Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 4 de 4
Open Forum Infectious Diseases ; 8(SUPPL 1):S280, 2021.
Article in English | EMBASE | ID: covidwho-1746643


Background. Antibiotic use among patients with COVID-19 is common, exceeds the prevalence of probable bacterial co-infection, and promotes development of resistant organisms. Lack of diagnostic microbiological data may prolong empiric broad-spectrum therapy. Here we evaluate the use of the BioFire FilmArray pneumonia panel (PP), a novel rapid diagnostic test, and antibiotic decisions among intensive care unit (ICU) patients with COVID-19. Methods. We conducted a retrospective review of adult ICU patients admitted with COVID-19 between January 2020 and May 2021 at an academic medical center. ICU patients who underwent bronchoscopy/bronchoalveolar lavage (BAL) with PP (PP group) were matched by age (< 65 or ≥65), BMI (< 30 or ≥30), and BAL date (within 60 days) to ICU patients who did not undergo BAL (no-BAL group). PP patients were matched by age and BMI to ICU patients who underwent BAL without PP (no-PP group). Antibiotic use was compared between groups. Chi squared analysis, t-test, and ANOVA were used for comparisons as appropriate. Results. 65 patients were included;the majority were male (65%), < 65 years (86%), and had BMI ≥30 (54%) (Table 1). Only 17 no-PP matches were identified for PP patients due to infrequent BALs. Similar proportion of patients in PP and no-PP groups had organisms identified from BAL (54% vs. 47%, p=0.65). Among PP patients with a detected organism, all (n=13) had subsequent changes in antibiotic regimen ≤72 hours after BAL;10/13 (77%) had a change targeted to detected organism and 5/13 (39%) had antibiotic narrowing. Among PP patients with no detected organism, only 4/11 (36%) had antibiotic narrowing or maintenance off antibiotics. In all groups, average antibiotic use exceeded 70% of admission duration. Table 1. Patient characteristics and antibiotic management. Abbreviations: BAL - bronchoalveolar lavage Conclusion. Rapid, highly sensitive diagnostic tests have potential to guide clinical decisions and promote antibiotic stewardship among patients with severe viral pneumonia and suspected bacterial co-infection. In this descriptive analysis, antibiotic management did not differ significantly with use of PP. While most patients with detected organism on PP had targeted antibiotic changes, a negative PP did not appear to influence antibiotic narrowing. Larger studies and provider education are needed to evaluate potential of the PP for antibiotic stewardship.

Clinical Infectious Diseases ; 71(16):2305-2306, 2020.
Article in English | GIM | ID: covidwho-1608839


This study reports NP viral load in infants, children, and adolescents hospitalised and discharged from 14 March to 24 April, 2020. Of the 57 patients who tested positive counted with SARS-CoV-2, 20 (35.1%) were infants 12 months of age or younger. Older children and adolescents range from 1 year old to 21 years old. The mean NP viral load in neonates was significantly higher than in older children and adolescents. However, the proportion of neonates with severe illness is significantly lower than in older patients. The mean time to positive test from onset of symptoms is shorter in neonates than in older children. Rates were similar in both groups examined within 7 days of symptom onset. The report suggests that symptomatic infants have higher NP viral loads at the time of presentation, but develop less severe disease than older children and adolescents. Whether this is due to a slightly earlier presentation to clinical care related to host biology is investigated. These data have implications for mitigating the spread, especially in collective settings (e.g. day care centers) or hospital units (e.g., primary care units) for infants that serve this group.

Working Paper Series National Bureau of Economic Research ; 19(11), 2020.
Article in English | GIM | ID: covidwho-1408097


The extent to which K-12 schools should remain open is at the forefront of discussions on longterm pandemic management. In this context, there has been little mention of the immediate importance of K-12 schooling for the rest of the economy. Eliminating in-person schooling reduces the amount of labour time parents of school-aged children have available to work, and therefore reduces income to those workers and the economy as a whole. We discuss two measures of economic importance, and how they can be modified to better reflect the vital role played by K-12 education. The first is its size, as captured by the fraction of GDP that is produced by that sector. The second is its centrality, reflecting how essential a sector is to the network of economic activity. Using data from Canada's Census of Population and Symmetric Input-Output Tables, we show how accounting for this role dramatically increases the importance of K-12 schooling.