Complications with moderate-to-severe COVID-19 during hospital admissions in patients with pneumonia

The effect of immunosuppressive therapy on the development of ventilator-associated pneumonia in patients with COVID-19

Aim: It remains unclear whether immunosuppressive treatments such as corticosteroids and IL-6 receptor blockers have an effect on the development of ventilator-associated pneumonia (VAP). The aim of this study was to investigate the effect of immunosuppressive therapy on the development of VAP in critically ill patients with COVID-19. Material and Method: Two hundred thirty five patients with critically ill patients with COVID-19, who were treated in the intensive care unit (ICU) and received mechanical ventilator support, were evaluated retrospectively. VAP development, secondary infections, microorganisms isolated, and resistance patterns were compared between the groups that received and did not receive immunosuppressive therapy, and also the groups that did not receive immunosuppressive therapy, received only corticosteroid, received only tocilizumab, and received corticosteroid plus tocilizumab were compared in the subgroup analysis. Results: In the immunosuppressive treatment group, VAP development (40.2% vs. 21.2%; p=0.001), secondary infection development (48.4% vs. 29.2%; p=0.003), at least one drug resistant bacteria growth (46.7% vs. 27.4%; p=0.001), extensively-drug resistant (XDR) microorganism growth (89.8% vs. 72.7%; p=0.033) were higher than the group that did not receive immunosuppressive treatment. VAP (53.3%; p=0.004), secondary infection (73.3%; p=0.0002), the growth of bacteria resistant to at least one drug (70%; p=0.0003) were highest in the corticosteroid plus tocilizumab group in the subgroup analysis. In addition, XDR (95.5% vs. 72.7%; p=0.032) and pan-drug resistant (PDR) microorganism growth (31.8% vs. 9.1% p=0.032) were higher in the corticosteroid plus tocilizumab group than the no immunosuppressive therapy group. There was no difference between the groups in terms of mortality (p>0.05). Conclusion: Immunosuppressive therapy has been found to potentially enhance the risk of VAP and secondary infections in critically ill patients with COVID-19 pneumonia as well as the growth of bacteria resistant to at least one drug, the length of stay in hospital and ICUs. In addition, it has been evaluated that there may be an increase in the growth of XDR and PDR microorganisms when corticosteroid and tocilizumab are used together. Although there was no difference in mortality, using immunosuppressive therapy may require careful use of targeted antibiotics and longer-term antimicrobial therapy.

The comparison of chest X-ray and CT visibility according to size and lesion types in the patients with COVID-19

Introduction: Chest X-ray (CXR) is one of the routinely used radiological examinations in COVID-19. However, the lesion detectability level of CXR is low. To date, to the best of our knowledge, the visualization quality of X-ray in COVID-19 has not been specifically evaluated in different lesions. Our study aims to determine the visualization quality of CXR in COVID-19 patients according to elementary lesions. Material and Method: 52 COVID-positive patients (26 Males and 26 Females); 69,6346±15,14250 (32-89) years [mean±SD age (range)] were included in the study. 98 different elementary lesions of lung detected on CT were evaluated in six different groups (consolidation, indeterminate ground-glass opacity (IGGO), dense GGO (DGGO), reversed halo, parenchymal band and curvilinear band). Lesions were compared with CXR taken on the same day. The detectability rates of the lesions on CXR were evaluated. Results: The mean sizes of CXR negative and CXR positive lesions for every group (consolidations, IGGO, DGGO, reversed halo sign, parenchymal band, curvilinear band) were respectively 1.36 cm -5.75 cm, 3.44 cm -5.50 cm, 2.25 cm -5.06 cm, 2.5cm -4.09 cm, N/A -3.14 cm and 1 cm -4.5 cm. According to Mann-Whitney U analysis, p values were found as (respectively in consolidations, IGGO, DGGO, reversed halo sign, and curvilinear band) 0.0001p, 0.145, 0.0001 p, 0.143 and 0.286. Given consolidation and DGGO groups, there was a statistically significant difference between non-visualized and visualized groups. According to ROC analysis, cut-off values were respectively 3 cm and 3.5 cm for consolidation and DGGO. Conclusion: Our study showed that consolidations smaller than 3 cm and DGGO smaller than 3.5 cm are difficult to visualize with CXR. Although there is no definite cut-off value in other elementary lesions, the visualization ratio of parenchymal bands and curvilinear bants on chest X-rays is quite high. IGGOs may not be detected even at higher dimensions. Reversed halos less than 3 cm can rarely be detected on CXR.