Antimicrobial resistance in Escherichia coli and Pseudomonas aeruginosa before and after the coronavirus disease 2019 (COVID-19) pandemic in the Dominican Republic

Objective: To describe antimicrobial resistance before and after the COVID-19 pandemic in the Dominican Republic. Design: Retrospective study. Setting: The study included 49 outpatient laboratory sites located in 13 cities nationwide. Participants: Patients seeking ambulatory microbiology testing for urine and bodily fluids Methods: We reviewed antimicrobial susceptibility reports for Escherichia coli isolates from urine and Pseudomonas aeruginosa (PSAR) from bodily fluids between January 1, 2018, to December 31, 2021, from deidentified susceptibility data extracted from final culture results. Results: In total, 27,718 urine cultures with E. coli and 2,111 bodily fluid cultures with PSAR were included in the analysis. On average, resistance to ceftriaxone was present in 25.19% of E. coli isolated from urine each year. The carbapenem resistance rates were 0.15% for E. coli and 3.08% for PSAR annually. The average rates of E. coli with phenotypic resistance consistent with possible extended-spectrum β-lactamase (ESBL) in urine were 25.63% and 24.75%, respectively, before and after the COVID-19 pandemic. The carbapenem resistance rates in urine were 0.11% and 0.20%, respectively, a 200% increase. The average rates of PSAR with carbapenem resistance in bodily fluid were 2.33% and 3.84% before and after the COVID-19 pandemic, respectively, a 130% percent increase. Conclusions: Resistance to carbapenems in PSAR and E. coli after the COVID-19 pandemic is rising. These resistance patterns suggest that ESBL is common in the Dominican Republic. Carbapenem resistance was uncommon but increased after the COVID-19 pandemic.

A mild deficiency of ADAMTS13 is associated with severity in COVID-19: comparison of the coagulation profile in critically and noncritically ill patients.

Early descriptions of COVID-19 associated coagulopathy identified it as a disseminated intravascular coagulation (DIC). However, recent studies have highlighted the potential role of endothelial cell injury in its pathogenesis, and other possible underlying mechanisms are being explored. This study aimed to analyse the coagulation parameters of critically and noncritically ill patients with COVID-19 bilateral pneumonia, determine if coagulation factors consumption occurs and explore other potential mechanisms of COVID-19 coagulopathy. Critically and noncritically ill patients with a diagnosis of COVID-19 bilateral pneumonia were recruited. For each patient, we performed basic coagulation tests, quantification of coagulation factors and physiological inhibitor proteins, an evaluation of the fibrinolytic system and determination of von Willebrand Factor (vWF) and ADAMTS13. Laboratory data were compared with clinical data and outcomes. The study involved 62 patients (31 ICU, 31 non-ICU). The coagulation parameters assessment demonstrated normal median prothrombin time (PT), international normalized ratio (INR) and activated partial thromboplastin time (APTT) in our cohort and all coagulation factors were within normal range. PAI-1 median levels were elevated (median 52.6 ng/ml; IQR 37.2-85.7), as well as vWF activity (median 216%; IQR 196-439) and antigen (median 174%; IQR 153.5-174.1). A mild reduction of ADAMTS13 was observed in critically ill patients and nonsurvivors. We demonstrated an inverse correlation between ADAMTS13 levels and inflammatory markers, D-dimer and SOFA score in our cohort. Elevated vWF and PAI-1 levels, and a mild reduction of ADAMTS13 in the most severe patients, suggest that COVID-19 coagulopathy is an endotheliopathy that has shared features with thrombotic microangiopathy.

Use of EHRs in a Tertiary Hospital During COVID-19 Pandemic: A Multi-Purpose Approach Based on Standards.

This work aims to describe how EHRs have been used to meet the needs of healthcare providers and researchers in a 1,300-beds tertiary Hospital during COVID-19 pandemic. For this purpose, essential clinical concepts were identified and standardized with LOINC and SNOMED CT. After that, these concepts were implemented in EHR systems and based on them, data tools, such as clinical alerts, dynamic patient lists and a clinical follow-up dashboard, were developed for healthcare support. In addition, these data were incorporated into standardized repositories and COVID-19 databases to improve clinical research on this new disease. In conclusion, standardized EHRs allowed implementation of useful multi- purpose data resources in a major Hospital in the course of the pandemic.