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1.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2269011

ABSTRACT

Background: SARS-CoV-2 has emerged as a novel pathogen of community-acquired pneumonia (CAP). Aims and objectives: We aimed to compare characteristics, clinical outcomes and pneumococcal identification in patients with COVID-19 vs non-COVID-19 CAP. Method(s): EGNATIA is an ongoing, prospective study of adults >=19yo hospitalized with clinical and radiographicallyconfirmed CAP in Greece. The primary objective is to estimate the proportion of CAP due to pneumococcal serotypes included in 13-valent pneumococcal conjugate vaccine (PCV13). Pneumococcus was identified using serotype-specific urinary antigen detection assays (UAD 1/2), BinaxNow and conventional cultures. Testing for SARS-CoV-2 was performed as per national guidelines. Result(s): We compared 202 patients with COVID-19 pneumonia during Apr2020-Mar2021 vs 1033 patients with nonCOVID-19 CAP during Nov2017-Oct2020. Patients with COVID-19 were younger (median age 68.8 vs 75.8 years) and had fewer comorbidities (67.8% with >=1 underlying condition vs 79.2%) than non-COVID-19 patients. Patients with COVID-19 less frequently reported past pneumonia episodes (0.5% vs 7.7%) but were more frequently nursing home residents (13.9% vs 6%). Patients with COVID-19 had less severe pneumonia presentation (CURB 65 3-5 6.4% vs 30.5%;PSI IV-V 41.1% vs 55.2%) but required mechanical ventilation more frequently (7.4% vs 1.9%) and had a longer hospital stay (mean 17.4 vs 9.6 days). In-hospital mortality was similar between the 2 groups (7.9% in COVID-19 vs 8.9% in non-COVID-19). Pneumococcus was identified less frequently in patients with COVID-19 vs non-COVID-19 CAP (4% vs 11.1%). Conclusion(s): Significant differences were identified in patients with COVID-19 vs non-COVID-19 CAP.

2.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2263735

ABSTRACT

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common and associated with respiratory function decline, increased morbidity and mortality. It is unclear how COVID19 has impacted AECOPD phenotype and if it is associated with worse outcomes compared to other infections in COPD patients. Aim(s): To explore changes in AECOPD clinical characteristics and outcomes during the COVID-19 pandemic. Method(s): A prospective cohort study of all adults >=18y admitted to either acute care hospital in Bristol UK, Aug 20- Jul 21. Patients presenting with signs/symptoms or a clinical/radiological diagnosis of acute respiratory disease were included. Result(s): 2557 hospitalisations with AECOPD were recorded (incidence 361 per 100000);13% had SARS-CoV-2 identified, 69% had another pathogen and 18% had no infectious aetiology identified. Patient characteristics and clinical features were similar for patients with and without COVID19. ICU admissions were more common with SARS-CoV-2 than other infections (4% v 1%, P<0.001). SARS-CoV-2 associated AECOPD had greater inpatient (25% v 9%, P<0.001) and 30-day mortality (25% v 12%, P<0.001) than AECOPD associated with other infections. Among all AECOPD patients who had received >=1 dose of any COVID vaccination, ICU admission rates were lower than for unvaccinated persons (4% v 0%, P<0.01). Discussion(s): SARS-CoV-2 infection was associated with worse outcomes among persons hospitalized with AECOPD. SARS-CoV-2 vaccination was effective in reducing disease severity and ICU admission. More data are needed about the effectiveness of COVID19 vaccines for modifying disease severity in COPD patients.

3.
Thorax ; 77(Suppl 1):A26, 2022.
Article in English | ProQuest Central | ID: covidwho-2263734

ABSTRACT

S38 Figure 1ConclusionsOmicron infection was associated with less severe illness compared to Delta infection across three separate measures of severity. COVID-19 vaccination was independently associated with lower in-hospital disease severity, regardless of variant. Lower severity of Omicron combined with the ability of vaccine to further reduce severity may result in reduced pressure on healthcare services;however, the increased transmissibility of Omicron and potential for higher numbers of infections, particularly in elderly patients, may mitigate these benefits.Please refer to page A208 for declarations of interest related to this .

4.
Thorax ; 77(Suppl 1):A28-A29, 2022.
Article in English | ProQuest Central | ID: covidwho-2263733

ABSTRACT

S41 Figure 1ConclusionsWhile SARS-CoV-2 infection was a large component of hospitalised aLRTD, non-SARS-CoV-2 infection caused 56% of respiratory infection hospitalisations overall. Measured incidences of non-SARS-CoV-2 pneumonia and NP-LRTI were higher than pre-pandemic UK estimates. Given public health interventions to reduce all infective aLRTD implemented during this year, these higher estimates likely reflect highly comprehensive surveillance although there may have been a true higher non-SARS-CoV-2 disease incidence. These results demonstrate the significant burden of acute respiratory infection on healthcare systems. Broader efforts to prevent and manage all forms of adult aLRTD should be prioritized in addition to current COVID-19 prevention efforts.Please refer to page A209 for declarations of interest related to this .

5.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2263732

ABSTRACT

Background: Acute Lower Respiratory Tract Disease (aLRTD) includes pneumonia, non-pneumonic lower respiratory tract infection (NP-LRTI), heart failure (HF) and chronic respiratory disease exacerbation (CRDE). COVID19 has affected aLRTD disease burden. Few studies estimate total aLRTD burden, and subgroup distribution may have changed. Aim(s): To describe the frequency of individual aLRTD components and determine the impact of COVID19 on aLRTD disease. Method(s): A prospective cohort study of all adults >=18y admitted to either acute care hospital in Bristol, UK, from Aug 20-Jul 21. Patients were included if presenting with signs/symptoms or a clinical/radiological diagnosis of aLRTD. Result(s): 9243 aLRTD hospitalisations occurred: 5161 pneumonia, 2636 NP-LRTI, 1990 HF, 4144 CRDE, and 198 undifferentiated aLRTD cases. Overlap was common (Fig1): 31% HF and 83% CRDE events occurred in association with pneumonia or NP-LRTI. Hospitalisation rates corresponded with COVID-19 incidence over time. 41% hospitalisations were associated with positive SARS-CoV-2 test. Non-COVID19 aLRTD hospitalisations showed less variation over time. Discussion(s): aLRTD is a complex matrix with significant overlap between CRDE, HF and pneumonia/NP-LRTI. COVID19 disease in hospitalised adults was a large component of total aLRTD during this pandemic year;however, non-COVID19 aLRTD caused considerable disease burden.

6.
Open Forum Infectious Diseases ; 8(SUPPL 1):S257, 2021.
Article in English | EMBASE | ID: covidwho-1746692

ABSTRACT

Background. Streptococcus pneumoniae (pneumococcus) is a common colonizer of the upper respiratory tract and can progress to cause invasive and mucosal disease. Additionally, infection with pneumococcus can complicate respiratory viral infections (influenza, respiratory syncytial virus, etc.) by exacerbating the initial disease. Limited data exist describing the potential relationship of SARS-CoV-2 infection with pneumococcus and the role of co-infection in influencing COVID-19 severity. Methods. Inpatients and healthcare workers testing positive for SARS-CoV-2 during March-August 2020 were tested for pneumococcus through culture-enrichment of saliva followed by RT-qPCR (to identify carriage) and for inpatients only, serotype-specific urine antigen detection (UAD) assays (to identify pneumococcal pneumonia). A multinomial multivariate regression model was used to examine the relationship between pneumococcal detection and COVID-19 severity. Results. Among the 126 subjects who tested positive for SARS-CoV-2, the median age was 62 years;54.9% of subjects were male;88.89% were inpatients;23.5% had an ICU stay;and 13.5% died. Pneumococcus was detected in 17 subjects (13.5%) by any method, including 5 subjects (4.0%) by RT-qPCR and 12 subjects (13.6%) by UAD. Little to no bacterial growth was observed on 21/235 culture plates. Detection by UAD was associated with both moderate and severe COVID-19 disease while RT-qPCR detection in saliva was not associated with severity. None of the 12 individuals who were UAD-positive died. Conclusion. Pneumococcal pneumonia (as determined by UAD) continues to occur during the ongoing pandemic and may be associated with more serious COVID-19 outcomes. Detection of pneumococcal carriage may be masked by high levels of antibiotic use. Future studies should better characterize the relationship between pneumococcus and SARS-CoV-2 across all disease severity levels.

7.
Open Forum Infectious Diseases ; 8(SUPPL 1):S749, 2021.
Article in English | EMBASE | ID: covidwho-1746303

ABSTRACT

Background. Despite the widespread use of pneumococcal conjugate vaccines, particularly in children, an important burden of pneumococcal disease remains in older adults. The acquisition and transmission rates of pneumococcus between older adults have not been well characterized. Methods. Between October 2020-June 2021, couples living in the Greater New Haven Area were enrolled if both individuals were over the age of 60 years and did not have any individuals under the age of 60 years living in the household. Saliva samples and questionnaires regarding social patterns and medical history were obtained every 2 weeks for a period of 10 weeks. Following culture-enrichment, extracted DNA was tested using qPCR for pneumococcus-specific sequences piaB and lytA. Individuals were considered positive for pneumococcal carriage when qPCR Ct-values for piaB +/- lytA were less than 40. Results. To date, we have collected 495 saliva samples from 95 individuals (48 households). Of 495 saliva samples, 31 (5.9%) have tested positive for pneumococcus by either piaB only (n=9) or both lytA and piaB (n=22). Of 95 individuals, 16 (16.8%) (representing 13, or 27.1% households) have tested positive at least once. Six of the 16 (37.5%) carriers tested positive at multiple timepoints, though none were colonized at all 6 time points over the course of the 10 weeks of study enrolment. For 3 of the 48 (6.3%) households, both members of the couple were identified as carriers, though not necessarily at the same sampling moment. Conclusion. The preliminary findings of this longitudinal transmission model demonstrate evidence of pneumococcal acquisition among older adults measured by molecular tools. These transmission patterns and high rates of pneumococcal carriage in adults were observed during a period when the COVID-19 pandemic led to numerous preventative public health measures that may have reduced pneumococcal transmission (e.g., social distancing, mask wearing, bans on mass gatherings, restaurant closures, travel restrictions).

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