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1.
J Med Microbiol ; 70(8)2021 Aug.
Article in English | MEDLINE | ID: covidwho-1376363

ABSTRACT

Following prolonged hospitalization that included broad-spectrum antibiotic exposure, a strain of Providencia rettgeri was cultured from the blood of a patient undergoing extracorporeal membrane oxygenation treatment for hypoxic respiratory failure due to COVID-19. The strain was resistant to all antimicrobials tested including the novel siderophore cephalosporin, cefiderocol. Whole genome sequencing detected ten antimicrobial resistance genes, including the metallo-ß-lactamase bla NDM-1, the extended-spectrum ß-lactamase bla PER-1, and the rare 16S methyltransferase rmtB2.


Subject(s)
Anti-Bacterial Agents/pharmacology , COVID-19/therapy , Drug Resistance, Bacterial , Enterobacteriaceae Infections/mortality , Pneumonia, Ventilator-Associated/mortality , Providencia/drug effects , Aged , COVID-19/complications , Enterobacteriaceae Infections/blood , Enterobacteriaceae Infections/etiology , Enterobacteriaceae Infections/microbiology , Extracorporeal Membrane Oxygenation , Fatal Outcome , Humans , Male , Microbial Sensitivity Tests , Pneumonia, Ventilator-Associated/etiology , Pneumonia, Ventilator-Associated/microbiology , Providencia/genetics , Providencia/isolation & purification
2.
BMC Pulm Med ; 21(1): 203, 2021 Jun 23.
Article in English | MEDLINE | ID: covidwho-1318281

ABSTRACT

BACKGROUND: Invasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV in the treatment of respiratory failure. However, the effectiveness remains unclear. Here, we performed a randomized controlled study to assess the efficacy and safety of sequential MV in the treatment of tuberculosis with respiratory failure. METHODS: Forty-four tuberculosis patients diagnosed with respiratory failure were randomly divided into sequential MV group (n = 24) and conventional MV group (n = 20). Initially, the patients in both groups received invasive positive pressure ventilation. When the patients' conditions were relieved, the ventilation modality in sequential MV group was switched to oronasal face mask continuous positive airway pressure until weaning. RESULTS: After treatment, the patients in sequential MV group had similar respiratory rate, heart rate, oxygenation index, alveolo-arterial oxygen partial pressure difference (A-aDO2), blood pH, PaCO2 to those in conventional MV group (all P value > 0.05). There was no significant difference in ventilation time and ICU stay between the two groups (P > 0.05), but sequential MV group significantly reduced the time of invasive ventilation (mean difference (MD): - 36.2 h, 95% confidence interval (CI) - 53.6, - 18.8 h, P < 0.001). Sequential MV group also reduced the incidence of ventilator-associated pneumonia (VAP; relative risk (RR): 0.44, 95% CI 0.24, 0.83, P = 0.006) and atelectasis (RR:0.49, 95% CI 0.24,1.00, P = 0.040). CONCLUSIONS: Sequential MV was effective in treating tuberculosis with respiratory failure. It showed advantages in reducing invasive ventilation time and ventilator-associated adverse events. REGISTRATION NUMBER FOR CLINICAL TRIAL: Chinese Clinical Trial Registry ChiCTR2000032311, April 21st, 2020.


Subject(s)
Pneumonia, Ventilator-Associated/etiology , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Tuberculosis/complications , Adult , Aged , Female , Humans , Male , Masks/adverse effects , Middle Aged , Prospective Studies , Respiration, Artificial/adverse effects , Treatment Outcome
4.
Crit Care ; 25(1): 197, 2021 06 07.
Article in English | MEDLINE | ID: covidwho-1261277

ABSTRACT

BACKGROUND: Hospitalized patients with COVID-19 admitted to the intensive care unit (ICU) and requiring mechanical ventilation are at risk of ventilator-associated bacterial infections secondary to SARS-CoV-2 infection. Our study aimed to investigate clinical features of Staphylococcus aureus ventilator-associated pneumonia (SA-VAP) and, if bronchoalveolar lavage samples were available, lung bacterial community features in ICU patients with or without COVID-19. METHODS: We prospectively included hospitalized patients with COVID-19 across two medical ICUs of the Fondazione Policlinico Universitario A. Gemelli IRCCS (Rome, Italy), who developed SA-VAP between 20 March 2020 and 30 October 2020 (thereafter referred to as cases). After 1:2 matching based on the simplified acute physiology score II (SAPS II) and the sequential organ failure assessment (SOFA) score, cases were compared with SA-VAP patients without COVID-19 (controls). Clinical, microbiological, and lung microbiota data were analyzed. RESULTS: We studied two groups of patients (40 COVID-19 and 80 non-COVID-19). COVID-19 patients had a higher rate of late-onset (87.5% versus 63.8%; p = 0.01), methicillin-resistant (65.0% vs 27.5%; p < 0.01) or bacteremic (47.5% vs 6.3%; p < 0.01) infections compared with non-COVID-19 patients. No statistically significant differences between the patient groups were observed in ICU mortality (p = 0.12), clinical cure (p = 0.20) and microbiological eradication (p = 0.31). On multivariable logistic regression analysis, SAPS II and initial inappropriate antimicrobial therapy were independently associated with ICU mortality. Then, lung microbiota characterization in 10 COVID-19 and 16 non-COVID-19 patients revealed that the overall microbial community composition was significantly different between the patient groups (unweighted UniFrac distance, R2 0.15349; p < 0.01). Species diversity was lower in COVID-19 than in non COVID-19 patients (94.4 ± 44.9 vs 152.5 ± 41.8; p < 0.01). Interestingly, we found that S. aureus (log2 fold change, 29.5), Streptococcus anginosus subspecies anginosus (log2 fold change, 24.9), and Olsenella (log2 fold change, 25.7) were significantly enriched in the COVID-19 group compared to the non-COVID-19 group of SA-VAP patients. CONCLUSIONS: In our study population, COVID-19 seemed to significantly affect microbiological and clinical features of SA-VAP as well as to be associated with a peculiar lung microbiota composition.


Subject(s)
COVID-19/complications , Pneumonia, Ventilator-Associated/microbiology , Staphylococcal Infections/etiology , Staphylococcus aureus/isolation & purification , Aged , Anti-Bacterial Agents/therapeutic use , Bronchoalveolar Lavage Fluid/microbiology , COVID-19/mortality , COVID-19/therapy , Female , Hospital Mortality , Hospitalization , Humans , Intensive Care Units , Italy , Logistic Models , Lung/microbiology , Male , Middle Aged , Organ Dysfunction Scores , Pneumonia, Ventilator-Associated/drug therapy , Pneumonia, Ventilator-Associated/etiology , Prospective Studies , Respiration, Artificial , Staphylococcal Infections/drug therapy
5.
Chest ; 159(6): 2309-2317, 2021 06.
Article in English | MEDLINE | ID: covidwho-1064065

ABSTRACT

BACKGROUND: Patients with obesity are at higher risk for community-acquired and nosocomial infections. However, no study has specifically evaluated the relationship between obesity and ventilator-associated pneumonia (VAP). RESEARCH QUESTION: Is obesity associated with an increased incidence of VAP? STUDY DESIGN AND METHODS: This study was a post hoc analysis of the Impact of Early Enteral vs Parenteral Nutrition on Mortality in Patients Requiring Mechanical Ventilation and Catecholamines (NUTRIREA2) open-label, randomized controlled trial performed in 44 French ICUs. Adults receiving invasive mechanical ventilation and vasopressor support for shock and parenteral nutrition or enteral nutrition were included. Obesity was defined as BMI ≥ 30 kg/m2 at ICU admission. VAP diagnosis was adjudicated by an independent blinded committee, based on all available clinical, radiologic, and microbiologic data. Only first VAP episodes were taken into account. Incidence of VAP was analyzed by using the Fine and Gray model, with extubation and death as competing risks. RESULTS: A total of 699 (30%) of the 2,325 included patients had obesity; 224 first VAP episodes were diagnosed (60 and 164 in obese and nonobese groups, respectively). The incidence of VAP at day 28 was 8.6% vs 10.1% in the two groups (hazard ratio, 0.85; 95% CI 0.63-1.14; P = .26). After adjustment on sex, McCabe score, age, antiulcer treatment, and Sequential Organ Failure Assessment at randomization, the incidence of VAP remained nonsignificant between obese and nonobese patients (hazard ratio, 0.893; 95% CI, 0.66-1.2; P = .46). Although no significant difference was found in duration of mechanical ventilation and ICU length of stay, 90-day mortality was significantly lower in obese than in nonobese patients (272 of 692 [39.3%] patients vs 718 of 1,605 [44.7%]; P = .02). In a subgroup of patients (n = 123) with available pepsin and alpha-amylase measurements, no significant difference was found in rate of abundant microaspiration of gastric contents, or oropharyngeal secretions between obese and nonobese patients. INTERPRETATION: Our results suggest that obesity has no significant impact on the incidence of VAP.


Subject(s)
Body Mass Index , Intensive Care Units , Obesity/complications , Pneumonia, Ventilator-Associated/etiology , Respiration, Artificial/adverse effects , Shock/therapy , Aged , Female , France/epidemiology , Humans , Incidence , Male , Middle Aged , Parenteral Nutrition, Total/methods , Pneumonia, Ventilator-Associated/epidemiology , Prevalence , Prognosis , Risk Factors , Survival Rate/trends
6.
Elife ; 92020 12 17.
Article in English | MEDLINE | ID: covidwho-1011747

ABSTRACT

Here, we describe the case of a COVID-19 patient who developed recurring ventilator-associated pneumonia caused by Pseudomonas aeruginosa that acquired increasing levels of antimicrobial resistance (AMR) in response to treatment. Metagenomic analysis revealed the AMR genotype, while immunological analysis revealed massive and escalating levels of T-cell activation. These were both SARS-CoV-2 and P. aeruginosa specific, and bystander activated, which may have contributed to this patient's persistent symptoms and radiological changes.


Subject(s)
Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Lymphocyte Activation , Pneumonia, Ventilator-Associated/drug therapy , Pseudomonas Infections/drug therapy , SARS-CoV-2 , T-Lymphocytes/immunology , Anti-Bacterial Agents/pharmacology , COVID-19/immunology , COVID-19/therapy , Drug Resistance, Multiple, Bacterial , Humans , Lung/microbiology , Male , Meropenem/pharmacology , Meropenem/therapeutic use , Metagenomics , Middle Aged , Piperacillin, Tazobactam Drug Combination/pharmacology , Piperacillin, Tazobactam Drug Combination/therapeutic use , Pneumonia, Ventilator-Associated/diagnostic imaging , Pneumonia, Ventilator-Associated/etiology , Pseudomonas Infections/diagnostic imaging , Pseudomonas Infections/etiology , Pseudomonas aeruginosa/isolation & purification , Recurrence , Respiration, Artificial
8.
J Clin Apher ; 36(1): 179-182, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-737548

ABSTRACT

Here we describe the effect of therapeutic plasma exchange with 5% albumin as sole replacement solution for the management of Covid-19. A 74-year-old man was admitted for severe Covid-19 acute respiratory distress syndrome. Based on the growing body of evidence that cytokine release syndrome, and especially interleukin-6, plays a key role in critically ill Covid-19 patients, we decided to implement therapeutic plasma exchange as a rescue therapy. The patient's clinical status rapidly improved, and biological records showed convincing results of decrease in interleukin-6 and inflammatory parameters under treatment. This case presents a proof-of-concept for the use of therapeutic plasma exchange with 5% albumin as sole replacement solution in a critically ill Covid-19 patient with cytokine release syndrome. This could constitute a major benefit in terms of security compared to long-lasting immunosuppressive monoclonal antibodies, or to therapeutic plasma exchange with plasma as replacement fluid. Hence, we think that a further evaluation of risk-benefit balance of this therapy in severe cases of Covid-19 should rapidly be undertaken.


Subject(s)
COVID-19/complications , Critical Illness/therapy , Cytokine Release Syndrome/therapy , Plasma Exchange , SARS-CoV-2 , Aged , Albumins , C-Reactive Protein/analysis , Combined Modality Therapy , Cytokine Release Syndrome/blood , Cytokine Release Syndrome/etiology , Fibrinogen/analysis , Humans , Interleukin-6/blood , Male , Oxygen/blood , Oxygen Inhalation Therapy , Pneumonia, Ventilator-Associated/etiology , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Salvage Therapy , Solutions
9.
Cell Mol Immunol ; 17(9): 1001-1003, 2020 09.
Article in English | MEDLINE | ID: covidwho-690856
10.
Int J Hematol ; 112(5): 746-750, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-619933

ABSTRACT

COVID-19 is a new disease with many undescribed clinical manifestations. We report herein a case of severe immune thrombocytopenic purpura (ITP) in a critical COVID-19 patient. A patient presented a severe episode of immune thrombocytopenia (< 10 × 109/L) 20 days after admission for a critical COVID-19. This thrombocytopenia was associated with a life-threatening bleeding. Response to first-line therapies was delayed as it took up to 13 days after initiation of intravenous immunoglobulin and high-dose dexamethasone to observe an increase in platelet count. COVID-19 may be associated with late presenting severe ITP. Such ITP may also be relatively resistant to first-line agents. Hematological manifestations of COVID-19, such as the ones associated with life-threatening bleeding, must be recognized.


Subject(s)
Coronavirus Infections/complications , Pandemics , Pneumonia, Viral/complications , Purpura, Thrombocytopenic, Idiopathic/etiology , Betacoronavirus , COVID-19 , Combined Modality Therapy , Coronavirus Infections/drug therapy , Dexamethasone/therapeutic use , Hemorrhage/etiology , Humans , Immunoglobulins, Intravenous , Intracranial Hemorrhages/etiology , Male , Middle Aged , Pneumonia, Staphylococcal/etiology , Pneumonia, Ventilator-Associated/etiology , Pulmonary Atelectasis/etiology , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Purpura, Thrombocytopenic, Idiopathic/therapy , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , SARS-CoV-2
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