Trends in Clostridioides difficile infection across a public health hospital system in New York City 2019-2021: A cautionary note.

Contrary to national reports, rates of healthcare facility-onset Clostridioides difficile infection across an 11-hospital system rose after the spring of 2020, when New York City was the epicenter for the COVID-19 pandemic. Antibiotic pressure from an escalation in cephalosporin usage correlated with this increase. The majority of cases of Clostridioides difficile were in patients without COVID-19, suggesting the pandemic has adversely impacted the healthcare of other inpatients.

Is remdesivir safe in patients with renal impairment? Experience at a large tertiary urban medical center.

PURPOSE: Remdesivir is FDA-approved for treatment of patients hospitalized with COVID-19 pneumonia, but not recommended in patients with severe renal failure. This study aims to evaluate the safety of remdesivir in this patient population. METHODS: This was a single-center, retrospective cohort study including patients ≥ 18 years old, admitted between May 1, 2020 and April 30, 2021 who received remdesivir. Patients were divided into two groups: estimated creatinine clearance (eCrCl) < 30 mL/min and eCrCl ≥ 30 ml/min. Primary outcomes were development of acute kidney injury (AKI) after remdesivir initiation and hepatotoxicity (alanine aminotransferase [ALT] or aspartate aminotransferase [AST] > 5 × upper limit of normal) both at end of treatment (EOT) or 5 days after EOT. Secondary outcomes were length of stay (days) and mortality. RESULTS: 513 patients were assessed with 416 patients included in the study (eCrCl < 30 mL/min, n = 55; eCrCl ≥ 30 mL/min n = 361). Incidence of AKI (eCrCl < 30 mL/min 11% vs eCrCl ≥ 30 mL/min 7%, OR 1.57, 95% CI 0.57, 4.3) and hepatotoxicity (ALT: 2% vs 4%, OR 0.47, 95% CI 0.05, 3.7 and AST: 2% vs 2%, OR 1.26, 95% CI 0.14, 11.04) were similar between the two groups. Length of stay was longer in the eCrCl < 30 mL/min group (mean 18.6 vs 11.9, difference 6.7, 95% CI 3.8, 9.6), and no difference in mortality was observed (21.8% vs 18.8%, OR 1.2, 95% CI 0.6, 2.4). CONCLUSION: Remdesivir was not associated with development of AKI or hepatotoxicity in patients with eCrCl < 30 mL/min compared to patients with eCrCl ≥ 30 mL/min, and warrants further investigation.

The initial and lingering impact of coronavirus disease 2019 (COVID-19) on catheter-associated infections in a large healthcare system in New York City

Catheter-related infections increased during surges of coronavirus disease 2019 (COVID-19) in an 11-hospital system in New York City. A disproportionate number of central-line infections occurred in larger hospitals. Patients with COVID-19 had shorter times from catheter insertion to infection and a higher incidence of infections with enterococci.

Methicillin-resistant Staphylococcus aureus bacteremia during the coronavirus disease 2019 (COVID-19) pandemic: Trends and distinguishing characteristics among patients in a healthcare system in New York City.

During the pandemic, the rate of healthcare facility-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was 5 times greater in patients admitted with coronavirus disease 2019 (COVID-19). The presence of central lines and mechanical ventilation likely contribute to this increased rate. The number of central-line-associated bacteremia cases may be underestimated in patients with COVID-19.

The initial and lingering impact of coronavirus disease 2019 (COVID-19) on catheter-associated infections in a large healthcare system in New York City.

Catheter-related infections increased during surges of coronavirus disease 2019 (COVID-19) in an 11-hospital system in New York City. A disproportionate number of central-line infections occurred in larger hospitals. Patients with COVID-19 had shorter times from catheter insertion to infection and a higher incidence of infections with enterococci.

HIV Diagnosis and the Clinical Course of COVID-19 Among Patients Seeking Care Within the New York City Public Hospital System During the Initial Pandemic Peak.

Reports conflict on how HIV infection influences the clinical course of COVID-19. The New York City (NYC) public hospital system provides care for over 14,000 people with HIV, was central in responding to the COVID-19 pandemic, and is therefore in a unique position to evaluate the intersection of these concurrent infections. Retrospective chart review of patients presenting to NYC Health and Hospitals (NYC H+H) diagnosed with COVID-19 infection from March 1, 2020, through April 28, 2020, compared people living with HIV (PLWH) and a propensity-matched (PM) control group of patients without HIV to evaluate associations between HIV status and COVID-19 outcomes. Two hundred thirty-four PLWH presented for COVID-19 testing and 110 (47%) were diagnosed with COVID-19. Among 17,413 patients with COVID-19 and without HIV, 1:n nearest neighbor propensity score matching identified 194 patients matched on age, sex, race, and any comorbidity. In the sample with COVID-19 (N = 304), PLWH (9.1%) had lower rates of mortality than controls [19.1%; PM odds ratio (PM-OR): 0.41, 95% confidence interval (CI): 0.19-0.86]. Among hospitalized COVID-19 patients (N = 179), HIV infection was associated with lower rates of mechanical ventilation (PM-OR: 0.31, 95% CI: 0.11-0.84) and mortality (PM-OR: 0.40, 95% CI: 0. 17-0.95). In the extended pandemic period through April 2021, aggregate data by HIV status suggested elevated hospitalization and mortality rates in PLWH versus people without HIV. These results suggest that the direct biological impacts of the HIV virus do not negatively influence COVID-19-related outcomes when controlling for comorbidity and demographic variables.

Tocilizumab therapy for COVID-19: A comparison of subcutaneous and intravenous therapies.

BACKGROUND: The release of pro-inflammatory cytokines, resulting in cytokine storm syndrome, contributes to the morbidity and mortality associated with COVID-19 disease. This study aimed to compare the effects of intravenous (IV) and subcutaneous (SC) tocilizumab, an IL-6 receptor antagonist, on respiratory parameters and clinical outcome in patients with COVID 19. METHODS: We performed a retrospective cohort study of hospitalized patients with COVID-19 treated with either IV or SC tocilizumab from March 26, 2020, to May 18, 2020. Respiratory parameters seven days after receiving tocilizumab therapy were compared to baseline measurements. All patients were assessed until discharged from the hospital. RESULTS: Tocilizumab was administered to 125 patients: 65 received IV, and 60 received SC therapy. At day seven, 52% of the IV group patients demonstrated improvement in respiratory parameters, compared to 28% in the SC group (P = 0.01). Mortality rates at days seven and 28 were 15% and 37%, respectively, in the IV group and 17% and 50%, respectively, in the SC group (PNS). The in-hospital mortality rate was 38% for the IV group versus 57% for the SC group (P = 0.04). More than 90% of patients in each group received corticosteroids; however, significantly more patients received convalescent plasma in the IV group. CONCLUSIONS: At the doses used in this study, IV tocilizumab is preferred over SC therapy to treat cytokine storm syndrome due to COVID-19.