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Pinargote-Celorio H, Otero-Rodríguez S, González-de-la-Aleja P, Rodríguez-Díaz JC, Climent E, Chico-Sánchez P, Riera G, Llorens P, Aparicio M, Montiel I, Boix V, Moreno-Pérez Ó, Ramos-Rincón JM, Merino E. Mild SARS-CoV-2 infection in vulnerable patients: implementation of a clinical pathway for early treatment. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:195-201. [PMID: 37003904 PMCID: PMC10063154 DOI: 10.1016/j.eimce.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 04/03/2023]
Abstract
INTRODUCTION The objective of this report is to describe the clinical pathway for early treatment of patients with acute SARS-CoV-2 infection and to evaluate the first results of its implementation. METHODS This is a descriptive and retrospective study of the implementation of a clinical pathway of treatment in outpatients (January 1 to June 30 2022). Clinical pathway: detection and referral systems from Primary Care, Emergency services, hospital specialities and an automated detection system; clinical evaluation and treatment administration in the COVID-19 day-hospital and subsequent clinical follow-up. Explanatory variables: demographics, comorbidity, vaccination status, referral pathways and treatment administration. OUTCOME VARIABLES hospitalization and death with 30 days, grade 2-3 toxicity related to treatment. RESULTS Treatment was administered to 262 patients (53,4% women, median age 60 years). The treatment indication criteria were immunosupression (68,3%), and the combination of age, vaccination status and comorbidity in the rest 47,3% of the patients s received remdesivir, 35,9% nirmatrelvir/ritonavir, 13,4% sotrovimab and 2,4% combined treatment with a median of 4 days after symptom onset. Hospital admission was required for 6,1% of the patients, 3,8% related to progression COVID-19. No patient died. Toxicity grade 2-3 toxicity was reported in 18,7%, 89,8% dysgeusia and metallic tasted related nirmatrelvir/ritonavir. Seven patients discontinued treatment due to toxicity. CONCLUSION The creation and implementation of a clinical pathway for non-hospitalized patients with SARS-CoV-2 infection is effective and it allows early accessibility and equity of currently available treatments.
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Affiliation(s)
- Héctor Pinargote-Celorio
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Silvia Otero-Rodríguez
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Pilar González-de-la-Aleja
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Juan-Carlos Rodríguez-Díaz
- Servicio de Microbiología, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Producción Vegetal y Microbiología, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Eduardo Climent
- Servicio de Farmacia, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Área de Farmacia y Tecnología Farmacéutica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Pablo Chico-Sánchez
- Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Gerónima Riera
- Servicio de Farmacia, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General Universitario Dr. Balmis, Instituto Investigación Biomédica y Sanitaria de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Marta Aparicio
- Farmacia de Atención Primaria, Hospital General Universitario Dr. Balmis, Alicante. Spain
| | - Inés Montiel
- Dirección de Atención Primaria, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL), Alicante, Spain
| | - Vicente Boix
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Óscar Moreno-Pérez
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain; Sección de Endocrinología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - José-Manuel Ramos-Rincón
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain; Servicio de Medicina Interna, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Esperanza Merino
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
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