ABSTRACT
Background: The COVID-19 pandemic remains a large contributor to the global burden of disease. SARS-CoV-2 RNAemia detection has been connected to higher mortality, but consistent data of solid organ transplant (SOT) recipients have not been analyzed. Aim: To determine and quantify RNAemia at hospital admission and its impact on robust unfavorable clinical outcomes. Methods: From January 6, 2020 to August 13, 2021, we followed a multicenter cohort of 408 immunocompetent and 47 SOT patients hospitalized with COVID-19. Outcome variables were 30-day allcause mortality and invasive mechanical ventilation. Multivariate Cox regression analyses were performed and a propensity score (PS) was calculated. Results: SARS-CoV-2 RNAemia was demonstrated in 104 (22.9%) patients. Those with RNAemia were more frequently transplanted and presented a higher proportion of severe symptoms and signs. Mortality was 29.8% (31/104) and 3.4% (12/351) in RNAemic and non-RNAemic patients (p <0.001). The multivariate analysis adjusted by PS selected CURB-65≥2 (HR, 3.61;95% CI, 1.18-11.01;p = 0.02) and RNAemia (HR, 7.46;95% CI, 2.41-25.38;p = 0.001) as independent predictors of death. In the PS matching, SOT patients showed higher prevalence of RNAemia (57.6% vs. 13.6%) and mortality (HR, 4.56;95% CI, 1.47-7.13;p = 0.01). Conclusions: Positive RNAemia is an independent predictor of unfavorable outcome in immunocompetent and SOT. High viral load was linked to worse prognosis in a univariate analysis. Our findings help elucidate the pathogenesis of SARS-CoV-2 and provide insights for the better management of patients.
ABSTRACT
BACKGROUND: As most automated surveillance (AS) methods to detect healthcare-associated infections (HAIs) have been developed and implemented in research settings, information about the feasibility of large-scale implementation is scarce. AIM: To describe key aspects of the design of AS systems and implementation in European institutions and hospitals. METHODS: An online survey was distributed via e-mail in February/March 2019 among (i) PRAISE (Providing a Roadmap for Automated Infection Surveillance in Europe) network members; (ii) corresponding authors of peer-reviewed European publications on existing AS systems; and (iii) the mailing list of national infection prevention and control focal points of the European Centre for Disease Prevention and Control. Three AS systems from the survey were selected, based on quintessential features, for in-depth review focusing on implementation in practice. FINDINGS: Through the survey and the review of three selected AS systems, notable differences regarding the methods, algorithms, data sources, and targeted HAIs were identified. The majority of AS systems used a classification algorithm for semi-automated surveillance and targeted HAIs were mostly surgical site infections, urinary tract infections, sepsis, or other bloodstream infections. AS systems yielded a reduction of workload for hospital staff. Principal barriers of implementation were strict data security regulations as well as creating and maintaining an information technology infrastructure. CONCLUSION: AS in Europe is characterized by heterogeneity in methods and surveillance targets. To allow for comparisons and encourage homogenization, future publications on AS systems should provide detailed information on source data, methods, and the state of implementation.