ABSTRACT
Bacterial infection can occur in patients hospitalized with SARS-CoV-2 in various conditions, resulting in poorer outcomes, such as a higher death rate. This current systematic review was conducted in order to assess the efficiency of multiplex PCR in detecting bacterial infections in hospitalized COVID-19 patients, as well as to analyze the most common bacterial pathogens and other factors that interfere with this diagnosis. The research was conducted using four electronic databases (PubMed, Taylor&Francis, Web of Science, and Wiley Online Library). Out of 290 studies, nine were included in the systematic review. The results supported the use of multiplex PCR in detecting bacteria, considering its high sensitivity and specificity rates. The most common bacterial pathogens found were Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Haemophilus influenzae. The median age at admission was 61.5 years, and the majority of patients were men (70.3%), out of a total of 1553 patients. The proportion of ICU admission was very high, with a pooled proportion of 52.6% over the analyzed studies, and an average duration of hospitalization of 13 days. The mortality rate was proportionally high, as was the rate of ICU admission, with a pooled mortality of 24.9%. It was discovered that 65.2% of all patients used antibiotics before admission, with or without medical prescription. Antibiotic treatment should be considered consciously, considering the high risks of developing antibiotic resistance.
ABSTRACT
The multiplex PCR is a powerful and efficient tool that was widely used during the COVID-19 pandemic to diagnose SARS-CoV-2 infections and that has applications for bacterial identification, as well as determining bacterial resistance to antibiotics. Therefore, this study aimed to determine the usability of multiplex PCR, especially in patients self-medicated with antibiotics, where bacterial cultures often give false-negative results. A cross-sectional study was developed in two COVID-19 units, where 489 eligible patients were included as antibiotic takers and non-antibiotic takers. Antibiotic takers used mostly over-the-counter medication; they suffered significantly more chronic respiratory conditions and were self-medicated most often with cephalosporins (41.4%), macrolide (23.2%), and penicillin (19.7%). The disease severity in these patients was significantly higher than in non-antibiotic takers, and bacterial superinfections were the most common finding in the same group (63.6%). Antibiotic takers had longer hospital and ICU admissions, although the mortality rate was not significantly higher than in non-antibiotic takers. The most common bacteria involved in secondary infections were Staphylococcus aureus (22.2%), Pseudomonas aeruginosa (27.8%), and Klebsiellaspp (25.0%). Patients self-medicating with antibiotics had significantly higher rates of multidrug resistance. The multiplex PCR test was more accurate in identifying multidrug resistance and resulted in a quicker initiation of therapeutic antibiotics compared with instances where a bacterial culture was initially performed, with an average of 26.8 h vs. 40.4 h, respectively. The hospital stay was also significantly shorter by an average of 2.5 days when PCR was used as an initial assessment tool for secondary bacterial infections. When adjusted for age, COVID-19 severity, and pulmonary disease, over-the-counter use of antibiotics represented a significant independent risk factor for a prolonged hospitalization (AOR = 1.21). Similar findings were observed for smoking status (AOR = 1.44), bacterial superinfection (AOR = 1.52), performing only a conventional bacterial culture (AOR = 1.17), and a duration of more than 48 h for bacterial sampling from the time of hospital admission (AOR = 1.36). Multiplex PCR may be a very effective method for diagnosing secondary bacterial infections in COVID-19 individuals self-medicating with antibiotics. Utilizing this strategy as an initial screen in COVID-19 patients who exhibit signs of sepsis and clinical deterioration will result in a faster recovery time and a shorter period of hospitalization.
ABSTRACT
The multiplex PCR is a powerful and efficient tool that was widely used during the COVID-19 pandemic to diagnose SARS-CoV-2 infections and that has applications for bacterial identification, as well as determining bacterial resistance to antibiotics. Therefore, this study aimed to determine the usability of multiplex PCR, especially in patients self-medicated with antibiotics, where bacterial cultures often give false-negative results. A cross-sectional study was developed in two COVID-19 units, where 489 eligible patients were included as antibiotic takers and non-antibiotic takers. Antibiotic takers used mostly over-the-counter medication;they suffered significantly more chronic respiratory conditions and were self-medicated most often with cephalosporins (41.4%), macrolide (23.2%), and penicillin (19.7%). The disease severity in these patients was significantly higher than in non-antibiotic takers, and bacterial superinfections were the most common finding in the same group (63.6%). Antibiotic takers had longer hospital and ICU admissions, although the mortality rate was not significantly higher than in non-antibiotic takers. The most common bacteria involved in secondary infections were Staphylococcus aureus (22.2%), Pseudomonas aeruginosa (27.8%), and Klebsiellaspp (25.0%). Patients self-medicating with antibiotics had significantly higher rates of multidrug resistance. The multiplex PCR test was more accurate in identifying multidrug resistance and resulted in a quicker initiation of therapeutic antibiotics compared with instances where a bacterial culture was initially performed, with an average of 26.8 h vs. 40.4 h, respectively. The hospital stay was also significantly shorter by an average of 2.5 days when PCR was used as an initial assessment tool for secondary bacterial infections. When adjusted for age, COVID-19 severity, and pulmonary disease, over-the-counter use of antibiotics represented a significant independent risk factor for a prolonged hospitalization (AOR = 1.21). Similar findings were observed for smoking status (AOR = 1.44), bacterial superinfection (AOR = 1.52), performing only a conventional bacterial culture (AOR = 1.17), and a duration of more than 48 h for bacterial sampling from the time of hospital admission (AOR = 1.36). Multiplex PCR may be a very effective method for diagnosing secondary bacterial infections in COVID-19 individuals self-medicating with antibiotics. Utilizing this strategy as an initial screen in COVID-19 patients who exhibit signs of sepsis and clinical deterioration will result in a faster recovery time and a shorter period of hospitalization.
ABSTRACT
Although laboratory data show that antibody responses to COVID-19 immunization give superior neutralization of certain circulating variations to spontaneous infection, few real-world epidemiological studies demonstrate the advantage of vaccination for previously infected individuals. This paper summarizes the outcomes of a case-control study conducted in Romania between March 2020 and October 2021 on patients previously infected with SARS-CoV-2. A case-control study was implemented after identification of 62 breakthrough cases. These cases were matched by age and gender to a 1:1 ratio with a control group of unvaccinated patients with SARS-CoV-2 reinfection status. There were no significant differences in the severity of cases and mortality between the study groups. However, unvaccinated patients had a shorter protection from natural immunity than patients with full vaccination status (58 days versus 89 days). The unvaccinated cases with SARS-CoV-2 reinfection were also statistically more likely to have a longer hospital admission duration (12.4 days versus 9.8 days), and required more non-invasive oxygen supplementation during their stay than breakthrough cases (37.1% versus 19.4%). Individuals with prior SARS-CoV-2 infection who were not vaccinated are not at a higher risk of severe COVID-19 infection or mortality compared to those who were completely vaccinated with the mRNA vaccine Comirnaty® Pfizer/BioNTech BNT162b2 and acquired a breakthrough infection within 2-3 months of the previous infection with a Beta or Delta SARS-CoV-2 variant. Although our findings are consistent with natural immunity offering similar short-term protection to a second dose of mRNA vaccine, all eligible individuals should be provided with immunization to lower their risk of infection, even if they have already been infected with SARS-CoV-2.
ABSTRACT
Background and Objectives: As maternal deaths associated with the SARS-CoV-2 infection remain at several times greater than the general population, significant factors that might contribute to the higher mortality and morbidity rate are the psychological impact of the disease and pregnancy itself. Therefore, the current study's main objective was to assess how pregnant women react and cope with the stress of COVID-19 disease and how it influences their overall health and quality of life in healthcare facilities. Materials and Methods: In this cross-sectional study, we included 304 pregnant women who successfully completed standardized forms to assess our topics of interest, comprising of the Hospital Anxiety and Depression Scale, the Short Form Health Survey-12, the Coping Orientation to Problems Experienced Inventory scale, the CORE-Outcome Measure Questionnaire, and the Quality from the Patient's Perspective questionnaire. Results: Unemployed, pregnant women living in poverty in the rural areas had higher SARS-CoV-2 infection rates during pregnancy. They faced higher anxiety levels and depression rates, with associated increased physical burden and exhaustion. However, these findings are not influenced by hospital care since it remained unchanged among COVID-19 and non-COVID-19 maternity units, excepting significantly lower technical competence scores of COVID-19 facilities. Conclusions: As the pandemic's consequences emerge and additional outbreaks occur, care must prioritize the additional physical burden experienced by pregnant women who have contracted COVID-19, as well as psychological, emotional, and mental health support.