ABSTRACT
In response to the coronavirus (COVID-19) pandemic, there has been an increased need for personal and environmental decontamination to aid in curbing transmission of the SARS-CoV-2 virus. Products used for this purpose include sanitizers for hands and disinfectants for surfaces. The active chemical ingredients used in these products, termed antimicrobials, can enter waste streams after application and may be emerging as more prominent environmental contaminants. Even prior to COVID-19, there was recognized need to examine their implications for aquatic biota, which is now made more pressing due to their exaggerated use in response to the pandemic. Our objectives were to identify current antimicrobial active ingredients, quantify their increased use, and determine which may be candidates for further consideration as possible aquatic contaminants. By consulting multiple sources of publicly available information in Canada, we identified current-use antimicrobials from the lists of sanitizers and surface disinfectants approved for use against SARS-CoV-2 by Health Canada and the drug registration database. To estimate the use of sanitizers and disinfectants, we evaluated import quantities and grocery store retail sales of related compounds and products (Statistics Canada) and both lines of evidence supported increased use trends. The list of identified antimicrobials was refined to include only candidates with potential to reach aquatic ecosystems, and information on their environmental concentrations and toxicity to aquatic biota was reviewed. Candidate antimicrobials (n = 32) fell into four main categories: quaternary ammonium compounds (QACs), phenols, acids, and salts. Benzalkonium chloride, a QAC, was the most prominent active ingredient used in both nonalcohol-based hand sanitizers and surface disinfectants. Four QACs followed in prevalence and the next most used antimicrobial was triclosan (hand sanitizers only), an established and regulated environmental contaminant. Little information was found on environmental concentrations of other candidates, suggesting that the majority would fall into the category of emerging contaminants if they enter aquatic systems. Several were classified as acutely or chronically toxic to aquatic biota (Globally Harmonized System), and thus we recommend empirical research begin focusing on environmental monitoring of all candidate antimicrobials as a critical next step, with detection method development first where needed. (English) [ABSTRACT FROM AUTHOR] En réponse à la pandémie de coronavirus (COVID-19), un besoin accru de décontamination personnelle et environnementale s'est manifesté pour aider à freiner la transmission du virus SRAS-CoV-2. Les produits utilisés à cette fin comprennent des assainisseurs pour les mains et des désinfectants pour les surfaces. Les ingrédients chimiques actifs utilisés dans ces produits, appelés antimicrobiens, peuvent entrer dans les systèmes des eaux usées après leur application et peuvent devenir des contaminants environnementaux plus importants. Avant même l'avènement de la COVID-19, on reconnaissait qu'il était nécessaire d'examiner leurs implications pour le biote aquatique, ce qui est aujourd'hui rendu plus urgent en raison de leur utilisation exagérée en réponse à la pandémie. Nos objectifs consistaient à identifier les ingrédients actifs antimicrobiens actuels, à quantifier leur utilisation accrue et à déterminer ceux qui pourraient être considérés comme des contaminants aquatiques potentiels. En consultant de multiples sources d'information publiquement accessibles au Canada, nous avons pu identifiéer les antimicrobiens utilisés actuellement à partir des listes d'assainisseurs et de désinfectants de surface dont l'utilisation contre le SRAS-CoV-2 a été approuvée par Santé Canada, et de la base de données sur les produits pharmaceutiques. Pour estimer l'utilisation des assainisseurs et des désinfectants, nous avons évalué les quantités importées et les ventes au détail dans les épiceries de composés et de produits connexes (Statistique Canada) et les deux sources de données ont confirmé les tendances à l'augmentation de l'utilisation. La liste des antimicrobiens identifiés a été affinée pour n'inclure que les candidats susceptibles d'atteindre les écosystèmes aquatiques, et les informations sur leurs concentrations environnementales et leur toxicité pour le biote aquatique ont été examinées. Les antimicrobiens candidats (n = 32) se répartissent en quatre grandes catégories: les composés d'ammonium quaternaire (CAQ), les phénols, les acides et les sels. Le chlorure de benzalkonium, un CAQ, était l'ingrédient actif le plus utilisé dans les désinfectants non alcoolisés pour les mains et les désinfectants de surface. Quatre CAQ suivaient en prévalence et l'antimicrobien le plus utilisé ensuite était le triclosan (uniquement dans les désinfectants pour les mains), un contaminant environnemental avéré et réglementé. Peu d'informations sur les concentrations environnementales des autres candidats étaient accessibles, ce qui suggère que la majorité d'entre eux entreraient dans la catégorie des contaminants émergents s'ils pénètrent dans les systèmes aquatiques. Plusieurs d'entre eux ont été classés comme présentant une toxicité aiguë ou chronique pour le biote aquatique (Système général harmonisé de classification et d'étiquetage des produits chimiques, SGH). Les auteurs recommandent donc que la recherche empirique commence à se concentrer sur la surveillance environnementale de tous les candidats antimicrobiens comme prochaine étape critique, en commençant par le développement de méthodes de détection si nécessaire. Le texte intégral de l'article en français est disponible parmi les documents supplémentaires. (French) [ABSTRACT FROM AUTHOR] Copyright of Environmental Reviews is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
In response to the coronavirus (COVID-19) pandemic, there has been an increased need for personal and environmental decontamination to aid in curbing transmission of the SARS-CoV-2 virus. Products used for this purpose include sanitizers for hands and disinfectants for surfaces. The active chemical ingredients used in these products, termed antimicrobials, can enter waste streams after application and may be emerging as more prominent environmental contaminants. Even prior to COVID19, there was recognized need to examine their implications for aquatic biota, which is now made more pressing due to their exaggerated use in response to the pandemic. Our objectives were to identify current antimicrobial active ingredients, quantify their increased use, and determine which may be candidates for further consideration as possible aquatic contaminants. By consulting multiple sources of publicly available information in Canada, we identified current-use antimicrobials from the lists of sanitizers and surface disinfectants approved for use against SARS-CoV-2 by Health Canada and the drug registration database. To estimate the use of sanitizers and disinfectants, we evaluated import quantities and grocery store retail sales of related compounds and products (Statistics Canada) and both lines of evidence supported increased use trends. The list of identified antimicrobials was refined to include only candidates with potential to reach aquatic ecosystems, and information on their environmental concentrations and toxicity to aquatic biota was reviewed. Candidate antimicrobials (n = 32) fell into four main categories: quaternary ammonium compounds (QACs), phenols, acids, and salts. Benzalkonium chloride, a QAC, was the most prominent active ingredient used in both nonalcohol-based hand sanitizers and surface disinfectants. Four QACs followed in prevalence and the next most used antimicrobial was triclosan (hand sanitizers only), an established and regulated environmental contaminant. Little information was found on environmental concentrations of other candidates, suggesting that the majority would fall into the category of emerging contaminants if they enter aquatic systems. Several were classified as acutely or chronically toxic to aquatic biota (Globally Harmonized System), and thus we recommend empirical research begin focusing on environmental monitoring of all candidate antimicrobials as a critical next step, with detection method development first where needed.
ABSTRACT
PURPOSE: The Coronavirus disease 2019 (COVID-19) has led to an unparalleled influx of patients. Prognostic scores could help optimizing healthcare delivery, but most of them have not been comprehensively validated. We aim to externally validate existing prognostic scores for COVID-19. METHODS: We used "COVID-19 Evidence Alerts" (McMaster University) to retrieve high-quality prognostic scores predicting death or intensive care unit (ICU) transfer from routinely collected data. We studied their accuracy in a retrospective multicenter cohort of adult patients hospitalized for COVID-19 from January 2020 to April 2021 in the Greater Paris University Hospitals. Areas under the receiver operating characteristic curves (AUC) were computed for the prediction of the original outcome, 30-day in-hospital mortality and the composite of 30-day in-hospital mortality or ICU transfer. RESULTS: We included 14,343 consecutive patients, 2583 (18%) died and 5067 (35%) died or were transferred to the ICU. We examined 274 studies and found 32 scores meeting the inclusion criteria: 19 had a significantly lower AUC in our cohort than in previously published validation studies for the original outcome; 25 performed better to predict in-hospital mortality than the composite of in-hospital mortality or ICU transfer; 7 had an AUC > 0.75 to predict in-hospital mortality; 2 had an AUC > 0.70 to predict the composite outcome. CONCLUSION: Seven prognostic scores were fairly accurate to predict death in hospitalized COVID-19 patients. The 4C Mortality Score and the ABCS stand out because they performed as well in our cohort and their initial validation cohort, during the first epidemic wave and subsequent waves, and in younger and older patients.
Subject(s)
COVID-19 , Adult , Cohort Studies , Hospitals, University , Humans , Paris , Prognosis , Retrospective Studies , SARS-CoV-2ABSTRACT
BACKGROUND: COVID-19 may be more frequent and more severe in cancer patients than in other individuals. Our aims were to assess the rate of COVID-19 in hospitalized cancer patients, to describe their demographic characteristics, clinical features and care trajectories, and to assess the mortality rate. METHODS: This multicenter cohort study was based on the Electronic Health Records of the Assistance Publique-Hôpitaux de Paris (AP-HP). Cancer patients with a diagnosis of COVID-19 between 3 March and 19 May 2020 were included. Main outcome was all-cause mortality within 30 days of COVID-19 diagnosis. RESULTS: A total of 29,141 cancer patients were identified and 7791 (27%) were tested for SARS-CoV-2. Of these, 1359 (17%) were COVID-19-positive and 1148 (84%) were hospitalized; 217 (19%) were admitted to an intensive care unit. The mortality rate was 33% (383 deaths). In multivariate analysis, mortality-related factors were male sex (aHR = 1.39 [95% CI: 1.07-1.81]), advanced age (78-86 y: aHR = 2.83 [95% CI: 1.78-4.51] vs. <66 y; 86-103 y: aHR = 2.61 [95% CI: 1.56-4.35] vs. <66 y), more than two comorbidities (aHR = 2.32 [95% CI: 1.41-3.83]) and C-reactive protein >20 ng/mL (aHR = 2.20 [95% CI: 1.70-2.86]). Primary brains tumors (aHR = 2.19 [95% CI: 1.08-4.44]) and lung cancer (aHR = 1.66 [95% CI: 1.02-2.70]) were associated with higher mortality. Risk of dying was lower among patients with metabolic comorbidities (aHR = 0.65 [95% CI: 0.50-0.84]). CONCLUSIONS: In a hospital-based setting, cancer patients with COVID-19 had a high mortality rate. This mortality was mainly driven by age, sex, number of comorbidities and presence of inflammation. This is the first cohort of cancer patients in which metabolic comorbidities were associated with a better outcome.