Serum butyrylcholinesterase as a marker of COVID-19 mortality: Results of the monocentric prospective observational study.

The COVID-19 pandemic represents an excessive burden on health care systems worldwide and the number of patients who require special care in the clinical setting is often hard to predict. Consequently, there is an unmet need for a reliable biomarker that could predict clinical outcomes of high-risk patients. Lower serum butyrylcholinesterase (BChE) activity was recently linked with poor outcomes of COVID-19 patients. In line with this, our monocentric observational study on hospitalized COVID-19 patients focused on changes in serum BChE activity in relation to disease progression. Blood samples from 148 adult patients of both sexes were collected during their hospital stay at the Clinics of Infectiology and Clinics of Anesthesiology and Intensive Care, Trnava University Hospital in alignment with routine blood tests. Sera were analyzed using modified Ellman's method. Patient data with information about the health status, comorbidities and other blood parameters were collected in pseudonymized form. Our results show a lower serum BChE activity together with progressive decline of BChE activity in non-survivors, while higher stable values were present in discharged or transferred patients requiring further care. Lower BChE activity was associated with higher age and lower BMI. Moreover, we observed a negative correlation of serum BChE activity with the routinely used inflammatory markers, C-reactive protein and interleukin-6. Serum BChE activity mirrored clinical outcomes of COVID-19 patients and thus serves as a novel prognostic marker in high-risk patients.

Micafungin Is an Efficient Treatment of Multi Drug-Resistant Candida glabrata Urosepsis: A Case Report.

Candiduria is a common nosocomial infection in hospitalized patients, which may progress into life-threatening candidemia. Successful treatment of urosepsis requires early and effective antifungal therapy, while the available agents within three pharmacological classes each have characteristic pharmacokinetics and side effect profiles. Moreover, treatment of Candida spp. infections is becoming challenging due to increasing multi drug-resistance. Here, we present a case of candidemia resulting from a multi drug-resistant C. glabrata infection of the urinary tract. Due to resistance to fluconazole and a contraindication for amphotericin B, micafungin was used in the treatment, regardless of its unfavorable pharmacokinetic properties. Our study showed that despite the expected low levels in the urinary tract, micafungin was successful in the eradication of C. glabrata allowing full recovery of the patient. Thus, micafungin should be considered in the management of urosepsis caused by sensitive Candida spp.

Medication-related factors associated with proton pump inhibitor prescription beyond official guidelines in older adults.

PURPOSE: To investigate the relationship between medications with a known risk of gastrointestinal bleeding and proton pump inhibitor (PPI) prescription not according to guidelines. METHODS: An analysis of the records of 592 hospitalised patients aged 65 years or older was undertaken. The number of all medicines, potentially inappropriate medicines according to the EU(7)-PIM list and the Beers Criteria 2019 and medicines with a known risk of gastrointestinal bleeding, was compared in patients with PPI prescription not given based on guidelines and in patients with no PPI prescription. RESULTS: Patients prescribed PPI not based on guidelines used more medications on average (9.6 vs. 6.4, p < 0.001), more PIMs according to the EU(7)-PIM list (2.4 vs. 1.1, p < 0.001) and the Beers criteria (2.0 vs. 0.6, p < 0.001) at hospital admission and at discharge (8.9 vs. 7.5, p < 0.001, mean number of medications), (2.0 vs. 1.2, p < 0.001, EU(7)-PIM list), (1.9 vs. 0.8, p < 0.001, Beers criteria) than patients with no PPI prescription. Patients prescribed PPI not according to guidelines were more frequently using direct oral anticoagulants (28% vs. 12.8%, p < 0.001), corticosteroids (5.3% vs. 0.7%, p = 0.025) at hospital admission and at discharge (25.9% vs. 16.5%, p = 0.018, oral anticoagulants), (6.6% vs. 1%, p = 0.006, corticosteroids), (13.3% vs. 5.4%, p = 0.004, warfarin) than patients with no PPI prescription. CONCLUSION: The number of medications, potentially inappropriate medications according to the EU(7)-PIM list and Beers criteria, and the use of direct oral anticoagulants, warfarin and corticosteroid prescriptions were the medication-related factors associated with PPI prescription not according to guidelines in elderly patients.