ABSTRACT
Background. Pulmonary fibrosis (PF) is a well-known consequence of severe lung disease and is associated with permanent changes as well as irreversible pulmonary dysfunction. The development of PF in patients infected with COVID-19 has been documented in multiple studies and case reports. However, prevalence and outcomes associated with PF have not been well established. Therefore, we sought to evaluate the prevalence and clinical outcomes of PF among patients infected with COVID-19. Methods. This is an observational cohort study from January 2020 - January 2022. We collected data from adult patients diagnosed with COVID-19 who had at least two separate computerized tomography (CT) scans. Patients were grouped based on whether evidence of developing PF, defined by clinical radiological parameters, were seen on CT. The initial CT must be negative for PF to be included. We collected the following information: baseline characteristics, secondary infection, mortality, and treatments. The primary objective was to determine the prevalence of PF among COVID-19 patients. Secondary objectives were to evaluate the differences in 30-day all-cause mortality;intensive care unit (ICU) mortality;and prevalence of secondary infections. Results. A total 161 patients were COVID-19 positive with multiple CT scans;27 (16.8%) had signs of PF while 134 (83.2%) did not. Of the patients with signs of PF, 13 (48.1%) were male (mean age of 57 years) and 13 (48.1%) were admitted to the ICU. There was no difference in secondary bacterial infection between fibrotic and nonfibrotic patients (55.6% vs 38.5%, p=0.20). The most common bacterial infection among PF patients was caused by S. aureus (26.7%). The most common infection type among PF patients was nosocomial pneumonia (46.7%). Mortality at 30-day was higher in the fibrotic patients, 70% vs 24.2% (p< 0.01). The ICU mortality trended higher in the fibrotic group (69.2% vs 36.6%, p=0.124), although it was not statistically significant. Conclusion. Pulmonary fibrosis can be fatal as a complication of COVID-19. Further investigation is warranted to evaluate the outcomes of PF in patients with COVID-19.
ABSTRACT
Introduction: Among COVID-19 patients, bacterial infections are associated with significant morbidity and mortality. Staphylococcus aureus is the principal pathogen causing bacterial infections in COVID-19 patients. Typically, clinical outcomes between methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) infections have demonstrated worse outcomes with MRSA. Outcomes of MRSA vs. MSSA remain limited in COVID-19 patients. Research Question or Hypothesis: We sought to evaluate clinical outcomes among COVID-19 patients with MRSA vs. MSSA infections. Study Design: Observational, retrospective cohort Methods: Hospitalized adults with confirmed COVID-19 and secondary S. aureus infections were evaluated from January 2020 to July 2022. Secondary infection was defined as a positive culture 48-hours after COVID-19 diagnosis. Cohorts were stratified by S. aureus susceptibility and pandemic year. Primary outcome was in-hospital allcause mortality. Secondary outcomes included 30-day mortality, allcause intensive care unit (ICU) mortality, and 60-day hospital readmission. Result(s): A total of 108 adults met the study criteria, 33 (30.5%) MRSA and 75 (69.4%) MSSA patients. At baseline, 84 (78%) patients were in the ICU with a mean APACHE-II score of 34.21+/-19.53. Six patients (5.6%) received at least 1 dose of mRNA vaccine. Primary sources of infection included respiratory (68%) and blood (25%), with no differences between cohorts. There was no statistical difference in inhospital all-cause mortality (51.5% vs. 62.7%, p=0.37), 30-day mortality (60.6% vs. 66.7%, p=0.61), all-cause ICU mortality (51.5% vs. 62.7%, p=0.37) and 60-day readmission (6.1% vs. 6.7%, p=0.92) between MRSA and MSSA, respectively. Mortality remained high when stratified by pandemic year 56.2% (2020), 68.2% (2021), and 46.2% (2022);p=0.619. Conclusion(s): Unlike patients without COVID-19, no significant differences in MRSA and MSSA outcomes were found. Mortality remained high in patients with secondary S. aureus infections throughout the study period. Further investigations are warranted to determine if COVID-19 patients respond differently than non-COVID-19 patients regarding the type of S. aureus secondary infection.