Healthcare-associated infections in COVID-19 ICU patients - two-centre study.

OBJECTIVE: The aim of this retrospective study was to estimate the prevalence of healthcare-associated infections (HAI), microbiological data including resistance patterns and impact of HAI on patients' survival. METHODS: Two-centre study on 172 patients was performed. Medical records of patients hospitalized in the two COVID-19 intensive care units (ICU) localized in Bydgoszcz between 1 October 2020 and 30 March 2021 were analysed retrospectively. Data collection included demographics, microbiological, clinical variables, and patient outcome. All infections were defined according to the HAI-Net ICU protocol of the European Centre for Disease Prevention and Control (ECDC). Detailed data concerning bloodstream infection (BSI), pneumonia (PN) and urinary tract infection (UTI) were collected. RESULTS: In 97 patients (56.4%), 138 HAI cases were identified. Patients with HAI statistically more often had been administered antimicrobial therapy prior to the admission to ICU (59.8% vs. 34.7%, p < 0.05), and needed catecholamines during hospitalization (93.8% vs. 70.7%, p < 0.001). The risk of HAI increased by 50% if antimicrobial therapy had been applied before the admission to ICU, and was three times higher if during the hospitalization in ICU catecholamines infusion was needed. Mortality was higher in patients diagnosed with HAI (72.2% vs. 65.3%) but the difference was not statistically significant (p = 0.34). CONCLUSIONS: Further investigation of co-infections in critically ill patients with COVID-19 is required in order to identify HAI risk factors, define the role of empiric antimicrobial therapy and proper prevention strategies.

Analysis of the role of selected demographic and psychological variables (anxiety and depression) as risk factors of inadequate control of bronchial asthma.

OBJECTIVE: The aim of the study was to analyze selected potential demographic and psychological variables (anxiety and depression) as risk factors of inadequate control of bronchial asthma. MATERIALS AND METHOD: The study consisted a group of 223 randomly selected asthma patients with varying degrees of asthma control. The study was designed as a diagnostic survey using the asthma control test (ACT), Beck's Depression Inventory (BDI), State- and Trait-Anxiety Inventory (STAI questionnaires X-1 and X-2), and the questionnaire for demographic data collection developed for the purposes of the presented study. RESULTS: Inadequate control of asthma was significantly more frequent amongst females (p=0.008) who were rural inhabitants (p=0.020) and professionally active (p=0.000) patients diagnosed with any grade of depression with an aid of BDI (p=0.000). Patients with inadequate control of asthma were characterized by a significantly higher level of depression, compared to patients controlling this condition adequately (p=0.001). CONCLUSIONS: The female gender, living in a rural environment, professional activity, and even a slight degree of depression can promote inadequate control of asthma. Consequently, asthma patients with such characteristics should be provided with careful allergological surveillance. Since none of the abovementioned variables represents an independent risk factor of inadequate asthma control, it is not possible to classify asthma patients into risk groups on the basis of single parameter assessment. The risk of inadequate asthma control involves also individuals with a low severity of depression (more than 9 points on BDI), i.e. the patients who would not be diagnosed with even mild depression based on the existing criteria.

Analysis of the relation between level of asthma control and depression and anxiety.

BACKGROUND: Frequent co-existence of bronchial asthma and depression or anxiety is an unquestioned phenomenon. In contrast, little is known about the relationship between the degree of asthma control and the prevalence of depression and anxiety. The aim of this study was to determine the potential relationship between the degree of asthma control and the prevalence of depression and anxiety. MATERIAL/METHODS: This study included a group of 128 randomly selected asthmatic individuals with various degree of asthma control. The study was based on a questionnaire survey, using the following tools: the Asthma Control Test, Beck Depression Inventory, and State-Trait Anxiety Inventory (STAI) - X-1 and X-2 questionnaires. All the questionnaires were completed during a single follow-up visit at the clinic. RESULTS: The occurrence of depression and its severity significantly correlated with the degree of asthma control. Individuals with depression were characterized by a significantly lower degree of asthma control compared to depression-free individuals (p<0.001). The degree of asthma control decreased significantly with increasing severity of depression (R=-0.367; p<0.001). No significant correlation was observed between the degree of asthma control and the levels of trait anxiety (R=-0.095; p=0.295) and state anxiety (R=-0.093; p=0.308). CONCLUSIONS: The prevalence of depression and its severity significantly correlate with the degree of asthma control. Large, standardized multicenter studies of the relationship between the degree of asthma control and the prevalence of depression and other psychopathological symptoms are needed. Furthermore, it seems reasonable to introduce the screening of asthmatics for mental disorders.

Long-term dilatation of polyester and expanded polytetrafluoroethylene tube grafts after open repair of infrarenal abdominal aortic aneurysms.

OBJECTIVES: Since 1995, expanded polytetrafluoroethylene (ePTFE) grafts have been implemented in open surgical repair (OSR) of abdominal aortic aneurysms (AAA) and are supposed to show less dilatation than polyester grafts. This study examined differences in graft dilatation and clinical outcome. METHODS: This single-center long-term, prospective randomized study monitored 99 consecutive patients after OSR of AAA. Implanted were 90 tube ePTFE Gore-Tex Stretch grafts, 56 tube Dacron grafts (Uni-Graft KDV, polyester, B. Braun, knitted), and 51 tube Dacron grafts (Gelseal Plus, polyester, Vascutek, triaxial knitted). Follow-up with ultrasound examination was performed at discharge, at 12 months, and at 6 years. RESULTS: Patients were a mean age of 67 years. Thirty-day mortality was 2.5% (n = 5 of 199), without significant differences among the groups. The Kaplan-Meier analysis showed 5-year survivals of 0.82 (ePTFE/Gore), 0.81 (polyester/Braun), and 0.83 (polyester/Vascutek). Mean ± standard deviation dilatation of the midgraft segment was 1% ± 5% (ePTFE/Gore), 10% ± 9% (polyester/Braun), and 7% ± 8% (polyester/Vascutek) (P ≤ .001) at discharge; 8% ± 11% (ePTFE/Gore), 24% ± 7% (polyester/Braun), and 20% ± 13% (polyester/Vascutek; P ≤ .001) after 12 months; and 19% ± 21% (ePTFE/Gore), 33% ± 22% (polyester/Braun), and 23% ± 19% (polyester/Vascutek; (P ≤ .001) after 6 years. No graft failure or rupture occurred. Graft patency was 100%. CONCLUSIONS: After a mean implantation of 6 years, the ePTFE/Gore, polyester/Braun, and polyester/Vascutek tube grafts presented with significant differences. The ePTFE grafts showed a stronger resistance against dilatation than the two types of polyester grafts. Owing to similar perioperative and postoperative courses, no advantage could be identified in any group concerning the overall outcome. Vascular implants for OSR of AAA made of ePTFE and polyester are safe, even after a long implantation time. Therefore, the choice of the suitable graft does not depend on its postimplantation dilative characteristics. The outcome is not likely to be connected with dilatation of the implanted graft, because a causal connection between graft dilatation and death cannot be made. The study does not offer a basis for the preference of one of the three graft types. Nevertheless, continuous ultrasound examinations should be performed after implantation of an aortic tube graft to identify possible problems arising from changes in the graft and the residual vascular branches over time.