Secondary bacterial infections in patients with coronavirus disease 2019-associated pneumonia

SUMMARY OBJECTIVE: The vast majority of patients who hospitalized with coronavirus disease 2019 are given empirical antibiotic therapy. However, information on the frequency, microorganism species, and resistance rates of secondary bacterial infections in coronavirus disease 2019 patients are insufficient. We aimed to show the frequency of secondary infections and resistance conditions in patients with coronavirus disease 2019 hospitalized in the intensive care unit. METHODS: The results of tracheal aspirate culture, blood culture, and urine culture obtained from coronavirus disease 2019 patients - at least 2 days after their admission to the intensive care unit - were examined microbiologically. RESULTS: A total of 514 patients hospitalized in intensive care unit were included in our study. Tracheal aspirate, blood, or urine cultures were collected from 369 patients (71.8%). Bacterial reproduction was detected in at least one sample in 171 (33.3%) of all patients. The rate of respiratory tract infection and/or bloodstream infection was found to be 21%. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa in tracheal aspirate culture; Coagulase-negative staphylococci, K. pneumoniae, and A. baumannii in blood culture; and Escherichia coli, K. pneumoniae, and Enterococcus faecalis in urine culture were the most common microorganisms. A. baumannii was resistant to most antibiotics except colistin and P. aeruginosa strains were resistant to most antibiotics except amikacin, colistin, cefepime, and imipenem. In K. pneumoniae, the highest meropenem sensitivity (73%) was observed; there was a strong resistance to most of the remaining antibiotics. CONCLUSIONS: We think that our study can be useful in choosing empirical antibiotic therapy in the coronavirus disease 2019 pandemic and reducing the mortality that may occur with secondary infection.

Evaluation of cardiac parameters between survivors and nonsurvivors of COVID-19 patients

SUMMARY OBJECTIVE: The present study compares the cardiac parameters of the survivor and nonsurvivor patients with COVID-19 infection. METHODS: This study was conducted in 379 patients diagnosed with COVID-19 disease. Information of 21 nonsurvivor and 358 survivor patients with COVID-19 was obtained from the hospital information management system and analyzed retrospectively. Relationship between cardiac parameters in patients categorized into the mortal and immortal groups was investigated. RESULTS: Of the total 379 patients involved in this study, 155 (40.9%) were females and 224 (59.1%) were males. No statistically significant difference in mortality was found between females and males (p=0.249). The total median age was 70, the median age in the nonsurvivor group was 74 (35-89), and it was 69.5 (18-96) in the survivor group (p=0.249). The median values of high-sensitivity troponin (hs-Tn), creatine kinase MB form, and especially myoglobin in the survivor and nonsurvivor groups were 25/64.9 (p=0.028), 18/23 (p=0.02), and 105.5/322.4 (p<0.001), and the difference was statistically significant. Comparing mortality, while there was 1 (0.7%) nonsurvivor out of 134 patients in the service unit, there were 20 (8.2%) nonsurvivors out of 245 patients in the intensive care unit. This difference was statistically significant (p=0.003). The cutoff value of myoglobin, which may pose a risk of mortality, was found to be 191.4 µg/L, while it was 45.7 ng/l for hs-Tn and 60.1 U/L for creatine kinase MB. CONCLUSIONS: Advanced age and increased levels of high-sensitivity troponin, creatine kinase MB, and myoglobin were found to be associated with mortality.

Evaluation of coagulation parameters: Coronavirus disease 2019 (COVID-19) between survivors and nonsurvivors

SUMMARY OBJECTIVE: This study aims to investigate and compare the coagulation parameters of coronavirus disease 2019 (COVID-19) patients with mortal and nonmortal conditions. METHODS: In this study, 511 patients diagnosed with COVID-19 were included. Information about 31 deceased and 480 recovered COVID-19 patients was obtained from the hospital information management system and analyzed retrospectively. Whether there was a correlation between coagulation parameters between the mortal and nonmortal patients was analyzed. Descriptive analyses on general characteristics of the study population were performed. Visual (probability plots and histograms) and analytical methods (Kolmogorov-Smirnov and Shapiro-Wilk test) were used to test the normal distribution. Analyses were performed using the SPSS statistical software package. RESULTS: Out of 511 patients, 219 (42.9%) were females and 292 (57.1%) were males. There was no statistically significant difference between males and females in terms of mortality (p=0.521). In total, the median age was 67 (22). The median age was 74 (13) in the nonsurvivor group and 67 (22) in the survivor group, and the difference was statistically significant (p=0.007). The D-dimer, prothrombin time, international normalized ratio, neutrophil, and lymphocyte median age values with p-values, in the recovered and deceased patient groups were: 1070 (2129), 1990 (7513) μg FEU/L, p=0.005; 12.6 (2.10), 13.3 (2.1), p=0.014; 1.17 (0.21), 1.22 (0.19), p=0.028; 5.51 (6.15), 8.54 (7.05), p=0.001; and 0.99 (0.96), 0.64 (0.84), p=0.037, respectively, with statistically significant differences. CONCLUSIONS: As a result of this study, D-dimer, prothrombin time, and international normalized ratio increase were found to be associated with mortality. These parameters need to be closely monitored during the patient follow-up.

Effect of COVID-19 on platelet count and its indices

SUMMARY BACKGROUND Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width. METHODS In total, 215 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant. RESULTS The patients' mean age was 64,32 ± 16,07 years. According to oxygen saturation, 81 patients had moderate and 134 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times. CONCLUSION In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

RESUMO OBJETIVO Testes laboratoriais de fácil acesso, baixo custo e amplamente utilizados capazes de demonstrar a gravidade da COVID-19 são importantes. Portanto, neste estudo, o nosso objetivo foi investigar a relação entre a mortalidade na COVID-19 e a contagem de plaquetas, volume plaquetário médio (VMP) e largura de distribuição de plaquetas. MÉTODOS No total, 215 pacientes com COVID-19 foram incluídos no estudo. Os pacientes foram divididos em dois grupos. Pacientes com saturação de oxigênio < 90% em ar ambiente foram considerados casos graves de COVID-19 e pacientes com valores ≥90% foram considerados casos moderados. Os registros médicos dos pacientes e o sistema eletrônico de monitoramento de dados de pacientes foram analisados retrospectivamente. As análises foram realizadas utilizando o software estatístico SPSS. Um valor de p <0,05 foi considerado significativo. RESULTADOS A média de idade dos pacientes foi de 64,32 ± 16,07 anos. Com base na saturação de oxigênio, 81 pacientes eram casos moderados e 134 tinham COVID-19 grave. Nosso estudo revelou que a saturação de oxigênio no momento da internação e a diferença nos valores de VPM entre o primeiro e terceiro dia de internação foram parâmetros significativos para predizer mortalidade de pacientes com COVID-19. A mortalidade foi 8,4 vezes maior nos pacientes com saturação abaixo de 90% no momento da internação, mas um aumento de apenas 1 unidade no valor de VPM aumentou a mortalidade 1,76 vezes. CONCLUSÃO Além da capacidade pulmonar dos pacientes, o volume plaquetário médio pode ser utilizado como um teste auxiliar para prever a mortalidade de pacientes com COVID-19.

Comparison of saliva and oro-nasopharyngeal swab sample in the molecular diagnosis of COVID-19

SUMMARY BACKGROUND Healthcare personnel are at risk of becoming infected while taking upper and/or lower respiratory tract specimens. Therefore, there is a need for sampling methods that do not risk infecting them. In this study, we aimed to compare the saliva and Oro-Nasopharyngeal Swab (ONS) sampling methods. METHODS Patients were divided into three groups. Group 1 included patients whose diagnosis of COVID-19 was confirmed by polymerase chain reaction (PCR). Group 2 included patients with COVID-19 compatible findings in lung computed tomography (CT), but with a negative PCR. Group 3 included patients who presented to the emergency department with COVID-19 compatible complaints but had normal CT. Saliva and ONS samples were taken on the third day of hospitalization in groups 1 and 2, whereas in group 3, they were taken at the time of admission to the hospital. RESULTS A total of 64 patients were included in the study. The average age was 51.04 ± 17.9 years, and 37 (57.8%) were male. SARS-CoV-2 was detected in 27 (42.2%) patients' saliva samples. While the sensitivity and positive predictive value of saliva samples were 85.2%, specificity and negative predictive value were 89.2%. The value of kappa was in substantial agreement (0.744), and it was found statistically significant (<0.001). CONCLUSIONS Saliva samples can be used instead of ONS samples in detecting SARS-CoV-2. Investigating SARS-CoV-2 with saliva is cheaper, easier for the patient and overall, and, most importantly, it poses much less risk of SARS-CoV-2 contamination to healthcare personnel.

RESUMO OBJETIVO Funcionários da saúde correm risco de infecção ao coletar amostras do trato superior e/ou inferior. Portanto, existe a necessidade de métodos de coleta de amostras que não representem um risco de infecção. Neste estudo, nosso objetivo foi comparar as métodos de coleta de saliva e swab de naso e orofaringe (ONS). MÉTODOS Os pacientes foram divididos em três grupos. O Grupo 1 incluiu pacientes cujo diagnóstico de COVID-19 foi confirmado por reação em cadeia da polimerase (PCR). O Grupo 2 incluiu pacientes com achados compatíveis com COVID-19 em exames de tomografia computadorizada (TC), mas com PCR negativo. O Grupo 3 incluiu pacientes que compareceram ao departamento de emergência com queixas compatíveis com COVID-19, mas TC normal. Amostras de saliva e ONS foram coletadas no terceiro dia de internação, nos Grupos 1 e 2, já no Grupo 3, foram coletadas no momento da internação. RESULTADOS Um total de 64 pacientes foram incluídos no estudo. A média de idade foi de 51,04 ± 17,9 anos, e 37 (57,8%) eram do sexo masculino. SARS-CoV-2 foi detectado em 27 (42,2%) amostras de saliva dos pacientes. A sensibilidade e valor preditivo positivo foi de 85,2% nas amostras de saliva, já a especificidade e o valor preditivo negativo foi 89,2%. O valor de Kappa estava substancialmente de acordo (0,744) e era estatisticamente significante (<0,001). CONCLUSÃO Amostras de saliva podem ser usada em vez de ONS na detecção de SARS-CoV-2. O uso de amostras de saliva para detecção de SARS-CoV-2 é mais barato, mais fácil para o paciente e em geral e, mais importante, representa um risco muito menor de contaminação de SARS-CoV-2 para os profissionais da saúde.

The effects of favipiravir on hematological parameters of covid-19 patients

SUMMARY INTRODUCTION This study aims to evaluate changes in hematological parameters after the follow-up of patients who received treatment with favipiravir due to COVID-19 infections. METHODS Sixty-two cases receiving favipiravir treatment for at least five days due to COVID-19 infection were evaluated retrospectively. Parameters including age, gender, nasopharyngeal swab positivity, and chronic diseases were analyzed. Hematologic parameters were analyzed before and after the treatment. RESULTS The mean age of the patients receiving treatment with favipiravir was 63.7±12.3 years. Nasopharyngeal swab positivity was detected in 67.7%. The most common comorbid conditions detected in patients were hypertension in 25 cases (40.3%) and diabetes in 16 cases (25.8%). In the statistical analysis of the hematological parameters before and after treatment with favipiravir, WBC, PT-PTT-INR levels were found to be unaffected; the mean RBC was found to have decreased from 4.33 ± 0.58 M/uL to 4.16 ± 0.54 M/uL (p:0.003); the median hemoglobin level was found to have decreased from 12.3 g/dl to 11.9 g/dl (p:0.041); the hematocrit level decreased from 38.1% ± 4.8 to 36.9% ± 4.2 (p:0.026); the median neutrophil count decreased from 4.57 K/uL to 3.85 K/uL (p:0.001); the mean lymphocyte count increased from 1.22 ± 0.53 K/uL to 1.84 ± 1.19 K/uL (p:0.000); and the mean platelet count increased from 244.1 ± 85.1 K/uL to 281.9 ± 103.3 K/uL (p:0.005). CONCLUSION We concluded that the pathological effect of treatment with favipiravir on the hematologic system was the suppression in the erythrocyte series, and there were no adverse effects in other hematologic parameters.

RESUMO INTRODUÇÃO Este estudo tem como objetivo avaliar as alterações nos parâmetros hematológicos após o acompanhamento de pacientes que receberam tratamento com favipiravir devido à infecção por Covid-19. MÉTODOS Sessenta e dois casos em tratamento com favipiravir por pelo menos cinco dias devido à infecção por Covid-19 foram avaliados retrospectivamente. Parâmetros como idade, sexo, positividade do swab nasofaríngeo e doenças crônicas foram analisados. Os parâmetros hematológicos foram analisados antes e após o tratamento. RESULTADOS A idade média dos pacientes que receberam tratamento com favipiravir foi de 63,7±12,3 anos. A positividade do swab nasofaríngeo foi detectada em 67,7%. As condições comórbidas mais comuns detectadas nos pacientes foram hipertensão em 25 casos (40,3%) e diabetes em 16 casos (25,8%). Na análise estatística dos parâmetros hematológicos antes e após o tratamento com favipiravir, os níveis de leucócitos, PT-PTT-INR não foram afetados. Verificou-se que o RBC médio diminuiu de 4,33±0,58 M/uL para 4,16±0,54 M/uL (p=0,003); o nível médio de hemoglobina foi reduzido de 12,3 g/dl para 11,9 g/dl (p=0,041); o nível de hematócrito diminuiu de 38,1%±4,8 para 36,9%±4,2 (p=0,026); a contagem mediana de neutrófilos diminuiu de 4,57 K/uL para 3,85 K/uL (p=0,001); a contagem média de linfócitos aumentou de 1,22±0,53 K/uL para 1,84±1,19 K/uL (p=0,000); a contagem média de plaquetas aumentou de 244,1±85,1 K/uL para 281,9±103,3 K/uL (p=0,005). CONCLUSÃO Concluiu-se que o efeito patológico do tratamento com favipiravir no sistema hematológico foi a supressão na série eritrocitária e que não houve efeitos adversos em outros parâmetros hematológicos.

The diagnostic process of covid-19 in the emergency department: laboratory and imaging methods

SUMMARY OBJECTIVES The 2019 Novel coronavirus disease puts a serious burden on the health system. Therefore, the detection of particularly serious patients at an early stage is extremely important in terms of controlling the outbreak and improving the prognosis. We investigated the role of inflammatory markers studied in patients suspected of COVID-19 at an emergency department in predicting PCR and CT results. METHODS This retrospective study was carried out with 133 patients who were admitted between 13 March and 1st April 2020 with suspicion of COVID-19. The patients were divided into four groups according to CT and RT-PCR results and evaluated. RESULTS Considering all patients, no specific findings were found in the hematological and biochemical values of patients in the laboratory analyses. Although all of the results remained within the reference range, there was a significant difference in white blood cell, neutrophil, platelet, and lymphocyte values when the groups were compared [p = 0.000; p = 0.004; p = 0.022; p = 0.023]. CONCLUSION Laboratory is not specific enough in the pre-diagnosis. In addition, this result does not alter with PCR or CT positivity. However, minimal changes observed in laboratory results may be partially guiding in patients in whom both PCR and CT are positive.

RESUMO OBJETIVOS A nova doença de coronavírus de 2019 coloca um fardo sério para o sistema de saúde. Portanto, a detecção de pacientes especialmente graves em um estágio inicial é extremamente importante em termos de controle do surto e melhoria do prognóstico. Investigamos o papel dos marcadores inflamatórios estudados em pacientes suspeitos de COVID-19 no pronto-socorro na previsão de resultados de PCR e CT. MÉTODOS Este estudo retrospectivo foi realizado entre 133 pacientes que foram admitidos entre 13 de março e 1o de abril de 2020 com suspeita de COVID-19. Os pacientes foram divididos em quatro grupos de acordo com os resultados da TC e RT-PCR e avaliados. RESULTADOS Considerando todos os pacientes, não foram encontrados achados específicos nos valores hematológicos e bioquímicos dos pacientes em análises laboratoriais. Embora todos os resultados tenham permanecido dentro do intervalo de referência, houve uma diferença significativa nos valores de glóbulos brancos, neutrófilos, plaquetas e linfócitos quando os grupos foram comparados [p = 0,000; p = 0,004; p = 0,022; p = 0,023]. CONCLUSÃO O laboratório não é suficientemente específico no pré-diagnóstico. Além disso, este resultado não se altera com a positividade para PCR ou CT. No entanto, alterações mínimas observadas nos resultados laboratoriais podem ser parcialmente norteadoras em pacientes com PCR e CT positivos.

The effect of abo and rh blood group antigens on admission to intensive care unit and mortality in patients with COVID-19 infection

SUMMARY AIM The aim of this study is to analyze the prognostic significance of ABO and Rh blood group antigens along with various parameters in patients followed-up with the diagnosis of COVID-19. METHODS We evaluated 397 patients who were follow-up and treated due to COVID-19 infections. The ages, genders, chronic diseases, ABO and Rh blood group antigens, admission rates to Intensive Care Units (ICU), and mortality rates of the patients were analyzed. FINDINGS The mean age of the 397 patients with COVID-19 was 47±17 years. In the blood group analysis of the patients, A Rh-positive (A +) was the most frequently seen blood type (176 patients, 44.3%) followed by O Rh-positive (0 +) (109 patients, 27,5%); 38 patients were Rh negative (Rh -) (9,6%). 53 of the patients (13,4%) were followed in ICU and 29 patients died (7,3%). Neither mortality nor admission to ICU was seen for Rh - group. The comparison of Rh groups concerning the need for ICU admission revealed a significantly high rate of ICU admission in the Rh + group (p=0,011), while no significant relationship was found between mortality and Rh antigen (p=0,069). CONCLUSION The most frequently seen blood type among COVID-19 patients was A +. The Rh + blood group was found in all cases who were admitted to ICU and had a death outcome. The Rh + blood group was found in a significantly high number of patients who were admitted to ICU, while no significant relationship was found between mortality and Rh blood group.

RESUMO OBJETIVO O objetivo deste estudo é analisar o significado prognóstico dos antígenos do grupo sanguíneo ABO e Rh, juntamente com vários parâmetros em pacientes acompanhados com o diagnóstico de COVID-19. MÉTODOS Foram avaliados 397 pacientes que foram acompanhados e tratados devido à infecção por COVID-19. Foram analisadas as idades, gêneros, doenças crônicas, antígenos do grupo sanguíneo ABO e Rh, taxas de internação em unidades de terapia intensiva (UTI) e taxas de mortalidade dos pacientes. A idade média de 397 pacientes com COVID foi de 47 ± 17 anos. Na análise do grupo sanguíneo dos pacientes, A Rh positivo (A +) foi o tipo sanguíneo mais frequentemente observado (176 dos pacientes, 44,3%), seguido pelo O Rh positivo (0 +) (109 dos pacientes, 27,5%) 38 dos pacientes eram Rh negativos (Rh -) (9,6%). 53 dos pacientes (13,4%) foram acompanhados em UTI e 29 faleceram (7,3%). Não houve mortalidade nem admissão na UTI para o grupo Rh. A comparação dos grupos Rh quanto à necessidade de admissão na UTI revelou uma taxa significativamente alta de admissão na UTI no grupo Rh + (p = 0,011), enquanto não foi encontrada relação significativa entre mortalidade e antígeno Rh (p = 0,069). CONCLUSÃO O tipo sanguíneo mais frequentemente observado foi o A + entre os pacientes com COVID-19. O grupo sanguíneo Rh + foi encontrado em todos os casos admitidos na UTI e com evolução mortal. O grupo sanguíneo Rh + foi encontrado em um número significativamente alto de pacientes internados na UTI, enquanto nenhuma relação significativa foi encontrada entre a mortalidade e o grupo sanguíneo Rh.