Factors that impact on recruitment to vaccine trials during a pandemic or epidemic: a qualitative evidence synthesis

Objectives: This is a protocol for a Cochrane Review (qualitative). The objectives are as follows:. This is a protocol for a Cochrane Review (qualitative). The review aims to explore the factors associated with a person’s decision to take part in a pandemic or epidemic vaccine trial.

Reducing broad-spectrum antibiotic use in intensive care unit between first and second waves of COVID-19 did not adversely affect mortality.

BACKGROUND: The COVID-19 pandemic increased the use of broad-spectrum antibiotics due to diagnostic uncertainty, particularly in critical care. Multi-professional communication became more difficult, weakening stewardship activities. AIM: To determine changes in bacterial co-/secondary infections and antibiotics used in COVID-19 patients in critical care, and mortality rates, between the first and second waves. METHODS: Prospective audit comparing bacterial co-/secondary infections and their treatment during the first two waves of the pandemic in a single-centre teaching hospital intensive care unit. Data on demographics, daily antibiotic use, clinical outcomes, and culture results in patients diagnosed with COVID-19 infection were collected over 11 months. FINDINGS: From March 9th, 2020 to September 2nd, 2020 (Wave 1), there were 156 patients and between September 3rd, 2020 and February 1st, 2021 (Wave 2) there were 235 patients with COVID-19 infection admitted to intensive care. No significant difference was seen in mortality or positive blood culture rates between the two waves. The proportion of patients receiving antimicrobial therapy (93.0% vs 81.7%; P < 0.01) and the duration of meropenem use (median (interquartile range): 5 (2-7) vs 3 (2-5) days; P = 0.01) was lower in Wave 2. However, the number of patients with respiratory isolates of Pseudomonas aeruginosa (4/156 vs 21/235; P < 0.01) and bacteraemia from a respiratory source (3/156 vs 20/235; P < 0.01) increased in Wave 2, associated with an outbreak of infection. There was no significant difference between waves with respect to isolation of other pathogens. CONCLUSION: Reduced broad-spectrum antimicrobial use in the second wave of COVID-19 compared with the first wave was not associated with significant change in mortality.

Comparison of Antibiotic Use between the First Two Waves of COVID-19 in an Intensive Care Unit at a London Tertiary Centre: reducing broad-spectrum antimicrobial use did not adversely affect mortality

Background The COVID-19 pandemic increased the use of broad-spectrum antibiotics due to diagnostic uncertainty, particularly in critical care. Multiprofessional communication became more difficult, weakening stewardship activities. Aim To determine changes in bacterial co-/secondary infections and antibiotics used in COVID-19 patients in critical care, and mortality rates, between the first and second waves. Methods Prospective audit comparing bacterial co-/secondary infections and their treatment during the first two waves of the pandemic in a single centre teaching hospital ICU. Data on demographics, daily antibiotic use, clinical outcomes, and culture results in patients diagnosed with COVID-19 infection were collected over 11 months. Findings From 9/3/20 to 2/9/20 (Wave 1), there were 156 patients and between 3/9/20 and 1/2/21 (Wave 2) there were 235 patients with COVID-19 infection admitted to intensive care. No significant difference was seen in mortality or positive blood culture rates between the two waves. The proportion of patients receiving antimicrobial therapy (93.0% vs 81.7%;p<0.01), and the duration of meropenem use (median (interquartile range): 5 (2-7) vs 3 (2-5) days;p=0.01) was lower in Wave 2. However, the number of patients with respiratory isolates of Pseudomonas aeruginosa (4/156 vs 21/235;p<0.01) and bacteraemia from a respiratory source (3/156 vs 20/235 p<0.01) increased in Wave 2, associated with an outbreak of infection. There was no significant difference between waves with respect to isolation of other pathogens. Conclusions Reduced broad spectrum antimicrobial use in the second wave of COVID-19 compared with the first wave was not associated with significant change in mortality.