Evaluation of changes in antimicrobial susceptibility in bacteria infecting children and their mothers in pediatric, neonatal-intensive care unit, and gynecology/obstetrics wards of a quaternary referral hospital during the COVID-19 pandemic.

The World Health Organization released a statement warning of increased risk for the incidence of multidrug resistant microorganisms and the absence of new drugs to control such infections soon. Since the beginning of the COVID-19 pandemic, the prescription of antimicrobial agents has increased and may have accelerated the emergence of multidrug resistant (MDR) bacteria. This study aimed to evaluate maternal and pediatric infections within a hospital from January 2019 to December 2021. An observational retrospective cohort study was performed at a quaternary referral hospital in a metropolitan area of Niteroi city, Rio de Janeiro state, Brazil. A total of 196 patients' medical records were analyzed. The data from 90 (45.9%) patients were collected before the SARS-CoV-2 pandemic, 29 (14.8%) from the 2020 pandemic period, and 77 (39.3%) from the 2021 pandemic period. A total of 256 microorganisms were identified during this period. Out of those, 101 (39.5%) were isolated in 2019, 51 (19.9%) in 2020, and 104 (40.6%) in 2021. Antimicrobial susceptibility tests were performed on 196 (76.6%) clinical isolates. The exact binomial test showed that the distribution of Gram-negative bacteria was predominant. The most common microorganism was Escherichia coli (23%; n = 45), followed by Staphylococcus aureus (17.9%, n = 35), Klebsiella pneumoniae (12.8%, n = 25), Enterococcus faecalis (7.7%, n = 15), Staphylococcus epidermidis (6.6%, n = 13) and Pseudomonas aeruginosa (5.6%, n = 11). Staphylococcus aureus was the predominant species among resistant bacteria. Among the antimicrobial agents tested, the following were resistant, presented on a descending scale: penicillin (72.7%, p = 0.001, Binomial test), oxacillin (68.3%, p = 0.006, Binomial test), ampicillin (64.3%, p = 0.003, Binomial test), and ampicillin/sulbactam (54.9%, p = 0.57, Binomial test). Infections with S. aureus were 3.1 times greater in pediatrics and maternal units than in other hospital wards. Despite the global reduction in the incidence of MRSA, we observed an increase in MDR S. aureus in this study. No changes were observed in the frequency of resistance profiles of the clinical isolates after the establishment of the global SARS-CoV-2 pandemic. More comprehensive studies are needed to understand the impact of the global SARS-CoV-2 pandemic on the resistance levels of bacteria associated with neonate and pediatric patients.

Association of upper respiratory Streptococcus pneumoniae colonization with SARS-CoV-2 infection among adults.

BACKGROUND: Streptococcus pneumoniae interacts with numerous viral respiratory pathogens in the upper airway. It is unclear whether similar interactions occur with SARS-CoV-2. METHODS: We collected saliva specimens from working-age adults receiving SARS-CoV-2 molecular testing at outpatient clinics and via mobile community-outreach testing between July and November 2020 in Monterey County, California. Following bacterial culture enrichment, we tested for pneumococci by quantitative polymerase chain reaction (qPCR) targeting the lytA and piaB genes, and measured associations with SARS-CoV-2 infection via conditional logistic regression. RESULTS: Analyses included 1,278 participants, with 564 enrolled in clinics and 714 enrolled through outreach-based testing. Prevalence of pneumococcal carriage was 9.2% (117/1,278) among all participants (11.2% [63/564] clinic-based testing; 7.6% [54/714] outreach testing). Prevalence of SARS-CoV-2 infection was 27.4% (32/117) among pneumococcal carriers and 9.6% (112/1,161) among non-carriers (adjusted odds ratio [aOR]: 2.73; 95% confidence interval: 1.58-4.69). Associations between SARS-CoV-2 infection and pneumococcal carriage were enhanced in the clinic-based sample (aOR = 4.01 [2.08-7.75]) and among symptomatic participants (aOR = 3.38 [1.35-8.40]), when compared to findings within the outreach-based sample and among asymptomatic participants. Adjusted odds of SARS-CoV-2 co-infection increased 1.24 (1.00-1.55)-fold for each 1-unit decrease in piaB qPCR CT value among pneumococcal carriers. Last, pneumococcal carriage modified the association of SARS-CoV-2 infection with recent exposure to a suspected COVID-19 case (aOR = 7.64 [1.91-30.7] and 3.29 [1.94-5.59]) among pneumococcal carriers and non-carriers, respectively). CONCLUSIONS: Associations of pneumococcal carriage detection and density with SARS-CoV-2 suggest a synergistic relationship in the upper airway. Longitudinal studies are needed to determine interaction mechanisms between pneumococci and SARS-CoV-2.

Worsening pain and quality of life for spine surgery patients during the COVID-19 pandemic: roles of psychological distress and patient activation

BACKGROUND CONTEXT The consequences of public health protection measures may include loss of income, lack of access to basic resources (including health care), and increased psychological burdens. This has led to cancellation of elective surgical cases and greater reliance on telemedicine to conduct consultations and maintain patient access to orthopedic providers. Little is currently known regarding the effects that this has on spine surgery patients and their recovery. The effects of the COVID-19 pandemic may affect individuals differently according to their access to socioeconomic resources, preexisting burden of psychological distress, and knowledge, skills, and confidence to manage their health care. Evidence suggests that the presence of psychological distress, defined as a high burden of symptoms of anxiety and/or depression, is associated with poorer postoperative outcomes than those for patients without psychological distress. Because of the effects of the pandemic, patients may need to rely more than ever on their internal strengths as they recover from spine surgery. One measure of internal strength is “patient activation,” which is a hierarchical construct that encompasses the knowledge, skills, and confidence to manage one's health care. Patient activation may mitigate the negative effects of psychological stress in patients undergoing spine surgery. PURPOSE We tested the hypotheses that patients with greater socioeconomic resources would experience less disruption of access to basic resources;those with psychological distress would experience worsening pain and HRQOL;and those with high patient activation would experience less worsening of pain and HRQOL. STUDY DESIGN/SETTING This was a prospective survey of patients presenting to an academic medical center. PATIENT SAMPLE We selected adults who had undergone or were scheduled to undergo spine surgery for cervical or lumbar spine degeneration or deformity correction at our academic center. Between May 1, 2020 and July 31, 2020, patients were asked to complete a survey regarding the effects of COVID-19 on their health, well-being, and personal life. Surveys were sent to 1,506 patients, 431 of whom (29%) completed and returned them. The mean (± standard deviation [SD]) age of the 431 respondents was 61 ± 15 years. Fifty-five percent of respondents identified as female, and most respondents were non-Hispanic (92%) and white (81%). Most reported living with a partner (71%) and were not currently employed (68%). Approximately one-fifth of respondents reported an annual household income of ≤$50,000, and 120 reported having less than a college education. Two hundred twenty-nine patients were being treated for a degenerative lumbar condition, 118 for a degenerative cervical condition, and 84 for spinal deformity. We found no significant differences between groups in terms of demographic characteristics. OUTCOME MEASURES Respondents reported on their access to basic resources and health care and on their health and wellness. Patients scored their worst back, leg, neck and arm pain during the previous week on a numeric rating scale, with 0 representing no pain and 10 representing the worst imaginable pain. Patients completed the Patient-Reported Outcome Measurement Information System 29-Item profile (PROMIS-29), version 2, which assesses HRQOL using the following domains: pain interference, Physical Function, Fatigue, Anxiety, Depression, Sleep Disturbance, and Satisfaction with Participation in Social Roles. At their preoperative visit, patients provided information on their annual income and highest level of education attained and completed assessments of psychological distress (anxiety and depression) and patient activation. Patient activation was assessed using the Patient Activation Measure. Psychological distress was assessed from PROMIS-29 domains. Methods We surveyed 431 patients who had undergone or were scheduled for surgical treatment of lumbar or cervical spine degeneration or deformity at 1 institution. The survey inquired about the effec s of COVID-19 on patients’ access to basic resources and health care and assessed pain (numeric rating scale) and HRQOL (PROMIS-29). We compared the proportions of patients who reported worsening pain and HRQOL between groups defined by presence of psychological distress and high patient activation measured before the pandemic. Alpha = 0.05. Results Respondents reported only minor disruptions in access to basic resources but significant worsening of pain and HRQOL during COVID-19. Health care access was interrupted, with 117 respondents (43%) reporting a canceled health care appointment. Respondents who had undergone spine surgery before the pandemic (N = 296) reported significantly worse outcomes between the most recent pre-pandemic and COVID-19. assessments. During COVID-19, respondents reported worsening of the following: back pain (mean increase, 0.57 ± 3.0 points;p=.027), leg pain (mean increase, 0.74 ± 3.4 points;p=.013), physical function (mean decrease, 2.4 ± 7.5 points;p<.001), fatigue (mean increase, 3.8 ± 9.6 points;p<.001) and satisfaction with participation in social roles (mean decrease, 1.9 ± 11 points;p=.048). Those with psychological distress were more likely to experience clinically relevant worsening of back pain, leg pain and physical function than those without distress (p<.01 for all outcomes). High patient activation (measured before the pandemic) was associated with less worsening of physical function (p = 0.031). Conclusions Spine surgery patients reported little disruption in access to basic resources during COVID-19. Psychological distress was associated with worsening of pain and HRQOL. High patient activation appeared to mitigate the worsening of physical function during COVID-19. Health care systems should screen for psychological distress and patient activation and, during times of disruption, enhance supports to manage pain and maintain HRQOL. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements.

The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.

Departmental Experience and Lessons Learned With Accelerated Introduction of Telemedicine During the COVID-19 Crisis.

Despite the use of digital technology in healthcare, telemedicine has not been readily adopted. During the COVID-19 pandemic, healthcare systems have begun crisis management planning. To appropriately allocate resources and prevent virus exposure while maintaining effective patient care, our orthopaedic surgery department rapidly introduced a robust telemedicine program during a 5-day period. Implementation requires attention to patient triage, technological resources, credentialing, education of providers and patients, scheduling, and regulatory considerations. This article provides practical instruction based on our experience for physicians who wish to implement telemedicine during the COVID-19 pandemic. Between telemedicine encounters and necessary in-person visits, providers may be able to achieve 50% of their typical clinic volume within 2 weeks. When handling the massive disruption to the routine patient care workflow, it is critical to understand the key factors associated with an accelerated introduction of telemedicine for the safe and effective continuation of orthopaedic care during this pandemic. LEVEL OF EVIDENCE:: V.