ABSTRACT
Purpose: The COVID-19 pandemic caused by the coronavirus SARS-CoV-2 has resulted in a global health care crisis. The provision of CT imaging services by radiology departments for COVID-19 patients poses multiple challenges. Thus, the clinical indications and utility of thoracic CT, determined by whether it subsequently alters patient management, in COVID-19 patients is important to establish. Current literature is not well established specifically for the 'Delta' SARS-CoV-2 variant. Methods and Materials: This is a single tertiary hospital centre retrospective review of all consecutive confirmed COVID-19 cases admitted during the peak of the 'Delta' variant wave in Australia who underwent a chest CT. Clinical indication for chest CT and patient management plan pre and post CT were ascertained. Result(s): During this period, 1403 patients were admitted with COVID-19 and 92 patients underwent CT of the thorax, with 18 patients scanned urgently. There were 73 CTPA, 14 CT Chest and 5 HRCT studies. 20 patients were in ICU at the time of scan. Regarding the clinical indications for thoracic CT, 72.8% of studies were to evaluate for pulmonary emboli, 16.2% for assessment of COVID-19 pneumonia complications, 5.4% for tuberculosis and 6.5% for other indications. 21 (23%) of these studies resulted in a change in management with 2 patients having a major change in management (thrombolysis, CT guided aspiration) whilst 19 had minor changes. Of 73 CTPA studies, 11 (15%) patients had evidence of pulmonary embolism. 6 patients underwent a second chest CT for diverse reasons. Conclusion(s): In conclusion, 6% of patients in the cohort of COVID- 19 patients admitted to our centre during the Delta variant wave of COVID-19 in NSW, Australia underwent a CT of the thorax. In 23% of these patients, chest CT resulted in a change in management. 72.8% of chest CT scans were for the evaluation of possible pulmonary emboli. CT was not used for diagnosis or follow-up of COVID-19 in any of our patients.
ABSTRACT
BACKGROUND: Wards caring for COVID-19 patients, including intensive care units (ICUs), have an important focus on preventing transmission of SARS-CoV-2 to other patients and healthcare workers. AIM: To describe an outbreak of carbapenemase-producing Enterobacterales (CPE) in a COVID-19 ICU and to discuss key infection control measures enabling prompt termination of the cluster. METHODS: CPE were isolated from clinical specimens and screening swabs from intensive care patients with COVID-19 disease and from environmental screening. Whole-genome sequencing analysis was instrumental in informing phylogenetic relationships. FINDINGS: Seven clinical isolates and one environmental carbapenemase-producing Klebsiella pneumoniae isolate - all carrying OXA-48, CTX-M-15 and outer membrane porin mutations in ompK35/ompK36 - were identified with ≤1 single nucleotide polymorphism difference, indicative of clonality. A bundle of infection control interventions including careful adherence with contact precautions and hand hygiene, twice weekly screening for multidrug-resistant organisms, strict antimicrobial stewardship, and enhanced cleaning protocols promptly terminated the outbreak. CONCLUSION: Prolonged use of personal protective equipment is common with donning and doffing stations at the ward entrance, leaving healthcare workers prone to reduced hand hygiene practices between patients. Minimizing transmission of pathogens other than SARS-CoV-2 by careful adherence to normal contact precautions including hand hygiene, even during high patient contact manoeuvres, is critical to prevent outbreaks of multidrug-resistant organisms. Appropriate antimicrobial stewardship and screening for multidrug-resistant organisms must also be maintained throughout surge periods to prevent medium-term escalation in antimicrobial resistance rates. Whole-genome sequencing is highly informative for multidrug-resistant Enterobacterales surveillance strategies.