Comparison of clinical characteristics and outcomes of hospitalized patients with seasonal coronavirus infection and COVID-19: a retrospective cohort study.

BACKGROUND: Unlike SARS-CoV and MERS-C0V, SARS-CoV-2 has the potential to become a recurrent seasonal infection; hence, it is essential to compare the clinical spectrum of COVID-19 to the existent endemic coronaviruses. We conducted a retrospective cohort study of hospitalized patients with seasonal coronavirus (sCoV) infection and COVID-19 to compare their clinical characteristics and outcomes. METHODS: A total of 190 patients hospitalized with any documented respiratory tract infection and a positive respiratory viral panel for sCoV from January 1, 2011, to March 31, 2020, were included. Those patients were compared with 190 hospitalized adult patients with molecularly confirmed symptomatic COVID-19 admitted from March 1, 2020, to May 25, 2020. RESULTS: Among 190 patients with sCoV infection, the Human Coronavirus-OC93 was the most common coronavirus with 47.4% of the cases. When comparing demographics and baseline characteristics, both groups were of similar age (sCoV: 74 years vs. COVID-19: 69 years) and presented similar proportions of two or more comorbidities (sCoV: 85.8% vs. COVID-19: 81.6%). More patients with COVID-19 presented with severe disease (78.4% vs. 67.9%), sepsis (36.3% vs. 20.5%), and developed ARDS (15.8% vs. 2.6%) compared to patients with sCoV infection. Patients with COVID-19 had an almost fourfold increased risk of in-hospital death than patients with sCoV infection (OR 3.86, CI 1.99-7.49; p < .001). CONCLUSION: Hospitalized patients with COVID-19 had similar demographics and baseline characteristics to hospitalized patients with sCoV infection; however, patients with COVID-19 presented with higher disease severity, had a higher case-fatality rate, and increased risk of death than patients with sCoV. Clinical findings alone may not help confirm or exclude the diagnosis of COVID-19 during high acute respiratory illness seasons. The respiratory multiplex panel by PCR that includes SARS-CoV-2 in conjunction with local epidemiological data may be a valuable tool to assist clinicians with management decisions.

A nationwide retrospective analysis of ventilator-associated pneumonia in the US.

Ventilator-associated pneumonia (VAP) is a major cause of healthcare-associated mortality and morbidity in critically ill patients who are mechanically ventilated. The purpose of this study was to describe the various primary discharge diagnoses of hospitalizations with VAP, to identify their demographic characteristics, and to identify risk factors for mortality in hospitalizations with VAP. Hospitalizations with a diagnosis of VAP with mechanical ventilation for over 24 hours were selected from the National Inpatient Sample in 2016 and 2017. In total, 33,140 hospitalizations with VAP were analyzed. The leading principal discharge diagnoses for hospitalizations leading to VAP were sepsis due to an unspecified organism (16.92%), respiratory failure (8.09%), and VAP (6.38%). Mortality among hospitalizations with VAP was 20.9%. Independent risk factors for mortality in hospitalizations with VAP were uninsured status (adjusted odds ratio [aOR] 2.13, 95% confidence interval [CI] 1.49-3.06, P < 0.001), acute renal failure (aOR 2.00, 95% CI 1.75-2.30, P < 0.001), and liver disease (aOR 1.82, 95% CI 1.52-2.18, P < 0.001). In conclusion, VAP is associated with significant mortality. Infective, traumatic, cardiovascular, and respiratory conditions accounted for over 85% of hospitalizations with VAP. Acute renal failure, the presence of liver disease, and lack of insurance are associated with higher mortality in hospitalizations with VAP.

An overlooked cause of septic shock: Staphylococcal Toxic Shock Syndrome secondary to an axillary abscess.

Staphylococcal Toxic Shock Syndrome (TSS) is characterized by rapid onset of fever, rash, hypotension, and multiorgan system involvement. Clinical manifestations of staphylococcal TSS include fever, chills, hypotension, and a diffuse macular erythroderma followed by desquamation one to two weeks later. The disease came to public attention in the 1980s with the occurrence of a series of menstrual-associated cases. However, the relative incidence of staphylococcal TSS not associated with menstruation has increased, and still, it remains an overlooked cause of septic shock. We present the case of a healthy 19-year-old male that presented with fever, chills, malaise, near-syncope, and a non-fluctuant, mobile nodule in the left armpit. The patient developed septic shock requiring critical care. He underwent extensive investigations resulting negative except for PCR for the detection of MRSA, raising the suspicion for STSS. For that reason, antibiotics for staphylococcal coverage were started, after which he started to improve. Ultimately, the mobile nodule evolved to fluctuant access. Incision and drainage was performed, and cultures confirmed the presence of Staphylococcus aureus.

Predicting COVID-19 Using Retrospective Data: Impact of Obesity on Outcomes of Adult Patients With Viral Pneumonia.

Background Community-acquired pneumonia due to viral pathogens is an under-recognized cause of healthcare-associated mortality and morbidity worldwide. We aimed to compare mortality rates and outcome measures of disease severity in obese vs non-obese patients admitted with viral pneumonia. Methods Adult patients admitted with viral pneumonia were selected from the Nationwide Inpatient Sample of 2016 and 2017. The arms were stratified based on the presence of a secondary discharge diagnosis of obesity. The primary outcome was inpatient mortality. Secondary outcomes included sepsis, acute respiratory failure, acute respiratory distress syndrome, acute kidney injury, and pulmonary embolism. Results and interpretation In total, 89,650 patients admitted with viral pneumonia were analyzed, and 17% had obesity. There was no significant difference in mortality between obese and non-obese patients (aOR: 0.98, 95% CI: 0.705 - 1.362, p < 0.001). Compared to non-obese patients, obese patients had higher adjusted odds of developing acute hypoxic respiratory failure (aOR: 1.37, 95% CI: 1.255 - 1.513, p < 0.001), acute respiratory distress syndrome (aOR: 2.29, 95% CI: 1.554 - 3.381, p < 0.001), need for mechanical ventilation (aOR: 1.50, 95% CI: 1.236 - 1.819, p < 0.001), and pulmonary embolism (aOR: 1.69, 95% CI: 1.024 - 2.788, p = 0.040). Conclusions Obesity was not found to be an independent predictor of inpatient mortality in patients admitted with viral pneumonia. However, obesity is associated with worse clinical outcomes and disease severity as defined by the presence of complications, greater incidence of acute respiratory failure (ARF), acute respiratory distress syndrome (ARDS), need for mechanical ventilation, acute kidney injury (AKI), pulmonary embolism (PE), stroke, and sepsis.

MMR Vaccine Adverse Drug Reactions Reports in the CDC WONDER System, 1989-2019.

Dissemination of misleading information regarding vaccine safety has contributed to the reduction in vaccination rates and the resurgence of diseases once considered eliminated. The CDC WONDER interface can be used to perform simple but powerful safety analyses and counter misinformation. The dissemination of false and misleading information regarding vaccine adverse reactions online has led to negative consequences, including raising parents' concerns about vaccine safety and fostering a growing opposition to the use of vaccines. However, health care workers can also use online resources to counter misinformation. The Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) is an online interface that allows health care workers to access the large-linked electronic health record database Vaccine Adverse Event Reporting System and perform near real-time vaccine safety analyses; hence it has the potential to become a powerful and accessible tool to provide information-driven decision-making regarding vaccine safety.

Impact of Protein Energy Malnutrition on Outcomes of Adults With Viral Pneumonia: A Nationwide Retrospective Analysis.

Background Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality. Viral organisms have been identified as the causal pathogen in approximately 20% of CAP. Nutritional status plays an important role in the response to pneumonia. This study aims to identify whether protein energy malnutrition (PEM) is an independent risk factor for mortality and morbidity in viral CAP. Materials and methods This was a retrospective cohort study involving adult hospitalizations for viral CAP in the United States using the Nationwide Inpatient Sample (NIS) database. This cohort was further divided based on the presence or absence of a secondary discharge diagnosis of PEM. The primary outcome was inpatient mortality. Secondary outcomes included the rate of mechanical ventilation among other complications. Results The in-hospital mortality for viral CAP was 2.22%. Patients with PEM had over two-fold high adjusted odds of inpatient mortality (aOR: 2.42, 95% CI: 1.746-3.351, p < 0.001) compared with patients without PEM. Patients with PEM had higher adjusted odds of having septic shock (aOR: 3.34, 95% CI: 2.158-5.160, p < 0.001). NSTEMI (aOR: 1.75, 95% CI: 1.163-2.621, p = 0.007), need for mechanical ventilation (aOR: 3.13, 95% CI: 2.448-4.006, p < 0.001), CVA (aOR: 3.49, 95% CI: 1.687-7.220, p = 0.001), DVT (aOR: 2.19, 95% CI: 1.453-3.295, p < 0.001), and PE (aOR: 2.24, 95% CI: 1.152-4.357, p = 0.017) relative to patients without PEM. Conclusion In conclusion, coexisting PEM is associated with a higher rate of in-hospital morbidity and mortality in patients with viral CAP. Early identification and treatment of nutritional deficiencies can lead to improved outcomes and reduced costs.

Racial Disparities in Outcomes of Adults Hospitalized for Viral Pneumonia.

Background Viral pneumonia is an important cause of respiratory morbidity and mortality. Cases of viral pneumonia are becoming increasingly more common as at-risk populations increase globally. We sought to highlight the racial distribution of hospitalized patients with viral pneumonia and compare their outcomes. Materials and methods Data were obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study involved adults who had a principal discharge diagnosis of viral pneumonia. The primary outcome analyzed was inpatient mortality. Secondary outcomes included the development of sepsis, septic shock, acute respiratory failure, acute respiratory distress syndrome, non-ST segment elevation myocardial infarction (NSTEMI), acute kidney failure, deep vein thrombosis, pulmonary embolism, cerebrovascular accident, need for mechanical ventilation, and use of vasopressors as well as mean length of hospitalization and mean total hospital charges. Results Blacks and Hispanics had lower inpatient mortality adjusted odds (aOR: 0.39, 95% CI = 0.229 - 0.662, p<0.001 and aOR: 0.55, 95% CI = 0.347 - 0.858, p=0.009, respectively) compared to Whites. Black and Hispanic patients were also found to have lower adjusted odds ratio of having acute respiratory failure (aOR: 0.54, 95% CI = 0.471 - 0.614, p<0.001, and 0.66, 95% CI = 0.576 - 0.753, p<0.001, respectively). Conclusion Black and Hispanic patients are at lower risk of adverse outcomes when compared to White patients with viral pneumonia.