Trends in hospital acquired New Delhi metallo-beta-lactamase-producing Enterobacterales in Tuscany (Italy) from 2019 to 2021: impact of the COVID-19 pandemic.

OBJECTIVES: In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) in hospitalized patients has increasingly been observed since 2018, leading in 2019 to the implementation of enhanced control measures successfully reducing transmission. We describe the NDM-CRE epidemiology during the COVID-19 pandemic in Tuscany. METHODS: Data on NDM-CRE patients hospitalized in five Tuscan hospitals were collected from January 2019 to December 2021. Weekly rates of NDM-CRE cases on hospital days in medical and critical-care wards were calculated. In March-December 2020, NDM-CRE rates were stratified by COVID-19 diagnosis. Multi-variate regression analysis was performed to assess outcomes' differences among two periods analysed and between COVID-19 populations. RESULTS: Since March 2020, an increase in NDM-CRE cases was observed, associated with COVID-19 admissions. COVID-19 patients differed significantly from non-COVID-19 ones by several variables, including patient features (age, Charlson index) and clinical history and outcomes (NDM-CRE infection/colonization, intensive care unit stay, length of stay, mortality). During the pandemic, we observed a higher rate of NDM-CRE cases per hospital day in both non-COVID-19 patients (273/100,000) and COVID-19 patients (370/100,00) when compared with pre-pandemic period cases (187/100,00). CONCLUSIONS: Our data suggest a resurgence in NDM-CRE spread among hospitalized patients in Tuscany during the COVID-19 pandemic, as well as a change in patients' case-mix. The observed increase in hospital transmission of NDM-CRE could be related to changes in infection prevention and control procedures, aimed mainly at COVID-19 management, leading to new challenges in hospital preparedness and crisis management planning.

FIRST, SECOND AND THIRD COVID-19 PANDEMIC WAVES AND THEIR DIFFERENT IMPACTS ON STROKE CARE: EVIDENCES FROM THE TUSCANY STROKE NETWORK

Background and aims: We aim at describing the impact of the first, second and third waves of the COVID-19 pandemic on stroke services in Tuscany. We measured the global impact of the COVID-19 pandemic on the volumes of both intracranial hemmorhage (ICH) and acute ischemic stroke (AIS) hospitalizations, as well as of reperfusion treatments throughout the pandemic years 2020-21 (January1, 2020 -June 30, 2021) compared with the year 2019 control period. Methods: Retrospective, observational, multicenter study, across 3 huband- spoke stroke systems, and 22 stroke hospitals. The diagnoses were identified by their ICD-9 CM codes and/or classifications in stroke databases at participating centers. Results: In comparison with the same periods of 2019, the hospitalization volumes for ICHs and for AIS declined by 26% and 30.1% respectively during the fist pandemic wave, by 11% and 24.6% during the second wave, and by 2.5% and 4% during the third wave. Reperfusion treatments decreased by 15% during the first wave, and by 11.4% and 0.3% during the second and third waves respectively. Treated patients' functional outcome at 90days did not vary throughout the pandemic waves. Casefatality at 30days increased from 10.3% to 10.8% for AIS, and from 26.5% to 27.6% for ICH before and after the COVID-19 outbreak. Conclusions: The COVID-19 pandemic waves were associated with a decreasing decline in the volume of stroke hospitalizations, nevertheless fewer and probably the most severe patients were able to reach the hospital within the therapeutic windows. We observed different pattern of variations across the three hub-and-spoke systems.

Hospital admissions for acute coronary syndromes during the first SARS-CoV-2 epidemic wave: time course, patients characteristics and in-hospital mortality

Background: During national lockdown (LD) fear of contagion and heath care services resources redistribution to face the COVID-19 emergency, may have affected hospital access rates as well as management and inhospital outcomes for patients with acute coronary syndromes (ACS). Purpose: To describe changes in the incidence of hospital admissions for STE- and NSTE-ACS and related short term outcomes during the first pandemic wave in Tuscany, Italy. Methods: The Agenzia Regionale di Sanità (ARS) collects administrative data from 40 hospitals in Tuscany, serving 3.730.000 inhabitants. We analyzed hospitalization rates, clinical characteristics and in-hospital mortality of STE- and NSTE-ACS patients admitted during the first 2020 pandemic wave and compared them with those of an historical reference period (2018-2019) in 3 time intervals: A) pre-LD (Jan-Feb);B) LD (March- May) and C) post-LD (June-Sept). Results: A total of 1955 STE-ACS (mean age 69±13 years;69% males) and 2582 NSTE-ACS (mean age 73±13 years;65% males) admissions were recorded. Compared to the historical reference period a notable and statistically significant decrease for both STE- (-10%, p<0.0001) and NSTE-ACS (-17.9%, p=0.004) was observed (Figure). Among STE-ACS hospital admissions, the greatest reduction was observed during B (-23%, p<0.0001), particularly in the month of April (-35.2%) and persisted, just missing statistical significance (-7%, p=0.08), during C. Among NSTEACS a similar behavior could be observed with the greatest reduction during B (-34%, p<0.0001) and a peak in the month of March (-43.3%). Interestingly, a significant decrease was observed both during A (-12.4%, p=0.004) and continued during C (-7%, p<0.04). Analyzing mean age and gender as well as baseline main clinical characteristics (eg. diabetes, heart failure, Charlson comorbidity score) no differences could be observed among STE- and NSTE-ACS patients between the two observation periods (2020 vs 2018-2019). Interestingly the percentage of STE-ACS patients presenting through the Emergency Medical System increased significantly (+10%) while no change was seen for the rate of those with a FMC to catheterization lab wire crossing <120 min. In Hospital mortality rates were 7.7% and 2.7% for STE-ACS and NSTE-ACS respectively and did not differ with those observed in the historical refence period. Conclusions: We found a marked reduction in ACS hospitalizations during the first pandemic wave compared to the same period of observation in the previous two years. This decline was present for both groups of ACS, but was more pronounced for patients presenting with NSTE-ACS and persisted to some extent in the post-lockdown period. Nevertheless, our data show that the process of care was granted as usual for the management of ACS patients who gained access to the emergency network during the first pandemic wave and in-hospital mortality did not increase.

Incidence of atrial fibrillation in tuscany during the first wave of the covid 19 pandemy

Background: Atrial fibrillation (AFib) represents the most common arrhythmia in the general population, Its prevalence is progressively increasing and currently is estimated around 3-4% and accounts for about 1.5% of all the admissions to our emergency departments (ED). Aim of the study: During the first wave of COVID 19 a significant decrease of Hospital admissions for several cardiovascular conditions was observed, The aim of the present investigation was to evaluate the incidence of new onset AFib admitted to our Regional Hospital Network during the first COVID wave. Methods: We analyzed all the Hospital admissions for AFib as major diagnosis through the data base of Agenzia Regionale di Sanità Toscana. We compared the 2020 data with those of 2018 and 2019. Results: Compared to the previous two years we observed an absolute reduction of-51% in AFIb ED accesses and Hospitalizations during the lock-down period (March-55.2%, April-54.9%, May-34.3%) (FIG 1). A reduction was also observed in the following months although to a lesser extent. Female gender, particulraly the youngest showed the greatest reduction. AFib patients admitted to the ED were more frequently admitted to the ward with respect to 2019 (15.6% vs 13.9%). We also detected a significant reduction of reported ischemic stroke that reached-24.7% on April 2020 (FIG 2). Conclusions: Our data, show a significant reduction of AFib incidence in the Regional Hospital Network during the first COVID 19 wave. The observed pattern may depend on several causes. The forced lockdown may have caused a true reduction in the AFib incidence due to a diminished exposure to favouring or predisposing factors. A second explanation may be the fear of public contacts or reluctancy to access to the Emergency wards and Hospitals seen as possible source of viral infection. The contemporary reduction of ischemic stroke occurrence or death and AFib incidence may suggest a positive effect of the lock-down on these conditions, at least over the short term. It is highly unlikely that patients with an acute condition such as AFib or stroke would not seek medical attention to such a wide extent as that observed. It appears worrisome the observed relative increase in Hospital admission of AFib patients during the lock down. Indeed, this pattern may reflect a delayed access to the necessary care with the progression to more severe complications and subsequent need of a prolonged care.