Decrease of hospital- and community-acquired bloodstream infections due to Streptococcus pneumoniae and Streptococcus pyogenes during the first year of the COVID-19 pandemic: A time-series analysis in Paris region.

The impact of the COVID-19 pandemic on bloodstream infections (BSIs) due to Streptococcus pneumoniae and Streptococcus pyogenes was assessed in 25 university hospitals of Paris. Monthly BSIs incidence rates that appeared stable in 2018 and 2019, decreased for the 2 pathogens during the 2 COVID-19 lockdown periods of 2020. Containment policies, including social distancing, masking and hand hygiene strengthening in both community and hospital settings are likely to reduce BSIs due to these pathogens.

Surging bloodstream infections and antimicrobial resistance during the first wave of COVID-19: a study in a large multihospital institution in the Paris region.

OBJECTIVES: This study measured the impact of the first wave of COVID-19 pandemic (COVID-19) (March-April 2020) on the incidence of bloodstream infections (BSIs) at Assistance Publique - Hôpitaux de Paris (APHP), the largest multisite public healthcare institution in France. METHODS: The number of patient admission blood cultures (BCs) collected, number of positive BCs, and antibiotic resistance and consumption were analysed retrospectively for the first quarter of 2020, and also for the first quarter of 2019 for comparison, in 25 APHP hospitals (ca. 14 000 beds). RESULTS: Up to a fourth of patients admitted in March-April 2020 in these hospitals had COVID-19. The BSI rate per 100 admissions increased overall by 24% in March 2020 and 115% in April 2020, and separately for the major pathogens (Escherichia coli, Klebsiella pneumoniae, enterococci, Staphylococcus aureus, Pseudomonas aeruginosa, yeasts). A sharp increase in the rate of BSIs caused by microorganisms resistant to third-generation cephalosporins (3GC) was also observed in March-April 2020, particularly in K. pneumoniae, enterobacterial species naturally producing inducible AmpC (Enterobacter cloacae...), and P. aeruginosa. A concomitant increase in 3GC consumption occurred. CONCLUSIONS: The COVID-19 pandemic had a strong impact on hospital management and also unfavourable effects on severe infections, antimicrobial resistance, and laboratory work diagnostics.

Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings.

Importance: Controversy remains regarding the transmission routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: To review current evidence on air contamination with SARS-CoV-2 in hospital settings and the factors associated with contamination, including viral load and particle size. Evidence Review: The MEDLINE, Embase, and Web of Science databases were systematically queried for original English-language articles detailing SARS-CoV-2 air contamination in hospital settings between January 1 and October 27, 2020. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patients. The SARS-CoV-2 RNA concentrations in copies per meter cubed of air were pooled, and their distribution was described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or median tissue culture infectious dose (TCID50) per meter cubed were analyzed after categorization as less than 1 µm, from 1 to 4 µm, and greater than 4 µm. Findings: Among 2284 records identified, 24 cross-sectional observational studies were included in the review. Overall, 82 of 471 air samples (17.4%) from close patient environments were positive for SARS-CoV-2 RNA, with a significantly higher positivity rate in intensive care unit settings (intensive care unit, 27 of 107 [25.2%] vs non-intensive care unit, 39 of 364 [10.7%]; P < .001). There was no difference according to the distance from patients (≤1 m, 3 of 118 [2.5%] vs >1-5 m, 13 of 236 [5.5%]; P = .22). The positivity rate was 5 of 21 air samples (23.8%) in toilets, 20 of 242 (8.3%) in clinical areas, 15 of 122 (12.3%) in staff areas, and 14 of 42 (33.3%) in public areas. A total of 81 viral cultures were performed across 5 studies, and 7 (8.6%) from 2 studies were positive, all from close patient environments. The median (interquartile range) SARS-CoV-2 RNA concentrations varied from 1.0 × 103 copies/m3 (0.4 × 103 to 3.1 × 103 copies/m3) in clinical areas to 9.7 × 103 copies/m3 (5.1 × 103 to 14.3 × 103 copies/m3) in the air of toilets or bathrooms. Protective equipment removal and patient rooms had high concentrations per titer of SARS-CoV-2 (varying from 0.9 × 103 to 40 × 103 copies/m3 and 3.8 × 103 to 7.2 × 103 TCID50/m3), with aerosol size distributions that showed peaks in the region of particle size less than 1 µm; staff offices had peaks in the region of particle size greater than 4 µm. Conclusions and Relevance: In this systematic review, the air close to and distant from patients with coronavirus disease 2019 was frequently contaminated with SARS-CoV-2 RNA; however, few of these samples contained viable viruses. High viral loads found in toilets and bathrooms, staff areas, and public hallways suggest that these areas should be carefully considered.

La Direction des Affaires Juridiques et des Droits des Patients de l’APHP et la première vague de la pandémie Covid-19

Résumé Pour faciliter la prise en charge des réclamations en lien avec la Covid19, la Direction des Affaires Juridiques et des Droits des Patients de l’APHP a constitué une cellule médicale assistée de juristes destinée à revoir l’état des connaissances et les mesures organisationnelles au cours de la première vague de l’épidémie. Cette cellule a regroupé des médecins identifiés en raison de leurs compétences scientifiques dans les principales spécialités impliquées au cours de cette infection et pour certains, par leurs connaissances en matière de réparation du dommage corporel. A partir des données de la littérature scientifique, des tableaux de bord hospitaliers et du recueil des procédures hospitalières mises en place pour les patients Covid-19 et non Covid-19, l’objectif de cette cellule a été de recueillir l’état des connaissances scientifiques et les mesures organisationnelles au début de l’épidémie, à son pic et au moment du dé-confinement. Ce travail montre qu’au cours des trois périodes de cette pandémie des modifications de prise en charge ont été observées concernant les admissions avec une plus grande sélectivitépar la prise en compte du terrain et des comorbidités. La prise en charge médicamenteuse a été en constante évolution et les mesures d’isolement ont été plus rigoureuses avec interruption des droits de visite.Les mesures hospitalières de prévention des contaminations avaient pour objectif d’éviter la contamination des sujets non infectés et de protéger les soignants pour maintenir les forces de soins.L’absence de sélection des malades admis en réanimation pour assurer une compensation de leur défaillance respiratoire a nécessité pour l’APHP, un doublement du nombre de lits de réanimation et des transferts inter-régionaux.Dans un contexte de connaissances scientifiques non stabilisées avec des mesures organisationnelles évolutives le recueil de ces données devrait faciliter l’analyse des réclamations en lien avec la Covid19 au sein de l’APHP et initier une étude prospective face à la seconde vague de cette pandémie. To facilitate the analysis and the management of claims related to the last Covid19 pandemic, the DAJ of the APHP constituted a medical group assisted by lawyers intending to review the scientific knowledge and organizational measures during the first wave of this pandemic.This group brought together medical doctors with both scientific expertise in the main specialties requested during this viral infection and knowledge of repairing bodily damage. Based on the data provided by the hospital dashboards and the collection of hospital procedures for Covid-19 and non-Covid-19 patients, the goal of this group was to assess the level of scientific knowledge and organizational measures respectively at the start of the epidemic, its peak and at the end. During the three periods of this pandemic the main changes observed included a greater selectivity on admissions with increasing consideration on the patient’s comorbidity;a continual evolution in drug management and more rigorous isolation measures with interruption of visiting rights. The target was to prevent contamination of the non-infected persons with an obsession to protect healthcare workers. The absence of selection for patients requiring intensive care for compensation of their respiratory failure forced APHP to double the number of intensive care beds and to refer some patients in other regions. In a context of unstable scientific knowledge and evolving organizational measures, the collection of these data should facilitate the management of claims related to Covid19 during the first wave of this pandemicand open a prospective study for the next pandemic.