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1.
J Korean Med Sci ; 38(4): e37, 2023 Jan 30.
Article in English | MEDLINE | ID: covidwho-2224745

ABSTRACT

BACKGROUND: The rate and composition of bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) were evaluated when microbiological testing was conducted on the majority of patients. We also evaluated whether the use of empirical antibacterials was associated with mortality. METHODS: In this retrospective study, all of the adult patients with COVID-19 hospitalized in a single tertiary hospital in South Korea between February 2020 and December 2021 were included. Bacterial co-infection was assessed by sputum cultures, blood cultures, and molecular testing, including polymerase chain reaction sputum testing and urinary antigen tests. Mortality was compared between patients who received empirical antibacterials and those who did not. RESULTS: Of the 367 adult patients admitted during the study period, 300 (81.7%) had sputum culture results and were included in the analysis. Of these 300 patients, 127 (42.3%) had a history of antibiotic exposure. The co-infection rate within 48 hours was 8.3% (25/300): 6.4% (11/173) of patients without prior antibiotic exposure and 11% (14/127) of patients with prior antibacterial exposure. The co-infected bacteria were different according to antibacterial exposure before admission, and multi-drug resistant pathogens were detected exclusively in the antibacterial exposed group. Among the patients without positive results for the microbiological tests, empirical antibacterials were used in 33.3% of cases (100/300). Empirical antibacterial therapy was not significantly related to the 30-day mortality or in-hospital mortality rates in the study cohort before or after the propensity score-matching. CONCLUSION: In this study including only patients underwent microbiological testing, bacterial co-infection was not frequent, and the co-infected organisms varied depending on previous antibacterial exposures. Given the rarity of co-infection and the lack of potential benefits, empiric antibacterial use in COVID-19 should be an important target of antibiotic stewardship.


Subject(s)
Bacterial Infections , COVID-19 , Coinfection , Adult , Humans , Retrospective Studies , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/complications , Bacterial Infections/drug therapy , Bacterial Infections/microbiology , Bacteria , Coinfection/drug therapy
2.
Pediatrics ; 150(6)2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2116382

ABSTRACT

OBJECTIVES: Our objective was to describe the prevalence of urinary tract infection (UTI) and invasive bacterial infection (IBI) in febrile infants during the coronavirus disease 2019 pandemic. METHODS: We conducted a multicenter cross-sectional study that included 97 hospitals in the United States and Canada. We included full-term, well-appearing infants 8 to 60 days old with a temperature of ≥38°C and an emergency department visit or hospitalization at a participating site between November 1, 2020 and March 31, 2022. We used logistic regression to determine trends in the odds of an infant having UTI and IBI by study month and to determine the association of COVID-19 prevalence with the odds of an infant having UTI and IBI. RESULTS: We included 9112 infants; 603 (6.6%) had UTI, 163 (1.8%) had bacteremia without meningitis, and 43 (0.5%) had bacterial meningitis. UTI prevalence decreased from 11.2% in November 2020 to 3.0% in January 2022. IBI prevalence was highest in February 2021 (6.1%) and decreased to 0.4% in January 2022. There was a significant downward monthly trend for odds of UTI (odds ratio [OR] 0.93; 95% confidence interval [CI]: 0.91-0.94) and IBI (OR 0.90; 95% CI: 0.87-0.93). For every 5% increase in COVID-19 prevalence in the month of presentation, the odds of an infant having UTI (OR 0.97; 95% CI: 0.96-0.98) or bacteremia without meningitis decreased (OR 0.94; 95% CI: 0.88-0.99). CONCLUSIONS: The prevalence of UTI and IBI in eligible febrile infants decreased to previously published, prepandemic levels by early 2022. Higher monthly COVID-19 prevalence was associated with lower odds of UTI and bacteremia.


Subject(s)
Bacteremia , Bacterial Infections , COVID-19 , Meningitis, Bacterial , Urinary Tract Infections , Infant , Humans , COVID-19/epidemiology , Pandemics , Prevalence , Cross-Sectional Studies , Fever/microbiology , Bacterial Infections/epidemiology , Bacterial Infections/complications , Urinary Tract Infections/microbiology , Meningitis, Bacterial/epidemiology , Bacteremia/epidemiology , Bacteremia/complications , Retrospective Studies
3.
Int Immunopharmacol ; 90: 107157, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1065211

ABSTRACT

Coronavirus disease 2019 (COVID-19) pandemic has brought challenges to health and social care systems. However, the empirical use of antibiotics is still confusing. Presently, a total of 1123 patients with COVID-19 admitted to Renmin Hospital of Wuhan University was included in this retrospective cohort study. The clinical features, complications and outcomes were compared between the suspected bacterial infection and the no evidence of bacterial infection. The risk factors of mortality and the incidence of acute organ injury were analyzed. As a result, 473 patients were selected to suspected bacterial infection (SI) group based on higher white blood cell count and procalcitonin or bacterial pneumonia on chest radiography. 650 patients were selected to the no evidence of bacterial infection (NI) group. The SI group had more severely ill patients (70.2% vs. 39.8%), more death (20.5% vs. 2.2%), and more acute organ injury (40.2% vs. 11.2%). Antibiotics were found associated with improved mortality and an increased risk for acute organ injury in hospitalized patients with COVID-19. Intravenous moxifloxacin and meropenem increased the death rate in patients with suspected bacterial infection, while oral antibiotics reduced mortality in this group. Moreover, penicillin and meropenem treatments were associated with increased mortality of the patients with no evidence of bacterial infection. In conclusion, patients with suspected bacterial infection were more likely to have negative clinical outcomes than those without bacterial infection. Empirical use of antibiotics may not have the expected benefits.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , COVID-19 Drug Treatment , Leukocytes/pathology , Lung/diagnostic imaging , SARS-CoV-2/physiology , Aged , Bacterial Infections/complications , Bacterial Infections/mortality , COVID-19/complications , COVID-19/mortality , China , Cohort Studies , Female , Humans , Lung/pathology , Male , Middle Aged , Pneumonia, Bacterial , Procalcitonin/metabolism , Retrospective Studies , Risk Factors , Survival Analysis
4.
Int J Infect Dis ; 104: 250-254, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1053456

ABSTRACT

The dissemination of COVID-19 around the globe has been followed by an increased consumption of antibiotics. This is related to the concern for bacterial superinfection in COVID-19 patients. The identification of bacterial pathogens is challenging in low and middle income countries (LMIC), as there are no readily-available and cost-effective clinical or biological markers that can effectively discriminate between bacterial and viral infections. Fortunately, faced with the threat of COVID-19 spread, there has been a growing awareness of the importance of antimicrobial stewardship programs, as well as infection prevention and control measures that could help reduce the microbial load and hence circulation of pathogens, with a reduction in dissemination of antimicrobial resistance. These measures should be improved particularly in developing countries. Studies need to be conducted to evaluate the worldwide evolution of antimicrobial resistance during the COVID-19 pandemic, because pathogens do not respect borders. This issue takes on even greater importance in developing countries, where data on resistance patterns are scarce, conditions for infectious pathogen transmission are optimal, and treatment resources are suboptimal.


Subject(s)
Bacterial Infections/drug therapy , COVID-19/epidemiology , Drug Resistance, Bacterial , Pandemics , SARS-CoV-2 , Superinfection , Anti-Bacterial Agents/therapeutic use , Antimicrobial Stewardship , Azithromycin/therapeutic use , Bacterial Infections/complications , COVID-19/complications , COVID-19/virology , Developing Countries , Humans
5.
Int J Mol Sci ; 22(1)2020 Dec 22.
Article in English | MEDLINE | ID: covidwho-1027278

ABSTRACT

Infectious diseases represent a relevant issue in lung cancer patients. Bacterial and viral infections might influence the patients' prognosis, both directly affecting the immune system and indirectly impairing the outcome of anticancer treatments, mainly immunotherapy. In this analysis, we aimed to review the current evidence in order to clarify the complex correlation between infections and lung cancer. In detail, we mainly explored the potential impact on immunotherapy outcome/safety of (1) bacterial infections, with a detailed focus on antibiotics; and (2) viral infections, discriminating among (a) human immune-deficiency virus (HIV), (b) hepatitis B/C virus (HBV-HCV), and (c) Sars-Cov-2. A series of studies suggested the prognostic impact of antibiotic therapy administration, timing, and exposure ratio in patients treated with immune checkpoint inhibitors, probably through an antibiotic-related microbiota dysbiosis. Although cancer patients with HIV, HBV, and HCV were usually excluded from clinical trials evaluating immunotherapy, some retrospective and prospective trials performed in these patient subgroups reported similar results compared to those described in not-infected patients, with a favorable safety profile. Moreover, patients with thoracic cancers are particularly at risk of COVID-19 severe outcomes and mortality. Few reports speculated about the prognostic implications of anticancer therapy, including immunotherapy, in lung cancer patients with concomitant Sars-Cov-2 infection, showing, to date, inconsistent results. The correlation between infectious diseases and immunotherapy remains to be further explored and clarified in the context of dedicated trials. In clinical practice, the accurate and prompt multidisciplinary management of lung cancer patients with infections should be encouraged in order to select the best treatment options for these patients, avoiding unexpected toxicities, while maintaining the anticancer effect.


Subject(s)
Bacterial Infections/complications , COVID-19/complications , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/therapy , Immunotherapy , Lung Neoplasms/complications , Lung Neoplasms/therapy , Virus Diseases/complications , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/immunology , Acquired Immunodeficiency Syndrome/pathology , Acquired Immunodeficiency Syndrome/therapy , Anti-Bacterial Agents/administration & dosage , Bacterial Infections/drug therapy , Bacterial Infections/pathology , COVID-19/pathology , Carcinoma, Non-Small-Cell Lung/microbiology , Carcinoma, Non-Small-Cell Lung/virology , HIV/drug effects , Hepatitis B/complications , Hepatitis B/immunology , Hepatitis B/pathology , Hepatitis C/complications , Hepatitis C/drug therapy , Hepatitis C/pathology , Humans , Immune Checkpoint Inhibitors/therapeutic use , Lung Neoplasms/microbiology , Lung Neoplasms/virology , Microbiota/drug effects , Microbiota/immunology , COVID-19 Drug Treatment
6.
Indian J Dent Res ; 31(5): 669, 2020.
Article in English | MEDLINE | ID: covidwho-1024709
7.
J Proteome Res ; 20(2): 1451-1454, 2021 02 05.
Article in English | MEDLINE | ID: covidwho-1006441

ABSTRACT

In this Letter, we reanalyze published mass spectrometry data sets of clinical samples with a focus on determining the coinfection status of individuals infected with SARS-CoV-2 coronavirus. We demonstrate the use of ComPIL 2.0 software along with a metaproteomics workflow within the Galaxy platform to detect cohabitating potential pathogens in COVID-19 patients using mass spectrometry-based analysis. From a sample collected from gargling solutions, we detected Streptococcus pneumoniae (opportunistic and multidrug-resistant pathogen) and Lactobacillus rhamnosus (a probiotic component) along with SARS-Cov-2. We could also detect Pseudomonas sps. Bc-h from COVID-19 positive samples and Acinetobacter ursingii and Pseudomonas monteilii from COVID-19 negative samples collected from oro- and nasopharyngeal samples. We believe that the early detection and characterization of coinfections by using metaproteomics from COVID-19 patients will potentially impact the diagnosis and treatment of patients affected by SARS-CoV-2 infection.


Subject(s)
Bacterial Infections/diagnosis , COVID-19/diagnosis , Proteomics/methods , SARS-CoV-2/metabolism , Acinetobacter/isolation & purification , Bacterial Infections/complications , Bacterial Infections/microbiology , COVID-19/complications , COVID-19/virology , Coinfection/microbiology , Coinfection/virology , Humans , Mass Spectrometry/methods , Nasopharynx/microbiology , Nasopharynx/virology , Pseudomonas/isolation & purification , SARS-CoV-2/physiology , Streptococcus pneumoniae/isolation & purification
8.
Discov Med ; 29(157): 129-137, 2020.
Article in English | MEDLINE | ID: covidwho-812954

ABSTRACT

Sepsis is a life-threatening clinical condition demanding accurate and rapid diagnosis of the culprit pathogen, thereby to improve prognosis. Pathogen determination through blood culture is the gold standard for diagnosis but has limitations due to low sensitivity. Recently, circulating DNAs derived from pathogenic organisms were found in the plasma of patients with sepsis and were further proved to be more sensitive biomarkers for the diagnosis of the pathogen origin in sepsis. However, the fundamental molecular characteristics of circulating DNA in patients with sepsis remain unclear. Here, we used specific PCR and Sanger sequencing to verify the microbiology culture results via the corresponding plasma circulating DNA. We analyzed the composition and molecular characteristics of circulating DNA in septic patients using next-generation sequencing technology. We showed the presence of pathogen-derived circulating DNA in the plasma of patients with sepsis. The sizes of circulating DNA fragments derived from pathogenic bacteria showed a skewed unimodal distribution, while those derived from host cells showed a normal unimodal distribution. Lengths of fragments at peak concentration for both origins ranged from 150 bp to 200 bp, and reads mapping to pathogenic bacteria genome distributed uniformly on the reference. Our findings have improved our understanding of microbial circulating DNA in patients with sepsis as a potential methodology for the accurate diagnosis of sepsis, especially in light of an urgent need for such a diagnosis associated with the COVID-19 infection.


Subject(s)
Bacterial Infections/microbiology , Cell-Free Nucleic Acids/blood , DNA, Bacterial/blood , Sepsis/microbiology , Adult , Aged , Bacterial Infections/complications , Bacterial Infections/diagnosis , Betacoronavirus , COVID-19 , COVID-19 Testing , Cell-Free Nucleic Acids/analysis , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Culture Techniques , DNA, Bacterial/analysis , Female , High-Throughput Nucleotide Sequencing , Humans , Male , Middle Aged , Neoplasms/complications , Pandemics , Pneumonia, Viral , Polymerase Chain Reaction , SARS-CoV-2 , Sepsis/complications , Sepsis/diagnosis , Sequence Analysis, DNA
9.
Br J Haematol ; 191(3): 386-389, 2020 11.
Article in English | MEDLINE | ID: covidwho-697165

ABSTRACT

The COVID-19 pandemic has dramatically challenged care for cancer patients, especially those with active treatment who represent a vulnerable population for SARS-CoV-2 infection. Aggressive lymphoid neoplasms, such as diffuse large B cell lymphoma and high-grade B cell lymphoma, need to be treated without delay in order to get the best disease outcome. Because of that, our clinical practice was changed to minimise the risk of SARS-CoV-2 infection while continuing haematological treatment. In this report, we analyse the management of front-line therapy in 18 patients during the COVID-19 outbreak, as well as the results of the implemented measures in their outcome.


Subject(s)
COVID-19/epidemiology , Lymphoma, Large B-Cell, Diffuse/drug therapy , Pandemics , Plasmablastic Lymphoma/drug therapy , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , Bacterial Infections/complications , Bacterial Infections/drug therapy , COVID-19/complications , COVID-19/prevention & control , COVID-19 Testing , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Febrile Neutropenia/chemically induced , Febrile Neutropenia/prevention & control , Female , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Infection Control/methods , Male , Middle Aged , Prednisone/administration & dosage , Prednisone/adverse effects , Rituximab/administration & dosage , Spain/epidemiology , Superinfection/drug therapy , Vincristine/administration & dosage , Vincristine/adverse effects , COVID-19 Drug Treatment
10.
Mil Med Res ; 7(1): 36, 2020 08 04.
Article in English | MEDLINE | ID: covidwho-693154

ABSTRACT

Sepsis is a life-threatening condition that is characterized by multiple organ dysfunction due to abnormal host response to various pathogens, like bacteria, fungi and virus. The differences between viral and bacterial sepsis are indeed of great significance to deepen the understanding of the pathogenesis of sepsis, especially under pandemics of SARS-CoV-2 infection.


Subject(s)
Bacterial Infections/complications , Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Sepsis/microbiology , Aged , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
12.
Med Intensiva (Engl Ed) ; 44(9): 525-533, 2020 Dec.
Article in English, Spanish | MEDLINE | ID: covidwho-644103

ABSTRACT

OBJECTIVE: To describe the clinical and respiratory characteristics of a cohort of 43 patients with COVID-19 after an evolutive period of 28 days. DESIGN: A prospective, single-center observational study was carried out. SETTING: Intensive care. PATIENTS: Patients admitted due to COVID-19 and respiratory failure. INTERVENTIONS: None. VARIABLES: Automatic recording was made of demographic variables, severity parameters, laboratory data, assisted ventilation (HFO: high-flow oxygen therapy and IMV: invasive mechanical ventilation), oxygenation (PaO2, PaO2/FiO2) and complications. The patients were divided into three groups: survivors (G1), deceased (G2) and patients remaining under admission (G3). The chi-squared test or Fisher exact test (categorical variables) was used, along with the Mann-Whitney U-test or Wilcoxon test for analyzing the differences between medians. Statistical significance was considered for p<0.05. RESULTS: A total of 43 patients were included (G1=28 [65.1%]; G2=10 [23.3%] and G3=5 [11.6%]), with a mean age of 65 years (range: 52-72), 62% males, APACHE II 18 (15-24), SOFA 6 (4-7). Arterial hypertension (30.2%) and obesity (25.6%) were the most frequent comorbidities. High-flow oxygen therapy was used in 62.7% of the patients, with failure in 85%. In turn, 95% of the patients required IMV and 85% received ventilation in prone decubitus. In the general population, initial PaO2/FiO2 improved after 7 days (165 [125-210] vs.194 [153-285]; p=0.02), in the same way as in G1 (164 [125-197] vs. 207 [160-294]; p=0.07), but not in G2 (163 [95-197] vs. 135 [85-177]). No bacterial coinfection was observed. The incidence of IMV-associated pneumonia was high (13 episodes/1000 days of IMV). CONCLUSIONS: Patients with COVID-19 require early IMV, a high frequency of ventilation in prone decubitus, and have a high incidence of failed HFO. The lack of improvement of PaO2/FiO2 at 7 days could be a prognostic marker. .


Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2 , Age Distribution , Aged , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/complications , Bacterial Infections/drug therapy , COVID-19/mortality , COVID-19/therapy , Chi-Square Distribution , Contraindications, Procedure , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Intensive Care Units , Male , Middle Aged , Multimorbidity , Noninvasive Ventilation/adverse effects , Prospective Studies , Respiration, Artificial/methods , Spain/epidemiology , Statistics, Nonparametric , Tertiary Care Centers , COVID-19 Drug Treatment
13.
Am J Transplant ; 20(7): 1879-1881, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-101378

ABSTRACT

Coronavirus Disease 2019 (COVID-19) has become a pandemic since March 2020. We describe here 2 cases of COVID-19 infection in a posttransplant setting. First one is a 59-year-old renal transplant recipient; the second is a 51-year-old allogeneic bone marrow transplant recipient. Both patients were on immunosuppressant therapy and had stable graft function before COVID-19 infection. After the diagnosis of COVID-19, immunosuppressive agents were discontinued and methylprednisolone with prophylactic antibiotics were initiated, however, the lung injury progressed. The T cells were extremely low in both patients after infection. Both patients died despite the maximal mechanical ventilatory support. Therefore, the prognosis of COVID-19 pneumonia following transplantation is not optimistic and remains guarded. Lower T cell count may be a surrogate for poor outcome.


Subject(s)
Bone Marrow Transplantation , Coronavirus Infections/complications , Kidney Failure, Chronic/complications , Kidney Transplantation , Leukemia, Myeloid, Acute/complications , Pneumonia, Viral/complications , Transplant Recipients , Anti-Bacterial Agents/administration & dosage , Bacterial Infections/complications , COVID-19 , China , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Cross Infection/complications , Fatal Outcome , Humans , Immunosuppressive Agents/administration & dosage , Kidney Failure, Chronic/surgery , Leukemia, Myeloid, Acute/therapy , Male , Methylprednisolone/administration & dosage , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Postoperative Complications , Prognosis , Respiration, Artificial , T-Lymphocytes/cytology
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