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Background: Over 600 million of COVID-19 cases have been reported. A remarkable fragment of these cases are reinfections, which are mostly explained by the genomic variability of the SARS-CoV-2 variants. However, little is known about other factors fostering these reinfections. Method(s): We recorded clinical and demographic data from subjects (N=3303, March 2020 - March 2022) with at least 2 PCR+ events separated by >=90 days, analyzed by the Microbiology Department, Northern Metropolitan Clinical Laboratory from Germans Trias i Pujol Hospital (Spain). Data collected included: age, sex, comorbidities, adjusted morbidity group (GMA), hospitalization, symptomatology, NAAT (PCR, TMA) tests, antigen tests, serology, and vaccination. Temporal data was encoded using Python, and demographic characterization was performed under R. Result(s): We identified 2344 cases of confirmed reinfections, where the 2 PCR+ events were separated by >=90 days and a negative test was obtained between episodes. 72.2% of reinfected subjects were females with a median age of 45 IQR [28-63] years. Age density analysis showed three peaks at 24, 45, and 85 years, probably mostly composed of young people, who usually are less cautious, healthcare workers, and people living in nursing homes, respectively, being all of them groups prone to be tested. Regarding health status, 86.2% of participants had at least one chronic condition, with 40.5% of patients having chronic conditions in >=4 systems based on GMA assessment. Interestingly, 75.2% of reinfected subjects < 26 years had at least one chronic condition. 121 (4.2%) participants were hospitalized during a COVID-19 episode, highlighting 8.3% (N=10) of them hospitalized during the reinfection (half of them vaccinated before hospitalization), and 5% (N=6) of them during both infections. The severity of the second infection may be caused by a diminished acquired immunity after the first infection. Time between reinfections density analysis provided three peaks at ~200, ~400, and ~600 days, corresponding with time between waves. A decrease of reinfections was observed between 40 and 100 days after vaccination, which would be the period of highest protection against reinfection. Conclusion(s): SARS-CoV-2 reinfections are more prevalent among women. Importantly, people with an undermined health status, independently of age, are more sensitive to reinfections, but in most of the cases no hospitalization was required. Finally, vaccination seems to have a short protective effect on reinfection.
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Introduction: Liposomal amphotericin B (L-AmB) represent a good treatment strategy for critically ill patients according to its unique pharmacological characteristics and a relatively broad spectrum of action. The aim of the present study is to asses the impact on renal function of L-AmB during the first days of ICU admission in critically ill patients. Method(s): Retrospective, single-center case series of patients with SARS-CoV-2 pneumonia admitted in ICU. Setting(s): 19-bed medical-surgical ICU of a community hospital. Time of study: 2 years. Study variables: APACHE II and SOFA at admission, clinical characteristics, oliguria and creatinine level at admission and 72 h after L-AmB treatment were recorded. Oliguria was defined as urinary output less than 400 ml per day or less than 20 ml per hour. Two groups of patients were selected according to whether or not they received anticipated antifungal treatment pending microbiologic confirmation or discarding of aspergillosis;dosage of L-AmB was 3 mg/kg/d. Statistical analysis: Data were analyzed by SPSS 18 and quantitative variables were expressed as a mean +/- standard deviation. Result(s): 160 patients were included, 102 who received 3 days of anticipated treatment with L-AmB at ICU admission or at the beginning of mechanical ventilation were compared with patients without this treatment. There were not differences in age, median 65 [57-71] years, gender with 28% female and BMI (kg/m2), 30,4 [26,6-33,2]. APACHE II at admission was higher in the treated group of patients 17 [12-23] vs 12 [9-14]. SOFA was 7 [4-8] in the treated group of patients vs 6 [3-8]. There were not differences in urinary output between groups during the three first days of ICU stay. Table 1 shows creatinine levels. Conclusion(s): According to our retrospective analysis, L-AmB is safe in the first days of treatment in critically ill patients admitted in ICU requiring mechanical ventilation.
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Background and Importance Antimicrobial prescribing prevalence in COVID-19 patients is estimated to be around 75%, whereas bacterial coinfection prevalence is estimated to be less than 10%. This data shows the unnecessary use of antibiotics. Aim and Objectives To compare the evolution of antimicrobial consumption in COVID-19 patients between the beginning of the pandemic and the third COVID-19 wave in our hospital. Material and Methods Observational retrospective study conducted in a tertiary care hospital during March to June 2020 and May to August 2021 in COVID-19 Intensive Care Unit (CICU) and COVID-19 medical ward (CMW) patients. We extracted antimicrobial consumption data from the Pharmacy database (Silicon) and bed-days data from Admission Service. We standardised antimicrobial consumption to defined daily doses (DDD)/100 bed-days. The descriptive analysis was performed with SPSS. We conducted a normality, an independence and a correlation test. Results An 8% decrease in global antimicrobial use was observed. However, we found a 30% decrease in CMW, and a 39% increase in CICU. The antibiotic use in the two periods showed a significance correlation (p<0,001). Conclusion and Relevance * There is a light decrease of antimicrobial prescriptions in all COVID-19 patients. * There is an important decrease in antimicrobial use in CMW and a considerable increase in CICU. * These results suggest the need for more antimicrobial stewardship programmes in CICU. (Table Presented).
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4CPS-018 Table 1MARCH-JUNE 2020 MAY-AUGUST 2021 EVOLUTION 2020-2021 CICU CMW GLOBAL CICU CMW GLOBAL CICU CMW GLOBAL BED-DAYS 573 2346 2919 493 2114 2607 Co-amoxiclav DDD/100BED-DAYS 0,9 22 17,9 1,2 21,1 17,3 +0,3 (33,3%) -0,9 (-4%) -0,6 (-3,4%) 3rd generation cephalosporins DDD/100BED-DAYS 32,3 8,9 13,5 35,7 3,5 9,6 +3,4 (10,5%) -5,4 (-60%) -3,9 (-28,9%) Antipseudomonal antibiotics DDD/100BED-DAYS 16,1 9,1 10,5 27,8 5,9 10 +11,7 (72,7%) -3.2 (-35.1%) -0,5 (-4,%) Quinolones DDD/100BED-DAYS 2,3 3,6 3,4 10,8 1,4 3,2 +8,5 (370%) -2,2 (-61,1%) -0,2 (-5,9%) Anti-MRSA antibiotics DDD/100BED-DAYS 23,4 3,4 7,3 18,6 2 5,1 -4,8 (-20,5%) -1,4 (-41,2%) -2,2 (-30,1%) Antifungal treatments DDD/100BED-DAYS 4,4 1 1,6 22,9 0 4,4 +18,5 (420%) -4,4 (-100%) +2,8 (175%) Total antimicrobial consumption DDD/100BED-DAYS 135,1 62,6 76,8 187,3 43,7 70,8 +52,2 (38,6%) -18,9 (-30,2%) -6 (-7,8%) The antibiotic use in the two periods showed a significance correlation (p<0,001).Conclusion and RelevanceThere is a light decrease of antimicrobial prescriptions in all COVID-19 patients.There is an important decrease in antimicrobial use in CMW and a considerable increase in CICU.These results suggest the need for more antimicrobial stewardship programmes in CICUReferences and/or AcknowledgementsConflict of InterestNo conflict of interest
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Background This study aimed to compare the risk of COVID-19 in patients with IBD versus the general population, and to evaluate predictors of infection acquisition, progression to severe forms, and risk of developing persistent COVID-19. We also assess the differences between cases across the different COVID-19 pandemic waves in our target population. Methods This single-center prospective, cohort study included consecutive IBD patients diagnosed of COVID-19 either by a positive polymerase chain reaction test and/or antigen test in nasopharyngeal swabs, or by anti-SARS-CoV-2 antibodies, and that they had a followup of at least 4 months. Using logistic regression, we evaluated cases versus IBD controls included in the IBD Unit database for predictors of COVID-19 acquisition. COVID-19 cases were distributed according to pandemic waves. Cox regression analysis was used for predictors of severe and persistent COVID-19. Results By May 31, 2021, 160 out of 1911 IBD patients (8.3%) were diagnosed with COVID-19. IBD patients had a similar adjusted incidence of COVID-19 (OR 0.94;95% CI 0.86-1.02;P=0.42), and a similar associated mortality ratio (OR 0.83;95% CI 0.6-1.06;P=0.48), compared to the general population. In multivariable analysis, treatment with biologics was associated with a higher risk (OR 2.22, 95% CI 1.54-3.2, P<0.001), and treatment with salicylates with a lower risk (OR 0.71, 95% CI 0.50-0.99, P=0.048) of contracting COVID-19. Sixty-two COVID-19 cases were diagnosed during the first wave of pandemic (until the end of June 2020), and 54 and 44 cases during the second and third waves (until the end of December 2020 and May 2021, respectively). (Figure 1) In multivariate analysis, first wave cases were associated with a higher risk of progression to severe forms of infection (OR 4.76, 95% CI 1.83-12.37, P= 0.001), and development of persistent COVID-19 (OR 2.4, 95% CI 1.16-4.95, P=0.018). Twenty-nine patients (18.1%) required hospitalization and were classified as severe COVID- 19, which was associated in multivariable analysis with age>48 (HR 3.68, P=0.007), cases diagnosed in the first wave (HR 6.04, P<0.001), and comorbidities (evaluated with Duke Severity of Illness Checklist [DUSOI], P<0.001). (Table 1) During a median follow-up of 8.4 months, 68 patients (42.5%) were diagnosed with persistent COVID-19. Multivariable analysis identified UC (OR 2.00, 95% CI 0.99-4.03, P=0.053), comorbidities (P=0.090), and being diagnosed during the first wave (OR 2.48, 95% CI 1.23-5.00, P=0.011) as risk factors for persistent COVID-19. Conclusion IBD patients have a similar risk of COVID- 19 and associated mortality as the general population. Cases diagnosed during the first wave of the pandemic had severe and persistent forms of COVID-19 more frequently. Age and comorbidity were the main risk factors for severe forms of the disease. (Figure Presented) (Table Presented)
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The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via respiratory fluids and droplets suggests that mouthwashes containing substances with virucidal activity can help reduce viral spread. We conducted a multicenter, double-blind, placebo-controlled, randomized trial to assess the virucidal activity of cetylpyridinium chloride (CPC) mouthwashes. Outpatients who tested positive for SARS-CoV-2 infection with or without symptoms were randomized to perform washes and gargles for 1 min with 15 mL of either colored distilled water or 0.07% CPC (Vitis CPC Protect) mouthwash. The study outcomes were the SARS-CoV-2 log10 viral RNA load and the nucleocapsid protein levels, both in saliva at 1 and 3 h after the intervention. In total, 118 patients were enrolled and randomized (mean [SD], age 46 [14] y). Thirteen of 118 participants (11%) did not complete follow-up or had insufficient sample volume for testing and were excluded from the analysis. The assessment of the viral load showed no significant differences between groups at any of the investigated points. However, the levels of SARS-CoV-2 nucleocapsid protein of lysed viruses were significantly higher in the CPC group compared with the control group at 1 h (adjusted difference 269.3 pg/mL; 95% confidence interval [CI], 97.1-441.5) and at 3 h postintervention (561.1 pg/mL; 95% CI, 380.0-742.2). In nonhospitalized patients with asymptomatic or mild symptomatic SARS-CoV-2 infection, a 0.07% CPC mouthwash, compared to placebo, was associated with a significant increase of nucleocapsid protein levels in saliva, indicating enhanced disruption of viral particles.
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COVID-19 , Cetylpyridinium , Mouthwashes , SARS-CoV-2 , Virus Shedding , Humans , Middle Aged , Cetylpyridinium/therapeutic use , Chlorides , Double-Blind Method , Mouthwashes/therapeutic use , Nucleocapsid Proteins , RNA, Viral , Virus Shedding/drug effectsABSTRACT
Background. Ralstonia pickettii are aerobic non fermenter gram negative bacilli isolated in water and soil. It is related to nosocomial infection outbreaks and considered an opportunistic pathogen. There have been outbreaks reports due to contaminated water systems and sterile drug solutions which mainly occurs during manufacturing. We present the report of an outbreak of R. pickettii bacteremia secondary to a contamination of hydromorphone vials. Methods. In February 2021 an outbreak of R. pickettii bacteremia was identified. All isolates were from blood cultures with slow growth, thus indicating the culturing of liquid inputs, intravenous administration solutions and commonly used drugs among patients including hydromorphone. Mass spectrometry (MALDI-TOF) was used for the identification and automated microdilution to determine sensitivity to antimicrobials of the isolates and clonality analysis of genetic relationships was carried out using the DICE coefficient, UPGMA algorithm Results. During the outbreak, 19 patients with R. pickettii bacteremia were identified The global attack rate was 1,9%. 11/19 (58%) were women and 13/19 (68%) of the isolations were from inward patients and 6/19 (32%) were from intensive care unit. Factors that could contribute to the appearance of the outbreak were underlying pathology, 2 patients with a diagnosis of diabetes mellitus, 10 patients with a diagnosis of arterial hypertension, 5 patients with obesity, 6 patients with heart disease, additionally 7 patients with a diagnosis of SARS COV 2 and 6 patients with the use of corticosteroids. The global attack rate was 1,9% and mortality was 31.5% (6 patients). R. pickettii was identified from two batches of hydromorphone by MALDI-TOF and the clonality study concluded that the isolates analyzed, were clonal with a 100% similarity. The associated mortality rate was 5/29 (26.3%). Conclusion. We confirmed an outbreak of R. pickettii due to the contamination of two hydromorphone badges in Colombia. It is crucial to acknowledge the importance of infection control and surveillance during the COVID-19 pandemic as well as maintaining adequate quality control of medication production in order to avoid presenting this kind of outbreaks.
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Background: This study aimed to compare the risk of COVID-19 in patients with IBD versus the general population, and to evaluate predictors of infection acquisition, progression to severe forms, and risk of developing persistent COVID-19. We also assess the differences between cases across the different COVID-19 pandemic waves in our target population. Methods: This single-centre prospective, cohort study included consecutive IBD patients diagnosed of COVID-19 either by a positive polymerase chain reaction test and/or antigen test in nasopharyngeal swabs, or by anti-SARS-CoV-2 antibodies, and that they had a follow-up of at least 4 months. Using logistic regression, we evaluated cases versus IBD controls included in the IBD Unit database for predictors of COVID-19 acquisition. COVID-19 cases were distributed according to pandemic waves. Cox regression analysis was used for predictors of severe and persistent COVID-19. Results: By May 31, 2021, 160 out of 1911 IBD patients (8.3%) were diagnosed with COVID-19. IBD patients had a similar adjusted incidence of COVID-19 (OR 0.94;95% CI 0.86-1.02;P=0.42), and a similar associated mortality ratio (OR 0.83;95% CI 0.6-1.06;P=0.48), compared to the general population. In multivariable analysis, treatment with biologics was associated with a higher risk (OR 2.22, P<0.001), and treatment with salicylates with a lower risk (OR 0.71, P=0.048) of contracting COVID-19.(Table 1) 62 COVID-19 cases were diagnosed during the first wave of pandemic (until the end of June 2020), and 54 and 44 cases during the second and third waves (until the end of December 2020 and May 2021, respectively).(Figure 1) In multivariate analysis, first wave cases were associated with a higher risk of progression to severe forms of infection (OR 4.76, 95% CI 1.83-12.37, P=0.001), and development of persistent COVID-19 (OR 2.4, 95% CI 1.16-4.95, P=0.018). 29 patients (18.1%) required hospitalisation and were classified as severe COVID-19, which was associated in multivariable analysis with age>48 (HR 3.68, P=0.007), cases diagnosed in the first wave (HR 6.04, P<0.001), and comorbidities (evaluated with Duke Severity of Illness Checklist [DUSOI], P<0.001).(Table 2) During a median follow-up of 8.4 months, 68 patients (42.5%) were diagnosed with persistent COVID-19. Multivariable analysis identified UC (P=0.053), comorbidities (P=0.090), and being diagnosed during the first wave (P=0.011) as risk factors for persistent COVID-19.(Table 3) Conclusion: IBD patients have a similar risk of COVID-19 and associated mortality as the general population. Cases diagnosed during the first wave of the pandemic had severe and persistent forms of COVID-19 more frequently. Age and comorbidity were the main risk factors for severe forms of the disease.
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The coronavirus pandemic has posed a range of unprecedented challenges for community journalism outlets, as the sector was hit with existential threat due to the economic impact of the pandemic and the logical challenges of reporting in a health emergency. Based on interviews with 57 community journalists in the UK and an online survey (n = 116), this chapter focuses on how community journalists adapted their professional practices and their roles in the community during the coronavirus lockdown. The closure of non-essential businesses led to a drop in local advertising revenues, while lockdown made the distribution of print newspapers more difficult or impossible. Although many outlets saw an increase in online audience figures, those that publish print editions were faced with logistical challenges that often halted publication or required dramatic shifts in practices. At the same time, many outlets changed the focus of their coverage, sharing positive stories about community initiatives and offering community-based solutions to citizens in need. The pandemic represented a profound rupture across all elements of journalistic practice, from reporting, to printing and distribution. However, community journalism outlets, because of their small size and agility, were able to adapt to the challenges and, in many cases, emerged stronger as a result. © 2022 selection and editorial matter, David Harte and Rachel Matthews individual chapters, the contributors.
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OBJECTIVES: The aim of this study was to trace contacts of coronavirus disease 2019 (COVID-19) hospitalised patients and determine the risk factors of infection in urban areas. STUDY DESIGN: Longitudinal analysis of contacts identified from index cases. METHODS: A contact tracing study was carried out in the Northern Metropolitan area of Barcelona, Spain, during the inter-epidemic lapse of May to July 2020, a period of low SARS-CoV-2 incidence. Index cases were notified from the referral hospital. Contacts were traced and followed up for 14 days. Reverse transcription polymerase chain reaction was performed on day 0 and day 14 for contacts. RESULTS: In total, 368 contacts were identified from 81 index cases (median of seven contacts per index case), from which 308 were traced successfully. The median age of contacts was 28 years, 62% (223 of 368) were men. During the follow-up period, 100 contacts tested positive for COVID-19 (32.5% [95% confidence interval {CI} = 27.3-38.0]), with a secondary infection rate of 48.3% (95% CI = 40.8-55.9) among housemates. Clusters of index and respective contacts tended to aggregate within disadvantaged neighbourhoods (P < 0.001), and non-national index cases (N = 28, 34.1%) resulted in higher secondary infection rates compared with nationals (51.0% [95% CI = 41.0-60.9] vs 22.3% [95% CI = 16.8-28.8]; P < 0.001). CONCLUSIONS: Disadvantaged communities experience a disproportionate burden of COVID-19 and may act as infection reservoirs. Contact tracing with a cross-cutting approach among these communities is required, especially during inter-epidemic periods.
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COVID-19/prevention & control , Contact Tracing , Epidemics/prevention & control , Social Determinants of Health , Vulnerable Populations , Adult , COVID-19/epidemiology , Humans , Incidence , Male , Middle Aged , Risk Factors , SARS-CoV-2 , Spain/epidemiologyABSTRACT
Background: Many immune studies of SARS-CoV-2 (CoV-2) infection have focused on the generation of virus-specific as a means of protection. However, a small group of CoV-2 infected individuals called Non-seroconverters (NSC), do not generate antibodies but experience a mild or moderate disease course. Identifying mechanism of CoV-2 control in NSC may inform the development of novel therapeutics and vaccines approaches. Methods: We identified eleven CoV-2 NSC (3.6%) from the King-cohort study (PI-20-217). NSC were defined by a positive CoV-2 PCR at the time of diagnosis in the absence of IgG, IgA and IgM in serum and plasma measured by two independent ELISA techniques. For comparison, we identify groups of CoV-2 convalescent (n=15) and low-neutralizers (n=15). We measured T-cell responses to the CoV-2 Spike (S) and Nucleocapsid (NP) recombinant proteins in PBMCs by ELISPOT and flow cytometry. We combined T-cell surface and lineage markers together with PD-1, functional (TNF, IFN-y, and IL-2) and activation induced markers (AIM: CD25, CD137 and OX40). Results: We identified CoV-2 specific CD4+ and CD8+ T-cells against the S and the NP in NSC individuals. All NSC responded to S by production of one or more cytokine in either CD4+ or CD8+ T-cells, and 57% responded to NP. Specific-CD8+ T cells against S in NSC were characterized by IFN-y, and TNF production, and we observed higher levels of TNF production as compared to low neutralizers (p=0.02). No differences were found in IFN-y, IL-2 and TNF production in S-specific CD4+ T cells between groups, nor in NP CD8+ or CD4+ T-cell responses. The levels of CD137/OX40 in CD8+ and CD4+ T cells were significantly lower in NSC in response to S (p=0.006, and p=0.012). Also, lower levels of PD-1 were observed in CD8+ T cells in response to NP in NSC (p=0.017). Conclusion: We provide evidence of SARS-CoV2 cellular immunity in NSC individuals despite the absence of humoral neutralizing responses. CD8+ and CD4+ T cells against the S and NP were present in NSC and characterized by TNF production in CD8+ T-cells in responses to S when compared to low neutralizers. Decreased levels of activation markers were observed in NSCs following S and NP stimulation. We propose a protective role of cellular immunity in NSC potentially driven by preexisting cellular responses.