ABSTRACT
Background. The incidence of bacterial or fungal coinfections in COVID-19 patients is low. The incidence of nosocomial superinfections is higher, especially related to ICU admission. Treating COVID-19 with steroids plus tocilizumab (TCZ) has been associated with superinfections. Therefore, the use of antibiotic prophylaxis prior to infusion of TCZ could be considered to reduce the risk of life-threatening superinfections in critically ill patients. Methods. Retrospective, single center cohort study. COVID-19 patients older than 14 years, admitted to Hospital Central de la Defensa (Madrid, Spain) from Mar 5th to Nov 24th, 2020 with a diagnosis of COVID-19 were included. Local protocols suggested antimicrobial prophylaxis before the infusion of TCZ. Medical records, treatments received, and microbiological data of all patients who received TCZ were reviewed. Microbiological isolates were considered in the 14 days following the administration of TCZ. Two ID specialists independently reviewed the medical record and decided to qualify the isolate as superinfection or colonization. Results. 2,069 patient records were analyzed. 70 patients received TCZ;all of them were admitted to ID wards and under steroid treatment. 45 (64,5%) patients received antibiotic prophylaxis. The preferred antibiotics were ceftriaxone (N = 18) and ceftobiprole (N = 14). No significant differences were found in age, Charlson index or COVID-19 SEIMC-Score. 24 isolates were detected in 14 patients (18 bacterial, 6 fungal). 17 isolates were considered superinfections;the most frequent isolates were C. albicans (N=5), E. faecalis (N=3) and S. epidermidis (N=2). There were no statistically significant differences between the different prophylaxis strategies in terms of in-hospital mortality or ICU admission. However, patients who received ceftobiprole tended to have fewer isolates and fewer superinfections than those receiving ceftriaxone (ceftobiprole group: 2 isolates in 1 patient, 1 (7,1%) patient with superinfection;ceftriaxone 11 isolates in 5 patients, 4 (22,2%) patients with superinfection) (p= 0,35, Fisher exact test). Conclusion. Antibiotic prophylaxis prior to infusion of TCZ in patients with COVID-19 and receiving steroids could determine the profile of bacterial and fungal superinfections.
ABSTRACT
SUMMARY Introduction: On December 31, 2019, the World Health Organization was informed of a group of cases of pneumonia of unknown etiology detected in the city of Wuhan (China). On January 30, 2020, the nCoV-2019 outbreak (later SARS-CoV-2) was declared a public health emergency of international concern. In this context, some western countries decided to evacuate their citizens. Aim: This article describes the approach taken in the case of people evacuated from Wuhan upon arrival in Spain. Methods: Information was collected on the criteria for selecting facilities and personnel, the number of quarantine cases, the infection control strategy, the duration of quarantine, clinical monitoring, and other relevant aspects. Results: The Spanish health authorities selected the Gómez Ulla Central Defense Hospital to carry out a hospital quarantine. Twenty-one people were transferred from Wuhan to Madrid, including two children. Preventive medicine and infectious disease physicians were selected to direct and assist surveillance. The visits were authorized following an established protocol. Conclusions: This is the first hospital quarantine report for SARS-CoV-2, designed specifically for returnees. Hospitalarian quarantine could be a useful method for selected cases of highly contagious diseases. However, good resource and facility support, selection of experienced staff, and revised protocols are required.