Does COVID-19 Increase the Risk of Central-Line-Associated Bloodstream Infections?

Objectives: All over the world, there has been a rapid and significant increase in the number of critically ill patients requiring mechanical ventilation, which was over the capacity of the intensive care units (ICU). This resulted in an increased risk of healthcare-associated infections. The most significant increase was in central-line-associated bloodstream infections (CLABSI). Our study aimed to determine the effect of COVID-19 infection on CLABSI rates in patients in the COVID-ICU and the factors affecting it. Methods: Adult patients hospitalized in the ICU between January 01, 2021, and December 31, 2021, and diagnosed with CLABSI were evaluated retrospectively. Only the first infection data of patients diagnosed with more than one CLABSI during hospitalization were included in the study. The patients were divided into two groups COVID-ICU and general ICU patients and were compared in terms of infection rate, risk factors, and agent distributions. Results: Twenty-two patients in the COVID-ICU and 32 patients in the general ICUs were diagnosed with CLABSI, and the infection rates were 2.05 and 1.03, respectively. The patients in the COVID-ICU had a shorter length of stay in the ICU and a significantly shorter time from ICU admission to CLABSI diagnosis. There was no difference in mortality between the two groups. Infections caused by Gram-negative microorganisms developed most frequently in both groups, and Acinetobacter baumannii was the most frequent among them. Conclusion: CLABSI is seen more frequently and earlier in patients followed in the COVID-ICU. According to our study, this situation did not significantly affect mortality. To prevent CLABSI in COVID-ICUs and improve health care quality, additional management strategies must be determined, and close data monitoring is needed.

Does COVID-19 Increase the Risk of Central-Line-Associated Bloodstream Infections?

Objectives: All over the world, there has been a rapid and significant increase in the number of critically ill patients requiring mechanical ventilation, which was over the capacity of the intensive care units (ICU). This resulted in an increased risk of healthcare-associated infections. The most significant increase was in central-line-associated bloodstream infections (CLABSI). Our study aimed to determine the effect of COVID-19 infection on CLABSI rates in patients in the COVID-ICU and the factors affecting it. Methods: Adult patients hospitalized in the ICU between January 01, 2021, and December 31, 2021, and diagnosed with CLABSI were evaluated retrospectively. Only the first infection data of patients diagnosed with more than one CLABSI during hospitalization were included in the study. The patients were divided into two groups COVID-ICU and general ICU patients and were compared in terms of infection rate, risk factors, and agent distributions. Results: Twenty-two patients in the COVID-ICU and 32 patients in the general ICUs were diagnosed with CLABSI, and the infection rates were 2.05 and 1.03, respectively. The patients in the COVID-ICU had a shorter length of stay in the ICU and a significantly shorter time from ICU admission to CLABSI diagnosis. There was no difference in mortality between the two groups. Infections caused by Gram-negative microorganisms developed most frequently in both groups, and Acinetobacter baumannii was the most frequent among them. Conclusion: CLABSI is seen more frequently and earlier in patients followed in the COVID-ICU. According to our study, this situation did not significantly affect mortality. To prevent CLABSI in COVID-ICUs and improve health care quality, additional management strategies must be determined, and close data monitoring is needed.

Does COVID-19 Increase the Risk of Central-Line-Associated Bloodstream Infections?

Objectives: All over the world, there has been a rapid and significant increase in the number of critically ill patients requiring mechanical ventilation, which was over the capacity of the intensive care units (ICU). This resulted in an increased risk of healthcare-associated infections. The most significant increase was in central-line-associated bloodstream infections (CLABSI). Our study aimed to determine the effect of COVID-19 infection on CLABSI rates in patients in the COVID-ICU and the factors affecting it. Method(s): Adult patients hospitalized in the ICU between January 01, 2021, and December 31, 2021, and diagnosed with CLABSI were evaluated retrospectively. Only the first infection data of patients diagnosed with more than one CLABSI during hospitalization were included in the study. The patients were divided into two groups COVID-ICU and general ICU patients and were compared in terms of infection rate, risk factors, and agent distributions. Result(s): Twenty-two patients in the COVID-ICU and 32 patients in the general ICUs were diagnosed with CLABSI, and the infection rates were 2.05 and 1.03, respectively. The patients in the COVID-ICU had a shorter length of stay in the ICU and a significantly shorter time from ICU admission to CLABSI diagnosis. There was no difference in mortality between the two groups. Infections caused by Gram-negative microorganisms developed most frequently in both groups, and Acinetobacter baumannii was the most frequent among them. Conclusion(s): CLABSI is seen more frequently and earlier in patients followed in the COVID-ICU. According to our study, this situation did not significantly affect mortality. To prevent CLABSI in COVID-ICUs and improve health care quality, additional management strategies must be determined, and close data monitoring is needed. Copyright © 2022, DOC Design and Informatics Co. Ltd.. All rights reserved.

Bemiparin Versus Enoxaparin for Extended Thromboprophylaxis in COVID-19 Patients at High Risk of Venous Thromboembolism

Introduction: Patients with COVID-19 are at increased risk of thromboembolic events during hospitalization and after discharge. Current guidelines recommend use of extended thromboprophylaxis in hospitalized COVID-19 patients who have high risk of post-discharge venous thromboembolism and low risk of bleeding. We aimed to report our experience regarding different low-molecular-weight heparins administered post-discharge in a COVID-19 patient population with high-thromboembolic and low-bleeding risk. Methods: This was a single-center, retrospective, observational study. Consecutive patients admitted with a confirmed diagnosis of COVID-19 between March 16 and July 16, 2020, were assessed for enrollment. Patients were included if they received prophylaxis with low-molecular-weight heparins after discharge, were ≥18 years of age, and completed follow-up. Pregnant women, children <18 years of age, patients with intensive care unit admission, and patients who experienced venous and/or arterial thromboembolism prior to discharge were excluded. Extended thromboprophylaxis with either enoxaparin 4000 IU once daily or bemiparin 3500 IU once daily was prescribed if a patient had a modified IMPROVE VTE score of ≥4, or a modified IMPROVE score of ≥2 and a D-dimer level of ≥2 times the reference range. Patients were followed-up for 30 days after discharge. Primary endpoint was occurrence of radiologically confirmed symptomatic venous thromboembolism (deep vein thrombosis and/or pulmonary embolism). Results: A total of 3498 consecutive patients were hospitalized with a diagnosis of COVID-19. Of them, 38 (20 women) received extended thromboprophylaxis. Mean of age was 66.6±15.7 years. Twenty-five patients received enoxaparin, and 13 received bemiparin. Three patients in the enoxaparin group and none of the patients in the bemiparin group experienced post-discharge venous thromboembolism (p=0.681). Major bleeding occurred in one patient in the enoxaparin group, and in zero patients in the bemiparin group (p=0.456). Conclusion: Enoxaparin and bemiparin have similar prophylactic properties when used for prevention of post-discharge venous thromboembolism in COVID-19 survivors who have high thromboembolic and low bleeding risk. © 2022 Ubiquity Press. All rights reserved.

Efficiencies of Laboratory Parameters in Covid-19 Patients Follow up

Introduction: Diagnostic efficiencies of laboratory parameters used in COVID-19 patients and their association with disease severity were evaluated. Materials and Methods: Laboratory parameters of COVID-19 patients hospitalized in Dr. Lutfi Kirdar Kartal City Hospital between March and August 2020 were evaluated. The patients were grouped as non-severe and severe according to the interim guidance of the World Health Organization (WHO). The diagnostic performances of NLR, D-dieter, CRP, procalcitonin, IL-6, LDH, and ferritin in discrimination of severe cases were evaluated by Receiver operator's characteristics (ROC) analysis. Generalized lineer model Analysis (GLM) was performed with mortality as a dependent variable and age, gender, NLR, D-dimer, CRP, Procalcitonin, IL-6, LDH, and ferritin as an independent variables. Results: A total of 257 patients were evaluated and there was a significant difference between non-severe and severe cases in terms of NLR, D-dimer, CRP, Procalcitonin, IL-6, LDH, and Ferritin values. All the parameters showed comparable perfoluiances in discriminating severe disease;D-dimer with the least (AUC 73.5%), and NLR with the highest (AUC 80.7%) efficiency. Values above 4.5 for NLR, 930 ug/L for D-dimer, 64 mg/L for CRP, 0.136 ug/L for procalcitonin, 44.3 pg/mL for IL-6, 304 IU for LDH, and 312 ug/L for ferritin were associated with severe disease. Contribution of age, NLR, D-dimer, and CRP were found significant on the model. Conclusions: NLR, D-dimer, CRP, procalcitonin, IL-6, LDH, and ferritin showed comparable performances in discriminating severe cases with predefined cut-offs. Age, NLR, D-dimer, and CRP may be considered as predictors of mortality in COVID-19 patients.

Characteristics of the healthcare workers infected with the COVID-19 virus after receiving the first dose of coronavirus vaccine

Objective: Healthcare workers (HCWs) are at higher risk of COVID-19 infection. As in many countries, priority has been given to the vaccination of healthcare in Turkey. Our aim in the present study is to examine healthcare workers who contracted COVID-19 infection after receiving the first dose of the CoronaVac vaccine in our hospital.

The effectiveness of hydroxychloroquine versus vydroxychloroquine plus Lopinavir/ritonavir therapy in SARSCoV- 2 Pneumonia

Introduction: There is no specific antiviral treatment with proven efficacy and safety in the management of Coronavirus disease-2019 (COVID-19). We aimed to compare the effectiveness of hydroxychloroquine (HQ) monotherapy and HQ-lopinavir/ritonavir (Lpv/r) combined therapy in patients with laboratory-confirmed COVID-19 and to determine the independent factors predicting mortality. Materials and Methods: Retrospective observational multi-centered cohort study. Results: In total, 151 patients (mean age 61±17 years, 66% male) with COVID-19 pneumonia were included: 68 patients received combination therapy, i.e., Lpv/r in addition to HQ, and 83 patients received only HQ. The patients in both groups were similar regarding the majority of baseline variables except for white blood cell count, procalcitonin, lactate dehydrogenase levels, intensive care unit (ICU) admission rates, which were significantly higher, and decreased oxygen saturation in the combination group. The mean duration of symptoms and hospital stay were 5.6±2.3 days and 12.7±9.4 days, respectively. Nearly 43% (n=65) of patients were admitted to the ICU. Patients in the HQ monotherapy group had a shorter stay in hospital than those in the combination group (10 vs. 16 days, p<0.005). The primary end points were 14- and 28-day mortality. Neither treatment group revealed significant differences with respect to 14-day and 28-day survival before and after propensity score matching. Age, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, the Charlson Comorbidity Index (CCI), and ICU stay length were variable predictors of 14-day mortality, while CCI [Hazard ratio (HR) 95% confidence interval (CI): 0.85 (0.43-0.9)] and ICU stay length [HR (95% CI): 1.5 (1.39-1.76)] were the independent predictors of 28-day mortality. Conclusion: Combination therapy with Lpv/r and HQ did not provide any benefit compared with HQ monotherapy. Charlson Comorbidity Index and ICU stay were independent predictors of 28-day mortality.