ABSTRACT
Pulmonary artery pseudoaneurysm is a differential diagnosis to be considered in COVID-19 patients presenting with or developing haemoptysis in order to facilitate early recognition as delayed management could be catastrophic https://bit.ly/3rQTrDT.
ABSTRACT
COVID-19-associated pulmonary aspergillosis (CAPA) is a recently recognized entity associated with the COVID-19 pandemic and known post-viral pneumonia complications. More data are awaited and there has been a recent consensus criteria published hoping to generate more research and registries to inform clinical decision-making. Nevertheless, it is clear that CAPA imposes a worsening disease course of COVID-19 pneumonia with added morbidity and mortality. We present two cases with differing outcomes managed within the limitations of our institute and make reference to the recent consensus criteria. We hope to highlight the importance of considering empirical treatment in the correct clinical context while awaiting the results of microbiological workup as ascertaining the diagnosis of proven CAPA is challenging in the real-world setting.
ABSTRACT
BACKGROUND: During the early phase of the COVID-19 pandemic, antibiotic usage among COVID-19 patients was noted to be high in many countries. The objective of this study was to determine the prevalence of antibiotic usage and factors affecting antibiotic usage among COVID-19 patients during the early phase of the COVID-19 pandemic in Malaysia. METHODS: This was a cross-sectional study that involved reviewing medical records of COVID-19 Malaysian patients aged 12 and above who were diagnosed with COVID-19 and received treatment in 18 COVID-19 hospitals from February to April 2020. A minimum sample of 375 patients was required. A binary logistic regression analysis was performed to determine factors associated with antibiotic usage. Variables with p < 0.05 were considered statistically significant. RESULTS: A total of 4043 cases were included for analysis. The majority of the patients (87.6%) were non-smokers, male (65.0%), and had at least one comorbidity (37.0%). The median age was 35 years (IQR: 38). The prevalence of antibiotic usage was 17.1%, with 5.5% of them being prescribed with two or more types of antibiotics. The most frequent antibiotics prescribed were amoxicillin/clavulanic acid (37.8%), ceftriaxone (12.3%), piperacillin/tazobactam (13.3%), azithromycin (8.3%), and meropenem (7.0%). Male patients (adjusted OR 1.53), who had a comorbidity (adjusted OR 1.36), associated with more severe stage of COVID-19 (adjusted OR 6.50-37.06), out-of-normal range inflammatory blood parameters for neutrophils, lymphocytes, and C-reactive protein (adjusted OR 2.04-3.93), corticosteroid use (adjusted OR 3.05), and ICU/HDU admission (adjusted OR 2.73) had higher odds of antibiotic use. CONCLUSIONS: The prevalence of antibiotic usage in the early phase of the COVID-19 pandemic was low, with amoxicillin/clavulanic acid as the most common antibiotic of choice. The study showed that clinicians rationalized antibiotic usage based on clinical assessment, supported by relevant laboratory parameters.
