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2.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-335969

ABSTRACT

Importance The SARS-CoV-2 pandemic portends a significant increase in health care use related to post-acute COVID sequelae, but the magnitude is not known. Objective To assess the burden of post-acute health care use after a positive versus negative polymerase chain reaction (PCR) test for SARS-CoV-2. Design, Setting, and Participants Retrospective cohort study of community-dwelling adults January 1, 2020 to March 31, 2021 in Ontario, Canada, using linked population-based health data. Follow-up began 56 days after PCR testing. Exposures Individuals with a positive SARS-CoV-2 PCR test were matched 1:1 to individuals who tested negative based on hospitalization, test date, public health unit, sex, and a propensity score of socio-demographic and clinical characteristics. Main Outcomes and Measures The health care utilization rate was the number of outpatient clinical encounters, homecare encounters, emergency department visits, days hospitalized, and days in long-term care per person-year. Mean health care utilization for test-positive versus negative individuals was compared using negative binomial regression, and rates at 95 th and 99 th percentiles were compared. Outcomes were also stratified by sex. Results Among 530,232 unique, matched individuals, mean age was 44 years (sd 17), 51% were female, and 0.6% had received ≥1 COVID-19 vaccine dose. The mean rate of health care utilization was 11% higher in test-positive individuals (RR 1.11, 95% confidence interval [CI] 1.10-1.13). At the 95 th percentile, test-positive individuals had 2.1 (95% CI 1.5-2.6) more health care encounters per person-year, and at the 99 th percentile 71.9 (95% CI 57.6-83.2) more health care encounters per person-year. At the 95 th percentile, test-positive women had 3.8 (95% CI 2.8-4.8) more health care encounters per person-year while there was no difference for men. At the 99 th percentile, test-positive women had 76.7 (95% CI 56.3-89.6) more encounters per person-year, compared to 37.6 (95% CI 16.7-64.3) per person-year for men. Conclusions and Relevance Post-acute health care utilization after a positive SARS-CoV-2 PCR test is significantly higher compared to matched test-negative individuals. Given the number of infections worldwide, this translates to a tremendous increase in use of health care resources. Stakeholders can use these findings to prepare for health care demand associated with long COVID. Key Points Question How does the burden of health care use ≥56 days after a positive SARS-CoV-2 polymerase chain reaction (PCR) test compare to matched individuals who tested negative? Findings After accounting for multiple factors, the mean burden of post-acute health care use was 11% higher among those who tested positive, with higher rates of outpatient encounters, days hospitalized, and days in long-term care. Rates of homecare use were higher for test-positive women but lower for men. For perspective, for every day in January 2022 with 100,000 or more infections, this translates to an estimated 72,000 additional post-acute health care encounters per year for the 1% of people who experienced the most severe complications of SARS-CoV-2;among those in the top 50% of health care use, this translates to 245,000 additional health care encounters per year. This increase will occur in the context of an ongoing pandemic and, in many health care systems, a depleted workforce and backlogs of care. Unless addressed, this increase is likely to exacerbate existing health inequities. Meaning Given the large number of people infected, stakeholders can use these findings to plan for health care use associated with long COVID.

3.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-334492

ABSTRACT

Background: Frequent use of antibiotics in patients with COVID-19 threatens to fuel the public health threat of antimicrobial resistance (AMR). This study sought to determine the prevalence and predictors of bacterial infections and AMR in patients with COVID-19. Methods: We performed a systematic review of studies evaluating bacterial co-infections (≤48 hours of presentation) and secondary infections (>48 hours after presentation) in outpatients or hospitalised patients with COVID-19. A search strategy using bacterial infection terms was applied to the World Health Organization COVID-19 Research Database on December 1, 2021. Studies reporting on microbiologically-confirmed bacterial infection in any anatomical site were eligible for inclusion. We reported the pooled prevalence of bacterial infections and AMR, by conducting a random-effects meta-analysis. Findings: 148 studies evaluating 362 976 patients were included. The prevalence of bacterial co-infection in COVID-19 patients was 5·3% (95%CI: 3·8–7·4%), whereas prevalence of secondary bacterial infection was 18·4% (95%CI: 14·0 –23·7%). While 93 (63%) studies reported resistance or susceptibility data for at least one species, 42 (28%) reported comprehensive data on the prevalence of AMR. Of patients with documented bacterial infections, 60·8% (95%CI: 38·6 to 79·3%, 17 studies) were infected with resistant pathogens and 37.5% (95%CI: 26·9 to 49·5%, 42 studies) of the organisms were resistant. Significant study-level predictors for AMR included ICU setting, use of IL-6 inhibitors, diabetes, antibiotic use and geographical region (Eastern Mediterranean and Asia). Interpretation: While the prevalence of bacterial co-infections in patients with COVID-19 is low, bacterial secondary infections are more frequent. Although infrequently evaluated, antibiotic resistance is highly prevalent in patients with COVID-19 who develop bacterial infections. These data can help to inform guidelines on appropriate antibiotic use in patients with COVID-19. Future research and surveillance evaluating the impact of COVID-19 on antibiotic resistance at the patient and population level are urgently needed.

4.
Open Forum Infect Dis ; 9(5): ofac156, 2022 May.
Article in English | MEDLINE | ID: covidwho-1831308

ABSTRACT

Background: For both the current and future pandemics, there is a need for high-throughput drug screening methods to identify existing drugs with potential preventive and/or therapeutic activity. Epidemiologic studies could complement laboratory-focused efforts to identify possible therapeutic agents. Methods: We performed a pharmacopeia-wide association study (PWAS) to identify commonly prescribed medications and medication classes that are associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in older individuals (≥65 years) in long-term care homes (LTCHs) and the community, between 15 January 2020 and 31 December 2020, across the province of Ontario, Canada. Results: A total of 26 121 cases and 2 369 020 controls from LTCHs and the community were included in this analysis. Many of the drugs and drug classes evaluated did not yield significant associations with SARS-CoV-2 detection. However, some drugs and drug classes appeared to be significantly associated with reduced SARS-CoV-2 detection, including cardioprotective drug classes such as statins (weighted odds ratio [OR], 0.91; standard P < .01, adjusted P < .01) and ß-blockers (weighted OR, 0.87; standard P < .01, adjusted P = .01), along with individual agents ranging from levetiracetam (weighted OR, 0.70; standard P < .01, adjusted P < .01) to fluoxetine (weighted OR, 0.86; standard P = .013, adjusted P = .198) to digoxin (weighted OR, 0.89; standard P < .01, adjusted P = .02). Conclusions: Using this epidemiologic approach, which can be applied to current and future pandemics, we have identified a variety of target drugs and drug classes that could offer therapeutic benefit in coronavirus disease 2019 (COVID-19) and may warrant further validation. Some of these agents (eg, fluoxetine) have already been identified for their therapeutic potential.

5.
Open forum infectious diseases ; 2022.
Article in English | EuropePMC | ID: covidwho-1824571

ABSTRACT

Background Nonpharmaceutical interventions such as physical distancing and mandatory masking were adopted in many jurisdictions during the COVID-19 pandemic to decrease spread of SARS-CoV-2. We determined the effects of these interventions on incidence of healthcare utilization for other infectious diseases. Methods Using a healthcare administrative dataset, we employed an interrupted time series analysis to measure changes in healthcare visits for various infectious diseases across the province of Ontario, Canada, from January 2017 to December 2020. We used a hierarchical clustering algorithm to group diagnoses that demonstrated similar patterns of change through the pandemic months. Results We found that visits for infectious diseases commonly caused by communicable respiratory pathogens (e.g. acute bronchitis, acute sinusitis) formed distinct clusters from diagnoses that often originate from pathogens derived from the patient’s own flora (e.g. urinary tract infection, cellulitis). Moreover, infectious diagnoses commonly arising from communicable respiratory pathogens (hierarchical cluster 1 – highly impacted diagnoses) were significantly decreased, with a rate ratio (RR) of 0.35 (95% CI = 0.30-0.40, p < 0.001) after the introduction of public health interventions in April 2020 through December 2020, whereas infections typically arising from the patient’s own flora (hierarchical cluster 3 – minimally impacted diagnoses) did not demonstrate a sustained change in incidence (RR = 0.95, 95% CI = 0.90-1.01, p = 0.085) Conclusions Public health measures to curtail the incidence of SARS-CoV-2 were widely effective against other communicable respiratory infectious diseases with similar modes of transmission but had little effect on infectious diseases not strongly dependent on person-to-person transmission.

7.
Open forum infectious diseases ; 2022.
Article in English | EuropePMC | ID: covidwho-1787289

ABSTRACT

Background For both the current and future pandemics, there is a need for high-throughput drug screening methods to identify existing drugs with potential preventative and/or therapeutic activity. Epidemiologic studies could complement lab-focused efforts to identify possible therapeutic agents. Methods We performed a pharmacopeia-wide association study (PWAS) to identify commonly prescribed medications and medication classes that are associated with the detection of SARS-CoV-2 in older individuals (>65 years) in long-term care homes (LTCH) and the community, between January 15 th, 2020 and December 31 st, 2020, across the province of Ontario, Canada. Results 26,121 cases and 2,369,020 controls from LTCH and the community were included in this analysis. Many of the drugs and drug classes evaluated did not yield significant associations with SARS-CoV-2 detection. However, some drugs and drug classes appeared significantly associated with reduced SARS-CoV-2 detection, including cardioprotective drug classes such as statins (weighted OR 0.91, standard p-value <0.01, adjusted p-value <0.01) and beta-blockers (weighted OR 0.87, standard p-value <0.01, adjusted p-value 0.01), along with individual agents ranging from levetiracetam (weighted OR 0.70, standard p-value <0.01, adjusted p-value <0.01) to fluoxetine (weighted OR 0.86, standard p-value 0.013, adjusted p-value 0.198) to digoxin (weighted OR 0.89, standard p-value <0.01, adjusted p-value 0.02). Conclusions Using this epidemiologic approach which can be applied to current and future pandemics we have identified a variety of target drugs and drug classes that could offer therapeutic benefit in COVID-19 and may warrant further validation. Some of these agents (e.g. fluoxetine) have already been identified for their therapeutic potential.

8.
Telemed J E Health ; 2022 Mar 30.
Article in English | MEDLINE | ID: covidwho-1769115

ABSTRACT

Recognizing emergency department overcrowding during the COVID-19 pandemic, a pathway to facilitate direct admissions for outpatients with worsening COVID-19 infection was created using the COVID-19 expansion to outpatients (COVIDEO) virtual care program. Outpatients appropriate for direct admission had oxygen saturations consistently <92% without severe respiratory distress. Pulse oximeters were proactively delivered to high-risk patients, and patients contacted the program in the event of worsening symptoms or desaturation persistently <92%. Over a 15-month period, 9,116 outpatients were managed by the program, 164 of whom were hospitalized, and 83 of those hospitalized (50.6%) were directly admitted through this pathway. Of those directly admitted, 10 (12.0%) patients required ICU admission, occurring a median of 4 days from hospital admission. The mortality rate among directly admitted patients was 3.6% (3/83). Implementation of a virtual care program to facilitate direct admissions in outpatients with COVID-19 created a safe, efficient, and patient-centered pathway of care.

9.
JAMMI: Journal of the Association of Medical Microbiology & Infectious Disease Canada ; 7(1):36-43, 2022.
Article in English | CINAHL | ID: covidwho-1753322

ABSTRACT

BACKGROUND: Resident physicians provide front-line care to coronavirus disease 2019 (COVID-19) patients, but little is known about how they perceive the risk to their own health or how this is affected by the increasing role of social media in disseminating information. This study aims to determine resident physicians' perceptions of personal COVID-19 risk during the first COVID wave and compare risk perceptions between low–average and high social media users. METHODS: We conducted a cross-sectional survey at the University of Toronto in May 2020 among resident physicians in internal medicine, emergency medicine, critical care, and anaesthesia. Participants were considered high social media users if above the median for daily social media use and low–average users if at or below the median. The primary outcome was perceived risk of hospitalization with COVID-19 within 6 months. RESULTS: A total of 98 resident physicians reported a median of 1–2 hours daily on social media, and 55.7% endorsed social media as a very or the most common source of information on COVID-19. The median overall perceived risk of hospitalization was 10% (inter-quartile range [IQR] 5–25)—7.5% for low–average social media users and 17.5% for high social media users (p = 0.10). CONCLUSIONS: Resident physicians have an elevated perception of COVID-19 risk, including a perceived risk of hospitalization 250 times greater than the local population risk. Although social media are an important source of information on COVID-19, risk perception did not significantly differ between high and low–average social media users. HISTORIQUE : Les résidents en médecine donnent des soins de première ligne aux patients atteints de la maladie à coronavirus 2019 (COVID-19), mais on possède peu d'information au sujet de la perception de leur risque personnel ou de l'effet de la diffusion croissante d'information et de désinformation dans les réseaux sociaux sur leur perception. La présente étude vise à déterminer les perceptions du risque personnel de COVID-19 chez les résidents en médecine pendant la première vague de la pandémie et à comparer les perceptions de risque entre les utilisateurs faibles à modérés et les grands utilisateurs des réseaux sociaux. MÉTHODOLOGIE : En mai 2020, les chercheurs ont réalisé une étude transversale auprès des résidents en médecine interne, en médecine d'urgence, en soins intensifs et en anesthésie de l'Université de Toronto. Ceux qui se situaient au-dessus de la médiane d'utilisation quotidienne des réseaux sociaux étaient considérés comme de grands utilisateurs des réseaux sociaux, et ceux qui se situaient sur ou sous la médiane, comme des utilisateurs faibles ou modérés. Le résultat clinique primaire était le risque perçu d'hospitalisation à cause de la COVID-19 dans les six mois, et les résultats cliniques secondaires, le risque estimatif de contracter la COVID-19 ou d'infecter des membres de la famille, le degré d'anxiété au sujet de la COVID-19 et les répercussions perçues de l'hospitalisation. RÉSULTATS : Au total, 98 résidents en médecine ont déclaré consacrer une médiane de une à deux heures par jour aux réseaux sociaux, et 55,7 % considéraient les réseaux sociaux comme leur principale source d'information ou une source d'information très importante sur la COVID-19. Le risque médian perçu de contracter la COVID-19 s'élevait à 60 % (ratio interquartile [RIQ] 32 à 75), d'être hospitalisé, à 10 % (RIQ 5 à 25), et d'infecter des membres de la famille, à 37 % (RIQ 10,5 à 60). Le risque médian perçu d'hospitalisation s'élevait à 7,5 % pour les utilisateurs faibles ou modérés des réseaux sociaux, et à 17,5 % pour les grands utilisateurs des réseaux sociaux (p = 0,10). CONCLUSIONS : Les résidents en médecine ont une perception élevée du risque de COVID-19, y compris une perception du risque d'hospitalisation 250 fois plus élevée que celle de la population locale. Même si les médias sociaux représentent une source importante d'information sur la COVID-19 pour les résidents en médecine, la perception du risque ne différait pas de manière significative entre les grands utilisateurs et les faibles utilisateurs des réseaux sociaux.

10.
CMAJ ; 194(7): E242-E251, 2022 02 22.
Article in English | MEDLINE | ID: covidwho-1714791

ABSTRACT

BACKGROUND: The role of remdesivir in the treatment of patients in hospital with COVID-19 remains ill defined in a global context. The World Health Organization Solidarity randomized controlled trial (RCT) evaluated remdesivir in patients across many countries, with Canada enrolling patients using an expanded data collection format in the Canadian Treatments for COVID-19 (CATCO) trial. We report on the Canadian findings, with additional demographics, characteristics and clinical outcomes, to explore the potential for differential effects across different health care systems. METHODS: We performed an open-label, pragmatic RCT in Canadian hospitals, in conjunction with the Solidarity trial. We randomized patients to 10 days of remdesivir (200 mg intravenously [IV] on day 0, followed by 100 mg IV daily), plus standard care, or standard care alone. The primary outcome was in-hospital mortality. Secondary outcomes included changes in clinical severity, oxygen- and ventilator-free days (at 28 d), incidence of new oxygen or mechanical ventilation use, duration of hospital stay, and adverse event rates. We performed a priori subgroup analyses according to duration of symptoms before enrolment, age, sex and severity of symptoms on presentation. RESULTS: Across 52 Canadian hospitals, we randomized 1282 patients between Aug. 14, 2020, and Apr. 1, 2021, to remdesivir (n = 634) or standard of care (n = 648). Of these, 15 withdrew consent or were still in hospital, for a total sample of 1267 patients. Among patients assigned to receive remdesivir, in-hospital mortality was 18.7%, compared with 22.6% in the standard-of-care arm (relative risk [RR] 0.83 (95% confidence interval [CI] 0.67 to 1.03), and 60-day mortality was 24.8% and 28.2%, respectively (95% CI 0.72 to 1.07). For patients not mechanically ventilated at baseline, the need for mechanical ventilation was 8.0% in those assigned remdesivir, and 15.0% in those receiving standard of care (RR 0.53, 95% CI 0.38 to 0.75). Mean oxygen-free and ventilator-free days at day 28 were 15.9 (± standard deviation [SD] 10.5) and 21.4 (± SD 11.3) in those receiving remdesivir and 14.2 (± SD 11) and 19.5 (± SD 12.3) in those receiving standard of care (p = 0.006 and 0.007, respectively). There was no difference in safety events of new dialysis, change in creatinine, or new hepatic dysfunction between the 2 groups. INTERPRETATION: Remdesivir, when compared with standard of care, has a modest but significant effect on outcomes important to patients and health systems, such as the need for mechanical ventilation. Trial registration: ClinicalTrials.gov, no. NCT04330690.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/administration & dosage , COVID-19/drug therapy , Hospital Mortality , Length of Stay/statistics & numerical data , Adenosine Monophosphate/administration & dosage , Adenosine Monophosphate/adverse effects , Aged , Alanine/administration & dosage , Alanine/adverse effects , Antiviral Agents/adverse effects , COVID-19/epidemiology , COVID-19/mortality , Canada/epidemiology , Comorbidity , Female , Humans , Male , Middle Aged , Pandemics , Respiration, Artificial/statistics & numerical data , SARS-CoV-2
11.
Clin Infect Dis ; 74(4): 703-706, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1708327

ABSTRACT

We compared secondary attack rates in households with B.1.1.7 variant of concern (VOC) versus non-VOC index cases in a matched cohort in Ontario, Canada. The secondary attack rate for VOC index cases was 1.31 times higher than non-VOC index cases. This increase was particularly accentuated for asymptomatic or presymptomatic index cases.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Incidence , Ontario/epidemiology
12.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-306571

ABSTRACT

Background: Convalescent plasma has been used for numerous viral diseases including influenza, severe acute respiratory syndrome, Middle East respiratory syndrome and Ebola virus;however, evidence to support its use is weak. SARS-CoV-2 is a novel coronavirus responsible for the 2019 global pandemic of COVID-19 community acquired pneumonia. We have undertaken a randomized controlled trial to assess the efficacy and safety of COVID-19 convalescent plasma (CCP) in patients with SARS-CoV-2 infection. Methods: : CONCOR-1 is an open-label, multicenter, randomized trial. Inclusion criteria include: patients > 16 years;admitted to hospital with COVID-19 infection;receiving supplemental oxygen for respiratory complications of COVID-19;and, availability of blood group compatible CCP. Exclusion criteria are: onset of respiratory symptoms more than 12 days prior to randomization;intubated or planned for intubation;and previous severe reactions to plasma. Consenting patients will be randomized 2:1 to receive either approximately 500 mL of CCP or standard of care. CCP will be collected from donors who have recovered from COVID-19 and who have detectable anti-SARS-CoV-2 antibodies quantified serologically. The primary outcome is intubation or death at Day 30. Secondary outcomes include ventilator free days, length of stay in intensive care or hospital, transfusion reactions, serious adverse events, and reduction in SARS-CoV-2 viral load. Exploratory analyses include patients who received CCP containing high titre antibodies. A sample size of 1200 patients gives 80% power to detect a 25% relative risk reduction assuming a 30% baseline risk of intubation or death at 30 days (two-sided test;α =0.05). An interim analysis and sample size re-estimation will be done by an unblinded independent biostatistician after primary outcome data are available for 50% of the target recruitment (n= 600). Discussion: This trial will determine whether CCP will reduce intubation or death non-intubated adults with COVID-19. The trial will also provide information on the role of and thresholds for SARS-CoV-2 antibody titers and neutralization assays for donor qualification. Trial registration: Clinicaltrials.gov NCT04348656;registered 16 April 2020;https://clinicaltrials.gov/ct2/show/NCT04348656?term=NCT04348656&draw=2&rank=1

13.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-322458

ABSTRACT

Background: Post-exposure prophylaxis (PEP) is a well-established strategy for the prevention of infectious diseases, in which recently exposed people take a short course of medication to prevent infection. The primary objective of the COVID-19 Ring-based Prevention Trial with lopinavir/ritonavir (CORIPREV-LR) is to evaluate the efficacy of a 14-day course of oral lopinavir/ritonavir as PEP against COVID-19 among individuals with a high-risk exposure to a confirmed case. Methods: : This is an open-label, multicenter, 1:1 cluster-randomized trial of LPV/r versus no intervention, using an adaptive approach to sample size calculation. Participants will be individuals aged >6 months with a high-risk exposure to a confirmed COVID-19 case within the past 7 days. A combination of remote and in-person study visits at days 1, 7, 14, 35 and 90 include comprehensive epidemiological, clinical, microbiologic and serologic sampling. The primary outcome is microbiologically confirmed COVID-19 infection within 14 days after exposure, defined as a positive respiratory tract specimen for SARS-CoV-2 by polymerase chain reaction. Secondary outcomes include safety, symptomatic COVID-19, seropositivity, hospitalization, respiratory failure requiring ventilator support, mortality, psychological impact, and health-related quality of life. Additional analyses will examine the impact of LPV/r on these outcomes in the subset of participants who test positive for SARS-CoV-2 at baseline. To detect a relative risk reduction of 40% with 80% power at α=0.05, assuming p 0 =15%, 5 contacts per case and intra-class correlation coefficient (ICC)=0.05, we require 110 clusters per arm, or 220 clusters overall and approximately 1220 enrollees after accounting for 10% loss-to-follow-up. We will modify the sample size target after 60 clusters, based on preliminary estimates of p0, ICC and cluster size and consider switching to an alternative drug after interim analyses and as new data emerges. The primary analysis will be a generalized linear mixed model with logit link to estimate the effect of LPV/r on the probability of infection. Discussion: Harnessing safe, existing drugs such as LPV/r as PEP could provide an important tool for control of the COVID-19 pandemic. Novel aspects of our design include the ring-based prevention approach, and the incorporation of remote strategies for conducting study visits and biospecimen collection. Trial registration: This trial was registered at www.clinicaltrials.gov (NCT04321174) on March 25, 2020. https://clinicaltrials.gov/ct2/show/NCT04321174

16.
BMJ Qual Saf ; 31(2): 94-104, 2022 02.
Article in English | MEDLINE | ID: covidwho-1630958

ABSTRACT

BACKGROUND: Urine culturing practices are highly variable in long-term care and contribute to overprescribing of antibiotics for presumed urinary tract infections. The purpose of this study was to evaluate the use of virtual learning collaboratives to support long-term care homes in implementing a quality improvement programme focused on reducing unnecessary urine culturing and antibiotic overprescribing. METHODS: Over a 4-month period (May 2018-August 2018), 45 long-term care homes were self-selected from five regions to participate in virtual learning collaborative sessions, which provided an orientation to a quality improvement programme and guidance for implementation. A process evaluation complemented the use of a controlled before-and-after study with a propensity score matched control group (n=127) and a difference-in-difference analysis. Primary outcomes included rates of urine cultures performed and urinary antibiotic prescriptions. Secondary outcomes included rates of emergency department visits, hospital admission and mortality. An 18-month baseline period was compared with a 16-month postimplementation period with the use of administrative data sources. RESULTS: Rates of urine culturing and urinary antibiotic prescriptions per 1000 resident days decreased significantly more among long-term care homes that participated in learning collaboratives compared with matched controls (differential reductions of 19% and 13%, respectively, p<0.0001). There was no statistically significant changes to rates of emergency department visits, hospital admissions or mortality. These outcomes were observed with moderate adherence to the programme model. CONCLUSIONS: Rates of urine culturing and urinary antibiotic prescriptions declined among long-term care homes that participated in a virtual learning collaborative to support implementation of a quality improvement programme. The results of this study have refined a model to scale this programme in long-term care.


Subject(s)
Education, Distance , Urinary Tract Infections , Anti-Bacterial Agents/therapeutic use , Female , Humans , Long-Term Care , Male , Nursing Homes , Urinary Tract Infections/drug therapy
17.
JAMMI: Journal of the Association of Medical Microbiology & Infectious Disease Canada ; 6(4):259-268, 2021.
Article in English | CINAHL | ID: covidwho-1566624

ABSTRACT

Background: Most individuals with coronavirus disease 2019 (COVID-19) experience mild symptoms and are managed in the outpatient setting. The aim of this study was to determine whether self-reported symptoms at the time of diagnosis can identify patients at risk of clinical deterioration. Methods: This was a retrospective cohort study of 671 outpatients with laboratory-confirmed COVID-19 diagnosed in Toronto between March 1 and October 16, 2020. We examined the association between patients' baseline characteristics and self-reported symptoms at the time of diagnosis and the risk of subsequent hospitalization. Results: Of 671 participants, 26 (3.9%) required hospitalization. Individuals aged 65 years or older were more likely to require hospitalization (odds ratio [OR] 5.29, 95% CI 2.19 to 12.77), whereas those without medical comorbidities were unlikely to be hospitalized (OR 0.02, 95% CI 0.00 to 0.17). After adjusting for age and presence of comorbidities, sputum production (adjusted OR [aOR] 5.01, 95% CI 1.97 to 12.75), arthralgias (aOR 4.82, 95% CI 1.85 to 12.53), diarrhea (aOR 4.56, 95% CI 1.82 to 11.42), fever (aOR 3.64, 95% CI 1.50 to 8.82), chills (aOR 3.62, 95% CI 1.54 to 8.50), and fatigue (aOR 2.59, 95% CI 1.04 to 6.47) were associated with subsequent hospitalization. Conclusions: Early assessment of symptoms among outpatients with COVID-19 can help identify individuals at risk of clinical deterioration. Additional studies are needed to determine whether more intense follow-up and early intervention among high-risk individuals can alter the clinical trajectory of and outcomes among outpatients with COVID-19. Historique : La plupart des personnes atteintes de la maladie à coronavirus 2019 (COVID-19) éprouvent des symptômes légers et sont prises en charge en milieu ambulatoire. La présente étude visait à déterminer si les symptômes autodéclarés au moment du diagnostic permettent de dépister les patients à risque de détérioration clinique. Méthodologie : Les chercheurs ont réalisé la présente étude de cohorte rétrospective auprès de 671 patients ambulatoires atteints d'une COVID-19 diagnostiquée à Toronto et confirmée en laboratoire entre le 1er mars et le 16 octobre 2020. Ils ont examiné l'association entre les caractéristiques de référence et les symptômes autodéclarés des patients au moment du diagnostic, d'une part, et le risque d'hospitalisation, d'admission en soins intensifs ou de décès par la suite, d'autre part. Résultats : Des 671 participants, 26 (3,9 %) ont dû être hospitalisés, sept (1,0 %) ont été admis en soins intensifs et trois (0,4 %) sont décédés dans les 30 jours suivant le diagnostic. Les personnes de 65 ans ou plus étaient plus susceptibles de devoir être hospitalisées (RC 5,29, IC à 95 % 2,19 à 12,77) et celles qui n'avaient pas d'autres problèmes de santé l'étaient moins (RC 0,02, IC à 95 % 0,00 à 0,17). Après redressement pour tenir compte de l'âge et de la présence d'autres problèmes de santé, la production de mucus (RC ajusté [RCa] 5,01, IC à 95 % 2,11 à 13,66), les arthralgies (RCa 4,82, IC à 95 % 1,85 à 12,53), la diarrhée (RCa 4,56, IC à 95 % 1,82 à 11,42), la fièvre (RCa 3,64, IC à 95 % 1,50 à 8,82), les frissons (RCa 3,62, IC à 95 % 1,54 à 8,50) et la fatigue (RCa 2,59, IC à 95 % 1,04 à 6,47) étaient associés à des hospitalisations. Conclusions : L'évaluation précoce des symptômes des patients ambulatoires atteints de la COVID-19 peut contribuer à dépister les personnes vulnérables à une détérioration clinique. Lorsque ce facteur s'ajoute à l'âge et à l'histoire de problèmes de santé, la symptomatologie fournit plus d'information pronostique aux cliniciens qui prennent en charge les patients atteints de COVID-19 en milieu ambulatoire. D'autres études s'imposent pour déterminer si un suivi plus intense et une intervention précoce auprès des personnes très vulnérables peuvent modifier la trajectoire clinique et le pronostic des patients ambulatoires atteints de la COVID-19.

18.
CMAJ ; 193(24): E921-E930, 2021 06 14.
Article in French | MEDLINE | ID: covidwho-1551317

ABSTRACT

CONTEXTE: Les interventions non pharmacologiques demeurent le principal moyen de maîtriser le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) d'ici à ce que la couverture vaccinale soit suffisante pour donner lieu à une immunité collective. Nous avons utilisé des données de mobilité anonymisées de téléphones intelligents afin de quantifier le niveau de mobilité requis pour maîtriser le SRAS-CoV-2 (c.-à-d., seuil de mobilité), et la différence par rapport au niveau de mobilité observé (c.-à-d., écart de mobilité). MÉTHODES: Nous avons procédé à une analyse de séries chronologiques sur l'incidence hebdomadaire du SRAS-CoV-2 au Canada entre le 15 mars 2020 et le 6 mars 2021. Le paramètre mesuré était le taux de croissance hebdomadaire, défini comme le rapport entre les cas d'une semaine donnée et ceux de la semaine précédente. Nous avons mesuré les effets du temps moyen passé hors domicile au cours des 3 semaines précédentes à l'aide d'un modèle de régression log-normal, en tenant compte de la province, de la semaine et de la température moyenne. Nous avons calculé le seuil de mobilité et l'écart de mobilité pour le SRAS-CoV-2. RÉSULTATS: Au cours des 51 semaines de l'étude, en tout, 888 751 personnes ont contracté le SRAS-CoV-2. Chaque augmentation de 10 % de l'écart de mobilité a été associée à une augmentation de 25 % du taux de croissance des cas hebdomadaires de SRAS-CoV-2 (rapport 1,25, intervalle de confiance à 95 % 1,20­1,29). Comparativement à la mobilité prépandémique de référence de 100 %, le seuil de mobilité a été plus élevé au cours de l'été (69 %, écart interquartile [EI] 67 %­70 %), et a chuté à 54 % pendant l'hiver 2021 (EI 52 %­55 %); un écart de mobilité a été observé au Canada entre juillet 2020 et la dernière semaine de décembre 2020. INTERPRÉTATION: La mobilité permet de prédire avec fiabilité et constance la croissance des cas hebdomadaires et il faut maintenir des niveaux faibles de mobilité pour maîtriser le SRAS-CoV-2 jusqu'à la fin du printemps 2021. Les données de mobilité anonymisées des téléphones intelligents peuvent servir à guider le relâchement ou le resserrement des mesures de distanciation physique provinciales et régionales.


Subject(s)
COVID-19/prevention & control , Geographic Mapping , Mobile Applications/standards , Patient Identification Systems/methods , COVID-19/epidemiology , COVID-19/transmission , Canada/epidemiology , Humans , Mobile Applications/statistics & numerical data , Patient Identification Systems/statistics & numerical data , Quarantine/methods , Quarantine/standards , Quarantine/statistics & numerical data , Regression Analysis , Time Factors
19.
Clin Microbiol Infect ; 28(4): 491-501, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1540547

ABSTRACT

BACKGROUND: The prevalence of bacterial infection in patients with COVID-19 is low, however, empiric antibiotic use is high. Risk stratification may be needed to minimize unnecessary empiric antibiotic use. OBJECTIVE: To identify risk factors and microbiology associated with respiratory and bloodstream bacterial infection in patients with COVID-19. DATA SOURCES: We searched MEDLINE, OVID Epub and EMBASE for published literature up to 5 February 2021. STUDY ELIGIBILITY CRITERIA: Studies including at least 50 patients with COVID-19 in any healthcare setting. METHODS: We used a validated ten-item risk of bias tool for disease prevalence. The main outcome of interest was the proportion of COVID-19 patients with bloodstream and/or respiratory bacterial co-infection and secondary infection. We performed meta-regression to identify study population factors associated with bacterial infection including healthcare setting, age, comorbidities and COVID-19 medication. RESULTS: Out of 33 345 studies screened, 171 were included in the final analysis. Bacterial infection data were available from 171 262 patients. The prevalence of co-infection was 5.1% (95% CI 3.6-7.1%) and secondary infection was 13.1% (95% CI 9.8-17.2%). There was a higher odds of bacterial infection in studies with a higher proportion of patients in the intensive care unit (ICU) (adjusted OR 18.8, 95% CI 6.5-54.8). Female sex was associated with a lower odds of secondary infection (adjusted OR 0.73, 95% CI 0.55-0.97) but not co-infection (adjusted OR 1.05, 95% CI 0.80-1.37). The most common organisms isolated included Staphylococcus aureus, coagulase-negative staphylococci and Klebsiella species. CONCLUSIONS: While the odds of respiratory and bloodstream bacterial infection are low in patients with COVID-19, meta-regression revealed potential risk factors for infection, including ICU setting and mechanical ventilation. The risk for secondary infection is substantially greater than the risk for co-infection in patients with COVID-19. Understanding predictors of co-infection and secondary infection may help to support improved antibiotic stewardship in patients with COVID-19.


Subject(s)
Antimicrobial Stewardship , Bacterial Infections , COVID-19 , Respiratory Tract Infections , Bacteria , Bacterial Infections/drug therapy , Bacterial Infections/epidemiology , COVID-19/epidemiology , Female , Humans , Respiratory Tract Infections/drug therapy
20.
Ethics Hum Res ; 43(6): 19-27, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1530137

ABSTRACT

Excluding pregnant people from Covid-19 clinical trials may lead to unintended harmful consequences. For this study, an online questionnaire was sent to physicians belonging to Canadian professional medical associations in order to evaluate their perspectives on the participation of pregnant women in Covid-19 clinical trials. The majority of respondents expressed support for including pregnant women in Covid-19 trials (119/165; 72%), especially those investigating therapies with a prior safety record in pregnancy (139/164; 85%). The main perceived barriers to inclusion identified were unwillingness of pregnant patients to participate and of treating teams to offer participation, the burden of regulatory approval, and a general "culture of exclusion" of pregnant women from trials. We describe why some physicians may be reluctant to include pregnant individuals in trials, and we identify barriers to the appropriate participation of pregnant people in clinical research.


Subject(s)
COVID-19 , Physicians , Canada , Female , Humans , Pregnancy , Pregnant Women , SARS-CoV-2
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