ABSTRACT
BACKGROUND: Debate continues regarding the usefulness and benefits of wide prescription of antibiotics in patients hospitalized with coronavirus disease 2019 (COVID-19). METHODS: All patients hospitalized in the Infectious Diseases Department, Dijon University Hospital, Dijon, France between 27 February and 30 April 2020 with confirmed COVID-19 were included in this study. Clinical, biological and radiological data were collected, as well as treatment and outcome data. An unfavourable outcome was defined as death or transfer to the intensive care unit. Patient characteristics and outcomes were compared between patients who did and did not receive antibiotic therapy using propensity score matching. FINDINGS: Among the 222 patients included, 174 (78%) received antibiotic therapy. The univariate analysis showed that patients who received antibiotic therapy were significantly older, frailer and had more severe presentation at admission compared with patients who did not receive antibiotic therapy. Unfavourable outcomes were more common in patients who received antibiotic therapy [hazard ratio (HR) 2.94, 95% confidence interval (CI) 1.07-8.11; P = 0.04]. Multi-variate analysis and propensity score matching indicated that antibiotic therapy was not significantly associated with outcome (HR 1.612, 95% CI 0.562-4.629; P = 0.37). CONCLUSION: Antibiotics were frequently prescribed in this study and this was associated with more severe presentation at admission. However, antibiotic therapy was not associated with outcome, even after adjustment. In line with recent publications, such data support the need to streamline antibiotic therapy in patients with COVID-19.
Subject(s)
Anti-Bacterial Agents/therapeutic use , COVID-19 Drug Treatment , SARS-CoV-2 , Aged , Aged, 80 and over , Female , France/epidemiology , Hospitalization , Hospitals, University , Humans , Male , Middle Aged , Prognosis , Propensity ScoreABSTRACT
INTRODUCTION: Carbapenems are broad-spectrum antibacterial molecules. Imipenem-cilastatin and meropenem are the two main molecules used in French healthcare services. OBJECTIVE: We aimed to evaluate the relative strengths and weaknesses of these two molecules by considering their pharmacokinetic, pharmacodynamic, microbiological, and clinical properties. We demonstrated that imipenem-cilastatin and meropenem are not alike. METHOD: Review of the literature by querying the MEDLINE network. RESULTS: Imipenem-cilastatin is the first marketed molecule of the carbapenem class. It is more effective against Gram-positive cocci. Its stability does not allow for long infusions and its main adverse effect on the central nervous system limits its use. Meropenem is more effective against Gram-negative bacilli. Its stability and its milder adverse effects distinguish it from imipenem-cilastatin. CONCLUSION: Meropenem is preferred for daily use in healthcare services when carbapenems are to be used.
Subject(s)
Anti-Bacterial Agents/pharmacology , Cilastatin, Imipenem Drug Combination/pharmacology , Meropenem/pharmacology , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/pharmacokinetics , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Biotransformation , Child , Child, Preschool , Cilastatin, Imipenem Drug Combination/adverse effects , Cilastatin, Imipenem Drug Combination/pharmacokinetics , Cilastatin, Imipenem Drug Combination/therapeutic use , Contraindications, Drug , Drug Resistance, Microbial , Drug Resistance, Multiple, Bacterial , Drug Stability , Female , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Humans , Infant , Liver Failure/metabolism , Meropenem/adverse effects , Meropenem/pharmacokinetics , Meropenem/therapeutic use , Molecular Structure , Organ Specificity , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Protein BindingSubject(s)
Adrenal Cortex Hormones/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Community-Acquired Infections/drug therapy , Pneumonia/complications , Pneumonia/drug therapy , Respiratory Distress Syndrome/prevention & control , Adrenal Cortex Hormones/adverse effects , Anti-Inflammatory Agents/adverse effects , Humans , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
BACKGROUND: The Hajj is the largest annual mass gathering event in the world, thus favoring the transmission of various infections: 183 different nationalities, high temperatures, coincidence with the start of the flu season in the Northern hemisphere, a long barefoot walk, tent-type accommodation, communal toilet facilities, absence of food control, and sharing of razors. Infections are the first cause of hospital admission, which often occurs in the home country of pilgrims. METHODS: Literature review on PubMed from 1952 to November 2015 on the epidemiology and prevention of infections contracted during the Hajj, using the keywords "Hajj" and "infections". RESULTS: Respiratory tract infections, ENT infections, influenza, pyogenic pneumonia, whooping cough, and tuberculosis are most frequently observed during the Hajj. Outbreaks of meningococcal meningitis have been reported in pilgrims and their contacts. Waterborne infections such as gastroenteritis and hepatitis A are common, despite the improvement of health conditions. Pyoderma and furuncles are also frequently observed. Recently, dengue fever, Alkhumra hemorrhagic fever, and Rift Valley fever have emerged but no case of MERS-coronavirus, appeared in Saudi Arabia in 2012, have yet been observed during the 2012-2014 Hajj. CONCLUSION: Prevention is based on compulsory meningococcal vaccination, vaccination against seasonal influenza and pneumococcal infections for pilgrims at high risk of contracting the infection, and on vaccination against hepatitis A. Updating immunization for diphtheria/tetanus/poliomyelitis/pertussis and measles/mumps is also crucial and pilgrims must comply with hygiene precautions.
Subject(s)
Community-Acquired Infections/epidemiology , Islam , Travel-Related Illness , Community-Acquired Infections/etiology , Community-Acquired Infections/prevention & control , France , Guidelines as Topic , Hospitalization/statistics & numerical data , Humans , Hygiene , Infection Control , Meteorological Concepts , Noncommunicable Diseases/mortality , Retrospective Studies , Saudi Arabia , Social Conditions , VaccinationABSTRACT
PIP: 11 patients and 14 staff members including 4 nurses were interviewed in a study of guilt felt by abortion patients and the role of nurses in its management. All patients experienced guilt feelings that were expressed in psychological, physical, or relational symptoms. 65% of the staff members believed that guilt is a normal reaction to the experience of abortion. Guilt may arise from personal factors or the abortion procedure itself, or it may be provoked by such elements of the social system as the education of young girls and religious culture. The attitude of health personnel is of utmost importance. Staff should not judge or influence their abortion patients. 93% of the staff interviewed believed that patients should be aided in managing their guilt feelings.^ieng
