COVID-19 Alcoholic Cirrhosis and Non-Alcoholic Steatohepatitis Cirrhosis Outcomes among Hospitalized Patients in the United States: Insight from National Inpatient Sample Database.

Patients with co-morbidities like cirrhosis are at risk of worse outcome from COVID-19 infection. Given limited prior studies, we evaluated outcomes associated with COVID-19 infection in alcoholic and non-alcoholic steatohepatitis cirrhotic (CC+) versus cirrhotic without COVID-19 (CC−). We performed retrospective analysis of 822,604 patients including 28,610 COVID-19 patients from the National Inpatient Sample database with alcoholic and NASH cirrhosis enrolled between 1 January 2020 to 31 December 2020, with univariate and multivariate regression analyses. Primary outcome was mortality and secondary outcomes was mechanical ventilation, vasopressor use, length of stay, hospitalization expense and predictors of mortality. In-hospital mortality was three time higher in the CC+ group compared to those in the CC− group(18.6% vs. 5.96%, p < 0.001, adjusted odds ratio (OR)3.39 (95% 3.08−3.74 CI). Hospitalization was more likely for underrepresented racial and ethnic groups with COVID-19 and cirrhosis. CC+ group had over twice the rates of mechanical ventilation (19.92% vs. 9.07%, adjusted OR 2.71 2.71 (95% 2.51−2.93 CI)),1.7 times likelihood of receiving vasopressors (4.12% vs. 2.45%, p < 0.001, adjusted OR 1.71 (95% CI 1.46−2.01). COVID-19 is associated with increased mortality in patients with alcoholic and NASH cirrhosis, and patients with alcoholic cirrhosis and COVID-19 have a slightly higher mortality compared to NASH cirrhosis.

Antibiotic Stewardship in Patients With Acute Bronchitis: A Case Report of Doxycycline-Induced Esophagitis.

Acute bronchitis is a self-limiting disease, characterized by mild constitutional symptoms and a cough lasting two to three weeks. The disease usually occurs secondary to viruses; therefore, only symptomatic and supportive care is advised for the patients. Despite the recommended guidelines, most patients are prescribed antibiotics. Here, we present a case of a 38-year-old female who presented to the hospital with a sudden onset of severe epigastric pain. The patient recently started a 10-day course of doxycycline for acute bronchitis. She was admitted, evaluated, and diagnosed with doxycycline-induced esophagitis, and managed accordingly. This report highlights how excessive use of antibiotics is leading to adverse effects, antibiotic resistance, increased health care costs, and invasive testing. It also emphasizes the importance of antibiotic stewardship.