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Lubkin A, Bernard-Raichon L, DuMont AL, Valero Jimenez AM, Putzel GG, Gago J, Zwack EE, Olusanya O, Boguslawski KM, Dallari S, Dyzenhaus S, Herrmann C, Ilmain JK, Isom GL, Pawline M, Perault AI, Perelman S, Sause WE, Shahi I, St. John A, Tierce R, Zheng X, Zhou C, Noval MG, O'Keeffe A, Podkowik M, Gonzales S, Inglima K, Desvignes L, Hochman SE, Stapleford KA, Thorpe LE, Pironti A, Shopsin B, Cadwell K, Dittmann M, Torres VJ. SARS-CoV-2 infection predisposes patients to coinfection with Staphylococcus aureus. mBio 2024; 15:e0166724. [PMID: 39037272 PMCID: PMC11323729 DOI: 10.1128/mbio.01667-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024] Open
Abstract
Severe COVID-19 has been associated with coinfections with bacterial and fungal pathogens. Notably, patients with COVID-19 who develop Staphylococcus aureus bacteremia exhibit higher rates of mortality than those infected with either pathogen alone. To understand this clinical scenario, we collected and examined S. aureus blood and respiratory isolates from a hospital in New York City during the early phase of the pandemic from both SARS-CoV-2+ and SARS-CoV-2- patients. Whole genome sequencing of these S. aureus isolates revealed broad phylogenetic diversity in both patient groups, suggesting that SARS-CoV-2 coinfection was not associated with a particular S. aureus lineage. Phenotypic characterization of the contemporary collection of S. aureus isolates from SARS-CoV-2+ and SARS-CoV-2- patients revealed no notable differences in several virulence traits examined. However, we noted a trend toward overrepresentation of S. aureus bloodstream strains with low cytotoxicity in the SARS-CoV-2+ group. We observed that patients coinfected with SARS-CoV-2 and S. aureus were more likely to die during the acute phase of infection when the coinfecting S. aureus strain exhibited high or low cytotoxicity. To further investigate the relationship between SARS-CoV-2 and S. aureus infections, we developed a murine coinfection model. These studies revealed that infection with SARS-CoV-2 renders mice susceptible to subsequent superinfection with low cytotoxicity S. aureus. Thus, SARS-CoV-2 infection sensitizes the host to coinfections, including S. aureus isolates with low intrinsic virulence. IMPORTANCE The COVID-19 pandemic has had an enormous impact on healthcare across the globe. Patients who were severely infected with SARS-CoV-2, the virus causing COVID-19, sometimes became infected with other pathogens, which is termed coinfection. If the coinfecting pathogen is the bacterium Staphylococcus aureus, there is an increased risk of patient death. We collected S. aureus strains that coinfected patients with SARS-CoV-2 to study the disease outcome caused by the interaction of these two important pathogens. We found that both in patients and in mice, coinfection with an S. aureus strain lacking toxicity resulted in more severe disease during the early phase of infection, compared with infection with either pathogen alone. Thus, SARS-CoV-2 infection can directly increase the severity of S. aureus infection.
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Affiliation(s)
- Ashira Lubkin
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Lucie Bernard-Raichon
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ashley L. DuMont
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Ana Mayela Valero Jimenez
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Gregory G. Putzel
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Antimicrobial-Resistant Pathogens Program, Microbial Genomics Core Lab, New York University Langone Health, New York, New York, USA
| | - Juan Gago
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Erin E. Zwack
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Olufolakemi Olusanya
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Antimicrobial-Resistant Pathogens Program, Microbial Genomics Core Lab, New York University Langone Health, New York, New York, USA
| | - Kristina M. Boguslawski
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Simone Dallari
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Sophie Dyzenhaus
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Christin Herrmann
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Juliana K. Ilmain
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Georgia L. Isom
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Miranda Pawline
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Andrew I. Perault
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Antimicrobial-Resistant Pathogens Program, Microbial Genomics Core Lab, New York University Langone Health, New York, New York, USA
| | - Sofya Perelman
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - William E. Sause
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Ifrah Shahi
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Amelia St. John
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Rebecca Tierce
- Division of Comparative Medicine, New York University Langone Health, New York, New York, USA
| | - Xuhui Zheng
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Chunyi Zhou
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Maria G. Noval
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Anna O'Keeffe
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Magda Podkowik
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Antimicrobial-Resistant Pathogens Program, Microbial Genomics Core Lab, New York University Langone Health, New York, New York, USA
| | - Sandra Gonzales
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Kenneth Inglima
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Ludovic Desvignes
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
- High Containment Laboratories, Office of Science and Research, NYU Langone Health, New York, New York, USA
| | - Sarah E. Hochman
- Antimicrobial-Resistant Pathogens Program, Microbial Genomics Core Lab, New York University Langone Health, New York, New York, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Kenneth A. Stapleford
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Lorna E. Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Alejandro Pironti
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Antimicrobial-Resistant Pathogens Program, Microbial Genomics Core Lab, New York University Langone Health, New York, New York, USA
| | - Bo Shopsin
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Antimicrobial-Resistant Pathogens Program, Microbial Genomics Core Lab, New York University Langone Health, New York, New York, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Ken Cadwell
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Meike Dittmann
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Victor J. Torres
- Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
- Antimicrobial-Resistant Pathogens Program, Microbial Genomics Core Lab, New York University Langone Health, New York, New York, USA
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Hu T, Ma Z, Guo Y, Qiu S, Lv F, Liu Y, Ng WH, Zu J, Yeo YH, Ji F, Lee EY, Li Z. Age and urban-rural disparities in cutaneous melanoma mortality rates in the United States during the COVID-19 pandemic. Pigment Cell Melanoma Res 2024. [PMID: 38868930 DOI: 10.1111/pcmr.13181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/14/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
Most recent studies on the coronavirus disease 2019 (COVID-19) pandemic and cutaneous melanoma (CM) focused more on delayed diagnosis or advanced presentation. We aimed to ascertain mortality trends of CM between 2012 and 2022, focusing on the effects of the COVID-19 pandemic. In this serial population-based study, the National Vital Statistics System dataset was queried for mortality data. Excess CM-related mortality rates were estimated by calculating the difference between observed and projected mortality rates during the pandemic. Totally there were 108,853 CM-associated deaths in 2012-2022. CM-associated mortality saw a declining trend from 2012 to 2019 overall. However, it increased sharply in 2020 (ASMR 3.73 per 100,000 persons, 5.95% excess mortality), and remained high in 2021 and 2022, with the ASMRs of 3.82 and 3.81, corresponding to 11.17% and 13.20% excess mortality, respectively. The nonmetro areas had the most pronounced rise in mortality with 12.20% excess death in 2020, 15.33% in 2021 and 20.52% in 2022, corresponding to a 4-6 times excess mortality risk compared to large metro areas during the pandemic. The elderly had the most pronounced rise in mortality, but the mortality in the younger population was reduced.
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Affiliation(s)
- Ting Hu
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhimiao Ma
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuxin Guo
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Sikai Qiu
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fan Lv
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ying Liu
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wee Han Ng
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Jian Zu
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi'an, China
| | - Ernest Y Lee
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Zhengxiao Li
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Erdoğan Eliuz EA, Everest A, Serin MS. Antimicrobial activity of Stachys rupestris Montbret et Aucher ex Benth. and inactivation of the pathogens inoculated on lab-made skin by the essential oil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:1749-1759. [PMID: 36121018 DOI: 10.1080/09603123.2022.2123457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this study was to investigate the antimicrobial activity of Stachys rupestris essential oil and inactivation of the pathogens on lab-made skin the oil in the fight against Escherichia coli, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecalis, Candida albicans and Candida tropicalis. S. rupestris EO was extracted by hydrodistillation, and its contents were analyzed by GCMS. Logarithmic reduction of the pathogens inoculated on the artificial skin surface by S. rupestris EO was studied for the first time. The highest inhibition zone was 22.1 mm on C. tropicalis, while the lowest IZ was 0.1 mm on E. coli. The other zones were 20.01 mm for Acinetobacter baumannii, 20.02 mm for Enterococcus faecalis, 20.01 mm for Staphylococcus aureus, 22.03 for Candida albicans (p < 0.05). As a result, S. rupestris essential oil was effective on most of the microorganisms and might be increased to use in the treatment of skin infections in the future.
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Affiliation(s)
- Elif Ayşe Erdoğan Eliuz
- Technical Sciences Vocational School, Department of FoodTechnology, Mersin University, Mersin, Turkey
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Agodi A, Montineri A, Manuele R, Noto P, Carpinteri G, Castiglione G, Grassi P, Lazzara A, Mattaliano AR, Granvillano G, La Mastra C, La Rosa MC, Maugeri A, Barchitta M. Molecular Typing and Resistance Profile of Acinetobacter baumannii Isolates during the COVID-19 Pandemic: Findings from the "EPIRADIOCLINF" Project. Antibiotics (Basel) 2023; 12:1551. [PMID: 37887252 PMCID: PMC10603994 DOI: 10.3390/antibiotics12101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Due to the COVID-19 pandemic, there has been a shift in focus towards controlling the spread of SARS-CoV-2, which has resulted in the neglect of traditional programs aimed at preventing healthcare-associated infections and combating antimicrobial resistance. The present work aims to characterize the colonization or infection with Acinetobacter baumannii of COVID-19 patients and to identify any clonality between different isolates. Specifically, data and resistance profiles of A. baumannii isolates were prospectively collected from patients recruited by the EPIRADIOCLINF project. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used for molecular typing. Overall, we analyzed 64 isolates of A. baumannii from 48 COVID-19 patients. According to our analysis, we have identified the spread of a clonally related isolate, referred to as B. The PFGE pattern B includes four subtypes: B1 (consisting of 37 strains), B2 (11), B3 (5), and B4 (2). Furthermore, in the isolates that were examined using MLST, the most observed sequence type was ST/281. In terms of resistance profiles, 59 out of the total isolates (92.2%) were found to be resistant to gentamicin, carbapenems, ciprofloxacin, and tobramycin. The isolation and identification of A. baumannii from COVID-19 patients, along with the high levels of transmission observed within the hospital setting, highlight the urgent need for the implementation of effective prevention and containment strategies.
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Affiliation(s)
- Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (C.L.M.); (M.C.L.R.); (A.M.); (M.B.)
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Arturo Montineri
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Rosa Manuele
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Paola Noto
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Giuseppe Carpinteri
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Giacomo Castiglione
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Patrizia Grassi
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Antonio Lazzara
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Anna Rita Mattaliano
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Giuseppa Granvillano
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Claudia La Mastra
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (C.L.M.); (M.C.L.R.); (A.M.); (M.B.)
| | - Maria Clara La Rosa
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (C.L.M.); (M.C.L.R.); (A.M.); (M.B.)
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (C.L.M.); (M.C.L.R.); (A.M.); (M.B.)
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (C.L.M.); (M.C.L.R.); (A.M.); (M.B.)
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Mobarak-Qamsari M, Jenaghi B, Sahebi L, Norouzi-Shadehi M, Salehi MR, Shakoori-Farahani A, Khoshnevis H, Abdollahi A, Feizabadi MM. Evaluation of Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus aureus respiratory tract superinfections among patients with COVID-19 at a tertiary-care hospital in Tehran, Iran. Eur J Med Res 2023; 28:314. [PMID: 37660109 PMCID: PMC10474718 DOI: 10.1186/s40001-023-01303-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/19/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The emergence of healthcare-associated infections (HAIs) or superinfections in COVID-19 patients has resulted in poor prognosis and increased mortality. METHODS In a cross-sectional study, 101 respiratory samples were collected from ICU-admitted COVID-19 patients. The HAI rate, demographics, and antibiotic resistance were assessed. RESULTS The HAI rate was 83.16% (76.62% bacterial and 6.54% fungal). The prevalence of 3 major HAI-causing organisms included Klebsiella pneumoniae (41.5%), Acinetobacter baumannii (20.8%), and Staphylococcus aureus (4.9%). Mortality and intubation ventilation proportions of 90% (p = 0.027) and 92.2% (p = 0.02) were significant among patients with superinfection, respectively. Multiple logistic regression analysis showed SpO2 pressure (odds ratio 0.842; 95% CI 0.750-0.945; p = 0.004) as a predictive factor in the association between antibiotic usage and mortality. More than 50% of patients received carbapenems. The resistance rates to at least one antibiotic of third-generation cephalosporins, aminoglycosides, quinolones/fluoroquinolones, tetracyclines, and β-lactam inhibitors were 95.2%, 95.2%, 90%, 57.1%, and 100% among A. baumannii isolates and 71.4%, 55%, 69%, 61.9%, and 59.5% among K. pneumoniae isolates, respectively. A proportion of 60% was recorded for methicillin-resistant S. aureus isolates. CONCLUSION As a result, antibiotic treatment should be administered following the microbial resistance profile. Contact isolation and infection control measures should be implemented as needed.
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Affiliation(s)
- Maryam Mobarak-Qamsari
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Jenaghi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Leyla Sahebi
- Family Health Research Institute. Maternal, Fetal, and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Norouzi-Shadehi
- Department of Infectious Disease, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Salehi
- Department of Infectious Diseases, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Shakoori-Farahani
- Department of Medical Genetics, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Khoshnevis
- Imam Khomeini Hospital Complex, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mehdi Feizabadi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Thorax Research Center, Imam Khomeini Hospital Complex., Tehran University of Medical Sciences, Tehran, Iran.
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Dueñas D, Daza J, Liscano Y. Coinfections and Superinfections Associated with COVID-19 in Colombia: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1336. [PMID: 37512147 PMCID: PMC10385172 DOI: 10.3390/medicina59071336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
The COVID-19 pandemic has had significant impacts on healthcare systems around the world, including in Latin America. In Colombia, there have been over 23,000 confirmed cases and 100 deaths since 2022, with the highest number of cases occurring in females and the highest number of deaths in males. The elderly and those with comorbidities, such as arterial hypertension, diabetes mellitus, and respiratory diseases, have been particularly affected. Coinfections with other microorganisms, including dengue virus, Klebsiella pneumoniae, and Mycobacterium tuberculosis, have also been a significant factor in increasing morbidity and mortality rates in COVID-19 patients. It is important for surveillance systems to be improved and protocols to be established for the early detection and management of coinfections in COVID-19. In addition to traditional treatments, alternatives such as zinc supplementation and nanomedicine may have potential in the fight against COVID-19. It is also crucial to consider the social, labor, educational, psychological, and emotional costs of the pandemic and to address issues such as poverty and limited access to potable water in order to better prepare for future pandemics.
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Affiliation(s)
- Diana Dueñas
- Grupo de Investigación en Salud Integral (GISI), Departamento Facultad de Salud, Universidad Santiago de Cali, Cali 760035, Colombia
| | - Jorge Daza
- Grupo de Investigación de Salud y Movimiento, Programa de Fisioterapia, Facultad de Salud, Universidad Santiago de Cali, Cali 760035, Colombia
| | - Yamil Liscano
- Grupo de Investigación en Salud Integral (GISI), Departamento Facultad de Salud, Universidad Santiago de Cali, Cali 760035, Colombia
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Andrianopoulos I, Maniatopoulou T, Lagos N, Kazakos N, Papathanasiou A, Papathanakos G, Koulenti D, Kittas C, Koulouras V. Acinetobacter baumannii Bloodstream Infections in the COVID-19 Era: A Comparative Analysis between COVID-19 and Non-COVID-19 Critically Ill Patients. Microorganisms 2023; 11:1811. [PMID: 37512983 PMCID: PMC10383443 DOI: 10.3390/microorganisms11071811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic increased the incidence of severe infections caused by multidrug-resistant (MDR) pathogens among critically ill patients, such as Acinetobacter baumannii (AB), whose bloodstream infections (BSIs) have been associated with significant mortality. Whether there is any difference in outcome between COVID-19 and non-COVID-19 patients with AB BSI still remains unknown. We conducted a retrospective study comparing clinical characteristics and outcomes of COVID-19 versus non-COVID-19 critically ill patients with AB BSI. Overall, 133 patients with AB BSI (102 COVID-19, 31 non-COVID-19) were studied. The 28-day mortality rate was high and did not differ significantly (69.6% COVID-19 vs. 61.3% non-COVID-19, p = 0.275). Patients with septic shock had a higher mortality rate irrespective of their status with the majority of deaths occurring during the first 7 days. COVID-19 patients were more likely to have ventilator-associated pneumonia (VAP) as the source of BSI (55.8% vs. 22.3%, respectively, p = 0.0001) and were more likely to develop acute respiratory distress syndrome (ARDS) (78.4% vs. 48.4%, respectively, p = 0.001), sepsis (86.3% vs. 67.7%, respectively, p = 0.03), and septic shock (88.3% vs. 58.1%, respectively, p = 0.007) compared to the non-COVID-19 patient group. In conclusion, COVID-19 patients with A. baumannii BSI have a high rate of mortality and more often develop septic shock, while VAP is the main origin of their BSI.
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Affiliation(s)
| | | | - Nikolaos Lagos
- Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Nikolaos Kazakos
- Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
| | | | | | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
- Second Critical Care Department, Attikon University Hospital, Rimini Street, 12462 Athens, Greece
| | - Christos Kittas
- Department of Microbiology, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Vasilios Koulouras
- Intensive Care Unit, University Hospital of Ioannina, 45500 Ioannina, Greece
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Platt AP, Bradley BT, Nasir N, Stein SR, Ramelli SC, Ramos-Benitez MJ, Dickey JM, Purcell M, Singireddy S, Hays N, Wu J, Raja K, Curto R, Salipante SJ, Chisholm C, Carnes S, Marshall DA, Cookson BT, Vannella KM, Madathil RJ, Soherwardi S, McCurdy MT, Saharia KK, Rabin J, Nih Covid-Autopsy Consortium, Grazioli A, Kleiner DE, Hewitt SM, Lieberman JA, Chertow DS. Pulmonary Co-Infections Detected Premortem Underestimate Postmortem Findings in a COVID-19 Autopsy Case Series. Pathogens 2023; 12:932. [PMID: 37513779 PMCID: PMC10383307 DOI: 10.3390/pathogens12070932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Bacterial and fungal co-infections are reported complications of coronavirus disease 2019 (COVID-19) in critically ill patients but may go unrecognized premortem due to diagnostic limitations. We compared the premortem with the postmortem detection of pulmonary co-infections in 55 fatal COVID-19 cases from March 2020 to March 2021. The concordance in the premortem versus the postmortem diagnoses and the pathogen identification were evaluated. Premortem pulmonary co-infections were extracted from medical charts while applying standard diagnostic definitions. Postmortem co-infection was defined by compatible lung histopathology with or without the detection of an organism in tissue by bacterial or fungal staining, or polymerase chain reaction (PCR) with broad-range bacterial and fungal primers. Pulmonary co-infection was detected premortem in significantly fewer cases (15/55, 27%) than were detected postmortem (36/55, 65%; p < 0.0001). Among cases in which co-infection was detected postmortem by histopathology, an organism was identified in 27/36 (75%) of cases. Pseudomonas, Enterobacterales, and Staphylococcus aureus were the most frequently identified bacteria both premortem and postmortem. Invasive pulmonary fungal infection was detected in five cases postmortem, but in no cases premortem. According to the univariate analyses, the patients with undiagnosed pulmonary co-infection had significantly shorter hospital (p = 0.0012) and intensive care unit (p = 0.0006) stays and significantly fewer extra-pulmonary infections (p = 0.0021). Bacterial and fungal pulmonary co-infection are under-recognized complications in critically ill patients with COVID-19.
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Affiliation(s)
- Andrew P Platt
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA
| | - Benjamin T Bradley
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Nadia Nasir
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sydney R Stein
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA
| | - Sabrina C Ramelli
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Marcos J Ramos-Benitez
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA
- Department of Basic Sciences, Division of Microbiology, Ponce Research Institute, School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA
| | - James M Dickey
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA
| | | | | | - Nicole Hays
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Jocelyn Wu
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Katherine Raja
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Ryan Curto
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Stephen J Salipante
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
| | - Claire Chisholm
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
| | | | - Desiree A Marshall
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
| | - Brad T Cookson
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
| | - Kevin M Vannella
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA
| | - Ronson J Madathil
- Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | | | - Michael T McCurdy
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Medicine, University of Maryland St. Joseph Medical Center, Towson, MD 21204, USA
| | - Kapil K Saharia
- Institute of Human Virology, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Joseph Rabin
- R Adams Cowley Shock Trauma Center, Department of Surgery and Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | | | - Alison Grazioli
- R Adams Cowley Shock Trauma Center, Department of Medicine and Program in Trauma, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - David E Kleiner
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Stephen M Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Joshua A Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
| | - Daniel S Chertow
- Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA
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9
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Ruiz-Cáceres I, Hermida Romero T, Guerra Merino I, Portu Zapirain J, Pérez-Mies B, Sánchez-Conde M, Riaño MA, Rubio R, Fortés Alen J, Vidal González Á, Salas Antón C, Múñez E, Sánchez Sánchez R, Corona-Mata D, Aldecoa Ansorregui I, Miró JM, Beloqui Pérez de Obanos R, Ibero C, Gómez-Román J, Fariñas MC, Tabuyo Bello T, de Alava E, Cisneros JM, Matías-Guiu X, Rivero A. Post-mortem findings in Spanish patients with COVID-19; a special focus on superinfections. Front Med (Lausanne) 2023; 10:1151843. [PMID: 37484846 PMCID: PMC10359908 DOI: 10.3389/fmed.2023.1151843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Whole-body autopsies may be crucial to understand coronavirus disease 2019 (COVID-19) pathophysiology. We aimed to analyze pathological findings in a large series of full-body autopsies, with a special focus on superinfections. Methods This was a prospective multicenter study that included 70 COVID-19 autopsies performed between April 2020 and February 2021. Epidemiological, clinical and pathological information was collected using a standardized case report form. Results Median (IQR) age was 70 (range 63.75-74.25) years and 76% of cases were males. Most patients (90%,) had at least one comorbidity prior to COVID-19 diagnosis, with vascular risk factors being the most frequent. Infectious complications were developed by 65.71% of the patients during their follow-up. Mechanical ventilation was required in most patients (75.71%) and was mainly invasive. In multivariate analyses, length of hospital stay and invasive mechanical ventilation were significantly associated with infections (p = 0.036 and p = 0.013, respectively). Necropsy findings revealed diffuse alveolar damage in the lungs, left ventricular hypertrophy in the heart, liver steatosis and pre-infection arteriosclerosis in the heart and kidneys. Conclusion Our study confirms the main necropsy histopathological findings attributed to COVID-19 in a large patient series, while underlining the importance of both comorbid conditions and superinfections in the pathology.
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Affiliation(s)
- Inmaculada Ruiz-Cáceres
- Department of Infectious Diseases, Reina Sofía University Hospital, The Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University (UCO), Córdoba, Spain
- CIBERINFEC, ISCIII – CIBER de Enfermedades Infecciosas Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Hermida Romero
- Department of Pathological Anatomy, A Coruña University Hospital Complex, A Coruña, Spain
| | - Isabel Guerra Merino
- Department of Pathological Anatomy, University Hospital of Álava, Vitoria-Gasteiz, Spain
| | - Joseba Portu Zapirain
- Bioaraba, Microbiology, Infectious Diseases, Antimicrobials and Gene Therapy Research Group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Álava University Hospital, Vitoria-Gasteiz, Spain
| | - Belén Pérez-Mies
- Department of Pathological Anatomy, Ramón y Cajal University Hospital, Madrid, Spain
| | - Matilde Sánchez-Conde
- Department of Infectious Diseases, Ramón y Cajal University Hospital-IRYCIS, CIBERINFEC, Madrid, Spain
| | - Marina Alonso Riaño
- Department of Pathological Anatomy, 12 de Octubre University Hospital, Madrid, Spain
| | - Rafael Rubio
- Section of Internal Medicine, 12 de Octubre University Hospital, Department of Medicine, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Jose Fortés Alen
- Department of Pathological Anatomy, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Ánxela Vidal González
- Department of Intensive Care Medicine, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Clara Salas Antón
- Department of Pathological Anatomy, Puerta de Hierro University Hospital, Majadahonda, Spain
| | - Elena Múñez
- Infectious Diseases Unit, Puerta de Hierro University Hospital, Majadahonda, Spain
| | | | - Diana Corona-Mata
- Department of Infectious Diseases, Reina Sofía University Hospital, The Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University (UCO), Córdoba, Spain
| | | | - José M. Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | | | - Carlos Ibero
- Infectious Diseases, COVID Coordination at University Hospital of Navarra, Pamplona, Spain
| | - Javier Gómez-Román
- Department of Pathological Anatomy, Marqués de Valdecilla University Hospital, Santander, Spain
| | - M. Carmen Fariñas
- Department of Infectious Diseases, Marqués de Valdecilla University Hospital, IDIVAL, CIBERINFEC, University of Cantabria, Santander, Cantabria, Spain
| | - Teresa Tabuyo Bello
- Department of Intensive Care, A Coruña University Hospital Complex, A Coruña, Spain
| | - Enrique de Alava
- Department of Pathological Anatomy, Virgen del Rocío University Hospital, Seville, Spain
| | - José Miguel Cisneros
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Xavier Matías-Guiu
- Department of Pathological Anatomy, Bellvitge University Hospital, Barcelona, Spain
| | - Antonio Rivero
- Department of Infectious Diseases, Reina Sofía University Hospital, The Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University (UCO), Córdoba, Spain
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10
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Colquhoun JM, Farokhyfar M, Anderson AC, Bethel CR, Bonomo RA, Clarke AJ, Rather PN. Collateral Changes in Cell Physiology Associated with ADC-7 β-Lactamase Expression in Acinetobacter baumannii. Microbiol Spectr 2023; 11:e0464622. [PMID: 37074187 PMCID: PMC10269689 DOI: 10.1128/spectrum.04646-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/15/2023] [Indexed: 04/20/2023] Open
Abstract
The ADC (AmpC) β-lactamase is universally present in the Acinetobacter baumannii chromosome, suggesting it may have a yet-to-be-identified cellular function. Using peptidoglycan composition analysis, we show that overexpressing the ADC-7 β-lactamase in A. baumannii drives changes consistent with altered l,d-transpeptidase activity. Based on this, we tested whether cells overexpressing ADC-7 would exhibit new vulnerabilities. As proof of principle, a screen of transposon insertions revealed that an insertion in the distal 3' end of canB, encoding carbonic anhydrase, resulted in a significant loss of viability when the adc-7 gene was overexpressed. A canB deletion mutant exhibited a more pronounced loss of viability than the transposon insertion, and this became amplified when cells overexpressed ADC-7. Interestingly, overexpression of the OXA-23 or TEM-1 β-lactamases also led to a pronounced loss of viability in cells with reduced carbonic anhydrase activity. In addition, we demonstrate that reduced CanB activity led to increased sensitivity to peptidoglycan synthesis inhibitors and to the carbonic anhydrase inhibitor ethoxzolamide. Furthermore, this strain exhibited a synergistic interaction with the peptidoglycan inhibitor fosfomycin and ethoxzolamide. Our results highlight the impact of ADC-7 overexpression on cell physiology and reveal that the essential carbonic anhydrase CanB may represent a novel target for antimicrobial agents that would exhibit increased potency against β-lactamase-overexpressing A. baumannii. IMPORTANCE Acinetobacter baumannii has become resistant to all classes of antibiotics, with β-lactam resistance responsible for the majority of treatment failures. New classes of antimicrobials are needed to treat this high-priority pathogen. This study had uncovered a new genetic vulnerability in β-lactamase-expressing A. baumannii, where reduced carbonic anhydrase activity becomes lethal. Inhibitors of carbonic anhydrase could represent a new method for treating A. baumannii infections.
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Affiliation(s)
- Jennifer M. Colquhoun
- Department of Microbiology and Immunology, Emory University, Atlanta, Georgia, USA
- Emory Antibiotic Resistance Center, Emory University, Atlanta, Georgia, USA
| | | | - Alexander C. Anderson
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
| | - Christopher R. Bethel
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs, Cleveland, Ohio, USA
| | - Robert A. Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs, Cleveland, Ohio, USA
- Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Proteomics and Bioinformatics, Case Western Reserve University, Cleveland, Ohio, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Case Western Reserve University, Cleveland, Ohio, USA
| | - Anthony J. Clarke
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, Canada
- Department of Chemistry & Biochemistry, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Philip N. Rather
- Department of Microbiology and Immunology, Emory University, Atlanta, Georgia, USA
- Emory Antibiotic Resistance Center, Emory University, Atlanta, Georgia, USA
- Research Service, Atlanta VA Medical Center, Decatur, Georgia, USA
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11
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Losier A, Gupta G, Caldararo M, Dela Cruz CS. The Impact of Coronavirus Disease 2019 on Viral, Bacterial, and Fungal Respiratory Infections. Clin Chest Med 2023; 44:407-423. [PMID: 37085229 PMCID: PMC9968485 DOI: 10.1016/j.ccm.2022.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Although coronavirus disease 2019 (COVID-19) remains an ongoing threat, concerns regarding other respiratory infections remain. Throughout the COVID-19 pandemic various epidemiologic trends have been observed in other respiratory viruses including a reduction in influenza and respiratory syncytial virus infections following onset of the COVID-19 pandemic. Observations suggest that infections with other respiratory viruses were reduced with social distancing, mask wearing, eye protection, and hand hygiene practices. Coinfections with COVID-19 exist not only with other respiratory viruses but also with bacterial pneumonias and other nosocomial and opportunistic infections. Coinfections have been associated with increased severity of illness and other adverse outcomes.
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Affiliation(s)
- Ashley Losier
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06511, USA.
| | - Gayatri Gupta
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Mario Caldararo
- Veteran's Affairs Connecticut Healthcare System, West Haven, CT 06516, USA
| | - Charles S Dela Cruz
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06511, USA
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12
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Shoham S, Batista C, Ben Amor Y, Ergonul O, Hassanain M, Hotez P, Kang G, Kim JH, Lall B, Larson HJ, Naniche D, Sheahan T, Strub-Wourgaft N, Sow SO, Wilder-Smith A, Yadav P, Bottazzi ME. Vaccines and therapeutics for immunocompromised patients with COVID-19. EClinicalMedicine 2023; 59:101965. [PMID: 37070102 PMCID: PMC10091856 DOI: 10.1016/j.eclinm.2023.101965] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
The COVID-19 pandemic has disproportionately impacted immunocompromised patients. This diverse group is at increased risk for impaired vaccine responses, progression to severe disease, prolonged hospitalizations and deaths. At particular risk are people with deficiencies in lymphocyte number or function such as transplant recipients and those with hematologic malignancies. Such patients' immune responses to vaccination and infection are frequently impaired leaving them more vulnerable to prolonged high viral loads and severe complications of COVID-19. Those in turn, have implications for disease progression and persistence, development of immune escape variants and transmission of infection. Data to guide vaccination and treatment approaches in immunocompromised people are generally lacking and extrapolated from other populations. The large clinical trials leading to authorisation and approval of SARS-CoV-2 vaccines and therapeutics included very few immunocompromised participants. While experience is accumulating, studies focused on the special circumstances of immunocompromised patients are needed to inform prevention and treatment approaches.
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Affiliation(s)
- Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolina Batista
- Médecins Sans Frontières, Rio de Janeiro, Brazil
- Baraka Impact Finance, Geneva, Switzerland
| | - Yanis Ben Amor
- Center for Sustainable Development, Columbia University, New York, NY, USA
| | - Onder Ergonul
- Koc University Research Center for Infectious Diseases, Istanbul, Turkey
| | - Mazen Hassanain
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Peter Hotez
- Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Bhavna Lall
- University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
| | | | - Denise Naniche
- ISGlobal, Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain
| | - Timothy Sheahan
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Nathalie Strub-Wourgaft
- ISGlobal, Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Samba O. Sow
- Center for Vaccine Development, Bamako, Mali
- University of Maryland, MD, USA
| | - Annelies Wilder-Smith
- London School of Hygiene & Tropical Medicine, London, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Prashant Yadav
- Center for Global Development, Washington, DC, USA
- Harvard Medical School, Boston, MA, USA
- Technology and Operations Management, INSEAD, Fontainebleau, France
| | - Maria Elena Bottazzi
- Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
| | - Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Médecins Sans Frontières, Rio de Janeiro, Brazil
- Baraka Impact Finance, Geneva, Switzerland
- Center for Sustainable Development, Columbia University, New York, NY, USA
- Koc University Research Center for Infectious Diseases, Istanbul, Turkey
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
- Christian Medical College, Vellore, India
- International Vaccine Institute, Seoul, South Korea
- University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
- London School of Hygiene & Tropical Medicine, London, UK
- ISGlobal, Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
- Center for Vaccine Development, Bamako, Mali
- University of Maryland, MD, USA
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Center for Global Development, Washington, DC, USA
- Harvard Medical School, Boston, MA, USA
- Technology and Operations Management, INSEAD, Fontainebleau, France
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13
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Reyes LF, Rodriguez A, Fuentes YV, Duque S, García-Gallo E, Bastidas A, Serrano-Mayorga CC, Ibáñez-Prada ED, Moreno G, Ramirez-Valbuena PC, Ospina-Tascon G, Hernandez G, Silva E, Díaz AM, Jibaja M, Vera-Alarcon M, Díaz E, Bodí M, Solé-Violán J, Ferrer R, Albaya-Moreno A, Socias L, Figueroa W, Lozano-Villanueva JL, Varón-Vega F, Estella Á, Loza-Vazquez A, Jorge-García R, Sancho I, Shankar-Hari M, Martin-Loeches I. Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study. Sci Rep 2023; 13:6553. [PMID: 37085552 PMCID: PMC10119842 DOI: 10.1038/s41598-023-32265-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/24/2023] [Indexed: 04/23/2023] Open
Abstract
Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
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Affiliation(s)
- Luis Felipe Reyes
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia.
- Clinica Universidad de La Sabana, Chía, Colombia.
- Pandemic Sciences Institute, University of Oxford, Oxford, UK.
| | - Alejandro Rodriguez
- Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Yuli V Fuentes
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
- Clinica Universidad de La Sabana, Chía, Colombia
| | - Sara Duque
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Esteban García-Gallo
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Alirio Bastidas
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Cristian C Serrano-Mayorga
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
- Clinica Universidad de La Sabana, Chía, Colombia
| | - Elsa D Ibáñez-Prada
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Gerard Moreno
- Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | | | - Glenn Hernandez
- Critical Care Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Ana Maria Díaz
- Eugenio Espejo Hospital of Specialties, Quito, Pichincha, Ecuador
| | - Manuel Jibaja
- Eugenio Espejo Hospital of Specialties, Quito, Pichincha, Ecuador
| | | | - Emili Díaz
- Critical Care Department, Hospital Universitari Parc Taulí, Universitat Autonoma Barcelona, Sabadell, Spain
| | - María Bodí
- Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Jordi Solé-Violán
- Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain
- Universidad Fernando Pessoa, Canarias, Spain
| | - Ricard Ferrer
- Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | | | - Lorenzo Socias
- Son Llatzer University Hospital, Palma de Mallorca, Spain
| | - William Figueroa
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | | | | | - Ángel Estella
- Jerez University Hospital, Jerez de la Frontera, Spain
| | - Ana Loza-Vazquez
- Critical Care Department, Hospital Universitario Virgen del Valme, Sevilla, Spain
| | | | - Isabel Sancho
- Critical Care Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Manu Shankar-Hari
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, UK
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14
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Cut TG, Mavrea A, Cumpanas AA, Novacescu D, Oancea CI, Bratosin F, Marinescu AR, Laza R, Mocanu A, Pescariu AS, Manolescu D, Dumache R, Enache A, Hogea E, Lazureanu VE. A Retrospective Assessment of Sputum Samples and Antimicrobial Resistance in COVID-19 Patients. Pathogens 2023; 12:pathogens12040620. [PMID: 37111506 PMCID: PMC10143659 DOI: 10.3390/pathogens12040620] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Data on bacterial or fungal pathogens and their impact on the mortality rates of Western Romanian COVID-19 patients are scarce. As a result, the purpose of this research was to determine the prevalence of bacterial and fungal co- and superinfections in Western Romanian adults with COVID-19, hospitalized in in-ward settings during the second half of the pandemic, and its distribution according to sociodemographic and clinical conditions. The unicentric retrospective observational study was conducted on 407 eligible patients. Expectorate sputum was selected as the sampling technique followed by routine microbiological investigations. A total of 31.5% of samples tested positive for Pseudomonas aeruginosa, followed by 26.2% having co-infections with Klebsiella pneumoniae among patients admitted with COVID-19. The third most common Pathogenic bacteria identified in the sputum samples was Escherichia coli, followed by Acinetobacter baumannii in 9.3% of samples. Commensal human pathogens caused respiratory infections in 67 patients, the most prevalent being Streptococcus penumoniae, followed by methicillin-sensitive and methicillin-resistant Staphylococcus aureus. A total of 53.4% of sputum samples tested positive for Candida spp., followed by 41.1% of samples with Aspergillus spp. growth. The three groups with positive microbial growth on sputum cultures had an equally proportional distribution of patients admitted to the ICU, with an average of 30%, compared with only 17.3% among hospitalized COVID-19 patients with negative sputum cultures (p = 0.003). More than 80% of all positive samples showed multidrug resistance. The high prevalence of bacterial and fungal co-infections and superinfections in COVID-19 patients mandates for strict and effective antimicrobial stewardship and infection control policies.
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Affiliation(s)
- Talida Georgiana Cut
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Academy of Romanian Scientists, Splaiul Independentei, Nr. 54, 50085 Bucharest, Romania
| | - Adelina Mavrea
- Department VII, Internal Medicine II, Discipline of Cardiology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alin Adrian Cumpanas
- Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Dorin Novacescu
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Academy of Romanian Scientists, Splaiul Independentei, Nr. 54, 50085 Bucharest, Romania
| | - Cristian Iulian Oancea
- Department XIII, Discipline of Pneumology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Adelina Raluca Marinescu
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Ruxandra Laza
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alexandra Mocanu
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alexandru Silvius Pescariu
- Academy of Romanian Scientists, Splaiul Independentei, Nr. 54, 50085 Bucharest, Romania
- Department VII, Internal Medicine II, Discipline of Cardiology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Diana Manolescu
- Department XV, Discipline of Radiology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Raluca Dumache
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Department VIII, Discipline of Forensic Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Alexandra Enache
- Center for Ethics in Human Genetic Identifications, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Department VIII, Discipline of Forensic Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Elena Hogea
- Department XIV, Discipline of Microbiology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Voichita Elena Lazureanu
- Department XIII, Discipline of Infectious Diseases, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
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15
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Healthcare-associated infections in Veterans Affairs acute-care and long-term healthcare facilities during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2023; 44:420-426. [PMID: 35379366 PMCID: PMC9043628 DOI: 10.1017/ice.2022.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infections (HAIs) reported from 128 acute-care and 132 long-term care Veterans Affairs (VA) facilities. METHODS We compared central-line-associated bloodstream infections (CLABSIs), ventilator-associated events (VAEs), catheter-associated urinary tract infections (CAUTIs), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridioides difficile infections and rates reported from each facility monthly to a centralized database before the pandemic (February 2019 through January 2020) and during the pandemic (July 2020 through June 2021). RESULTS Nationwide VA COVID-19 admissions peaked in January 2021. Significant increases in the rates of CLABSIs, VAEs, and MRSA all-site HAIs (but not MRSA CLABSIs) were observed during the pandemic in acute-care facilities. There was no significant change in CAUTI rates, and C. difficile rates significantly decreased. There were no significant increases in HAIs in long-term care facilities. CONCLUSIONS The COVID-19 pandemic had a differential impact on HAIs of various types in VA acute care, with many rates increasing. The decrease in CDI HAIs may be due, in part, to evolving diagnostic testing. The minimal impact of COVID-19 in VA long-term facilities may reflect differences in patient numbers and acuity and early recognition of the impact of the pandemic on nursing home residents leading to increased vigilance and optimization of infection prevention and control practices in that setting. These data support the need for building and sustaining conventional infection prevention and control strategies before and during a pandemic.
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16
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Camacho Silvas LA. [Bacterial resistance, a current crisis.]. Rev Esp Salud Publica 2023; 97:e202302013. [PMID: 36815211 PMCID: PMC10541255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
Bacterial resistance is a constant battle representing a Public Health trouble. So much, that the World Health Organization considerate Public Health as a priority in health, due to the impact that generates as much as in health (giving that recent projections indicate that by 2050 it'll be produced more deaths because of this than the ones occasioned because of cancer) as its economic impact (which, according to a recent study in the United Kingdom, it'll cost the world's economy an estimated of 100 trillion dollars). The quick appearance of multidrug-resistant and pandrug-resistant bacteria is a world nature phenomenon, questioning the antibiotics efficiency. Implement protocols and recommendations is essential, just as essential and necessary as give awareness to health personnel, taking as base the knowledge of resistance generation and its impact through the years, empowered by the actual pandemic of COVID 19.
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Affiliation(s)
- Luis Arturo Camacho Silvas
- Laboratorio de Farmacoepidemiología, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de ChihuahuaUniversidad Autónoma de ChihuahuaChihuahuaMexico
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17
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Rangel K, De-Simone SG. Acinetobacter baumannii during COVID-19: What Is the Real Pandemic? Pathogens 2022; 12:pathogens12010041. [PMID: 36678389 PMCID: PMC9863904 DOI: 10.3390/pathogens12010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022] Open
Abstract
The novel Coronavirus Disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, has had a monumental impact on public health globally [...].
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Affiliation(s)
- Karyne Rangel
- Center for Technological Development in Health (CDTS), National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil
- Laboratory of Epidemiology and Molecular Systematics (LESM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil
- Correspondence: (K.R.); (S.G.D.-S.); Tel.: +55-21386581-82 (K.R. & S.G.D.-S.)
| | - Salvatore Giovanni De-Simone
- Center for Technological Development in Health (CDTS), National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil
- Laboratory of Epidemiology and Molecular Systematics (LESM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil
- Post-Graduation Program in Science and Biotechnology, Department of Molecular and Cellular Biology, Biology Institute, Federal Fluminense University (UFF), Niterói 22040-036, Brazil
- Correspondence: (K.R.); (S.G.D.-S.); Tel.: +55-21386581-82 (K.R. & S.G.D.-S.)
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18
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Wu HY, Chang PH, Chen KY, Lin IF, Hsih WH, Tsai WL, Chen JA, Lee SSJ. Coronavirus disease 2019 (COVID-19) associated bacterial coinfection: Incidence, diagnosis and treatment. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:985-992. [PMID: 36243668 PMCID: PMC9536868 DOI: 10.1016/j.jmii.2022.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/25/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
Coronavirus disease 2019 (COVID-19) emerged as a pandemic that spread rapidly around the world, causing nearly 500 billion infections and more than 6 million deaths to date. During the first wave of the pandemic, empirical antibiotics was prescribed in over 70% of hospitalized COVID-19 patients. However, research now shows a low incidence rate of bacterial coinfection in hospitalized COVID-19 patients, between 2.5% and 5.1%. The rate of secondary infections was 3.7% in overall, but can be as high as 41.9% in the intensive care units. Over-prescription of antibiotics to treat COVID-19 patients fueled the ongoing antimicrobial resistance globally. Diagnosis of bacterial coinfection is challenging due to indistinguishable clinical presentations with overlapping lower respiratory tract symptoms such as fever, cough and dyspnea. Other diagnostic methods include conventional culture, diagnostic syndromic testing, serology test and biomarkers. COVID-19 patients with bacterial coinfection or secondary infection have a higher in-hospital mortality and longer length of stay, timely and appropriate antibiotic use aided by accurate diagnosis is crucial to improve patient outcome and prevent antimicrobial resistance.
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Affiliation(s)
- Huan-Yi Wu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Peng-Hao Chang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuan-Yu Chen
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - I-Fan Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wen-Hsin Hsih
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wan-Lin Tsai
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jiun-An Chen
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Susan Shin-Jung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan,Corresponding author. 386, Ta-Chung 1st Rd., Kaohsiung 813, Taiwan. Fax: +886 -7 -3468292
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19
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Pérez-Varela M, Tierney ARP, Dawson E, Hutcheson AR, Tipton KA, Anderson SE, Haldopoulos ME, Song S, Tomlinson BR, Shaw LN, Weiss DS, Kim M, Rather PN. Stochastic activation of a family of TetR type transcriptional regulators controls phenotypic heterogeneity in Acinetobacter baumannii. PNAS NEXUS 2022; 1:pgac231. [PMID: 36704122 PMCID: PMC9802203 DOI: 10.1093/pnasnexus/pgac231] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022]
Abstract
Phenotypic heterogeneity is an important mechanism for regulating bacterial virulence, where a single regulatory switch is typically activated to generate virulent and avirulent subpopulations. The opportunistic pathogen Acinetobacter baumannii can transition at high frequency between virulent opaque (VIR-O) and avirulent translucent subpopulations, distinguished by cells that form opaque or translucent colonies. We demonstrate that expression of 11 TetR-type transcriptional regulators (TTTRs) can drive cells from the VIR-O opaque subpopulation to cells that form translucent colonies. Remarkably, in a subpopulation of VIR-O cells, four of these TTTRs were stochastically activated in different combinations to drive cells to the translucent state. The resulting translucent subvariants exhibited unique phenotypic differences and the majority were avirulent. Due to their functional redundancy, a quadruple mutant with all four of these TTTRs inactivated was required to observe a loss of switching from the VIR-O state. Further, we demonstrate a small RNA, SrvS, acts as a "rheostat," where the levels of SrvS expression influences both the VIR-O to translucent switching frequency, and which TTTR is activated when VIR-O cells switch. In summary, this work has revealed a new paradigm for phenotypic switching in bacteria, where an unprecedented number of related transcriptional regulators are activated in different combinations to control virulence and generate unique translucent subvariants with distinct phenotypic properties.
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Affiliation(s)
- María Pérez-Varela
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - Aimee R P Tierney
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - Emma Dawson
- Department of Physics, Emory University, Atlanta, GA 30322, USA
| | - Anna R Hutcheson
- Research Service, Atlanta VA Medical Center, Decatur, GA 30033, USA
| | - Kyle A Tipton
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - Sarah E Anderson
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
- Research Service, Atlanta VA Medical Center, Decatur, GA 30033, USA
| | - Marina E Haldopoulos
- Emory Antibiotic Resistance Center, Emory University, Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Shaina Song
- Research Service, Atlanta VA Medical Center, Decatur, GA 30033, USA
| | - Brooke R Tomlinson
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, FL 33620, USA
| | - Lindsey N Shaw
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, FL 33620, USA
| | - David S Weiss
- Research Service, Atlanta VA Medical Center, Decatur, GA 30033, USA
- Emory Antibiotic Resistance Center, Emory University, Atlanta, GA 30322, USA
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Minsu Kim
- Department of Physics, Emory University, Atlanta, GA 30322, USA
- Emory Antibiotic Resistance Center, Emory University, Atlanta, GA 30322, USA
| | - Philip N Rather
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
- Research Service, Atlanta VA Medical Center, Decatur, GA 30033, USA
- Emory Antibiotic Resistance Center, Emory University, Atlanta, GA 30322, USA
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20
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Saturno MC, Manni P, Accorinti M. Bilateral Conjunctivitis, Keratitis, and Anterior Uveitis in a Patient Co-infected with Parvovirus B19 and SARS-CoV-2. Case Rep Ophthalmol 2022; 13:988-992. [PMID: 36466069 PMCID: PMC9710448 DOI: 10.1159/000527235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/14/2022] [Indexed: 08/18/2023] Open
Abstract
Parvovirus B-19 (B19V) is a common infection in children, occasionally complicated by ocular manifestations. In patients infected with severe acute respiratory syndrome virus (SARS-CoV-2), many cases of bacterial, fungal, and viral co-infections have been described. We report on a case of bilateral conjunctivitis, keratitis, and anterior uveitis that occurred in a patient co-infected by B19V and SARS-CoV-2. A young nurse developed, 20 days after the onset of asthenia and fever, a maculopapular rash and, in the following month, B19V-related arthritis. Shortly after a course of antibiotics and corticosteroids and the resolution of the arthritis, she began to complain of hearing loss and tinnitus. A polymerase chain reaction for SARS-CoV-2, previously negative, turned out positive; IgM for B19V decreased while IgG increased and antinuclear autoantibody and rheumatoid factor test results were positive. Ear symptoms disappeared after a course of prednisone, but eye burning and itching appeared 2 weeks after the coronavirus disease 2019 (COVID-19) positive swab. Bilateral conjunctivitis, keratitis, and anterior uveitis were diagnosed, which responded completely to a topical corticosteroid and mydriatic therapy. No relapses were observed in the following 12 months. The onset and progression of the symptoms, along with the laboratory findings, suggest a double pathogenesis of the ocular manifestations: keratitis and uveitis, along with the ear symptoms, seem to be the expression of an autoimmune reaction to B19V infection, while the conjunctivitis was likely related to direct infection of the conjunctiva by SARS-CoV-2.
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Affiliation(s)
- Maria Carmela Saturno
- Department of Sense Organs, Ocular Immunovirology Service, Sapienza University of Rome, Rome, Italy
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21
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Filograna L, Manenti G, Grassi S, Zedda M, Cazzato F, Ryan CP, Arena V, Pascali VL, Colosimo C, Floris R, Oliva A. Virtual autopsy in SARS-CoV-2 breakthrough infection: a case report. FORENSIC IMAGING 2022. [PMCID: PMC9433066 DOI: 10.1016/j.fri.2022.200520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
It is well documented that COVID-19 vaccines are effective tools for limiting the pandemic. Unfortunately, as is true for all vaccines, SARS-CoV-2 infection in vaccinated individuals is still possible. We present an autopsy case of SARS-CoV-2 infection after vaccination (“breakthrough infection”) in an elderly man with several comorbidities where post-mortem CT scan was performed. The death was histologically attributed to cardio-respiratory arrest due to ischemic heart failure related to superinfected COVID-19 pneumonia and pre-existing comorbidities. For the first time in the literature, PMCT imaging related to a fatal, autopsy case of breakthrough SARS-CoV-2 infection is reported. PMCT of the lungs, in accordance with histopathological results, showed few signs of COVID-19 pneumonia, large area of consolidation in the right lower lobe, interpreted as bronco-pneumonic focus, and hypostasis. These findings were well-correlated with the previously reported literature about both PMCT and clinical CT imaging of the lungs in non-vaccinated individuals with early COVID-19 pneumonia and about pulmonary clinical CT imaging in COVID-19 pneumonia in breakthrough SARS-COV-2 infections. Further studies are needed to cover the whole spectrum of PMCT lung imaging in fatal breakthrough SARS-CoV-2 infection, however, this case represent a first step for exploring this difficult challenge during SARS-CoV-2 pandemic using virtual autopsy.
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22
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Jampilek J. Drug repurposing to overcome microbial resistance. Drug Discov Today 2022; 27:2028-2041. [PMID: 35561965 DOI: 10.1016/j.drudis.2022.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 12/15/2022]
Abstract
Infections are a growing global threat, and the number of resistant species of microbial pathogens is alarming. However, the rapid development of cross-resistant or multidrug-resistant strains and the development of so-called 'superbugs' are in stark contrast to the number of newly launched anti-infectives on the market. In this review, I summarize the causes of antimicrobial resistance, briefly discuss different approaches to the discovery and development of new anti-infective drugs, and focus on drug repurposing strategy, which is discussed from all possible perspectives. A comprehensive overview of drugs of other indications tested for their in vitro antimicrobial activity to support existing anti-infective therapeutics is provided, including several critical remarks on this strategy of repurposing non-antibiotics to antibacterial drugs.
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Affiliation(s)
- Josef Jampilek
- Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University, Ilkovicova 6, 842 15 Bratislava, Slovakia; Department of Chemical Biology, Faculty of Science, Palacky University, Slechtitelu 27, 783 71 Olomouc, Czech Republic.
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23
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Falcone M, Suardi LR, Tiseo G, Galfo V, Occhineri S, Verdenelli S, Ceccarelli G, Poli M, Merli M, Bavaro D, Carretta A, Nunnari G, Venanzi Rullo E, Trecarichi EM, Papalini C, Franco A, Del Vecchio RF, Bianco V, Punzi R, Francisci D, Rubino R, Torti C, Puoti M, Carbonara S, Cascio A, Saracino A, Santantonio T, Venditti M, Menichetti F. Superinfections caused by carbapenem-resistant Enterobacterales in hospitalized patients with COVID-19: a multicentre observational study from Italy (CREVID Study). JAC Antimicrob Resist 2022; 4:dlac064. [PMID: 35719203 PMCID: PMC9201238 DOI: 10.1093/jacamr/dlac064] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To describe clinical characteristics and outcomes of COVID-19 patients who developed secondary infections due to carbapenem-resistant Enterobacterales (CRE).
Methods
Retrospective observational study including COVID-19 patients admitted to 12 Italian hospitals from March to December 2020 who developed a superinfection by CRE. Superinfection was defined as the occurrence of documented bacterial infection >48 h from admission. Patients with polymicrobial infections were excluded. Demographic, clinical characteristics and outcome were collected. Isolates were classified as KPC, metallo-β-lactamase (MBL) and OXA-48-producing CRE. A Cox regression analysis was performed to identify factors independently associated with 30 day mortality.
Results
Overall, 123 patients (median age 66 years, IQR 59–75) were included. The majority of infections occurred in the ICU (81, 65.9%), while 42 (34.1%) in medical wards. The most common types of infection were bloodstream infections (BSI) (n = 64, 52%), followed by urinary-tract infections (UTI) (n = 28, 22.8%), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) (n = 28, 22.8%), intra-abdominal infections (n = 2, 1.6%) and skin infections (n = 1, 0.8%). Sixty-three (51.2%) infections were caused by KPC-, 54 (43.9%) by MBL-, and 6 (4.8%) by OXA-48-producing CRE. Thirty-day mortality was 33.3% (41/123). On Cox regression analysis, HAP/VAP compared with UTI (HR 7.23, 95% CI 2.09–24.97, P = 0.004), BSI compared with UTI (HR 3.96, 95% CI, 1.33–11.77, P = 0.004), lymphopenia on admission (HR 3, 95% CI 1.44–6.26, P = 0.003) and age (HR 1.05, 95% CI 1.02–1.08, P = 0.002) were predictors of 30 day mortality.
Conclusions
Superinfections by CRE were associated with high risk of 30 day mortality in patients with COVID-19. HAP/VAP was the strongest predictor of death in these patients.
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Affiliation(s)
- Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Lorenzo Roberto Suardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Valentina Galfo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Sara Occhineri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Stefano Verdenelli
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome , Rome , Italy
| | - Melita Poli
- Vittorio Emanuele II Hospital , Bisceglie , Italy
| | - Marco Merli
- Divisione di Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Davide Bavaro
- University of Bari, Clinic of Infectious Diseases , Bari , Italy
| | - Anna Carretta
- Department of Infectious Diseases, University Hospital ‘Ospedali Riuniti’ of Foggia , Foggia , Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Enrico Maria Trecarichi
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro-‘Mater Domini’ Teaching Hospital , Catanzaro , Italy
| | - Chiara Papalini
- Department of Medicine and Surgery, Clinic of Infectious Diseases, ‘Santa Maria della Misericordia’ Hospital, University of Perugia , Perugia , Italy
| | | | | | - Vincenzo Bianco
- Department of Infectious diseases, AORN Ospedali dei Colli, Cotugno Hospital , Naples , Italy
| | - Rodolfo Punzi
- Department of Infectious diseases, AORN Ospedali dei Colli, Cotugno Hospital , Naples , Italy
| | - Daniela Francisci
- Department of Medicine and Surgery, Clinic of Infectious Diseases, ‘Santa Maria della Misericordia’ Hospital, University of Perugia , Perugia , Italy
| | - Raffaella Rubino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo , Palermo , Italy
| | - Carlo Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro-‘Mater Domini’ Teaching Hospital , Catanzaro , Italy
| | - Massimo Puoti
- Divisione di Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | | | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo , Palermo , Italy
| | | | - Teresa Santantonio
- Department of Infectious Diseases, University Hospital ‘Ospedali Riuniti’ of Foggia , Foggia , Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome , Rome , Italy
| | - Francesco Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
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Schwab N, Nienhold R, Henkel M, Baschong A, Graber A, Frank A, Mensah N, Koike J, Hernach C, Sachs M, Daun T, Zsikla V, Willi N, Junt T, Mertz KD. COVID-19 Autopsies Reveal Underreporting of SARS-CoV-2 Infection and Scarcity of Co-infections. Front Med (Lausanne) 2022; 9:868954. [PMID: 35492342 PMCID: PMC9046787 DOI: 10.3389/fmed.2022.868954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) mortality can be estimated based on reliable mortality data. Variable testing procedures and heterogeneous disease course suggest that a substantial number of COVID-19 deaths is undetected. To address this question, we screened an unselected autopsy cohort for the presence of SARS-CoV-2 and a panel of common respiratory pathogens. Lung tissues from 62 consecutive autopsies, conducted during the first and second COVID-19 pandemic waves in Switzerland, were analyzed for bacterial, viral and fungal respiratory pathogens including SARS-CoV-2. SARS-CoV-2 was detected in 28 lungs of 62 deceased patients (45%), although only 18 patients (29%) were reported to have COVID-19 at the time of death. In 23 patients (37% of all), the clinical cause of death and/or autopsy findings together with the presence of SARS-CoV-2 suggested death due to COVID-19. Our autopsy results reveal a 16% higher SARS-CoV-2 infection rate and an 8% higher SARS-CoV-2 related mortality rate than reported by clinicians before death. The majority of SARS-CoV-2 infected patients (75%) did not suffer from respiratory co-infections, as long as they were treated with antibiotics. In the lungs of 5 patients (8% of all), SARS-CoV-2 was found, yet without typical clinical and/or autopsy findings. Our findings suggest that underreporting of COVID-19 contributes substantially to excess mortality. The small percentage of co-infections in SARS-CoV-2 positive patients who died with typical COVID-19 symptoms strongly suggests that the majority of SARS-CoV-2 infected patients died from and not with the virus.
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Affiliation(s)
- Nathalie Schwab
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Ronny Nienhold
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Maurice Henkel
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Albert Baschong
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Anne Graber
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Angela Frank
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Nadine Mensah
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Jacqueline Koike
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Claudia Hernach
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Melanie Sachs
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Till Daun
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Veronika Zsikla
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Niels Willi
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Tobias Junt
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Kirsten D. Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
- University of Basel, Basel, Switzerland
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Jampilek J, Kralova K. Advances in Nanostructures for Antimicrobial Therapy. MATERIALS (BASEL, SWITZERLAND) 2022; 15:2388. [PMID: 35407720 PMCID: PMC8999898 DOI: 10.3390/ma15072388] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
Microbial infections caused by a variety of drug-resistant microorganisms are more common, but there are fewer and fewer approved new antimicrobial chemotherapeutics for systemic administration capable of acting against these resistant infectious pathogens. Formulation innovations of existing drugs are gaining prominence, while the application of nanotechnologies is a useful alternative for improving/increasing the effect of existing antimicrobial drugs. Nanomaterials represent one of the possible strategies to address this unfortunate situation. This review aims to summarize the most current results of nanoformulations of antibiotics and antibacterial active nanomaterials. Nanoformulations of antimicrobial peptides, synergistic combinations of antimicrobial-active agents with nitric oxide donors or combinations of small organic molecules or polymers with metals, metal oxides or metalloids are discussed as well. The mechanisms of actions of selected nanoformulations, including systems with magnetic, photothermal or photodynamic effects, are briefly described.
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Affiliation(s)
- Josef Jampilek
- Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University, Ilkovicova 6, 842 15 Bratislava, Slovakia
- Department of Chemical Biology, Faculty of Science, Palacky University Olomouc, Slechtitelu 27, 783 71 Olomouc, Czech Republic
| | - Katarina Kralova
- Institute of Chemistry, Faculty of Natural Sciences, Comenius University, Ilkovicova 6, 842 15 Bratislava, Slovakia;
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Rescuing Tetracycline Class Antibiotics for the Treatment of Multidrug-Resistant Acinetobacter baumannii Pulmonary Infection. mBio 2022; 13:e0351721. [PMID: 35012353 PMCID: PMC8749419 DOI: 10.1128/mbio.03517-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Acinetobacter baumannii causes high mortality in ventilator-associated pneumonia patients, and antibiotic treatment is compromised by multidrug-resistant strains resistant to β-lactams, carbapenems, cephalosporins, polymyxins, and tetracyclines. Among COVID-19 patients receiving ventilator support, a multidrug-resistant A. baumannii secondary infection is associated with a 2-fold increase in mortality. Here, we investigated the use of the 8-hydroxyquinoline ionophore PBT2 to break the resistance of A. baumannii to tetracycline class antibiotics. In vitro, the combination of PBT2 and zinc with either tetracycline, doxycycline, or tigecycline was shown to be bactericidal against multidrug-resistant A. baumannii, and any resistance that did arise imposed a fitness cost. PBT2 and zinc disrupted metal ion homeostasis in A. baumannii, increasing cellular zinc and copper while decreasing magnesium accumulation. Using a murine model of pulmonary infection, treatment with PBT2 in combination with tetracycline or tigecycline proved efficacious against multidrug-resistant A. baumannii. These findings suggest that PBT2 may find utility as a resistance breaker to rescue the efficacy of tetracycline-class antibiotics commonly employed to treat multidrug-resistant A. baumannii infections. IMPORTANCE Within intensive care unit settings, multidrug-resistant (MDR) Acinetobacter baumannii is a major cause of ventilator-associated pneumonia, and hospital-associated outbreaks are becoming increasingly widespread. Antibiotic treatment of A. baumannii infection is often compromised by MDR strains resistant to last-resort β-lactam (e.g., carbapenems), polymyxin, and tetracycline class antibiotics. During the on-going COVID-19 pandemic, secondary bacterial infection by A. baumannii has been associated with a 2-fold increase in COVID-19-related mortality. With a rise in antibiotic resistance and a reduction in new antibiotic discovery, it is imperative to investigate alternative therapeutic regimens that complement the use of current antibiotic treatment strategies. Rescuing the efficacy of existing therapies for the treatment of MDR A. baumannii infection represents a financially viable pathway, reducing time, cost, and risk associated with drug innovation.
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Hogan JI, Kotton CN. A Call for Caution in the Immunocompromised: Coronavirus Disease 2019 Associated With Mortality in a Vaccinated Lung Transplant Recipient. Open Forum Infect Dis 2022; 8:ofab557. [PMID: 34988243 PMCID: PMC8694205 DOI: 10.1093/ofid/ofab557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/08/2021] [Indexed: 12/29/2022] Open
Abstract
We describe a vaccinated lung transplant recipient who experienced a fatal outcome associated with coronavirus disease 2019 (COVID-19). Tocilizumab was administered. The patient exhibited clinical and radiographic evidence of colitis during the course of multiple secondary infections. This report emphasizes the need for more conservative precautions to prevent COVID-19 infection in transplant recipients.
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Affiliation(s)
- John I Hogan
- Division of Infectious Diseases and International Health, Hospital of the University of Virginia, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Camille N Kotton
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kumar S, Kumar H, Mali M, Meena BL. A study of rhino-orbito-cerebral mucormycosis with COVID-19: A new challenge in North West of Rajasthan. Ann Afr Med 2022; 21:383-389. [PMID: 36412339 PMCID: PMC9850881 DOI: 10.4103/aam.aam_129_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Mucormycosis is a life-threatening fungal disease in immunocompromised patients. There has been increase in the number of mucormycosis associated with COVID-19 patients in second wave. Now country battle with both COVID-19 and mucormycosis. An invasive mucormycosis infection has been a significant burden in India after COVID-19. It has been recently emerged a notifiable disease by the Rajasthan government. Our aim is to develop awareness regarding the importance of early detection and treatment of mucormycosis with COVID-19 and reduce the morbidity and mortality. Materials and Methods This is a Prospective longitudinal study including 34 patients diagnosed with acute invasive fungal infection by contrast enhancement magnetic resonance imaging studies of paranasal, orbit and brain or nasal biopsy for KOH/culture. Diagnosis is made through routine blood tests, biopsy, and radiological imaging. The patients taken for the study were COVID-19 reverse transcription-polymerase chain reaction positive or recent post COVID-19 (within 15 days) or symptoms of COVID-19 with bilateral pneumonitis. The study was conducted with 34 patients admitted to the department of medicine with mucormycosis within a month may 2021. Results A total of 34 patients with a mean age of 50.92 years old and male female ratio 24/10 (70.5/29.41) were included in this study. The most common comorbidity was diabetes mellitus (23 patients 67.64%). Nine patients were newly diagnosed or recent onset of diabetes with or after COVID-19 infection. Twenty-four (70.58%) patients were COVID-19 positive or recent (within 15 days) history of COVID-19 positive. Seven (20.58) patients had the history of steroid as a treatment during COVID-19 and 5 (14.70) patients was on oxygen inhalation. One (2.94%) patient was fully vaccinated, and 5 (14.70) patients had the history of steam inhalation. The most common involvement was naso-orbital mucormycosis found in 28 patients (82.35%) followed by nasal-and orbital 26 (76.47) and 18 (52.94), respectively. Naso-Orbito-Cerebral was seen in 16 (47.05) patients. The more common reported symptoms and signs were headache (76.47), facial numbness (64.70), Nasal discharge (52.94), and ophthalmoplegia (52.94). Cranial nerve involvement was seen in 10 patients (facial palsy in 8 patients and bulbar palsy in 2 patients). Total mortality was 7 (7/34 20.58%). Conclusion COVID-19 infection associated with the wide range of invasive mucormycosis. Early diagnosis and Clinical suspicion of acute invasive fungal sinusitis among COVID-19 patients is essential for better outcomes and higher survival.
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Affiliation(s)
- Surendra Kumar
- Department of Medicine, S P Medical College, Bikaner, Rajasthan, India
| | - Harish Kumar
- Department of Emergency Medicine, S P Medical College, Bikaner, Rajasthan, India,Address for correspondence: Dr. Harish Kumar, B-3 Shastri Nagar, Bikaner - 334 001, Rajasthan, India. E-mail:
| | - Manoj Mali
- Department of Medicine, S P Medical College, Bikaner, Rajasthan, India
| | - Babu Lal Meena
- Department of Medicine, S P Medical College, Bikaner, Rajasthan, India
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Pfaller MA, Carvalhaes CG, DeVries S, Rhomberg PR, Castanheira M. OUP accepted manuscript. Med Mycol 2022; 60:6576774. [PMID: 35511210 PMCID: PMC9075155 DOI: 10.1093/mmy/myac028] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/08/2022] [Accepted: 04/11/2022] [Indexed: 12/02/2022] Open
Abstract
Studies demonstrated the impact of the COVID-19 pandemic in the prevalence and susceptibility profiles of bacterial and fungal organisms. We analyzed 4821 invasive fungal isolates collected during 2018, 2019, and 2020 in 48 hospitals worldwide to evaluate the impact of this event in the occurrence and susceptibility rates of common fungal species. Isolates were tested using the CLSI broth microdilution method. While the percentage of total isolates that were C. glabrata (n = 710 isolates) or C. krusei (n = 112) slightly increased in 2020, the percentage for C. parapsilosis (n = 542), A. fumigatus (n = 416), and C. lusitaniae (n = 84) significantly decreased (P < .05). Fluconazole resistance in C. glabrata decreased from 5.8% in 2018–2019 to 2.0% in 2020, mainly due to fewer hospitals in the US having these isolates (5 vs. 1 hospital). Conversely, higher fluconazole-resistance rates were noted for C. parapsilosis (13.9 vs. 9.8%) and C. tropicalis (3.5 vs. 0.7%; P < .05) during 2020. Voriconazole resistance also increased for these species. Echinocandin resistance was unchanged among Candida spp. Voriconazole susceptibility rates in A. fumigatus were similar in these two periods (91.7% in 2018 and 2019 vs. 93.0% in 2020). Changes were also noticed in the organisms with smaller numbers of collected isolates. We observed variations in the occurrence of organisms submitted to a global surveillance and the susceptibility patterns for some organism-antifungal combinations. As the COVID-19 pandemic is still ongoing, the impact of this event must continue to be monitored to guide treatment of patients affected by bacterial and fungal infections.
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Affiliation(s)
- Michael A Pfaller
- Alternate author: Michael A. Pfaller, JMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA. E-mail:
| | | | | | | | - Mariana Castanheira
- To whom correspondence should be addressed. Mariana Castanheira, PhD, JMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA. E-mail:
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SARS-CoV-2 and Streptococcus pneumoniae Coinfection in a Previously Healthy Child. Case Rep Pediatr 2021; 2021:8907944. [PMID: 34900356 PMCID: PMC8660239 DOI: 10.1155/2021/8907944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in December 2019 in Wuhan, China. This novel coronavirus has been responsible for a pandemic that continues to devastate nations worldwide. COVID-19, like other viruses, causes pneumonia. However, unlike other viral respiratory tract infections such as influenza, bacterial coinfection in COVID-19 patients has uncommonly been described in adult and pediatric patients. We report a case of Streptococcus pneumoniae and COVID-19 coinfection in a previously healthy 4-year-old child.
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Grinbaum RS, Kiffer CRV. Bacterial infections in COVID-19 patients: a review. Rev Assoc Med Bras (1992) 2021; 67:1863-1868. [PMID: 34909963 DOI: 10.1590/1806-9282.20210812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/28/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Renato Satovschi Grinbaum
- Hospital e Maternidade São Luiz São Caetano - São Caetano do Sul (SP), Brazil.,Universidade Cidade de São Paulo - São Paulo (SP), Brazil.,Universidade Municipal de São Caetano do Sul - São Caetano do Sul (SP), Brazil
| | - Carlos Roberto Veiga Kiffer
- Hospital e Maternidade São Luiz São Caetano - São Caetano do Sul (SP), Brazil.,Universidade Federal de São Paulo, Laboratório Especial de Microbiologia Clínica, Escola Paulista de Medicina - São Paulo (SP), Brazil
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Dodson BK, Major CK, Grant M, Yoo BS, Goodman BM. Platypnea Orthodeoxia Due to a Patent Foramen Ovale and Intrapulmonary Shunting After Severe COVID-19 Pneumonia. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933975. [PMID: 34697281 PMCID: PMC8559663 DOI: 10.12659/ajcr.933975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patient: Male, 85-year-old
Final Diagnosis: Platypnea orthodeoxia
Symptoms: Dyspnea • orthostatic intolerance
Medication: —
Clinical Procedure: —
Specialty: Infectious Diseases
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Affiliation(s)
- Blair K Dodson
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - C Kendall Major
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Maxwell Grant
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Byung Soo Yoo
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - B Mitchell Goodman
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
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Rothe K, Spinner CD, Panning M, Pletz MW, Rohde G, Rupp J, Witzenrath M, Erber J, Eberhardt F, Essig A, Schneider J. Evaluation of a multiplex PCR screening approach to identify community-acquired bacterial co-infections in COVID-19: a multicenter prospective cohort study of the German competence network of community-acquired pneumonia (CAPNETZ). Infection 2021; 49:1299-1306. [PMID: 34687426 PMCID: PMC8536912 DOI: 10.1007/s15010-021-01720-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023]
Abstract
Purpose Thorough knowledge of the nature and frequency of co-infections is essential to optimize treatment strategies and risk assessment in cases of coronavirus disease 2019 (COVID-19). This study aimed to evaluate the multiplex polymerase chain reaction (PCR) screening approach for community-acquired bacterial pathogens (CABPs) at hospital admission, which could facilitate identification of bacterial co-infections in hospitalized COVID-19 patients. Methods Clinical data and biomaterials from 200 hospitalized COVID-19 patients from the observational cohort of the Competence Network for community-acquired pneumonia (CAPNETZ) prospectively recruited between March 17, 2020, and March 12, 2021 in 12 centers in Germany and Switzerland, were included in this study. Nasopharyngeal swab samples were analyzed on hospital admission using multiplex real-time reverse transcription (RT)-PCR for a broad range of CABPs. Results In total of 200 patients Staphylococcus aureus (27.0%), Haemophilus influenzae (13.5%), Streptococcus pneumoniae (5.5%), Moraxella catarrhalis (2.5%), and Legionella pneumophila (1.5%) were the most frequently detected bacterial pathogens. PCR detection of bacterial pathogens correlated with purulent sputum, and showed no correlation with ICU admission, mortality, and inflammation markers. Although patients who received antimicrobial treatment were more often admitted to the ICU and had a higher mortality rate, PCR pathogen detection was not significantly related to antimicrobial treatment. Conclusion General CABP screening using multiplex PCR with nasopharyngeal swabs may not facilitate prediction or identification of bacterial co-infections in the early phase of COVID-19-related hospitalization. Most patients with positive PCR results appear to be colonized rather than infected at that time, questioning the value of routine antibiotic treatment on admission in COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01720-8.
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Affiliation(s)
- Kathrin Rothe
- School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, Munich, Germany
| | - Christoph D Spinner
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marcus Panning
- Faculty of Medicine, Institute of Virology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- CAPNETZ Stiftung, Hannover, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine, Medical Clinic I, Goethe University Hospital, Frankfurt, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
| | - Martin Witzenrath
- Division of Pulmonary Inflammation, Department of Infectious Diseases and Pulmonary Medicine, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- CAPNETZ STIFTUNG, Hannover, Germany
| | - Johanna Erber
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | | | - Andreas Essig
- Department of Medical Microbiology and Hygiene, University of Ulm, Ulm, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Liu HH, Yaron D, Piraino AS, Kapelusznik L. Bacterial and fungal growth in sputum cultures from 165 COVID-19 pneumonia patients requiring intubation: evidence for antimicrobial resistance development and analysis of risk factors. Ann Clin Microbiol Antimicrob 2021; 20:69. [PMID: 34563202 PMCID: PMC8465781 DOI: 10.1186/s12941-021-00472-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Coronavirus SARS-CoV-2 causes COVID-19 illness which can progress to severe pneumonia. Empiric antibacterials are often employed though frequency of bacterial coinfection superinfection is debated and concerns raised about selection of bacterial antimicrobial resistance. We evaluated sputum bacterial and fungal growth from 165 intubated COVID-19 pneumonia patients. Objectives were to determine frequency of culture positivity, risk factors for and outcomes of positive cultures, and timing of antimicrobial resistance development. METHODS Retrospective reviews were conducted of COVID-19 pneumonia patients requiring intubation admitted to a 1058-bed four community hospital system on the east coast United States, March 1 to May 1, 2020. Length of stay (LOS) was expressed as mean (standard deviation); 95% confidence interval (95% CI) was computed for overall mortality rate using the exact binomial method, and overall mortality was compared across each level of a potential risk factor using a Chi-Square Test of Independence. All tests were two-sided, and significance level was set to 0.05. RESULTS Average patient age was 68.7 years and LOS 19.9 days. Eighty-three patients (50.3% of total) originated from home, 10 from group homes (6.1% of total), and 72 from nursing facilities (43.6% of total). Mortality was 62.4%, highest for nursing home residents (80.6%). Findings from 253 sputum cultures overall did not suggest acute bacterial or fungal infection in 73 (45%) of 165 individuals sampled within 24 h of intubation. Cultures ≥ 1 week following intubation did grow potential pathogens in 72 (64.9%) of 111 cases with 70.8% consistent with late pneumonia and 29.2% suggesting colonization. Twelve (10.8% of total) of these late post-intubation cultures revealed worsened antimicrobial resistance predominantly in Pseudomonas, Enterobacter, or Staphylococcus aureus. CONCLUSIONS In severe COVID-19 pneumonia, a radiographic ground glass interstitial pattern and lack of purulent sputum prior to/around the time of intubation correlated with no culture growth or recovery of normal oral flora ± yeast. Discontinuation of empiric antibacterials should be considered in these patients aided by other clinical findings, history of prior antimicrobials, laboratory testing, and overall clinical course. Continuing longterm hospitalisation and antibiotics are associated with sputum cultures reflective of hospital-acquired microbes and increasing antimicrobial resistance. TRIAL REGISTRATION Not applicable as this was a retrospective chart review study without interventional arm.
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Affiliation(s)
- Hans H Liu
- Division of Infectious Diseases, Department of Medicine, Bryn Mawr Hospital, Main Line Health System, Bryn Mawr, PA, USA.
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
- , 219 Garnet Lane, Bala Cynwyd, PA, 19004, USA.
| | - David Yaron
- Department of Family Medicine, Bryn Mawr Hospital, Main Line Health System, Bryn Mawr, PA, USA
| | - Amanda Stahl Piraino
- Department of Family Medicine, Bryn Mawr Hospital, Main Line Health System, Bryn Mawr, PA, USA
| | - Luciano Kapelusznik
- Division of Infectious Diseases, Department of Medicine, Bryn Mawr Hospital, Main Line Health System, Bryn Mawr, PA, USA
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Polemis M, Mandilara G, Pappa O, Argyropoulou A, Perivolioti E, Koudoumnakis N, Pournaras S, Vasilakopoulou A, Vourli S, Katsifa H, Karampatakis T, Papavasiliou A, Petinaki E, Xitsas S, Skoura L, Protonotariou E, Mantzana P, Gartzonika K, Priavali E, Kallinteri A, Giannopoulou P, Charalampaki N, Memezas M, Calina Oana Z, Papadogianni M, Panopoulou M, Koutsidou A, Vatopoulos A, Tryfinopoulou K. COVID-19 and Antimicrobial Resistance: Data from the Greek Electronic System for the Surveillance of Antimicrobial Resistance-WHONET-Greece (January 2018-March 2021). Life (Basel) 2021; 11:996. [PMID: 34685368 PMCID: PMC8538738 DOI: 10.3390/life11100996] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 12/15/2022] Open
Abstract
Changes in hospitals' daily practice due to COVID-19 pandemic may have an impact on antimicrobial resistance (AMR). We aimed to assess this possible impact as captured by the Greek Electronic System for the Surveillance of Antimicrobial Resistance (WHONET-Greece). Routine susceptibility data of 17,837 Gram-negative and Gram-positive bacterial isolates from blood and respiratory specimens of hospitalized patients in nine COVID-19 tertiary hospitals were used in order to identify potential differences in AMR trends in the last three years, divided into two periods, January 2018-March 2020 and April 2020-March 2021. Interrupted time-series analysis was used to evaluate differences in the trends of non-susceptibility before and after the changes due to COVID-19. We found significant differences in the slope of non-susceptibility trends of Acinetobacter baumannii blood and respiratory isolates to amikacin, tigecycline and colistin; of Klebsiella pneumoniae blood and respiratory isolates to meropenem and tigecycline; and of Pseudomonas aeruginosa respiratory isolates to imipenem, meropenem and levofloxacin. Additionally, we found significant differences in the slope of non-susceptibility trends of Staphylococcus aureus isolates to oxacillin and of Enterococcus faecium isolates to glycopeptides. Assessing in this early stage, through surveillance of routine laboratory data, the way a new global threat like COVID-19 could affect an already ongoing pandemic like AMR provides useful information for prompt action.
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Affiliation(s)
- Michalis Polemis
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (O.P.); (K.T.)
| | - Georgia Mandilara
- School of Public Health, University of West Attica, 11521 Athens, Greece; (G.M.); (A.V.)
| | - Olga Pappa
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (O.P.); (K.T.)
| | - Athina Argyropoulou
- “Evaggelismos” General Hospital, 10676 Athens, Greece; (A.A.); (E.P.); (N.K.)
| | | | | | - Spyros Pournaras
- “Attikon” University Hospital, 12462 Athens, Greece; (S.P.); (A.V.); (S.V.)
| | | | - Sophia Vourli
- “Attikon” University Hospital, 12462 Athens, Greece; (S.P.); (A.V.); (S.V.)
| | - Helen Katsifa
- General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (H.K.); (T.K.); (A.P.)
| | - Theodoros Karampatakis
- General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (H.K.); (T.K.); (A.P.)
| | - Anastasia Papavasiliou
- General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (H.K.); (T.K.); (A.P.)
| | - Efthymia Petinaki
- University Hospital of Larissa, 41110 Larissa, Greece; (E.P.); (S.X.)
| | - Stylianos Xitsas
- University Hospital of Larissa, 41110 Larissa, Greece; (E.P.); (S.X.)
| | - Lemonia Skoura
- “Axepa” University Hospital, 54636 Thessaloniki, Greece; (L.S.); (E.P.); (P.M.)
| | | | - Paraskevi Mantzana
- “Axepa” University Hospital, 54636 Thessaloniki, Greece; (L.S.); (E.P.); (P.M.)
| | | | - Efthalia Priavali
- University Hospital of Ioannina, 45500 Ioannina, Greece; (K.G.); (E.P.); (A.K.)
| | - Amalia Kallinteri
- University Hospital of Ioannina, 45500 Ioannina, Greece; (K.G.); (E.P.); (A.K.)
| | | | | | - Meletis Memezas
- “Thriasio” General Hospital of Elefsina, 19600 Athens, Greece; (P.G.); (N.C.); (M.M.)
| | - Zervaki Calina Oana
- “St. George” General Hospital, 73300 Crete (Chania), Greece; (Z.C.O.); (M.P.)
| | - Marina Papadogianni
- “St. George” General Hospital, 73300 Crete (Chania), Greece; (Z.C.O.); (M.P.)
| | - Maria Panopoulou
- University Hospital of Alexandroupolis, 68100 Alexandroupoli, Greece; (M.P.); (A.K.)
| | - Athanasia Koutsidou
- University Hospital of Alexandroupolis, 68100 Alexandroupoli, Greece; (M.P.); (A.K.)
| | - Alkiviadis Vatopoulos
- School of Public Health, University of West Attica, 11521 Athens, Greece; (G.M.); (A.V.)
| | - Kyriaki Tryfinopoulou
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (O.P.); (K.T.)
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Aldika Akbar MI, Gumilar KE, Tjokroprawiro BA, Ulhaq RA. Successful management of a pregnant woman with COVID-19 and multiple severe complications. BMJ Case Rep 2021; 14:14/9/e243594. [PMID: 34531234 PMCID: PMC8449948 DOI: 10.1136/bcr-2021-243594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We report a case of a 36-year-old gravida 2 para 1 woman at 38 weeks of gestation. A caesarean section was performed for severe pre-eclampsia, intrauterine growth restriction and oligohydramnios. The patient suffered postoperative bleeding, and exploratory laparotomy was performed. Uterine atonia, Couvelaire uterus and left adnexal haematoma were found, requiring a supracervical hysterectomy. As COVID-19 pneumonia and superimposed bacterial infection developed, the patient was mechanically ventilated in the intensive care unit. Remdesivir and meropenem were initially administered, but were changed to levofloxacin and ciprofloxacin following antibiotic sensitivity tests. Blood culture grew Enterococcus galinarum. Meanwhile, bleeding of the incisional wound occurred, which was controlled by the cessation of heparin therapy and regular wound care. With intensive monitoring and multidisciplinary management, the patient’s condition improved, and she was discharged from the hospital on day 25 from admission.
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Affiliation(s)
| | - Khanisyah Erza Gumilar
- Department of Obstetrics and Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
| | | | - Renata Alya Ulhaq
- Midwifery Study Program, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
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Risk factors for invasive aspergillosis in ICU patients with COVID-19: current insights and new key elements. Ann Intensive Care 2021; 11:136. [PMID: 34524562 PMCID: PMC8441237 DOI: 10.1186/s13613-021-00923-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/29/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) has always been a challenging diagnosis and risk factors an important guide to investigate specific population, especially in Intensive Care Unit. Traditionally recognized risk factors for IPA have been haematological diseases or condition associated with severe immunosuppression, lately completed by chronic conditions (such as obstructive pulmonary disease, liver cirrhosis, chronic kidney disease and diabetes), influenza infection and Intensive Care Unit (ICU) admission. Recently, a new association with SARS-CoV2 infection, named COVID-19-associated pulmonary aspergillosis (CAPA), has been reported worldwide, even if its basic epidemiological characteristics have not been completely established yet. In this narrative review, we aimed to explore the potential risk factors for the development of CAPA and to evaluate whether previous host factors or therapeutic approaches used in the treatment of COVID-19 critically ill patients (such as mechanical ventilation, intensive care management, corticosteroids, broad-spectrum antibiotics, immunomodulatory agents) may impact this new diagnostic category. Reviewing all English-language articles published from December 2019 to December 2020, we identified 21 papers describing risk factors, concerning host comorbidities, ICU management, and COVID-19 therapies. Although limited by the quality of the available literature, data seem to confirm the role of previous host risk factors, especially respiratory diseases. However, the attention is shifting from patients' related risk factors to factors characterizing the hospital and intensive care course, deeply influenced by specific features of COVID treatment itself. Prolonged invasive or non-invasive respiratory support, as well as the impact of corticosteroids and/or immunobiological therapies seem to play a pivotal role. ICU setting related factors, such as environmental factors, isolation conditions, ventilation systems, building renovation works, and temporal spread with respect to pandemic waves, need to be considered. Large, prospective studies based on new risk factors specific for CAPA are warranted to guide surveillance and decision of when and how to treat this particular population.
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Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation. Infect Dis Rep 2021; 13:835-842. [PMID: 34563000 PMCID: PMC8482120 DOI: 10.3390/idr13030075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Few reports of necrotizing pneumonia in patients with COVID-19 have been published. We have observed an elevated incidence at two hospitals in our city, suggesting this complication is not uncommon, and may have been overlooked. (2) Methods: This article presents a retrospective, descriptive cohort study that was undertaken from 22 March 2020 to 15 June 2021 in two tertiary care hospitals in Medellín, Colombia. All adult patients admitted to the intensive care unit (ICU) for respiratory failure related to confirmed COVID-19, on invasive mechanical ventilation (IMV), with imaging or surgical findings documenting necrotizing pneumonia (NP) were included. (3) Results: Of 936 patients with COVID-19 that required IMV, 42 (4.5%) developed NP. Overall mortality was 57% and in-hospital mortality was 71%, occurring 15–79 days after COVID-19 diagnosis. NP was diagnosed at a median of 27 days after COVID-19 symptom onset and 15.5 days after initiation of IMV. Infections were polymicrobial in 52.4% of patients. Klebsiella pneumoniae (57%) and Pseudomonas aeruginosa (33%) were the most common etiologic agents. Pulmonary embolism (PE) was documented in 13 patients overall (31%), and in 50% of patients who underwent an angioCT. Drainage and/or surgical procedures were performed on 19 patients (45.2%) with a 75% mortality rate. (4) Conclusions: In our experience, NP is a relatively common, albeit neglected, complication in mechanically ventilated COVID-19 patients, possibly originating in poorly vascularized areas of lung parenchyma. Associated mortality is high. Although drainage procedures did not seem to favorably impact patient outcomes, diagnosis and treatment were late events in the overall disease course, suggesting that early recognition and timely treatment could have a positive impact on prognosis.
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Risa E, Roach D, Budak JZ, Hebert C, Chan JD, Mani NS, Bryson-Cahn C, Town J, Johnson NJ. Characterization of Secondary Bacterial Infections and Antibiotic Use in Mechanically Ventilated Patients With COVID-19 Induced Acute Respiratory Distress Syndrome. J Intensive Care Med 2021; 36:1167-1175. [PMID: 34372721 PMCID: PMC8358424 DOI: 10.1177/08850666211021745] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: COVID-19 has a widely variable clinical syndrome that is difficult to
distinguish from bacterial sepsis, leading to high rates of antibiotic use.
Early studies indicate low rates of secondary bacterial infections (SBIs)
but have included heterogeneous patient populations. Here, we catalogue all
SBIs and antibiotic prescription practices in a population of mechanically
ventilated patients with COVID-19 induced acute respiratory distress
syndrome (ARDS). Methods: This was a retrospective cohort study of all patients with COVID-19 ARDS
requiring mechanical ventilation from 3 Seattle, Washington hospitals in
2020. Data were obtained via electronic and manual review of the electronic
medical record. We report the incidence and site of SBIs, mortality, and
antibiotics per day using descriptive statistics. Results: We identified 126 patients with COVID-19 induced ARDS during the study
period. Of these patients, 61% developed clinical infection confirmed by
bacterial culture. Ventilator associated pneumonia was confirmed in 55% of
patients, bacteremia in 20%, and urinary tract infection (UTI) in 17%.
Staphylococcus aureus was the most commonly isolated
bacterial species. A total of 97% of patients received antibiotics during
their hospitalization, and patients received nearly one antibiotic per day
during their hospital stay. Conclusions: Mechanically ventilated patients with COVID-19 induced ARDS are at high risk
for secondary bacterial infections and have extensive antibiotic
exposure.
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Affiliation(s)
- Erik Risa
- University of Washington School of Medicine, Seattle, WA, USA
| | - David Roach
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jehan Z Budak
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - Christopher Hebert
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeannie D Chan
- Harborview Medical Center, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Nandita S Mani
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - Chloe Bryson-Cahn
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, WA, USA
| | - James Town
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Nicholas J Johnson
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Identification of bacterial co-detections in COVID-19 critically Ill patients by BioFire® FilmArray® pneumonia panel: a systematic review and meta-analysis. Diagn Microbiol Infect Dis 2021; 101:115476. [PMID: 34303085 PMCID: PMC8245667 DOI: 10.1016/j.diagmicrobio.2021.115476] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 12/14/2022]
Abstract
Among critically ill COVID-19 patients, bacterial coinfections may occur, and timely appropriate therapy may be limited with culture-based microbiology due to turnaround time and diagnostic yield challenges (e.g. antibiotic pre-exposure). We performed a systematic review and meta-analysis of the impact of BioFire® FilmArray® Pneumonia Panel in detecting bacteria and clinical management among critically ill COVID-19 patients admitted to the ICU. Seven studies with 558 patients were included. Antibiotic use before respiratory sampling occurred in 28-79% of cases. The panel incidence of detections was 33% (95% CI 0.25 to 0.41, I2=32%) while culture yielded 18% (95% CI 0.02 to 0.45; I2=93%). The panel was associated with approximately a 1 and 2 day decrease in turnaround for identification and common resistance targets, respectively. The panel may be an important tool for clinicians to improve antimicrobial use in critically ill COVID-19 patients.
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Castro-Lopes A, Correia S, Leal C, Resende I, Soares P, Azevedo A, Paiva JA. Increase of Antimicrobial Consumption in a Tertiary Care Hospital during the First Phase of the COVID-19 Pandemic. Antibiotics (Basel) 2021; 10:antibiotics10070778. [PMID: 34202340 PMCID: PMC8300755 DOI: 10.3390/antibiotics10070778] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 01/15/2023] Open
Abstract
Background: The COVID-19 pandemic poses novel challenges in antimicrobial consumption metrics and stewardship strategies. COVID-19 patients became the major cause of hospital admission during the first wave of the pandemic, often leading to an antimicrobial prescription upon admission or treatment for superinfections. The aim of this study was to understand how antimicrobial consumption was impacted at the beginning of the pandemic in a tertiary care hospital, a reference center for COVID-19. Materials and Methods: A retrospective before-and-after study was done. Descriptive statistics of discharges, patient-days, and antimicrobial use indicators (defined daily doses (DDD)/100 discharges, DDD/100 patient-days) for various groups were calculated for the first three months of the pandemic (March, April, and May 2020) as a quarterly value, and for each year in 2011–2019, and their annual percentage changes were used to estimate 95% confidence intervals. The indicators were compared to patient type (medical/surgical), type of admission (urgent/elective), and age groups using Spearman’s correlation coefficient. Results: Statistically significant increases occurred in 2020 for total antibacterials, macrolides, cephalosporins, amoxicillin/clavulanic acid, carbapenems, meropenem, and third-generation cephalosporins, while a reduction was seen in cefazolin/cefoxitin. A correlation was found between antibacterial consumption and patient or admission type. In 2020, unlike in pre-pandemic years, there was a different impact in DDD/100 discharges and DDD/100 patient-days due to increased lengths-of-stay and longer antimicrobial therapy. Conclusions: The COVID-19 pandemic led to an increase in antimicrobial consumption with a different impact in DDD/100 discharges and DDD/100 patient-days. This highlights the need to use both indicators simultaneously to better understand the causes of antimicrobial consumption variation and improve the design of effective antimicrobial stewardship interventions.
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Affiliation(s)
- Alexandre Castro-Lopes
- Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
- Correspondence: ; Tel.: +351-915875818
| | - Sofia Correia
- EPIUnit, Public Health Institute of University of Porto, 4050-091 Porto, Portugal; (S.C.); (C.L.); (A.A.)
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4200-319 Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
| | - Cátia Leal
- EPIUnit, Public Health Institute of University of Porto, 4050-091 Porto, Portugal; (S.C.); (C.L.); (A.A.)
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4200-319 Porto, Portugal
| | - Inês Resende
- Pharmaceutical Service, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (I.R.); (P.S.)
| | - Pedro Soares
- Pharmaceutical Service, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (I.R.); (P.S.)
| | - Ana Azevedo
- EPIUnit, Public Health Institute of University of Porto, 4050-091 Porto, Portugal; (S.C.); (C.L.); (A.A.)
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4200-319 Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
- Hospital Epidemiology Center, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
| | - José-Artur Paiva
- Intensive Care Medicine Service, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal;
- Department of Medicine, Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
- Infection and Sepsis Group, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
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The COVID-19 pandemic: a threat to antimicrobial resistance containment. Future Sci OA 2021; 7:FSO736. [PMID: 34290883 PMCID: PMC8204817 DOI: 10.2144/fsoa-2021-0012] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/26/2021] [Indexed: 12/23/2022] Open
Abstract
As of 23 April 2021, the outbreak of COVID-19 claimed around 150 million confirmed cases with over 3 million deaths worldwide. Yet, an even more serious but silent pandemic, that of antimicrobial resistance (AMR), is likely complicating the outcome of COVID-19 patients. This study discusses the current knowledge on the emergence of the SARS-CoV-2 and highlights the likely contribution of the COVID-19 pandemic on the escalation of AMR. COVID-19 engenders extensive antibiotic overuse and misuse, and will undoubtedly and substantially increase AMR rates worldwide. Amid the expanding COVID-19 pandemic, policymakers should consider the hidden threat of AMR much more, which may well be enhanced through improper use of antibiotics to treat patients with severe COVID-19 infection. Antimicrobial resistance (AMR) is a natural phenomenon that allows microorganisms to resist to the action of antimicrobial medicines that were previously active against them and cured the infection. AMR is caused by the appropriate and inappropriate use of antimicrobial medicines. The occurrence of the COVID-19 pandemic engenders extensive antimicrobial use that is likely to aggravated the AMR pandemic. This paper discusses the current knowledge on the SARS-CoV-2, and underscores the contribution of the COVID-19 pandemic on the escalation of AMR. Beyond the expanding COVID-19 pandemic, the hidden threat of AMR should also be considered by the decision-makers.
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O’Kelly B, Cronin C, Connellan D, Griffin S, Connolly SP, McGrath J, Cotter AG, McGinty T, Muldoon EG, Sheehan G, Cullen W, Doran P, McHugh T, Vidal L, Avramovic G, Lambert JS. Antibiotic prescribing patterns in patients hospitalized with COVID-19: lessons from the first wave. JAC Antimicrob Resist 2021; 3:dlab085. [PMID: 34223144 PMCID: PMC8242139 DOI: 10.1093/jacamr/dlab085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A high proportion of hospitalized patients with COVID-19 receive antibiotics despite evidence to show low levels of true bacterial coinfection. METHODS A retrospective cohort study examining antibiotic prescribing patterns of 300 patients sequentially diagnosed with COVID-19. Patients were grouped into 3 sub-cohorts: Group 1 received no antibiotics, Group 2 received antibiotics for microbiologically confirmed infections and Group 3 was empirically treated with antibiotics for pneumonia. The primary aim was to identify factors that influenced prescription and continuation of antibiotics in Group 3. Secondary aims were to examine differences in outcomes between groups. RESULTS In total, 292 patients were included (63 Group 1, 35 Group 2, 194 Group 3), median age was 60 years (IQR 44-76) and the majority were ethnically Irish (62%). The median duration of antibiotics was 7 days (IQR 5-10). In Group 3, factors associated with prescription IV antibiotics on admission were raised C-reactive protein (CRP) (P = 0.024), increased age (P = 0.023), higher quick SOFA (P = 0.016) score and fever >37.5 °C (P = 0.011). Factors associated with duration of antibiotic course were duration of hypoxia (P < 0.001) and maximum respiratory support requirement (P = 0.013). Twenty-one patients in Group 3 had one or more antibiotic escalation events, most (n = 139) had no escalation or de-escalation of therapy. CONCLUSIONS Duration of hypoxia and need for respiratory support may have acted as surrogate measures of improvement where usual response measures (CRP, neutrophilia, culture clearance) were absent. Continuous review of antibiotic prescriptions should be at the forefront of clinical management of hospitalized patients with COVID-19.
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Affiliation(s)
- Brendan O’Kelly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - Colm Cronin
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - David Connellan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sean Griffin
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Stephen Peter Connolly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - Jonathan McGrath
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Aoife G Cotter
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tara McGinty
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Eavan G Muldoon
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Gerard Sheehan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tina McHugh
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Louise Vidal
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | | | - John S Lambert
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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Puzniak L, Bauer KA, Yu KC, Moise P, Finelli L, Ye G, De Anda C, Vankeepuram L, Gupta V. Effect of Inadequate Empiric Antibacterial Therapy on Hospital Outcomes in SARS-CoV-2-Positive and -Negative US Patients With a Positive Bacterial Culture: A Multicenter Evaluation From March to November 2020. Open Forum Infect Dis 2021; 8:ofab232. [PMID: 34141818 PMCID: PMC8204877 DOI: 10.1093/ofid/ofab232] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022] Open
Abstract
Background Increased utilization of antimicrobial therapy has been observed during the coronavirus disease 2019 pandemic. We evaluated hospital outcomes based on the adequacy of antibacterial therapy for bacterial pathogens in US patients. Methods This multicenter retrospective study included patients with ≥24 hours of inpatient admission, ≥24 hours of antibiotic therapy, and discharge/death from March to November 2020 at 201 US hospitals in the BD Insights Research Database. Included patients had a test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a positive bacterial culture (gram-positive or gram-negative). We used generalized linear mixed models to evaluate the impact of inadequate empiric therapy (IET), defined as therapy not active against the identified bacteria or no antimicrobial therapy in the 48 hours following culture, on in-hospital mortality and hospital and intensive care unit length of stay (LOS). Results Of 438 888 SARS-CoV-2-tested patients, 39 203 (8.9%) had positive bacterial cultures. Among patients with positive cultures, 9.4% were SARS-CoV-2 positive, 74.4% had a gram-negative pathogen, 25.6% had a gram-positive pathogen, and 44.1% received IET for the bacterial infection. The odds of mortality were 21% higher for IET (odds ratio [OR], 1.21; 95% CI, 1.10–1.33; P < .001) compared with adequate empiric therapy. IET was also associated with increased hospital LOS (LOS, 16.1 days; 95% CI, 15.5–16.7 days; vs LOS, 14.5 days; 95% CI, 13.9–15.1 days; P < .001). Both mortality and hospital LOS findings remained consistent for SARS-CoV-2-positive and -negative patients. Conclusions Bacterial pathogens continue to play an important role in hospital outcomes during the pandemic. Adequate and timely therapeutic management may help ensure better outcomes.
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Affiliation(s)
| | | | - Kalvin C Yu
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | | | - Lyn Finelli
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Gang Ye
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
| | | | | | - Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA
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Nguyen LP, Park CS, Pinto NA, Lee H, Seo HS, Vu TN, Mai H, Pham AHT, Jang E, Cho YL, Goglin K, Nguyen K, White R, D’Souza R, Fouts DE, Yong D. In Vitro Activity of a Novel Siderophore-Cephalosporin LCB10-0200 (GT-1), and LCB10-0200/Avibactam, against Carbapenem-Resistant Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa Strains at a Tertiary Hospital in Korea. Pharmaceuticals (Basel) 2021; 14:370. [PMID: 33923801 PMCID: PMC8072773 DOI: 10.3390/ph14040370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022] Open
Abstract
The siderophore-antibiotic conjugate LCB10-0200 (a.k.a. GT-1) has been developed to combat multidrug-resistant Gram-negative bacteria. In this study, the in vitro activity of LCB10-0200 and LCB10-0200/avibactam (AVI) has been investigated against carbapenem-resistant Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Minimal inhibitory concentrations (MICs) of LCB10-0200, LCB10-0200/AVI, aztreonam, aztreonam/AVI, ceftazidime, ceftazidime/AVI, and meropenem were measured using the agar dilution method. Whole genome sequencing was performed using Illumina and the resistome was analyzed. LCB10-0200 displayed stronger activity than the comparator drugs in meropenem-resistant E. coli and K. pneumoniae, and the addition of AVI enhanced the LCB10-0200 activity to MIC ≤ 0.12 mg/L for 90.5% of isolates. In contrast, whereas LCB10-0200 alone showed potent activity against meropenem-resistant A. baumannii and P. aeruginosa at MIC ≤ 4 mg/L for 84.3% of isolates, the combination with AVI did not improve its activity. LCB10-0200/AVI was active against CTX-M-, SHV-, CMY-, and KPC- producing E. coli and K. pneumoniae, while LCB10-0200 alone was active against ADC-, OXA-, and VIM- producing A. baumannii and P. aeruginosa. Both LCB10-0200 and LCB10-0200/AVI displayed low activity against IMP- and NDM- producing strains. LCB10-0200 alone exhibited strong activity against selected strains. The addition of AVI significantly increased LCB10-0200 activity against carbapenem-resistant E. coli, K. pneumoniae.
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Affiliation(s)
- Le Phuong Nguyen
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Chul Soon Park
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
| | - Naina Adren Pinto
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Hyunsook Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Hyun Soo Seo
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
| | - Thao Nguyen Vu
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Hung Mai
- School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - An H. T. Pham
- UCI School of Biological Sciences, University of California, Irvine, CA 92617, USA;
| | - Eris Jang
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
| | | | | | - Kevin Nguyen
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Richard White
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Roshan D’Souza
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Derrick E. Fouts
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
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