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Objective: To determine the frequency of antibiotic use and to know which clinical and socio-demographic variables were related to the probability of suffering infections associated with COVID-19. Method(s): Adults hospitalized for COVID-19 who received one or more antibiotics during hospitalization were evaluated. We performed a descriptive analysis of variables in the general population' bivariate analysis in two groups (documented vs. suspected infection) and multivariate logistic regression of factors associated with mortality. Result(s): It was determined that 60.4% of adults hospitalized for COVID-19 received antibiotics. Coinfection was documented in 6.2% and superinfection in 23.3%. Gram-negative germs were reported in 75.8% of cultures, fungi in 17.8% and gram-positive in 14.2%. Variables such as age, comorbidities, ICU, anemia, steroids, mechanical ventilation, hemofiltration were statistically significantly related to documented infection. High-flow cannula was associated as a protective factor. Overall mortality was 43.9%, 57.8% in the first group and 38.1% in the second (p=0.002). Conclusion(s): There is a considerable frequency of antibiotic use in subjects hospitalized for COVID-19, particularly related to relevant findings of bacterial superinfection, in those with comorbidities, such as diabetes mellitus, immunosuppression, anemia and fragility, in whom the behavior of the disease is more severe and lethal.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.
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Introduction: In this study, we share the results of immunosuppressed patients who suffered from acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia managed in our ICU. Method(s): We tracked all patients admitted to ICU of a Tertiary Hospital diagnosed with severe SARS-COV2 pneumonia from March 1, 2020 to January 31, 2022. The definition of Immunocompromised patient is based on history of transplantation, active neoplasia, autoimmune diseases or HIV. Collected data includes: sex, age, type of immunosuppression, vaccination, mechanical ventilation, ECMO VV, incidence of superinfections and mortality. Result(s): From a cohort of 425 patients, 55 met the inclusion criteria. 33% were women and 67% male. The average age was 58 years for women and 62 years for men. Out of these patients, 27% had solid organ transplants. 40% suffered from neoplasic disease. 27% had autoimmune diseases and were under treatment with immunosuppressants. 3 had HIV. Only the 29% had received at least 1 dose of COVID 19 vaccine. 80% required orotracheal intubation. 3.64% (2) required Veno-Venous ECMO. 61% presented bacterial superinfection, with the most frequent germs being Pseudomonas aeruginosa and Enterococcus. 36% had viral superinfection, being cytomegalovirus the most frequent one. 32% had fungal superinfection, mainly by Aspergillus fumigatus. 27% did not suffer any superinfection. 40% of the total sample died. After logistic regression, in our model (AUC 83,4% (Se 57.1%, Sp 87.9%), we identified need of intubation as independent variable of mortality (OR 27,06 IC95% 1.76-415.55, p = 0.018). Conclusion(s): Immunocompromised patients with ARDS secondary to COVID-19 pneumonia present high mortality, with statistically significant difference when mechanical ventilation is needed. The most frequently isolated germs causing superinfection in this group of patients are bacterias. We believe that this group of patients require special care in our ICU units and an in-depth analysis and study to optimize their prognosis.
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The future waves of COVID 19 infections will continue to raise serious problems in patients with severe forms of the disease. Bacterial infections associated with SARS-CoV-2 disease may complicate the progress of hospitalized patients with COVID-19. The present study aimed to evaluate the etiological spectrum of superinfection in adult patients with COVID-19 and to investigate the correlation between superinfection with multidrug-resistant (MDR) bacteria and serum procalcitonin (PCT). A total of 82 COVID-19 hospitalized patients with COVID-19 and bacterial superinfection were included. The superinfections were classified into early infections (3-7 days from admission) and late infections (>7 days from admission). Bacterial superinfection etiological spectrum, MDR bacteria profile and levels of serum PCT were studied. The most frequently isolated bacteria were Klebsiella pneumoniae, Acinetobacter baumannii and Enterococcus spp. MDR bacteria were involved in 73.17% of COVID-19 patients with bacterial superinfections. Most MDR bacteria superinfections (73.52%) occurred in the late infection period. Klebsiella pneumoniae, Enterococcus spp. and Methicillin-resistant Staphylococcus aureus were the most common MDR bacteria identified in late infections after hospitalization in 20.43, 4.30 and 4.30% of all infections, respectively. Serum PCT values were significantly higher in patients with MDR bacteria superinfection compared with patients with sensitive bacteria superinfection (P=0.009). The principal findings of the present study were the high prevalence of superinfection with MDR bacteria among the COVID-19 patients with bacterial superinfections and the presence of a statistically significant association between serum PCT levels and the presence of superinfection with MDR bacteria. The most effective way to fight against microbial resistance to antibiotics, whether it occurs independently or overlaps with viral infections, is to pursue a national policy for the rational use of antibiotics.
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Case report We present the case of a 63-year- old man with two consecutive admissions, due to COVID19 infection and subsequent bacterial superinfection. Three days after the second admission (04/28), and 43 days from the beginning of the infection an assessment by dermatology and allergology is then requested. The patient had generalized erythematous maculopapular rash in the trunk, back, groin and limbs. On the left side and back, pustular lesions not focused on follicles were also added, with a fever of 37.7degreeC. There were no oral and genital lesions. No psoriasis. The drugs used during the present and previous admissions were reviewed. Previous admission (04/04-22/ 20): Linezolid, ciprofloxacin, meropenem 04/13-22, piperacillin/tazobactam, hydroxychloroquine, azithromycin, ceftriaxone. Upon discharge amoxicillin/acid clavulanic. Present admission (04/25) Cutaneous reaction 04/28. 04/25: meropenem, paracetamol, enoxaparin, insulin, omeprazole, venlafaxine. 04/26: Darbepoetin, furosemide, mycophenolate in single dose. 04/27: Linezolid, macrogol, Clopidogrel, Magnesium, Calcitriol. Medical records: DM type 2, liver transplantation due to HCV cirrhosis, HCV recurrence, uninodular hepatocarcinoma, advanced CKD, secondary hyperparathyroidism, multiple neurological antecedents. We performed a detailed study. We hypothesized with a pharmagological/ drug reaction with several drugs possibly involved and our main suspicion was an allergic reaction to beta-lactams. Biopsy: Subcorneal pustules, basal spongiosis and presence in the superficial dermis of edema and an inflammatory infiltrate with abundant neutrophils. No fungi. Findings compatible with clinical diagnosis of generalized acute exanthematic pustulosis (PEGA). Immunohistochemical study Covid19. (Jimenez Diaz Foundation) Finely granular positivity in endothelium and more coarse in sweaty epithelium. Neutrophilic superficial inflammatory component with presumably spure staining. ACe-2 (positive external control) is not detected. The patient presents a EuroSCAR score of 9, sum of the clinic and the pathological anatomy, and therefore defined diagnosis. Clinical diagnosis: PEGA secondary to meropenem. Conclusion(s): We present the case of a PEGA by meropenem, not very often described in the literature. We highlight the importance of differential diagnosis with viral infections. Skin tests, especially epicutaneous tests, are key to the diagnosis. (Figure Presented).
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Previous findings suggest that bacterial coinfections are less common in ICU patients with COVID-19 than with influenza, but evidence is limited. OBJECTIVES: This study aimed to compare the rate of early bacterial coinfections in ICU patients with COVID-19 or influenza. DESIGN SETTING AND PARTICIPANTS: Retrospective propensity score matched cohort study. We included patients admitted to ICUs of a single academic center with COVID-19 or influenza (January 2015 to April 2022). MAIN OUTCOMES AND MEASURES: The primary outcome was early bacterial coinfection (i.e., positive blood or respiratory culture within 2 d of ICU admission) in the propensity score matched cohort. Key secondary outcomes included frequency of early microbiological testing, antibiotic use, and 30-day all-cause mortality. RESULTS: Out of 289 patients with COVID-19 and 39 patients with influenza, 117 (n = 78 vs 39) were included in the matched analysis. In the matched cohort, the rate of early bacterial coinfections was similar between COVID-19 and influenza (18/78 [23%] vs 8/39 [21%]; odds ratio, 1.16; 95% CI, 0.42-3.45; p = 0.82). The frequency of early microbiological testing and antibiotic use was similar between the two groups. Within the overall COVID-19 group, early bacterial coinfections were associated with a statistically significant increase in 30-day all-cause mortality (21/68 [30.9%] vs 40/221 [18.1%]; hazard ratio, 1.84; 95% CI, 1.01-3.32). CONCLUSIONS AND RELEVANCE: Our data suggest similar rates of early bacterial coinfections in ICU patients with COVID-19 and influenza. In addition, early bacterial coinfections were significantly associated with an increased 30-day mortality in patients with COVID-19.
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Background: Patients with coronavirus disease 2019 (COVID-19) and severe acute respiratory distress syndrome (ARDS) need in 10.5 to 15% veno-venous ECMO (V-V ECMO) therapy. The worldwide mortality in COVID-19 patients on ECMO has been described as extremely high with a mortality rate of 40 to 70%. Method(s): We collected data from 56 patients with severe ARDS who received V-V ECMO in 2020 to January 2022 at the University Hospital Magdeburg due to COVID-19 infection. We recorded demographic, pre-, intra-, and posttreatment data retrospectively. We divided the patients into two groups (survivors and nonsurvivors) to build the final prediction model based on our statistic and to detect relevant mortality risk factors. Result(s): Only 39.3% of patients survived the intensive care unit. Compared groups didn't differ in associated diseases. Most of the non-survivors were male (14 [63.6%] vs. 28 [82.4%], p = 0.114). Nonsurvivors showed a higher incidence of bleeding complications (10 [45.5%] vs. 23 [67.6%], p = 0,099), especially hemothorax (1 [4.5%] vs. 7 [20.6%], p = 0.094) and endobronchial bleeding (0 vs. 5 [14.7%], p = 0.059) as well as a higher incidence of bacterial superinfection (9 [40.1%] vs. 22 [64.7%], p = 0.080). Moreover, groups differed concerning the incidence of acute kidney injury without dialysis (1 [4.5% vs. 9 [26.5%], p = 0.036), and acute liver failure (1 [4.5%] vs. 7 [20.6%], p = 0.094). According to the results of bivariate regression analysis, male sex (odd ratio [OR]: 2.66;95% confidence interval [CI]: 0.773-9.194;p = 0.120), major bleeding events (OR: 2.50;95% CI: 0.831-7.574;p = 0.103), bacterial superinfection (OR: 2.65;95% CI: 0.879-7.981;p = 0.084), acute kidney injury without dialysis (OR: 7.56;95% CI: 0.884-64.636;p = 0.065), and acute liver failure (OR: 5.44;95% CI: 0.621-47.756, p = 0.126) were tendentious significant predictors of death. Subsequently, according to the results of multivariate analysis, the most significant factors of mortality were major bleeding events (OR: 3.27;95% CI: 0.888-12.047, p = 0.075) and the bacterial superinfection (OR: 2.81;95% CI: 0.800-9.888, p = 0.107). The mortality prediction model explained 31.8% (Nagelkerke R2) of the variance in-hospital mortality and correctly classified 71.4% of the cases. Conclusion(s): Major bleeding events and bacterial superinfection might be relevant mortality factors in COVID-19 patients on V-V ECMO therapy. Especially prevention of superinfection and strictly anticoagulation management might result in lower mortality rates.
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BACKGROUND Tocilizumab (TCZ) is an interleukin-6 (IL-6) inhibitor approved for use in patients severely affected by COVID-19, which has been shown to reduce mortality but has as yet undetermined effects on procalcitonin (PCT) and C-reactive protein (CRP). In Malta, TCZ started being administered to COVID-19 patients who experience worsening symptoms or increased oxygen requirements over a period of hours in January 2021. This study aimed to assess the effect of TCZ on PCT primarily, and white cell count (WCC), lymphocyte and neutrophil counts, neutrophil to lymphocyte ratio (NLR), CRP and PaO2/FiO2 (P/F) ratio as secondary measures. METHODS Fifty patients who received tocilizumab were recruited to the treatment group along with a matched control group of 50 patients who did not receive the drug. Serum PCT and other biochemical markers were recorded daily for both groups and differences in the values for the two groups extracted. Outcome measures included differences between the biomarkers at 5, 10 and 15 days. RESULTS PCT and CRP were significantly lowered by administration of TCZ on Day 5. WCC, lymphocyte and neutrophil counts and P/F ratios were not affected. There was no difference in positive blood culture results between the two groups. CONCLUSI ON PCT and CRP may not be reliable indicators of bacterial superinfection in severe COVID-19 pneumonia patients who have been given TCZ.Copyright © 2023, University of Malta. All rights reserved.
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The SARS-CoV-2 is the betacoronavirus responsible for the coronavirus disease 2019 (COVID-19) pandemic. Severe COVID-19 affects approximately 10-15% of patients and results in prolonged morbidity and mortality. Little is known about the immunophenotypic changes of the lung parenchyma driven by the viral infection in patients who die of severe COVID-19. Ultrasound-guided lung biopsies (LB) were collected (IRB approval#1561/21) within few hours from death in 15 severe COVID-19 patients between November 2020 and January 2021, in two patients who underwent lung transplantation after COVID-19 and in one patient who had surgery for bacterial superinfection during COVID-19 disease. All samples underwent histologic and immunohistochemistry evaluation and molecular profiling using the nCounter Host Response and Coronavirus Panel plus. As controls, lungs from end-stage usual interstitial pneumonia (UIP;n=9) and from lobectomy for lung cancer (Norm;n=5) were used. Eleven lungs (61%) were positive for SARS-CoV-2 RNA. Signs of diffuse alveolar damage (DAD) were observed in 6 patients (30%). COVID-19 lungs showed a marked macrophage infiltration with M2 polarization compared with controls. Globally, COVID-19 lungs showed distinct molecular profiles from UIP or Norm lungs. Specifically, a marked upregulation of interferon-genes that was directly correlated with SARS-CoV-2 genes was seen in COVID-19 lungs. COVID-19-specific genes signatures (Log2FC >1.5;adj p<0.05) obtained using VENN diagram showed impairment of the STAT3-pathway accompanied by the upregulation of the NFkB signaling. Results herein provide new insights into lung alterations induced by severe COVID-19 and suggest novel potential targets for therapeutic intervention.
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Background: Patients hospitalized with COVID-19 are at significant risk for superimposed bacterial pneumonia. However, diagnosing superinfection is challenging due to its clinical resemblance to severe COVID-19. We therefore evaluated whether the immune biomarker, procalcitonin, could facilitate the diagnosis of bacterial superinfection. Methods: We retrospectively identified 185 patients hospitalized with severe COVID-19 who underwent lower respiratory culture; 85 had evidence of bacterial superinfection. Receiver operating characteristic curve and area under the curve (AUC) analyses were performed to assess the utility of procalcitonin for diagnosing superinfection. Results: This approach demonstrated that procalcitonin measured at the time of culture was incapable of distinguishing patients with bacterial infection (AUC, 0.52). The AUC not affected by exposure to antibiotics, treatment with immunomodulatory agents, or timing of procalcitonin measurement. Conclusion: Static measurement of procalcitonin does not aid in the diagnosis of superinfection in severe COVID-19.
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Background: While the exact prevalence of bacterial co-infection and superinfection in children with coronavirus disease 2019 (COVID-19) remains unclear, numerous scattered reports of it are on the rise. Case Presentation: Our case was a 14-month-old infant with fever, truncal erythema, and scalded skin in flexor folds and also in perianal and perioral regions. A positive Nikolsky's sign was observed. The oropharyngeal mucosa was intact. The patient was diagnosed with staphylococcal scalded skin syndrome (SSSS) according to clinical features and a skin culture report. Due to the general impact of COVID-19 these days, the patient was evaluated for coronavirus via a polymerase chain reaction (PCR) test, and the result was positive. The patient successfully responded to the treatment which included hydration, wet compress, topical emollient, topical mupirocin for periorificial regions, and intravenous clindamycin. He was discharged after nine days without any complications. Conclusion(s): This case highlights a clear bacterial infection superimposed on COVID-19. Nevertheless, inconspicuous cases of co-infections remain obscure and require a more diagnostic suspicion. Copyright © 2022 Hoseininasab et al.
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Background The evaluation of coronavirus disease 2019 (COVID-19) patients with respiratory secondary bacterial infection, and the causative pathogens, is crucial for the treatment plan of those patients and to ensure the effective needed treatment with antibiotics and to decrease its abuse. Aim To clarify the incidence of bacterial infection in patients with COVID-19 and sensitivity to antibiotics. Patients and methods Samples of sputum were collected from 120 patients with confirmed COVID-19 by clinical, laboratory, radiological signs of pneumonia, or PCR, the severity of COVID-19 was classified as moderate and severe. The moderate type included patients with pneumonia without hypoxemia. The severe type was characterized by (a) dyspnea (respiratory rate >=30/min), (b) blood oxygen saturation less than or equal to 93%, and (c) PaO2 /FiO2 ratio less than 300 or lung infiltrates more than 50%. If one of the above items was met, it was classified as severe. Then, all cases were sent for screening of the presence of secondary bacterial infections by quantitative sputum bacterial culture and sensitivity. Positive cases of bacterial infection were classified into patients with early bacterial infection less than 15 days from COVID-19 infection and patients with late bacterial infections after more than 15 days of COVID-19 infection. Results In total, 40 (33.3%) cases out of 120 cases of COVID-19 showed bacterial growth, while 80 (66.7%) cases were negative for bacterial secondary infection. The most common organisms isolated were Klebsiella pneumoniae 12 cases, streptococci 10 cases, MERSA eight cases, Escherichia coli five cases and mixed infection by E. coli, Klebsiella, and Candida in five cases, Staphylococcus aureus was the same rate in early and late infections, all streptococci were early infection, and more cases of K. pneumoniae were late infection nine cases out of 13, where E. coli was early infection four cases out of five. All mixed infections were late. Conclusion Hidden secondary bacterial infection should be screened in COVID-19 patients. Early bacterial infections and moderate COVID-19 pneumonia are mainly caused by Gram-positive bacteria, but late bacterial infections and severe COVID-19 pneumonia are mainly caused by Gram-negative bacteria. Copyright © 2022 Indian Journal of Anaesthesia Published by Wolters Kluwer - Medknow.
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INTRODUCTION: The appropriate use of empiric antibiotics is a clinical challenge for patients with severe COVID-19. Early in the pandemic, there was concern that bacterial coinfection would influence morbidity and mortality. This concern often led to treating patients empirically with antibiotics. Fortunately, early data from the COVID-19 pandemic suggests bacterial coinfection is uncommon. However, there has been little published data on the antibiotic prescribing practices over the course of the pandemic. This study aims to investigate the inter-center variation and temporal trends of early antibiotic prescribing in patients hospitalized with COVID-19. METHOD(S): We performed a retrospective analysis using the National COVID Cohort Collaborative database. We identified patients admitted between March 2020 and December 2021 who had a positive COVID-19 PCR or antigen test 15 days prior or within 48 hours of admission. Age at time of COVID-19 diagnosis, gender, race/ethnicity, Charlson comorbidity index, the month of hospitalization, antibiotics received, labs at the time of hospital admission, and center identifier were collected. A chi-square test was used for categorical data and Wilcoxon rank-sum test for continuous data. Mixed effects logistic regression was used to evaluate predictors of early empiric antibiotic use. RESULT(S): Of 280,601 qualifying first hospitalizations, 30,469 patients received early empiric antibiotics. Antibiotic use declined across all centers over time from the first month (23%) to the last month in (8.1%) in the data collection period (p < 0.01). Antibiotic use decreased slightly by day 2 of hospitalization and was significantly reduced by day 5. Mechanical ventilation before day 2 (OR 2.25, 95% CI 2.14 - 2.36) and ECMO before day 2 (OR 1.60, 95% CI 1.25 - 2.05) but not region of residence was associated with early empiric antibiotic use. CONCLUSION(S): Although treatment of COVID-19 patients with empiric intravenous antibiotics has declined during the pandemic, the frequency of use remains higher than the reported incidence of bacterial superinfection. There is significant inter-center variation in antibiotic prescribing practices. Future research should focus on comparing outcomes and adverse events among COVID-19 patients treated with and without empiric antibiotics.
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INTRODUCTION: Acute epiglottitis is a potentially fatal condition due to high risk of respiratory failure from upper airway obstruction and resultant difficulty securing a patent airway. The etiology is most commonly infectious although noninfectious etiologies have been identified. We present a rare case of acute epiglottitis as a presentation of COVID-19. DESCRIPTION: A 37-year-old male with a past medical history of health presented due to acute throat pain with difficulty swallowing, and without dyspnea or cough. The patient took no medications or supplements, had no known sick contacts, chemical inhalation, recent travel, or any known allergies. He had never received vaccination for COVID-19. He occasionally smoked cigarettes and marijuana, and did not consume alcohol or use illicits. The patient was febrile and had a swollen, tender submandibular area and tender cervical lymphadenopathy. Solids, liquids, and saliva were difficult to swallow but he was in no respiratory distress. A CT of the neck showed the classic "thumb sign" of a thickened epiglottis as well as thickening of the laryngeal soft tissues. Visualized by flexible laryngoscopy, the epiglottis was erythematous and severely swollen;vocal cords functioned normally. He had neutrophilic predominant leukocytosis with monocytosis. A nasopharyngeal swab PCR was positive for SARS-CoV-2, however a broad work up for other viral and bacterial pathogens was negative. He was admitted to the intensive care unit and treated with broad spectrum antibiotics and high dose corticosteroids. After five days of monitoring, no intubation or airway intervention was needed. He improved as he tolerated a liquid diet and was discharged home with antibiotics. DISCUSSION: 18 cases of acute epiglottitis associated with COVID-19 have been reported, and the incidence is likely underestimated. The mechanism of epiglottitis in SARSCoV- 2 infection is poorly understood;whether directly caused by the virus versus by Increased susceptibility to bacterial superinfection. Clinicians should be aware of this condition due to the high risk of airway compromise and mortality without prompt diagnosis and appropriate management. Early involvement of skilled providers is critical as patients may require nasotracheal intubation, tracheostomy, or emergent cricothyrotomy.
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Introduction: The COVID-19 pandemic caused by the new coronavirus has led to enormous pressure on health systems around the world, with an increase in the number of hospitalizations for pneumonia with a higher incidence of healthcare-associated infections (1). Material(s) and Method(s): We performed a retrospective analysis of 40 cases hospitalized in the first pandemic wave between March 2020-May 2020, addmited in the Intensive Care Unit of the Clinical Hospital for Infectious Diseases Constanta, including patients with a diagnosis of SARS-CoV-2 infection and Bacterial superinfection. Multiple parameters were analysed: Clinical, biological, bacterial culture results, resistance profile of isolated strains, as well as patient's evolution. Results and Conclusion(s): In terms of patient profile, the average age was 62.3 years, with the male sex being the majority represented by a number of 30 cases (75%). All patients had associated comorbidities. The clinical picture presented by the patients was characteristic of severe forms of infection, with respiratory failure. The observed bio-humoral changes characteristic of bacterial superinfections were found in all patients, leukocytosis with marked neutrophilia, significant biological inflammatory syndrome and positive procalcitonin. During the period analysed we observed a significant increase in carbapenem-resistant strains. The resistant strains were represented by Klebsiella Pneumoniae found in 35 samples (54%), Acinetobacter Buamanni was isolated in 15 culture samples (23%). The antibiotic regimen used consisted of a combination of 2 or 3 classes of antibiotics depending on the resistance profile, monotherapy is not recommended in infections with multi-resistant germs. All patients required oxygen therapy, the average length of hospital stay was 28 days. Death was recorded in 10 cases (25%). Copyright © 2022 Mihai Raluca et al., published by Sciendo.
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The COVID-19 pandemic, due to SARS-CoV-2, has affected all facets of society, including actions to address antimicrobial resistance (AMR). AMR was already among the top priorities for global public health, before the COVID pandemic began. The propagation of COVID-19 around the globe has been followed by an increased use of antibiotics. This is related to the alarm for bacterial superinfection in COVID-19 patients. With the risk of COVID-19 spread, there has been a rising awareness of the importance of antimicrobial stewardship programs (AMSP), as well as infection prevention and control (IPC) measures that could help decrease the microbial load and hence circulation of pathogens, with a drop-in dissemination of AMR. Here is an overview of factors during the pandemic that influenced AMR. Patients with COVID-19 often needed multiple courses of broad-spectrum antibiotics, mechanical ventilation, other organ support, and/or other invasive devices. This amplified exposure to, and risk of, infections with hospital-associated pathogens that are often highly resistant such as methicillinresistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Candida auris, and Acinetobacter baumannii. On the brighter side, vitamins C, D3 and Zinc micronutrients have shown immunomodulating activity & as epithelial and endothelial barriers. ICU patients with continued illness/intubation have more common detection of multidrug-resistant (MDR) Gram-negative pathogens, likely reflecting hospital-acquired infection. Biomarkers such as CRP and PCT help in diagnosing bacterial infections, which may be raised in severe COVID-19 patients. In the particular setting of SARS-CoV-2 infection, fluid and pusfilled pulmonary alveoli generate a nutritive setting for bacteria such as P. aeruginosa and S. aureus. Chief recommendation to battle AMR problem includes, to optimize antibiotic use by confirming that the apt antibiotic is directed at the correct dose, for the correct duration, and in a manner that checks the best consequence and restricts side effects and AMR. Investigation of resistance must endure and be strengthened, in both COVID-19 and non-COVID-19 patients. Among the many consequences of the COVID-19 pandemic, there is the dominant potential impact on AMR. If not addressed, AMR will likely have hostile consequences, though over a period.
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The demographics and outcomes of ICU patients admitted for a COVID-19 infection have been characterized in extensive reports, but little is known about antimicrobial stewardship for these patients. We designed this retrospective, observational study to investigate our hypothesis that the COVID-19 pandemic has disrupted antimicrobial stewardship practices and likely affected the rate of antibiotic de-escalation (ADE), patient outcomes, infection recurrence, and multidrug-resistant bacteria acquisition. We reviewed the prescription of antibiotics in three ICUs during the pandemic from March 2020 to December 2021. All COVID-19 patients with suspected or proven bacterial superinfections who received antibiotic treatment were included. The primary outcome was the rate of ADE, and secondary outcomes included the rate of appropriate empirical treatment, mortality rates and a comparison with a control group of infected patients before the COVID-19 pandemic. We included 170 COVID-19 patients who received antibiotic treatment for a suspected or proven superinfection, of whom 141 received an empirical treatment. For the latter, antibiotic treatment was de-escalated in 47 (33.3%) patients, escalated in 5 (3.5%) patients, and continued in 89 (63.1%) patients. The empirical antibiotic treatment was appropriate for 87.2% of cases. ICU, hospital, and day 28 and day 90 mortality rates were not associated with the antibiotic treatment strategy. The ADE rate was 52.2% in the control group and 27.6% in the COVID-19 group (p < 0.001). Our data suggest that empirical antibiotic treatment was appropriate in most cases. The ADE rates were lower in the COVID-19 group than in the control group, suggesting that the stress associated with COVID-19 affected our practices.
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BACKGROUND: In the period following the declaration of the COVID-19 pandemic, more evidence became available on the epidemiology of bacterial co-/superinfections (bCSs) in hospitalized COVID-19 patients. Various European therapeutic guidelines were published, including guidance on rational antibiotic use. METHODS: In this letter to the editor, we provide an overview of the largest meta-analyses or prospective studies reporting on bCS rates in COVID-19 patients and discuss why the reader should interpret the results of those reports with care. Moreover, we compare different national and international COVID-19 therapeutic guidelines from countries of the European Union. Specific attention is paid to guidance dedicated to rational antibiotic use. RESULTS: We found a significant heterogeneity in studies reporting on the epidemiology of bCSs in COVID-19 patients. Moreover, European national and international guidelines differ strongly from each other, especially with regard to the content and extent of antibiotic guidance in hospitalized COVID-19 patients. CONCLUSION: A standardized way of reporting on bCSs and uniform European guidelines on rational antibiotic use in COVID-19 patients are crucial for antimicrobial stewardship teams to halt unnecessary antibiotic use in the COVID-19 setting.
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Clinicians in the emergency department (ED) face challenges in concurrently assessing patients with suspected COVID-19 infection, detecting bacterial coinfection, and determining illness severity since current practices require separate workflows. Here, we explore the accuracy of the IMX-BVN-3/IMX-SEV-3 29 mRNA host response classifiers in simultaneously detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and bacterial coinfections and predicting clinical severity of COVID-19. A total of 161 patients with PCR-confirmed COVID-19 (52.2% female; median age, 50.0 years; 51% hospitalized; 5.6% deaths) were enrolled at the Stanford Hospital ED. RNA was extracted (2.5 mL whole blood in PAXgene blood RNA), and 29 host mRNAs in response to the infection were quantified using Nanostring nCounter. The IMX-BVN-3 classifier identified SARS-CoV-2 infection in 151 patients with a sensitivity of 93.8%. Six of 10 patients undetected by the classifier had positive COVID tests more than 9 days prior to enrollment, and the remaining patients oscillated between positive and negative results in subsequent tests. The classifier also predicted that 6 (3.7%) patients had a bacterial coinfection. Clinical adjudication confirmed that 5/6 (83.3%) of the patients had bacterial infections, i.e., Clostridioides difficile colitis (n = 1), urinary tract infection (n = 1), and clinically diagnosed bacterial infections (n = 3), for a specificity of 99.4%. Two of 101 (2.8%) patients in the IMX-SEV-3 "Low" severity classification and 7/60 (11.7%) in the "Moderate" severity classification died within 30 days of enrollment. IMX-BVN-3/IMX-SEV-3 classifiers accurately identified patients with COVID-19 and bacterial coinfections and predicted patients' risk of death. A point-of-care version of these classifiers, under development, could improve ED patient management, including more accurate treatment decisions and optimized resource utilization. IMPORTANCE We assay the utility of the single-test IMX-BVN-3/IMX-SEV-3 classifiers that require just 2.5 mL of patient blood in concurrently detecting viral and bacterial infections as well as predicting the severity and 30-day outcome from the infection. A point-of-care device, in development, will circumvent the need for blood culturing and drastically reduce the time needed to detect an infection. This will negate the need for empirical use of broad-spectrum antibiotics and allow for antibiotic use stewardship. Additionally, accurate classification of the severity of infection and the prediction of 30-day severe outcomes will allow for appropriate allocation of hospital resources.
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Background: The coronavirus disease 2019 (COVID‐19) was first reported in December 2019 in Wuhan, China. Skin manifestations of COVID-19 have been reported sporadically. Staphylococcus aureus occurs after viral infection due to unregulated IFN-α. We designed this reported case to pay more attention to the rare skin manifestations following COVID-19. Case Report: The patient was a 12-month-old girl who presented with fever and skin rashes. Two days before admission, erythematous rashes spread around the mouth, nose, eyes, and trunk. Erythematous lesions begin to peel the next day. RT-PCR of the nasopharynx was positive for COVID-19. Treatment with vancomycin and clindamycin was started. The patient was discharged with complete recovery of skin lesions. Conclusion: One of the early manifestations of COVID-19 in children can be fever and rash. Clinical suspicion led to more attention to complications of bacterial superinfection such as staphylococcal scalded skin syndrome.
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Bovine respiratory disease (BRD) is one of the most important diseases impacting the global cattle industry, resulting in significant economic loss. Commonly referred to as shipping fever, BRD is especially concerning for young calves during transport when they are most susceptible to developing disease. Despite years of extensive study, managing BRD remains challenging as its aetiology involves complex interactions between pathogens, environmental and host factors. While at the beginning of the twentieth century, scientists believed that BRD was only caused by bacterial infections ("bovine pasteurellosis"), we now know that viruses play a key role in BRD induction. Mixtures of pathogenic bacteria and viruses are frequently isolated from respiratory secretions of animals with respiratory illness. The increased diagnostic screening data has changed our understanding of pathogens contributing to BRD development. In this review, we aim to comprehensively examine experimental evidence from all existing studies performed to understand coinfections between respiratory pathogens in cattle. Despite the fact that pneumonia has not always been successfully reproduced by in vivo calf modelling, several studies attempted to investigate the clinical significance of interactions between different pathogens. The most studied model of pneumonia induction has been reproduced by a primary viral infection followed by a secondary bacterial superinfection, with strong evidence suggesting this could potentially be one of the most common scenarios during BRD onset. Different in vitro studies indicated that viral priming may increase bacterial adherence and colonization of the respiratory tract, suggesting a possible mechanism underpinning bronchopneumonia onset in cattle. In addition, a few in vivo studies on viral coinfections and bacterial coinfections demonstrated that a primary viral infection could also increase the pathogenicity of a secondary viral infection and, similarly, dual infections with two bacterial pathogens could increase the severity of BRD lesions. Therefore, different scenarios of pathogen dynamics could be hypothesized for BRD onset which are not limited to a primary viral infection followed by a secondary bacterial superinfection.