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1.
Antimicrob Resist Infect Control ; 11(1): 45, 2022 03 07.
Article in English | MEDLINE | ID: covidwho-1731546

ABSTRACT

BACKGROUND: Pneumonia from SARS-CoV-2 is difficult to distinguish from other viral and bacterial etiologies. Broad-spectrum antimicrobials are frequently prescribed to patients hospitalized with COVID-19 which potentially acts as a catalyst for the development of antimicrobial resistance (AMR). OBJECTIVES: We conducted a systematic review and meta-analysis during the first 18 months of the pandemic to quantify the prevalence and types of resistant co-infecting organisms in patients with COVID-19 and explore differences across hospital and geographic settings. METHODS: We searched MEDLINE, Embase, Web of Science (BioSIS), and Scopus from November 1, 2019 to May 28, 2021 to identify relevant articles pertaining to resistant co-infections in patients with laboratory confirmed SARS-CoV-2. Patient- and study-level analyses were conducted. We calculated pooled prevalence estimates of co-infection with resistant bacterial or fungal organisms using random effects models. Stratified meta-analysis by hospital and geographic setting was also performed to elucidate any differences. RESULTS: Of 1331 articles identified, 38 met inclusion criteria. A total of 1959 unique isolates were identified with 29% (569) resistant organisms identified. Co-infection with resistant bacterial or fungal organisms ranged from 0.2 to 100% among included studies. Pooled prevalence of co-infection with resistant bacterial and fungal organisms was 24% (95% CI 8-40%; n = 25 studies: I2 = 99%) and 0.3% (95% CI 0.1-0.6%; n = 8 studies: I2 = 78%), respectively. Among multi-drug resistant organisms, methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and multi-drug resistant Candida auris were most commonly reported. Stratified analyses found higher proportions of AMR outside of Europe and in ICU settings, though these results were not statistically significant. Patient-level analysis demonstrated > 50% (n = 58) mortality, whereby all but 6 patients were infected with a resistant organism. CONCLUSIONS: During the first 18 months of the pandemic, AMR prevalence was high in COVID-19 patients and varied by hospital and geography although there was substantial heterogeneity. Given the variation in patient populations within these studies, clinical settings, practice patterns, and definitions of AMR, further research is warranted to quantify AMR in COVID-19 patients to improve surveillance programs, infection prevention and control practices and antimicrobial stewardship programs globally.


Subject(s)
Bacteria/drug effects , Bacterial Infections/drug therapy , COVID-19/complications , Drug Resistance, Bacterial , Drug Resistance, Fungal , Mycoses/drug therapy , Anti-Bacterial Agents/pharmacology , Antifungal Agents/pharmacology , Bacteria/classification , Bacteria/genetics , Bacteria/isolation & purification , Bacterial Infections/etiology , Bacterial Infections/microbiology , COVID-19/virology , Fungi/classification , Fungi/drug effects , Fungi/genetics , Fungi/isolation & purification , Humans , Mycoses/etiology , Mycoses/microbiology , SARS-CoV-2/physiology
2.
Hematology Am Soc Hematol Educ Program ; 2021(1): 587-591, 2021 12 10.
Article in English | MEDLINE | ID: covidwho-1566498

ABSTRACT

Infections are a major cause of morbidity and can result in mortality in long-term survivors after allogeneic hematopoietic cell transplantation. Chronic graft-versus-host disease and delayed immune reconstitution are recognized risk factors. Different strategies must be utilized depending on the individual patient's situation but include prolonged antimicrobial prophylaxis and vaccination. Some important infections due to pathogens preventable by vaccination are pneumococci, influenza, varicella-zoster virus, and SARS-CoV-2. Despite the fact that such recommendations have been in place for decades, implementation of these recommendations has been reported to be poor.


Subject(s)
Bacterial Infections/prevention & control , Hematopoietic Stem Cell Transplantation/adverse effects , Mycoses/prevention & control , Vaccination , Virus Diseases/prevention & control , Aged , Bacterial Infections/etiology , COVID-19/etiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/therapeutic use , Hematopoietic Stem Cell Transplantation/methods , Humans , Infections/etiology , Male , Mycoses/etiology , Transplantation, Homologous/adverse effects , Transplantation, Homologous/methods , Vaccination/adverse effects , Vaccination/methods , Vaccines/adverse effects , Vaccines/therapeutic use , Virus Diseases/etiology
3.
Bioorg Chem ; 119: 105550, 2022 02.
Article in English | MEDLINE | ID: covidwho-1561636

ABSTRACT

Infectious diseases caused by new or unknown bacteria and viruses, such as anthrax, cholera, tuberculosis and even COVID-19, are a major threat to humanity. Thus, the development of new synthetic compounds with efficient antimicrobial activity is a necessity. Herein, rationally designed novel multifunctional cationic alternating copolymers were directly synthesized through a step-growth polymerization reaction using a bivalent electrophilic cross-linker containing disulfide bonds and a diamine heterocyclic ring. To optimize the activity of these alternating copolymers, several different diamines and cross-linkers were explored to find the highest antibacterial effects. The synthesized nanopolymers not only displayed good to excellent antibacterial activity as judged by minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, and Escherichia coli, but also reduced the number of biofilm cells even at low concentrations, without killing mammalian cells. Furthermore, in vivo experiments using infected burn wounds in mice demonstrated good antibacterial activity and stimulated wound healing, without causing systemic inflammation. These findings suggest that the multifunctional cationic nanopolymers have potential as a novel antibacterial agent for eradication of multidrug resistant bacterial infections.


Subject(s)
Anti-Bacterial Agents/pharmacology , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Biofilms/drug effects , Cations/pharmacology , Polymers/pharmacology , Wound Healing/drug effects , Amines/chemistry , Animals , Bacteria/drug effects , Bacterial Infections/drug therapy , Bacterial Infections/etiology , Burns/complications , COVID-19 , Cell Survival/drug effects , Cross-Linking Reagents , Drug Resistance, Multiple, Bacterial/drug effects , HEK293 Cells/drug effects , Humans , Mice , Microbial Sensitivity Tests , Polymers/chemistry
4.
J Med Virol ; 93(12): 6641-6652, 2021 12.
Article in English | MEDLINE | ID: covidwho-1544314

ABSTRACT

Acute kidney injury (AKI) may develop in patients with coronavirus disease 2019 (COVID-19) and is associated with in-hospital death. We investigated the incidence of AKI in 223 hospitalized COVID-19 patients and analyzed the influence factors of AKI. The incidence of cytokine storm syndrome and its correlation with other clinicopathologic variables were also investigated. We retrospectively enrolled adult patients with virologically confirmed COVID-19 who were hospitalized at three hospitals in Wuhan and Guizhou, China between February 13, 2020, and April 8, 2020. We included 124 patients with moderate COVID-19 and 99 with severe COVID-19. AKI was present in 35 (15.7%) patients. The incidence of AKI was 30.3% for severe COVID-19 and 4.0% for moderate COVID-19 (p < 0.001). Furthermore, cytokine storm was found in 30 (13.5%) patients and only found in the severe group. Kidney injury at admission (odds ratio [OR]: 3.132, 95% confidence interval [CI]: 1.150-8.527; p = 0.025), cytokine storm (OR: 4.234, 95% CI: 1.361-13.171; p = 0.013), and acute respiratory distress syndrome (ARDS) (OR: 7.684, 95% CI: 2.622-22.523; p < 0.001) were influence factors of AKI. Seventeen (48.6%) patients who received invasive mechanical ventilation developed AKI, of whom 64.7% (11/17) died. Up to 86.7% of AKI patients with cytokine storms may develop a secondary bacterial infection. The leukocyte counts were significantly higher in AKI patients with cytokine storm than in those without (13.0 × 109/L, interquartile range [IQR] 11.3 vs. 8.3 × 109/L, IQR 7.5, p = 0.005). Approximately 1/6 patients with COVID-19 eventually develop AKI. Kidney injury at admission, cytokine storm and ARDS are influence factors of AKI. Cytokine storm and secondary bacterial infections may be responsible for AKI development in COVID-19 patients.


Subject(s)
Acute Kidney Injury/etiology , Bacterial Infections/etiology , COVID-19/complications , Cytokine Release Syndrome/complications , Adult , Aged , China , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Middle Aged , Respiration, Artificial/adverse effects , Respiration, Artificial/statistics & numerical data , Respiratory Distress Syndrome/complications , Respiratory Distress Syndrome/etiology , Retrospective Studies , Risk Factors
5.
JAMA Netw Open ; 4(10): e2128615, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1453504

ABSTRACT

Importance: The number of clinics marketing stem cell products for joint diseases, chronic pain, and most recently, COVID-19, has increased despite warnings from the US Food and Drug Administration that stem cell products for these and other indications have not been proven safe or effective. Objective: To examine bacterial infections in 20 patients who received umbilical cord blood-derived products marketed as stem cell treatment. Design, Setting, and Participants: This case series is a national public health investigation including case-finding, medical record review and abstraction, and laboratory investigation, including sterility testing of products and whole-genome sequencing of patient and product isolates. Participants included patients who developed bacterial infections following administration of umbilical cord blood-derived products marketed as stem cell treatment during August 2017 to September 2018. Data analysis was performed from March 2019 to September 2021. Exposures: Umbilical cord blood-derived products marketed as stem cell treatment. Main Outcomes and Measures: Data were collected on patient infections and exposures. The Centers for Disease Control and Prevention performed sterility testing on undistributed and distributed vials of product marketed as stem cell treatment and performed whole-genome sequencing to compare patient and product bacterial isolates. Results: Culture-confirmed bacterial infections were identified in 20 patients (median [range] age, 63 [2-89] years; 13 male patients [65%]) from 8 US states who sought stem cell treatment for conditions including pain, osteoarthritis, rheumatoid arthritis, and injury; all but 1 required hospitalization. The most frequently isolated bacteria from patients with infections were common enteric species, including Escherichia coli (14 patients) and Enterobacter cloacae (7 patients). Of unopened, undistributed products sampled for testing, 65% (22 of 34 vials) were contaminated with at least 1 of 16 bacterial species, mostly enteric. A patient isolate from Arizona matched isolates obtained from products administered to patients in Florida, and patient isolates from Texas matched undistributed product sent from the company in California. Conclusions and Relevance: Unapproved stem cell products can expose patients to serious risks without proven benefit. Sequencing results suggest a common source of extensive contamination, likely occurring during the processing of cord blood into product. Patients and health care practitioners who are considering the use of unapproved products marketed as stem cell treatment should be aware of their unproven benefits and potential risks, including serious infections.


Subject(s)
Bacterial Infections/etiology , Blood Safety/statistics & numerical data , Cord Blood Stem Cell Transplantation/adverse effects , Disease Outbreaks , Adolescent , Adult , Aged , Aged, 80 and over , Bacterial Infections/epidemiology , Bacterial Infections/prevention & control , Blood Safety/standards , Centers for Disease Control and Prevention, U.S. , Child , Child, Preschool , Cord Blood Stem Cell Transplantation/standards , Female , Humans , Male , Marketing , Middle Aged , Outcome Assessment, Health Care , Public Health Surveillance , United States/epidemiology , United States Food and Drug Administration , Young Adult
6.
Crit Care ; 25(1): 317, 2021 08 31.
Article in English | MEDLINE | ID: covidwho-1379797

ABSTRACT

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .


Subject(s)
Bacterial Infections/etiology , COVID-19/complications , Mycoses/etiology , Anti-Infective Agents/therapeutic use , Bacterial Infections/drug therapy , Critical Illness , Humans , Mycoses/drug therapy
7.
J Med Virol ; 93(12): 6641-6652, 2021 12.
Article in English | MEDLINE | ID: covidwho-1326777

ABSTRACT

Acute kidney injury (AKI) may develop in patients with coronavirus disease 2019 (COVID-19) and is associated with in-hospital death. We investigated the incidence of AKI in 223 hospitalized COVID-19 patients and analyzed the influence factors of AKI. The incidence of cytokine storm syndrome and its correlation with other clinicopathologic variables were also investigated. We retrospectively enrolled adult patients with virologically confirmed COVID-19 who were hospitalized at three hospitals in Wuhan and Guizhou, China between February 13, 2020, and April 8, 2020. We included 124 patients with moderate COVID-19 and 99 with severe COVID-19. AKI was present in 35 (15.7%) patients. The incidence of AKI was 30.3% for severe COVID-19 and 4.0% for moderate COVID-19 (p < 0.001). Furthermore, cytokine storm was found in 30 (13.5%) patients and only found in the severe group. Kidney injury at admission (odds ratio [OR]: 3.132, 95% confidence interval [CI]: 1.150-8.527; p = 0.025), cytokine storm (OR: 4.234, 95% CI: 1.361-13.171; p = 0.013), and acute respiratory distress syndrome (ARDS) (OR: 7.684, 95% CI: 2.622-22.523; p < 0.001) were influence factors of AKI. Seventeen (48.6%) patients who received invasive mechanical ventilation developed AKI, of whom 64.7% (11/17) died. Up to 86.7% of AKI patients with cytokine storms may develop a secondary bacterial infection. The leukocyte counts were significantly higher in AKI patients with cytokine storm than in those without (13.0 × 109/L, interquartile range [IQR] 11.3 vs. 8.3 × 109/L, IQR 7.5, p = 0.005). Approximately 1/6 patients with COVID-19 eventually develop AKI. Kidney injury at admission, cytokine storm and ARDS are influence factors of AKI. Cytokine storm and secondary bacterial infections may be responsible for AKI development in COVID-19 patients.


Subject(s)
Acute Kidney Injury/etiology , Bacterial Infections/etiology , COVID-19/complications , Cytokine Release Syndrome/complications , Adult , Aged , China , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Middle Aged , Respiration, Artificial/adverse effects , Respiration, Artificial/statistics & numerical data , Respiratory Distress Syndrome/complications , Respiratory Distress Syndrome/etiology , Retrospective Studies , Risk Factors
9.
Pediatr Emerg Care ; 37(4): 232-236, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1180679

ABSTRACT

OBJECTIVES: The purposes of this study were to describe the clinical characteristics of febrile infants younger than 90 days with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, to investigate the prevalence of serious bacterial infections (SBIs) in these infants, and to compare the risk of SBI in SARS-CoV-2-positive febrile infants with sex- and age-matched SARS-CoV- 2-negative febrile infants. METHODS: This was a retrospective cohort study conducted from March to November 2020 in a tertiary children's hospital. Patients were identified by International Classification of Diseases, 10th Revision codes and included if age was younger than 90 days, a SARS-CoV-2 test was performed, and at least 1 bacterial culture was collected. Positive cases of SARS-CoV-2 were age- and sex-matched to negative controls for analysis. Serious bacterial infection was defined as a urinary tract infection, bacterial enteritis, bacteremia, and/or bacterial meningitis. RESULTS: Fifty-three SARS-CoV-2-positive infants were identified with a higher rate of respiratory symptoms and lower white blood cell and C-reactive protein values than their SARS-CoV-2 matched controls. The rate of SBI in the SARS-CoV-2-positive infants was 8% compared with 34% in the controls; the most common infections were urinary tract infections (6% vs 23%). There were no cases of bacteremia or bacterial meningitis in the COVID-19 (coronavirus disease 2019) infants and 2 (4%) cases of bacteremia in the controls. The relative risk of any SBI between the 2 groups was 0.22 (95% confidence interval, 0.1-0.6; P ≤ 0.001). CONCLUSIONS: These results suggest that febrile infants younger than 90 days with COVID-19 have lower rates of SBI than their matched SARS-CoV-2-negative controls. These data are consistent with previous studies describing lower risks of SBI in febrile infants with concomitant viral respiratory tract infections.


Subject(s)
Bacterial Infections/etiology , COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Risk Assessment/methods , SARS-CoV-2 , Bacterial Infections/epidemiology , COVID-19/complications , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Prevalence , Retrospective Studies , United States
10.
PLoS One ; 16(4): e0249349, 2021.
Article in English | MEDLINE | ID: covidwho-1172877

ABSTRACT

BACKGROUND: Tocilizumab, an interleukin-6 receptor blocker, has been used in the inflammatory phase of COVID-19, but its impact independent of corticosteroids remains unclear in patients with severe disease. METHODS: In this retrospective analysis of patients with COVID-19 admitted between March 2 and April 14, 2020 to a large academic medical center in New York City, we describe outcomes associated with tocilizumab 400 mg (without methylprednisolone) compared to a propensity-matched control. The primary endpoints were change in a 7-point ordinal scale of oxygenation and ventilator free survival, both at days 14 and 28. Secondary endpoints include incidence of bacterial superinfections and gastrointestinal perforation. Primary outcomes were evaluated using t-test. RESULTS: We identified 33 patients who received tocilizumab and matched 74 controls based on demographics and health measures upon admission. After adjusting for illness severity and baseline ordinal scale, we failed to find evidence of an improvement in hypoxemia based on an ordinal scale at hospital day 14 in the tocilizumab group (OR 2.2; 95% CI, 0.7-6.5; p = 0.157) or day 28 (OR 1.1; 95% CI, 0.4-3.6; p = 0.82). There also was no evidence of an improvement in ventilator-free survival at day 14 (OR 0.8; 95% CI, 0.18-3.5; p = 0.75) or day 28 (OR 1.1; 95% CI, 0.1-1.8; p = 0.23). There was no increase in secondary bacterial infection rates in the tocilizumab group compared to controls (OR 0.37; 95% CI, 0.09-1.53; p = 0.168). CONCLUSIONS: There was no evidence to support an improvement in hypoxemia or ventilator-free survival with use of tocilizumab 400 mg in the absence of corticosteroids. No increase in secondary bacterial infections was observed in the group receiving tocilizumab.


Subject(s)
Antibodies, Monoclonal, Humanized/administration & dosage , Bacterial Infections , COVID-19 , Disease Outbreaks , Hospitals, Teaching , SARS-CoV-2 , Antibodies, Monoclonal, Humanized/adverse effects , Bacterial Infections/etiology , Bacterial Infections/mortality , COVID-19/drug therapy , COVID-19/mortality , Disease-Free Survival , Female , Humans , Male , Middle Aged , New York City/epidemiology , Respiration, Artificial , Retrospective Studies , Survival Rate
11.
Front Public Health ; 9: 559595, 2021.
Article in English | MEDLINE | ID: covidwho-1119561

ABSTRACT

Uncontrolled diabetes results in several metabolic alterations including hyperglycemia. Indeed, several preclinical and clinical studies have suggested that this condition may induce susceptibility and the development of more aggressive infectious diseases, especially those caused by some bacteria (including Chlamydophila pneumoniae, Haemophilus influenzae, and Streptococcus pneumoniae, among others) and viruses [such as coronavirus 2 (CoV2), Influenza A virus, Hepatitis B, etc.]. Although the precise mechanisms that link glycemia to the exacerbated infections remain elusive, hyperglycemia is known to induce a wide array of changes in the immune system activity, including alterations in: (i) the microenvironment of immune cells (e.g., pH, blood viscosity and other biochemical parameters); (ii) the supply of energy to infectious bacteria; (iii) the inflammatory response; and (iv) oxidative stress as a result of bacterial proliferative metabolism. Consistent with this evidence, some bacterial infections are typical (and/or have a worse prognosis) in patients with hypercaloric diets and a stressful lifestyle (conditions that promote hyperglycemic episodes). On this basis, the present review is particularly focused on: (i) the role of diabetes in the development of some bacterial and viral infections by analyzing preclinical and clinical findings; (ii) discussing the possible mechanisms by which hyperglycemia may increase the susceptibility for developing infections; and (iii) further understanding the impact of hyperglycemia on the immune system.


Subject(s)
Bacterial Infections/etiology , COVID-19/etiology , Diabetes Complications/immunology , Diabetes Complications/physiopathology , Disease Susceptibility , Hyperglycemia/complications , Virus Diseases/etiology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged
13.
Therapie ; 75(4): 355-362, 2020.
Article in English | MEDLINE | ID: covidwho-1005987

ABSTRACT

Non-steroidal anti-inflammatory drugs (NSAIDs) have an optional prescription status that has resulted in frequent use, in particular for the symptomatic treatment of fever and non-rheumatic pain. In 2019, a multi-source analysis of complementary pharmacological data showed that using NSAIDs in these indications (potentially indicative of an underlying infection) increases the risk of a severe bacterial complication, in particular in the case of lung infections. First, the clinical observations of the French Pharmacovigilance Network showed that severe bacterial infections can occur even after a short NSAID treatment, and even if the NSAID is associated with an antibiotic. Second, pharmacoepidemiological studies, some of which minimized the protopathic bias, all converged and confirmed the risk. Third, experimental in vitro and in vivo animal studies suggest several biological mechanisms, which strengthens a causal link beyond the well-known risk of delaying the care of the infection (immunomodulatory effects, effects on S. pyogenes infections, and reduced antibiotics efficacy). Therefore, in case of infection, symptomatic treatment with NSAIDs for non-severe symptoms (fever, pain, or myalgia) is not to be recommended, given a range of clinical and scientific arguments supporting an increased risk of severe bacterial complication. Besides, the existence of a safer drug alternative, with paracetamol at recommended doses, makes this recommendation of precaution and common sense even more legitimate. In 2020, such recommendation is more topical than ever with the emergence of COVID-19, especially since it results in fever, headaches, muscular pain, and cough, and is further complicated with pneumopathy, and given experimental data suggesting a link between ibuprofen and the level of expression of angiotensin-converting enzyme 2.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Coronavirus Infections/drug therapy , Pneumonia, Viral/drug therapy , Angiotensin-Converting Enzyme 2 , Animals , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Bacterial Infections/epidemiology , Bacterial Infections/etiology , COVID-19 , Coronavirus Infections/physiopathology , France , Humans , Ibuprofen/administration & dosage , Ibuprofen/adverse effects , Ibuprofen/pharmacology , Pandemics , Peptidyl-Dipeptidase A/drug effects , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/physiopathology
14.
Int J Radiat Oncol Biol Phys ; 109(4): 849-858, 2021 03 15.
Article in English | MEDLINE | ID: covidwho-927159

ABSTRACT

PURPOSE: Currently, there are about 15 ongoing clinical studies on low dose radiation therapy for Coronavirus Disease 2019 pneumonia. One of the underlying assumptions is that irradiation of 0.5 to 1.5 Gy is effective at ameliorating viral pneumonia. We aimed to reanalyze all available experimental radiobiologic data to assess evidence for such amelioration. METHODS AND MATERIALS: With standard statistical survival models, and based on a systematic literature review, we reanalyzed 13 radiobiologic animal data sets published in 1937 to 1973 in which animals (guinea pigs/dogs/cats/rats/mice) received radiation before or after bacterial or viral inoculation, and assessing various health endpoints (mortality/pneumonia morbidity). In most data sets absorbed doses did not exceed 7 Gy. RESULTS: For 6 studies evaluating postinoculation radiation exposure (more relevant to low dose radiation therapy for Coronavirus Disease 2019 pneumonia) the results are heterogeneous, with one study showing a significant increase (P < .001) and another showing a significant decrease (P < .001) in mortality associated with radiation exposure. Among the remaining 4 studies, mortality risk was nonsignificantly increased in 2 studies and nonsignificantly decreased in 2 others (P > .05). For preinoculation exposure the results are also heterogeneous, with 6 (of 8) data sets showing a significant increase (P < .01) in mortality risk associated with radiation exposure and the other 2 showing a significant decrease (P < .05) in mortality or pneumonitis morbidity risk. CONCLUSIONS: These data do not provide support for reductions in morbidity or mortality associated with postinfection radiation exposure. For preinfection radiation exposure the inconsistency of direction of effect is difficult to interpret. One must be cautious about adducing evidence from such published reports of old animal data sets.


Subject(s)
Bacterial Infections/etiology , COVID-19/radiotherapy , Radiation Dosage , Radiation Injuries/etiology , Radiobiology , Humans , Radiotherapy Dosage
16.
Med Sci Monit ; 26: e925974, 2020 Sep 25.
Article in English | MEDLINE | ID: covidwho-796268

ABSTRACT

BACKGROUND Coronavirus disease 2019 (COVID-19) is a new infectious disease, and acute respiratory syndrome (ARDS) plays an important role in the process of disease aggravation. The detailed clinical course and risk factors of ARDS have not been well described. MATERIAL AND METHODS We retrospectively investigated the demographic, clinical, and laboratory data of adult confirmed cases of COVID-19 in Beijing Ditan Hospital from Jan 20 to Feb 29, 2020 and compared the differences between ARDS cases and non-ARDS cases. Univariate and multivariate logistic regression methods were employed to explore the risk factors associated with ARDS. RESULTS Of the 130 adult patients enrolled in this study, the median age was 46.5 (34-62) years and 76 (58.5%) were male. ARDS developed in 26 (20.0%) and 1 (0.8%) death occurred. Fever occurred in 114 patients, with a median highest temperature of 38.5 (38-39)°C and median fever duration of 8 (3-11) days. The median time from illness onset to ARDS was 10 (6-13) days, the median time to chest CT improvement was 17 (14-21) days, and median time to negative nucleic acid test result was 27 (17-33) days. Multivariate regression analysis showed increasing odds of ARDS associated with age older than 65 years (OR=4.75, 95% CL1.26-17.89, P=0.021), lymphocyte counts [0.5-1×109/L (OR=8.80, 95% CL 2.22-34.99, P=0.002); <0.5×109/L(OR=36.23, 95% CL 4.63-2083.48, P=0.001)], and temperature peak ≥39.1°C (OR=5.35, 95% CL 1.38-20.76, P=0.015). CONCLUSIONS ARDS tended to occur in the second week of the disease course. Potential risk factors for ARDS were older age (>65 years), lymphopenia (≤1.0×109/L), and temperature peak (≥39.1°C). These findings could help clinicians to predict which patients will have a poor prognosis at an early stage.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pandemics , Pneumonia, Viral/complications , Respiratory Distress Syndrome/etiology , Adult , Aged , Aged, 80 and over , Bacterial Infections/etiology , COVID-19 , China , Cities/epidemiology , Comorbidity , Coronavirus Infections/epidemiology , Female , Fever/etiology , Humans , Logistic Models , Lymphopenia/etiology , Male , Middle Aged , Pneumonia, Viral/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2
17.
Int J Mol Sci ; 21(15)2020 Jul 24.
Article in English | MEDLINE | ID: covidwho-699380

ABSTRACT

Sarcopenia in patients with liver cirrhosis (LC) has been attracting much attention these days because of the close linkage to adverse outcomes. LC can be related to secondary sarcopenia due to protein metabolic disorders and energy metabolic disorders. LC is associated with profound alterations in gut microbiota and injuries at the different levels of defensive mechanisms of the intestinal barrier. Dysbiosis refers to a state in which the diversity of gut microbiota is decreased by decreasing the bacterial species and the number of bacteria that compose the gut microbiota. The severe disturbance of intestinal barrier in LC can result in dysbiosis, several bacterial infections, LC-related complications, and sarcopenia. Here in this review, we will summarize the current knowledge of the relationship between sarcopenia and dysbiosis in patients with LC.


Subject(s)
Bacterial Infections , Dysbiosis , Gastrointestinal Microbiome , Liver Cirrhosis , Sarcopenia , Bacterial Infections/etiology , Bacterial Infections/metabolism , Bacterial Infections/microbiology , Bacterial Infections/pathology , Dysbiosis/etiology , Dysbiosis/metabolism , Dysbiosis/microbiology , Dysbiosis/pathology , Humans , Intestinal Mucosa/metabolism , Intestinal Mucosa/microbiology , Intestinal Mucosa/pathology , Liver Cirrhosis/complications , Liver Cirrhosis/metabolism , Liver Cirrhosis/microbiology , Liver Cirrhosis/pathology , Sarcopenia/etiology , Sarcopenia/metabolism , Sarcopenia/microbiology , Sarcopenia/pathology
18.
Int J Antimicrob Agents ; 56(3): 106103, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-664350

ABSTRACT

This systemic review and meta-analysis aimed to assess the efficacy of tocilizumab for the treatment of severe coronavirus disease 2019 (COVID-19). Candidate studies up to 24 May 2020 were identified from PubMed, Cochrane Library, Embase, medRxiv and bioRxiv. Treatment outcomes included mortality, risk of intensive care unit (ICU) admission and the requirement for mechanical ventilation (MV). Seven retrospective studies involving 592 adult patients with severe COVID-19, including 240 in the tocilizumab group and 352 in the control group, were enrolled. All-cause mortality of severe COVID-19 patients among the tocilizumab group was 16.3% (39/240), which was lower than that in the control group (24.1%; 85/352). However, the difference did not reach statistical significance [risk ratio (RR) = 0.62, 95% confidence interval (CI) 0.31-1.22; I2 = 68%]. Additionally, risk of ICU admission was similar between the tocilizumab and control groups (35.1% vs. 15.8%; RR = 1.51, 95% CI 0.33-6.78; I2 = 86%). The requirement for MV was similar between the tocilizumab and control groups (32.4% vs. 28.6%; RR = 0.82, 95% CI 0.14-4.94; I2 = 91%). However, these non-significant differences between the tocilizumab and control groups may have been the result of baseline characteristics of the tocilizumab group, which were more severe than those of the control group. Based on low-quality evidence, there is no conclusive evidence that tocilizumab would provide any additional benefit to patients with severe COVID-19. Therefore, further recommendation of tocilizumab for COVID-19 cases should be halted until high-quality evidence from randomised controlled trials is available.


Subject(s)
Anti-Inflammatory Agents/administration & dosage , Antibodies, Monoclonal, Humanized/administration & dosage , Antiviral Agents/administration & dosage , Coronavirus Infections/therapy , Immunologic Factors/administration & dosage , Pneumonia, Viral/therapy , Anti-Inflammatory Agents/adverse effects , Antibodies, Monoclonal, Humanized/adverse effects , Antiviral Agents/adverse effects , Bacterial Infections/diagnosis , Bacterial Infections/etiology , Bacterial Infections/immunology , Bacterial Infections/mortality , Betacoronavirus/drug effects , Betacoronavirus/growth & development , Betacoronavirus/immunology , COVID-19 , Coronavirus Infections/immunology , Coronavirus Infections/mortality , Coronavirus Infections/virology , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/mortality , Cytokine Release Syndrome/therapy , Cytokine Release Syndrome/virology , Cytokines/antagonists & inhibitors , Cytokines/genetics , Cytokines/immunology , Drug Administration Schedule , Humans , Immunologic Factors/adverse effects , Intensive Care Units , Opportunistic Infections/diagnosis , Opportunistic Infections/etiology , Opportunistic Infections/immunology , Opportunistic Infections/mortality , Pandemics , Pneumonia, Viral/immunology , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Respiration, Artificial , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Survival Analysis , Treatment Outcome
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