ABSTRACT
Objective of the study: The aim of this study was to evaluate the trend of the incidence of deep vein thrombosis (DVT), using serial compression ultrasound (CUS) surveillance, in patients hospitalized with COVID-19 pneumonia in a non-ICU setting in different waves of the pandemic. Methods: Multicenter, prospective study of patients with COVID- 19 pneumonia admitted to Internal Medicine units. All patients were screened for DVT with serial CUS. Anticoagulation was defined as low dose, intermediate dose, high dose. Results: Two periods of time, named first wave (March-May 2020) and subsequent waves (November 2020- April 2021), were considered, and a total of 363 consecutive patients with moderate-severe COVID-19 pneumonia were enrolled. The incidence of DVT was 13.7% in the first wave, and 4.2% in subsequent waves (p=0.002). Almost all patients received anticoagulation (LMWH 89,8%) at the following doses: low 50.4%, intermediate 25.6%, high 23.1%. Patients enrolled in the first and subsequent waves had similar clinical characteristics, nevertheless a difference in anticoagulant regimen (lower doses in the first wave, p=0.005) was observed. Patients enrolled in subsequent waves were more likely treated at home before hospitalization with LMWH (p<0.001). Conclusions: We noted a significant reduction in the incidence of DVT over time during the Sars-CoV-2 pandemic. Among other factors, a significant increase in thromboprophylaxis prior to hospitalization, and the increase of the dosage of anticoagulation during hospitalization probably played a relevant role.
ABSTRACT
Background: CoViD-19 pneumonia has a bacterial co-infection rate about 3-5% at the admission to hospital care. The aim of our study is to assess the utility of pneumococcal urinary antigen (Ag) test in the diagnosis of bacterial pulmonary co-infection in CoViD- 19 pneumonia and its support in the decision about antibiotic therapy. Materials and Methods: We searched in NIH and PubMed for a revision of literature about the characteristics of pneumococcal urinary Ag test and the respiratory co-infection rate in CoViD-19 pneumonia. We analyzed1268 cases of pneumonia admitted at the hospital: 703 CoViD-19 pneumonia and 565 community-acquired pneumonia. We compared positivity test rate in these two groups, the presence of clinical features suggestive for bacterial co-infection and antibiotic treatment rates. Results: There was no statistical significative difference rate of positive test between the two groups (p-value=0,6): 703 CoViD- 19 pneumonia,10,8% (N=76) positive and 89,2% (n=627) negative;565 community-acquired pneumonia, 9,9% (n=56) positive and 90,1% (509) negative. Positive test wasn't always correlated with sign/symptoms of bacterial co-infection;the rate of antibiotic treatment was higher in community-acquired pneumonia group than in CoViD-19 pneumonia one. Conclusions: In conclusion, we support the use of pneumococcal Ag test in CoViD-19 pneumonia patients with sign/symptoms suggestive for bacterial co-infection. A positive test in this subgroup of patients must be considered as diagnostic for pneumococcal pneumonia and antibiotic treatment must be started.
ABSTRACT
A diagnostic algorithm that allows for the rapid identification of sepsis and possibly guides the appropriate antimicrobial therapy application is the cornerstone to obtaining effective treatment and better results. The use of emerging surrogate markers could significantly improve clinical practice, but the validity and clinical utility have been proved only for very few of them, and their availability in clinical routine is limited. For this purpose, numerous scientific evidence has indicated procalcitonin as a marker linked to sepsis and its evolution. This review aims to retrace the main evidence relating to the use of procalcitonin in sepsis. We analyzed the primary studies in the literature and the existing meta-analysis evaluating the behavior of procalcitonin as a marker of bacterial sepsis, its prognostic power, and its ability to influence antibiotic therapy. Recent evidence has suggested that procalcitonin could be an efficient marker for diagnosing sepsis and its therapeutic management in many types of patients. The choice of the appropriate timing to initiate and suspend antibiotic therapy, with obvious clinical advantages, the favorable effects could also include reducing health costs, both avoiding the administration of inappropriate antibiotic therapies, and reducing the duration of hospitalization. Moreover, limited studies reported high procalcitonin levels in coronavirus disease 2019 patients with a worse prognosis. Despite the considerable evidence in favor of the potential of procalcitonin as an index for managing septic patients, there are conflicting data that deserve specific and detailed studies. © 2021 the Author(s).
ABSTRACT
Available data suggest that the issue of CoViD-19 is particularly critical in patients with diabetes. In Italy, Internal Medicine (IM) wards have played a pivotal role in contrasting the spread of SARS-Cov2. During this pandemic, FADOI submitted a brief questionnaire to a group of its members acting as Head of IM units. Considering 38 units, 58% of beds dedicated to CoViD patients in CoViD Hospitals were in charge of IM, and globally cared for 6650 patients during a six-week period. Of these patients, 1264 (19%) had diabetes. Mortality rate in CoViD patients with or without diabetes were 20.5% and 14%, respectively (p < 0.001). Our survey seems to confirm that diabetes is a major comorbidity of CoViD-19, but it does not support an increased incidence of CoViD-19 infection in people with diabetes, if compared with the figures of patients with diabetes and hospitalized before the outbreak. On the other side, patients with diabetes appeared at a significantly increased risk of worse outcome. This finding underlines the importance of paying special attention to this patient population and its management.