ABSTRACT
This is a single-center, retrospective, cohort study aimed to evaluate the clinical outcomes of multi-drug resistance in Acinetobacter baumannii infections (MDR-AB) in intensive care unit (ICU) patients with or without a COVID-19 infection and risk factors for blood stream infection. A total of 170 patients with MDR-AB were enrolled in the study. Of these, 118 (70%) patients were admitted to the ICU due to a COVID-19 infection. Comparing the COVID-19 and non-COVID-19 groups, the use of mechanical ventilation (98.31% vs. 76.92%, p = 0.000), the presence of septic shock (96.61% vs. 82.69%, p = 0.002), and the use of steroid (99.15% vs. 71.15%, p = 0.000) and tocilizumab therapies (33.05% vs. 0%, p = 0.000) were more prevalent and statistically more significant in patients with COVID-19 infections. The average length of the ICU stay (21.2 vs. 28.33, p = 0.0042) was significantly lower in patients with COVID-19 infections. Survival rate was 21.19% for the COVID-19 group and 28.85% for non-COVID-19 group with a p-value = 0.0361. COVID-19 status was associated with significantly higher hazards of death (HR 1.79, CI 95% 1.02-3.15, p = 0.043). Higher SOFAB (15.07 vs. 12.07, p = 0.0032) and the placement of an intravascular device (97.06% vs. 89.71%, p = 0.046) were significantly associated with the development of a bloodstream infection. Our study has shown that critically ill patients with an MDR-AB infection, who were admitted due to a COVID-19 infection, had a higher hazard for death compared to non-COVID-19 infected patients.
ABSTRACT
Background: During the initial days of the COVID-19 pandemic in March 2020, medical students at The George Washington University School of Medicine •Health Sciences (GWU SMHS) sought to address the rapid dissemination of misinformation by creating DC COVID Connect (DCC), a reliable web-based resource specific to the Washington, D.C Metropolitan area. With the emphasis on clinical public health in the GW SMHS M.D. Program curriculum, these students were well-equipped to consolidate a comprehensive body of information to help members of all ages in the local community navigate all aspects of their lives during the pandemic. Methods: The online resource was originally a 130-page html document. Sections of the document include but are not limited to: age-group specific health information about COVID-19, local news updates in the DMV pertaining to COVID19, information for at-risk populations: individuals experiencing homelessness, incarceration, and disability, peer-reviewed research, services (housing, legal services, etc). To better disseminate these resources, our team transformed the document into a website, available in 12 different languages.The DCC team is now in the process of launching a mobile application with a database connected to the website for a more user-friendly interface for the pediatric population. The app prioritized: certain age-appropriate sections relating to emerging vaccine guidelines for younger populations, educational resources, and sexual and reproductive health topics. Results: The DCC team began with 60 fourth-year medical students and grew to include over 100 medical students with guidance from physician/resident mentors. DCC has been recognized as a trusted resource by the community and has been utilized by D.C. Medicaid, the Black Coalition Against COVID, “El Tiempo Latino”, and providers at local hospitals and clinics including Children's National Medical Center (CNMC). In the past several months, we have collaborated with the providers at CNMC and plan to launch the app in August 2021. QR code badges will be used to facilitate distribution among patients and families. Our Google Analytics report showed that DCC had a total of 13,332 users since the launch in July 2020. With additional data regarding user demographics from QR code tracking and surveys, we hope to utilize this information to increase accessibility of our resource. Conclusion: The framework of the DCC app provides the much needed infrastructure that is lacking in the DC community by keeping pace with the breadth of information and resources that are being made available to our pediatric population. The impact of the pandemic will linger for years to come and our resource will continue to evolve and repurpose the work that we do to reflect such changes.
ABSTRACT
BACKGROUND: SARS-CoV-2 infection has a high mortality rate and continues to be a global threat, which warrants the identification of all mortality risk factors in critically ill patients. METHODS: This is a retrospective multicenter cohort study conducted in five hospitals in the Kingdom of Saudi Arabia (KSA). We enrolled patients with confirmed SARS-COV-2 infection admitted to any of the intensive care units from the five hospitals between March 2020 and July 2020, corresponding to the peak of recorded COVID-19 cases in the KSA. RESULTS: In total, 229 critically ill patients with confirmed SARS-CoV-2 infection were included in the study. The presenting symptoms and signs of patients who died during hospitalization were not significantly different from those observed among patients who survived. The baseline comorbidities that were significantly associated with in-hospital mortality were diabetes (62% vs. 48% among patients who died and survived (p = 0.046)), underlying cardiac disease (38% vs. 19% (p = 0.001)), and underlying kidney disease (32% vs. 12% (p < 0.001)). CONCLUSION: In our cohort, the baseline comorbidities that were significantly associated with in-hospital mortality were diabetes, underlying cardiac disease, and underlying kidney disease. Additionally, the factors that independently influenced mortality among critically ill COVID-19 patients were high Activated Partial Thromboplastin Time (aPTT )and international normalization ratio (INR), acidosis, and high ferritin.