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Gaudin J, Thayalakulasingam T. Invasive Pneumococcal Disease and COVID-19 With Acute Otitis Media and a Tegmen Tympani Defect. Cureus 2023; 15:e44869. [PMID: 37814724 PMCID: PMC10560565 DOI: 10.7759/cureus.44869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
Streptococcus pneumoniae is a leading cause of otitis media, pneumonia, sinusitis, and meningitis. This encapsulated, gram-positive bacterium colonizes the nasopharynx. Major risk factors, including age, hyposplenism, and immunosuppression, predispose to serious infections. Viral infections are known to increase the risk of secondary bacterial infections as the initial immune response can compromise defenses against bacteria. Coronavirus disease 2019 (COVID-19) similarly poses a risk for secondary bacterial infections and coinfections, such as invasive pneumococcal disease (IPD). Still, temporal relationships between IPD and COVID-19 are not fully understood. IPD may also be a complication of untreated acute otitis media. COVID-19 and pneumococcal bacteremia, a form of IPD, have both been shown to damage the blood-brain barrier and gain access to the central nervous system, resulting in deep infections, namely, meningitis and encephalitis. Presented here is the case of a 70-year-old female partially vaccinated against pneumococcal disease, who was initially evaluated for an elevated temperature, acute encephalopathy, and COVID-19. Further investigation confirmed IPD in the form of bacteremia and meningitis. The patient had a protracted disease course complicated by sick sinus syndrome and altered mental status, which led to the identification of otitis media and a right tegmen tympani defect. Emergent implantation of a single-chamber temporary pacemaker and myringotomy with tube placement was performed. Lumbar puncture showed evidence of meningitis. Antibiotic therapy eventually narrowed to ceftriaxone and continued for a total of six weeks. The presence of comorbidities, history of incomplete pneumococcal vaccination series, and concomitant infection with COVID-19 may explain the development of IPD and other complications seen in this case. Furthermore, tegmen tympani defects and damage to the blood-brain barrier can serve as a route for otogenic intracranial sepsis and meningitis. This case serves to reinforce the importance of pneumococcal vaccination and the high clinical suspicion necessary for the prompt diagnosis and treatment of IPD. However, despite vaccination, IPD remains a life-threatening disease due to poor antibiotic penetration in the central nervous system and overlapping presentations with coinfections, such as COVID-19.
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Affiliation(s)
- Julie Gaudin
- Internal Medicine, Edward Via College of Osteopathic Medicine, Monroe, USA
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2
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Castañeda-Mogollón D, Kamaliddin C, Oberding L, Liu Y, Mohon AN, Faridi RM, Khan F, Pillai DR. A metagenomics workflow for SARS-CoV-2 identification, co-pathogen detection, and overall diversity. J Clin Virol 2021; 145:105025. [PMID: 34775144 PMCID: PMC8564975 DOI: 10.1016/j.jcv.2021.105025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/24/2022]
Abstract
An unbiased metagenomics approach to virus identification can be essential in the initial phase of a pandemic. Better molecular surveillance strategies are needed for the detection of SARS-CoV-2 variants of concern and potential co-pathogens triggering respiratory symptoms. Here, a metagenomics workflow was developed to identify the metagenome diversity by SARS-CoV-2 diagnosis (npositive = 65; nnegative = 60), symptomatology status (nsymptomatic = 71; nasymptomatic = 54) and anatomical swabbing site (nnasopharyngeal = 96; nthroat = 29) in 125 individuals. Furthermore, the workflow was able to identify putative respiratory co-pathogens, and the SARS-CoV-2 lineage across 29 samples. The diversity analysis showed a significant shift in the DNA-metagenome by symptomatology status and anatomical swabbing site. Additionally, metagenomic diversity differed between SARS-CoV-2 infected and uninfected asymptomatic individuals. While 31 co-pathogens were identified in SARS-CoV-2 infected patients, no significant increase in pathogen or associated reads were noted when compared to SARS-CoV-2 negative patients. The Alpha SARS-CoV-2 VOC and 2 variants of interest (Zeta) were successfully identified for the first time using a clinical metagenomics approach. The metagenomics pipeline showed a sensitivity of 86% and a specificity of 72% for the detection of SARS-CoV-2. Clinical metagenomics can be employed to identify SARS-CoV-2 variants and respiratory co-pathogens potentially contributing to COVID-19 symptoms. The overall diversity analysis suggests a complex set of microorganisms with different genomic abundance profiles in SARS-CoV-2 infected patients compared to healthy controls. More studies are needed to correlate severity of COVID-19 disease in relation to potential disbyosis in the upper respiratory tract. A metagenomics approach is particularly useful when novel pandemic pathogens emerge.
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Affiliation(s)
- Daniel Castañeda-Mogollón
- Cumming School of Medicine, Department of Pathology & Laboratory Medicine, the University of Calgary, AB, Canada; Cumming School of Medicine, Department of Microbiology, Immunology, and Infectious Diseases, the University of Calgary, Canada; Calvin, Phoebe & Joan Snyder Institute for Chronic Diseases, the University of Calgary, Calgary, AB, Canada
| | - Claire Kamaliddin
- Cumming School of Medicine, Department of Pathology & Laboratory Medicine, the University of Calgary, AB, Canada; Cumming School of Medicine, Department of Microbiology, Immunology, and Infectious Diseases, the University of Calgary, Canada; Calvin, Phoebe & Joan Snyder Institute for Chronic Diseases, the University of Calgary, Calgary, AB, Canada
| | - Lisa Oberding
- Cumming School of Medicine, Department of Pathology & Laboratory Medicine, the University of Calgary, AB, Canada; Cumming School of Medicine, Department of Microbiology, Immunology, and Infectious Diseases, the University of Calgary, Canada; Calvin, Phoebe & Joan Snyder Institute for Chronic Diseases, the University of Calgary, Calgary, AB, Canada
| | - Yan Liu
- Cumming School of Medicine, Department of Pathology & Laboratory Medicine, the University of Calgary, AB, Canada; Cumming School of Medicine, Department of Microbiology, Immunology, and Infectious Diseases, the University of Calgary, Canada; Calvin, Phoebe & Joan Snyder Institute for Chronic Diseases, the University of Calgary, Calgary, AB, Canada
| | - Abu Naser Mohon
- Cumming School of Medicine, Department of Pathology & Laboratory Medicine, the University of Calgary, AB, Canada; Cumming School of Medicine, Department of Microbiology, Immunology, and Infectious Diseases, the University of Calgary, Canada; Calvin, Phoebe & Joan Snyder Institute for Chronic Diseases, the University of Calgary, Calgary, AB, Canada
| | - Rehan Mujeeb Faridi
- Alberta Precision Laboratories, Diagnostic & Scientific Centre, Calgary, AB, Canada; Hematology Translational Lab, University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Institute, the University of Calgary, Calgary, AB, Canada
| | - Faisal Khan
- Alberta Precision Laboratories, Diagnostic & Scientific Centre, Calgary, AB, Canada; Hematology Translational Lab, University of Calgary, Calgary, AB, Canada; Arnie Charbonneau Cancer Institute, the University of Calgary, Calgary, AB, Canada
| | - Dylan R Pillai
- Cumming School of Medicine, Department of Pathology & Laboratory Medicine, the University of Calgary, AB, Canada; Cumming School of Medicine, Department of Microbiology, Immunology, and Infectious Diseases, the University of Calgary, Canada; Calvin, Phoebe & Joan Snyder Institute for Chronic Diseases, the University of Calgary, Calgary, AB, Canada; Alberta Precision Laboratories, Diagnostic & Scientific Centre, Calgary, AB, Canada.
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3
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Risa E, Roach D, Budak JZ, Hebert C, Chan JD, Mani NS, Bryson-Cahn C, Town J, Johnson NJ. Characterization of Secondary Bacterial Infections and Antibiotic Use in Mechanically Ventilated Patients With COVID-19 Induced Acute Respiratory Distress Syndrome. J Intensive Care Med 2021; 36:1167-1175. [PMID: 34372721 PMCID: PMC8358424 DOI: 10.1177/08850666211021745] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: COVID-19 has a widely variable clinical syndrome that is difficult to
distinguish from bacterial sepsis, leading to high rates of antibiotic use.
Early studies indicate low rates of secondary bacterial infections (SBIs)
but have included heterogeneous patient populations. Here, we catalogue all
SBIs and antibiotic prescription practices in a population of mechanically
ventilated patients with COVID-19 induced acute respiratory distress
syndrome (ARDS). Methods: This was a retrospective cohort study of all patients with COVID-19 ARDS
requiring mechanical ventilation from 3 Seattle, Washington hospitals in
2020. Data were obtained via electronic and manual review of the electronic
medical record. We report the incidence and site of SBIs, mortality, and
antibiotics per day using descriptive statistics. Results: We identified 126 patients with COVID-19 induced ARDS during the study
period. Of these patients, 61% developed clinical infection confirmed by
bacterial culture. Ventilator associated pneumonia was confirmed in 55% of
patients, bacteremia in 20%, and urinary tract infection (UTI) in 17%.
Staphylococcus aureus was the most commonly isolated
bacterial species. A total of 97% of patients received antibiotics during
their hospitalization, and patients received nearly one antibiotic per day
during their hospital stay. Conclusions: Mechanically ventilated patients with COVID-19 induced ARDS are at high risk
for secondary bacterial infections and have extensive antibiotic
exposure.
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Affiliation(s)
- Erik Risa
- University of Washington School of Medicine, Seattle, WA, USA
| | - David Roach
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jehan Z Budak
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - Christopher Hebert
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeannie D Chan
- Harborview Medical Center, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Nandita S Mani
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - Chloe Bryson-Cahn
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - James Town
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Nicholas J Johnson
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA
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4
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Foschi C, Zignoli A, Gaibani P, Vocale C, Rossini G, Lafratta S, Liberatore A, Turello G, Lazzarotto T, Ambretti S. Respiratory bacterial co-infections in intensive care unit-hospitalized COVID-19 patients: Conventional culture vs BioFire FilmArray pneumonia Plus panel. J Microbiol Methods 2021; 186:106259. [PMID: 34062210 PMCID: PMC8164500 DOI: 10.1016/j.mimet.2021.106259] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 12/29/2022]
Abstract
The prevalence and microbiology of concomitant respiratory bacterial infections in patients with SARS-CoV-2 infection are not yet fully understood. In this retrospective study, we assessed respiratory bacterial co-infections in lower respiratory tract samples taken from intensive care unit-hospitalized COVID-19 patients, by comparing the conventional culture approach to an innovative molecular diagnostic technology. A total of 230 lower respiratory tract samples (i.e., bronchial aspirates or bronchoalveolar lavages) were taken from 178 critically ill COVID-19 patients. Each sample was processed by a semi-quantitative culture and by a multiplex PCR panel (FilmArray Pneumonia Plus panel), allowing rapid detection of a wide range of clinically relevant pathogens and a limited number of antimicrobial resistance markers. More than 30% of samples showed a positive bacterial culture, with Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus the most detected pathogens. FilmArray showed an overall sensitivity and specificity of 89.6% and 98.3%, respectively, with a negative predictive value of 99.7%. The molecular test significantly reduced the turn-around-time (TAT) and increased the rates of microbial detection. Most cases missed by culture were characterized by low bacterial loads (104–105 copies/mL). FilmArray missed a list of pathogens not included in the molecular panel, especially Stenotrophomonas maltophilia (8 cases). FilmArray can be useful to detect bacterial pathogens in lower respiratory tract specimens of COVID-19 patients, with a significant decrease of TAT. The test is particularly useful to rule out bacterial co-infections and avoid the inappropriate prescription of antibiotics.
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Affiliation(s)
- Claudio Foschi
- Microbiology, DIMES, University of Bologna, via Massarenti 9, Bologna, Italy; Microbiology Unit, IRCCS S.Orsola-Malpighi Hospital, Via Massarenti n 9, Bologna, Italy.
| | - Anna Zignoli
- Microbiology, DIMES, University of Bologna, via Massarenti 9, Bologna, Italy
| | - Paolo Gaibani
- Microbiology Unit, IRCCS S.Orsola-Malpighi Hospital, Via Massarenti n 9, Bologna, Italy
| | - Caterina Vocale
- Microbiology Unit, IRCCS S.Orsola-Malpighi Hospital, Via Massarenti n 9, Bologna, Italy
| | - Giada Rossini
- Microbiology Unit, IRCCS S.Orsola-Malpighi Hospital, Via Massarenti n 9, Bologna, Italy
| | - Silvia Lafratta
- Microbiology, DIMES, University of Bologna, via Massarenti 9, Bologna, Italy
| | - Andrea Liberatore
- Microbiology, DIMES, University of Bologna, via Massarenti 9, Bologna, Italy
| | - Gabriele Turello
- Microbiology, DIMES, University of Bologna, via Massarenti 9, Bologna, Italy
| | - Tiziana Lazzarotto
- Microbiology, DIMES, University of Bologna, via Massarenti 9, Bologna, Italy; Microbiology Unit, IRCCS S.Orsola-Malpighi Hospital, Via Massarenti n 9, Bologna, Italy
| | - Simone Ambretti
- Microbiology Unit, IRCCS S.Orsola-Malpighi Hospital, Via Massarenti n 9, Bologna, Italy
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5
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The lower respiratory tract microbiome of critically ill patients with COVID-19. Sci Rep 2021; 11:10103. [PMID: 33980943 PMCID: PMC8115177 DOI: 10.1038/s41598-021-89516-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/11/2021] [Indexed: 12/19/2022] Open
Abstract
COVID-19 infection may predispose to secondary bacterial infection which is associated with poor clinical outcome especially among critically ill patients. We aimed to characterize the lower respiratory tract bacterial microbiome of COVID-19 critically ill patients in comparison to COVID-19-negative patients. We performed a 16S rRNA profiling on bronchoalveolar lavage (BAL) samples collected between April and May 2020 from 24 COVID-19 critically ill subjects and 24 patients with non-COVID-19 pneumonia. Lung microbiome of critically ill patients with COVID-19 was characterized by a different bacterial diversity (PERMANOVA on weighted and unweighted UniFrac Pr(> F) = 0.001) compared to COVID-19-negative patients with pneumonia. Pseudomonas alcaligenes, Clostridium hiranonis, Acinetobacter schindleri, Sphingobacterium spp., Acinetobacter spp. and Enterobacteriaceae, characterized lung microbiome of COVID-19 critically ill patients (LDA score > 2), while COVID-19-negative patients showed a higher abundance of lung commensal bacteria (Haemophilus influenzae, Veillonella dispar, Granulicatella spp., Porphyromonas spp., and Streptococcus spp.). The incidence rate (IR) of infections during COVID-19 pandemic showed a significant increase of carbapenem-resistant Acinetobacter baumannii (CR-Ab) infection. In conclusion, SARS-CoV-2 infection and antibiotic pressure may predispose critically ill patients to bacterial superinfection due to opportunistic multidrug resistant pathogens.
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6
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Rusic D, Vilovic M, Bukic J, Leskur D, Seselja Perisin A, Kumric M, Martinovic D, Petric A, Modun D, Bozic J. Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks. Life (Basel) 2021; 11:life11030220. [PMID: 33801799 PMCID: PMC8000815 DOI: 10.3390/life11030220] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 12/23/2022] Open
Abstract
The net effect of the coronavirus disease 2019 (COVID-19) pandemic and the response to it on the emergence of antimicrobial resistance is yet unknown. Positive impacts on the spread of multiresistant pathogens and infections in general may be observed with the implementation of general preventative measures for the spread of infectious disease such as social distancing, reduced travel and increased personal hygiene. This pandemic has accelerated the development of novel technologies, such as mRNA vaccines, that may be used to fight other diseases. These should be capitalized upon to manage the ongoing antimicrobial resistance pandemic in the background. However, it is likely that the COVID-19 pandemic is fueling the emergence of antimicrobial resistance due to high rates of inappropriate antimicrobial prescribing, the high use of biocides and the interruption of treatment for other conditions. Clinical uncertainty driven by the lack of effective diagnostics and practice of telemedicine may have driven the inappropriate use of antimicrobials. As pathogens know no borders, increased focus is needed for infectious diseases still threatening low- and middle-income countries such as tuberculosis. Stewardship measures for future outbreaks should stress the importance of social distancing and hand washing but discourage the overuse of disinfectants and antimicrobials that are not proven effective.
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Affiliation(s)
- Doris Rusic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Josipa Bukic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Ana Seselja Perisin
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Dinko Martinovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
| | - Ana Petric
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
- Split-Dalmatia County Pharmacy, Kneza Ljudevita Posavskog 12 b, 21 000 Split, Croatia
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (D.L.); (A.S.P.); (A.P.); (D.M.)
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (M.V.); (M.K.); (D.M.)
- Correspondence:
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7
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Ayad S, Alyacoub R, Gergis K, Grossman D, Salamera J. Invasive Pneumococcal Disease in a Patient With COVID-19: A Case Report. Cureus 2021; 13:e13559. [PMID: 33791177 PMCID: PMC8004547 DOI: 10.7759/cureus.13559] [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] [Indexed: 01/19/2023] Open
Abstract
The spread of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has resulted in a global health pandemic and caused profound morbidity and mortality worldwide. The virus is known to cause severe hypoxemic respiratory failure and has been associated with extrapulmonary manifestations and end-organ dysfunction in the setting of extensive inflammatory response. Recently, the association between COVID-19 and pneumococcal pneumonia co-infection or superinfections has gained increasing interest. In this report, we present the case of a 58-year-old man with a past medical history significant for pulmonary tuberculosis, diagnosed over two decades ago, who presented with pleuritic chest pain, myalgia, intermittent fevers, chills, and productive cough and was found to have invasive pneumococcal disease and COVID-19. To our knowledge, this is the first reported case of invasive pneumococcal infection in a patient with COVID-19.
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Affiliation(s)
- Sarah Ayad
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Ramez Alyacoub
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | | | - Daniel Grossman
- Internal Medicine, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Julius Salamera
- Infectious Disease, Rutgers-New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
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8
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Baindara P, Chakraborty R, Holliday Z, Mandal S, Schrum A. Oral probiotics in coronavirus disease 2019: connecting the gut-lung axis to viral pathogenesis, inflammation, secondary infection and clinical trials. New Microbes New Infect 2021; 40:100837. [PMID: 33425362 PMCID: PMC7785423 DOI: 10.1016/j.nmni.2021.100837] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/12/2020] [Accepted: 12/31/2020] [Indexed: 01/07/2023] Open
Abstract
Defined as helpful live bacteria that can provide medical advantages to the host when administered in tolerable amounts, oral probiotics might be worth considering as a possible preventive or therapeutic modality to mitigate coronavirus disease 2019 (COVID-19) symptom severity. This hypothesis stems from an emerging understanding of the gut-lung axis wherein probiotic microbial species in the digestive tract can influence systemic immunity, lung immunity, and possibly viral pathogenesis and secondary infection co-morbidities. We review the principles underlying the gut-lung axis, examples of probiotic-associated antiviral activities, and current clinical trials in COVID-19 based on oral probiotics.
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Affiliation(s)
- P. Baindara
- Department of Molecular Microbiology & Immunology, School of Medicine, University of Missouri, Columbia, MO, USA,Corresponding author: P. Baindara, Department of Molecular Microbiology & Immunology, School of Medicine, University of Missouri, Columbia, MO, USA.
| | - R. Chakraborty
- Department of Biotechnology, North Bengal University, Darjeeling, India
| | - Z.M. Holliday
- Pulmonary Disease, Critical Care Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - S.M. Mandal
- Central Research Facility, Indian Institute of Technology Kharagpur, Kharagpur, India,Corresponding author: S.M. Mandal, Central Research Facility, Indian Institute of Technology Kharagpur, Kharagpur, India.
| | - A.G. Schrum
- Department of Molecular Microbiology & Immunology, School of Medicine, University of Missouri, Columbia, MO, USA,Department of Surgery, School of Medicine, University of Missouri, Columbia, MO, USA,Department of Biomedical, Biological, & Chemical Engineering, College of Engineering, University of Missouri, Columbia, MO, USA,Corresponding author: A. Schrum, Department of Molecular Microbiology & Immunology, School of Medicine, University of Missouri, Columbia, MO, USA.
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9
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Fernández-Urrusuno R, Meseguer Barros CM, Anaya-Ordóñez S, Borrego Izquierdo Y, Lallana-Álvarez MJ, Madridejos R, Tejón EM, Sánchez RP, Pérez Rodríguez O, García Gil M, Escudero Vilaplana B, Riádigos GMS, López-Fando MSP, Olmo Quintana V, Pina Gadea MB, García Alvarez A, Martorell MLS, Jiménez Arce JI, Aguilella Vizcaíno R, Pérez Martín J, Alzueta Isturiz N. Patients receiving a high burden of antibiotics in the community in Spain: a cross-sectional study. Pharmacol Res Perspect 2020; 9:e00692. [PMID: 33340264 PMCID: PMC7749514 DOI: 10.1002/prp2.692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023] Open
Abstract
Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross-sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient's average age was 70 years; 52% were men; 60% smokers/ex-smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty-five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad-spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally.
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Affiliation(s)
- Rocío Fernández-Urrusuno
- Clinical Unit Primary Care Pharmacy Sevilla, Aljarafe-Sevilla Norte Primary Health Area, Andalusian Health Service, Seville, Spain
| | | | - Sonia Anaya-Ordóñez
- Service of Pharmacy, Granada Metropolitano Primary Health Care Area, Andalusian Health Service, Granada, Spain
| | | | | | | | - Esther Marco Tejón
- Cuenca Primary Care Management, Hospital Virgen de la Luz, Castilla La Mancha Health Service, Cuenca, Spain
| | | | - Olatz Pérez Rodríguez
- Mallorca Primary Care Management, Islas Baleares Health Service IB-SALUT, Palma de Mallorca, Spain
| | - María García Gil
- Service of Pharmacy, Sagunto Health Care Area, Comunidad Valenciana, Valencia, Spain
| | | | - Genma M Silva Riádigos
- Service of Pharmacy, Ouest Primary Health Care Area, Madrid Health Service, Madrid, Spain
| | | | - Vicente Olmo Quintana
- Service of Pharmacy, Gran Canaria Primary Care Management, Canarian Health Service, Gran Canaria, Spain
| | - M Belén Pina Gadea
- Service of Primary Care Pharmacy, Aragón Health Service, Zaragoza, Spain
| | - Angel García Alvarez
- Tramuntana Primary Care Management, Islas Baleares Health Care Service, Palma de Mallorca, Spain
| | - M Llüisa Sastre Martorell
- Service of Pharmacy, Hospital Universitari Son Espases, Islas Baleares Health Service IB-SALUT, Palma de Mallorca, Spain
| | - Jorge I Jiménez Arce
- Clinical Unit Primary Care Pharmacy Area VII Asturias, Principado de Asturias Health Service, Mieres, Asturias, Spain
| | | | - Joaquín Pérez Martín
- Faculty of Social Sciences, Area of Design, Gaming and Multimedia, European University of Madrid, Madrid, Spain
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