Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

Introduction: Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. Methods: Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. Results: The median [p25–p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions. Conclusion: Age and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities. (AU)

Linezolid more efficacious than vancomycin to eradicate infecting organism in critically ill patients with Gram-positive infections

Objetivo: Se realizó un estudio prospectivo y observacionalcon el objetivo de analizar la eficacia de linezolid comparadocon vancomicina para erradicar los organismos infectantesen los pacientes críticos con infecciones por grampositivos.Pacientes y Métodos: Estudio prospectivo, observacional yno controlado en una unidad de cuidados intensivos (UCI) deun hospital universitario. Se estudiaron un total de 53 pacientescríticos con tratamiento para una infección bacteriana probaday producida por grampositivos. Los pacientes infectadosfueron diagnosticados y tratados siguiendo las guías internacionalesy los protocolos estándares locales establecidos paralas infecciones de los pacientes críticos. Se analizó la erradicaciónmicrobiológica del organismo infectante al séptimo día detratamiento y la evolución clínica.Resultados: Veintisiete pacientes recibieron tratamientocon linezolid y veintiséis recibieron vancomicina. Los focos infecciososfueron: neumonía adquirida en el hospital (21 casos:39.6 %), infección quirúrgica complicada (19 casos: 35.8 %) ybacteriemia relacionada con el catéter (13 casos: 24.5 %). Elmicroorganismo más frecuentemente aislado fue Staphylococcusaureus (SARM) (28 casos: 52.8 %). El éxito clínico seobtuvo en 20/27 pacientes (74.1 %) en el grupo de linezolid y en 16/26 pacientes (61.5 %) en el grupo de vancomicina, conuna p = 0.3. El modelo de regresión logística mostró que el tratamientocon linezolid se asoció de forma significativa a unaerradicación microbiológica del organismo infectante al séptimodía de tratamiento [OR = 7.88 (95 % CI 1.86-33.52)], p =0.005. En este modelo, la estancia en el hospital fue más bajaen el grupo de pacientes con erradicación microbiológica alséptimo día, (p = 0.015). Los efectos adversos observados fueronsimilares en ambos grupos de tratamiento...(AU)

Objetive: A prospective and observational study hasbeen conducted to analyze the efficacious of linezolidcompared to vancomycin to eradicate the infecting organismin critically ill patients with Gram-positive infections.Patients and Methods: Prospective, observationaland non-controlled study in a medical-surgical intensivecare unit (ICU) in a university hospital. A total numberof 53 critically ill patients with therapy to proven Grampositivebacterial infection were studied. Infected patientswere diagnosed and treated according to internationalguidelines, following standard protocol for thecritically ill infected patients. Microbiologic eradicationof the infecting organism at the seventh day of treatmentand patients’ clinical outcome were analysed.Results: Twenty-seventh patients received linezolidand twenty-six received vancomycin. Infection-site diagnoseswere: hospital-acquired pneumonia (21 cases:39.6%), complicated surgical-site infection (19 cases:35.8%) and catheter-related bacteraemia (13 cases: 24.5%).The most important isolated microorganism was methicillin-resistant Staphylococcus aureus (MRSA) (28 cases:52.8%). Clinical success was 20/27 (74.1%) in the linezolidgroup and 16/26 (61.5 %) in the vancomycin group, with p= 0.3. The adjusted logistic regression model demonstratedthat the treatment with linezolid is associated to microbiologiceradication of the infecting organism at the seventhday of treatment [OR = 7.88 (95% CI 1.86-33.52)] and p =0.005. In this model, the length of hospital stay was lowerin the group with microbiologic eradication at the seventhday (p = 0.015). Drug-related adverse events were comparablein both groups of treatment...(AU)