ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Various case reports have associated transient sinus bradycardia with Remdesivir (RDV) therapy for SARS-CoV2 infection. Pallotto et al., Gubitosa et al., and Touafchia et al. all reported the association of Remdesivir with increased risk of bradycardia in small samples of patients treated with RDV for COVID-19. To our knowledge, no large studies looked at this side effect of RDV therapy. We aimed to analyze the association between sinus bradycardia and Remdesivir therapy for COVID-19. METHODS: A retrospective case-control analysis was done for 1535 patients with SARS-CoV2 infection who were admitted to four teaching hospitals in an urban area in 2020. The mean age was 66 years (SD of 16.7, range 18-99), with 774 males (50.4%). Patients were divided into cases (treated with RDV) and controls (not treated with RDV). Multivariate logistic regression methods were used to analyze the associations between independent variables and outcomes. Pulse rate variables were recorded as pulse rate at day-0, day-3, day-7, and incidence of bradycardia on three consecutive days during admission. Other variables recorded were age, gender, comorbidities, prior history of cardiac disease/arrhythmias, concomitant medications (including AV nodal blockers, dexamethasone, Albuterol, and Lasix), and ICU admission. Survival analysis was run for 7-day and 30-day mortality, as well as survival to hospital discharge. RESULTS: 1415 patients were included in the final analysis, after the exclusion of 120 patients with previous heart blocks. 600 patients (39.1%) were in the Remdesivir group, and 935 patients (60.9%) were in the control group. Between both groups, a total of 454 patients (29.6%) had transient bradycardia on three consecutive days during hospitalization. A multivariate regression analysis was done after adjusting for all confounding variables (age, gender, history of cardiac diseases, AV-nodal blocking drugs, dexamethasone, furosemide, and albuterol therapy). It was seen that there was no statistically significant association between RDV therapy and persistent transient bradycardia (transient bradycardic events on three consecutive days) (Odds Ratio 0.823, 95% confidence interval (CI) 0.594-1.134, p=0.236). There was no statistically significant association of RDV therapy with patients having any bradycardia event during hospitalization in a sub-analysis (Odds Ratio 0.888, 95% confidence interval (CI) 0.665-1.184, p=0.419). Also, RDV failed to show any statistically significant mortality benefit (OR 1.1, CI 0.75-1.62, p=0.6). CONCLUSIONS: Our findings indicate that although transient sinus bradycardia in patients with COVID-19, can be triggered by severe hypoxia, inflammatory damage to AV-nodal cells, or exaggerated response to medications, there was no statistically significant association of RDV therapy with the risk of developing bradycardia. RDV therapy should not be withheld in patients at risk of developing bradycardia. CLINICAL IMPLICATIONS: Remdesivir therapy did not increase the risk of developing bradycardia in our patient population. RDV therapy should not be withheld in patients at risk of developing bradycardia. Larger RCTs are needed to validate these findings. DISCLOSURES: No relevant relationships by Rahul Bollam, source=Web Response No relevant relationships by Bhagat Kondaveeti, source=Web Response No relevant relationships by Florencio Mamauag, source=Web Response No relevant relationships by Kainat Saleem, source=Web Response No relevant relationships by Manasi Sejpal, source=Web Response No relevant relationships by Megha Sood, source=Web Response No relevant relationships by Morgan Stalder, source=Web Response No relevant relationships by Rosalie Traficante, source=Web Response No relevant relationships by Syed Arsalan Zaidi, source=Web Response
ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The COVID-19 pandemic has affected over half a billion people worldwide. Series report that up to 75% of hospitalized patients with COVID-19 receive broad-spectrum antibiotics;however, the incidence of bacterial coinfection is consistently reported to be low. The diagnosis of bacterial superinfection of the lungs (BSL) is clinical, which presents the possibility of overdiagnosis and overutilization of antibiotics. The aim of this study was to describe the outcomes of patients who were treated for a bacterial superinfection of the lungs (BSL) compared to those who were not. METHODS: We conducted a retrospective chart review of all consecutive patients with a diagnosis of COVID-19 hospitalized at our center. We defined BSL as a documented episode of pneumonia treated with antibiotics. We collected information on demographics, comorbidities, and microbiological markers. We compared patients with and without a diagnosis of BSL in terms of intensive care unit (ICU) stay, intubation, length on mechanical ventilation, length of hospital stay (LOS) and 7-day and 30-day mortality. RESULTS: Five hundred eighty-two patients had a diagnosis of COVID-19, of which 105 had BSL. Patients with BSL were older compared to those without BSL (mean age 74 vs 70 years) and more likely to be male (57% vs 47%), but they were similar in proportion of White patients (64 vs 63.6) and Charlson comorbidity index (5 vs 4). Patients with BSL had a higher likelihood of admission to the ICU (63% vs 19%) and higher intubation rates (31% vs 9%). BSL patients had longer mechanical ventilation (9 vs 3 days) and greater length of stay (13 vs 7). Only 17 BSL patients had sputum cultures, of which 10 were positive. None of the BSL patients had a positive Legionella urinary antigen or Streptococcus pneumoniae urinary antigen, and only 6/57 (10.5%) had a positive MRSA nasal screen. Seven-day and 30-day mortality were not statistically different between BSL and non-BSL patients (p=0.18, p=0.65 respectively). Interestingly, Cox proportional hazard analysis adjusted for age, sex, race, CCI and ICU stay yielded a significantly reduced mortality at 7 and 30-day among BSL patients (HR=0.2 CI [.1-0.7], p=.0106, HR=0.5 [CI.3-0.8], p=0.0101, respectively). CONCLUSIONS: Patients with BSL received more intense supportive care, and had a longer ICU stay, yet did not have a greater mortality. When adjusting for age, sex, race, CCI and ICU, there was a significant reduction in mortality. It is tempting to interpret these finding as an effect of antibiotics;however, we did not record COVID-19-specific treatments such as steroids, tocilizumab and remdesivir. It is likely that the BSL patients received more steroids, which have been associated with reduced mortality. In our population, microbiological testing was performed in a minority of patients, and it was therefore not a reliable marker of true infection. It is possible that many patients in the BSL group did not truly have a bacterial infection. CLINICAL IMPLICATIONS: Patients with a diagnosis of BSL were sicker, but we observed no difference in unadjusted mortality. Studies on the outcomes of the BSL among COVID-19 patients should account for the effect of concurrent COVID-19 specific therapy. DISCLOSURES: No relevant relationships by Abdelrhman Abo-zed, source=Web Response No relevant relationships by Abasin Amanzai, source=Web Response No relevant relationships by Ricardo Arbulu Guerra, source=Web Response No relevant relationships by NIRZARI PANDYA, source=Web Response No relevant relationships by Morgan Stalder, source=Web Response No relevant relationships by Rosalie Traficante, source=Web Response No relevant relationships by Mohamed Yassin, source=Web Response
ABSTRACT
SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: S. Aureus is a cause of community acquired pneumonia in the winter months. It is associated with severe disease and is more severe when occurring with influenza infection. We report a case of MRSA pneumonia secondary to influenza infection, with an interesting journey to the patient's ultimate diagnosis. CASE PRESENTATION: A 34-year-old woman, working as a nursing assistant in a nursing facility with no chronic medical conditions presented with thick purulent blood tinged sputum, subjective fevers, night sweats and chest pain. She immigrated to the US in 2009 from southeast Asia and had a positive PPD in the past for which she did not undergo treatment. Of note she did have a viral upper respiratory infection 2 weeks prior to presentation treated with a course of Levofloxacin. She was found to have a positive influenza swab at that time as well. A CT chest with contrast obtained during this admission revealed a large thick-walled cavitations bilaterally, involving the apical segment of the right upper lung and the apical posterior segment of the left upper lobe. The differential at this time remained broad, given her numerous risk factors for tuberculosis and COVID-19. The patient underwent AFB testing which was negative and COVID-19 testing which was negative. Three days after admission, her blood cultures grew MRSA. The patient was treated with Vancomycin and eventually discharged home with antibiotics, with improvement in her clinical status. DISCUSSION: MRSA is an important cause of necrotizing pneumonia and assessment of etiologic agents in all hospitalized patients should include sputum Gram stain and culture and blood cultures prior to antibiotic therapy. MRSA and multidrug-resistant gram-negative bacilli, such as P. aeruginosa and extended-spectrum beta-lactamase–producing gram-negative bacilli, should be considered in patients who have certain comorbidities, who have recently received antibiotics, and/or who have had exposure to healthcare settings.(1) CONCLUSIONS: With this case report we would like to highlight the importance of a broad thought process while encountering patients presenting with symptoms like those with COVID 19. Reference #1: File TM- Epidemiology, pathogenesis, and microbiology of community-acquired pneumonia in adults- In: UpToDate DISCLOSURES: No relevant relationships by Amitha Avasarala, source=Web Response No relevant relationships by Rosalie Traficante, source=Web Response