Skin dysbiosis and loss of microbiome site specificity in critically ill patients.

An increasing amount of evidence has linked critical illness with dysbiotic microbiome signatures in different body sites. The disturbance of the indigenous microbiota structures has been further associated with disease severity and outcome and has been suggested to pose an additional risk for complications in intensive care units (ICUs), including hospital-acquired infections. A better understanding of the microbial dysbiosis in critical illness might thus help to develop strategies for the prevention of such complications. While most of the studies addressing microbiome changes in ICU patients have focused on the gut, the lung, or the oral cavity, little is known about the microbial communities on the skin of ICU patients. Since the skin is the outermost organ and the first immune barrier against pathogens, its microbiome might play an important role in the risk management for critically ill patients. This observational study characterizes the skin microbiome in ICU patients covering five different body sites at the time of admission. Our results show a profound dysbiosis on the skin of critically ill patients, which is characterized by a loss of site specificity and an overrepresentation of gut bacteria on all skin sites when compared to a healthy group. This study opens a new avenue for further investigations on the effect of skin dysbiosis in the ICU setting and points out the need of strategies for the management of dysbiosis in critically ill patients.IMPORTANCEUnbalanced gut microbiota in critically ill patients has been associated with poor outcome and complications during the intensive care unit (ICU) stay. Whether the disturbance of the microbial communities in these patients is extensive for other body sites, such as the skin, is largely unknown. The skin not only is the largest organ of the body but also serves as the first immune barrier against potential pathogens. This study characterized the skin microbiota on five different body sites in ICU patients at the time of admission. The observed disturbance of the bacterial communities might help to develop new strategies in the risk management of critically ill patients.

Symptoms, antibody levels and vaccination attitude after asymptomatic to moderate COVID-19 infection in 200 healthcare workers.

Aim: In Germany, the willingness to be vaccinated against COVID-19 is rather low among medical staff. We collected data on symptoms, antibody titers and vaccination readiness from clinic employees at a municipal clinic who had already been through a COVID-19 infection (asymptomatic to moderate). We also examined the antibody titers for their possible importance as an individual decision-making aid with regard to vaccination. Method: 200 employees of our municipal clinics were included in the study. COVID-19 antibody determination was performed using an ELISA (EUROIMMUN™, PerkinElmer, Inc. Company). The participants were given an anonymous questionnaire containing anthropometrical issues, symptoms of the infection and questions concerning the vaccination decision. Finally, the antibody levels were reported to the participants and the attitude towards a vaccination was reevaluated. Results: In all 200 participants who had already gone through a COVID-19 infection, 75 employees were in favor of a vaccination (37.5%), 96 were opposed to vaccination (48%), and 29 were undecided (14.5%). In the different occupational groups, the positive trend in terms of willingness to be vaccinated was highest among physicians and is least among nurses. The antibody results showed considerable variation in titer levels and therefore did not correlate with disease severity in asymptomatic to moderately ill persons. We also observed a pro-vaccination trend with increasing age of the participants. The specifically-asked symptom of cutaneous hyperesthesia during COVID-19 infection occurred in 5% of the participants. Conclusion: In medical personnel who had already suffered from a COVID-19 infection, the willingness to receive a vaccination tends to be highest among physicians, and lowest in nurses, and increases with age. For the vast majority of those affected, knowledge of the antibody titers only reinforces the vaccination decision made beforehand and thus does not contribute to a change in vaccination decision. The specifically-requested symptom of cutaneous hyperesthesia during COVID-19 infection was unexpectedly frequent.

Antibody titers and rapid antigen testing in elderly patients with SARS-CoV-2 pneumonia vs. staff of ICU and "Covid-19" wards.

Aim: The majority of patients hospitalized with COVID-19 are older individuals. Age and the comorbidities typically associated with it usually go hand in hand with a less favorable course of the disease. We were interested in the antibody response in this particular patient group as well as in the results of rapid antigen testing. Methods: In 30 elderly patients (>75 years), antibody titers (IgA and IgG) against COVID-19 were measured, and rapid antigen testing was determined about 3 weeks after the onset of symptoms of SARS-CoV-2 infection. The results were compared with those of a "high-risk" group consisting of "Covid-19" ward regular staff, as well as with "low-risk" staff consisting of members of the intensive care unit (ICU). The antibody titer against SARS-CoV-2 was determined by ELISA (EUROIMMUN™, PerkinElmer, Inc. Company); for rapid antigen testing, we used the SARS-CoV-2 Rapid Antigen test (Roche®). Results: Our investigations demonstrate a robust antibody response in the majority of elderly, comorbid patients about three weeks after the onset of infection. At this timepoint, most of the results of rapid antigen testing were negative. Furthermore, in the group of employees of our clinic ("Covid-19" ward vs. the ICU staff), the prevalence of antibodies was very low and antigen testing was negative in the whole ICU group. Conclusion: Although frequently comorbid, elderly patients are capable of significantly increasing antibodies against COVID-19 about 3 weeks after the onset of infection. Since the viral load can be assumed to have been low at that point, rapid antigen testing was negative in most cases. In the test group of employees of our clinic ("Covid-19" ward vs. the ICU staff), the data demonstrate that - given adequate protective measures - the risk of infection is not higher in a "Covid-19" ward compared to other wards.

Seroprevalence of COVID-19 antibodies in the cleaning and oncological staff of a municipal clinic.

Aim: To prevent shedding of the novel COVID-19 virus in hospitals, strict hygiene measures and surveillance of the staff and patients is mandatory. Studying the available literature, we assumed that monitoring of the cleaning staff may sometimes be a "blind spot" in surveillance. Although the cleaning personnel is not entrusted with the medical and nursing care of patients, the extent of patient contacts in this group may be comparable to medical personnel and even increase in times of a visit ban in many hospitals. The aim of this study was to investigate the prevalence of COVID-19 infections already undergone in this group. Methods: Antibody titers (IgA and IgG) against COVID-19 were measured in the cleaning staff from June 15th to 30th, 2020 in our clinic. Antibodies against COVID-19 were determined using ELISA (EUROIMMUN™, PerkinElmer, Inc. Company). For purposes of comparison, the same procedure was performed in the staff of the oncology ward, who were regarded as an important group due to their high-risk patients. Results: During the study period, 45 members of the cleaning staff and 20 members of the oncology ward were tested. Significantly elevated IgA antibody titers were detected in 1 person in the first group and in 1 person in the second group. Significantly elevated IgG antibody titers were not detected in the first group and in 1 person of the second group. In case of positive or indeterminate testing, swabs for direct virus detection were taken, but were negative in all cases. Conclusion: The prevalence of already undergone infections in both groups is low, as to be expected due to the still low incidence of COVID-19 infections in the German federal state of Thuringia. However, the presence of such antibodies in the cleaning personnel demonstrates the need for equally strict surveillance in this group.