Frequency of antibiotic prescribing in adults hospitalized for SARS-CoV-2 in a high complexity institution in Santiago de Cali, Colombia.

Objective: To determine the frequency of antibiotic use and to know which clinical and socio-demographic variables were related to the probability of suffering infections associated with COVID-19. Method(s): Adults hospitalized for COVID-19 who received one or more antibiotics during hospitalization were evaluated. We performed a descriptive analysis of variables in the general population' bivariate analysis in two groups (documented vs. suspected infection) and multivariate logistic regression of factors associated with mortality. Result(s): It was determined that 60.4% of adults hospitalized for COVID-19 received antibiotics. Coinfection was documented in 6.2% and superinfection in 23.3%. Gram-negative germs were reported in 75.8% of cultures, fungi in 17.8% and gram-positive in 14.2%. Variables such as age, comorbidities, ICU, anemia, steroids, mechanical ventilation, hemofiltration were statistically significantly related to documented infection. High-flow cannula was associated as a protective factor. Overall mortality was 43.9%, 57.8% in the first group and 38.1% in the second (p=0.002). Conclusion(s): There is a considerable frequency of antibiotic use in subjects hospitalized for COVID-19, particularly related to relevant findings of bacterial superinfection, in those with comorbidities, such as diabetes mellitus, immunosuppression, anemia and fragility, in whom the behavior of the disease is more severe and lethal.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.

Social Sciences, the World and the Pandemic: for a Possible Future

The reflection presented in the document addresses the social sciences, from a complex and multidimensional perspective, whose purpose is to address the current and future challenges derived from the COVID-19 pandemic, as a reconfiguring instrument of a new world order. The analysis will show the panorama outlined by the social sciences in the current situation, and will propose some lines of reflection regarding the possible future of humanity and institutions in the face of the new social scenario. This is based on a bibliographic review, which makes evident the profuse reflection on the construction of the social sciences of the future.

Basic Cyber Security Considerations for Licensees of Radioactive Materials and Registrants of Radiation Producing Devices in an Era of Remote or Hybrid Compliance Inspections.

ABSTRACT: The onset of the COVID pandemic impacted various regulatory agencies' ability to safely fulfill their regulatory compliance inspection mandates via on-site inspections. Some agencies shifted to a remote or hybrid inspection process, which necessitates the electronic transmittal of a variety of records that may or may not have been transmitted in this fashion in the past, raising concerns about the records being sent and received securely. Considering this new environment, some basic cyber security diagnostic considerations are described for radiation source permit holders to consider prior to responding to an apparent legitimate regulatory inspection request, both in the current COVID cyber risk environment and the environment likely to exist into the future.

Considerations for Radiation Safety Professionals to Prepare and Respond to the Next Pandemic.

ABSTRACT: The Health Physics Society's stated mission is "excellence in the science and practice of radiation safety." Why, then, should we discuss disease outbreaks, epidemics, and pandemics with radiation safety professionals? The answer is simple: all workers are impacted by infectious diseases-and, as safety professionals, we will inevitably be called upon to prepare for and respond to these events. The COVID-19 pandemic has disrupted every facet of life, including home, school, work, and leisure. Moreover, virtually all radiation safety professionals have been impacted by the pandemic either personally, academically, or professionally. Even if radiation safety professionals were not involved directly with COVID-19 response, they were impacted by school closures, remote schooling and work, testing regimes, temperature screenings, vaccination programs, and so forth. However, many radiation safety professionals have been intimately involved in COVID-19 response through activities such as the deployment of personal protective equipment, directional airflow verification for isolation areas, disinfection and decontamination efforts, the design and layout of testing and vaccine centers, and in many other ways. Yet, it is likely that many radiation safety professionals have not received formal training in epidemiology, disease control, or other related topics, and thus may not be attuned to the key aspects to consider when the next pandemic emerges-and it will.

Immunosuppressive treatment management in a cohort of hospitalised solid organ recipients affected by COVID-19

Background and importance Management of immunosuppression in recipients of solid organ transplantation (SOT) is challenging. Drugs used in COVID-19 involve drug-drug interactions (DDIs) with immunosuppressants. Aim and objectives To describe DDIs in hospitalised SOT recipients (SOTr) and to analyse DDI management and their clinical impact. Material and methods A retrospective single centre study was conducted in SOTr with COVID-19 hospitalised from 11 March to 25 April. Clinical data and pharmacotherapy were recorded from admission up to 28 days or discharge. Lexicomp was used to detect and categorise DDIs according to: risk level (X: avoid combination;D: consider therapy modification;C: monitor therapy;B: no action needed), reliability rating and severity. 46 patients were included: 33 (71.7%) men, aged 62.7 ±12.6 (mean±SD) years. They had received kidney (30;56.2%), lung (13;28.3%) or liver (3;6.5%) transplants. Results Immunosuppression at admission: tacrolimus (41;89.1%), mycophenolate mofetil/mycophenolate sodium (28;60.9%), prednisone (39;84.8%), everolimus (7;15.2%), sirolimus (7;15.2%) and cyclosporine (1;2.2%). 106 DDIs affecting 42 (91.3%) patients were detected (patients could have >1 DDI). DDIs were classified as confirmed (18;39.1%) or potential (33;71.7%). Immunosuppressants with DDIs: tacrolimus (65;61.3%), everolimus (12;11.3%), sirolimus (6;5.7%), methylprednisolone (12;11.3%), prednisone (10;9.4%) and mycophenolate (1;0.9%). Drugs for COVID-19 with DDIs: lopinavir/ritonavir (45;42.5%), azithromycin (32;30.2%), tocilizumab (15;14.2%), darunavir/cobicistat (10;9.4%), and hydroxychloroquine (4;3.8%). DDIs were risk X (6;5.6%), risk D (42;40.8%), risk C (57;53.7%) and risk B (1;0.9%). The reliability rate of DDIs was excellent (0.9%), good (52.8%) and fair (44.3%). Severity was low, moderate and major in 6.6%, 84.9% and 8.5% of cases, respectively. Immunosuppression was withheld in 33 (71.7%) patients due to DDIs. 36 (87.7%) of 41 patients receiving tacrolimus had 65 DDIs;tacrolimus was withdrawn in 22 (61.1%), reduced in 18 (50%) and increased in 4 (11.1%) cases. Seven patients receiving everolimus had 12 DDIs and 4 patients with sirolimus had 6 DDIs;immunosuppressant was stopped in all cases. Tacrolimus levels were supratherapeutic (>10 ng/mL) in 8 (25%) patients at admission, 13 (43.3%;n=30) at 48 hours, 10 (31.3%, n=32) at 7 days and 2 at 14 days (17.7%, n=28). No graft rejection was detected. Mean creatinine serum concentration was 2.2 mg/dL at admission and 2.6 mg/ dL 7 days later. Two cases of acute kidney failure were attributable to tacrolimus intoxication. Conclusion and relevance DDIs were highly prevalent in hospitalised SOTr with COVID-19. Pharmaceutical care is critical to promptly detect and manage DDIs in SOTr.

4CPS-317 Immunosuppressive treatment management in a cohort of hospitalised solid organ recipients affected by COVID-19

Background and importanceManagement of immunosuppression in recipients of solid organ transplantation (SOT) is challenging. Drugs used in COVID-19 involve drug–drug interactions (DDIs) with immunosuppressants.Aim and objectivesTo describe DDIs in hospitalised SOT recipients (SOTr) and to analyse DDI management and their clinical impact.Material and methodsA retrospective single centre study was conducted in SOTr with COVID-19 hospitalised from 11 March to 25 April. Clinical data and pharmacotherapy were recorded from admission up to 28 days or discharge. Lexicomp was used to detect and categorise DDIs according to: risk level (X: avoid combination;D: consider therapy modification;C: monitor therapy;B: no action needed), reliability rating and severity. 46 patients were included: 33 (71.7%) men, aged 62.7±12.6 (mean±SD) years. They had received kidney (30;56.2%), lung (13;28.3%) or liver (3;6.5%) transplants.ResultsImmunosuppression at admission: tacrolimus (41;89.1%), mycophenolate mofetil/mycophenolate sodium (28;60.9%), prednisone (39;84.8%), everolimus (7;15.2%), sirolimus (7;15.2%) and cyclosporine (1;2.2%). 106 DDIs affecting 42 (91.3%) patients were detected (patients could have >1 DDI). DDIs were classified as confirmed (18;39.1%) or potential (33;71.7%). Immunosuppressants with DDIs: tacrolimus (65;61.3%), everolimus (12;11.3%), sirolimus (6;5.7%), methylprednisolone (12;11.3%), prednisone (10;9.4%) and mycophenolate (1;0.9%).Drugs for COVID-19 with DDIs: lopinavir/ritonavir (45;42.5%), azithromycin (32;30.2%), tocilizumab (15;14.2%), darunavir/cobicistat (10;9.4%), and hydroxychloroquine (4;3.8%). DDIs were risk X (6;5.6%), risk D (42;40.8%), risk C (57;53.7%) and risk B (1;0.9%). The reliability rate of DDIs was excellent (0.9%), good (52.8%) and fair (44.3%). Severity was low, moderate and major in 6.6%, 84.9% and 8.5% of cases, respectively.Immunosuppression was withheld in 33 (71.7%) patients due to DDIs. 36 (87.7%) of 41 patients receiving tacrolimus had 65 DDIs;tacrolimus was withdrawn in 22 (61.1%), reduced in 18 (50%) and increased in 4 (11.1%) cases. Seven patients receiving everolimus had 12 DDIs and 4 patients with sirolimus had 6 DDIs;immunosuppressant was stopped in all cases. Tacrolimus levels were supratherapeutic (>10 ng/mL) in 8 (25%) patients at admission, 13 (43.3%;n=30) at 48 hours, 10 (31.3%, n=32) at 7 days and 2 at 14 days (17.7%, n=28). No graft rejection was detected. Mean creatinine serum concentration was 2.2 mg/dL at admission and 2.6 mg/dL 7 days later. Two cases of acute kidney failure were attributable to tacrolimus intoxication.Conclusion and relevanceDDIs were highly prevalent in hospitalised SOTr with COVID-19. Pharmaceutical care is critical to promptly detect and manage DDIs in SOTr.References and/or acknowledgementsThanks to the COVID-19 Vall d’Hebron Working GroupConflict of interestNo conflict of interest