Using Precision Medicine for the Diagnosis and Treatment of Viral Pneumonia.

The COVID-19 pandemic has drawn considerable attention to viral pneumonia from clinicians, public health authorities, and the general public. With dozens of viruses able to cause pneumonia in humans, differentiating viral from bacterial pneumonia can be very challenging in clinical practice using traditional diagnostic methods. Precision medicine is a medical model in which decisions, practices, interventions, and therapies are adapted to the individual patient on the basis of their predicted response or risk of disease. Precision medicine approaches hold promise as a way to improve outcomes for patients with viral pneumonia. This review describes the latest advances in the use of precision medicine for diagnosing and treating viral pneumonia in adults and discusses areas where further research is warranted.

Antibiotic stewardship in the era of precision medicine.

Antimicrobial resistance (AMR) continues to spread at an alarming rate worldwide. Novel approaches are needed to mitigate its deleterious impact on antibiotic efficacy. Antibiotic stewardship aims to promote the appropriate use of antibiotics through evidence-based interventions. One paradigm is precision medicine, a medical model in which decisions, practices, interventions, and therapies are adapted to the individual patient based on their predicted response or risk of disease. Precision medicine approaches hold promise as a way to improve outcomes for patients with myriad illnesses, including infections such as bacteraemia and pneumonia. This review describes the latest advances in precision medicine as they pertain to antibiotic stewardship, with an emphasis on hospital-based antibiotic stewardship programmes. The impact of the COVID-19 pandemic on AMR and antibiotic stewardship, gaps in the scientific evidence, and areas for further research are also discussed.

Influenza Vaccination Reduces the Risk of Major Cardiovascular Events

The ARR was 4.5% (95% CI, 2.6% to 6.4%;P < 0.001) with an NNT of 23 patients (95% CI, 16-39 patients) to prevent one cardiovascular event. [...]76 of the 4,510 patients (1.7%) who received the influenza vaccine died as a result of cardiovascular causes compared with 111 of the 4,491 patients (2.5%) who received placebo or control within one year of follow-up (RR, 0.74;95% CI, 0.42-1.30), although this result was not statistically significant (P = 0.29). [...]presumably none of the patients with influenza were co-infected with COVID-19, since only one study was conducted during the pandemic (2021). Unfortunately, the vaccine has to be reformulated before each influenza season because of mutations in viral surface proteins. [...]having a universally effective influenza vaccine would be a major advancement.

Fluvoxamine Reduces the Risk for Hospitalization from COVID-19

[...]other oral options remain an important goal. Since being approved by the Food and Drug Administration (FDA) in 1997, fluvoxamine has had a good safety record and generally is well tolerated. [...]whether fluvoxamine can help those already hospitalized (e.g., prevent intensive care unit admission) is uncertain. [...]the study was conducted in one geographic area with a relatively homogeneous population, so the results might not be applicable to other regions and should be considered preliminary.

Extensive Loss of Health at Six Months in Survivors of COVID-19

[...]the impact of SARS-CoV-2 variant strains and widespread vaccination on long-term symptoms remains to be elucidated. [...]with high-dimensional data sets, the number of features can exceed the number of observations, thus increasing the risk for confounding. Since this will burden an already stretched healthcare system further, additional studies are needed urgently to help inform future health system planning.

Clinical Outcomes in Pregnant Women with COVID-19

The inclusion criteria for the study were: pregnant women;COVID-19 infection confirmed by reverse-transcription polymerase chain reaction (RT-PCR) from throat and/or nasal swabs;and available neonatal outcome data. [...]regarding vaccines, the Centers for Disease Control and Prevention currently recommends that pregnant women should talk to their healthcare providers to make an informed decision.1 There is no evidence that antibodies formed from COVID-19 vaccination cause any problem during pregnancy, including the development of the placenta, yet data do exist that COVID-19 is a serious threat to both the mother and her baby. [...]all of the participants were hospitalized;thus, the findings might not apply to pregnant women in the ambulatory setting.

Children Are Not Major Spreaders of COVID-19 in Schools

The risks associated with transmission of COVID-19 in children have not been fully elucidated. [...]Yung and colleagues aimed to identify these risks in schools to better inform public health control policies. [...]adolescents were not included in the analysis and, therefore, the findings should not be extrapolated to this age group. [...]COVID-19 vaccination of preschool and secondary school staff is strongly encouraged. 1.

Hospitalized COVID-19 Patients: SARS-CoV-2 RNA in Plasma Associated with ICU Admission and Mortality

No correlation was identified between days from symptom onset and RNAemia frequency or RNA load at baseline. [...]no correlations were found between upper respiratory Ct values and RNAemia frequency or plasma RNA loads, nor between the number of days from symptom onset to ICU admission. There has not been a consistent association found between SARS-CoV-2 RNA in the nasopharynx and asymptomatic vs. symptomatic disease, or with symptomatic disease severity. [...]viral RNA at a local site of initial infection does not give an accurate measure of viral replication in the lower respiratory tract or dissemination of the virus via the bloodstream to other organs. [...]as mentioned earlier, the presence of viral RNA does not necessarily indicate there is replication-competent virus.

Contact Isolation Is Not Better than Standard Precautions for Decreasing Acquisition of ESBL-Producing Enterobacterales

Antibiotic consumption at the ward level did not differ between intervention protocols. [...]there was no difference in acquisition of ESBL-producing E. coli (which made up 73% of cases) and K. pneumonia between contact isolation and standard precautions. [...]the delay in laboratory turnaround time in reporting ESBL-E positive samples (median four days, range three to five days) led to delays in implementing contact isolation. [...]evidence suggests that patient-to-patient transmission is not the main pathway for the spread of ESBL-E.

Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020).

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.