Bacterial coinfection and antibiotic resistance in hospitalized COVID-19 patients: a systematic review and meta-analysis

Background There were a few studies on bacterial coinfection in hospitalized COVID-19 patients worldwide. This systematic review aimed to provide the pooled prevalence of bacterial coinfection from published studies from 2020 to 2022. Methods Three databases were used to search the studies, and 49 studies from 2,451 identified studies involving 212,605 COVID-19 patients were included in this review. Results The random-effects inverse-variance model determined that the pooled prevalence of bacterial coinfection in hospitalized COVID-19 patients was 26.84% (95% CI [23.85–29.83]). The pooled prevalence of isolated bacteria for Acinetobacter baumannii was 23.25% (95% CI [19.27–27.24]), Escherichia coli was 10.51% (95% CI [8.90–12.12]), Klebsiella pneumoniae was 15.24% (95% CI [7.84–22.64]), Pseudomonas aeruginosa was 11.09% (95% CI [8.92–13.27]) and Staphylococcus aureus (11.59% (95% CI [9.71–13.46])). Meanwhile, the pooled prevalence of antibiotic-resistant bacteria for extended-spectrum beta-lactamases producing Enterobacteriaceae was 15.24% (95% CI [7.84–22.64]) followed by carbapenem-resistant Acinetobacter baumannii (14.55% (95% CI [9.59–19.52%])), carbapenem-resistant Pseudomonas aeruginosa (6.95% (95% CI [2.61–11.29])), methicillin-resistant Staphylococcus aureus (5.05% (95% CI [3.49–6.60])), carbapenem-resistant Enterobacteriaceae (4.95% (95% CI [3.10–6.79])), and vancomycin-resistant Enterococcus (1.26% (95% CI [0.46–2.05])). Conclusion All the prevalences were considered as low. However, effective management and prevention of the infection should be considered since these coinfections have a bad impact on the morbidity and mortality of patients.

Experiences, Challenges, and Coping Strategies of Frontline Healthcare Providers in Response to the COVID-19 Pandemic in Kelantan, Malaysia.

Introduction: In the fight against the COVID-19 pandemic, frontline healthcare providers who are engaged in the direct diagnosis, treatment, and care of patients face a high risk of infection and inadequate protection from contamination, overwork, frustration, and exhaustion. These impose significant psychological and mental health concerns for frontline healthcare providers. Objectives: This study aimed to explore the experiences and challenges faced and coping strategies adopted by frontline healthcare providers in response to the COVID-19 pandemic in Kelantan, Malaysia. Methodology: This phenomenological approach to qualitative study used a telephone-based in-depth interview that followed a semistructured interview guide. The number of frontline healthcare providers was based on saturation theory. All the participants recruited fulfilled the inclusion and exclusion criteria from May to July 2020 in Raja Perempuan Zainab II Hospital. All interviews were audio recorded and transcribed verbatim. Thematic data analysis using NVIVO version 10 was performed. Result: The 10 respondents involved in this study consisted of doctors, medical assistants, and nurses. The findings were divided into four main themes: invaluable experiences during the pandemic, challenges, coping strategies, and future expectations. The providers responded well in facing the disease even though they felt psychologically disturbed at the initial phase of the COVID-19 pandemic. Conclusion: Healthcare providers perceived themselves as being more resilient and less vulnerable to psychological impacts than they were before the pandemic.

Systematic Review and Meta-Analysis of COVID-19 Vaccination Acceptance.

INTRODUCTION: Vaccination is an essential intervention to curb the coronavirus disease 2019 (COVID-19) pandemic. This review aimed to estimate the pooled proportion of COVID-19 vaccine acceptance worldwide. METHODS: A systematic search of the MEDLINE (PubMed) database using "COVID-19," "vaccine" and "acceptance" to obtain original research articles published between 2020 and July 2021. Only studies with full text and that were published in English were included. The Joanna Briggs Institute meta-analysis was used to assess the data quality. The meta-analysis was performed using generic inverse variance with a random-effects model using the Review Manager software. RESULTS: A total of 172 studies across 50 countries worldwide were included. Subgroup analyses were performed with regard to vaccine acceptance, regions, population, gender, vaccine effectiveness, and survey time. The pooled proportion of COVID-19 vaccine acceptance was 61% (95% CI: 59, 64). It was higher in Southeast Asia, among healthcare workers, in males, for vaccines with 95% effectiveness, and during the first survey. CONCLUSION: COVID-19 vaccine acceptance needs to be increased to achieve herd immunity to protect the population from the disease. It is crucial to enhance public awareness of COVID-19 vaccination and improve access to vaccines. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2021, identifier CRD42021268645.

Performance of Rapid Antigen Tests for COVID-19 Diagnosis: A Systematic Review and Meta-Analysis.

The identification of viral RNA using reverse transcription quantitative polymerase chain reaction (RT-qPCR) is the gold standard for identifying an infection caused by SARS-CoV-2. The limitations of RT-qPCR such as requirement of expensive instruments, trained staff and laboratory facilities led to development of rapid antigen tests (RATs). The performance of RATs has been widely evaluated and found to be varied in different settings. The present systematic review aims to evaluate the pooled sensitivity and specificity of the commercially available RATs. This review was registered on PROSPERO (registration number: CRD42021278105). Literature search was performed through PubMed, Embase and Cochrane COVID-19 Study Register to search studies published up to 26 August 2021. The overall pooled sensitivity and specificity of RATs and subgroup analyses were calculated. Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was used to assess the risk of bias in each study. The overall pooled sensitivity and specificity of RATs were 70% (95% CI: 69-71) and 98% (95% CI: 98-98), respectively. In subgroup analyses, nasal swabs showed the highest sensitivity of 83% (95% CI: 80-86) followed by nasopharyngeal swabs 71% (95% CI: 70-72), throat swabs 69% (95% CI: 63-75) and saliva 68% (95% CI: 59-77). Samples from symptomatic patients showed a higher sensitivity of 82% (95% CI: 82-82) as compared to asymptomatic patients at 68% (95% CI: 65-71), while a cycle threshold (Ct) value ≤25 showed a higher sensitivity of 96% (95% CI: 95-97) as compared to higher Ct value. Although the sensitivity of RATs needs to be enhanced, it may still be a viable option in places where laboratory facilities are lacking for diagnostic purposes in the early phase of disease.

Prevalence of Psychological Impacts on Healthcare Providers during COVID-19 Pandemic in Asia.

COVID-19 has impacted people psychologically globally, including healthcare providers. Anxiety, depression, and stress are the most common impacts that have affected these people. Thus, this study was aimed to ascertain the estimated prevalence of psychological impacts among healthcare providers in the Asian region. A systematic search was performed in the MEDLINE, CINAHL, and Scopus databases for original research articles published between 2020 and April 2021. Only studies published in English were included. The quality of data was assessed using the Joanna Briggs Institute Meta-Analysis, and the analysis was performed using generic inverse variance with a random-effects model by Review Manager software. A total of 80 studies across 18 countries in Asia region were pooled to assess the data prevalence on anxiety (34.81% (95% CI: 30.80%, 38.83%)), depression (34.61% (95% CI: 30.87%, 38.36%)), stress (31.72% (95% CI: 21.25%, 42.18%)), insomnia (37.89% (95% CI: 25.43%, 50.35%)), and post-traumatic stress disorder (15.29% (95% CI: 11.43%, 19.15%)). Subgroup analyses were conducted across regions, type of healthcare providers, sex, and occupation. This review has identified a high prevalence of anxiety, depression, stress, and insomnia but a low prevalence of post-traumatic stress disorder among healthcare providers in Asia regions. Effective intervention support programs are urgently needed to improve psychological health of healthcare providers and maintaining the health system.

Depressive symptoms among frontline and non-frontline healthcare providers in response to the COVID-19 pandemic in Kelantan, Malaysia: A cross sectional study.

BACKGROUND: Healthcare providers are vulnerable in the fight against COVID-19 and may experience significant psychological and mental health consequences. This study aimed to compare the levels of depressive symptoms among frontline and non-frontline healthcare providers in response to the COVID-19 pandemic. METHODS: A comparative cross-sectional study was conducted in two government hospitals managing COVID-19-related cases in Kelantan, Malaysia from May to July 2020 to identify and compared depressive symptoms levels of frontline and non-frontline healthcare providers. Convenient sampling was applied in the selection of eligible participants and those diagnosed as having any psychiatric illnesses were excluded. The self-administered questionnaires for the Malay versions of the Hospital Anxiety and Depression Scale to measure depressive symptoms score and the Medical Outcome Study Social Support Survey to measure social support score as an important confounder. A descriptive analysis, independent t-test and ANCOVA were performed using SPSS version 26. RESULTS: A total of 306 respondents from healthcare providers were recruited which 160 were frontline healthcare providers and 146 were non-frontline healthcare providers. The level of depressive symptoms (HADS score >8) was 27.5% for the frontline healthcare providers and 37.7% for the non-frontline healthcare providers. The mean depressive symptoms score for the non-frontline healthcare providers was 0.75 points higher than that of the frontline healthcare providers after adjusting for gender, duration of employment and social support. CONCLUSION: Non-frontline healthcare providers are also experiencing psychological distress during the COVID-19 pandemic even though they do not have direct contact with COVID-19 patients.

Vicarious traumatization in healthcare providers in response to COVID-19 pandemic in Kelantan, Malaysia.

BACKGROUND: In the fight against the COVID-19 pandemic, frontline healthcare providers who are engaged in the direct diagnosis, treatment, and care of patients face a high risk of infection yet receive inadequate protection from contamination and minimal support to cope with overwork, frustration, and exhaustion. These problems have created significant psychological and mental health concerns for frontline healthcare providers. This study aimed to compare the levels of vicarious traumatization between frontline and non-frontline healthcare providers in response to the COVID-19 pandemic. METHODOLOGY: All the subjects who met the inclusion criteria were recruited for this comparative cross-sectional study, which was conducted from May to July 2020 in two hospitals in Kelantan, Malaysia. A self-administered questionnaire, namely, the Malay-version Vicarious Traumatization Questionnaire and the Medical Outcome Study Social Support Survey were utilized. A descriptive analysis, independent t-test, and analysis of covariance were performed using SPSS Statistics version 26. RESULTS: A total of 160 frontline and 146 non-frontline healthcare providers were recruited. Vicarious traumatization was significantly higher among the non-frontline healthcare providers (estimated marginal mean [95% CI]: 79.7 [75.12, 84.30]) compared to the frontline healthcare providers (estimated marginal mean [95% CI]: 74.3 [68.26, 80.37]) after adjusting for sex, duration of employment, and social support. CONCLUSION: The level of vicarious traumatization was higher among non-frontline compared to frontline healthcare providers. However, the level of severity may differ from person to person, depending on how they handle their physical, psychological, and mental health. Hence, support from various resources, such as colleagues, family, the general public, and the government, may play an essential role in the mental health of healthcare providers.

Vicarious Traumatization Questionnaire: Psychometric Properties Using Rasch Model and Structural Equation Modeling.

Frontline healthcare providers are exposed to indirect trauma through dealing with traumatized patients. This puts them at risk of vicarious traumatization. In response to the COVID-19 pandemic, this study seeks to establish the psychometric properties of the Malay version of the Vicarious Traumatization Questionnaire among healthcare providers. A cross-sectional study was conducted. The translated Malay version of the Vicarious Traumatization Questionnaire was completed by 352 healthcare providers in Kelantan, Malaysia. The data was entered using IBM SPSS Statistics version 26.0 (SPSS Inc., Chicago, IL, USA, 2019), and descriptive analysis was performed. The psychometric properties of the scale were assessed in two phases. The Rasch model to assess the validity and reliability was performed using Winsteps version 3.72.3. The confirmatory factor analysis using the structural equation modeling was performed using AMOS version 23.0. The Rasch analysis showed that the 38 items, in two constructs, had high item reliability and item separation at 0.97 and item separation at 5.36, respectively, while good person reliability and person separation were at 0.95 and 4.58, respectively. The correlations of all persons and items are greater than 0.20. There are no misfitting or overfitting items in the outfit MNSQ. There are four items that are challenging in answering the scale. The final model of the confirmatory factor analysis shows two constructs with 38 items demonstrating acceptable factor loadings, domain to domain correlation, and best fit (Chi-squared/degree of freedom = 4.73; Tucker-Lewis index = 0.94; comparative fit index = 0.94; and root mean square error of approximation = 0.10). Composite reliability and average variance extracted of the domains were higher than 0.7 and 0.5, respectively. The Vicarious Traumatization Questionnaire tested among healthcare providers has been shown to valid and reliable to assess vicarious traumatization.