RESUMEN
Treatment of COVID-19 patients and their extreme numbers represented an unprecedented challenge for the intensive care system in healthcare facilities throughout the Czech Republic, a country particularly affected by the new coronavirus SARS-CoV-2 pandemic. A steep increase in the need for intensive care placed an excess burden on bed and staff capacity. For a severe and critical course of COVID-19, bilateral pneumonia with acute hypoxemic respiratory failure is pathognomonic. In the intensive care setting, COVID-19 therapy is primarily symptomatic, supporting failing respiratory function to gain time needed to restore it and to repair the lungs. The aggressiveness and comprehensiveness of respiratory support depend on the severity of failure, ranging from simple oxygen therapy, to non-invasive support and mechanical ventilation, to extracorporeal support. By contrast, specific COVID-19 therapy is directly targeted against SARS-CoV-2 or modulates the organism's response to the virus. Primary, virus-induced lung injury may be secondarily complicated by coinfection or superinfection, most commonly bacterial, increasing the severity and lethality of the disease. Therefore, anti-infective therapy is crucial for the prognosis and outlook of intensive care COVID-19 patients. Among nosocomial infections com-plicating COVID-19, ventilator-associated pneumonia (developing in mechanically ventilated patients) is particularly important and challenging, and so are issues related to bacterial resistance and rational antibiotic therapy.Copyright © 2021, Trios spol. s.r.o.. All rights reserved.
RESUMEN
Objectives: The COVID-19 pandemic has had a major impact on the healthcare system, which has been forced to manage large num-bers of patients, including those with respiratory insufficiency and in need of oxygen therapy. Due to concerns about bacterial co-in-fection, antibiotic therapy was administered to many patients. The aim of the present study was to compare antimicrobial resistance in intensive care patients in the pre-pandemic and pandemic periods. Material(s) and Method(s): Patients hospitalized at the Department of Anesthesiology, Resuscitation and Intensive Care Medicine of the University Hospital Olomouc in the pre-COVID-19 period (2018-2019) and during the pandemic (2020-2021) were enrolled in the stu-dy. Clinical samples from the lower respiratory tract were routinely collected twice a week, with one strain of a given species first isolated from each patient being included in the study. Result(s): While several bacterial species (Escherichia coli, Proteus mirabilis and Haemophilus influenzae) were found to occur less fre-quently, an increased occurrence was documented for Enterococcus faecium, Serratia marcescens and Klebsiella variicola. Overall, ho-wever, it can be concluded that there was no major change in the frequency of bacterial pathogens isolated from the lower respiratory tract during the COVID-19 period. Similarly, with only a few exceptions, antimicrobial resistance did not change significantly. More significant increases in resistance to piperacillin/tazobactam, cefotaxime, ciprofloxacin and gentamicin have been demonstrated for Serratia marcescens. However, a decrease in the resistance of Pseudomonas aeruginosa and Burkholderia cepacia complex to mero-penem was also observed. Conclusion(s): There was no significant change in the frequency of bacterial pathogens and their resistance to antibiotics during the COVID-19 pandemic. However, there was an increase or decrease in the percentage of some species and in their resistance.Copyright © 2022, Trios spol. s.r.o.. All rights reserved.
RESUMEN
Objectives: The COVID-19 pandemic has had a major impact on the healthcare system, which has been forced to manage large number of patients, including those with respiratory insufficiency and in need of oxygen therapy. Due to concerns about bacterial co-infection, antibiotic therapy was administered to many patients. The aim of the present study was to compare antimicrobial resistance in intensive care patients in the pre-pandemic and pandemic periods. Material and Methods: Patients hospitalized at the Department of Anesthesiology, Resuscitation and Intensive Care Medicine of the University Hospital Olomouc in the pre-COVID-19 period (2018-2019) and during the pandemic (2020-2021) were enrolled in the study. Clinical samples from the lower respiratory tract were routinely collected twice a week, with one strain of a given species first isolated from each patient being included in the study.
RESUMEN
Treatment of COVID-19 patients and their extreme numbers represented an unprecedented challenge for the intensive care system in healthcare facilities throughout the Czech Republic, a country particularly affected by the new coronavirus SARS-CoV-2 pandemic. A steep increase in the need for intensive care placed an excess burden on bed and staff capacity. For a severe and critical course of COVID-19, bilateral pneumonia with acute hypoxemic respiratory failure is pathognomonic. In the intensive care setting, COVID-19 therapy is primarily symptomatic, supporting failing respiratory function to gain time needed to restore it and to repair the lungs. The aggressiveness and comprehensiveness of respiratory support depend on the severity of failure, ranging from simple oxygen therapy, to non-invasive support and mechanical ventilation, to extracorporeal support. By contrast, specific COVID-19 therapy is directly targeted against SARS-CoV-2 or modulates the organism's response to the virus. Primary, virus-induced lung injury may be secondarily complicated by coinfection or superinfection, most commonly bacterial, increasing the severity and lethality of the disease. Therefore, anti-infective therapy is crucial for the prognosis and outlook of intensive care COVID-19 patients. Among nosocomial infections complicating COVID-19, ventilator-associated pneumonia (developing in mechanically ventilated patients) is particularly important and challenging, and so are issues related to bacterial resistance and rational antibiotic therapy.
RESUMEN
The COVID-19 pandemic may increase the current threat of antimicrobial resistance and exacerbate another, rather silent, pandemic posed by the increasing frequency of multidrug-resistant bacterial pathogens and the associated potential for loss of effective antibiotics. Antibiotic treatment has often been used in patients hospitalized for COVID-19 due to concerns about possible bacterial co-infection, as confirmed by previous experience with viral respiratory infections such as H1N1 influenza, SARS and MERS. Concerns or unknowns related to the COVID-19 pandemic have also affected physicians‘ behavior, including the use of antibiotics. However, the high rate of antibiotic use in patients, especially those with mild to moderate COVID-19 disease, is inconsistent with the actual incidence of bacterial co-infections and/or secondary respiratory infections. Thus, it is clear that a careful assessment of the role of antibiotic treatment in patients hospitalized for COVID-19 is required. According to the current WHO recommendation, the application of antibiotics is especially suitable for patients with severe/critical de-gree of respiratory insufficiency requiring intensive oxygen therapy, artificial lung ventilation or support by extracorporeal membrane oxygenation.
RESUMEN
Objective/Method: Six-month survival analysis of 28 consecutive patients (78.6 % male, mean age 54.3±12.2years, mean BMI 35.3±8.5kg/m2) with critical hypoxemic and/or hypercapnic COVID-19-related severe respiratory failure (mean P/F ratio 69.8±12.3 mmHg, mean pCO2 78.0±15.7 mmHg, Murray Score 3.68±0.4) were supported on V-V ECMO from October 2020 to March 2021. Results: With mean support duration 223.8±65.1 hours, 21 patients (75%) were successfully weaned off. Subsequently, 14 of them (50%) were discharged home with good neurological outcome (CPC 1,2). During follow-up, 30-day, 90-, 180-day survival rate was 64.3%, 53.6% and 42.8%, respectively. Three device-related complications (partial oxygenator thrombosis), 4 thrombotic (1 ischemic stroke, 3 leg cannula-related vein thrombosis), and 3 severe bleeding complications (massive hemothorax, GI bleeding, IC bleeding) occurred. In survivor group shorter length of MV (1.3±0.6 vs. 3.1±3.5, p=0.03), higher P/F ration (74.1±14.2 vs. 61.3±12.1 mmHg, p=0.04), lower IL-6 level (63.5±55.5 vs. 75.9±68.8 ng/l, p=0.04), and D-dimmers (3744.4±4202.3 vs. 6219.9±10431.9 mg/l, p=0.01) were analysed before cannulation. Two late death (≥ 90 day) occurred, as a consequence of critical illness myopathy and recurrent bacterial/fungal pneumonia. Conclusion: Mid-term outcome of V-V ECMO support for COVID-19-related severe respiratory failure is promising even in the scope of lowvolume ECMO centre. Further evaluation of survivors' real quality of life as well as long-term morbidity and mortality analysis is needed.
RESUMEN
Objective: We sought to evaluate interim results of V-V ECMO support for COVID-19-related severe respiratory failure during the 2nd wave of coronavirus pandemic. Methods: A total of 18 consecutive patients (83.3% male, mean age 54.7.8±12.6 years, mean BMI 34.9±9.4 kg/m2) with critical hypoxemic and/or hypercapnic failure (mean P/F ratio 68.5±12.3 mmHg, mean pCO2 78.0±15.7 mmHg) were supported in our centre from October to December 2020. Interim outcome analysis focused on 30-, 60-day survival was conducted. Results: Prior the ECMO, all patients were prone positioned and mechanically ventilated (MV) for the mean of 2.9±2.8 days, subsequently, all were successfully cannulated under ultrasound guidance (83.3%) or angiographic control (16.7%). Mean ECMO support duration reached 217.3±48.5 hours, 15 patients (83.3%) were successfully weaned off. Five patients (27.8%) were discharged home with good neurological outcome (CPC 1,2), 5 patients (27.8%) remained hospitalized, 4 of them in acute rehabilitation centre, and only 1 still remains in ICU with MV dependency. A total of 8 in-hospital deaths (44.4%) were recorded, predominantly due to sepsis-related MOF (75%). During follow-up, 30-day and 60-day survival rate was Kaplan-Meier survival analysis. 72.2% and 55.6%, respectively. One device-related complication (oxygenator thrombosis), 3 thrombotic (1 ischemic stroke, 2 leg cannula-related vein thrombosis), and 1 severe bleeding complications (massive hemothorax) occurred. Conclusions: With respect to limited value of interim results, outcome of V-V ECMO support for COVID-19- related severe respiratory failure is promising even in the scope of low-volume ECMO centre. Long-term outcome analysis including evaluation of survivors' real quality of life is needed.