Asunto(s)
Tratamiento Farmacológico de COVID-19 , Infecciones Relacionadas con Catéteres , Cateterismo Venoso Central , Catéteres Venosos Centrales , Infección Hospitalaria , Sepsis , Infecciones Relacionadas con Catéteres/complicaciones , Cateterismo Venoso Central/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Infección Hospitalaria/etiología , Dexametasona/efectos adversos , Humanos , Interleucinas , Sepsis/complicacionesRESUMEN
BACKGROUND: Guidelines recommend maximal efforts to obtain blood and sputum cultures in patients with COVID-19, as bacterial coinfection is associated with worse outcomes. The aim of this study was to evaluate the yield of bacteriological tests, including blood and sputum cultures, and the association of multiple biomarkers and the Pneumonia Severity Index (PSI) with clinical and microbiological outcomes in patients with COVID-19 presenting to the emergency department (ED). METHODS: This is a substudy of a large observational cohort study (PredictED study). The PredictED included adult patients from whom a blood culture was drawn at the ED of Haga Teaching Hospital, The Netherlands. For this substudy, all patients who tested positive for SARS-CoV-2 by PCR in March and April 2020 were included. The primary outcome was the incidence of bacterial coinfection. We used logistic regression analysis for associations of procalcitonin, C reactive protein (CRP), ferritin, lymphocyte count and PSI score with a severe disease course, defined as intensive care unit admission and/or 30-day mortality. The area under the receiver operating characteristics curve (AUC) quantified the discriminatory performance. RESULTS: We included 142 SARS-CoV-2 positive patients. On presentation, the median duration of symptoms was 8 days. 41 (29%) patients had a severe disease course and 24 (17%) died within 30 days. The incidence of bacterial coinfection was 2/142 (1.4%). None of the blood cultures showed pathogen growth while 6.3% was contaminated. The AUCs for predicting severe disease were 0.76 (95% CI 0.68 to 0.84), 0.70 (0.61 to 0.79), 0.62 (0.51 to 0.74), 0.62 (0.51 to 0.72) and 0.72 (0.63 to 0.81) for procalcitonin, CRP, ferritin, lymphocyte count and PSI score, respectively. CONCLUSION: Blood cultures appear to have limited value while procalcitonin and the PSI appear to be promising tools in helping physicians identify patients at risk for severe disease course in COVID-19 at presentation to the ED.
Asunto(s)
Infecciones Bacterianas/diagnóstico , Técnicas Bacteriológicas/métodos , COVID-19/diagnóstico , Coinfección/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/sangre , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/microbiología , Técnicas Bacteriológicas/estadística & datos numéricos , Proteína C-Reactiva/análisis , COVID-19/sangre , COVID-19/complicaciones , COVID-19/virología , Prueba de Ácido Nucleico para COVID-19 , Coinfección/sangre , Coinfección/epidemiología , Coinfección/microbiología , Servicio de Urgencia en Hospital , Femenino , Ferritinas/sangre , Humanos , Incidencia , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Polipéptido alfa Relacionado con Calcitonina/sangre , Pronóstico , Curva ROC , Estudios Retrospectivos , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la EnfermedadRESUMEN
We report a case of a man with COVID-19 who developed acute hepatotoxicity related to remdesivir with probable interaction of P-glycoprotein (P-gp) inhibitors. Until further details on this interaction become available, we recommend physicians to be cautious with the prescription of P-gp inhibitors in patients receiving remdesivir therapy.
Asunto(s)
Tratamiento Farmacológico de COVID-19 , Enfermedad Hepática Inducida por Sustancias y Drogas , Subfamilia B de Transportador de Casetes de Unión a ATP , Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Humanos , Masculino , SARS-CoV-2RESUMEN
PURPOSE: The COVID-19 crisis put a strain on intensive care resources everywhere in the world increasing the risk of burnout. Previously, the prevalence of burnout among Dutch intensivists was found to be low. Engagement and resilience among intensivists have not previously been studied quantitatively, however, both are related to burnout and provide a possible way to mitigate burnout. Our objective was to study burnout and its association with work engagement and resilience among Dutch intensivists in the aftermath of the COVID-19 crisis. METHODS: An online questionnaire was sent to all Dutch intensivists. The questionnaire consisted of questions on personal and work-related characteristics and validated questionnaires: the Maslach Burnout Inventory, the Utrecht Work Engagement Scale, and the Resilience Evaluation Scale. RESULTS: The response rate was 27.2% with 162 evaluable responses. Thirteen respondents (8.0%) were classified as having burnout, 63 (38.9%) respondents were reporting high work engagement. Burnout was found to be negatively associated with both work engagement and resilience. CONCLUSION: In the aftermath of the 2020 COVID-19 crisis, we found a raised prevalence of burnout among intensivists, however this is still low in international comparisons. Intensivists with burnout scored low on resilience and low on work engagement.