ABSTRACT
Background. The empiric prescription of antibiotics in COVID 19 ICU patients is frequent due to the severity of disease and presentation of patients with septic shock. In this study we compared two approaches of antimicrobial prescription: empiric use vs. FilmArray pneumonia (FAP) panel guided treatment. We evaluated costs of intervention, clinical outcomes as development of hospital acquired infections (HAI), length of stay and mortality. Methods. Retrospective study. Patients with severe COVID-19 infection hospitalized in ICU of two institutions in Pereira were included. The prescription of antibiotic without FAP panel was defined as empiric. The prescription according to FAP panel results was defined as guided. Data analysis was performed in Epiinfo version 7.5.2.0. The study protocol was approved by the ethics committee of Universidad Tecnologica de Pereira. Results. 252 patients were included, 180 received empiric therapy and 72 were FAP panel guided. The median age was 65 years (IQR 53-73), the PaO2/FiO2 ratio mean was 108 (IQR 64-130). In the group of empiric treatment, 21 (11.67%) patients presented confirmed bacterial infection. Patients on guided antimicrobial therapy presented less HAI (RR 0,54 (IC 95% 0.30-0.95) p 0.02). The median length of stay in ICU was 16 days for both groups. Klebsiella pneumoniae was the most frequent bacteria identified during the first episode of infection followed of Pseudomonas aeruginosa. Mortality on guided group was 54% Vs. 42% on empiric group (p< 0,3). Meropenem was the main antibiotic prescribed (DDD empiric 3.17 Vs. 1.8DDDguided) followed of cefepime (DDD empiric 0.9 Vs. DDD guided 0.12). The median cost of antimicrobial treatment in the empiric group was US$530 (US$30-US$1579) per patient compared to the median cost of guided prescription that was US$292 (US$16-US $8767). When including the cost of FAP panel, the median cost per patient treatment course was US$429 (US$153-US$8904) p< 0.7. Conclusion. Implementation of a guided antimicrobial therapy using FAP panel could be useful and cost effective in COVID-19 ICU patients to reduce antimicrobial consumption and adverse outcomes related to the inappropriate use of antibiotics without significant impact on mortality or length of stay.
ABSTRACT
The COVID-19 pandemic has created an unprecedented crisis in schools globally, posing challenges for children with exceptionalities. Government policies during the pandemic necessitate the inclusion of people with special needs, as no one should be left behind. The researchers explore the Philippine laws governing inclusive education and the safety protocols that should be taken in the online sphere. Two legal consultants were presented with a hypothetical problem in the subject, Technology and Livelihood Education, which involves life skills activities. This paper explores safety in planning school activities, given the shift to online learning and the special needs of atypical students. This research has found that it is vital that prior home-school agreements, proper home-school communication, and efforts to carry out one's role under loco in parentis must be maintained to enable safe inclusive education to continue in the online sphere. © 2022 ACM.