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Arzilli G, Forni S, Righi L, Barnini S, Petricci P, Parisio EM, Pistello M, Vivani P, Gemignani G, Baggiani A, Bellandi T, Privitera G, Gemmi F, Tavoschi L, Porretta A. Trends in hospital acquired NDM-producing Enterobacterales in Tuscany (Italy) from 2019 to 2021: impact of the COVID-19 pandemic. J Hosp Infect 2023:S0195-6701(23)00142-1. [PMID: 37160231 DOI: 10.1016/j.jhin.2023.04.016] [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: 11/13/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) in hospitalised patients has increasingly been observed since 2018, leading in 2019 to the implementation of enhanced control measures successfully reducing transmission. We describe the NDM-CRE epidemiology during the COVID-19 pandemic in Tuscany. METHODS Data on NDM-CRE patients hospitalised in five Tuscan hospitals were collected from 01/2019 to 12/2021. Weekly rates of NDM-CRE cases on hospital days in medical and critical-care wards were calculated. In March-December 2020, NDM-CRE rates were stratified by COVID-19 diagnosis. Multivariate regression analysis was performed to assess outcomes' differences among two periods analysed and between COVID-19 populations. RESULTS Since March 2020 an increase in NDM-CRE cases was observed, associated with COVID-19 admissions. COVID-19 patients differed significantly from non-COVID-19 ones by several variables, including patient features (age, Charlson index) and clinical history and outcomes (NDM-CRE infection/colonisation, ICU stay, length of stay, mortality). During the pandemic, we observed a higher rate of NDM-CRE cases per hospital days in both non-COVID-19 patients (273/100,000) and COVID-19 patients (370/100,00) when compared with pre-pandemic period cases (187/100,00). CONCLUSIONS Our data suggest a resurgence in NDM-CRE spread among hospitalised patients in Tuscany during the COVID-19 pandemic, as well as a change in patients' case-mix. The observed increase in hospital transmission of NDM-CRE could be related to changes in infection prevention and control procedures, aimed mainly at COVID-19 management, leading to new challenges in hospital preparedness and crisis management planning.
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Affiliation(s)
- Guglielmo Arzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Silvia Forni
- Regional Health Agency of Tuscany, Florence, Italy
| | - Lorenzo Righi
- Quality of care and Clinical networks, Tuscany Region, Florence, Italy
| | - Simona Barnini
- Microbiology Unit, University Hospital of Pisa, Pisa, Italy
| | | | | | - Mauro Pistello
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Virology Unit, University Hospital of Pisa, Pisa, Italy
| | - Paola Vivani
- Massa Carrara Hospital, Toscana Northwest Health Authority, Massa Carrara, Italy
| | | | - Angelo Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; University Hospital of Pisa, Pisa, Italy
| | - Tommaso Bellandi
- Centre for Clinical Risk Management and Patient Safety, Florence, Italy
| | - Gaetano Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; University Hospital of Pisa, Pisa, Italy
| | | | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Andrea Porretta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; University Hospital of Pisa, Pisa, Italy
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Prokein B, Dau M, Mittlmeier T, Schafmayer C, Frerich B. [Surgical emergencies during the COVID-19 pandemic]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:454-459. [PMID: 36859604 PMCID: PMC9977090 DOI: 10.1007/s00104-023-01832-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Within a few months coronavirus disease 2019 (COVID-19) spread around the world. Some studies showed a significant reduction in medical consultations. Due to new discussions about restrictions in the case of rising COVID-19 case numbers, this study investigated the consequences of the COVID-19 pandemic on surgical emergencies at the Rostock University Medical Center and compared the results to the years before. MATERIAL AND METHODS The aim of the study was to compare the case numbers of the surgical emergency department of the Rostock University Medical Center from the period 2020 and 2021 to the years before (2018, 2019). Furthermore, the consequences of COVID-19 case numbers for the case numbers of the surgical emergency department were investigated. RESULTS A total of 74,936 patient cases could be included in this study. The results showed a significant reduction of surgical emergencies during the COVID-19 pandemic (p < 0.001). There was a significant negative correlation with the COVID-19 case numbers (p < 0.001). The restrictions of the government showed a direct influence on COVID-19 case numbers and emergency visits. CONCLUSION The results showed a correlation of COVID-19 case numbers with the case numbers of the surgical emergency department. Due to difficult workforce planning during a pandemic, this can be important information for workforce management in similar future events.
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Affiliation(s)
- Benjamin Prokein
- Klinik für Mund‑, Kiefer- und Plastische Gesichtschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland.
| | - Michael Dau
- grid.413108.f0000 0000 9737 0454Klinik für Mund‑, Kiefer- und Plastische Gesichtschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18055 Rostock, Deutschland
| | - Thomas Mittlmeier
- grid.413108.f0000 0000 9737 0454Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18055 Rostock, Deutschland
| | - Clemens Schafmayer
- grid.413108.f0000 0000 9737 0454Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax‑, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18055 Rostock, Deutschland
| | - Bernhard Frerich
- grid.413108.f0000 0000 9737 0454Klinik für Mund‑, Kiefer- und Plastische Gesichtschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18055 Rostock, Deutschland
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Impact of the COVID-19 Pandemic on Pediatric Surgical Volume in Four Low- and Middle-Income Country Hospitals: Insights from an Interrupted Time Series Analysis. World J Surg 2022; 46:984-993. [PMID: 35267077 PMCID: PMC8908743 DOI: 10.1007/s00268-022-06503-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/24/2022]
Abstract
Background The impact of the COVID-19 pandemic on surgical care delivery in low- and middle-income countries (LMIC) has been challenging to assess due to a lack of data. This study examines the impact of COVID-19 on pediatric surgical volumes at four LMIC hospitals. Methods Retrospective and prospective pediatric surgical data collected at hospitals in Burkina Faso, Ecuador, Nigeria, and Zambia were reviewed from January 2019 to April 2021. Changes in surgical volume were assessed using interrupted time series analysis. Results 6078 total operations were assessed. Before the pandemic, overall surgical volume increased by 21 cases/month (95% CI 14 to 28, p < 0.001). From March to April 2020, the total surgical volume dropped by 32%, or 110 cases (95% CI − 196 to − 24, p = 0.014). Patients during the pandemic were younger (2.7 vs. 3.3 years, p < 0.001) and healthier (ASA I 69% vs. 66%, p = 0.003). Additionally, they experienced lower rates of post-operative sepsis (0.3% vs 1.5%, p < 0.001), surgical site infections (1.3% vs 5.8%, p < 0.001), and mortality (1.6% vs 3.1%, p < 0.001). Conclusions During the COVID-19 pandemic, children’s surgery in LMIC saw a sharp decline in total surgical volume by a third in the month following March 2020, followed by a slow recovery afterward. Patients were healthier with better post-operative outcomes during the pandemic, implying a widening disparity gap in surgical access and exacerbating challenges in addressing the large unmet burden of pediatric surgical disease in LMICs with a need for immediate mitigation strategies. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06503-2.
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Al-Omran AS. COVID-19 Pandemic Impact on Orthopaedic Trauma Practice: A Global Perspective. Orthop Res Rev 2022; 14:9-15. [PMID: 35115847 PMCID: PMC8800867 DOI: 10.2147/orr.s345301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/15/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE We conducted a systematic review to evaluate the global impact on orthopaedic trauma admissions during the COVID-19 crisis and compare it to that in Saudi Arabia. METHODS We conducted an extensive search of the PubMed and the Cochrane Central Register of Clinical Trials databases for articles published on orthopaedic trauma during the pandemic. We used the terms "orthopaedic trauma", "coronavirus", "covid-19", and "Sars-cov-2" for the search. We retrieved data to assess the impact of COVID-19 on orthopaedic and trauma patients attending hospitals during the pandemic. Secondary outcomes included reports from various regions of the world, differences in patient age, gender, and comparison to the nonlockdown period. We excluded questionnaires, surveys, reviews, and meta-analyses. The studies were divided based on where they were conducted: the Americas; the United Kingdom; Europe; Asia; the Middle East; and Australia, including New Zealand. RESULTS We retrieved 763 studies using the keywords and initially analyzed 70. We chose 23 studies for final analysis, which were all retrospective studies, from which we extracted 50% of our preset data. These articles included 16,383 patients who sought advice related to orthopaedic and trauma necessities during the pandemic. Before the pandemic, 61,559 patients sought advice for orthopaedic and trauma necessities. Most of the reports focused on adults, and in three studies, researchers reported on paediatric on orthopaedic patients. The average decrease in patients seeking orthopaedic and trauma assistance during the pandemic was 45.5 ± 20.4 (range 18.9-86%, p < 0.001). The largest decrease in patients seeking advice occurred in Asia (>60%), and the lowest occurred in Australia and New Zealand (about 20%, p < 0.001). CONCLUSION Presentations of orthopaedic trauma during the COVID-19 during pandemic lockdown was less but not as profoundly as one may have expected.
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Affiliation(s)
- Abdallah S Al-Omran
- Department of Orthopaedic Surgery, College of Medicine, Imam AbdulRahman Bin Faisal University Dammam and King Fahd Hospital of the University, AlKhobar, Saudi Arabia
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Rajesh J, Valentelyte G, McNamara DA, Sorensen J. Impact of the COVID-19 pandemic on provision and outcomes of emergency abdominal surgery in Irish public hospitals. Ir J Med Sci 2021; 191:2275-2282. [PMID: 34822021 PMCID: PMC8613337 DOI: 10.1007/s11845-021-02857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
Background The SARS-CoV-2 pandemic caused severe disruption to scheduled surgery in Ireland but its impact on emergency abdominal surgery (EAS) is unknown. Aims The primary objective was to identify changes in volume, length of stay (LOS), and survival outcomes following EAS during the pandemic. A secondary objective was to evaluate differences in EAS patient flow including admission source, ITU utilisation, discharge destination, and readmission rates. Methods Using a national administrative dataset, demographic, comorbidity, and patient flow data on 5611 patients admitted for EAS between 2018 and 2020 were extracted. Pre-pandemic and pandemic timeframes were compared using graphic and regression analyses, and bivariate logistic regression, adjusting for demographics and case-mix. Results There was a 19.9% decrease in EAS during the 2020 COVID-19 pandemic with no difference in comorbidity, nor in the commonest procedures. Most patients (92.4%) were admitted from home. In-hospital post-operative mortality was unchanged (7.6%). Patients over 80 comprised 16.3% of EAS pre-COVID, but 17.9% during COVID. Average total LOS reduced significantly by 4.9 days and 3.5 days during COVID-19 waves 1 (29 Feb 2020–30 June 2020) and 2 (1 July 2020–30 Nov 2020), respectively. During wave 1, pre-operative LOS reduced (1 day) and ICU LOS was significantly shorter (0.8 days), but similar change was not observed during wave 2. Conclusions Significant improvements in patient flow following admission for EAS during the pandemic were observed. These changes were not associated with greater mortality nor increased readmission rates and offer important insights into optimal delivery of EAS services.
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Affiliation(s)
- Joel Rajesh
- National Clinical Programme in Surgery (NCPS), Royal College of Surgeons in Ireland (RCSI), 2 Proud's Lane, Dublin, Ireland
| | - Gintare Valentelyte
- Healthcare Outcomes Research Centre (HORC), Royal College of Surgeons in Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, Ireland
| | - Deborah A McNamara
- National Clinical Programme in Surgery (NCPS), Royal College of Surgeons in Ireland (RCSI), 2 Proud's Lane, Dublin, Ireland.
| | - Jan Sorensen
- Healthcare Outcomes Research Centre (HORC), Royal College of Surgeons in Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, Ireland
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Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111185. [PMID: 34833403 PMCID: PMC8624623 DOI: 10.3390/medicina57111185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/29/2022]
Abstract
Background and Objectives: The outbreak of the COVID-19 pandemic had a major impact on all aspects of health care. Few up-to-date studies have actually assessed the impact of COVID-19 on emergency surgeries. The aim of this study was to provide an overview of the impact of the pandemic relating to the emergency surgery performed, as well as morbidity and mortality rates during the first year of the pandemic (March 2020–February 2021) and during the control period. In this period, the first propaedeutic surgery department and the third surgery department of the University General Hospital of Thessaloniki “AHEPA” in Greece provided continuous emergency general surgery services. Material and Methods: The study is in a retrospective cohort and included patients who were admitted to the Emergency Department and underwent emergency general surgery during the control period (n = 456), March 2019–February 2020 and during the first year of the pandemic (n = 223), March 2020–February 2021. Gender, age, type of surgical operation (morbidity), ICU need, the patient’s outcome, and days of hospitalization were compared. Results: A total of 679 emergency surgeries were included. Statistically significant differences emerged between the two time periods in the total number of emergency surgeries performed (p < 0.001). The most common type of surgery in the control period was associated with soft tissue infection while, during the pandemic period, the most common type of surgery was associated with the hepatobiliary system. In addition, the mortality rates nearly doubled during the pandemic period (2.2% vs. 4%). Finally, the mean age of our sample was 50.6 ± 17.5 and the majority of the participants in both time periods were males. Conclusions: The COVID-19 pandemic changed significantly the total number of emergency general surgeries performed. Mortality rates doubled and morbidity rates were affected between the control and pandemic periods. Finally, age, gender, length of hospitalization, intensive care unit hospitalization, and laparoscopy use in patients undergoing emergency surgery during the pandemic were stable.
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