ABSTRACT
The overall incidence of healthcare-associated infections (HAIs) in patients with COVID-19 is lower than 15%. However, in critical COVID-19 patients, the incidence of HAIs may reach 50%, and the mortality rate may exceed 50%. This makes effective antibiotic therapy in this category of patients extremely important. The aim of the study was to assess the rationality of antibiotic therapy in critically ill COVID-19 patients with HAIs, as well as analyse the timeliness and sufficiency of microbiological and laboratory diagnostic testing in these patients. Material(s) and Method(s): the study comprised a retrospective analysis of medical records of the patients with COVID-19 complicated by HAIs who had been admitted to an intensive care unit of Moscow City Clinical Hospital 4 from 27.04.2020 to 01.11.2020. Antibacterial therapy was analysed in accordance with the principles set forth in the Strategy for the Control of Antimicrobial Therapy (antimicrobial stewardship) and the current Interim Guidelines on the Prevention, Diagnosis and Treatment of Novel Coronavirus Infection (COVID-19) of the Russian Ministry of Health. Statistical significance was evaluated using Student's unpaired t-test. The qualitative comparison of independent groups was made using the chi2 test. Result(s): HAIs developed in 138 (20.8%) of 664 patients admitted to the intensive care unit. The authors considered empirical antibiotic therapy irrational in 53.6% of these cases (74/138 patients) due to nonconformity to the current clinical recommendations. Empirical antimicrobial therapy was rational in 68.6% of survivors and 33.3% of non-survivors (p < 0.001). It was corrected based on the results of microbiological testing in 56.9% of survivors and 30.2% of non-survivors (p = 0.005). Procalcitonin levels, as a marker of bacterial infection, were determined in 74.5% survivors and 48.3% of non-survivors (p = 0.003). Conclusion(s): Antibiotic therapy was rational in less than 50% of critically ill COVID-19 patients with HAIs. Having demonstrated a significant mortality decrease in the category of studied patients with rational antibiotic therapy, the study suggests that it is necessary to follow the current recommendations more carefully. The success of therapy also largely depends on its timely correction based on the results of HAI pathogen identification and other diagnostic measures, in particular, procalcitonin biomarker tests. Copyright © 2022 Obstetrics, Gynecology and Reproduction. All rights reserved.
ABSTRACT
Background. Cefiderocol (CFDC) is a Gram-negative antibiotic (GNA) with a unique mode of cell entry against carbapenem resistance. This study described the initial use of CFDC in US hospitals since its approval in November 2019. Methods. This was a retrospective study of patients treated with CFDC consecutively for >=3 days in US hospitals, as captured in Premier Healthcare Data from January 2020 to June 2021. This study described the clinical characteristics, CFDC usage, and Post-CFDC initiation 14-day and 28-day in-hospital all-cause mortality (IH-ACM). For patients with microbiology results, the pathogen, susceptibility and culture site associated with CFDC use were described. Index culture was the culture(s) taken on the day closest to CFDC initiation. Results. Among 313 of 360 in-patients who received >=3 days CFDC, the median age was 58 years (range: 17 - 89 years), and 91% were hospitalized via emergency room, trauma, or urgent admission. The most common conditions were severe sepsis with septic shock, palliative care, and multi-drug resistant infection. Also 34% had a 'do not resuscitate order'. About 64% of patients received mechanical ventilation and 79% had ICU stay. Median length of hospital stay was 27 days (range: 3-310 days). Median days on CFDC was 8 days (range: 3 - 66 days). Over 58% received >=2 other GNAs within 14-days of initiatingCFDC.Among 187 patients withmicrobiology results, 75% had index cultures with one pathogen, and 73% had confirmed carbapenem resistant pathogens. The most common pathogens were Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Klebsiella pneumoniae and Acinetobacter baumannii. The most common index culture site was respiratory. The 14-day and 28-day crude IH-ACM from CFDC initiation was 16.3% (95%CI: 12.2%-20.4%) and 23.6% (95%CI: 18.9 - 28.4%), respectively. Among those with microbiology results, 14-day and 28-day IH-ACMwas 17.1% (95%CI: 11.7% - 22.5%) and 23.5%(95%CI: 17.4-29.6%), respectively. Among patients who died, 83% had severe sepsis with septic shock, 76% were in palliative care, 71% had a 'do not resuscitate order', and 44% had COVID-19. Conclusion. CFDC was used most frequently in critically ill patients. IH-ACM was comparable with other studies.
ABSTRACT
In December 2019, outbreak of coronavirus 2019 (COVID-19) disease occurred in Wuhan and rapidly spread to other areas. Nephrologic problems among patients with COVID-19 can manifest as acute kidney injury (AKI), hematuria, or proteinuria and some kind of complications like hypertension. AKI is largely due to hemodynamic changes and cytokine release but somehow due to the direct cytotoxicity of virus or drug nephrotoxicity. Patients with suspected or confrmed COVID-19 may present with different stages of acute kidney injury as part of their overall illness. The incidence of AKI in patients with COVID-19 was about 17 percent (range 0.5 to 80 percent) and approximately 5 percent of patients require renal replacement therapy (RRT). The incidence seems to vary by geographic location and proportion of critically ill patients included in each study. AKI was noted on admission or within 24 hours of admission in one-third of the patients. AKI correlated with severity of illness. For prevention of AKI in hospitalized patients, an emphasis should be placed on optimization of volume status to exclude and treat prerenal azotemia while avoiding hypervolemia, which may worsen the patient's respiratory status. Diferences in management of AKI among patients with COVID-19 may include limited use of intravenous solutions. Most patients with COVID-19 characterized by respiratory problems have variable degree of oxygen requirements and/or airway control. Fluid resuscitation are understandably conservative as per acute respiratory distress syndrome criteria. Thus, fuid resuscitation should be individualized and based on trackable objective measures. The indications for RRT for AKI remain the same indications regardless of the COVID-19 status. Alterations in RRT that might be undertaken during the COVID-19 outbreak include continuous renal replacement therapy (CRRT) which remains preferred among critically ill patients with AKI and hypotension.