The three facets of the SARS-CoV-2 pandemic during the first two waves in the northern, central, and southern Italy

Background: There is a scarcity of information in literature regarding the clinical differences and co-morbidities of patients affected by Coronavirus disease 2019 (COVID-19), which could clarify the different prevalence of the outcomes (composite and only death) between several Italian regions.Objective: This study aimed to assess the heterogeneity of clinical features of patients with COVID-19 upon hospital admission and disease outcomes in the northern, central, and southern Italian regions.Methods: An observational cohort multicenter retrospective study including 1210 patients who were admitted for COVID-19 in Infectious diseases, Pulmonology, Endocrinology, Geriatrics and Internal Medicine Units in Italian cities stratified between north (263 patients);center (320 patients);and south (627 patients), during the first and second pandemic waves of SARS-CoV-2 (from February 1, 2020 to January 31, 2021). The data, obtained from clinical charts and collected in a single database, comprehended demographic characteristics, co-morbidities, hospital and home pharmacological therapies, oxygen therapy, laboratory values, discharge, death and Intensive care Unit (ICU) transfer. Death or ICU transfer were defined as composite outcomes.Results: Male patients were more frequent in the northern Italian region than in the central and southern regions. Diabetes mellitus, arterial hypertension, chronic pulmonary and chronic kidney diseases were the comorbidities more frequent in the southern region;cancer, heart failure, stroke and atrial fibrillation were more frequent in the central region. The prevalence of the composite outcome was recorded more fre-quently in the southern region. Multivariable analysis showed a direct association between the combined event and age, ischemic cardiac disease, and chronic kidney disease, in addition to the geographical area.Conclusions: Statistically significant heterogeneity was observed in patients with COVID-19 characteristics at admission and outcomes from northern to southern Italy. The higher frequency of ICU transfer and death in the southern region may depend on the wider hospital admission of frail patients for the availability of more beds since the burden of COVID-19 on the healthcare system was less intense in southern region. In any case, predictive analysis of clinical outcomes should consider that the geographical differences that may reflect clinical differences in patient characteristics, are also related to access to health-care facilities and care modalities. Overall, the present results caution against generalizability of prognostic scores in COVID-19 patients derived from hospital cohorts in different settings.(c) 2023 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/li-censes/by-nc-nd/4.0/).

Efficacy of cefiderocol- vs colistin-containing regimen for treatment of bacteraemic ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii in patients with COVID-19.

INTRODUCTION: Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) in patients hospitalized in intensive care units (ICUs) is an important and challenging complication, including in patients with coronavirus disease 2019 (COVID-19). Considering the poor lung penetration of most antibiotics, including intravenous colistin due to the poor pharmacokinetics/pharmacodynamics at the infection site, the choice of the best antibiotic regimen is still being debated. METHODS: This single-centre, observational study was conducted from March 2020 to August 2022, and included all patients hospitalized consecutively with VAP and concomitant bloodstream infection due to CRAB in the COVID-ICU. The main goal of the study was to evaluate risk factors associated with survival or death at 30 days from VAP onset. A propensity score for receiving therapy was added to the model. RESULTS: During the study period, 73 patients who developed VAP and concomitant positive blood cultures caused by CRAB were enrolled in the COVID-ICU. Of these patients, 67 (91.7%) developed septic shock, 42 (57.5%) had died at 14 days and 59 (80.8%) had died at 30 days. Overall, 54 (74%) patients were treated with a colistin-containing regimen and 19 (26%) were treated with a cefiderocol-containing regimen. Cox regression analysis showed that chronic obstructive pulmonary disease and age were independently associated with 30-day mortality. Conversely, cefiderocol-containing regimens and cefiderocol + fosfomycin in combination were independently associated with 30-day survival, as confirmed by propensity score analysis. CONCLUSIONS: This real-life study in patients with bacteraemic VAP caused by CRAB provides useful suggestions for clinicians, showing a possible benefit of cefiderocol and its association with fosfomycin.

Morphological Changes of the Mindray Bc6800plus Diff Scattergram in Covid-19 Patients

Introduction: Covid-19 patients may have unusual arrangements of their blood count, compared to most viral infections. Neutrophilia can be associated with lymphopenia within the first few days. Therefore, an increasing neutrophil to lymphocyte ratio on admission has been considered an indicator of the disease severity Among the qualitative anomalies associated with the quantitative ones, reactive lymphocytes and nucleocytoplasmic morphological changes of the neutrophil granulocytes have been reported.Our study aimed to evaluate whether these leukocyte abnormalities modify the morphology of the instrumental cytograms of the Mindray BC6800plus haematological analyser resulting in diagnostic utility. Method(s): We evaluated the instrumental scattergrams provided by the Mindray BC6800plus analyser in 61patients admitted to the Monaldi and SS Trinita Hospitals (Naples and Borgomanero, Italy) with clinical evidence of SARSCoV- 2 infection confirmed with PCR research of viral RNA, comparing them with 61 healthy subjects. We used the 3D-Cube function - which allows a three-dimensional observation - to evaluate the lymphocyte and neutrophil cluster morphology in the DIFF scattergram. Blood cell morphology was assessed by microscopy. A prolonged microscopic review was performed in case of relevant lymphopenia. Result(s): Covid-19 samples showed evocative anomalies of the lymphocyte clusters in 47 out 61 samples (77%) related to the peripheral blood's morphological findings. Cytographic abnormalities concern the presence of an additional high fluorescence lymphocyte cluster - always well separated from the main one - with numerical consistency ranging between a few units to a few dozen (range 7.0 - 126) (Figure 1). Interestingly, the rotation of the 3D-Cube shows a widening of the high fluorescence cells along the FS axis attributable to the heterogeneity of cellular size (Figure 2). The microscopic review showed activated lymphocytes ranging between plasmacytoid and type III Downey morphologies. Positional indices of the neutrophil clusters showed significant differences from normal. Conclusion(s): Further studies need to associate positional indices with cytographic and microscopic anomalies of the neutrophils. The morphology of the lymphocyte clusters resulting from the 3D projections makes possible an accurate activated lymphocytes quantification, especially in severe lymphopenia thus evocative for Covid-19 infection and helpful for diagnostic and prognostic purposes.

On the use of clinical based infection data for pandemic case studies

Epidemiological models are relevant to study and analyze clinical as well as environmental and behavioural data, useful to support health studies. The target is to perform epidemiological analysis producing fast and reliable data access useful to guide prevention and curing processes. This is currently true in pandemic emergency as the current Covid-19 context. Epidemiological models should support in the early identification of pandemic phenomena and in making available data set for studying more accurate drug-based strategy for vaccines or virus containment.In this contribution we present an epidemiology database which integrates different types of clinical data to support research, follow-up and patient monitoring. The idea starts from an hospital databases cooperation integration where virus available data have been integrated to support statistical based studies. Starting from an available database containing 5 years data of infection related viruses (such as HPC, hepatitis) and patient anonymous data, the proposed system provide an integrated data access able to (i) extracting data filtered by means of clinical hypothesis based on patient profiles, environment and drugs and (ii) allowing to build large scale geographical data mappings in order to study correlations among chronic infection diseases and their relations with upcoming pandemic phenomena. Even if the application is in its infancy, the application is relevant with high very important applications. © 2020 IEEE.