ABSTRACT
Background. The seroprevalence of COVID-19 among health-care workers (HCWs) is still not well characterized in Latin America and the Caribbean. The objective of this study was to compare incidence rates (IR) during the COVID-19 pandemic among HCWs vs. non-HCWs in a university hospital in Cali, Colombia. (Table Presented) Methods. A prospective study was performed. The study included two groups: HCWs with high-risk contact of SARS-CoV-2 infections vs. administrative hospital workers (non-HCW). Seroprevalence of SARS-CoV-2 antibodies between both groups was compared according to vaccination history and confirmed SARS-CoV-2 infection during follow-up (March 6th, 2020, to February 28th, 2022). The study was developed in three phases according to the infection waves in Colombia, measuring antibodies anti-nucleocapsid and anti-spike serum concentration in each one. A descriptive analysis was done to compare both groups and IR per month (Figure 1). Results. 480 participants were included, 291 (60.6%) were HCWs, and 189 (39.4%) were non-HCWs. After the second wave and before vaccination, the accumulative seroprevalence was 40.6%: 49.1% of HCWs vs. 27.5% of non-HCWs (p< 0.001). 9.2% of HCWs and 7.9% of non-HCWs seropositive individuals had an asymptomatic infection (p=0.447). Of the 51.9% of susceptible HCWs and 72.5% of susceptible non-HCWs before the third wave, the risk of developing SARS-CoV-2 infection was 9.2% and 12.8%, respectively. After 24 months, the infection rate was higher in HCWs and non-HCWs (55.6% vs. 41.9%, p< 0.001) (Figure 2). The total IR was 31.4/1,000 person-month, with an IR difference of 21/1,000 person-month being higher in HCWs comparing non-HCWs (40.7 vs. 19.8, p< 0.001), but after vaccination (April 2021), the IR difference was not significative (IR difference 5%, p=0.1605). The asymptomatic disease was 9.8% of HCWs vs. 10.2% of non-HCWs. Since vaccination, 93.6% of workers had positive anti-S antibodies after 2 doses;and 100% had them after 3rd dose. SARS-CoV-2 Omicron variant increased cases during the fourth wave, more in non-HCWs. Conclusion. Before vaccination, HCWs had higher infection rates, mainly after the second wave. However, after the immunization, the IR in both groups significantly decreased and equalized in both groups.
ABSTRACT
Background. Secondary infections are common among severe COVID-19 patients, increasing complications and mortality risk. These infections are not well characterized in Latin America and the Caribbean. Methods. A cross-sectional observational study of adult patients with COVID-19 admitted to the hospital Fundacion Valle del Lili in Cali-Colombia from March 2020 to March 2021. Demographic data, clinical characteristics, laboratory parameters, and clinical outcomes were collected. We describe secondary infection, antibiotic therapy, and antibiotic resistance profiles. Secondary infection was defined if the diagnosis occurred >=48 hours after hospital admission for COVID-19. Results. A total of 2138 patients with COVID-19 were analyzed;350 (16.3%) presented secondary infection. 60% were male;the median age was 65 years [IQR: 55-72]. Glucocorticoid therapy was indicated in 335 patients (96.3%). 281 received high doses and 54 low doses. Bacterial infections were the most common, affecting 81.3 % of patients, followed by fungal (14.4%) and viral (4.3%) infections. Most bacterial isolates were orotracheal secretion, blood, urine, and bronchoalveolar lavage fluid culture. The three most frequently identified bacteria were Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. Most of the initial isolates were not antibiotic-resistant (75-89.7%). Empiric antibiotic therapy was indicated in 346 patients (98.9%), 268 received carbapenems (76.6%), 267 Vancomycin (76.3%), and 233 cefepime (66.6%). Of the 350 patients, 327 (93.4%) required management in the intensive care unit, and overall mortality was 35.4% (124/350). Conclusion. Our results showed a lower frequency of secondary infection than previous reports;However, a high frequency of broad-spectrum antibiotics usage was found despite a high prevalence of non-resistant bacteria. Further studies are needed to establish the best approach for antibiotics therapy.
ABSTRACT
Background. Differences in access to specialized medical care services and their overcrowding due to the pandemic could impact clinical outcomes. Availability of newer treatments, vaccination, and emergence of newer SARS-CoV-2 variants could also explain these differences. Methods. We performed a single-centered, observational study comparing clinical outcomes of COVID-19 admitted to the emergency department among the first three waves of the pandemic defined as June to August 2020, November 2020 to January 2021, and May to July 2021, respectively. The primary outcomes included intensive care unit admission, invasive mechanical ventilation requirement, hospital length of stay, and hospital mortality categorized by age groups. Effective COVID 19 antiviral therapy and monoclonal antibodies are not available in Colombia. Vaccination was available after March 2021. Results. Out of a total of 2264 patients were admitted. Fifty-six percent were male, with a median age of 58 years [IQR, 45-70]. A significant increase of patients was seen after each wave: 530 in the first, 568 in the second, and 1166 in the third-wave worsening hospital overcrowding. Patients from the third wave were significantly younger (59 vs. 62 vs. 56 years, p < 0.01). Patients from the first wave had higher proportion of intensive care unit admission (62.83% vs. 51.23% vs. 52.23%, p< 0.01), invasive mechanical ventilation (39.25% vs. 32.22% vs. 31.22%, p< 0.01), and length of hospital stay (9 vs 7 vs 7 days, p< 0.01). Overall, no difference was found inmortalityamong waves (18.4%vs 19% 18.8%, p = 0.974). However, patients of 70-79 and >= 80 had a lower mortality during the third wave (24.4% vs 33.3% vs 19%, p=0.018), (30.6% vs 29.6% vs 23.6%, p=0.018). Vaccination was very low in all the age groups but was higher in elderly patients. Conclusion. Overall mortality did not increase between infection waves, although there was an increase in cases during the third wave. We found a significant decrease in mortality among the elderly. Major efforts of medical teams succeed in containing COVID 19 mortality.