Healthcare-associated infections on the ICU in 21 Brazilian hospitals during the early months of the COVID-19 pandemic: an ecological study.

OBJECTIVE: The COVID-19 pandemic has caused a global health crisis and may have affected healthcare-associated infections (HAI) prevention strategies. This study aims to evaluate the impact of the COVID-19 pandemic on HAI incidence in Brazilian ICUs. METHODS: This ecological study compared adult patients admitted to the ICU from April through June 2020 (pandemic period) with the same period in 2019 (pre-pandemic period) in 21 Brazilian hospitals. The difference in microbiologically confirmed central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) incidence density (cases per 1,000 patient days), the proportion of organisms that caused HAI, and antibiotic consumption (DDD) between the pandemic and the pre pandemic periods were compared in a pairwise analysis using the Wilcoxon signed rank sum test. RESULTS: We observed a significant increase in median CLABSI incidence during the pandemic (1.60 [0.44-4.20] vs. 2.81 [1.35-6.89], p = 0.002). There was no difference in VAP incidence between the two periods. In addition, there was a significant increase in the proportion of CLABSI caused by Enterococcus faecalis and Candida species during the pandemic, although only the latter retained statistical significance after correction for multiple comparisons. There was no significant change in ceftriaxone, piperacillin/tazobactam, meropenem, or vancomycin consumption between the studied periods. CONCLUSIONS: There was an increase in CLABSI incidence in Brazilian ICUs during the first months of COVID-19 pandemic. Additionally, we observed an increase in the proportion of CLABSI caused by E. faecalis and Candida species in this period. CLABSI prevention strategies must be reinforced in ICUs during the COVID-19 pandemic.

IMPACTO DO PROGRAMA DE GERENCIAMENTO DO USO DE ANTIMICROBIANOS-STEWARDSHIP (ASP) NA UNIDADE DE TERAPIA INTENSIVA DURANTE A PANDEMIA DA COVID-19 EM UM HOSPITAL PRIVADO EM SÃO PAULO

Introdução A pandemia da COVID-19 trouxe diversos impactos negativos para a saúde no mundo e um dos pontos recentemente destacados é o seu papel no aumento do consumo de antimicrobianos e nas infecções por micro-organismos multirresistentes. Objetivo Descrever o impacto de um Programa de Stewardship de Antimicrobianos (ASP) nas Unidades de Terapia Intensiva de um hospital privado comparando os dados de consumo de antimicrobianos (ATM), a taxa de infecção relacionada a dispositivos invasivos e a bacteremia por bacilos gram-negativos resistentes a carbapenêmicos (BGN Carba-R) no período pré-implantação (antes da pandemia da COVID 19) com o pós-implantação (durante a pandemia da COVID-19). Método O ASP foi estruturado e teve sua atuação plena a partir de 2020 com avaliação diária de todos os antimicrobianos por infectologistas e farmacêuticos clínicos com registro em prontuário eletrônico. O consumo de ATM foi mensurado em dias de terapia (DOT) e por dose diária definida (DDD) por 1000 pacientes-dia. Foram consideradas as IRAS relacionadas a dispositivos invasivos (pneumonia, infecção urinária e infecção da corrente sanguínea), com cálculo da densidade de incidência (DI) por 1000 dispositivos-dia. Os pacientes foram estratificados em pacientes COVID-19 e não-COVID-19. Resultados Após a implantação do programa de Sterwardship houve queda do consumo de ATM em nosso serviço: comparando-se o consumo em todas as áreas de 2020 e 2021 versus 2019 houve redução de 12,72% do DOT Geral e 12,19% do DDD Geral;49,33% do DOT de Meropenem e 50% do DDD de Meropenem. Quando se analisam apenas as áreas não-COVID essa redução é de 21,23% no DOT Geral;26,16% no DDD Geral;49,33% No DOT de Meropenem e 62,48%no DDD de Meropenem. Dos 18 ATM avaliados, 14 apresentaram redução em consumo nesse período. A economia mensurada em custo de medicação foi de R$460490,90 em 2020 e R$ 782693,35 em 2021. Acompanhando a redução de consumo de ATM houve redução no número de bacteremias por BGN CarbaR de 21 para 2 em 2020 e 7 em 2021, com DI de 1,53/ 1000 paciente.dia para 0,33 em 2020 e 0,47 em 2021. A mortalidade geral do serviço foi de 5,5 % em 2019, 5% em 2020 e 3,7% em 2021. Conclusão Apesar dos relatos do aumento do consumo de antimicrobianos e consequentemente da multirresistência ao redor do mundo durante a pandemia da COVID-19, a atuação ativa dos profissionais do ASP em concordância com a equipe médica nas UTI, resultou em um uso sustentável dos antimicrobianos e consequente associação na redução das bacteremias por BGN Carba-R.

Hydroxychloroquine plus azithromycin early treatment of mild COVID-19 in an outpatient setting: a randomized, double-blinded, placebo-controlled clinical trial evaluating viral clearance.

BACKGROUND: Hydroxychloroquine has shown potential to block viral replication of SARS-CoV-2 in some in vitro studies. This randomised, double-blinded, placebo controlled clinical trial evaluated the efficacy of hydroxychloroquine plus azithromycin (HCQ/AZT) in reducing viral loads in patients with early and mild SARS-CoV-2 infection. METHODS: A single-centre randomised placebo-controlled clinical trial was conducted with outpatients with early and mild SARS-CoV-2 infection. Inclusion criteria were: patients aged 18-65 years with symptoms suggestive of COVID-19 for < 5 days, no significant comorbidities, and positive nasopharyngeal/oropharyngeal swab screening tests (POCT-PCR). Randomised patients received either hydroxychloroquine for 7 days plus azithromycin for 5 days or placebo. The primary endpoint was viral clearance within a 9-day period. Secondary endpoints included viral load reduction, clinical evolution, hospitalization rates, chest computed tomography evolution, and adverse effects. RESULTS: From 107 potential trial participants, 84 were enrolled following predetermined criteria. Statistical analyses were performed on an intention-to-treat (N = 84) and per-protocol (PP) basis (N = 70). On the PP analysis, the treatment (N = 36) and placebo (N = 34) groups displayed similar demographic characteristics. At 95% CI, no statistically significant between-group differences were found in viral clearance rates within 9 days following enrolment (P = 0.26). CONCLUSIONS: This randomised, double-blinded, placebo-controlled clinical trial evaluating outpatients with early and mild COVID-19 showed that viral clearance rates within a 9-day period from enrolment did not change with HCQ/AZT treatment compared with placebo, although no major cardiovascular events were observed in participants without comorbidities. Secondary outcomes were also not significantly improved with HCQ/AZT treatment compared with placebo. These findings do not support use of HCQ/AZT in this setting.