ABSTRACT
Introduction: Patients with COVID-19 admitted to the ICU are at high risk of developing infectious complications during their ICU stay. Data on acquired(AI) in Portuguese critical COVID-19 patients are scarce. The aim of this study was to investigate the characteristics and risk factors for AI in critical patients with COVID-19 pneumonia admitted to the ICU. Methods: Retrospective cohort of patients with COVID-19 pneumonia admitted to an ICU in a tertiary hospital, between September 2020 and June 2021. AI considered were ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT), bacteremia, CVC associated infections, urinary tract infections and soft skin tissue infections. Baseline characteristics, 3-months previous antibiotic (ATB) exposure, ATB treatment at ICU-admission and clinical management of COVID-19 pneumonia were analyzed. Results: Of the 159 patients included, with a median (IQR) age of 66 (57-72) and 63.5% males, 14 (8.8%) had no known comorbidities. A total of 63 patients(39.6%) developed AI: 45(71.4%) VAP, 20(33.3%) VAT, 28 (45.2%) UTI, 6 (9.5%) CVC associated infections and 3(4.8%) soft skin tissue infections. In univariate analysis, both SOFA score at admission (p < 0.001), acute cardiovascular (p = 0.003) and neurologic (p = 0.006) disfunction at ICU admission were associated with the development of AI. AI were also correlated to need of tracheostomy(p < 0.001), development of delirium (p < 0.001) or shock (p < 0.001);and with longer ICU and in-hospital stay (p < 0.001) and ICU and hospital mortality (p = 0.011 and p = 0.011, respectively). None of the COVID-19 pharmacologic treatments considered (remdesivir, steroids and tocilizumab), neither different regimens of ATB therapy at ICU admission were significantly associated with AI. Conclusions: In this cohort, almost 40% of the patients developed AI, that was associated with 4 times higher hazard of needing mechanical ventilation and higher rate of adverse events such as delirium, shock during in-ICU stay and longer length of ICU and in-hospital stay.
ABSTRACT
Summary: This study aimed to characterise how the follow-up of outpatients was done during the first months of COVID-19 pandemic by a multidisciplinary group of physicians involved in an asthma mHealth project. A cross-sectional study based on a web survey was conducted. The survey was sent to 123 physicians working at secondary care centres of Portugal and Spain, that participate in the INSPIRERS project. A total of 65 physicians completed the survey (53% response rate). They had a mean of 18 (11) years of clinical practice and 14% were residents. More than half were allergists (58%), 22% pulmonologists and 20% paediatricians. Most were working in Portugal (89%) and in public hospitals (88%). All were conducting consultations: 71% presential (median [p25 , p75] duration 30 [20, 30] min), 91% telephonic (15 [10, 20] min) and 20% video consultations (20 [10, 28] min). The median duration of presential consultations was significantly higher than pre-COVID-19 (20 [20, 30] min; p = 0.021). From the physicians conducting video consultations, 92% were allergists and only 54% considered that their institution provided adequate conditions. The physicians of the INSPIRERS group used telephonic consultations as the main alternative to presential ones and 1/5 used video consultations. These results suggest the need to rethink clinical follow-up services for outpatients in the near future increasing the use of telemedicine, especially video consultations.