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Yogo A, Yamamoto S, Tochitani K. Timing and prediction of secondary bacteremia in patients with COVID-19: A retrospective cohort study. J Gen Fam Med 2024; 25:206-213. [PMID: 38966654 PMCID: PMC11221055 DOI: 10.1002/jgf2.697] [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: 12/22/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 07/06/2024] Open
Abstract
Background We aimed to aid the appropriate use of antimicrobial agents by determining the timing of secondary bacteremia and validating and updating clinical prediction models for bacteremia in patients with COVID-19. Methods We performed a retrospective cohort study on all hospitalized patients diagnosed with COVID-19 who underwent blood culture tests from January 1, 2020, and September 30, 2021, at an urban teaching hospital in Japan. The primary outcome measure was secondary bacteremia in patients with COVID-19. Results Of the 507 patients hospitalized with COVID-19, 169 underwent blood culture tests. Eleven of them had secondary bacteremia. The majority of secondary bacteremia occurred on or later than the 9th day after symptom onset. Positive blood culture samples collected on day 9 or later after disease onset had an odds ratio of 22.4 (95% CI 2.76-181.2, p < 0.001) compared with those collected less than 9 days after onset. The area under the receiver operating characteristic curve of the modified Shapiro rule combined with blood culture collection on or after the 9th day from onset was 0.919 (95% CI, 0.843-0.995), and the net benefit was high according to the decision curve analysis. Conclusions The timings of symptom onset and hospital admission may be valuable indicators for making a clinical decision to perform blood cultures in patients hospitalized with COVID-19.
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Affiliation(s)
- Aoi Yogo
- Division of Infectious DiseasesUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
- Department of Infectious DiseaseKyoto City HospitalKyotoJapan
| | - Shungo Yamamoto
- Department of Transformative Infection Control Development StudiesOsaka University Graduate School of MedicineOsakaJapan
- Division of Fostering Required Medical Human Resources, Center for Infectious Disease Education and Research (CiDER)Osaka UniversityOsakaJapan
- Division of Infection Control and PreventionOsaka University HospitalSuita cityOsakaJapan
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Jansen T, Gouwens S, Meijerink L, Meulman I, Kouwenberg LHJA, de Wit GA, Polder JJ, Kunst AE, Uiters E. Disruption of hospital care during the first year of the COVID-19 pandemic impacted socioeconomic groups differently: population based study using routine registration data. BMC Health Serv Res 2024; 24:294. [PMID: 38448939 PMCID: PMC10918870 DOI: 10.1186/s12913-024-10695-9] [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: 04/13/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, provision of non-COVID healthcare was recurrently severely disrupted. The objective was to determine whether disruption of non-COVID hospital use, either due to cancelled, postponed, or forgone care, during the first pandemic year of COVID-19 impacted socioeconomic groups differently compared with pre-pandemic use. METHODS National population registry data, individually linked with data of non-COVID hospital use in the Netherlands (2017-2020). in non-institutionalised population of 25-79 years, in standardised household income deciles (1 = low, 10 = high) as proxy for socioeconomic status. Generic outcome measures included patients who received hospital care (dichotomous): outpatient contact, day treatment, inpatient clinic, and surgery. Specific procedures were included as examples of frequently performed elective and acute procedures, e.g.: elective knee/hip replacement and cataract surgery, and acute percutaneous coronary interventions (PCI). Relative risks (RR) for hospital use were reported as outcomes from generalised linear regression models (binomial) with log-link. An interaction term was included to assess whether income differences in hospital use during the pandemic deviated from pre-pandemic use. RESULTS Hospital use rates declined in 2020 across all income groups. With baseline (2019) higher hospital use rates among lower than higher income groups, relatively stronger declines were found for lower income groups. The lowest income groups experienced a 10% larger decline in surgery received than the highest income group (RR 0.90, 95% CI 0.87 - 0.93). Patterns were similar for inpatient clinic, elective knee/hip replacement and cataract surgery. We found small or no significant income differences for outpatient clinic, day treatment, and acute PCI. CONCLUSIONS Disruption of non-COVID hospital use in 2020 was substantial across all income groups during the acute phases of the pandemic, but relatively stronger for lower income groups than could be expected compared with pre-pandemic hospital use. Although the pandemic's impact on the health system was unprecedented, healthcare service shortages are here to stay. It is therefore pivotal to realise that lower income groups may be at risk for underuse in times of scarcity.
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Affiliation(s)
- Tessa Jansen
- Centre for Public Health, Healthcare, and Society, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - Sigur Gouwens
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000, LE, Tilburg, The Netherlands
| | - Lotta Meijerink
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000, LE, Tilburg, The Netherlands
| | - Iris Meulman
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000, LE, Tilburg, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105, BK, Amsterdam, the Netherlands
| | - Lisanne H J A Kouwenberg
- Centre for Public Health, Healthcare, and Society, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
- Department of Health Sciences, Faculty of Science & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1007, MB, Amsterdam, The Netherlands
| | - G Ardine de Wit
- Centre for Public Health, Healthcare, and Society, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
- Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment (RIVM), 3720, BA, Bilthoven, The Netherlands
| | - Johan J Polder
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, 5000, LE, Tilburg, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105, BK, Amsterdam, the Netherlands
| | - Anton E Kunst
- Department of Health Sciences, Faculty of Science & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1007, MB, Amsterdam, The Netherlands
| | - Ellen Uiters
- Centre for Public Health, Healthcare, and Society, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
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Carney M, Pelaia TM, Chew T, Teoh S, Phu A, Kim K, Wang Y, Iredell J, Zerbib Y, McLean A, Schughart K, Tang B, Shojaei M, Short KR. Host transcriptomics and machine learning for secondary bacterial infections in patients with COVID-19: a prospective, observational cohort study. THE LANCET. MICROBE 2024; 5:e272-e281. [PMID: 38310908 DOI: 10.1016/s2666-5247(23)00363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Viral respiratory tract infections are frequently complicated by secondary bacterial infections. This study aimed to use machine learning to predict the risk of bacterial superinfection in SARS-CoV-2-positive individuals. METHODS In this prospective, multicentre, observational cohort study done in nine centres in six countries (Australia, Indonesia, Singapore, Italy, Czechia, and France) blood samples and RNA sequencing were used to develop a robust model of predicting secondary bacterial infections in the respiratory tract of patients with COVID-19. Eligible participants were older than 18 years, had known or suspected COVID-19, and symptoms of a recent respiratory infection. A control cohort of participants without COVID-19 who were older than 18 years and with no infection symptoms was also recruited from one Australian centre. In the pre-analysis phase, data were filtered to include only individuals with complete blood transcriptomics and patient data (ie, age, sex, location, and WHO severity score at the time of sample collection). The dataset was then divided randomly (4:1) into a training set (80%) and a test set (20%). Gene expression data in the training set and control cohort were used for differential expression analysis. Differentially expressed genes, along with WHO severity score, location, age, and sex, were used for feature selection with least absolute shrinkage and selection operator (LASSO) in the training set. For LASSO analysis, samples were excluded if gene expression data were not obtained at study admission, no longitudinal clinical information was available, a bacterial infection at the time of study admission was present, or a fungal infection in the absence of a bacterial infection was detected. LASSO regression was performed using three subsets of predictor variables: patient data alone, gene expression data alone, or a combination of patient data and gene expression data. The accuracy of the resultant models was tested on data from the test set. FINDINGS Between March, 2020, and October, 2021, we recruited 536 SARS-CoV-2-positive individuals and between June, 2013, and January, 2020, we recruited 74 participants into the control cohort. After prefiltering analysis and other exclusions, samples from 158 individuals were analysed in the training set and 47 in the test set. The expression of seven host genes (DAPP1, CST3, FGL2, GCH1, CIITA, UPP1, and RN7SL1) in the blood at the time of study admission was identified by LASSO as predictive of the risk of developing a secondary bacterial infection of the respiratory tract more than 24 h after study admission. Specifically, the expression of these genes in combination with a patient's WHO severity score at the time of study enrolment resulted in an area under the curve of 0·98 (95% CI 0·89-1·00), a true positive rate (sensitivity) of 1·00 (95% CI 1·00-1·00), and a true negative rate (specificity) of 0·94 (95% CI 0·89-1·00) in the test cohort. The combination of patient data and host transcriptomics at hospital admission identified all seven individuals in the training and test sets who developed a bacterial infection of the respiratory tract 5-9 days after hospital admission. INTERPRETATION These data raise the possibility that host transcriptomics at the time of clinical presentation, together with machine learning, can forward predict the risk of secondary bacterial infections and allow for the more targeted use of antibiotics in viral infection. FUNDING Snow Medical Research Foundation, the National Health and Medical Research Council, the Jack Ma Foundation, the Helmholtz-Association, the A2 Milk Company, National Institute of Allergy and Infectious Disease, and the Fondazione AIRC Associazione Italiana per la Ricerca contro il Cancro.
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Affiliation(s)
- Meagan Carney
- School of Mathematics and Physics, University of Queensland, Brisbane, QLD, Australia
| | - Tiana Maria Pelaia
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia
| | - Tracy Chew
- Sydney Informatics Hub, Core Research Facilities, University of Sydney, Sydney, NSW, Australia
| | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia
| | - Amy Phu
- Faculty of Medicine and Health, Sydney Medical School Westmead, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Karan Kim
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Ya Wang
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Jonathan Iredell
- Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia; Sydney Institute for Infectious Disease, University of Sydney, Sydney, NSW, Australia; Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Sydney, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Yoann Zerbib
- Intensive Care Department, Amiens University Hospital, Amiens, France
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Klaus Schughart
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA; Institute of Virology Münster, University of Münster, Münster, Germany
| | - Benjamin Tang
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Maryam Shojaei
- Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia; The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Sydney, NSW, Australia.
| | - Kirsty R Short
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia.
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Duan Y, Wang J, Wang S, Zhang R, Hu J, Li W, Chen B. Risk factors, outcomes, and epidemiological and etiological study of hospitalized COVID-19 patients with bacterial co-infection and secondary infections. Eur J Clin Microbiol Infect Dis 2024; 43:577-586. [PMID: 38246947 PMCID: PMC10917871 DOI: 10.1007/s10096-024-04755-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND As a common complication of viral respiratory tract infection, bacterial infection was associated with higher mortality and morbidity. Determining the prevalence, culprit pathogens, outcomes, and risk factors of co-infection and secondary infection occurring in hospitalized patients with coronavirus disease 2019 (COVID-19) will be beneficial for better antibiotic management. METHODS In this retrospective cohort research, we assessed clinical characteristics, laboratory parameters, microbiologic results, and outcomes of laboratory-confirmed COVID-19 patients with bacterial co-infection and secondary infection in West China Hospital from 2022 December 2nd to 2023 March 15th. RESULTS The incidence of bacterial co-infection and secondary infection, as defined by positive culture results of clinical specimens, was 16.3% (178/1091) and 10.1% (110/1091) respectively among 1091 patients. Acinetobacter, Klebsiella, and Pseudomonas were the most commonly identified bacteria in respiratory tract samples of COVID-19 patients. In-hospital mortality of COVID-19 patients with co-infection (17.4% vs 9.5%, p = 0.003) and secondary infection (28.2% vs 9.5%, p < 0.001) greatly exceeded that of COVID-19 patients without bacterial infection. Cardiovascular disease (1.847 (1.202-2.837), p = 0.005), severe COVID-19 (1.694 (1.033-2.778), p = 0.037), and critical COVID-19 (2.220 (1.196-4.121), p = 0.012) were proved to be risk factors for bacterial co-infection, while only critical COVID-19 (1.847 (1.202-2.837), p = 0.005) was closely related to secondary infection. CONCLUSIONS Bacterial co-infection and secondary infection could aggravate the disease severity and worsen clinical outcomes of COVID-19 patients. Notably, only critical COVID-19 subtype was proved to be an independent risk factor for both co-infection and secondary infection. Therefore, standard empirical antibiotics was recommended for critically ill COVID-19 rather than all the inpatients according to our research.
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Affiliation(s)
- Yishan Duan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jing Wang
- Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Suyan Wang
- Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Rui Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jinrui Hu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
- Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, China
- Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- The Research Units of West China, Chinese Academy of Medical Sciences, West China Hospital, Chengdu, 610041, Sichuan, China
- State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Chengdu, 610041, Sichuan, China
| | - Bojiang Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Sili U, Tekin A, Bilgin H, Khan SA, Domecq JP, Vadgaonkar G, Segu SS, Rijhwani P, Raju U, Surapaneni KM, Zabolotskikh I, Gomaa D, Goodspeed VM, Ay P. Early empiric antibiotic use in COVID-19 patients: results from the international VIRUS registry. Int J Infect Dis 2024; 140:39-48. [PMID: 38128643 PMCID: PMC10939992 DOI: 10.1016/j.ijid.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES COVID-19 escalated inappropriate antibiotic use. We determined the distribution of pathogens causing community-acquired co-infections, the rate, and factors associated with early empiric antibiotic (EEAB) treatment among hospitalized COVID-19 patients. METHODS The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry including 68,428 patients from 28 countries enrolled between January 2020 and October 2021 were screened. After exclusions, 7830 patients were included in the analysis. Azithromycin and/or other antibiotic treatment given within the first 3 days of hospitalization was investigated. Univariate and multivariate analyses were performed to determine factors associated with EEAB use. RESULTS The majority (6214, 79.4%) of patients received EEAB, with azithromycin combination being the most frequent (3146, 40.2%). As the pandemic advanced, the proportion of patients receiving EEAB regressed from 84.4% (786/931) in January-March 2020 to 65.2% (30/46) in April-June 2021 (P < 0.001). Beta-lactams, especially ceftriaxone was the most commonly used antibiotic. Staphylococcus aureus was the most commonly isolated pathogen. Multivariate analysis showed geographical location and pandemic timeline as the strongest independent predictors of EEAB use. CONCLUSIONS EEAB administration decreased as pandemic advanced, which may be the result of intensified antimicrobial stewardship efforts. Our study provides worldwide goals for antimicrobial stewardship programs in the post-COVID-19 era.
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Affiliation(s)
- Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Türkiye.
| | - Aysun Tekin
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Huseyin Bilgin
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Syed Anjum Khan
- Division of Critical Care Medicine, Mayo Clinic Health System, Mankato, Minnesota, United States
| | - Juan Pablo Domecq
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Smitha S Segu
- Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Puneet Rijhwani
- Department of Medicine, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, Rajasthan, India
| | | | - Krishna Mohan Surapaneni
- Departments of Biochemistry, Molecular Virology, Research and Clinical Skills & Simulation, Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Chennai, Tamil Nadu, India
| | - Igor Zabolotskikh
- Department of Anesthesiology, Intensive Care Medicine and Transfusiology, Kuban State Medical University with affiliation Territorial Hospital #2, Krasnodar, Russia
| | - Dina Gomaa
- Department of Surgery Division of Trauma and Critical Care- Trauma Research University of Cincinnati, Cincinnati, Ohio, United States
| | - Valerie M Goodspeed
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Pinar Ay
- Department of Public Health, School of Medicine, Marmara University, Istanbul, Türkiye
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Mehrizi R, Golestani A, Malekpour MR, Karami H, Nasehi MM, Effatpanah M, Ranjbaran H, Shahali Z, Sari AA, Daroudi R. Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data. Front Public Health 2023; 11:1280434. [PMID: 38164450 PMCID: PMC10758044 DOI: 10.3389/fpubh.2023.1280434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Background Different medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran. Methods We retrieved hospitalized patients' data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020-2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models. Results During the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55.84% [95% CI: 55.74-55.94]), corticosteroids (54.14% [54.04-54.24]), and antibiotics (42.22% [42.12-42.32]) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 [0.94-0.95]) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 [95%CI, 0.73-0.76]), corticosteroids (0.97 [0.95-0.99]), antivirals (0.82 [0.80-0.83]), and ACE inhibitor/ARB (0.79 [0.77-0.80]) were significantly associated with lower mortality. Conclusion Over 2 years of investigation, antithrombotics, corticosteroids, and antibiotics were the top medications for hospitalized patients with COVID-19. Trends in medication prescription varied based on various factors across the country. Medication prescriptions could potentially significantly impact the trends of mortality and hospitalization during epidemics, thereby affecting both health and economic burdens.
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Affiliation(s)
- Reza Mehrizi
- National Center for Health Insurance Research, Tehran, Iran
| | - Ali Golestani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Karami
- National Center for Health Insurance Research, Tehran, Iran
| | - Mohammad Mahdi Nasehi
- National Center for Health Insurance Research, Tehran, Iran
- Pediatric Neurology Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Effatpanah
- National Center for Health Insurance Research, Tehran, Iran
- School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ranjbaran
- National Center for Health Insurance Research, Tehran, Iran
- Immunogenetics Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Shahali
- National Center for Health Insurance Research, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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7
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Kumar M, Mazumder P, Silori R, Manna S, Panday DP, Das N, Sethy SK, Kuroda K, Mahapatra DM, Mahlknecht J, Tyagi VK, Singh R, Zang J, Barceló D. Prevalence of pharmaceuticals and personal care products, microplastics and co-infecting microbes in the post-COVID-19 era and its implications on antimicrobial resistance and potential endocrine disruptive effects. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 904:166419. [PMID: 37625721 DOI: 10.1016/j.scitotenv.2023.166419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
The COVID-19 (coronavirus disease 2019) pandemic's steady condition coupled with predominance of emerging contaminants in the environment and its synergistic implications in recent times has stoked interest in combating medical emergencies in this dynamic environment. In this context, high concentrations of pharmaceutical and personal care products (PPCPs), microplastics (MPs), antimicrobial resistance (AMR), and soaring coinfecting microbes, tied with potential endocrine disruptive (ED) are critical environmental concerns that requires a detailed documentation and analysis. During the pandemic, the identification, enumeration, and assessment of potential hazards of PPCPs and MPs and (used as anti-COVID-19 agents/applications) in aquatic habitats have been attempted globally. Albeit receding threats in the magnitude of COVID-19 infections, both these pollutants have still posed serious consequences to aquatic ecosystems and the very health and hygiene of the population in the vicinity. The surge in the contaminants post-COVID also renders them to be potent vectors to harbor and amplify AMR. Pertinently, the present work attempts to critically review such instances to understand the underlying mechanism, interactions swaying the current health of our environment during this post-COVID-19 era. During this juncture, although prevention of diseases, patient care, and self-hygiene have taken precedence, nevertheless antimicrobial stewardship (AMS) efforts have been overlooked. Unnecessary usage of PPCPs and plastics during the pandemic has resulted in increased emerging contaminants (i.e., active pharmaceutical ingredients and MPs) in various environmental matrices. It was also noticed that among COVID-19 patients, while the bacterial co-infection prevalence was 0.2-51%, the fungi, viral, protozoan and helminth were 0.3-49, 1-22, 2-15, 0.4-15% respectively, rendering them resistant to residual PPCPs. There are inevitable chances of ED effects from PPCPs and MPs applied previously, that could pose far-reaching health concerns. Furthermore, clinical and other experimental evidence for many newer compounds is very scarce and demands further research. Pro-active measures targeting effective waste management, evolved environmental policies aiding strict regulatory measures, and scientific research would be crucial in minimizing the impact and creating better preparedness towards such events among the masses fostering sustainability.
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Affiliation(s)
- Manish Kumar
- Sustainability Cluster, School of Advanced Engineering, UPES, Dehradun, Uttarakhand 248007, India; Escuela de Ingenieria y Ciencias, Tecnologico de Monterrey, Campus Monterrey, Monterrey 64849, Nuevo Leon, Mexico.
| | - Payal Mazumder
- Sustainability Cluster, School of Advanced Engineering, UPES, Dehradun, Uttarakhand 248007, India
| | - Rahul Silori
- Sustainability Cluster, School of Advanced Engineering, UPES, Dehradun, Uttarakhand 248007, India
| | - Suvendu Manna
- Sustainability Cluster, School of Advanced Engineering, UPES, Dehradun, Uttarakhand 248007, India
| | - Durga Prasad Panday
- Sustainability Cluster, School of Advanced Engineering, UPES, Dehradun, Uttarakhand 248007, India
| | - Nilotpal Das
- ENCORE Insoltech Pvt. Ltd, Randesan, Gandhinagar, Gujarat 382421, India
| | - Susanta Kumar Sethy
- Sustainability Cluster, School of Advanced Engineering, UPES, Dehradun, Uttarakhand 248007, India
| | - Keisuke Kuroda
- Department of Environmental and Civil Engineering, Toyama Prefectural University, Imizu 939 0398, Japan
| | - Durga Madhab Mahapatra
- Department of Chemical and Petroleum Engineering, School of Advanced Engineering, UPES, Dehradun, Uttarakhand 248007, India; Department of Biological and Ecological Engineering, Oregon State University, Corvallis, OR 97331, USA
| | - Jürgen Mahlknecht
- Escuela de Ingenieria y Ciencias, Tecnologico de Monterrey, Campus Monterrey, Monterrey 64849, Nuevo Leon, Mexico
| | - Vinay Kumar Tyagi
- Wastewater Division, National Institute of Hydrology Roorkee, Roorkee, Uttranchal, India
| | - Rajesh Singh
- Wastewater Division, National Institute of Hydrology Roorkee, Roorkee, Uttranchal, India
| | - Jian Zang
- Department of Civil Engineering, Chongqing University, China
| | - Damià Barceló
- Sustainability Cluster, School of Advanced Engineering, UPES, Dehradun, Uttarakhand 248007, India; Water and Soil Quality Research Group, Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Jordi Girona 1826, Barcelona 08034, Spain
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8
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Langford BJ, Leung V, Lo J, Akl EA, Nieuwlaat R, Lotfi T, Brown KA, Daneman N, Schwartz KL, Schünemann HJ. Antibiotic prescribing guideline recommendations in COVID-19: a systematic survey. EClinicalMedicine 2023; 65:102257. [PMID: 37842549 PMCID: PMC10568086 DOI: 10.1016/j.eclinm.2023.102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
Background COVID-19 and antimicrobial resistance (AMR) are two intersecting public health crises. Antimicrobial overuse in patients with COVID-19 threatens to worsen AMR. Guidelines are fundamental in encouraging antimicrobial stewardship. We sought to assess the quality of antibiotic prescribing guidelines and recommendations in the context of COVID-19, and whether they incorporate principles of antimicrobial stewardship. Methods We performed a systematic survey which included a search using the concepts "antibiotic/antimicrobial" up to November 15, 2022 of the eCOVID-19 living map of recommendations (RecMap) which aggregates guidelines across a range of international sources and all languages. Guidelines providing explicit recommendations regarding antibacterial use in COVID-19 were eligible for inclusion. Guideline and recommendation quality were assessed using the AGREE II and AGREE-REX instruments, respectively. We extracted guideline characteristics including panel representation and the presence or absence of explicit statements related to antimicrobial stewardship (i.e., judicious antibiotic use, antimicrobial resistance or adverse effects as a consequence of antibiotic use). We used logistic regression to evaluate the relationship between guideline characteristics including quality and incorporation of antimicrobial stewardship principles. Protocol registration (OSF): https://osf.io/4pgtc. Findings Twenty-eight guidelines with 63 antibiotic prescribing recommendations were included. Recommendations focused on antibiotic initiation (n = 52, 83%) and less commonly antibiotic selection (n = 13, 21%), and duration of therapy (n = 15, 24%). Guideline and recommendation quality varied widely. Twenty (71%) guidelines incorporated at least one concept relating to antimicrobial stewardship. Including infectious diseases expertise on the guideline panel (OR 9.44, 97.5% CI: 1.09-81.59) and AGREE-REX score (OR 3.26, 97.5% CI: 1.14-9.31 per 10% increase in overall score) were associated with a higher odds of guidelines addressing antimicrobial stewardship. Interpretation There is an opportunity to improve antibiotic prescribing guidelines in terms of both quality and incorporation of antimicrobial stewardship principles. These findings can help guideline developers better address antibiotic stewardship in future recommendations beyond COVID-19. Funding This project was funded by Michael G. DeGroote Cochrane Canada and McMaster GRADE centres.
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Affiliation(s)
- Bradley J. Langford
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Public Health Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Valerie Leung
- Public Health Ontario, Toronto, Canada
- Toronto East Health Network, Toronto, Canada
| | - Jennifer Lo
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Elie A. Akl
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Robby Nieuwlaat
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote Cochrane Canada Centre, Hamilton, Canada
- McMaster GRADE Centre, Hamilton, Canada
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote Cochrane Canada Centre, Hamilton, Canada
- McMaster GRADE Centre, Hamilton, Canada
| | - Kevin A. Brown
- Public Health Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Kevin L. Schwartz
- Public Health Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Unity Health Toronto, Toronto, Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
- Michael G. DeGroote Cochrane Canada Centre, Hamilton, Canada
- McMaster GRADE Centre, Hamilton, Canada
- Humanitas University, Milan, Italy
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9
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Sunder S, Bhandari K, Sounkaria S, Vyas M, Singh BP, Chandra P. Antibiotics and nano-antibiotics in treatment of lung infection: In management of COVID-19. Microb Pathog 2023; 184:106356. [PMID: 37743025 DOI: 10.1016/j.micpath.2023.106356] [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: 05/20/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
The world has witnessed the cruelty of COVID-19 disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The association of COVID-19 with other secondary and bacterial co-infections has tremendously contributed to lung infections. An increased probability of having a secondary lung infection was observed among the post-COVID patients. The treatment of antibiotics has ameliorated the mortality rate. However, the stewardship of antibiotic treatment was linked to increased organ failure. Therefore, the paper discusses the interactions between the virus and host through the ACE2 receptors that contribute to COVID-19 development. Furthermore, the paper provides an invaluable compendium history of SARS-CoV-2 genomic composition. It revolves around most classes of antibiotics used to treat COVID-19 disease and post-COVID lung infections with the complete mechanism. This binds with the exertion of the antibiotics for bacterial infection associated with COVID-19 patients and how beneficial and effective responses have been recorded for the treatment. The application of nanotechnology and possible approaches of nanomedicines is also discussed to its potential usage.
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Affiliation(s)
- Sushant Sunder
- Department of Biotechnology, Delhi Technological University, New Delhi, 110042, India; Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Kriti Bhandari
- Department of Biotechnology, Delhi Technological University, New Delhi, 110042, India
| | - Shruti Sounkaria
- Department of Biotechnology, Delhi Technological University, New Delhi, 110042, India
| | - Manjari Vyas
- Department of Biotechnology, Delhi Technological University, New Delhi, 110042, India
| | - Bhupendra Pratap Singh
- Department of Environmental Studies, Central University of Haryana, Jant-Pali, Mahendergarh, Haryana, 123031, India
| | - Prakash Chandra
- Department of Biotechnology, Delhi Technological University, New Delhi, 110042, India.
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10
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Viskupicova J, Rezbarikova P, Kovacikova L, Kandarova H, Majekova M. Inhibitors of SARS-CoV-2 main protease: Biological efficacy and toxicity aspects. Toxicol In Vitro 2023; 92:105640. [PMID: 37419426 DOI: 10.1016/j.tiv.2023.105640] [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: 04/18/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
The emergence of the highly contagious respiratory disease, COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a significant global public health concern. To combat this virus, researchers have focused on developing antiviral strategies that target specific viral components, such as the main protease (Mpro), which plays a crucial role in SARS-CoV-2 replication. While many compounds have been identified as potent inhibitors of Mpro, only a few have been translated into clinical use due to the potential risk-benefit trade-offs. Development of systemic inflammatory response and bacterial co-infection in patients belong to severe, frequent complications of COVID-19. In this context, we analysed available data on the anti-inflammatory and antibacterial activities of the SARS-CoV-2 Mpro inhibitors for possible implementation in the treatment of complicated and long COVID-19 cases. Synthetic feasibility and ADME properties were calculated and included for better characterisation of the compounds' predicted toxicity. Analysis of the collected data resulted in several clusters pointing to the most prospective compounds for further study and design. The complete tables with collected data are attached in Supplementary material for use by other researchers.
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Affiliation(s)
- Jana Viskupicova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | | | - Lucia Kovacikova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia; Department of Organic Chemistry, Faculty of Natural Sciences, Comenius University, Bratislava, Slovakia
| | - Helena Kandarova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia; Institute of Biochemistry and Microbiology, Faculty of Chemical and Food Technology, Slovak University of Technology, Bratislava, Slovakia
| | - Magdalena Majekova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia.
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11
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Van Laethem J, Pierreux J, Wuyts SC, De Geyter D, Allard SD, Dauby N. Using risk factors and markers to predict bacterial respiratory co-/superinfections in COVID-19 patients: is the antibiotic steward's toolbox full or empty? Acta Clin Belg 2023; 78:418-430. [PMID: 36724448 DOI: 10.1080/17843286.2023.2167328] [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: 10/30/2022] [Accepted: 01/07/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adequate diagnosis of bacterial respiratory tract co-/superinfection (bRTI) in coronavirus disease (COVID-19) patients is challenging, as there is insufficient knowledge about the role of risk factors and (para)clinical parameters in the identification of bacterial co-/superinfection in the COVID-19 setting. Empirical antibiotic therapy is mainly based on COVID-19 severity and expert opinion, rather than on scientific evidence generated since the start of the pandemic. PURPOSE We report the best available evidence regarding the predictive value of risk factors and (para)clinical markers in the diagnosis of bRTI in COVID-19 patients. METHODS A multidisciplinary team identified different potential risk factors and (para)clinical predictors of bRTI in COVID-19 and formulated one or two research questions per topic. After a thorough literature search, research gaps were identified, and suggestions concerning further research were formulated. The quality of this narrative review was ensured by following the Scale for the Assessment of Narrative Review Articles. RESULTS Taking into account the scarcity of scientific evidence for markers and risk factors of bRTI in COVID-19 patients, to date, COVID-19 severity is the only parameter which can be associated with higher risk of developing bRTI. CONCLUSIONS Evidence on the usefulness of risk factors and (para)clinical factors as predictors of bRTI in COVID-19 patients is scarce. Robust studies are needed to optimise antibiotic prescribing and stewardship activities in the context of COVID-19.
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Affiliation(s)
- Johan Van Laethem
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jan Pierreux
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Stephanie Cm Wuyts
- Universitair Ziekenhuis Brussel (UZ Brussel), Hospital Pharmacy, Brussels, Belgium
- Research group Clinical Pharmacology and Pharmacotherapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Deborah De Geyter
- Microbiology and Infection Control Department, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Sabine D Allard
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Nicolas Dauby
- Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Centre for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Infectious Diseases, CHU Saint-Pierre - Université Libre de Bruxelles (ULB), Brussels, Belgium
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12
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Wen R, Li J, Wang X, Xu P, Li G, Wang J, Zeng X, Liu C. Pre-Existing Allergies Patients with Higher Viral Load and Longer Recovery Days Infected by SARS-CoV-2 Omicron BA.2 in Shanghai, China, 2022. J Asthma Allergy 2023; 16:903-913. [PMID: 37680299 PMCID: PMC10480291 DOI: 10.2147/jaa.s402674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/12/2023] [Indexed: 09/09/2023] Open
Abstract
Background It is not known whether the viral load and the number of days to negative nucleic acid increased in patients with a history of allergy during the COVID-19 pandemic. Objective To investigate the impact of allergy labels on SARS-CoV-2 Omicron outcomes. Methods This retrospective cohort study included 62,293 patients with mild Omicron infection between April 9, 2022, and May 31, 2022. Using 1:2 propensity score matching, we identified 2177 COVID-19 patients with a history of allergy and 4254 COVID-19 patients with no history of allergy. The differences in viral load, days to nucleic acid turning negative, and clinical symptoms were compared between the two groups. Results Compared with the group with no allergies, the number of days before negative nucleic acid conversion of COVID-19 patients with allergies was significantly higher, the viral load was significantly higher, and the cumulative negative conversion rates at 5-10 days were all lower (p < 0.01). Patients with a history of allergy to antibiotics had higher viral load and more days with negative nucleic acid levels (p < 0.001). Subgroup analysis revealed that the viral load in penicillin-allergic and cephalosporins-allergic patients was significantly compared to patients without any history of allergies (p < 0.05). Conclusion Patients with a history of allergy have a more significant viral load and a longer duration of nucleic acid negative conversion upon COVID-19 infection, particularly those allergic to antibiotics.
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Affiliation(s)
- Ru Wen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People’s Republic of China
- Department of Medical Imaging, Guizhou Provincial People Hospital, Guiyang City, Guizhou Province, 550000, People’s Republic of China
- Medical College, Guizhou University, Guiyang City, Guizhou Province, 550000, People’s Republic of China
| | - Jingwen Li
- Department of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People’s Republic of China
| | - Xingang Wang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People’s Republic of China
| | - Peng Xu
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People’s Republic of China
| | - Guizhu Li
- College of Mathematics and Statistics, Chongqing University, Chongqing, 400044, People’s Republic of China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People’s Republic of China
| | - Xianchun Zeng
- Department of Medical Imaging, Guizhou Provincial People Hospital, Guiyang City, Guizhou Province, 550000, People’s Republic of China
- NHC Key Laboratory of Pulmonary Immunological Diseases (Guizhou Provincial People’s Hospital), Guiyang, Guizhou, China
| | - Chen Liu
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People’s Republic of China
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13
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Hessels LM, Speksnijder E, Paternotte N, van Huisstede A, Thijs W, Scheer M, van der Steen-Dieperink M, Knarren L, van Den Bergh JP, Winckers K, Henry R, Simsek S, Boersma WG. Procalcitonin-Guided Antibiotic Prescription in Patients With COVID-19: A Multicenter Observational Cohort Study. Chest 2023; 164:596-605. [PMID: 37116748 PMCID: PMC10132833 DOI: 10.1016/j.chest.2023.04.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/24/2023] [Accepted: 04/14/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Despite the low rate of bacterial coinfection, antibiotics are very commonly prescribed in hospitalized patients with COVID-19. RESEARCH QUESTION Does the use of a procalcitonin (PCT)-guided antibiotic protocol safely reduce the use of antibiotics in patients with a COVID-19 infection? STUDY DESIGN AND METHODS In this multicenter cohort, three groups of patients with COVID-19 were compared in terms of antibiotic consumption, namely one group treated based on a PCT-algorithm in one hospital (n = 216) and two control groups, consisting of patients from the same hospital (n = 57) and of patients from three similar hospitals (n = 486) without PCT measurements during the same period. The primary end point was antibiotic prescription in the first week of admission. RESULTS Antibiotic prescription during the first 7 days was 26.8% in the PCT group, 43.9% in the non-PCT group in the same hospital, and 44.7% in the non-PCT group in other hospitals. Patients in the PCT group had lower odds of receiving antibiotics in the first 7 days of admission (OR, 0.33; 95% CI, 0.16-0.66 compared with the same hospital; OR, 0.42; 95% CI, 0.28-0.62 compared with the other hospitals). The proportion of patients receiving antibiotic prescription during the total admission was 35.2%, 43.9%, and 54.5%, respectively. The PCT group had lower odds of receiving antibiotics during the total admission only when compared with the other hospitals (OR, 0.23; 95% CI, 0.08-0.63). There were no significant differences in other secondary end points, except for readmission in the PCT group vs the other hospitals group. INTERPRETATION PCT-guided antibiotic prescription reduces antibiotic prescription rates in hospitalized patients with COVID-19, without major safety concerns.
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Affiliation(s)
- Lisa M Hessels
- Department of Pulmonary Medicine, Northwest Clinics, Alkmaar, The Netherlands.
| | - Esther Speksnijder
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Nienke Paternotte
- Department of Pulmonary Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Willemien Thijs
- Department of Pulmonary Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Margot Scheer
- Department of Intensive Care Medicine, Martini Hospital, Groningen, The Netherlands
| | | | - Lieve Knarren
- Department of Internal Medicine, Viecuri Medical Centre, Venlo, The Netherlands
| | | | - Kristien Winckers
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ronald Henry
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Wim G Boersma
- Department of Pulmonary Medicine, Northwest Clinics, Alkmaar, The Netherlands
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14
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Chu RBH, Zhao S, Zhang JZ, Chan KCK, Ng PY, Chan C, Fong KM, Au SY, Yeung AWT, Chan JKH, Tsang HH, Law KI, Chow FL, Lam KN, Chan KM, Dharmangadan M, Wong WT, Joynt GM, Wang MH, Ling L. Comparison of COVID-19 with influenza A in the ICU: a territory-wide, retrospective, propensity matched cohort on mortality and length of stay. BMJ Open 2023; 13:e067101. [PMID: 37429680 DOI: 10.1136/bmjopen-2022-067101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVES Direct comparisons between COVID-19 and influenza A in the critical care setting are limited. The objective of this study was to compare their outcomes and identify risk factors for hospital mortality. DESIGN AND SETTING This was a territory-wide, retrospective study on all adult (≥18 years old) patients admitted to public hospital intensive care units in Hong Kong. We compared COVID-19 patients admitted between 27 January 2020 and 26 January 2021 with a propensity-matched historical cohort of influenza A patients admitted between 27 January 2015 and 26 January 2020. We reported outcomes of hospital mortality and time to death or discharge. Multivariate analysis using Poisson regression and relative risk (RR) was used to identify risk factors for hospital mortality. RESULTS After propensity matching, 373 COVID-19 and 373 influenza A patients were evenly matched for baseline characteristics. COVID-19 patients had higher unadjusted hospital mortality than influenza A patients (17.5% vs 7.5%, p<0.001). The Acute Physiology and Chronic Health Evaluation IV (APACHE IV) adjusted standardised mortality ratio was also higher for COVID-19 than influenza A patients ((0.79 (95% CI 0.61 to 1.00) vs 0.42 (95% CI 0.28 to 0.60)), p<0.001). Adjusting for age, PaO2/FiO2, Charlson Comorbidity Index and APACHE IV, COVID-19 (adjusted RR 2.26 (95% CI 1.52 to 3.36)) and early bacterial-viral coinfection (adjusted RR 1.66 (95% CI 1.17 to 2.37)) were directly associated with hospital mortality. CONCLUSIONS Critically ill patients with COVID-19 had substantially higher hospital mortality when compared with propensity-matched patients with influenza A.
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Affiliation(s)
- Raymond Bak Hei Chu
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shi Zhao
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jack Zhenhe Zhang
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - King Chung Kenny Chan
- Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong SAR, China
- Department of Intensive Care, Pok Oi Hospital, Hong Kong SAR, China
| | - Pauline Yeung Ng
- Adult Intensive Care Unit, The University of Hong Kong, Hong Kong SAR, China
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Carol Chan
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Ka Man Fong
- Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Shek Yin Au
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong SAR, China
| | - Alwin Wai Tak Yeung
- Department of Medicine & Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong SAR, China
| | | | - Hin Hung Tsang
- Department of Intensive Care, Kwong Wah Hospital, Hong Kong SAR, China
| | - Kin Ip Law
- Department of Intensive Care, United Christian Hospital, Hong Kong SAR, China
| | - Fu Loi Chow
- Department of Intensive Care, Caritas Medical Centre, Hong Kong SAR, China
| | - Koon Ngai Lam
- Department of Intensive Care, North District Hospital, Hong Kong SAR, China
| | - Kai Man Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Manimala Dharmangadan
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong SAR, China
- Department of Intensive Care, Yan Chai Hospital, Hong Kong SAR, China
| | - Wai Tat Wong
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Maggie Haitian Wang
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Maisonneuve E, de Bruin O, Favre G, Goncé A, Donati S, Engjom H, Hurley E, Al-Fadel N, Siiskonen S, Bloemenkamp K, Nordeng H, Sturkenboom M, Baud D, Panchaud A. Evolution of National Guidelines on Medicines Used to Treat COVID-19 in Pregnancy in 2020-2022: A Scoping Review. J Clin Med 2023; 12:4519. [PMID: 37445553 DOI: 10.3390/jcm12134519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The lack of inclusion of pregnant women in clinical trials evaluating the effectiveness of medicines to treat COVID-19 has made it difficult to establish evidence-based treatment guidelines for pregnant women. Our aim was to provide a review of the evolution and updates of the national guidelines on medicines used in pregnant women with COVID-19 published by the obstetrician and gynecologists' societies in thirteen countries in 2020-2022. Based on the results of the RECOVERY (Randomized Evaluation of COVID-19 Therapy) trial, the national societies successively recommended against prescribing hydroxychloroquine, lopinavir-ritonavir and azithromycin. Guidelines for remdesivir differed completely between countries, from compassionate or conditional use to recommendation against. Nirmatrelvir-ritonavir was authorized in Australia and the UK only in research settings and was no longer recommended in the UK at the end of 2022. After initial reluctance to use corticosteroids, the results of the RECOVERY trial have enabled the recommendation of dexamethasone in case of severe COVID-19 since mid-2020. Some societies recommended prescribing tocilizumab to pregnant patients with hypoxia and systemic inflammation from June 2021. Anti-SARS-CoV-2 monoclonal antibodies were authorized at the end of 2021 with conditional use in some countries, and then no longer recommended in Belgium and the USA at the end of 2022. The gradual convergence of the recommendations, although delayed compared to the general population, highlights the importance of the inclusion of pregnant women in clinical trials and of international collaboration to improve the pharmacological treatment of pregnant women with COVID-19.
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Affiliation(s)
- Emeline Maisonneuve
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Graduate School for Health Sciences (GHS), University of Bern, 3012 Bern, Switzerland
- Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Odette de Bruin
- Department of Obstetrics, WKZ Birthcentre, Division Woman and Baby, UMC Utrecht, 3584 CX Utrecht, The Netherlands
- Julius Global Health, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Anna Goncé
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Hilde Engjom
- Department of Health Promotion, Department of Health Registry Research and Development, Norwegian Institute of Public Health, N-5808 Bergen, Norway
| | - Eimir Hurley
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway
| | - Nouf Al-Fadel
- Saudi Food and Drug Authority, Riyadh 13513-7148, Saudi Arabia
| | - Satu Siiskonen
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Kitty Bloemenkamp
- Department of Obstetrics, WKZ Birthcentre, Division Woman and Baby, UMC Utrecht, 3584 CX Utrecht, The Netherlands
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway
| | - Miriam Sturkenboom
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
- Service of Pharmacy, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
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Favilli A, Mattei Gentili M, De Paola F, Laganà AS, Vitagliano A, Bosco M, Cicinelli E, Chiantera V, Uccella S, Parazzini F, Gerli S, Garzon S. COVID-19 and Pregnancy: An Updated Review about Evidence-Based Therapeutic Strategies. J Pers Med 2023; 13:1035. [PMID: 37511648 PMCID: PMC10381390 DOI: 10.3390/jpm13071035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic posed a significant challenge for clinicians in managing pregnant women, who were at high risk of virus transmission and severe illness. While the WHO declared in May 2023 that COVID-19 is no longer a public health emergency, it emphasized that it remains a global health threat. Despite the success of vaccines, the possibility of new pandemic waves due to viral mutations should be considered. Ongoing assessment of the safety and effectiveness of pharmacological therapies is crucial in clinical practice. This narrative review summarizes the evidence-based therapeutic strategies for pregnant women with COVID-19, considering over three years of pandemic experience. The review discusses the safety and effectiveness of various drug regimens (antivirals, anticoagulants, corticosteroids, immunoglobulins, monoclonal antibodies, and therapeutic gases) and procedures (prone positioning and extracorporeal membrane oxygenation). Drugs with contraindications, inefficacy during pregnancy, or unknown adverse effects were excluded from our evaluation. The aim is to provide healthcare professionals with a comprehensive guide for managing pregnant women with COVID-19 based on lessons learned from the pandemic outbreak.
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Affiliation(s)
- Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Marta Mattei Gentili
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Francesca De Paola
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Amerigo Vitagliano
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Mariachiara Bosco
- Unit of Obstetrics and Gynecology-Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona-University of Verona Piazzale A. Stefani 1, 37126 Verona, Italy
| | - Ettore Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Stefano Uccella
- Unit of Obstetrics and Gynecology-Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona-University of Verona Piazzale A. Stefani 1, 37126 Verona, Italy
| | - Fabio Parazzini
- Department of Clinic and Community Science, Mangiagalli Hospital, University of Milan, 20122 Milan, Italy
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Simone Garzon
- Unit of Obstetrics and Gynecology-Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona-University of Verona Piazzale A. Stefani 1, 37126 Verona, Italy
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17
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Segala FV, Pafundi PC, Masciocchi C, Fiori B, Taddei E, Antenucci L, De Angelis G, Guerriero S, Pastorino R, Damiani A, Posteraro B, Sanguinetti M, De Pascale G, Fantoni M, Murri R. Incidence of bloodstream infections due to multidrug-resistant pathogens in ordinary wards and intensive care units before and during the COVID-19 pandemic: a real-life, retrospective observational study. Infection 2023:10.1007/s15010-023-02000-3. [PMID: 36867310 PMCID: PMC9983510 DOI: 10.1007/s15010-023-02000-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/07/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE SARS-COV-2 pandemic led to antibiotic overprescription and unprecedented stress on healthcare systems worldwide. Knowing the comparative incident risk of bloodstream infection due to multidrug-resistant pathogens in COVID ordinary wards and intensive care-units may give insights into the impact of COVID-19 on antimicrobial resistance. METHODS Single-center observational data extracted from a computerized dataset were used to identify all patients who underwent blood cultures from January 1, 2018 to May 15, 2021. Pathogen-specific incidence rates were compared according to the time of admission, patient's COVID status and ward type. RESULTS Among 14,884 patients for whom at least one blood culture was obtained, a total of 2534 were diagnosed with HA-BSI. Compared to both pre-pandemic and COVID-negative wards, HA-BSI due to S. aureus and Acinetobacter spp. (respectively 0.3 [95% CI 0.21-0.32] and 0.11 [0.08-0.16] new infections per 100 patient-days) showed significantly higher incidence rates, peaking in the COVID-ICU setting. Conversely, E. coli incident risk was 48% lower in COVID-positive vs COVID-negative settings (IRR 0.53 [0.34-0.77]). Among COVID + patients, 48% (n = 38/79) of S. aureus isolates were resistant to methicillin and 40% (n = 10/25) of K. pneumoniae isolates were resistant to carbapenems. CONCLUSIONS The data presented here indicate that the spectrum of pathogens causing BSI in ordinary wards and intensive care units varied during the pandemic, with the greatest shift experienced by COVID-ICUs. Antimicrobial resistance of selected high-priority bacteria was high in COVID positive settings.
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Affiliation(s)
- Francesco Vladimiro Segala
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Pia Clara Pafundi
- Facility of Epidemiology and Biostatistics, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlotta Masciocchi
- Real World Data Facility, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Barbara Fiori
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Taddei
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Antenucci
- Real World Data Facility, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia De Angelis
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Guerriero
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Pastorino
- Facility of Epidemiology and Biostatistics, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Damiani
- Real World Data Facility, Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Brunella Posteraro
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gennaro De Pascale
- Department of Anesthesia and Intensive Care, Agostino Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rita Murri
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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18
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Survey of healthcare worker perceptions of changes in infection control and antimicrobial stewardship practices in India and South Africa during the COVID-19 pandemic. IJID REGIONS 2023; 6:90-98. [PMID: 36466212 PMCID: PMC9703863 DOI: 10.1016/j.ijregi.2022.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Objective To identify perceptions and awareness of changes in infection prevention and control (IPC) and antimicrobial stewardship (AMS) practices among healthcare workers (HCWs) during the COVID-19 pandemic in India and South Africa (SA). Method A self-administered online survey which included participant demographics, knowledge and sources of COVID-19 infection, perceived risks and barriers, and self-efficacy. Data were analysed using descriptive statistics. Results The study received 321 responses (response rate: 89.2%); 131/321 (40.8%) from India and 190/321 (59.2%) from SA; male to female response rate was 3:2, with majority of respondents aged 40-49 (89/321, 27.7%) and 30-39 (87/321, 27.1%) years. Doctors comprised 47.9% (57/119) of respondents in India and 74.6% (135/181) in SA. Majority of respondents in India (93/119, 78.2%) and SA (132/181, 72.9%) were from the private and public sectors, respectively, with more respondents in SA (123/174, 70.7%) than in India (38/104, 36.5%) involved in antimicrobial prescribing.Respondents reported increased IPC practices since the pandemic and noted a need for more training on case management, antibiotic and personal protective equipment (PPE) use. While they noted increased antibiotic prescribing since the pandemic, they did not generally associate their practice with such an increase. A willingness to be vaccinated, when vaccination becomes available, was expressed by 203/258 (78.7%) respondents. Conclusions HCWs reported improved IPC practices and changes in antibiotic prescribing during the COVID-19 pandemic. Targeted education on correct use of PPE was an identified gap. Although HCWs expressed concerns about antimicrobial resistance, their self-perceived antibiotic prescribing practices seemed unchanged. Additional studies in other settings could explore how our findings fit other contexts.
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19
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Fabre I, Tardieu L, Ouissa R, Mounsamy L, Chahim B, Roger PM. Severe COVID-19 Pneumonia in Elderly Patients: Success Rate of Compassioned Use of High Flow Nasal Cannula Therapy. Aging Dis 2023; 14:1-5. [PMID: 36818557 PMCID: PMC9937705 DOI: 10.14336/ad.2022.0619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/19/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Isabelle Fabre
- Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France.
| | - Laurène Tardieu
- Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France.
| | - Rachida Ouissa
- Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France.
| | - Ludwig Mounsamy
- Gérontologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France.
| | - Bassel Chahim
- Service Post-urgence, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France
| | - Pierre-Marie Roger
- Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, Guadeloupe, France.,Faculté de Médecine, Université des Antilles, Guadeloupe, France.,Correspondence should be addressed to: Pr. Pierre-Marie Roger, Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, Pointe-à-Pitre, 97110, Guadeloupe, France.
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20
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Chen JZ, Hoang HL, Yaskina M, Kabbani D, Doucette KE, Smith SW, Lau C, Stewart J, Remtulla S, Zurek K, Schultz M, Koriyama-McKenzie H, Cervera C. Efficacy and safety of antimicrobial stewardship prospective audit and feedback in patients hospitalised with COVID-19 (COVASP): a pragmatic, cluster-randomised, non-inferiority trial. THE LANCET. INFECTIOUS DISEASES 2023; 23:673-682. [PMID: 36716763 PMCID: PMC9977404 DOI: 10.1016/s1473-3099(22)00832-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic has been associated with increased antimicrobial use despite low rates of bacterial co-infection. Prospective audit and feedback is recommended to optimise antibiotic prescribing, but high-quality evidence supporting its use for COVID-19 is absent. We aimed to study the efficacy and safety of prospective audit and feedback in patients admitted to hospital for the treatment of COVID-19. METHODS COVASP was a prospective, pragmatic, non-inferiority, small-unit, cluster-randomised trial comparing prospective audit and feedback plus standard of care with standard of care alone in adults admitted to three hospitals in Edmonton, AB, Canada, with COVID-19 pneumonia. All patients aged at least 18 years who were admitted from the community to a designated study bed with microbiologically confirmed SARS-CoV-2 infection in the preceding 14 days were included if they had an oxygen saturation of 94% or lower on room air, required supplemental oxygen, or had chest-imaging findings compatible with COVID-19 pneumonia. Patients were excluded if they were transferred in from another acute care centre, enrolled in another clinical trial that involved antibiotic therapy, expected to progress to palliative care or death within 48 h of hospital admission, or managed by any member of the research team within 30 days of enrolment. COVID-19 unit and critical care unit beds were stratified and randomly assigned (1:1) to the prospective audit and feedback plus standard of care group or the standard of care group. Patients were masked to their bed assignment but the attending physician and study team were not. The primary outcome was clinical status on postadmission day 15, measured using a seven-point ordinal scale. We used a non-inferiority margin of 0·5. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, NCT04896866, and is now closed. FINDINGS Between March 1 and Oct 29, 2021, 1411 patients were screened and 886 were enrolled: 457 into the prospective audit and feedback plus standard of care group, of whom 429 completed the study, and 429 into the standard of care group, of whom 404 completed the study. Baseline characteristics were similar for both groups, with an overall mean age of 56·7 years (SD 17·3) and a median baseline ordinal scale of 4·0 (IQR 4·0-5·0). 301 audit and feedback events were recorded in the intervention group and 215 recommendations were made, of which 181 (84%) were accepted. Despite lower antibiotic use in the intervention group than in the control group (length of therapy 364·9 vs 384·2 days per 1000 patient days), clinical status at postadmission day 15 was non-inferior (median ordinal score 2·0 [IQR 2·0-3·0] vs 2·0 [IQR 2·0-4·0]; p=0·37, Mann-Whitney U test). Neutropenia was uncommon in both the intervention group (13 [3%] of 420 patients) and the control group (20 [5%] of 396 patients), and acute kidney injury occurred at a similar rate in both groups (74 [18%] of 421 patients in the intervention group and 76 [19%] of 399 patients in the control group). No intervention-related deaths were recorded. INTERPRETATION This cluster-randomised clinical trial shows that prospective audit and feedback is safe and effective in optimising and reducing antibiotic use in adults admitted to hospital with COVID-19. Despite many competing priorities during the COVID-19 pandemic, antimicrobial stewardship should remain a priority to mitigate the overuse of antibiotics in this population. FUNDING None.
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Affiliation(s)
- Justin Z Chen
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Holly L Hoang
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Dima Kabbani
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Karen E Doucette
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Stephanie W Smith
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Cecilia Lau
- Pharmacy Services, Alberta Health Services, Edmonton, AB, Canada
| | - Jackson Stewart
- Pharmacy Services, Alberta Health Services, Edmonton, AB, Canada
| | | | - Karen Zurek
- Pharmacy Services, Covenant Health, Edmonton, AB, Canada
| | - Morgan Schultz
- Pharmacy Services, Covenant Health, Edmonton, AB, Canada
| | | | - Carlos Cervera
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada,Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada
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21
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Antibiotics Used for COVID-19 In-Patients from an Infectious Disease Ward. Antibiotics (Basel) 2023; 12:antibiotics12010150. [PMID: 36671351 PMCID: PMC9854891 DOI: 10.3390/antibiotics12010150] [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] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Background: although the prevalence of bacterial co-infections for COVID-19 patients is very low, most patients receive empirical antimicrobial therapy. Furthermore, broad spectrum antibiotics are preferred to narrow spectrum antibiotics. Methods: in order to estimate the excess of antibiotic prescriptions for patients with COVID-19, and to identify the factors that were correlated with the unjustified antibiotic usage, we conducted an observational (cohort) prospective study in patients hospitalized with COVID-19 at the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, on an infectious disease ward, from November 2021 to January 2022. To evaluate the prevalence of bacterial co-infection in these patients, all positive microbiology results and concomitant suspected or confirmed bacterial co-infections, as documented by the treating doctor, were recorded. The patients were grouped in two categories: patients who received antibiotics and those who did not receive antibiotics, justified or not. Results: from the 205 patients enrolled in the study, 83 (40.4%) received antibiotics prior to being admitted to the hospital. 84 patients (41.0%) received antibiotics during their hospitalization; however, only 32 patients (15.6%) had signs and symptoms suggestive of an infection, 19 (9.3%) presented pulmonary consolidation on the computed tomography (CT) scan, 20 (9.7%) patients had leukocytosis, 29 (14.1%) had an increased procalcitonin level and only 22 (10.7%) patients had positive microbiological tests. It was observed that patients treated with antibiotics were older [70 (54−76) vs. 65 (52.5−71.5), p = 0.023, r = 0.159], had a higher Charlson index [4 (2−5) vs. 2 (1−4), p = 0.007, r = 0.189], had a severe/critical COVID-19 disease more frequently [61 (72.6%) vs. 38 (31.4%), p < 0.001, df = 3, X2 = 39.563] and required more oxygen [3 (0−6) vs. 0 (0−2), p < 0.001, r = 0.328]. Conclusion: empirical antibiotic treatment recommendation should be reserved for COVID-19 patients that also had other clinical or paraclinical changes, which suggest a bacterial infection. Further research is needed to better identify patients with bacterial co-infection that should receive antibiotic treatment.
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22
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Lowry J, McEvoy N, O'Connell K, Burns K, Dinesh B, O'Donnell S, Curley G, Fitzpatrick F. Antimicrobial overuse in COVID-19 - reasons to remain vigilant as we approach the winter 'twindemic'. J Hosp Infect 2023; 131:247-248. [PMID: 36283476 PMCID: PMC9595493 DOI: 10.1016/j.jhin.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 01/25/2023]
Affiliation(s)
- J. Lowry
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland,Corresponding author. Department of Clinical Microbiology, Beaumont Hospital, Beaumont Road, Beaumont, Dublin 9, D09V2N0 Ireland
| | - N. McEvoy
- Department of Critical Care, Beaumont Hospital, Dublin, Ireland,Department of Critical Care, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K. O'Connell
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K. Burns
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B. Dinesh
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - S. O'Donnell
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - G.F. Curley
- Department of Critical Care, Beaumont Hospital, Dublin, Ireland,Department of Critical Care, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F. Fitzpatrick
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland,Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
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23
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Abouellil A, Bilal M, Taubert M, Fuhr U. A population pharmacokinetic model of remdesivir and its major metabolites based on published mean values from healthy subjects. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:73-82. [PMID: 36123499 PMCID: PMC9485022 DOI: 10.1007/s00210-022-02292-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/08/2022] [Indexed: 01/29/2023]
Abstract
Remdesivir is a direct-acting anti-viral agent. It was originally evaluated against filoviruses. However, during the COVID-19 pandemic, it was investigated due to its anti-viral activities against (SARS-CoV-2) virus. Therefore remdesivir received conditional approval for treatment of patients with severe coronavirus disease. Yet, its pharmacokinetic properties are inadequately understood. This report describes the population pharmacokinetics of remdesivir and its two plasma-detectable metabolites (GS-704277 and GS-441524) in healthy volunteers. The data was extracted from published phase I single escalating and multiple i.v remdesivir dose studies conducted by the manufacturer. The model was developed by standard methods using non-linear mixed effect modeling. Also, a series of simulations were carried out to test suggested clinical doses. The model describes the distribution of remdesivir and each of its metabolites by respective two compartments with sequential metabolism between moieties, and elimination from central compartments. As individual data were not available, only inter-cohort variability could be assessed. The estimated point estimates for central (and peripheral) volumes of distribution for remdesivir, GS-704277, and GS-441524 were 4.89 L (46.5 L), 96.4 L (8.64 L), and 26.2 L (66.2 L), respectively. The estimated elimination clearances of remdesivir, GS704277, and GS-441524 reached 18.1 L/h, 36.9 L/h, and 4.74 L/h, respectively. The developed model described the data well. Simulations of clinically approved doses showed that GS-441524 concentrations in plasma exceeded the reported EC50 values during the complete duration of treatment. Nonetheless, further studies are needed to explore the pharmacokinetics of remdesivir and its relationship to clinical efficacy, and the present model may serve as a useful starting point for additional evaluations.
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Affiliation(s)
- Ahmed Abouellil
- grid.411097.a0000 0000 8852 305XFaculty of Medicine, Center for Pharmacology, Department I of Pharmacology, University Hospital Cologne, University of Cologne, Gleueler Straße 24, 50931 Cologne, Germany ,grid.15090.3d0000 0000 8786 803XImmunosensation Cluster of Excellence, University Hospital Bonn, Bonn, Germany
| | - Muhammad Bilal
- grid.411097.a0000 0000 8852 305XFaculty of Medicine, Center for Pharmacology, Department I of Pharmacology, University Hospital Cologne, University of Cologne, Gleueler Straße 24, 50931 Cologne, Germany ,grid.10388.320000 0001 2240 3300Department of Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany
| | - Max Taubert
- grid.411097.a0000 0000 8852 305XFaculty of Medicine, Center for Pharmacology, Department I of Pharmacology, University Hospital Cologne, University of Cologne, Gleueler Straße 24, 50931 Cologne, Germany
| | - Uwe Fuhr
- grid.411097.a0000 0000 8852 305XFaculty of Medicine, Center for Pharmacology, Department I of Pharmacology, University Hospital Cologne, University of Cologne, Gleueler Straße 24, 50931 Cologne, Germany
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24
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Point Prevalence Survey of Antimicrobial Use during the COVID-19 Pandemic among Different Hospitals in Pakistan: Findings and Implications. Antibiotics (Basel) 2022; 12:antibiotics12010070. [PMID: 36671271 PMCID: PMC9854885 DOI: 10.3390/antibiotics12010070] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
The COVID-19 pandemic has significantly influenced antimicrobial use in hospitals, raising concerns regarding increased antimicrobial resistance (AMR) through their overuse. The objective of this study was to assess patterns of antimicrobial prescribing during the current COVID-19 pandemic among hospitals in Pakistan, including the prevalence of COVID-19. A point prevalence survey (PPS) was performed among 11 different hospitals from November 2020 to January 2021. The study included all hospitalized patients receiving an antibiotic on the day of the PPS. The Global-PPS web-based application was used for data entry and analysis. Out of 1024 hospitalized patients, 662 (64.64%) received antimicrobials. The top three most common indications for antimicrobial use were pneumonia (13.3%), central nervous system infections (10.4%) and gastrointestinal indications (10.4%). Ceftriaxone (26.6%), metronidazole (9.7%) and vancomycin (7.9%) were the top three most commonly prescribed antimicrobials among surveyed patients, with the majority of antibiotics administered empirically (97.9%). Most antimicrobials for surgical prophylaxis were given for more than one day, which is a concern. Overall, a high percentage of antimicrobial use, including broad-spectrums, was seen among the different hospitals in Pakistan during the current COVID-19 pandemic. Multifaceted interventions are needed to enhance rational antimicrobial prescribing including limiting their prescribing post-operatively for surgical prophylaxis.
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25
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Walsh TJ, Bright RA, Ahuja A, McCarthy MW, Marfuggi RA, Simpson SQ. Meeting the Challenges of Sepsis in Severe Coronavirus Disease 2019: A Call to Arms. Open Forum Infect Dis 2022; 10:ofac645. [PMID: 36686626 PMCID: PMC9850274 DOI: 10.1093/ofid/ofac645] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Sepsis is a life-threatening organ dysfunction that is caused by a dysregulated host response to infection. Sepsis may be caused by bacterial, fungal, or viral pathogens. The clinical manifestations exhibited by patients with severe coronavirus disease 2019 (COVID-19)-related sepsis overlap with those exhibited by patients with sepsis from secondary bacterial or fungal infections and can include an altered mental status, dyspnea, reduced urine output, tachycardia, and hypotension. Critically ill patients hospitalized with severe acute respiratory syndrome coronavirus 2 infections have increased risk for secondary bacterial and fungal infections. The same risk factors that may predispose to sepsis and poor outcome from bloodstream infections (BSIs) converge in patients with severe COVID-19. Current diagnostic standards for distinguishing between (1) patients who are critically ill, septic, and have COVID-19 and (2) patients with sepsis from other causes leave healthcare providers with 2 suboptimal choices. The first choice is to empirically administer broad-spectrum, antimicrobial therapy for what may or may not be sepsis. Such treatment may not only be ineffective and inappropriate, but it also has the potential to cause harm. The development of better methods to identify and characterize antimicrobial susceptibility will guide more accurate therapeutic interventions and reduce the evolution of new antibiotic-resistant strains. The ideal diagnostic test should (1) be rapid and reliable, (2) have a lower limit of detection than blood culture, and (3) be able to detect a specific organism and drug sensitivity directly from a clinical specimen. Rapid direct detection of antimicrobial-resistant pathogens would allow targeted therapy and result in improved outcomes in patients with severe COVID-19 and sepsis.
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Affiliation(s)
- Thomas J Walsh
- Correspondence: Thomas J. Walsh MD, PhD, Center for Innovative Therapeutics and Diagnostics, 6641 West Broad Street, Room 100, Richmond, Virginia 23220 ()
| | - Rick A Bright
- The Rockefeller Foundation, Pandemic Prevention Institute, New York, New York, USA
| | | | - Matthew W McCarthy
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA
| | - Richard A Marfuggi
- American Medical Association Foundation, Chicago, Illinois, USA,WBB Research Institute, Cranford, New Jersey, USA
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26
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Slim MA, Appelman B, Peters-Sengers H, Dongelmans DA, de Keizer NF, Schade RP, de Boer MGJ, Müller MCA, Vlaar APJ, Wiersinga WJ, van Vught LA. Real-world Evidence of the Effects of Novel Treatments for COVID-19 on Mortality: A Nationwide Comparative Cohort Study of Hospitalized Patients in the First, Second, Third, and Fourth Waves in the Netherlands. Open Forum Infect Dis 2022; 9:ofac632. [PMID: 36519114 PMCID: PMC9745783 DOI: 10.1093/ofid/ofac632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/20/2022] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Large clinical trials on drugs for hospitalized coronavirus disease 2019 (COVID-19) patients have shown significant effects on mortality. There may be a discrepancy with the observed real-world effect. We describe the clinical characteristics and outcomes of hospitalized COVID-19 patients in the Netherlands during 4 pandemic waves and analyze the association of the newly introduced treatments with mortality, intensive care unit (ICU) admission, and discharge alive. METHODS We conducted a nationwide retrospective analysis of hospitalized COVID-19 patients between February 27, 2020, and December 31, 2021. Patients were categorized into waves and into treatment groups (hydroxychloroquine, remdesivir, neutralizing severe acute respiratory syndrome coronavirus 2 monoclonal antibodies, corticosteroids, and interleukin [IL]-6 antagonists). Four types of Cox regression analyses were used: unadjusted, adjusted, propensity matched, and propensity weighted. RESULTS Among 5643 patients from 11 hospitals, we observed a changing epidemiology during 4 pandemic waves, with a decrease in median age (67-64 years; P < .001), in in-hospital mortality on the ward (21%-15%; P < .001), and a trend in the ICU (24%-16%; P = .148). In ward patients, hydroxychloroquine was associated with increased mortality (1.54; 95% CI, 1.22-1.96), and remdesivir was associated with a higher rate of discharge alive within 29 days (1.16; 95% CI, 1.03-1.31). Corticosteroids were associated with a decrease in mortality (0.82; 95% CI, 0.69-0.96); the results of IL-6 antagonists were inconclusive. In patients directly admitted to the ICU, hydroxychloroquine, corticosteroids, and IL-6 antagonists were not associated with decreased mortality. CONCLUSIONS Both remdesivir and corticosteroids were associated with better outcomes in ward patients with COVID-19. Continuous evaluation of real-world treatment effects is needed.
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Affiliation(s)
- Marleen A Slim
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Brent Appelman
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Hessel Peters-Sengers
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - Nicolette F de Keizer
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
- Department of Medical Informatics, Amsterdam University Medical Centers, University of Amsterdam—Location AMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Rogier P Schade
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark G J de Boer
- Department of Infectious Diseases and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marcella C A Müller
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Division of Infectious Diseases, Department of Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lonneke A van Vught
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
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Bernard-Raichon L, Venzon M, Klein J, Axelrad JE, Zhang C, Sullivan AP, Hussey GA, Casanovas-Massana A, Noval MG, Valero-Jimenez AM, Gago J, Putzel G, Pironti A, Wilder E, Thorpe LE, Littman DR, Dittmann M, Stapleford KA, Shopsin B, Torres VJ, Ko AI, Iwasaki A, Cadwell K, Schluter J. Gut microbiome dysbiosis in antibiotic-treated COVID-19 patients is associated with microbial translocation and bacteremia. Nat Commun 2022; 13:5926. [PMID: 36319618 PMCID: PMC9626559 DOI: 10.1038/s41467-022-33395-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
Although microbial populations in the gut microbiome are associated with COVID-19 severity, a causal impact on 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. We first demonstrate SARS-CoV-2 infection induces gut microbiome dysbiosis in mice, which correlated with alterations to Paneth cells and goblet cells, and markers of barrier permeability. Samples collected from 96 COVID-19 patients at two different clinical sites also revealed substantial gut microbiome dysbiosis, including blooms of opportunistic pathogenic bacterial genera known to include antimicrobial-resistant species. Analysis of blood culture results testing for secondary microbial bloodstream infections with paired microbiome data indicates that bacteria may 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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Affiliation(s)
- Lucie Bernard-Raichon
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University Grossman School of Medicine, New York, NY, USA
| | - Mericien Venzon
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University Grossman School of Medicine, New York, NY, USA
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY, USA
| | - Jon Klein
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Jordan E Axelrad
- Division of Gastroenterology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Chenzhen Zhang
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY, USA
| | - Alexis P Sullivan
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY, USA
| | - Grant A Hussey
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY, USA
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Maria G Noval
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ana M Valero-Jimenez
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Juan Gago
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Gregory Putzel
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
- Antimicrobial-Resistant Pathogens Program, New York University School of Medicine, New York, NY, USA
| | - Alejandro Pironti
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
- Antimicrobial-Resistant Pathogens Program, New York University School of Medicine, New York, NY, USA
| | - Evan Wilder
- Division of Gastroenterology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Antimicrobial-Resistant Pathogens Program, New York University School of Medicine, New York, NY, USA
| | - Dan R Littman
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University Grossman School of Medicine, New York, NY, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Meike Dittmann
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Kenneth A Stapleford
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Bo Shopsin
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
- Antimicrobial-Resistant Pathogens Program, New York University School of Medicine, New York, NY, USA
- Department of Medicine, Division of Infectious Diseases, New York University Grossman School of Medicine, New York, NY, USA
| | - Victor J Torres
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
- Antimicrobial-Resistant Pathogens Program, New York University School of Medicine, New York, NY, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Ken Cadwell
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University Grossman School of Medicine, New York, NY, USA.
- Division of Gastroenterology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA.
- Antimicrobial-Resistant Pathogens Program, New York University School of Medicine, New York, NY, USA.
| | - Jonas Schluter
- Institute for Systems Genetics, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA.
- Antimicrobial-Resistant Pathogens Program, New York University School of Medicine, New York, NY, USA.
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Choi YJ, Song JY, Hyun H, Nham E, Yoon JG, Seong H, Noh JY, Cheong HJ, Kim WJ. Prognostic factors of 30-day mortality in patients with COVID-19 pneumonia under standard remdesivir and dexamethasone treatment. Medicine (Baltimore) 2022; 101:e30474. [PMID: 36197235 PMCID: PMC9508954 DOI: 10.1097/md.0000000000030474] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Although some studies have reported prognostic factors for coronavirus disease 2019 (COVID-19), they were conducted before standard treatment with remdesivir and dexamethasone was implemented. This retrospective, observational study was conducted to evaluate various prognostic factors in patients with COVID-19 pneumonia receiving standard treatment with remdesivir and dexamethasone. Of 99 patients with COVID-19 pneumonia, 68 (68.7%) died within 30 days of hospitalization. The mean age was 71.3 years. Remdesivir and dexamethasone were administered to 80 (80.8%) and 84 (84.8%) patients, respectively. Early antibiotic treatment was administered to 70 patients (70.7%) within 5 days of hospitalization. Dexamethasone (79.4% vs 96.8%, P = .033) was more frequently administered in the survived group, whereas early antibiotics (60.3% vs 93.5%, P = .001) were less frequently administered. In the multivariate analysis, a high National Early Warning Score (NEWS; odds ratio [OR] 1.272), high Charlson Comorbidity Index (CCI; OR 1.441), and dyspnea (OR 4.033) were independent risk factors for 30-day mortality. There was no significant difference in age, sex, and vaccination doses between the survived and fatal groups. Lymphopenia, monocytopenia and high levels of C-reactive protein (CRP)/lactate dehydrogenase (LDH) reflected poor prognosis. NEWS, CCI, and dyspnea were predictors of 30-day mortality in patients with COVID-19 pneumonia. Early antibiotic use did not lower the 30-day mortality risk.
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Affiliation(s)
- Yu Jung Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Joon Young Song, Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Gurodong-ro 148, Guro-gu, Seoul 08308, Republic of Korea (e-mail: )
| | - Hakjun Hyun
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eliel Nham
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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29
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Affiliation(s)
- O M P Jolobe
- Medical Division British Medical Association BMA HouseTavistock Square London WC1H 9JP, UK
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30
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Zacharias M, Kashofer K, Wurm P, Regitnig P, Schütte M, Neger M, Ehmann S, Marsh LM, Kwapiszewska G, Loibner M, Birnhuber A, Leitner E, Thüringer A, Winter E, Sauer S, Pollheimer MJ, Vagena FR, Lackner C, Jelusic B, Ogilvie L, Durdevic M, Timmermann B, Lehrach H, Zatloukal K, Gorkiewicz G. Host and microbiome features of secondary infections in lethal covid-19. iScience 2022; 25:104926. [PMID: 35992303 PMCID: PMC9374491 DOI: 10.1016/j.isci.2022.104926] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022] Open
Abstract
Secondary infections contribute significantly to covid-19 mortality but driving factors remain poorly understood. Autopsies of 20 covid-19 cases and 14 controls from the first pandemic wave complemented with microbial cultivation and RNA-seq from lung tissues enabled description of major organ pathologies and specification of secondary infections. Lethal covid-19 segregated into two main death causes with either dominant diffuse alveolar damage (DAD) or secondary pneumonias. The lung microbiome in covid-19 showed a reduced biodiversity and increased prototypical bacterial and fungal pathogens in cases of secondary pneumonias. RNA-seq distinctly mirrored death causes and stratified DAD cases into subgroups with differing cellular compositions identifying myeloid cells, macrophages and complement C1q as strong separating factors suggesting a pathophysiological link. Together with a prominent induction of inhibitory immune-checkpoints our study highlights profound alterations of the lung immunity in covid-19 wherein a reduced antimicrobial defense likely drives development of secondary infections on top of SARS-CoV-2 infection. Covid-19 autopsy cohort complemented with microbial cultivation and deep sequencing Major death causes stratify into DAD and secondary pneumonias Prototypical bacterial and fungal agents are found in secondary pneumonias Macrophages and C1q stratify DAD subgroups and indicate immune impairment in lungs
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Affiliation(s)
- Martin Zacharias
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Karl Kashofer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Philipp Wurm
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Moritz Schütte
- Alacris Theranostics GmbH, Max-Planck-Strasse 3, 12489 Berlin, Germany
| | - Margit Neger
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Sandra Ehmann
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Leigh M Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstrasse 6/VI, 8010 Graz, Austria
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstrasse 6/VI, 8010 Graz, Austria
| | - Martina Loibner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Anna Birnhuber
- Ludwig Boltzmann Institute for Lung Vascular Research, Neue Stiftingtalstrasse 6/VI, 8010 Graz, Austria
| | - Eva Leitner
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Andrea Thüringer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Elke Winter
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Stefan Sauer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Marion J Pollheimer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Fotini R Vagena
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Carolin Lackner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Barbara Jelusic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Lesley Ogilvie
- Alacris Theranostics GmbH, Max-Planck-Strasse 3, 12489 Berlin, Germany
| | - Marija Durdevic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Bernd Timmermann
- Max Planck Institute for Molecular Genetics, Ihnestrasse 63, 14195 Berlin, Germany
| | - Hans Lehrach
- Alacris Theranostics GmbH, Max-Planck-Strasse 3, 12489 Berlin, Germany.,Max Planck Institute for Molecular Genetics, Ihnestrasse 63, 14195 Berlin, Germany
| | - Kurt Zatloukal
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
| | - Gregor Gorkiewicz
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria
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Incidence and Impact of Ventilator Associated Multidrug Resistant Pneumonia in Patients with SARS-COV2. Crit Care Res Pract 2022; 2022:9730895. [PMID: 36092685 PMCID: PMC9463029 DOI: 10.1155/2022/9730895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/28/2022] [Accepted: 08/20/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Ventilator Associated Pneumonia (VAP) is associated with significant cost, morbidity, and mortality. There is limited data on the incidence of VAP, appropriate antibiotic timing, and the impact of multidrug resistant VAP in intubated Coronavirus disease-19 (COVID-19) patients. Methods A retrospective study was conducted at 2 tertiary urban academic centers involving 132 COVID-19 patients requiring invasive mechanical ventilation (IMV). The epidemiology of VAP, the impact of prior empiric antibiotic administration on the development of Multidrug Resistant Organism (MDRO) infections, and the impact of VAP on patient outcomes were studied. Results The average age of the patients was 60.58% were males, 70% were African-Americans and two-thirds of patients had diabetes, hypertension, or heart disease. The average Body Mass Index (BMI) was 32.9. Forty-one patients (27%) developed VAP. Patients with VAP had a significantly higher Sequential Organ Failure Assessment (SOFA) score prior to Intensive Care Unit (ICU) admission. Sixty percent received empiric antibiotics before initiation of IMV, mostly on hospital admission, and 81% received empiric antibiotics at the time of intubation. The administration of empiric antibiotics was not associated with a higher prevalence of VAP. The prevalence of VAP was 22 per 1000 days on ventilation. No difference in mortality was seen between VAP and non-VAP groups at 49% and 57% respectively (p = 0.4). VAP was associated with increased ICU length of stay (LOS), 30 vs. 16 days (p < 0.001), and longer hospital LOS 35 vs. 17 days (p < 0.001). 40% of VAPs were caused by MDROs. The most common organism was Staphylococcus aureus (28%), with almost half (48%) being methicillin resistant Staphylococcus aureus (MRSA). Conclusion VAP was a common complication of patients intubated for COVID-19 pneumonia. Most patients received empiric antibiotics upon the hospital and/or ICU admission. There was a 40% incidence of multidrug resistant pneumonia. Patients who developed VAP had almost twice as long hospital and ICU LOS.
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Factors Affecting the Self-Isolation Monitoring Program for COVID-19 Patients at the Universitas Indonesia Hospital. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:2297328. [PMID: 36060870 PMCID: PMC9433271 DOI: 10.1155/2022/2297328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/05/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
Abstract
When the outbreak of the COVID-19 delta variant occurred in June 2021, there was a marked increase in Indonesia's number of self-isolated patients. The Universitas Indonesia Hospital provided a One-Stop Service (OSS) to monitor COVID-19 patients on self-isolation. This study was conducted to determine the effectiveness of the self-isolation monitoring performed by hospitals and the factors that determined the outcomes of patients on self-isolation. This study was conducted using a cross-sectional method based on secondary data from electronic medical records. Data analysis was performed by determining the relationship of patient risk factors and characteristics with COVID-19 outcomes. The study found that poorer symptoms, administration of antibiotics, absence of shortness of breath, and normal ALT levels significantly improved the outcome of OSS patients. The study also suggested that during monitoring of patients on COVID-19 self-isolation, chest/thorax radiography is necessary. The self-isolation monitoring program is essential to observe the patient's condition and evaluate the possibility of deteriorating conditions that could lead to admission decisions in the early or middle stages of the program. This will be beneficial during pandemic emergencies.
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Lee CM, Lee E, Park WB, Choe PG, Song KH, Kim ES, Park SW. Breakthrough COVID-19 Infection During the Delta Variant Dominant Period: Individualized Care Based on Vaccination Status Is Needed. J Korean Med Sci 2022; 37:e252. [PMID: 35971766 PMCID: PMC9424692 DOI: 10.3346/jkms.2022.37.e252] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The clinical features of coronavirus disease 2019 (COVID-19) patients in the COVID-19 vaccination era need to be clarified because breakthrough infection after vaccination is not uncommon. METHODS We retrospectively analyzed hospitalized COVID-19 patients during a delta variant-dominant period 6 months after the national COVID-19 vaccination rollout. The clinical characteristics and risk factors for severe progression were assessed and subclassified according to vaccination status. RESULTS A total of 438 COVID-19 patients were included; the numbers of patients in the unvaccinated, partially vaccinated and fully vaccinated groups were 188 (42.9%), 117 (26.7%) and 133 (30.4%), respectively. The vaccinated group was older, less symptomatic and had a higher Charlson comorbidity index at presentation. The proportions of patients who experienced severe progression in the unvaccinated and fully vaccinated groups were 20.3% (31/153) and 10.8% (13/120), respectively. Older age, diabetes mellitus, solid cancer, elevated levels of lactate dehydrogenase and chest X-ray abnormalities were associated with severe progression, and the vaccination at least once was the only protective factor for severe progression. Chest X-ray abnormalities at presentation were the only predictor for severe progression among fully vaccinated patients. CONCLUSION In the hospitalized setting, vaccinated and unvaccinated COVID-19 patients showed different clinical features and risk of oxygen demand despite a relatively high proportion of patients in the two groups. Vaccination needs to be assessed as an initial checkpoint, and chest X-ray may be helpful for predicting severe progression in vaccinated patients.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eunyoung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
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Gang J, Wang H, Xue X, Zhang S. Microbiota and COVID-19: Long-term and complex influencing factors. Front Microbiol 2022; 13:963488. [PMID: 36033885 PMCID: PMC9417543 DOI: 10.3389/fmicb.2022.963488] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/25/2022] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). According to the World Health Organization statistics, more than 500 million individuals have been infected and more than 6 million deaths have resulted worldwide. Although COVID-19 mainly affects the respiratory system, considerable evidence shows that the digestive, cardiovascular, nervous, and reproductive systems can all be involved. Angiotensin-converting enzyme 2 (AEC2), the target of SARS-CoV-2 invasion of the host is mainly distributed in the respiratory and gastrointestinal tract. Studies found that microbiota contributes to the onset and progression of many diseases, including COVID-19. Here, we firstly conclude the characterization of respiratory, gut, and oral microbial dysbiosis, including bacteria, fungi, and viruses. Then we explore the potential mechanisms of microbial involvement in COVID-19. Microbial dysbiosis could influence COVID-19 by complex interactions with SARS-CoV-2 and host immunity. Moreover, microbiota may have an impact on COVID-19 through their metabolites or modulation of ACE2 expression. Subsequently, we generalize the potential of microbiota as diagnostic markers for COVID-19 patients and its possible association with post-acute COVID-19 syndrome (PACS) and relapse after recovery. Finally, we proposed directed microbiota-targeted treatments from the perspective of gut microecology such as probiotics and prebiotics, fecal transplantation and antibiotics, and other interventions such as traditional Chinese medicine, COVID-19 vaccines, and ACE2-based treatments.
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Affiliation(s)
- Jiaqi Gang
- Department of Emergency, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Oncology, Xiuwu County People’s Hospital, Jiaozuo, China
| | - Haiyu Wang
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangsheng Xue
- Department of Oncology, Xiuwu County People’s Hospital, Jiaozuo, China
- *Correspondence: Xiangsheng Xue,
| | - Shu Zhang
- Department of Emergency, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Shu Zhang,
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Faraz F, Rehman MEU. COVID-19 and the rising scourge of antimicrobial resistance: A perspective from Pakistan. Ann Med Surg (Lond) 2022; 80:104262. [PMID: 35936560 PMCID: PMC9339076 DOI: 10.1016/j.amsu.2022.104262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Fatima Faraz
- Corresponding author. Department of Medicine, Rawalpindi Medical University, Rawalpindi Pakistan.
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Lee S, Lee JM, Choi T, Park K, Lee KY, Jang JY. Procalcitonin as a Predictive Factor for the Clinical Outcome of Patients with Coronavirus Disease 2019. JOURNAL OF ACUTE CARE SURGERY 2022. [DOI: 10.17479/jacs.2022.12.2.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: The coronavirus disease 2019 (COVID-19) pandemic continues. It has been reported that patients with bacterial coinfection have a higher mortality rate than patients without coinfection. However, there are no clear standard guidelines for the use of antibacterial drugs. Therefore, the purpose of this study was to determine the usefulness of procalcitonin, a specific indicator of bacterial infection, as a biomarker for predicting death in COVID-19 patients.Methods: This was a retrospective study of confirmed COVID-19 patients (<i>N</i> = 283) between December 2020 and February 2021 who survived or died. Logistic regression analysis was performed to determine whether there was an association between the level of procalcitonin and death. In addition, receiver operating characteristic curve analysis was performed to determine the usefulness of procalcitonin as a predictor of death.Results: In the non-survivor group, age, the number of patients transferred from a health care center, segment neutrophil ratio, C reactive protein, ferritin, and procalcitonin were significantly higher in the survivor group. In multivariate analysis, procalcitonin was identified as an independent factor associated with death (hazard ratio 6.162, confidential interval 2.285-26.322, <i>p</i> = 0.014). In addition, the predictive power of procalcitonin level and mortality was statistically significant using receiver operating characteristic curve analysis which gave an area under the curve value of 0.823, a cut-off value of 0.05, a sensitivity of 72.2%, a specificity of 87.5% (<i>p</i> < 0.001).Conclusion: Measurement of procalcitonin and other biomarkers may be useful to determine whether to use or discontinue use of antibacterial drugs in patients with COVID-19.
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Meng K, Liang X, Xue S, Xu S, Zheng X, Chen Z, Zhou M, Li Z. Organic-free growth of gold nanosheets inside 3D bacterial cellulose as highly efficient and robust antibacterial biopolymers. JOURNAL OF MATERIALS SCIENCE 2022; 57:13903-13913. [PMID: 35910044 PMCID: PMC9310681 DOI: 10.1007/s10853-022-07273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Without any chemical agent, gold nanosheets (AuNSs) were controllable synthesized through a facile photo-induced reduction within bacterial cellulose (BC) biopolymers. Compared with traditional polymers, AuNSs modified BC biopolymers (AuNSs@BC) biopolymers exhibited similar levels of softness, ductility, and better tensile strength. The in situ constructing of AuNSs@BC biopolymers was demonstrated to provide great reusability and antibacterial activities and towards both of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). The optimized AuNSs@BC biopolymers remain at least 95% antibacterial activities after three cycles. The facile and shape-controlled synthesis of AuNSs@BC biopolymers is believed to be useful for the design and application of biomass-based medical dressing. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10853-022-07273-x.
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Affiliation(s)
- Kehui Meng
- Jiangsu Key Laboratory of Advanced Catalytic Materials and Technology, School of Petrochemical Engineering, Changzhou University, Changzhou, 213164 China
| | - Xuan Liang
- Jiangsu Key Laboratory of Advanced Catalytic Materials and Technology, School of Petrochemical Engineering, Changzhou University, Changzhou, 213164 China
| | - Suting Xue
- Jiangsu Key Laboratory of Advanced Catalytic Materials and Technology, School of Petrochemical Engineering, Changzhou University, Changzhou, 213164 China
| | - Song Xu
- Jiangsu Key Laboratory of Advanced Catalytic Materials and Technology, School of Petrochemical Engineering, Changzhou University, Changzhou, 213164 China
| | - Xudong Zheng
- Jiangsu Key Laboratory of Advanced Catalytic Materials and Technology, School of Petrochemical Engineering, Changzhou University, Changzhou, 213164 China
| | - Zhidong Chen
- Advanced Catalysis and Green Manufacturing Collaborative Innovation Center, Changzhou University, Changzhou, 213164 China
| | - Man Zhou
- Jiangsu Key Laboratory of Advanced Catalytic Materials and Technology, School of Petrochemical Engineering, Changzhou University, Changzhou, 213164 China
- Advanced Catalysis and Green Manufacturing Collaborative Innovation Center, Changzhou University, Changzhou, 213164 China
| | - Zhongyu Li
- Jiangsu Key Laboratory of Advanced Catalytic Materials and Technology, School of Petrochemical Engineering, Changzhou University, Changzhou, 213164 China
- School of Environmental and Safety Engineering, Changzhou University, Changzhou, 213164 China
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Park DH, Lee CM, Chang E, Kang CK, Park WB, Kim NJ, Choe PG, Oh MD. Clinical Impact of Empirical Antibiotic Therapy in Patients With Coronavirus Disease 2019 Requiring Oxygen Therapy. J Korean Med Sci 2022; 37:e238. [PMID: 35880508 PMCID: PMC9313981 DOI: 10.3346/jkms.2022.37.e238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/20/2022] [Indexed: 12/27/2022] Open
Abstract
Despite the low prevalence of secondary bacterial infection in coronavirus disease 2019 (COVID-19) patients, most of them were administered antibiotic therapy empirically. However, the prognostic impact of empirical antibiotic therapy has not been evaluated. We conducted retrospective propensity score-matched case-control study of 233 COVID-19 patients with moderate to severe illnesses who required oxygen therapy and evaluated whether empirical antibiotic therapy could improve clinical outcomes. Empirical antibiotic therapy did not improve clinical outcomes including length of stay, days with oxygen requirement, the proportion of patients with increased oxygen demand, the proportion of patients who required mechanical ventilation, and overall mortality. This finding implies that routine administration of antibiotics for the treatment of COVID-19 is not essential and should be restricted.
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Affiliation(s)
- Do Hyeon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Khalil MAF, El-Ansary MRM, Bassyouni RH, Mahmoud EE, Ali IA, Ahmed TI, Hassan EA, Samir TM. Oropharyngeal Candidiasis among Egyptian COVID-19 Patients: Clinical Characteristics, Species Identification, and Antifungal Susceptibility, with Disease Severity and Fungal Coinfection Prediction Models. Diagnostics (Basel) 2022; 12:diagnostics12071719. [PMID: 35885623 PMCID: PMC9316654 DOI: 10.3390/diagnostics12071719] [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: 05/31/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 12/04/2022] Open
Abstract
The study aimed to investigate the causative species, antifungal susceptibility, and factors associated with oropharyngeal candidiasis (OPC) among Egyptian COVID-19 patients. This is an observational, case-controlled, single-center study that included three groups: COVID-19 patients (30), COVID-19 patients with OPC (39), and healthy individuals (31). Patients’ demographic data (age, sex), laboratory tests, comorbidities, treatment, and outcomes were included. Candida species were isolated from COVID-OPC patient’s oropharyngeal swabs by convenient microbiological methods. Isolated strains were tested for antimicrobial susceptibility, biofilm production, aspartyl protease, and phospholipase activities. The most common respiratory symptoms reported were dyspnea (36/39; 92.4%) and cough (33/39; 84.7%). Candida albicans was the most common isolated species, accounting for 74.36% (29/39), followed by Candida tropicalis and Candida glabrata (15.38% and 10.26%, respectively). Amphotericin was effective against all isolates, while fluconazole was effective against 61.5%. A total of 53.8% of the isolates were biofilm producers. The phospholipase activity of C. albicans was detected among 58.6% (17/29) of the isolates. Significant variables from this study were used to create two equations from a regression model that can predict the severity of disease course and liability to fungal infection, with a stativity of 87% and 91%, respectively. According to our findings, COVID-19 patients with moderate to severe infection under prolonged use of broad-spectrum antibiotics and corticosteroids should be considered a high-risk group for developing OPC, and prophylactic measures are recommended to be included in the treatment protocols. In addition, due to the increased rate of fluconazole resistance, other new antifungals should be considered.
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Affiliation(s)
- Mahmoud A. F. Khalil
- Department of Microbiology and Immunology, Faculty of Pharmacy, Fayoum University, Fayoum 63514, Egypt;
| | - Mahmoud R. M. El-Ansary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Misr University for Science and Technology (MUST), Giza 12566, Egypt;
| | - Rasha H. Bassyouni
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum 63514, Egypt;
| | - Eman E. Mahmoud
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Fayoum University, Fayoum 63514, Egypt;
| | - Inas A. Ali
- Department of Family and Community Medicine, Faculty of Medicine, Misr University for Science and Technology (MUST), Giza 12566, Egypt;
| | - Tarek I. Ahmed
- Department of Internal Medicine, Faculty of Medicine, Fayoum University, Fayoum 63514, Egypt;
| | - Essam A. Hassan
- Department of Tropical Medicine, Faculty of Medicine, Fayoum University, Fayoum 63514, Egypt;
| | - Tamer M. Samir
- Department of Microbiology and Immunology, Faculty of Pharmacy, Misr University for Science and Technology (MUST), Giza 12566, Egypt
- Correspondence:
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Rebold N, Alosaimy S, Morrisette T, Holger D, Lagnf AM, Ansari I, Belza AC, Cheaney L, Hussain H, Herbin SR, Abdul-Mutakabbir J, Carron C, Sandhu A, Chopra T, Rybak MJ. Clinical Characteristics Associated with Bacterial Bloodstream Coinfection in COVID-19. Infect Dis Ther 2022; 11:1281-1296. [PMID: 35538335 PMCID: PMC9090596 DOI: 10.1007/s40121-022-00636-6] [Citation(s) in RCA: 2] [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: 03/07/2022] [Accepted: 04/04/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Inappropriate antibiotic use in COVID-19 is often due to treatment of presumed bacterial coinfection. Predictive factors to distinguish COVID-19 from COVID-19 with bacterial coinfection or bloodstream infection are limited. METHODS We conducted a retrospective cohort study of 595 COVID-19 patients admitted between March 8, 2020, and April 4, 2020, to describe factors associated with a bacterial bloodstream coinfection (BSI). The primary outcome was any characteristic associated with BSI in COVID-19, with secondary outcomes including 30-day mortality and days of antibiotic therapy (DOT) by antibiotic consumption (DOT/1000 patient-days). Variables of interest were compared between true BSI (n = 25) and all other COVID-19 cases (n = 570). A secondary comparison was performed between positive blood cultures with true BSI (n = 25) and contaminants (n = 33) on antibiotic use. RESULTS Fever (> 38 °C) (as a COVID-19 symptom) was not different between true BSI (n = 25) and all other COVID-19 patients (n = 570) (p = 0.93), although it was different as a reason for emergency department (ED) admission (p = 0.01). Neurological symptoms (ED reason or COVID-19 symptom) were significantly higher in the true BSI group (p < 0.01, p < 0.01) and were independently associated with true BSI (ED reason: OR = 3.27, p < 0.01; COVID-19 symptom: OR = 2.69, p = 0.03) on multivariate logistic regression. High (15-19.9 × 109/L) white blood cell (WBC) count at admission was also higher in the true BSI group (p < 0.01) and was independently associated with true BSI (OR = 2.56, p = 0.06) though was not statistically significant. Thirty-day mortality was higher among true BSI (p < 0.01). Antibiotic consumption (DOT/1000 patient-days) between true BSI and contaminants was not different (p = 0.34). True bloodstream coinfection was 4.2% (25/595) over the 28-day period. CONCLUSION True BSI in COVID-19 was associated with neurological symptoms and nonsignificant higher WBC, and led to overall higher 30-day mortality and worse patient outcomes.
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Affiliation(s)
- Nicholas Rebold
- Wayne State University, Detroit, MI, USA.
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
| | - Sara Alosaimy
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Taylor Morrisette
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
- Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina College of Pharmacy, Charleston, SC, USA
- Department of Pharmacy Services, Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston, SC, USA
| | - Dana Holger
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | - Abdalhamid M Lagnf
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
| | | | | | | | | | - Shelbye R Herbin
- Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA
- Department of Pharmacy, Henry Ford Wyandotte Hospital, Henry Ford Health System, Wyandotte, MI, USA
| | - Jacinda Abdul-Mutakabbir
- Wayne State University, Detroit, MI, USA
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, USA
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | - Avnish Sandhu
- Wayne State University, Detroit, MI, USA
- Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA
- Department of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Teena Chopra
- Wayne State University, Detroit, MI, USA
- Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA
- Department of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Michael J Rybak
- Wayne State University, Detroit, MI, USA.
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
- Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA.
- Department of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA.
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Naseef HA, Mohammad U, Al-Shami N, Sahoury Y, Abukhalil AD, Dreidi M, Alsahouri I, Farraj M. Bacterial and fungal co-infections among ICU COVID-19 hospitalized patients in a Palestinian hospital: a retrospective cross-sectional study. F1000Res 2022; 11:30. [PMID: 35811795 PMCID: PMC9206111 DOI: 10.12688/f1000research.74566.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 01/08/2023] Open
Abstract
Background: Diagnosis of co-infections with multiple pathogens among hospitalized coronavirus disease 2019 (COVID-19) patients can be jointly challenging and essential for appropriate treatment, shortening hospital stays and preventing antimicrobial resistance. This study proposes to investigate the burden of bacterial and fungal co-infections outcomes on COVID-19 patients. It is a single center cross-sectional study of hospitalized COVID-19 patients at Beit-Jala hospital in Palestine. Methods: The study included 321 hospitalized patients admitted to the ICU between June 2020 and March 2021 aged ≥20 years, with a confirmed diagnosis of COVID-19 via reverse transcriptase-polymerase chain reaction assay conducted on a nasopharyngeal swab. The patient's information was gathered using graded data forms from electronic medical reports. Results: The diagnosis of bacterial and fungal infection was proved through the patient’s clinical presentation and positive blood or sputum culture results. All cases had received empirical antimicrobial therapy before the intensive care unit (ICU) admission, and different regimens during the ICU stay. The rate of bacterial co-infection was 51.1%, mainly from gram-negative isolates (
Enterobacter species and
K.pneumoniae). The rate of fungal co-infection caused by
A.fumigatus was 48.9%, and the mortality rate was 8.1%. However, it is unclear if it had been attributed to SARS-CoV-2 or coincidental. Conclusions: Bacterial and fungal co-infection is common among COVID-19 patients at the ICU in Palestine, but it is not obvious if these cases are attributed to SARS-CoV-2 or coincidental, because little data is available to compare it with the rates of secondary infection in local ICU departments before the pandemic. Comprehensively, those conclusions present data supporting a conservative antibiotic administration for severely unwell COVID-19 infected patients. Our examination regarding the impacts of employing antifungals to manage COVID-19 patients can work as a successful reference for future COVID-19 therapy.
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Affiliation(s)
- Hani A. Naseef
- Pharmacy, Birzeit University, Ramallah, Palestine, 14, Palestinian Territory
| | - Ula Mohammad
- Pharmacy, Birzeit University, Ramallah, Palestine, 14, Palestinian Territory
| | - Nimeh Al-Shami
- Pharmacy, Birzeit University, Ramallah, Palestine, 14, Palestinian Territory
| | - Yousef Sahoury
- Pharmacy, Birzeit University, Ramallah, Palestine, 14, Palestinian Territory
| | | | - Mutaz Dreidi
- Department of Nursing, Birzeit University, Ramallah, Palestine, 14, Palestinian Territory
| | - Ibrahim Alsahouri
- Infectious Disease Department, Beit Jala Govermental Hospital, Ministry of Health, West Bank, Palestinian Territory
| | - Mohammad Farraj
- Master Program in Clinical Laboratory Science, Birzeit University, Ramallah, Palestine, 14, Palestinian Territory
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Li A, Chen JY, Hsu CL, Oyang YJ, Huang HC, Juan HF. A Single-Cell Network-Based Drug Repositioning Strategy for Post-COVID-19 Pulmonary Fibrosis. Pharmaceutics 2022; 14:pharmaceutics14050971. [PMID: 35631558 PMCID: PMC9147547 DOI: 10.3390/pharmaceutics14050971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/22/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
Post-COVID-19 pulmonary fibrosis (PCPF) is a long-term complication that appears in some COVID-19 survivors. However, there are currently limited options for treating PCPF patients. To address this problem, we investigated COVID-19 patients’ transcriptome at single-cell resolution and combined biological network analyses to repurpose the drugs treating PCPF. We revealed a novel gene signature of PCPF. The signature is functionally associated with the viral infection and lung fibrosis. Further, the signature has good performance in diagnosing and assessing pulmonary fibrosis. Next, we applied a network-based drug repurposing method to explore novel treatments for PCPF. By quantifying the proximity between the drug targets and the signature in the interactome, we identified several potential candidates and provided a drug list ranked by their proximity. Taken together, we revealed a novel gene expression signature as a theragnostic biomarker for PCPF by integrating different computational approaches. Moreover, we showed that network-based proximity could be used as a framework to repurpose drugs for PCPF.
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Affiliation(s)
- Albert Li
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 106, Taiwan; (A.L.); (J.-Y.C.); (Y.-J.O.)
| | - Jhih-Yu Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 106, Taiwan; (A.L.); (J.-Y.C.); (Y.-J.O.)
| | - Chia-Lang Hsu
- Department of Medical Research, National Taiwan University Hospital, Taipei 106, Taiwan;
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei 106, Taiwan
| | - Yen-Jen Oyang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 106, Taiwan; (A.L.); (J.-Y.C.); (Y.-J.O.)
| | - Hsuan-Cheng Huang
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Correspondence: (H.-C.H.); (H.-F.J.)
| | - Hsueh-Fen Juan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 106, Taiwan; (A.L.); (J.-Y.C.); (Y.-J.O.)
- Department of Life Science, National Taiwan University, Taipei 106, Taiwan
- Center for Computational and Systems Biology, National Taiwan University, Taipei 106, Taiwan
- Correspondence: (H.-C.H.); (H.-F.J.)
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Long B, Chavez S, Carius BM, Brady WJ, Liang SY, Koyfman A, Gottlieb M. Clinical update on COVID-19 for the emergency and critical care clinician: Medical management. Am J Emerg Med 2022; 56:158-170. [PMID: 35397357 PMCID: PMC8956349 DOI: 10.1016/j.ajem.2022.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/28/2022] [Accepted: 03/19/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. OBJECTIVE This is the second part in a series on COVID-19 updates providing a focused overview of the medical management of COVID-19 for emergency and critical care clinicians. DISCUSSION COVID-19, caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality worldwide. A variety of medical therapies have been introduced for use, including steroids, antivirals, interleukin-6 antagonists, monoclonal antibodies, and kinase inhibitors. These agents have each demonstrated utility in certain patient subsets. Prophylactic anticoagulation in admitted patients demonstrates improved outcomes. Further randomized data concerning aspirin in outpatients with COVID-19 are needed. Any beneficial impact of other therapies, such as colchicine, convalescent plasma, famotidine, ivermectin, and vitamins and minerals is not present in reliable medical literature. In addition, chloroquine and hydroxychloroquine are not recommended. CONCLUSION This review provides a focused update of the medical management of COVID-19 for emergency and critical care clinicians to help improve care for these patients.
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Affiliation(s)
- Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX, USA.
| | - Summer Chavez
- Department of Emergency Medicine, UT Health Houston McGovern School of Medicine, 6431 Fannin Street, Houston, TX, 77030, USA.
| | | | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
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Sahu T, Verma HK, Bhaskar LVKS. Bacterial and fungal co-infection is a major barrier in COVID-19 patients: A specific management and therapeutic strategy is required. World J Virol 2022; 11:107-110. [PMID: 35433338 PMCID: PMC8966592 DOI: 10.5501/wjv.v11.i2.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/08/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Microbial co-infections are another primary concern in patients with coronavirus disease 2019 (COVID-19), yet it is an untouched area among researchers. Preliminary data and systematic reviews only show the type of pathogens responsible for that, but its pathophysiology is still unknown. Studies show that these microbial co-infections are hospital-acquired/nosocomial infections, and patients admitted to intensive care units with invasive mechanical ventilation are highly susceptible to it. Patients with COVID-19 had elevated inflammatory cytokines and a weakened cell-mediated immune response, with lower CD4+ T and CD8+ T cell counts, indicating vulnerability to various co-infections. Despite this, there are only a few studies that recommend the management of co-infections.
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Affiliation(s)
- Tarun Sahu
- Department of Physiology, All India Institute of Medical Science, Raipur 492001, Chhattisgarh, India
| | - Henu Kumar Verma
- Department of Immunopathology, Institute of Lung Health and Immunity, Comprehensive Pneumology Center, Helmholtz Zentrum, Munich 85764, Germany
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45
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Kariyawasam RM, Julien DA, Jelinski DC, Larose SL, Rennert-May E, Conly JM, Dingle TC, Chen JZ, Tyrrell GJ, Ronksley PE, Barkema HW. Antimicrobial resistance (AMR) in COVID-19 patients: a systematic review and meta-analysis (November 2019-June 2021). Antimicrob Resist Infect Control 2022; 11:45. [PMID: 35255988 PMCID: PMC8899460 DOI: 10.1186/s13756-022-01085-z] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/20/2022] [Indexed: 12/23/2022] Open
Abstract
Background Pneumonia from SARS-CoV-2 is difficult to distinguish from other viral and bacterial etiologies. Broad-spectrum antimicrobials are frequently prescribed to patients hospitalized with COVID-19 which potentially acts as a catalyst for the development of antimicrobial resistance (AMR). Objectives We conducted a systematic review and meta-analysis during the first 18 months of the pandemic to quantify the prevalence and types of resistant co-infecting organisms in patients with COVID-19 and explore differences across hospital and geographic settings. Methods We searched MEDLINE, Embase, Web of Science (BioSIS), and Scopus from November 1, 2019 to May 28, 2021 to identify relevant articles pertaining to resistant co-infections in patients with laboratory confirmed SARS-CoV-2. Patient- and study-level analyses were conducted. We calculated pooled prevalence estimates of co-infection with resistant bacterial or fungal organisms using random effects models. Stratified meta-analysis by hospital and geographic setting was also performed to elucidate any differences. Results Of 1331 articles identified, 38 met inclusion criteria. A total of 1959 unique isolates were identified with 29% (569) resistant organisms identified. Co-infection with resistant bacterial or fungal organisms ranged from 0.2 to 100% among included studies. Pooled prevalence of co-infection with resistant bacterial and fungal organisms was 24% (95% CI 8–40%; n = 25 studies: I2 = 99%) and 0.3% (95% CI 0.1–0.6%; n = 8 studies: I2 = 78%), respectively. Among multi-drug resistant organisms, methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and multi-drug resistant Candida auris were most commonly reported. Stratified analyses found higher proportions of AMR outside of Europe and in ICU settings, though these results were not statistically significant. Patient-level analysis demonstrated > 50% (n = 58) mortality, whereby all but 6 patients were infected with a resistant organism. Conclusions During the first 18 months of the pandemic, AMR prevalence was high in COVID-19 patients and varied by hospital and geography although there was substantial heterogeneity. Given the variation in patient populations within these studies, clinical settings, practice patterns, and definitions of AMR, further research is warranted to quantify AMR in COVID-19 patients to improve surveillance programs, infection prevention and control practices and antimicrobial stewardship programs globally. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01085-z.
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Affiliation(s)
- Ruwandi M Kariyawasam
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada.,Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Alberta Precision Laboratories - Public Health Laboratory (ProvLab), Edmonton, AB, Canada
| | - Danielle A Julien
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
| | - Dana C Jelinski
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
| | - Samantha L Larose
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
| | - Elissa Rennert-May
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada.,Departments of Medicine, Microbiology, Immunology and Infectious Diseases, and Community Health Sciences, O'Brien Institute for Public Health and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - John M Conly
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada.,Departments of Medicine, Pathology and Laboratory Medicine, Microbiology, Immunology and Infectious Diseases, O'Brien Institute for Public Health, Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Tanis C Dingle
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada.,Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Alberta Precision Laboratories - Public Health Laboratory (ProvLab), Edmonton, AB, Canada
| | - Justin Z Chen
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada.,Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gregory J Tyrrell
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada.,Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Alberta Precision Laboratories - Public Health Laboratory (ProvLab), Edmonton, AB, Canada
| | - Paul E Ronksley
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada.,Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Herman W Barkema
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada. .,Departments of Production Animal Health and Community Health Sciences,, One Health at UCalgary, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Canada.
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Venzon M, Bernard-Raichon L, Klein J, Axelrad JE, Zhang C, Hussey GA, Sullivan AP, Casanovas-Massana A, Noval MG, Valero-Jimenez AM, Gago J, Putzel G, Pironti A, Wilder E, Thorpe LE, Littman DR, Dittmann M, Stapleford KA, Shopsin B, Torres VJ, Ko AI, Iwasaki A, Cadwell K, Schluter J. Gut microbiome dysbiosis during COVID-19 is associated with increased risk for bacteremia and microbial translocation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2022. [PMID: 35262080 PMCID: PMC8902880 DOI: 10.1101/2021.07.15.452246] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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 in a mouse model that SARS-CoV-2 infection can induce gut microbiome dysbiosis, which correlated with alterations to Paneth cells and goblet cells, and markers of barrier permeability. Comparison with stool samples collected from 96 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 indicates that bacteria may 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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47
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Bahceci I, Yildiz IE, Duran OF, Soztanaci US, Kirdi Harbawi Z, Senol FF, Demiral G. Secondary Bacterial Infection Rates Among Patients With COVID-19. Cureus 2022; 14:e22363. [PMID: 35371794 PMCID: PMC8938257 DOI: 10.7759/cureus.22363] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 12/23/2022] Open
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48
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Ramírez-Lozada T, Loranca-García MC, Fuentes-Venado CE, Rodríguez-Cerdeira C, Ocharan-Hernández E, Soriano-Ursúa MA, Farfán-García ED, Chávez-Gutiérrez E, Ramírez-Magaña X, Robledo-Cayetano M, Loza-Mejía MA, Santa-Olalla IAG, Torres-Paez OU, Pinto-Almazán R, Martínez-Herrera E. Does the Fetus Limit Antibiotic Treatment in Pregnant Patients with COVID-19? Antibiotics (Basel) 2022; 11:antibiotics11020252. [PMID: 35203854 PMCID: PMC8868538 DOI: 10.3390/antibiotics11020252] [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: 01/01/2022] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 02/07/2023] Open
Abstract
During pregnancy, there is a state of immune tolerance that predisposes them to viral infection, causing maternal-fetal vulnerability to the adverse effects of COVID-19. Bacterial coinfections significantly increase the mortality rate for COVID-19. However, it is known that all drugs, including antibiotics, will enter the fetal circulation in a variable degree despite the role of the placenta as a protective barrier and can cause teratogenesis or other malformations depending on the timing of exposure to the drug. Also, it is important to consider the impact of the indiscriminate use of antibiotics during pregnancy can alter both the maternal and fetal-neonatal microbiota, generating future repercussions in both. In the present study, the literature for treating bacterial coinfections in pregnant women with COVID-19 is reviewed. In turn, we present the findings in 50 pregnant women hospitalized diagnosed with SARS-CoV-2 without previous treatment with antibiotics; moreover, a bacteriological culture of sample types was performed. Seven pregnant women had coinfection with Staphylococcus haemolyticus, Staphylococcus epidermidis, Streptococcus agalactiae, Escherichia coli ESBL +, biotype 1 and 2, Acinetobacter jahnsonii, Enterococcus faecium, and Clostridium difficile. When performing the antibiogram, resistance to multiple drugs was found, such as macrolides, aminoglycosides, sulfa, dihydrofolate reductase inhibitors, beta-lactams, etc. The purpose of this study was to generate more scientific evidence on the better use of antibiotics in these patients. Because of this, it is important to perform an antibiogram to prevent abuse of empirical antibiotic treatment with antibiotics in pregnant women diagnosed with SARS-CoV-2.
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Affiliation(s)
- Tito Ramírez-Lozada
- Servicio de Ginecología y Obstetricia, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (T.R.-L.); (X.R.-M.)
| | - María Concepción Loranca-García
- Hospital General de Zona No. 53, Los Reyes, Instituto Mexicano del Seguro Social (IMSS), Carr Federal México-Puebla Km 17.5, Villa de la Paz, Rincón de los Reyes, Los Reyes Acaquilpan 56400, Mexico;
| | | | - Carmen Rodríguez-Cerdeira
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain;
- Dermatology Department, Hospital Vithas Ntra. Sra. de Fátima, 36206 Vigo, Spain
- Campus Universitario, University of Vigo, 36310 Vigo, Spain
| | - Esther Ocharan-Hernández
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (E.O.-H.); (M.A.S.-U.); (E.D.F.-G.)
| | - Marvin A. Soriano-Ursúa
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (E.O.-H.); (M.A.S.-U.); (E.D.F.-G.)
| | - Eunice D. Farfán-García
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (E.O.-H.); (M.A.S.-U.); (E.D.F.-G.)
| | - Edwin Chávez-Gutiérrez
- Doctorado en Ciencias en Biomedicina y Biotecnología Molecular, Escuela Nacional de Ciencias Biológicas, IPN, Mexico City 07738, Mexico;
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de Mexico 56530, Mexico; (M.R.-C.); (O.U.T.-P.)
| | - Xóchitl Ramírez-Magaña
- Servicio de Ginecología y Obstetricia, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (T.R.-L.); (X.R.-M.)
| | - Maura Robledo-Cayetano
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de Mexico 56530, Mexico; (M.R.-C.); (O.U.T.-P.)
| | - Marco A. Loza-Mejía
- Design, Isolation, and Synthesis of Bioactive Molecules Research Group, Chemical Sciences School, Universidad La Salle-México, Benjamín Franklin 45, Mexico City 06140, Mexico;
| | | | - Oscar Uriel Torres-Paez
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Estado de Mexico 56530, Mexico; (M.R.-C.); (O.U.T.-P.)
| | - Rodolfo Pinto-Almazán
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (E.O.-H.); (M.A.S.-U.); (E.D.F.-G.)
- Non-Communicable Disease Research Group, Facultad Mexicana de Medicina, Universidad La Salle-México, Las Fuentes 17, Tlalpan Centro I, Tlalpan, Mexico City 14000, Mexico
- Correspondence: (R.P.-A.); (E.M.-H.)
| | - Erick Martínez-Herrera
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain;
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico; (E.O.-H.); (M.A.S.-U.); (E.D.F.-G.)
- Correspondence: (R.P.-A.); (E.M.-H.)
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49
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Mandell LA, Zhanel GG, Rotstein C, Muscedere J, Loeb M, Johnstone J. Community-Acquired Pneumonia in Canada During COVID-19. Open Forum Infect Dis 2022; 9:ofac043. [PMID: 35211634 PMCID: PMC8863085 DOI: 10.1093/ofid/ofac043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/03/2022] [Indexed: 12/15/2022] Open
Abstract
Dealing with coronavirus disease 2019 (COVID-19) has been a monumental test of medical skills and resources worldwide. The management of community-acquired pneumonia (CAP) can at times be difficult, but treating CAP in the setting of COVID-19 can be particularly trying and confusing and raises a number of challenging questions relating to etiology, diagnosis, and treatment. This article is based on the authors’ experiences and presents an overview of how CAP during COVID-19 is handled in Canada. We touch on the issues of microbial etiology in patients with CAP in the setting of COVID-19 as well as diagnostic, site of care, and treatment approaches. Published guidelines are the basis of management of CAP and are discussed in the context of Canadian data. We also outline the usual treatment approaches to COVID-19, particularly in patients who have been hospitalized.
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Affiliation(s)
- L A Mandell
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - G G Zhanel
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C Rotstein
- Department of Medicine, University of Toronto, Toronto, Canada
| | - J Muscedere
- Department of Critical Care Medicine, Queens University, Kingston, Canada
| | - M Loeb
- Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - J Johnstone
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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50
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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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