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1.
Infect Dis Ther ; 2022.
Article in English | PubMed | ID: covidwho-2158223

ABSTRACT

INTRODUCTION: The profiles of patients with COVID-19 have been widely studied, but little is known about differences in baseline characteristics and in outcomes between subjects with a ceiling of care assigned at hospital admission and subjects without a ceiling of care. The aim of this study is to compare, by ceiling of care, clinical features and outcomes of hospitalized subjects during four waves of COVID-19 in a metropolitan area in Catalonia. METHODS: Observational study conducted during the first (March-April 2020), second (October-November 2020), third (January-February 2021), and fourth wave (July-August 2021) of COVID-19 in five centers of Catalonia. All subjects were adults (> 18 years old) hospitalized with a proven SARS-CoV-2 infection and with therapeutic ceiling of care assessed by the attending physician at hospital admission. RESULTS: A total of 5813 subjects were analyzed. Subjects with a ceiling of care were mainly older (difference in median age of 20 years), with more comorbidities (Charlson index 3 points higher) and with fewer clinical signs at baseline than patients without a ceiling of care. Some features of their clinical profiles changed among waves. There were differences in treatments received during hospital admission across waves, but not between subjects with and without a ceiling of care. Subjects with a ceiling of care had a death incidence more than four times the death incidence of subjects a without a ceiling of care (risk ratio (RR) ranging from 3.5 in the first wave to almost 6 in the third and fourth). Incidence of severe pneumonia and complications for subjects with a ceiling of care was around 1.5 times the incidence in subjects without a ceiling of care. DISCUSSION: Analysis of hospitalized subjects with SARS-CoV-2 infection should be stratified according to therapeutic ceiling of care to avoid bias and outcome misestimation.

2.
Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias ; 34(2):103-110, 2022.
Article in English, Spanish | Scopus | ID: covidwho-1762499

ABSTRACT

OBJECTIVES: To evaluate the effectiveness of a care pathway (Spanish acronym, COVID-A2R) through which patients with SARS-CoV-2 infection were referred by a hospital emergency department (ED) for fast-track in-person outpatient clinic care if they did not have respiratory insufficiency but were at high risk for complications and poor outcome. MATERIAL AND METHODS: Retrospective cohort of patients referred to the COVID-A2R pathway after being diagnosed with COVID-19 by reverse transcription polymerase chain reaction assay in a tertiary care hospital ED between January 7 and February 17, 2021. The inclusion criteria were 1) absence of pneumonia but presence of serious comorbidity and/or elevated biomarkers of inflammation, and 2) pneumonia with or without elevated inflammatory markers but without respiratory insufficiency. The main outcome was need for an emergency department revisit with hospital admission and time from ED evaluation to hospitalization. Secondary outcomes were the number of COVID-A2R visits and the potential economic impact. RESULTS: We included 278 patients with a median age of 57 years (57.9% men) and a median Charlson Comorbidity Index of 1. The median time since onset of symptoms was 7 days (interquartile range, 4-11 days). Pneumonia was diagnosed in 71.8%, and 64.7% required only 1 in-person visit in the COVID-A2R pathway. No revisits to the ED were needed by 87.8% (83.4%-91.1%) of the patients. Of the 34 patients who were hospitalized, 88.2% were admitted within 5 days. The COVID-A2R model potentially saved 1708 days of hospitalization. CONCLUSION: The fast-track ambulatory care model was effective after emergency department discharge of patients with COVID-19 without respiratory insufficiency but with clinical or laboratory indicators of risk for poor outcome. OBJETIVO: Evaluar la efectividad de un modelo asistencial basado en la derivación desde el servicio de urgencias hospitalarios (SUH) a una consulta presencial precoz de alta resolución (COVID-A2R), para pacientes con infección por SARS-CoV-2 sin insuficiencia respiratoria, pero con factor de riesgo de complicación/deterioro clínico. METODO: Cohorte retrospectiva de pacientes remitidos por COVID-19 (RT-PCR) desde el SUH de un hospital terciario a COVID-A2R (7 de enero - 17 de febrero de 2021). Los criterios de inclusión son presencia de alta comorbilidad y elevación de biomarcadores inflamatorios en pacientes sin neumonía, o la presencia de neumonía con elevación de biomarcadores inflamatorios sin insuficiencia respiratoria. La variable de resultado principal fue el no requerimiento de revisita en el SUH con ingreso hospitalario y su distribución temporal. Los objetivos secundarios son la frecuentación en COVID-A2R y el impacto económico potencial. RESULTADOS: Se incluyeron 278 pacientes, edad mediana de 57 años, 57,9% hombres e índice de Charlson de 1. Consultaron en el SUH tras 7 (4-11) días de clínica y un 71,8% de los casos presentaban neumonía. El 64,7% de los pacientes requirió una visita única en COVID-A2R. No se produjo una revisita a urgencias con ingreso en el 87,8% (83,4-91,1) de los pacientes. De los 34 pacientes que ingresaron, el 88,2% lo hizo en menos de 5 días. El ahorro potencial del modelo fue de 1.708 días de ingreso hospitalario. CONCLUSIONES: Un modelo asistencial ambulatorio con una consulta de alta resolución tras el alta de urgencias es efectivo para pacientes con COVID-19 sin insuficiencia respiratoria con marcadores clínicos o analíticos de evolución desfavorable.

3.
Antimicrobial Resistance and Infection Control ; 10(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1448405

ABSTRACT

Introduction: Candida parapsilosis is the second leading cause of candidemia and fluconazole is the treatment of choice. In July 2020, an outbreak caused by azole-resistant C. parapsilosis (ARCP) strains was detected in the Intensive Care Unit (ICU) of a tertiary-care center in Spain. Objectives: This study aims to describe an ongoing ARCP outbreak that started during the COVID-19 pandemic. Methods: We implemented a package of interventions: 1) collection of surveillance cultures (throat, axilla, and groin) on patient admission and weekly thereafter;2) daily chlorhexidine bathing of patients;3) change of daily routine cleaning from 1% sodium hypochlorite to hydrogen peroxide. The presence of ERG11 mutations and the genotyping of 17 random ARCP isolates were performed by microsatellite analysis. Changes in annual defined daily doses (DDD) of antifungals/ 100 patient-days from 2019 to 2020 were reported to assess antifungal overuse. Cultures from the environment and gowns were obtained with a sterile gauze soaked in saline solution. Results: Between April 2020-May 2021, 239 patients (2 retrospectively identified) were found to be colonized or infected with an ARCP. Patients were initially identified in a COVID-19 ICU ward, but other units were affected after transferring colonized patients. Microbiological analysis: 15/17 (88.2%) strains had the Y132F mutation in the ERG11 gene, 1 had the K143R mutation, and 1 did not have any mutations. Most ARCP isolates belonged to the same genotype III. The use of antifungals increased 1.4-fold from 2019 to 2020 (2.7 to 3.7 DDD/100 patient-days). Environmental cultures obtained before daily routine cleaning were positive for ARCP strains in 34/88 (38.6%). Patient care equipment, surfaces in close contact to the patient, and high-touch surfaces were frequently contaminated. Two out of 3 reusable gowns (99% polyester), cultured after patient care, and 1 sink were contaminated with ARCP. Conclusion: The frequent contamination of the environment coupled with suboptimal infection prevention practices during the COVID-19 pandemic (shared gowns between patients) have been important challenges to control an ARCP outbreak.

4.
Antimicrobial Resistance and Infection Control ; 10(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1448285

ABSTRACT

Introduction: Hospitals rapidly prepared to identify, isolate, and take care of SARS-COV-2 cases while ensuring health-care workers (HCWs) safety. Initial shortages in personal protective equipment (PPE) and lack of hospital preparedness posed at risk infection control practices. Objectives: To assess the impact of COVID-19 pandemic on infection control practices in a tertiary-care hospital in Spain. Methods: An electronic survey was sent to 753 frontline HCWs on March, 2021. The survey included questions about hand hygiene, catheter maintenance, and PPE. More questions focused on the impact of COVID-19 on infection preventionists daily routine. Results: A total of 163 HCWs (21.6%) completed the survey [Intensive care unit: 32.5%;Infectious diseases unit: 22.7%;Pulmonology unit: 20.4%]. Sixty-seven were physicians, sixty-four nurses, twenty nursing assistants, four infection preventionists and eight other groups. Low compliance with hand hygiene prior to an aseptic procedure and after touching patient's environment was reported in 70.6% (115/163) and 82.2% (134/163) respondents. Barriers to infection control practices were: 1) Glove use was an interfering factor for compliance with the 5-moments of hand hygiene in 44.8% (53/163);2) regarding catheter care, 23.1% (15/65) of nurses reported problems with catheter dressings and, among them, 53.3% stated that dressing change was difficult with glove use. Further, 65.6% of nurses (42/65) recognized drawing blood cultures from the central venous catheter, instead of venipuncture 3) the incorporation of untrained personnel during the pandemic was perceived as a limiting factor for appropriate infection control practices in 47.2% (77/163). Finally, infection preventionists reported that during the first COVID-19 wave (March-June 2020), 70-90% of their activities shifted to COVID-19 issues, and this interfered in other duties. Conclusion: COVID-19 pandemic negatively affected infection control practices, namely hand hygiene and catheter use. The use of gloves and the need to rapidly incorporate untrained personnel were perceived as barriers for optimal infection control practices.

5.
J Infect ; 83(3): 306-313, 2021 09.
Article in English | MEDLINE | ID: covidwho-1376048

ABSTRACT

BACKGROUND: We aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19. METHODS: International, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections. RESULTS: 684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa. Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections. CONCLUSIONS: Infectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized.


Subject(s)
COVID-19 , Coinfection , Neoplasms , Superinfection , Cohort Studies , Coinfection/epidemiology , Humans , Intensive Care Units , Neoplasms/complications , Neoplasms/epidemiology , SARS-CoV-2
6.
Topics in Antiviral Medicine ; 29(1):86-87, 2021.
Article in English | EMBASE | ID: covidwho-1250792

ABSTRACT

Background: Understanding the adaptive immune response to SARS-CoV-2, kinetics, persistence and their relationship with the disease severity would be crucial in order to predict recurrences, reinfections and could serve in the design of vaccination strategies. We sought to characterize IgG and neutralizing antibodies (NAbs) against SARS-CoV-2 in patients who were admitted to hospital with COVID-19 disease. Methods: All patients admitted between March-April 2020 with moderate, severe and critical SARS-CoV-2 pneumonia were prospectively studied. Clinical, laboratory data and IgG against SARS-CoV-2 levels were assessed at baseline (upon admission) and months 1, 3 and 6. NAbs were assessed at month 1, 3 and 6. IgG against the SARS-CoV-2 spike (S) protein was measured in serum by chemiluminescence (LIAISON® SARS-CoV-2 S1/S2, DiaSorin) and results were expressed in arbitrary units (AU)/mL. The neutralizing activity of plasma samples was analyzed in a 293T/hACE2 cell infection test using a surrogate viral inhibition assay that uses human immunodeficiency virus type 1 (HIV-1)-based virus expressing SARS-CoV-2 S protein and Luciferase. For neutralization assays, pseudoviruses were incubated with increasing plasma dilutions (range 1/60-1/14,580) in order to obtain the ID50 values. Results: A total of 110 patients who were discharged from hospital were recruited. Median (range) age was 61 (57-71);61.2% were male and most reported comorbidities were hypertension (39.6%), diabetes (24.3%) and obesity (19.8%). Median time from symptoms onset to admission was 9 days (range 7-11). Median (range) IgG levels (AU/mL) at baseline and months 1, 3 and 6 were 48 (28-81), 168 (134-210), 140 (112-171) and 146 (104-206) respectively. No significant differences were observed in median IgG fold change values up to month 6 among severity groups. Median (range) ID50 values for NAbs at months 1, 3 and 6 were 3938 (1958-6407), 4344 (2335-6752) and 424 (124-1022) respectively. NAb titers presented a significant decrease (overall-10.2-fold change from maximal values) without differences among severity groups (Figure 1 a and b). No reinfections occurred. Conclusion: Specific humoral immune response to SARS CoV-2 in patients requiring hospital admission characterizes for a clear peak between 30 and 90 days after admission followed by a significant decline in titer of NAbs by day 180 regardless of disease severity. Longer follow-up may help to determine the longevity of the specific immune response.

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