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil; Serviço de Infectologia, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, GO, Brazil; Centro de Reabilitação e Readaptação Dr. Henrique Santillo-CRER, Goiânia, GO, Brazil
| | - Lísia Gomes Martins de Moura Tomich
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil; Hospital Estadual de Doenças Tropicais, Goiânia, GO, Brazil; Universidade de Rio Verde - campus Aparecida de Goiânia, Aparecida de Goiânia, GO, Brazil
| | - Marília Dalva Turchi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, GO, Brazil
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Pérez-Lazo G, Silva-Caso W, del Valle-Mendoza J, Morales-Moreno A, Ballena-López J, Soto-Febres F, Martins-Luna J, Carrillo-Ng H, del Valle LJ, Kym S, Aguilar-Luis MA, Peña-Tuesta I, Tinco-Valdez C, Illescas LR. Identification of Coinfections by Viral and Bacterial Pathogens in COVID-19 Hospitalized Patients in Peru: Molecular Diagnosis and Clinical Characteristics. Antibiotics (Basel) 2021; 10:1358. [PMID: 34827296 PMCID: PMC8615059 DOI: 10.3390/antibiotics10111358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 01/14/2023] Open
Abstract
The impact of respiratory coinfections in COVID-19 is still not well understood despite the growing evidence that consider coinfections greater than expected. A total of 295 patients older than 18 years of age, hospitalized with a confirmed diagnosis of moderate/severe pneumonia due to SARS-CoV-2 infection (according to definitions established by the Ministry of Health of Peru) were enrolled during the study period. A coinfection with one or more respiratory pathogens was detected in 154 (52.2%) patients at hospital admission. The most common coinfections were Mycoplasma pneumoniae (28.1%), Chlamydia pneumoniae (8.8%) and with both bacteria (11.5%); followed by Adenovirus (1.7%), Mycoplasma pneumoniae/Adenovirus (0.7%), Chlamydia pneumoniae/Adenovirus (0.7%), RSV-B/Chlamydia pneumoniae (0.3%) and Mycoplasma pneumoniae/Chlamydia pneumoniae/Adenovirus (0.3%). Expectoration was less frequent in coinfected individuals compared to non-coinfected (5.8% vs. 12.8%). Sepsis was more frequent among coinfected patients than non-coinfected individuals (33.1% vs. 20.6%) and 41% of the patients who received macrolides empirically were PCR-positive for Mycoplasma pneumoniae and Chlamydia pneumoniae.
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Affiliation(s)
- Giancarlo Pérez-Lazo
- Division of Infectious Diseases, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (A.M.-M.); (J.B.-L.); (F.S.-F.); (L.R.I.)
| | - Wilmer Silva-Caso
- Centre of Research and Innovation, Faculty of Health Sciences, School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru; (H.C.-N.); (M.A.A.-L.); (I.P.-T.); (C.T.-V.)
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima 15024, Peru;
| | - Juana del Valle-Mendoza
- Centre of Research and Innovation, Faculty of Health Sciences, School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru; (H.C.-N.); (M.A.A.-L.); (I.P.-T.); (C.T.-V.)
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima 15024, Peru;
| | - Adriana Morales-Moreno
- Division of Infectious Diseases, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (A.M.-M.); (J.B.-L.); (F.S.-F.); (L.R.I.)
| | - José Ballena-López
- Division of Infectious Diseases, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (A.M.-M.); (J.B.-L.); (F.S.-F.); (L.R.I.)
| | - Fernando Soto-Febres
- Division of Infectious Diseases, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (A.M.-M.); (J.B.-L.); (F.S.-F.); (L.R.I.)
| | - Johanna Martins-Luna
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima 15024, Peru;
- Facultad de Ciencias de la Salud, Universidad Tecnológica del Perú, Lima 15046, Peru
| | - Hugo Carrillo-Ng
- Centre of Research and Innovation, Faculty of Health Sciences, School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru; (H.C.-N.); (M.A.A.-L.); (I.P.-T.); (C.T.-V.)
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima 15024, Peru;
| | - Luís J. del Valle
- Barcelona Research Center for Multiscale Science and Engineering, Departament d’Enginyeria Química, EEBE, Universitat Politècnica de Catalunya (UPC), 08034 Barcelona, Spain;
| | - Sungmin Kym
- Korea International Cooperation for Infectious Diseases, Chungnam National University College of Medicine, Daejeon 305764, Korea;
| | - Miguel Angel Aguilar-Luis
- Centre of Research and Innovation, Faculty of Health Sciences, School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru; (H.C.-N.); (M.A.A.-L.); (I.P.-T.); (C.T.-V.)
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima 15024, Peru;
| | - Issac Peña-Tuesta
- Centre of Research and Innovation, Faculty of Health Sciences, School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru; (H.C.-N.); (M.A.A.-L.); (I.P.-T.); (C.T.-V.)
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima 15024, Peru;
| | - Carmen Tinco-Valdez
- Centre of Research and Innovation, Faculty of Health Sciences, School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru; (H.C.-N.); (M.A.A.-L.); (I.P.-T.); (C.T.-V.)
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima 15024, Peru;
| | - Luis Ricardo Illescas
- Division of Infectious Diseases, Guillermo Almenara Irigoyen National Hospital-EsSalud, Lima 15033, Peru; (A.M.-M.); (J.B.-L.); (F.S.-F.); (L.R.I.)
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Avila WS, Kirschbaum M, Devido MS, Demarchi LMMF. COVID-19, congenital heart disease, and pregnancy: dramatic conjunction-case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab291. [PMID: 34729452 PMCID: PMC8557342 DOI: 10.1093/ehjcr/ytab291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/12/2021] [Accepted: 07/05/2021] [Indexed: 11/12/2022]
Abstract
Background Epidemiological data from the COVID-19 pandemic report that patients with pre-existing cardiovascular disease have worse outcomes and higher mortality, and that pregnant women should be considered at high risk. Case summary A 25-year-old pregnant woman on the waiting list for a heart transplant, with a history of complete atrioventricular canal surgery, mitral mechanical prosthetic implant (St Jude-27), and cardiac resynchronization therapy (Boston Scientific) was hospitalized at 30 weeks of gestation for treatment of heart failure. After 7 days of hospitalization, she had a positive RT–PCR test for severe acute respiratory syndrome coronavirus 2 with progressive worsening of her clinical condition and acute foetal distress. Hence emergency caesarean section was performed. After the birth, the patient required mechanical ventilation, progressing to multiple organ system failures. Conventional inotropic drugs, antibiotics, and mechanical ventilation for 30 days in the intensive care unit provided significant clinical, haemodynamic, and respiratory improvement. However, on the 37th day, she suddenly experienced respiratory failure, gastrointestinal and airway bleeding, culminating in death. Discussion Progressive physiological changes during pregnancy cause cardiovascular complications in women with severe heart disease and higher susceptibility to viral infection and severe pneumonia. COVID-19 is known to incite an intense inflammatory and prothrombotic response with clinical expression of severe acute respiratory syndrome, heart failure, and thromboembolic events. The overlap of these COVID-19 events with those of pregnancy in this woman with underlying heart disease contributed to an unfortunate outcome and maternal death.
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Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração do Hospital das Clínicas da, Faculdade de Medicina da Universidade de São Paulo, Rua Eneas Carvalho de Aguiar 44, Cerqueira Cesar, São Paulo, SP CEP 05403-000, Brazil
| | - Marcelo Kirschbaum
- Instituto do Coração do Hospital das Clínicas da, Faculdade de Medicina da Universidade de São Paulo, Rua Eneas Carvalho de Aguiar 44, Cerqueira Cesar, São Paulo, SP CEP 05403-000, Brazil
| | - Marcela Santana Devido
- Instituto do Coração do Hospital das Clínicas da, Faculdade de Medicina da Universidade de São Paulo, Rua Eneas Carvalho de Aguiar 44, Cerqueira Cesar, São Paulo, SP CEP 05403-000, Brazil
| | - Lea Maria Macruz Ferreira Demarchi
- Instituto do Coração do Hospital das Clínicas da, Faculdade de Medicina da Universidade de São Paulo, Rua Eneas Carvalho de Aguiar 44, Cerqueira Cesar, São Paulo, SP CEP 05403-000, Brazil
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Fouka E, Kalomenidis I, Gianniou N, Gida S, Steiropoulos P. COVID-19 Advanced Care. J Pers Med 2021; 11:1082. [PMID: 34834434 PMCID: PMC8621119 DOI: 10.3390/jpm11111082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/10/2021] [Accepted: 10/22/2021] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, related to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial burden in public health due to an enormous increase in hospitalizations for pneumonia with the multiorgan disease. Treatment for individuals with COVID-19 includes best practices for supportive management of acute hypoxic respiratory failure. Emerging data indicate that dexamethasone therapy reduces 28-day mortality in patients requiring supplemental oxygen compared with usual care, and ongoing trials are testing the efficacy of antiviral therapies, immune modulators and anticoagulants in the prevention of disease progression and complications, while monoclonal antibodies and hyperimmune globulin may provide additional preventive strategies. Consensus suggestions can standardize care, thereby improving outcomes and facilitating future research. This review discusses current evidence regarding the pharmacotherapy of COVID-19.
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Affiliation(s)
- Evangelia Fouka
- Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, 57010 Thessaloniki, Greece
| | - Ioannis Kalomenidis
- 1st Department of Critical Care and Pulmonary Medicine, Evaggelismos Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece; (I.K.); (N.G.)
| | - Niki Gianniou
- 1st Department of Critical Care and Pulmonary Medicine, Evaggelismos Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece; (I.K.); (N.G.)
| | - Sofia Gida
- Intensive Care Unit, General Hospital of Trikala, 42100 Trikala, Greece;
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, 67100 Alexandroupolis, Greece;
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Bogdanová K, Doubravská L, Vágnerová I, Hricová K, Pudová V, Röderová M, Papajk J, Uvízl R, Langová K, Kolář M. Clostridioides difficile and Vancomycin-Resistant Enterococci in COVID-19 Patients with Severe Pneumonia. Life (Basel) 2021; 11:life11111127. [PMID: 34833003 PMCID: PMC8653967 DOI: 10.3390/life11111127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023] Open
Abstract
Broad-spectrum antibiotics administered to patients with severe COVID-19 pneumonia pose a risk of infection caused by Clostridioides difficile. This risk is reduced mainly by strict hygiene measures and early de-escalation of antibiotic therapy. Recently, oral vancomycin prophylaxis (OVP) has also been discussed. This retrospective study aimed to assess the prevalence of C. difficile in critical COVID-19 patients staying in an intensive care unit of a tertiary hospital department of anesthesiology, resuscitation, and intensive care from November 2020 to May 2021 and the rates of vancomycin-resistant enterococci (VRE) after the introduction of OVP and to compare the data with those from controls in the pre-pandemic period (November 2018 to May 2019). During the COVID-19 pandemic, there was a significant increase in toxigenic C. difficile rates to 12.4% of patients, as compared with 1.6% in controls. The peak rates were noted in February 2021 (25% of patients), immediately followed by initiation of OVP, changes to hygiene precautions, and more rapid de-escalation of antibiotic therapy. Subsequently, toxigenic C. difficile detection rates started to fall. There was a nonsignificant increase in VRE detected in non-gastrointestinal tract samples to 8.9% in the COVID-19 group, as compared to 5.3% in the control group. Molecular analysis confirmed mainly clonal spread of VRE.
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Affiliation(s)
- Kateřina Bogdanová
- Department of Microbiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (K.B.); (I.V.); (M.K.)
| | - Lenka Doubravská
- Department of Anesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (J.P.); (R.U.)
- Correspondence: ; Tel.: +420-588-445-979
| | - Iva Vágnerová
- Department of Microbiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (K.B.); (I.V.); (M.K.)
| | - Kristýna Hricová
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic; (K.H.); (V.P.); (M.R.)
| | - Vendula Pudová
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic; (K.H.); (V.P.); (M.R.)
| | - Magdaléna Röderová
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic; (K.H.); (V.P.); (M.R.)
| | - Jan Papajk
- Department of Anesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (J.P.); (R.U.)
| | - Radovan Uvízl
- Department of Anesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (J.P.); (R.U.)
| | - Kateřina Langová
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic;
| | - Milan Kolář
- Department of Microbiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (K.B.); (I.V.); (M.K.)
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Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review. Viruses 2021; 13:v13112110. [PMID: 34834917 PMCID: PMC8624326 DOI: 10.3390/v13112110] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 01/08/2023] Open
Abstract
Antimicrobial resistance is an urgent threat to public health and global development; in this scenario, the SARS-CoV2 pandemic has caused a major disruption of healthcare systems and practices. A narrative review was conducted on articles focusing on the impact of COVID-19 on multidrug-resistant gram-negative, gram-positive bacteria, and fungi. We found that, worldwide, multiple studies reported an unexpected high incidence of infections due to methicillin-resistant S. aureus, carbapenem-resistant A. baumannii, carbapenem-resistant Enterobacteriaceae, and C. auris among COVID-19 patients admitted to the intensive care unit. In this setting, inappropriate antimicrobial exposure, environmental contamination, and discontinuation of infection control measures may have driven selection and diffusion of drug-resistant pathogens.
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70
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Tomczyk S, Taylor A, Brown A, de Kraker MEA, El-Saed A, Alshamrani M, Hendriksen RS, Jacob M, Löfmark S, Perovic O, Shetty N, Sievert D, Smith R, Stelling J, Thakur S, Vietor AC, Eckmanns T. Impact of the COVID-19 pandemic on the surveillance, prevention and control of antimicrobial resistance: a global survey. J Antimicrob Chemother 2021; 76:3045-3058. [PMID: 34473285 PMCID: PMC8499888 DOI: 10.1093/jac/dkab300] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Surveillance and Quality Assessment Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control. METHODS From October to December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) national focal points completed a questionnaire, including Likert scales and open-ended questions. Data were descriptively analysed, income/regional differences were assessed and free-text questions were thematically analysed. RESULTS Seventy-three countries across income levels participated. During the COVID-19 pandemic, 67% reported limited ability to work with AMR partnerships; decreases in funding were frequently reported by low- and middle-income countries (LMICs; P < 0.01). Reduced availability of nursing, medical and public health staff for AMR was reported by 71%, 69% and 64%, respectively, whereas 67% reported stable cleaning staff availability. The majority (58%) reported reduced reagents/consumables, particularly LMICs (P < 0.01). Decreased numbers of cultures, elective procedures, chronically ill admissions and outpatients and increased ICU admissions reported could bias AMR data. Reported overall infection prevention and control (IPC) improvement could decrease AMR rates, whereas increases in selected inappropriate IPC practices and antimicrobial prescribing could increase rates. Most did not yet have complete data on changing AMR rates due to COVID-19. CONCLUSIONS This was the first survey to explore the global impact of COVID-19 on AMR among GLASS countries. Responses highlight important actions to help ensure that AMR remains a global health priority, including engaging with GLASS to facilitate reliable AMR surveillance data, seizing the opportunity to develop more sustainable IPC programmes, promoting integrated antibiotic stewardship guidance, leveraging increased laboratory capabilities and other system-strengthening efforts.
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Affiliation(s)
- Sara Tomczyk
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
| | - Angelina Taylor
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
| | - Allison Brown
- Centers for Disease Control and Prevention, WHO Collaborating Centre for International Monitoring of Bacterial Resistance to Antimicrobial Agents, Atlanta, GA, USA
| | - Marlieke E A de Kraker
- Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety, Geneva, Switzerland
| | - Aiman El-Saed
- King Abdulaziz Medical City, WHO Collaborating Centre for Infection Prevention and Control and Anti-Microbial, Riyadh, Saudi Arabia
| | - Majid Alshamrani
- King Abdulaziz Medical City, WHO Collaborating Centre for Infection Prevention and Control and Anti-Microbial, Riyadh, Saudi Arabia
| | - Rene S Hendriksen
- Technical University of Denmark, National Food Institute, WHO Collaborating Centre for Antimicrobial Resistance in Foodborne Pathogens and Genomics, Kongens Lyngby, Denmark
| | - Megan Jacob
- College of Veterinary Medicine, North Carolina State University, WHO Collaborating Centre for Global One Health and Antimicrobial Resistance Initiatives, Raleigh, NC, USA
| | - Sonja Löfmark
- Public Health Agency of Sweden, WHO Collaborating Centre for Antimicrobial Resistance Containment, Stockholm, Sweden
| | - Olga Perovic
- National Institute for Communicable Diseases and School of Pathology at University of Witwatersrand, WHO Collaborating Centre for Antimicrobial Resistance, Johannesburg, South Africa
| | - Nandini Shetty
- National Infection Service Laboratories, Public Health England, WHO Collaborating Centre for Reference & Research on Antimicrobial Resistance and Healthcare Associated Infections, London, UK
| | - Dawn Sievert
- Centers for Disease Control and Prevention, WHO Collaborating Centre for International Monitoring of Bacterial Resistance to Antimicrobial Agents, Atlanta, GA, USA
| | - Rachel Smith
- Centers for Disease Control and Prevention, WHO Collaborating Centre for International Monitoring of Bacterial Resistance to Antimicrobial Agents, Atlanta, GA, USA
| | - John Stelling
- Brigham and Women’s Hospital, WHO Collaborating Centre for Surveillance of Antimicrobial Resistance, Boston, MA, USA
| | - Siddhartha Thakur
- College of Veterinary Medicine, North Carolina State University, WHO Collaborating Centre for Global One Health and Antimicrobial Resistance Initiatives, Raleigh, NC, USA
| | - Ann Christin Vietor
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
| | - Tim Eckmanns
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
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Schons MJ, Caliebe A, Spinner CD, Classen AY, Pilgram L, Ruethrich MM, Rupp J, Nunes de Miranda S, Römmele C, Vehreschild J, Jensen BE, Vehreschild M, Degenhardt C, Borgmann S, Hower M, Hanses F, Haselberger M, Friedrichs AK. All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy: an analysis of the LEOSS cohort. Infection 2021; 50:423-436. [PMID: 34625912 PMCID: PMC8500268 DOI: 10.1007/s15010-021-01699-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022]
Abstract
Purpose Reported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary. Methods 6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account. Results Three thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase (n = 996) (both p > 0.05). For the secondary endpoints, patients in the uncomplicated phase (n = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics (p > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment (n = 286) had a significantly increased all-cause mortality (p = 0.029) but no significantly different probability of progression to the critical phase (p > 0.05). Conclusion In this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.
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Affiliation(s)
- Maximilian J Schons
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Amke Caliebe
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,Kiel University, Kiel, Germany
| | - Christoph D Spinner
- School of Medicine, Department of Internal Medicine II, Technical University of Munich, University Hospital Rechts Der Isar, Munich, Germany
| | - Annika Y Classen
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Lisa Pilgram
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Maria M Ruethrich
- Institute for Infection Medicine and Hospital Hygiene, University Hospital Jena, Jena, Germany
| | - Jan Rupp
- University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - Christoph Römmele
- Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Janne Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Bjoern-Erik Jensen
- Clinic for Gastroenterology, Hepatology and Infectiology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Maria Vehreschild
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | | | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | - Martin Hower
- Department of Pneumology, Infectious Diseases and Intensive Care, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Frank Hanses
- Interdisciplinary Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | | | - Anette K Friedrichs
- Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Robba C, Battaglini D, Ball L, Pelosi P, Rocco PR. Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19. Expert Rev Respir Med 2021; 15:1293-1302. [PMID: 33734900 PMCID: PMC8040493 DOI: 10.1080/17476348.2021.1906226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/17/2021] [Indexed: 02/08/2023]
Abstract
Introduction: The ongoing pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed important challenges for clinicians and health-care systems worldwide.Areas covered: The aim of this manuscript is to provide brief guidance for intensive care unit management of mechanically ventilated patients with COVID-19 based on the literature and our direct experience with this population. PubMed, EBSCO, and the Cochrane Library were searched up until 15th of January 2021 for relevant literature.Expert opinion: Initially, the respiratory management of COVID-19 relied on the general therapeutic principles for acute respiratory distress syndrome; however, recent findings have suggested that the pathophysiology of hypoxemia in patients with COVID-19 presents specific features and changes over time. Several therapies, including antiviral and anti-inflammatory agents, have been proposed recently. The optimal intensive care unit management of patients with COVID-19 remains unclear; therefore, ongoing and future clinical trials are warranted to clarify the optimal strategies to adopt in this cohort of patients.
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Affiliation(s)
- Chiara Robba
- Policlinico San Martino, IRCCS per l’Oncologia e Neuroscienze, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy
| | - Denise Battaglini
- Dipartimento di Anestesia e Rianimazione, Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze, Genoa, Italy
| | - Lorenzo Ball
- Policlinico San Martino, IRCCS per l’Oncologia e Neuroscienze, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy
| | - Paolo Pelosi
- Policlinico San Martino, IRCCS per l’Oncologia e Neuroscienze, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy
| | - Patricia R.M. Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- COVID-19 Virus Network from Ministry of Science, Technology, and Innovation, Brazilian Council for Scientific and Technological Development, and Foundation Carlos Chagas Filho Research Support of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Jagiasi B, Nasa P, Chanchalani G, Ahmed A, AK AK, Sodhi K, Mangal K, Singh MK, Gupta N, Bidkar PU, Tyagi RS, Khanikar RG, Tripathy S, Khanzode S, Subba Reddy K, Saigal S, Sivakumar VA, Javeri Y, Tekwani SS. Variation in therapeutic strategies for the management of severe COVID-19 in India: A nationwide cross-sectional survey. Int J Clin Pract 2021; 75:e14574. [PMID: 34171154 PMCID: PMC8420329 DOI: 10.1111/ijcp.14574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 02/05/2023] Open
Abstract
AIM During the pandemic of coronavirus disease 2019 (COVID-19), the physicians are using various off-label therapeutics to manage COVID-19. We undertook a cross-sectional survey to study the current variation in therapeutic strategies for managing severe COVID-19 in India. METHODS From January 4 to January 18, 2021, an online cross-sectional survey was conducted among physicians involved in the management of severe COVID-19. The survey had three sections: 1. Antiviral agents, 2. Immunomodulators, and 3. Adjuvant therapies. RESULTS 1055 respondents (from 24 states and five union territories), of which 64.2% were consultants, 54.3% working in private hospitals, and 39.1% were from critical care medicine completed the survey. Remdesivir (95.2%), antithrombotics (94.2%), corticosteroids (90.3%), vitamins (89.7%) and empirical antibiotics (85.6%) were the commonly used therapeutics. Ivermectin (33%), convalescent plasma (28.6%) and favipiravir (17.6%) were other antiviral agents used. Methylprednisolone (50.2%) and dexamethasone (44.1%) were preferred corticosteroids and at a dose equivalent of 8 mg of dexamethasone phosphate (70.2%). There was significant variation among physicians from different medical specialities in the use of favipiravir, corticosteroids, empirical antibiotics and vitamins. CONCLUSION There is a considerable variation in the physicians' choice of therapeutic strategies for the management of severe COVID-19 in India, as compared with the available evidence.
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Affiliation(s)
- Bharat Jagiasi
- Critical Care DepartmentReliance HospitalNavi MumbaiMaharashtraIndia
| | - Prashant Nasa
- Critical Care MedicineNMC Specialty HospitalDubaiUnited Arab Emirates
| | | | - Ahsan Ahmed
- Anesthesiology and Critical CareKPC Medical College and HospitalKolkataWest BengalIndia
| | - Ajith Kumar AK
- Critical Care MedicineManipal HospitalsBengaluruKarnatakaIndia
| | | | | | - Manoj K. Singh
- Critical Care & Sleep MedicineApollo HospitalAhmedabadGujaratIndia
| | - Nitesh Gupta
- Department of PulmonaryCritical Care and Sleep MedicineVMMC and Safdarjung HospitalNew DelhiIndia
| | - Prasanna U. Bidkar
- Department of Anaesthesiology and Critical CareJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia
| | - Ranvir S. Tyagi
- Department of Anaesthesia and Critical Care MedicineSynergy Plus HospitalAgraUttar PradeshIndia
| | - Reshu G. Khanikar
- Department of Critical Care MedicineHealth City HospitalGuwahatiAssamIndia
| | - Swagata Tripathy
- Anesthesia & Intensive CareAll India Institute of Medical SciencesBhubaneswarOdishaIndia
| | - Swapna Khanzode
- Medicine and Critical CareWockhardt Multispecialty HospitalNagpurMaharashtraIndia
| | | | - Saurabh Saigal
- Anaesthesia and Intensive CareAll India Institute of Medical SciencesBhopalMadhya PradeshIndia
| | | | - Yash Javeri
- Critical Care Medicine and Emergency MedicineRegency Super Specialty HospitalLucknowUttar PradeshIndia
| | - Seema S. Tekwani
- Division of Pulmonary, Allergy, Critical Care and Sleep MedicineEmory University School of MedicineAtlantaGAUSA
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Antibiotic Prescriptions Targeting Bacterial Respiratory Infections in Admitted Patients with COVID-19: A Prospective Observational Study. Infect Dis Ther 2021; 10:2575-2591. [PMID: 34529255 PMCID: PMC8444524 DOI: 10.1007/s40121-021-00535-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Although bacterial co- and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19. Methods In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of an antibiotic prescription in patients with a confirmed COVID-19 diagnosis. Results Of 403 eligible participants with a suspected COVID-19 infection, 281 were included. In 13.8% of the 203 admissions with a COVID-19 confirmed diagnosis, antibiotics were initiated for a (presumed) bacterial respiratory tract co-/superinfection (0.86 DDD/admission; 8.92 DDD/100 bed days; 39.4% were scored as ‘appropriate’). Five drivers of antibiotic prescribing were identified: history of cerebrovascular disease, high neutrophil/lymphocyte ratio in male patients, age, elevated ferritin levels and the collection of respiratory samples for bacteriological analysis. Conclusion In the studied population, the antibiotic consumption for a (presumed) bacterial respiratory tract co-/superinfection was low. In particular, the small total number of DDDs in patients with confirmed COVID-19 diagnosis suggests thoughtful antibiotic use. However, antibiotic stewardship programmes remain crucial to counter unnecessary and inappropriate antibiotic use in hospitalized patients with COVID-19. Trial Registration The study is registered at ClinicalTrials.gov (NCT04544072). Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00535-2.
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Sars-Cov-2 Infection in Patients on Long-Term Treatment with Macrolides in Spain: A National Cross-Sectional Study. Antibiotics (Basel) 2021; 10:antibiotics10091039. [PMID: 34572621 PMCID: PMC8468207 DOI: 10.3390/antibiotics10091039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to know the prevalence and severity of COVID-19 in patients treated with long-term macrolides and to describe the factors associated with worse outcomes. A cross-sectional study was conducted in Primary Care setting. Patients with macrolides dispensed continuously from 1 October 2019 to 31 March 2020, were considered. Main outcome: diagnosis of coronavirus disease-19 (COVID-19). Secondary outcomes: symptoms, severity, characteristics of patients, comorbidities, concomitant treatments. A total of 3057 patients met the inclusion criteria. Median age: 73 (64–81) years; 55% were men; 62% smokers/ex-smokers; 56% obese/overweight. Overall, 95% of patients had chronic respiratory diseases and four comorbidities as a median. Prevalence of COVID-19: 4.8%. This was in accordance with official data during the first wave of the pandemic. The most common symptoms were respiratory: shortness of breath, cough, and pneumonia. Additionally, 53% percent of patients had mild/moderate symptoms, 28% required hospital admission, and 19% died with COVID-19. The percentage of patients hospitalized and deaths were 2.6 and 5.8 times higher, respectively, in the COVID-19 group (p < 0.001). There was no evidence of a beneficial effect of long-term courses of macrolides in preventing SARS-CoV-2 infection or the progression to worse outcomes in old patients with underlying chronic respiratory diseases and a high burden of comorbidity.
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Russell CD, Fairfield CJ, Drake TM, Turtle L, Seaton RA, Wootton DG, Sigfrid L, Harrison EM, Docherty AB, de Silva TI, Egan C, Pius R, Hardwick HE, Merson L, Girvan M, Dunning J, Nguyen-Van-Tam JS, Openshaw PJM, Baillie JK, Semple MG, Ho A. Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study. THE LANCET. MICROBE 2021; 2:e354-e365. [PMID: 34100002 PMCID: PMC8172149 DOI: 10.1016/s2666-5247(21)00090-2] [Citation(s) in RCA: 200] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Microbiological characterisation of co-infections and secondary infections in patients with COVID-19 is lacking, and antimicrobial use is high. We aimed to describe microbiologically confirmed co-infections and secondary infections, and antimicrobial use, in patients admitted to hospital with COVID-19. METHODS The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study is an ongoing, prospective cohort study recruiting inpatients from 260 hospitals in England, Scotland, and Wales, conducted by the ISARIC Coronavirus Clinical Characterisation Consortium. Patients with a confirmed or clinician-defined high likelihood of SARS-CoV-2 infection were eligible for inclusion in the ISARIC WHO CCP-UK study. For this specific study, we excluded patients with a recorded negative SARS-CoV-2 test result and those without a recorded outcome at 28 days after admission. Demographic, clinical, laboratory, therapeutic, and outcome data were collected using a prespecified case report form. Organisms considered clinically insignificant were excluded. FINDINGS We analysed data from 48 902 patients admitted to hospital between Feb 6 and June 8, 2020. The median patient age was 74 years (IQR 59-84) and 20 786 (42·6%) of 48 765 patients were female. Microbiological investigations were recorded for 8649 (17·7%) of 48 902 patients, with clinically significant COVID-19-related respiratory or bloodstream culture results recorded for 1107 patients. 762 (70·6%) of 1080 infections were secondary, occurring more than 2 days after hospital admission. Staphylococcus aureus and Haemophilus influenzae were the most common pathogens causing respiratory co-infections (diagnosed ≤2 days after admission), with Enterobacteriaceae and S aureus most common in secondary respiratory infections. Bloodstream infections were most frequently caused by Escherichia coli and S aureus. Among patients with available data, 13 390 (37·0%) of 36 145 had received antimicrobials in the community for this illness episode before hospital admission and 39 258 (85·2%) of 46 061 patients with inpatient antimicrobial data received one or more antimicrobials at some point during their admission (highest for patients in critical care). We identified frequent use of broad-spectrum agents and use of carbapenems rather than carbapenem-sparing alternatives. INTERPRETATION In patients admitted to hospital with COVID-19, microbiologically confirmed bacterial infections are rare, and more likely to be secondary infections. Gram-negative organisms and S aureus are the predominant pathogens. The frequency and nature of antimicrobial use are concerning, but tractable targets for stewardship interventions exist. FUNDING National Institute for Health Research (NIHR), UK Medical Research Council, Wellcome Trust, UK Department for International Development, Bill & Melinda Gates Foundation, EU Platform for European Preparedness Against (Re-)emerging Epidemics, NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool, and NIHR HPRU in Respiratory Infections at Imperial College London.
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Affiliation(s)
- Clark D Russell
- University of Edinburgh Centre for Inflammation Research, Edinburgh, UK
- Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, UK
| | - Cameron J Fairfield
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Drake
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lance Turtle
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - R Andrew Seaton
- Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK
| | - Dan G Wootton
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thushan I de Silva
- South Yorkshire Regional Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, UK
| | - Conor Egan
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Riinu Pius
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Hayley E Hardwick
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Laura Merson
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michelle Girvan
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Jake Dunning
- Emerging Infections and Zoonoses Unit, National Infection Service, Public Health England, Colindale, London, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
- UK Department of Health and Social Care, London, UK
| | | | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh, UK
| | - Malcolm G Semple
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Antonia Ho
- Medical Research Council—University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
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Impact of Pneumococcal Urinary Antigen Testing in COVID-19 Patients: Outcomes from the San Matteo COVID-19 Registry (SMACORE). J Pers Med 2021; 11:jpm11080762. [PMID: 34442406 PMCID: PMC8401143 DOI: 10.3390/jpm11080762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022] Open
Abstract
Despite low rates of bacterial co-infections, most COVID-19 patients receive antibiotic therapy. We hypothesized that patients with positive pneumococcal urinary antigens (PUAs) would benefit from antibiotic therapy in terms of clinical outcomes (death, ICU admission, and length of stay). The San Matteo COVID-19 Registry (SMACORE) prospectively enrolls patients admitted for COVID-19 pneumonia at IRCCS Policlinico San Matteo, Pavia. We retrospectively extracted the data of patients tested for PUA from October to December 2020. Demographic, clinical, and laboratory data were recorded. Of 469 patients, 42 tested positive for PUA (8.95%), while 427 (91.05%) tested negative. A positive PUA result had no significant impact on death (HR 0.53 CI [0.22-1.28] p-value 0.16) or ICU admission (HR 0.8; CI [0.25-2.54] p-value 0.70) in the Cox regression model, nor on length of stay in linear regression (estimate 1.71; SE 2.37; p-value 0.47). After adjusting for age, we found no significant correlation between urinary antigen positivity and variations in the WHO ordinal scale and laboratory markers at admission and after 14 days. We found that a positive PUA result was not frequent and had no impact on clinical outcomes or clinical improvement. Our results did not support the routine use of PUA tests to select COVID-19 patients who will benefit from antibiotic therapy.
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Venzon M, Bernard-Raichon L, Klein J, Axelrad J, Hussey G, Sullivan A, Casanovas-Massana A, Noval M, Valero-Jimenez A, Gago J, Wilder E, Team YIR, Iwasaki A, Thorpe L, Littman D, Dittmann M, Stapleford K, Shopsin B, Torres V, Ko A, Cadwell K, Schluter J. Gut microbiome dysbiosis during COVID-19 is associated with increased risk for bacteremia and microbial translocation. RESEARCH SQUARE 2021. [PMID: 34341786 PMCID: PMC8328072 DOI: 10.21203/rs.3.rs-726620/v1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The microbial populations in the gut microbiome have recently been associated with COVID-19 disease severity. However, a causal impact of the gut microbiome on COVID-19 patient health has not been established. Here we provide evidence that gut microbiome dysbiosis is associated with translocation of bacteria into the blood during COVID-19, causing life-threatening secondary infections. Antibiotics and other treatments during COVID-19 can potentially confound microbiome associations. We therefore first demonstrate that the gut microbiome is directly affected by SARS-CoV-2 infection in a dose-dependent manner in a mouse model, causally linking viral infection and gut microbiome dysbiosis. Comparison with stool samples collected from 101 COVID-19 patients at two different clinical sites also revealed substantial gut microbiome dysbiosis, paralleling our observations in the animal model. Specifically, we observed blooms of opportunistic pathogenic bacterial genera known to include antimicrobial-resistant species in hospitalized COVID-19 patients. Analysis of blood culture results testing for secondary microbial bloodstream infections with paired microbiome data obtained from these patients suggest that bacteria translocate from the gut into the systemic circulation of COVID-19 patients. These results are consistent with a direct role for gut microbiome dysbiosis in enabling dangerous secondary infections during COVID-19.
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79
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Kaal A, Snel L, Dane M, van Burgel N, Ottens T, Broekman W, El Bouazzaoui L, Kolfschoten N, Schippers E, Steyerberg E, Meziyerh S, van Nieuwkoop C. Diagnostic yield of bacteriological tests and predictors of severe outcome in adult patients with COVID-19 presenting to the emergency department. Emerg Med J 2021; 38:685-691. [PMID: 34289966 PMCID: PMC8300553 DOI: 10.1136/emermed-2020-211027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/11/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Guidelines recommend maximal efforts to obtain blood and sputum cultures in patients with COVID-19, as bacterial coinfection is associated with worse outcomes. The aim of this study was to evaluate the yield of bacteriological tests, including blood and sputum cultures, and the association of multiple biomarkers and the Pneumonia Severity Index (PSI) with clinical and microbiological outcomes in patients with COVID-19 presenting to the emergency department (ED). METHODS This is a substudy of a large observational cohort study (PredictED study). The PredictED included adult patients from whom a blood culture was drawn at the ED of Haga Teaching Hospital, The Netherlands. For this substudy, all patients who tested positive for SARS-CoV-2 by PCR in March and April 2020 were included. The primary outcome was the incidence of bacterial coinfection. We used logistic regression analysis for associations of procalcitonin, C reactive protein (CRP), ferritin, lymphocyte count and PSI score with a severe disease course, defined as intensive care unit admission and/or 30-day mortality. The area under the receiver operating characteristics curve (AUC) quantified the discriminatory performance. RESULTS We included 142 SARS-CoV-2 positive patients. On presentation, the median duration of symptoms was 8 days. 41 (29%) patients had a severe disease course and 24 (17%) died within 30 days. The incidence of bacterial coinfection was 2/142 (1.4%). None of the blood cultures showed pathogen growth while 6.3% was contaminated. The AUCs for predicting severe disease were 0.76 (95% CI 0.68 to 0.84), 0.70 (0.61 to 0.79), 0.62 (0.51 to 0.74), 0.62 (0.51 to 0.72) and 0.72 (0.63 to 0.81) for procalcitonin, CRP, ferritin, lymphocyte count and PSI score, respectively. CONCLUSION Blood cultures appear to have limited value while procalcitonin and the PSI appear to be promising tools in helping physicians identify patients at risk for severe disease course in COVID-19 at presentation to the ED.
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Affiliation(s)
- Anna Kaal
- Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands
| | - Lars Snel
- Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands
| | - Martijn Dane
- Clinical Chemistry, Haga Teaching Hospital, Den Haag, The Netherlands
| | | | - Thomas Ottens
- Intensive Care, Haga Teaching Hospital, Den Haag, The Netherlands
| | | | | | - Nikki Kolfschoten
- Emergency Medicine, Haga Teaching Hospital, Den Haag, The Netherlands
| | - Emile Schippers
- Internal Medicine, Haga Teaching Hospital, Den Haag, The Netherlands
| | - Ewout Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Soufian Meziyerh
- Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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80
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Kaminsky LW, Dalessio S, Al-Shaikhly T, Al-Sadi R. Penicillin Allergy Label Increases Risk of Worse Clinical Outcomes in COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3629-3637.e2. [PMID: 34293501 PMCID: PMC8288230 DOI: 10.1016/j.jaip.2021.06.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) ranges from asymptomatic to severe. Several comorbidities are associated with worse clinical outcomes. Antibiotic use is common in COVID-19 and penicillin (PCN) allergy can affect antibiotic choice and may influence COVID-19 outcomes. OBJECTIVE To investigate the impact of PCN allergy label on COVID-19 outcomes. METHODS For this retrospective, cohort study, a Web-based tool for population cohort research, TriNetX, was used to identify adult COVID-19 patients with and without PCN allergy label. The two cohorts were matched using 1:1 propensity score matching for baseline demographics and conditions associated with risk for severe COVID-19. The 30-day risks for hospitalization, acute respiratory failure, intensive care unit requirement, mechanical ventilation requirement, and mortality were then compared between groups. Because bacterial infection can drive alternative antibiotic regimens, additional analyses focused on patients without bacterial infection. RESULTS After propensity score matching, each cohort consisted of 13,183 patients. COVID-19 patients with PCN allergy had higher risks for hospitalization (risk ratio [RR] = 1.46; 95% confidence interval [CI], 1.41-1.52) acute respiratory failure (RR = 1.25; 95% CI, 1.19-1.31), intensive care unit requirement (RR = 1.20; 95% CI, 1.08-1.34), and mechanical ventilation (RR = 1.17; 95% CI 1.03-1.32) compared with patients without PCN allergy; however, there was no mortality difference (RR = 1.09; 95% CI, 0.96-1.23). Although the bacterial infection risk was higher in PCN allergic COVID-19 patients, exclusion of patients with bacterial infections yielded similar results. CONCLUSIONS Penicillin allergic patients have higher risk for worse COVID-19 outcomes and should be considered for risk mitigation strategies.
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Affiliation(s)
- Lauren W Kaminsky
- Section of Allergy, Asthma, and Immunology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pa.
| | - Shannon Dalessio
- Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Taha Al-Shaikhly
- Section of Allergy, Asthma, and Immunology, Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Rana Al-Sadi
- Division of Gastroenterology and Hepatology, Pennsylvania State University College of Medicine, Hershey, Pa
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81
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Putot A, Bouiller K, Laborde C, Gilis M, Févre A, Hacquin A, Manckoundia P, Hoefler F, Bermejo M, Mendes A, Serratrice C, Prendki V, Sanchez S. Association between Early Antibiotic Therapy and In-Hospital Mortality among Older Patients with SARS-CoV-2 Pneumonia. J Gerontol A Biol Sci Med Sci 2021; 77:e115-e123. [PMID: 34272847 PMCID: PMC8406862 DOI: 10.1093/gerona/glab209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background It is uncertain whether antibiotic therapy should be started in SARS CoV-2 pneumonia. We aimed to investigate the association between early antibiotic therapy and the risk of in-hospital mortality in older patients. Methods We performed a retrospective international cohort study (ANTIBIOVID) in five COVID-19 geriatric units in France and Switzerland. Among 1,357 consecutive patients aged 75 or more hospitalised and testing positive for SARS-CoV-2, 1072 had a radiologically confirmed pneumonia, of which 914 patients were still alive and hospitalized at 48 hours. To adjust for confounders, a propensity score for treatment was created, and stabilized inverse probability of treatment weighting (SIPTW) was applied. To assess the association between early antibiotic therapy and in-hospital 30-day mortality, SIPTW-adjusted Kaplan-Meier and Cox proportional hazards regression analyses were performed. Results Of the 914 patients with SARS-CoV-2 pneumonia, median age of 86, 428 (46.8%) received antibiotics in the first 48 hours after diagnosis. Among these patients, 147 (34.3%) died in hospital within one month vs 118 patients (24.3%) with no early antibiotic treatment. After SIPTW, early antibiotic treatment was not significantly associated with mortality (adjusted hazard ratio, 1.23; 95% CI, 0.92-1.63; P = .160). Microbiologically confirmed superinfections occurred rarely in both groups (bacterial pneumonia: 2.5% vs 1.5%, P = .220; blood stream infection: 8.2% vs 5.2%, P = .120; Clostridioides difficile colitis: 2.4% vs 1.0%, P = .222). Conclusions In a large multicentre cohort of older inpatients with SARS-CoV-2 pneumonia, early antibiotic treatment did not appear to be associated with an improved prognosis.
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Affiliation(s)
- Alain Putot
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Kevin Bouiller
- Department of Infectious Diseases, Besançon University Hospital, Besançon, France
| | - Caroline Laborde
- Department of Geriatric Internal Medicine, Nimes University Hospital, Nimes, France
| | - Marine Gilis
- Department of Geriatrics, Besançon University Hospital, Besançon, France
| | - Amélie Févre
- Department of Geriatric Internal Medicine, Nimes University Hospital, Nimes, France
| | - Arthur Hacquin
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Patrick Manckoundia
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Florence Hoefler
- Department of Internal Medicine and Infectious Diseases, Troyes Hospital Centre, Troyes, France
| | - Messaline Bermejo
- Department of Internal Medicine and Infectious Diseases, Troyes Hospital Centre, Troyes, France
| | - Aline Mendes
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Christine Serratrice
- Division of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland.,Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Sanchez
- Department of Clinical Research, Troyes Hospital Centre, Troyes, France
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Frohman EM, Villemarette-Pittman NR, Rodriguez A, Glanzman R, Rugheimer S, Komogortsev O, Zamvil SS, Cruz RA, Varkey TC, Frohman AN, Frohman AR, Parsons MS, Konkle EH, Frohman TC. Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease. J Neurol Sci 2021; 426:117463. [PMID: 33971376 PMCID: PMC8055502 DOI: 10.1016/j.jns.2021.117463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
The COVID-19 pandemic has devastated individuals, families, and institutions throughout the world. Despite the breakneck speed of vaccine development, the human population remains at risk of further devastation. The decision to not become vaccinated, the protracted rollout of available vaccine, vaccine failure, mutational forms of the SARS virus, which may exhibit mounting resistance to our molecular strike at only one form of the viral family, and the rapid ability of the virus(es) to hitch a ride on our global transportation systems, means that we are will likely continue to confront an invisible, yet devastating foe. The enemy targets one of our human physiology's most important and vulnerable life-preserving body tissues, our broncho-alveolar gas exchange apparatus. Notwithstanding the fear and the fury of this microbe's potential to raise existential questions across the entire spectrum of human endeavor, the application of an early treatment intervention initiative may represent a crucial tool in our defensive strategy. This strategy is driven by evidence-based medical practice principles, those not likely to become antiquated, given the molecular diversity and mutational evolution of this very clever "world traveler".
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Affiliation(s)
- Elliot M Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
| | | | - Adriana Rodriguez
- Department of Emergency Medicine, Cook Children's Medical Center, Ft. Worth, TX, United States of America
| | - Robert Glanzman
- Clene Nanomedicine, Inc., Salt Lake City, UT 84121, United States of America.
| | - Sarah Rugheimer
- Department of Physics, University Oxford, Oxford OX1 3PU, UK.
| | - Oleg Komogortsev
- Department of Computer Sciences, Texas State University, San Marcos, TX, United States of America.
| | - Scott S Zamvil
- Department of Neurology and Program in Immunology, University of California San Francisco, San Francisco, CA, United States of America.
| | - Roberto Alejandro Cruz
- Department of Neurology, Doctor's Health at Renaissance Health Neurology Institute, United States of America; Department of Neurology, University of Texas Rio Grande Valley School of Medicine, United States of America.
| | - Thomas C Varkey
- Dell Medical School, University of Texas at Austin, United States of America.
| | | | | | - Matthew S Parsons
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, United States of America; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States of America.
| | | | - Teresa C Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
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Cataño-Correa JC, Cardona-Arias JA, Porras Mancilla JP, García MT. Bacterial superinfection in adults with COVID-19 hospitalized in two clinics in Medellín-Colombia, 2020. PLoS One 2021; 16:e0254671. [PMID: 34255801 PMCID: PMC8277025 DOI: 10.1371/journal.pone.0254671] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022] Open
Abstract
COVID-19 represents high morbidity and mortality, its complications and lethality have increased due to bacterial superinfections. We aimed to determine the prevalence of bacterial superinfection in adults with COVID-19, hospitalized in two clinics in Medellín-Colombia during 2020, and its distribution according to sociodemographic and clinical conditions. A cross sectional study was made with 399 patients diagnosed with COVID-19 by RT-PCR. We determined the prevalence of bacterial superinfection and its factors associated with crude and adjusted prevalence ratios by a generalized linear model. The prevalence of superinfection was 49.6%, with 16 agents identified, the most frequent were Klebsiella (pneumoniae and oxytoca) and Staphylococcus aureus. In the multivariate adjustment, the variables with the strongest association with bacterial superinfection were lung disease, encephalopathy, mechanical ventilation, hospital stay, and steroid treatment. A high prevalence of bacterial superinfections, a high number of agents, and multiple associated factors were found. Among these stood out comorbidities, complications, days of hospitalization, mechanical ventilation, and steroid treatment. These results are vital to identifying priority clinical groups, improving the care of simultaneous infections with COVID-19 in people with the risk factors exposed in the population studied, and identifying bacteria of public health interest.
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84
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Mahalmani V, Kumaravel J, Jain M, Prakash A, Medhi B. Antimicrobial resistance: An unseen threat prowling behind the COVID-19 outbreak. Indian J Pharmacol 2021; 53:187-191. [PMID: 34169902 PMCID: PMC8262419 DOI: 10.4103/ijp.ijp_430_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Vidya Mahalmani
- Department of Pharmacology, Jawaharlal Nehru Medical College, KAHER, Belgaum, Karnataka, India
| | - J Kumaravel
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Manav Jain
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Ajay Prakash
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, PGIMER, Chandigarh, India
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Lehmann B, Baumgartner C, Brill AK, Günther G, Nüesch S, Ott D, Ruder TD, Thurnheer Zürcher MC, Furrer H. [COVID-19 in the Family Practice - Outpatient Treatment or Hospitalization?]. PRAXIS 2021; 110:517-524. [PMID: 34231383 DOI: 10.1024/1661-8157/a003686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
COVID-19 in the Family Practice - Outpatient Treatment or Hospitalization? Abstract. Switzerland has been severely affected by the COVID-19 pandemic. The clinical spectrum of this disease in terms of its clinical presentation and course is very broad. A correct initial evaluation in the practice or in the emergency department is important and includes history-taking and clinical examination as well as imaging and laboratory tests. Most patients with COVID-19 can be treated as outpatients. Hospitalization may be necessary in patients with a marked COVID-19 pneumonia or further complications, which occur primarily in the second or third phase of the disease. The dynamics of the disease must also be taken into consideration. In outpatients, symptomatic therapy is often sufficient, antibiotics and corticosteroids are not indicated.
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Affiliation(s)
- Beat Lehmann
- Universitäres Notfallzentrum, Inselspital, Universität Bern, Bern
| | - Christine Baumgartner
- Universitätsklinik für Allgemeine Innere Medizin, Inselspital, Universität Bern, Bern
| | | | - Gunar Günther
- Universitätsklinik für Pneumologie, Inselspital, Universität Bern, Bern
| | - Susanne Nüesch
- Universitäres Notfallzentrum, Inselspital, Universität Bern, Bern
| | - Daniel Ott
- Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Universität Bern, Bern
| | - Thomas D Ruder
- Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Universität Bern, Bern
| | | | - Hansjakob Furrer
- Universitätsklinik für Infektiologie, Inselspital, Universität Bern, Bern
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86
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Cong W, Poudel AN, Alhusein N, Wang H, Yao G, Lambert H. Antimicrobial Use in COVID-19 Patients in the First Phase of the SARS-CoV-2 Pandemic: A Scoping Review. Antibiotics (Basel) 2021; 10:antibiotics10060745. [PMID: 34205440 PMCID: PMC8235357 DOI: 10.3390/antibiotics10060745] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/27/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
This scoping review provides new evidence on the prevalence and patterns of global antimicrobial use in the treatment of COVID-19 patients; identifies the most commonly used antibiotics and clinical scenarios associated with antibiotic prescribing in the first phase of the pandemic; and explores the impact of documented antibiotic prescribing on treatment outcomes in COVID-19 patients. The review complies with PRISMA guidelines for Scoping Reviews and the protocol is registered with the Open Science Framework. In the first six months of the pandemic, there was a similar mean antibiotic prescribing rate between patients with severe or critical illness (75.4%) and patients with mild or moderate illness (75.1%). The proportion of patients prescribed antibiotics without clinical justification was 51.5% vs. 41.9% for patients with mild or moderate illness and those with severe or critical illness. Comparison of patients who were provided antibiotics with a clinical justification with those who were given antibiotics without clinical justification showed lower mortality rates (9.5% vs. 13.1%), higher discharge rates (80.9% vs. 69.3%), and shorter length of hospital stay (9.3 days vs. 12.2 days). In the first 6 months of the pandemic, antibiotics were prescribed for COVID-19 patients regardless of severity of illness. A large proportion of antibiotic prescribing for mild and moderate COVID-19 patients did not have clinical evidence of a bacterial co-infection. Antibiotics may not be beneficial to COVID-19 patients without clinical evidence of a bacterial co-infection.
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Affiliation(s)
- Wenjuan Cong
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; (N.A.); (H.L.)
- Correspondence: ; Tel.: +44-0117-3314528
| | - Ak Narayan Poudel
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.N.P.); (G.Y.)
| | - Nour Alhusein
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; (N.A.); (H.L.)
| | - Hexing Wang
- Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China;
| | - Guiqing Yao
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (A.N.P.); (G.Y.)
| | - Helen Lambert
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK; (N.A.); (H.L.)
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Safarika A, Wacker JW, Katsaros K, Solomonidi N, Giannikopoulos G, Kotsaki A, Koutelidakis IM, Coyle SM, Cheng HK, Liesenfeld O, Sweeney TE, Giamarellos-Bourboulis EJ. A 29-mRNA host response test from blood accurately distinguishes bacterial and viral infections among emergency department patients. Intensive Care Med Exp 2021; 9:31. [PMID: 34142256 PMCID: PMC8211458 DOI: 10.1186/s40635-021-00394-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Whether or not to administer antibiotics is a common and challenging clinical decision in patients with suspected infections presenting to the emergency department (ED). We prospectively validate InSep, a 29-mRNA blood-based host response test for the prediction of bacterial and viral infections. METHODS The PROMPT trial is a prospective, non-interventional, multi-center clinical study that enrolled 397 adult patients presenting to the ED with signs of acute infection and at least one vital sign change. The infection status was adjudicated using chart review (including a syndromic molecular respiratory panel, procalcitonin and C-reactive protein) by three infectious disease physicians blinded to InSep results. InSep (version BVN-2) was performed using PAXgene Blood RNA processed and quantified on NanoString nCounter SPRINT. InSep results (likelihood of bacterial and viral infection) were compared to the adjudicated infection status. RESULTS Subject mean age was 64 years, comorbidities were significant for diabetes (17.1%), chronic obstructive pulmonary disease (13.6%), and severe neurological disease (6.8%); 16.9% of subjects were immunocompromised. Infections were adjudicated as bacterial (14.1%), viral (11.3%) and noninfected (0.25%): 74.1% of subjects were adjudicated as indeterminate. InSep distinguished bacterial vs. viral/noninfected patients and viral vs. bacterial/noninfected patients using consensus adjudication with AUROCs of 0.94 (95% CI 0.90-0.99) and 0.90 (95% CI 0.83-0.96), respectively. AUROCs for bacterial vs. viral/noninfected patients were 0.88 (95% CI 0.79-0.96) for PCT, 0.80 (95% CI 0.72-89) for CRP and 0.78 (95% CI 0.69-0.87) for white blood cell counts (of note, the latter biomarkers were provided as part of clinical adjudication). To enable clinical actionability, InSep incorporates score cutoffs to allocate patients into interpretation bands. The Very Likely (rule in) InSep bacterial band showed a specificity of 98% compared to 94% for the corresponding PCT band (> 0.5 µg/L); the Very Unlikely (rule-out) band showed a sensitivity of 95% for InSep compared to 86% for PCT. For the detection of viral infections, InSep demonstrated a specificity of 93% for the Very Likely band (rule in) and a sensitivity of 96% for the Very Unlikely band (rule out). CONCLUSIONS InSep demonstrated high accuracy for predicting the presence of both bacterial and viral infections in ED patients with suspected acute infections or suspected sepsis. When translated into a rapid, point-of-care test, InSep will provide ED physicians with actionable results supporting early informed treatment decisions to improve patient outcomes while upholding antimicrobial stewardship. Registration number at Clinicaltrials.gov NCT03295825.
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Affiliation(s)
- Asimina Safarika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, ATTIKON University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | | | | | - Nicky Solomonidi
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, ATTIKON University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | | | - Antigone Kotsaki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, ATTIKON University Hospital, 1 Rimini Str, 12462, Athens, Greece
| | | | | | - Henry K Cheng
- Inflammatix Inc, Clinical Affairs, Burlingame, CA, USA
| | | | | | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, ATTIKON University Hospital, 1 Rimini Str, 12462, Athens, Greece.
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88
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Rosalia RA, Ugurov P, Neziri D, Despotovska S, Kostoska E, Veljanovska-Kiridjievska L, Kuzmanov D, Trifunovski A, Popevski D, Villa G, Mitrev Z. Extracorporeal Blood Purification in Moderate and Severe COVID-19 Patients: A Prospective Cohort Study. Blood Purif 2021; 51:233-242. [PMID: 34126617 DOI: 10.1159/000515627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/02/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is characterized by hyperinflammation and coagulopathy. Severe cases often develop respiratory distress, requiring mechanical ventilation and with critical cases progressing to acute respiratory distress syndrome. Control of hyperinflammation has been proposed as a possible therapeutic avenue for COVID-19; extracorporeal blood purification (EBP) modalities offer an attractive mean to ameliorate maladaptive inflammation. With this work, we evaluated the longitudinal changes of systemic inflammatory markers in critically ill COVID-19 patients treated with blood purification using AN69ST (oXiris®) haemofilter. METHODS We performed a time-series analysis of 44 consecutive COVID-19 cases treated with the AN69ST (oXiris®) cytokine adsorbing haemofilter (CAH) according to local practice; we visualize longitudinal results of biochemical, inflammatory, blood gas, and vital sign parameters focussing on systemic levels of interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin. RESULTS All patients were treated with ≥1 cycle extracorporeal continuous venovenous haemofiltration (CVVH) with CAH; of these, 30 severe patients received CVVH-CAH within 4-12 h of admission after recognizing a hyper-inflammatory state. Another 14 patients admitted with mild-to-moderate symptoms progressed to severe disease and were placed on EBP during hospitalization. The treatment was associated with a reduction of ferritin, CRP, fibrinogen, several inflammatory markers, and a resolution of numerous cytopenias. The observed mortality across the cohort was 36.3%. CONCLUSION EBP with CAH was associated with a decrease in CRP, and control of IL-6 and procalcitonin.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gianluca Villa
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Florence, Italy
| | - Zan Mitrev
- Zan Mitrev Clinic, Skopje, North Macedonia
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89
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Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - Wen-Liang Yu
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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90
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Caméléna F, Poncin T, Dudoignon E, Salmona M, Le Goff J, Donay JL, Lafaurie M, Darmon M, Azoulay E, Plaud B, Mebazaa A, Dépret F, Jacquier H, Berçot B. Rapid identification of bacteria from respiratory samples of patients hospitalized in intensive care units, with FilmArray Pneumonia Panel Plus. Int J Infect Dis 2021; 108:568-573. [PMID: 34087488 DOI: 10.1016/j.ijid.2021.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the performance of FilmArray Pneumonia Panel Plus (FA-PP) for the detection of typical bacterial pathogens in respiratory samples from patients hospitalized in intensive care units (ICUs). METHODS FA-PP was implemented for clinical use in the microbiology laboratory in March 2020. A retrospective analysis on a consecutive cohort of adult patients hospitalized in ICUs between March 2020 and May 2020 was undertaken. The respiratory samples included sputum, blind bronchoalveolar lavage (BBAL) and protected specimen brush (PSB). Conventional culture and FA-PP were performed in parallel. RESULTS In total, 147 samples from 92 patients were analysed; 88% had coronavirus disease 2019 (COVID-19). At least one pathogen was detected in 46% (68/147) of samples by FA-PP and 39% (57/147) of samples by culture. The overall percentage agreement between FA-PP and culture results was 98% (93-100%). Bacteria with semi-quantitative FA-PP results ≥105 copies/mL for PSB samples, ≥106 copies/mL for BBAL samples and ≥107 copies/mL for sputum samples reached clinically significant thresholds for growth in 90%, 100% and 91% of cultures, respectively. FA-PP detected resistance markers, including mecA/C, blaCTX-M and blaVIM. The median turnaround time was significantly shorter for FA-PP than for culture. CONCLUSIONS FA-PP may constitute a faster approach to the diagnosis of bacterial pneumonia in patients hospitalized in ICUs.
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Affiliation(s)
- François Caméléna
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Thibaut Poncin
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Emmanuel Dudoignon
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - Maud Salmona
- University of Paris, Inserm U976, Insight team, F-75010, Paris France; Department of Virology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérôme Le Goff
- University of Paris, Inserm U976, Insight team, F-75010, Paris France; Department of Virology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Luc Donay
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Disease, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1153, Centre of Epidemiology and Biostatistics, ECSTRA Team, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1153, Centre of Epidemiology and Biostatistics, ECSTRA Team, Paris, France
| | - Benoît Plaud
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - François Dépret
- Department of Anaesthesiology and Critical Care and Burns Unit, Saint-Louis-Lariboisière Hospital Group, Assistance Publique - Hôpitaux de Paris, Paris, France; University of Paris, FHU PROMICE, INSERM 942, INI-CRCT Network, Paris, France
| | - Hervé Jacquier
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France
| | - Béatrice Berçot
- Department of Bacteriology, Saint-Louis-Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, INSERM 1137, IAME, Paris, France.
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91
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Elsayed AA, Darwish SF, Zewail MB, Mohammed M, Saeed H, Rabea H. Antibiotic misuse and compliance with infection control measures during COVID-19 pandemic in community pharmacies in Egypt. Int J Clin Pract 2021; 75:e14081. [PMID: 33559255 PMCID: PMC7995210 DOI: 10.1111/ijcp.14081] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Globally, antibiotics misuse by the public has been reported in the era of COVID-19, despite the discouraging instructions of the World Health Organization, especially for mild cases. OBJECTIVE Is to describe this antibiotic misuse and its contributing factors. Also, to measure the pharmacists' application of infection preventive practices during the pandemic. METHODS A cross-sectional study was conducted among randomly selected Egyptian community pharmacists (Center, East, Delta, and Upper Egypt) using a questionnaire and direct interviews from 1 to 30 August 2020. The questionnaire consisted of two parts, the first covered pharmacist's demographic data and their application of basic infection preventive practices (eg, wearing face masks, regular hand sanitization, etc), and the other part was related to antibiotic dispensing patterns. Data were descriptively analyzed and the impact of participant experience on the responses was evaluated using the χ2 test. RESULTS From 480 randomly selected Egyptian community pharmacists, 413 (87%) consented to participate in the study. 86.7% of the participants were keen to wear face masks (n = 358) and 86.2% kept regular hand sanitization (n = 356); whereas, 46.9% (n = 194) maintained adequate antibiotic stock supply during the pandemic. Nearly 67% (n = 275) of the pharmacists reported that patients were more likely to be given antibiotics for showing any sign or symptom of COVID-19 infection, and 82% (n = 74 278) of the dispensed antibiotics were given upon physician recommendation. Azithromycin, Ceftriaxone, and Linezolid were the major antibiotics dispensed to COVID-19 presumptive patients Azithromycin was given to ~40% of presumptive patients showing only mild or moderate symptoms for 5-10 days. Additionally, antibiotic combinations were given to 74% (n = 62 479) of home-isolated patients for a maximum of 2 weeks. CONCLUSIONS Pharmacists applied suitable sanitation and infection control protocols. Meanwhile, antibiotics were dispensed heavily during this pandemic without proper clinical indication and for long durations supporting the idea of antibiotic misuse.
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Affiliation(s)
- Asmaa A. Elsayed
- Clinical Pharmacy DepartmentFaculty of PharmacyBeni‐Suef UniversityBeni‐SuefEgypt
| | - Samar F. Darwish
- Pharmacology and Toxicology DepartmentFaculty of PharmacyBadr UniversityCairoEgypt
| | - Moataz B. Zewail
- Pharmaceutics DepartmentFaculty of PharmacyBadr UniversityCairoEgypt
| | | | - Haitham Saeed
- Clinical Pharmacy DepartmentFaculty of PharmacyBeni‐Suef UniversityBeni‐SuefEgypt
| | - Hoda Rabea
- Clinical Pharmacy DepartmentFaculty of PharmacyBeni‐Suef UniversityBeni‐SuefEgypt
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92
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Molero-García JM, Arranz-Izquierdo J, Gutiérrez-Pérez MI, Redondo Sánchez JM. [Basic aspects of COVID-19 for management from primary care]. Aten Primaria 2021; 53:101966. [PMID: 33852979 PMCID: PMC7762708 DOI: 10.1016/j.aprim.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
SARS-CoV-2 is transmitted from person to person by inhalation or contact with respiratory droplets and aerosols. The median incubation period is 5.1 days. Fever, dry cough, dyspnea and fatigue are the most common symptoms. Almost half of the cases are asymptomatic. The spectrum of disease varies from mild (81%) to critical (5%). Older age, male gender and comorbidities negatively impact on the severity and mortality of COVID-19. The diagnosis of acute COVID-19 is made with RT-PCR or antigenic detection tests. In hospital patients, remdesivir reduces recovery time. Oral steroids are recommended for severe or critical cases requiring oxygen therapy or mechanical ventilation. Thromboprophylaxis is recommended in all severe and non-severe cases with high thrombotic risk. Antibiotherapy is limited to cases of high suspicion of bacterial superinfection. Mild-moderate and severe cases after discharge from hospital should be clinically monitored for a minimum period of two weeks.
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Affiliation(s)
- José María Molero-García
- CS San Andrés, DA CENTRO (SERMAS), Grupo de trabajo de enfermedades infecciosas de SemFYC, Madrid, España.
| | - Javier Arranz-Izquierdo
- Instituto de Investigación Sanitaria de Illes Balears (Idisba), CS Escola Graduada, Ibsalut, Palma de Mallorca, Illes Balears, Grupo de trabajo de enfermedades infecciosas de SemFYC, Illes Balears, España
| | - María Isabel Gutiérrez-Pérez
- CS Delicias I (GAP Oeste) Valladolid, Coordinadora del Grupo de trabajo de enfermedades infecciosas de SemFYC, Valladolid, España
| | - Jesús María Redondo Sánchez
- CS Ramón y Cajal, DA OESTE (SERMAS), Grupo de trabajo de enfermedades infecciosas de SoMaMFyC, Alcorcón, España
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93
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Ul Mustafa Z, Salman M, Aldeyab M, Kow CS, Hasan SS. Antimicrobial consumption among hospitalized patients with COVID-19 in Pakistan. ACTA ACUST UNITED AC 2021; 3:1691-1695. [PMID: 34095752 PMCID: PMC8162632 DOI: 10.1007/s42399-021-00966-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/16/2022]
Abstract
The discovery of different antimicrobial agents has revolutionized the treatment against a variety of infections for many decades, but the emergence of antimicrobial resistance require rigorous measures, even amid the coronavirus disease 2019 (COVID-19) pandemic. This retrospective study aimed to examine the consumption of antibiotics in patients with COVID-19 admitted into the five hospitals in the province of Punjab, Pakistan. We collected data on the consumption of antibiotics, classified using the World Health Organization (WHO) AWaRe (Access, Watch, and Reserve), within two months—August and September, 2020, and the corresponding months in 2019. Consumption of antibiotics was presented as daily define dose (DDD) per 100 occupied bed-days. Eight different classes of antibiotics were prescribed to patients with COVID-19 without culture tests being performed, with the prescribing of antibiotics of the Watch category was especially prevalent. The consumption of antibiotics was higher during the COVID-19 pandemic compared to the pre-pandemic period: the consumption of azithromycin increased from 11.5 DDDs per 100 occupied bed-days in 2019 to 17.0 DDDs per 100 occupied bed-days in 2020, while the consumption of ceftriaxone increased from 20.2 DDDs per 100 occupied bed-days in 2019 to 25.1 DDDs per 100 occupied bed-days in 2020. The current study revealed non-evidence-based utilization of antibiotics among patients with COVID-19 admitted into the hospitals in Pakistan. Evidently, the current COVID-19 pandemic is a public health threat of notable dimensions which has compromised the ongoing antimicrobial stewardship program, potentially leading to the emergence of antimicrobial resistance among pathogens.
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Affiliation(s)
- Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Muhammad Salman
- Department of Pharmacy Practice, The University of Lahore, Lahore, Pakistan
| | - Mamoon Aldeyab
- Department of Pharmacy, University of Huddersfield, Huddersfield, UK
| | - Chia Siang Kow
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia.,School of Pharmacy, Monash University Malaysia, Bandar Sunway, Petaling Jaya, Selangor Malaysia
| | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, UK.,School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, Australia
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Calderón-Parra J, Muiño-Miguez A, Bendala-Estrada AD, Ramos-Martínez A, Muñez-Rubio E, Fernández Carracedo E, Tejada Montes J, Rubio-Rivas M, Arnalich-Fernandez F, Beato Pérez JL, García Bruñén JM, del Corral Beamonte E, Pesqueira Fontan PM, Carmona MDM, Fernández-Madera Martínez R, González García A, Salazar Mosteiro C, Tuñón de Almeida C, González Moraleja J, Deodati F, Martín Escalante MD, Asensio Tomás ML, Gómez Huelgas R, Casas Rojo JM, Millán Núñez-Cortés J. Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID. PLoS One 2021; 16:e0251340. [PMID: 33974637 PMCID: PMC8112666 DOI: 10.1371/journal.pone.0251340] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Most patients with COVID-19 receive antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased complications, including antibacterial resistance. We aim to analyze risk factors for inappropriate antibiotic prescription in these patients and describe possible complications arising from their use. METHODS The SEMI-COVID-19 Registry is a multicenter, retrospective patient cohort. Patients with antibiotic were divided into two groups according to appropriate or inappropriate prescription, depending on whether the patient fulfill any criteria for its use. Comparison was made by means of multilevel logistic regression analysis. Possible complications of antibiotic use were also identified. RESULTS Out of 13,932 patients, 3047 (21.6%) were prescribed no antibiotics, 6116 (43.9%) were appropriately prescribed antibiotics, and 4769 (34.2%) were inappropriately prescribed antibiotics. The following were independent factors of inappropriate prescription: February-March 2020 admission (OR 1.54, 95%CI 1.18-2.00), age (OR 0.98, 95%CI 0.97-0.99), absence of comorbidity (OR 1.43, 95%CI 1.05-1.94), dry cough (OR 2.51, 95%CI 1.94-3.26), fever (OR 1.33, 95%CI 1.13-1.56), dyspnea (OR 1.31, 95%CI 1.04-1.69), flu-like symptoms (OR 2.70, 95%CI 1.75-4.17), and elevated C-reactive protein levels (OR 1.01 for each mg/L increase, 95% CI 1.00-1.01). Adverse drug reactions were more frequent in patients who received ANTIBIOTIC (4.9% vs 2.7%, p < .001). CONCLUSION The inappropriate use of antibiotics was very frequent in COVID-19 patients and entailed an increased risk of adverse reactions. It is crucial to define criteria for their use in these patients. Knowledge of the factors associated with inappropriate prescribing can be helpful.
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Affiliation(s)
- Jorge Calderón-Parra
- Infectious Diseases Unit, Internal Medicine Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Antonio Muiño-Miguez
- Internal Medicine Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Antonio Ramos-Martínez
- Infectious Diseases Unit, Internal Medicine Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Elena Muñez-Rubio
- Infectious Diseases Unit, Internal Medicine Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | | | | | - Manuel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | | | | | - Andrés González García
- Systemic Autoimmune Diseases and Rare Diseases Unit, Internal Medicine Department, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Cristina Salazar Mosteiro
- Internal Medicine Department, Nuestra Señora del Prado Hospital, Talavera de la Reina, Toledo, Spain
| | | | | | - Francesco Deodati
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Madrid, Spain
| | | | - María Luisa Asensio Tomás
- General Internal Medicine Department, San Juan de Alicante University Hospital, San Juan de Alicante, Alicante, Spain
| | - Ricardo Gómez Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
| | - José Manuel Casas Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Madrid, Spain
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Feldman C, Anderson R. The role of co-infections and secondary infections in patients with COVID-19. Pneumonia (Nathan) 2021; 13:5. [PMID: 33894790 PMCID: PMC8068564 DOI: 10.1186/s41479-021-00083-w] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/12/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND It has been recognised for a considerable time-period, that viral respiratory infections predispose patients to bacterial infections, and that these co-infections have a worse outcome than either infection on its own. However, it is still unclear what exact roles co-infections and/or superinfections play in patients with COVID-19 infection. MAIN BODY This was an extensive review of the current literature regarding co-infections and superinfections in patients with SARS-CoV-2 infection. The definitions used were those of the Centers for Disease Control and Prevention (US), which defines coinfection as one occurring concurrently with the initial infection, while superinfections are those infections that follow on a previous infection, especially when caused by microorganisms that are resistant, or have become resistant, to the antibiotics used earlier. Some researchers have envisioned three potential scenarios of bacterial/SARS-CoV-2 co-infection; namely, secondary SARS-CoV-2 infection following bacterial infection or colonisation, combined viral/bacterial pneumonia, or secondary bacterial superinfection following SARS-CoV-2. There are a myriad of published articles ranging from letters to the editor to systematic reviews and meta-analyses describing varying ranges of co-infection and/or superinfection in patients with COVID-19. The concomitant infections described included other respiratory viruses, bacteria, including mycobacteria, fungi, as well as other, more unusual, pathogens. However, as will be seen in this review, there is often not a clear distinction made in the literature as to what the authors are referring to, whether true concomitant/co-infections or superinfections. In addition, possible mechanisms of the interactions between viral infections, including SARS-CoV-2, and other infections, particularly bacterial infections are discussed further. Lastly, the impact of these co-infections and superinfections in the severity of COVID-19 infections and their outcome is also described. CONCLUSION The current review describes varying rates of co-infections and/or superinfections in patients with COVID-19 infections, although often a clear distinction between the two is not clear in the literature. When they occur, these infections appear to be associated with both severity of COVID-19 as well as poorer outcomes.
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Affiliation(s)
- Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Malézieux-Picard A, Ferrer Soler C, De Macedo Ferreira D, Gaud-Luethi E, Serratrice C, Mendes A, Zekry D, Gold G, Lobrinus JA, Arnoux G, Serra F, Prendki V. Undetected Causes of Death in Hospitalized Elderly with COVID-19: Lessons from Autopsy. J Clin Med 2021; 10:jcm10071337. [PMID: 33804890 PMCID: PMC8037274 DOI: 10.3390/jcm10071337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Mechanisms and causes of death in older patients with SARS-CoV-2 infection are still poorly understood. Methods: We conducted in a retrospective monocentric study, a clinical chart review and post-mortem examination of patients aged 75 years and older hospitalized in acute care and positive for SARS-CoV-2. Full body autopsy and correlation with clinical findings and suspected causes of death were done. Results: Autopsies were performed in 12 patients (median age 85 years; median of 4 comorbidities, mainly hypertension and cardiovascular disease). All cases showed exudative or proliferative phases of alveolar damage and/or a pattern of organizing pneumonia. Causes of death were concordant in 6 cases (50%), and undetected diagnoses were found in 6. Five patients died from hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), five had another associated diagnosis and two died from alternative causes. Deaths that occurred in the second week were related to SARS-CoV-2 pneumonia whereas those occurring earlier were related mainly to heart failure and those occurring later to complications. Conclusions: Although COVID-19 hypoxemic respiratory failure was the most common cause of death, post-mortem pathological examination revealed that acute decompensation from chronic comorbidities during the first week of COVID-19 and complications in the third week contributed to mortality.
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Affiliation(s)
- Astrid Malézieux-Picard
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (D.D.M.F.); (C.S.); (D.Z.); (V.P.)
- Correspondence:
| | - Cecilia Ferrer Soler
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (C.F.S.); (E.G.-L.); (A.M.); (G.G.)
| | - David De Macedo Ferreira
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (D.D.M.F.); (C.S.); (D.Z.); (V.P.)
| | - Emilie Gaud-Luethi
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (C.F.S.); (E.G.-L.); (A.M.); (G.G.)
| | - Christine Serratrice
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (D.D.M.F.); (C.S.); (D.Z.); (V.P.)
| | - Aline Mendes
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (C.F.S.); (E.G.-L.); (A.M.); (G.G.)
| | - Dina Zekry
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (D.D.M.F.); (C.S.); (D.Z.); (V.P.)
| | - Gabriel Gold
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (C.F.S.); (E.G.-L.); (A.M.); (G.G.)
| | | | - Grégoire Arnoux
- Division of Pathology, University Hospitals of Geneva, 1205 Geneva, Switzerland; (J.A.L.); (G.A.); (F.S.)
| | - Fulvia Serra
- Division of Pathology, University Hospitals of Geneva, 1205 Geneva, Switzerland; (J.A.L.); (G.A.); (F.S.)
| | - Virginie Prendki
- Division of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Hôpital des Trois-Chêne, 1226 Thônex-Genève, Switzerland; (D.D.M.F.); (C.S.); (D.Z.); (V.P.)
- Division of Infectious Disease, University Hospitals of Geneva, 1205 Geneva, Switzerland
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97
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Ghosh S, Bornman C, Zafer MM. Antimicrobial Resistance Threats in the emerging COVID-19 pandemic: Where do we stand? J Infect Public Health 2021; 14:555-560. [PMID: 33848884 PMCID: PMC7934675 DOI: 10.1016/j.jiph.2021.02.011] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 01/08/2023] Open
Abstract
Antimicrobial resistance (AMR) continues to exert a substantial toll on the global health and world economy and is now expected to be hidden by COVID-19 for a while. The wrong consumption of antibiotics during the COVID-19 pandemic will raise disastrous effects on AMR management and antibiotic stewardship programs. This is related to the concerns extrapolated due to an increase in mortality rates in patients with bacterial coinfections. Importantly, the immune system of COVID-19 patients in regions with high AMR may be fighting on two fronts altogether, the virus and MDR bacteria. Current control policies to manage AMR and prioritization of antibiotic stewardship plans are mandatory during this pandemic. This review aims to discuss the rising concerns of the excess use of antibiotics in COVID-19 patients highlighting the role of bacterial coinfections in these patients. Types of prescribed antibiotics and the development of antibiotic resistance is addressed as well.
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Affiliation(s)
- Soumya Ghosh
- Department of Genetics, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Charné Bornman
- Department of Genetics, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Mai M Zafer
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt.
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98
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Mussini C, Falcone M, Nozza S, Sagnelli C, Parrella R, Meschiari M, Petrosillo N, Mastroianni C, Cascio A, Iaria C, Galli M, Chirianni A, Sagnelli E, Iacobello C, Di Perri G, Mazzotta F, Carosi G, Tinelli M, Grossi P, Armignacco O, Portelli V, Andreoni M, Tavio M. Therapeutic strategies for severe COVID-19: a position paper from the Italian Society of Infectious and Tropical Diseases (SIMIT). Clin Microbiol Infect 2021; 27:389-395. [PMID: 33359375 PMCID: PMC7833273 DOI: 10.1016/j.cmi.2020.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/29/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023]
Abstract
SCOPE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become pandemic, reaching almost one million death worldwide. At present standard treatment for coronavirus disease 2019 (COVID-19) is not well defined because the evidence, either from randomized or observational studies, with conflicting results, has led to rapid changes in treatment guidelines. Our aim was to narratively summarize the available literature on the management of COVID-19 in order to combine current evidence and interpretation of the data by experts who are treating patients in the frontline setting. METHODS The panel conducted a detailed review of the literature and eventual press releases from randomized clinical trials for each possible available treatment. Inductive PubMed search waws performed for publications relevant to the topic, including all clinical trials conducted. The result was a flowchart with treatment indications for patients with COVID-19. IMPLICATIONS After 6 months of a pandemic situation and before a possible second coronavirus wave descends on Europe, it is important to evaluate which drugs proved to be effective while also considering that results from many randomized clinical trials are still awaited. Indeed, among treatments for COVID-19, only glucocorticoids have resulted in an association with a significant decrease in mortality in published randomized controlled trials. New therapeutic strategies are urgently needed.
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Affiliation(s)
- Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy.
| | - Marco Falcone
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Pisa University, Pisa, Italy
| | - Silvia Nozza
- Department of Infectious and Tropical Diseases, San Raffaele Hospital, Milan, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Roberto Parrella
- Respiratory Infectious Diseases Unit, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Marianna Meschiari
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Petrosillo
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Chiara Iaria
- Infectious Disease Unit, ARNAS Civico - Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Massimo Galli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | | | | | | | | | | | | | - Marco Tinelli
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Paolo Grossi
- Unit of Infectious and Tropical Diseases, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | - Massimo Andreoni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Infectious Diseases Clinic, University Hospital "Tor Vergata", Rome, Italy
| | - Marcello Tavio
- Unit of Emerging and Immunosuppressed Infectious Diseases, Department of Gastroenterology and Transplantation, Polytechnic University of Marche, Ancona, Italy
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99
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Thelen JM, Buenen AGN, van Apeldoorn M, Wertheim HF, Hermans MHA, Wever PC. Community-acquired bacteraemia in COVID-19 in comparison to influenza A and influenza B: a retrospective cohort study. BMC Infect Dis 2021; 21:199. [PMID: 33618663 PMCID: PMC7897875 DOI: 10.1186/s12879-021-05902-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background During the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands it was noticed that very few blood cultures from COVID-19 patients turned positive with clinically relevant bacteria. This was particularly evident in comparison to the number of positive blood cultures during previous seasonal epidemics of influenza. This observation raised questions about the occurrence and causative microorganisms of bacteraemia in COVID-19 patients, especially in the perspective of the widely reported overuse of antibiotics and the rising rate of antibiotic resistance. Methods We conducted a retrospective cohort study on blood culture results in influenza A, influenza B and COVID-19 patients presenting to two hospitals in the Netherlands. Our main outcome consisted of the percentage of positive blood cultures. The percentage of clinically relevant blood cultures, isolated bacteria and 30-day all-cause mortality served as our secondary outcomes. Results A total of 1331 viral episodes were analysed in 1324 patients. There was no statistically significant difference (p = 0.47) in overall occurrence of blood culture positivity in COVID-19 patients (9.0, 95% CI 6.8–11.1) in comparison to influenza A (11.4, 95% CI 7.9–14.8) and influenza B patients (10.4, 95% CI 7.1–13.7,). After correcting for the high rate of contamination, the occurrence of clinically relevant bacteraemia in COVID-19 patients amounted to 1.0% (95% CI 0.3–1.8), which was statistically significantly lower (p = 0.04) compared to influenza A patients (4.0, 95% CI 1.9–6.1) and influenza B patients (3.0, 95% CI 1.2–4.9). The most frequently identified bacterial isolates in COVID-19 patients were Escherichia coli (n = 2) and Streptococcus pneumoniae (n = 2). The overall 30-day all-cause mortality for COVID-19 patients was 28.3% (95% CI 24.9–31.7), which was statistically significantly higher (p = <.001) when compared to patients with influenza A (7.1, 95% CI 4.3–9.9) and patients with influenza B (6.4, 95% CI 3.8–9.1). Conclusions We report a very low occurrence of community-acquired bacteraemia amongst COVID-19 patients in comparison to influenza patients. These results reinforce current clinical guidelines on antibiotic management in COVID-19, which only advise utilization of antibiotics when a bacterial co-infection is suspected.
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Affiliation(s)
- Julinha M Thelen
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands. .,Radboud University Nijmegen, Nijmegen, the Netherlands.
| | - A G Noud Buenen
- Department of Emergency Medicine, Bernhoven Hospital, Uden, the Netherlands
| | - Marjan van Apeldoorn
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Heiman F Wertheim
- Department of Medical Microbiology, Radboud university medical center, Nijmegen, the Netherlands
| | - Mirjam H A Hermans
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Peter C Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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100
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Asmarawati TP, Rosyid AN, Suryantoro SD, Mahdi BA, Windradi C, Wulaningrum PA, Arifianto MV, Bramantono B, Triyono EA, Rusli M, Rachman BE, Marfiani E, Endraswari PD, Hadi U, Kuntaman K, Nasronudin N. The clinical impact of bacterial co-infection among moderate, severe and critically ill COVID-19 patients in the second referral hospital in Surabaya. F1000Res 2021; 10:113. [PMID: 33868645 PMCID: PMC8030114 DOI: 10.12688/f1000research.31645.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Data on the prevalence of bacterial co-infections among COVID-19 patients are limited, especially in our country, Indonesia. We aimed to assess the rate of bacterial co-infections in hospitalized COVID-19 patients and report the most common microorganisms involved and the antibiotic use in these patients. Methods: This study is a retrospective cohort study,among COVID-19 adult patients admitted to Universitas Airlangga Hospital Surabaya from 14 March-30 September 2020. The bacterial infection is defined based on clinical assessment, laboratory parameters, and microbiology results. Results: A total of 218 patients with moderate to critical illness and confirmed COVID-19 were included in this study. Bacterial infection was confirmed in 43 patients (19.7%). COVID-19 patients with bacterial infections had longer hospital length of stay (17.6 6.62 vs 13.317.12), a higher proportion of respiratory failure, intensive care treatment, and ventilator use. COVID-19 patients with bacterial infection had a worse prognosis than those without bacterial infection (p<0.04). The empirical antibiotic was given to 75.2% of the patients. Gram-negative bacteria were commonly found as causative agents in this study (n = 39; 70.37%). Conclusion: COVID-19 patients with bacterial infection have a longer length of stay and worse outcomes. Healthcare-associated infections during intensive care treatment for COVID-19 patients must be carefully prevented.
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Affiliation(s)
- Tri Pudy Asmarawati
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Alfian Nur Rosyid
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Department of Pulmonology and Respiratory Medicine,, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60115, Indonesia
| | - Satriyo Dwi Suryantoro
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
| | - Bagus Aulia Mahdi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia
| | - Choirina Windradi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia
| | - Prastuti Asta Wulaningrum
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Department of Pulmonology and Respiratory Medicine,, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60115, Indonesia
| | - Muhammad Vitanata Arifianto
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Bramantono Bramantono
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Erwin Astha Triyono
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Musofa Rusli
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Brian Eka Rachman
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Erika Marfiani
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Pepy Dwi Endraswari
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia.,Department of Clinical Microbiology, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60286, Indonesia
| | - Usman Hadi
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Kuntaman Kuntaman
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia.,Department of Clinical Microbiology, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60286, Indonesia
| | - Nasronudin Nasronudin
- Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surbaya, East Java, 60115, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
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