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Open Forum Infectious Diseases ; 7(SUPPL 1):S672, 2020.
Article in English | EMBASE | ID: covidwho-1185952


Background. Countless diseases and medications have been implicated in the past as causing prolongation of the QT interval. Their unique role through the means of quantifying the definite magnitude of relative risk they contribute during hospitalization still requires further investigation. The aim of this study was to describe the impact of commonly used anti-infectives on the QT interval in hospitalized patients during the COVID-19 era. Methods. Demographic information, medical history, laboratory data, medication administration history and ECG recording data was collected from the electronic records of adult patients admitted to two urban hospitals. A mixed effects approach with four sub-models for the QT interval comprised of: heart rate, circadian rhythm, gender, and the drug (regressed as the cumulative mg dose administered over time) and disease effects was used. Fixed and random effects with between occasion variability were estimated for the parameters with a Bayesian approach using the STAN software. Results. Data from 2180 patients were used with baseline characteristics shown in Table 1. Observed vs. predicted plots based on the training (Figure 1.A) and validation data set (Figure 1.B) showed excellent fit. The parameters for QTc0, α, gender, and circadian rhythm were identified within the range previously described (Table 2.). Similarly, the model correctly identified the impact of acute or chronic diseases on the QT interval. Model coefficient estimates [mean (95% CI) of 0.010 (0.006, 0.15) and 0.0045 (0.0013, 0.01100) msec/mg cumulative dose, respectively] suggest that patients treated with conventional regimens of fluconazole and levofloxacin are most likely to present with a QT interval increase > 5 msec, the cutoff threshold of regulatory concern. Figure 1. A-B Table 1. Table 2. Conclusion: The model developed accurately identified the impact baseline risk factors and concomitant medications have on the QT interval. When adjusted for these confounding variables, estimates of QT interval prolongation show that treatment with fluconazole and levofloxacin pose a considerable risk;while treatment with azithromycin or hydroxychloroquine is of moderate risk for QT interval prolongation.

Open Forum Infectious Diseases ; 7(SUPPL 1):S337, 2020.
Article in English | EMBASE | ID: covidwho-1185900


Background: COVID-19 is an emerging pathogen that has caused a global pandemic, with New York City as one of its epicenters. Data are still forthcoming if pregnant women are more vulnerable to COVID-19, as they are with influenza. Additionally, it is not known if infants born to COVID-19 positive women are at risk of being infected at birth. Methods: In March 2020, our hospital instituted a policy of testing all pregnant women presenting for active labor and scheduled C-section or induction of labor, with a nasopharyngeal swab that was sent for RT-PCR qualitative SARSCoV- 2 assay (Roche Cobas® 6800). Upon birth, infants were also tested, unless the parent did not give consent. We retrospectively reviewed the COVID-19 test results of all pregnant women and their infants, from March 23 through May 31, 2020 using our infection control surveillance system (VigiLanz®). We also reviewed the electronic medical record (EPIC®) for documentation of any symptoms consistent with COVID-19 infection either prior to hospitalization or during the hospital stay. Results: A total of 415 women and 72 infants were tested for SARS-CoV-2. Of the 415 women tested, 41 (9.9%) were positive. Of the 72 infants tested, 2 (2.8%) were positive and concordant with their birth parent. Only 1 (2.4%) of the women who tested positive was symptomatic. The remaining 40 (97.6%) women did not report any symptoms of COVID-19 during labor. Neither of the two positive infants displayed any signs or symptoms of COVID-19. Of the 41 women who were positive, 5 did not consent to have their infant tested. The one symptomatic woman who tested positive for COVID-19 had an infant who tested negative by PCR. Conclusion: During the first wave of the COVID-19 pandemic, we found 9.9% (41/415) of pregnant women presenting for labor tested positive for SARS-CoV-2. Among the 41 women who tested positive, only 1 (2.4%) had symptoms on presentation and only 2 newborn infants tested positive. Our data suggests that pregnant women may not be at increased risk for complications from COVID-19 disease and are not likely to transmit the disease to their infants during labor.