ABSTRACT
BACKGROUND AND OBJECTIVES: Streptococcus pneumoniae urinary antigen (u-Ag) testing has recently gained attention in the early diagnosis of severe and critical acute respiratory syndrome coronavirus-2/pneumococcal co-infection. The aim of this study is to assess the effectiveness of Streptococcus pneumoniae u-Ag testing in coronavirus disease 2019 (COVID-19) patients, in order to assess whether pneumococcal co-infection is associated with different mortality rate and hospital stay in these patients. MATERIALS AND METHODS: Charts, protocols, mortality, and hospitalization data of a consecutive series of COVID-19 patients admitted to a tertiary hospital in northern Italy during COVID-19 outbreak were retrospectively reviewed. All patients underwent Streptococcus pneumoniae u-Ag testing to detect an underlying pneumococcal co-infection. Covid19+/u-Ag+ and Covid19+/u-Ag- patients were compared in terms of overall survival and length of hospital stay using chi-square test and survival analysis. RESULTS: Out of 575 patients with documented pneumonia, 13% screened positive for the u-Ag test. All u-Ag+ patients underwent treatment with Ceftriaxone and Azithromycin or Levofloxacin. Lopinavir/Ritonavir or Darunavir/Cobicistat were added in 44 patients, and hydroxychloroquine and low-molecular-weight heparin (LMWH) in 47 and 33 patients, respectively. All u-Ag+ patients were hospitalized. Mortality was 15.4% and 25.9% in u-Ag+ and u-Ag- patients, respectively (p = 0.09). Survival analysis showed a better prognosis, albeit not significant, in u-Ag+ patients. Median hospital stay did not differ among groups (10 vs. 9 days, p = 0.71). CONCLUSIONS: The routine use of Streptococcus pneumoniae u-Ag testing helped to better target antibiotic therapy with a final trend of reduction in mortality of u-Ag+ COVID-19 patients having a concomitant pneumococcal infection. Randomized trials on larger cohorts are necessary in order to draw definitive conclusion.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , Coinfection/diagnosis , Coronavirus Infections/drug therapy , Hospital Mortality , Pneumonia, Pneumococcal/drug therapy , Pneumonia, Viral/drug therapy , Adult , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Antigens, Bacterial/urine , Azithromycin/therapeutic use , Betacoronavirus , COVID-19 , Ceftriaxone/therapeutic use , Cobicistat/therapeutic use , Coinfection/urine , Coronavirus Infections/complications , Cross-Sectional Studies , Darunavir/therapeutic use , Drug Combinations , Female , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Length of Stay/statistics & numerical data , Levofloxacin/therapeutic use , Lopinavir/therapeutic use , Male , Mass Screening , Middle Aged , Pandemics , Pneumonia, Pneumococcal/complications , Pneumonia, Pneumococcal/diagnosis , Pneumonia, Pneumococcal/urine , Pneumonia, Viral/complications , Retrospective Studies , Ritonavir/therapeutic use , SARS-CoV-2 , Streptococcus pneumoniae/immunology , COVID-19 Drug TreatmentABSTRACT
Dimethyl fumarate (DMF) is a chemical compound which has been added to silica gel bags used for preserving leather products during shipment. DMF has recently been singled out due to its ability to induce a number of medical problems in people which touch products contaminated by it. Its use as a biocide has been recently made illegal in Europe. Two different extraction techniques, namely ultrasound-assisted extraction (UAE) and solid-phase microextraction (SPME), both coupled with gas chromatography/mass spectrometry were applied to the quantitative determination of DMF in silica gel. Linearity of the methods, reproducibility and detection limits were determined. The two methods were applied to the quantification of DMF in thirty-four silica gel samples used as anti-mould agents in different leather products sold in Italy, and the obtained results were statistically compared.
