ABSTRACT
Objetivos. Evaluar la frecuencia de coinfección bacteriana al ingreso en UCI en pacientes con neumonía por SARS-CoV-2, su microbiología e impacto en el pronóstico. El objetivo secun dario fue identificar factores de riesgo de coinfección al ingreso. Métodos. Estudio retrospectivo, se incluyeron pacientes con neumonía por SARS-CoV-2 ingresados en UCI. Definimos coinfección bacteriana por síntomas respiratorios, datos radioló gicos, resultados microbiológicos positivos y clínicamente signi ficativos en muestras obtenidas en las primeras 48 h de ingreso y/o una determinación de procalcitonina ≥ 0,5 ng/mL en las pri meras 48 h. Evaluamos variables demográficas, comorbilidades, datos de la infección por SARS-CoV-2, scores de gravedad, tra tamientos recibidos, necesidad de soporte respiratorio y resulta dos (estancia y mortalidad durante el ingreso en UCI y hospital). Resultados. Se analizaron 182 pacientes, 62 (34.1%) con coinfección bacteriana. La microbiología más frecuente fue S. pneumoniae y M. pneumoniae. El 96.1% de los pacientes re cibieron antibioterapia al ingreso, 98,9% corticoides, 27,5% tocilizumab y 7,7% remdesivir. El 85.7% necesitó ventilación mecánica invasiva. La puntuación en SOFA (OR: 1,315, IC 95% 1,116-1,548) y el retraso en el ingreso en UCI (OR: 0,899, IC 95% 0,831-0,972) se relacionaron con el riesgo de coinfección. La coinfección bacteriana aumenta el riesgo de muerte en el hospital (OR 2,283; IC 95% 1,011-5,151; p=0,047). Conclusiones. La coinfección bacteriana es frecuente en pacientes COVID ingresados en UCI y aumenta el riesgo de muerte. No es posible identificar con seguridad, en el momen to de ingreso, qué pacientes no se benefician de tratamiento antibiótico (AU)
ion upon ICU admission in SARS-CoV-2 pneumonia patients, its microbiology, and impact on prognosis.The secondary ob jective was to identify risk factors for coinfection on admis sion. Methods. Retrospective study, including patients with SARS-CoV-2 pneumonia admitted to the ICU.We defined bac terial coinfection by respiratory symptoms, radiological data, positive and clinically significant microbiological results in samples obtained in the first 48 h of admission and/or a de termination of procalcitonin ≥ 0.5 ng/mL in the first 48 h.We evaluated demographic variables, comorbidities, SARS-CoV-2 infection data, severity scores, treatments received, need for respiratory support and outcomes (ICU and hospital mortality). Results. A total of 182 patients were analyzed, 62 (34.1%) with bacterial coinfection.The most frequent microbiology was S. pneumoniae and M. pneumoniae.96.1% of the patients re ceived antibiotic therapy on admission, 98.9% corticosteroids, 27.5% tocilizumab, and 7.7% remdesivir.85.7% required inva sive mechanical ventilation.The SOFA score (OR: 1.315, 95% CI 1.116-1.548) and the delay in ICU admission (OR: 0.899, 95% CI 0.831-0.972) were related to the risk of coinfection.Bacterial coinfection increases the risk of death in hospital (OR 2.283; 95% CI 1.011.5.151; p=0.047). Conclusions. Bacterial coinfection is common in COVID patients admitted to the ICU and increases the risk of death.It is not possible to identify with certainty, at the time of admis sion, which patients do not benefit from antibiotic treatment (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Bacterial Infections/complications , Bacterial Infections/epidemiology , /complications , /epidemiology , Coinfection , Retrospective Studies , IncidenceABSTRACT
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Understanding the physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies. AIM: To describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of hyperinflammation and abnormal immune responses to disease progression together with a complete narrative review of the different immunoadjuvant treatments used so far in COVID-19 and their indication in severe and life-threatening subsets. METHODS: A comprehensive literature search was developed. Authors reviewed the selected manuscripts following the PRISMA recommendations for systematic review and meta-analysis documents and selected the most appropriate. Finally, a recommendation of the use of each treatment was established based on the level of evidence of the articles and documents reviewed. This recommendation was made based on the consensus of all the authors. RESULTS: A brief rationale on the SARS-CoV-2 pathogenesis, immune response, and inflammation was developed. The usefulness of 10 different families of treatments related to inflammation and immunopathogenesis of COVID-19 was reviewed and discussed. Finally, based on the level of scientific evidence, a recommendation was established for each of them. CONCLUSION: Although several promising therapies exist, only the use of corticosteroids and tocilizumab (or sarilumab in absence of this) have demonstrated evidence enough to recommend its use in critically ill patients with COVID-19. Endotypes including both, clinical and biological characteristics can constitute specific targets for better select certain therapies based on an individualized approach to treatment.
ABSTRACT
This article explores the ability of locational variables and spillover to influence Airbnb listing performance in Milan. The effects of different determinants are analyzed for the periods before and during the pandemic. The sample includes 7213 listings, is based on AirDNA data, and developed using two regression models. The findings confirm the hypotheses proposed. The revenue estimated for a standard apartment in 2020 was approximately double that estimated for 2021. The results showed some substantial changes during the pandemic, which considerably reduced the ability of well-known variables (such as size) to explain the listing performance variance. The role of host characteristics (superhost badge) increased during the pandemic, while some contractual terms were significantly changed, and the spatial spillover almost doubled.
ABSTRACT
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is very common in mucopolysaccharidosis I (MPS I). Hematopoietic stem cell transplantation (HSCT) is the preferred treatment for patients with severe MPS I diagnosed early in life. The protective effect of HSCT on the development of long term OSAS is not known. METHODS: Overnight polysomnography (PSG) and biomarker data were analyzed during the annual follow-up in consecutive MPS I patients treated with HSCT. RESULTS: The data of 13 patients (6 boys) were analyzed. Median age at HSCT was 17 (range 14-19) months, median age at PSG was 9.0 (4.5-14.5) years, and median time elapsed since HSCT was 7.6 (2.4-13.2) years. A significant correlation was observed between time elapsed since HSCT and the apnea-hypopnea index (AHI, r(2)=0.493, p=+0.003) and the oxygen desaturation index (r(2)=0.424, p=+0.02). Patients older than 10 years of age had a higher mean AHI (25.8/h vs 1.4/h, p=0.0008), a lower mean pulse oximetry (94.7% vs 97.2%, p=0.01) and a higher mean hypopnea index (18.8 vs 0.71/h, p=0.016) as compared to those younger than 10 years of age. No correlation was observed between the AHI and the metabolic clearance, assessed by urine glycosaminoglycan (GAG) excretion and residual enzyme activity, although there was a positive trend for the urinary GAG/higher normal value for age ratio (p=0.09). CONCLUSION: HSCT does not offer long term protection against OSAS in MPS I with OSAS being documented in all patients after a time elapse since HSCT exceeding 10 years. The potential benefit of additional enzyme replacement therapy needs to be assessed.
