Prevalence of secondary infections and association with mortality rates of hospitalized COVID-19 patients

Impact of COVID-19 on mortality in out-of-hospital cardiac arrest patients with return of spontaneous circulation: a retrospective cohort study

BACKGROUND

This study aims to compare the mortality rates of OHCA patients with and without COVID-19 infection across different follow-up periods and explores the factors may play a significant role in determining OHCA outcomes.

METHODS

This study utilized data from the US Collaborative Network in TriNetX. A total of 25,271 hospitalized OHCA patients were recruited from records spanning from January 1, 2020, to December 31, 2023. Study population divided into two groups, COVID-19 positive and COVID-19 negative groups. The mortality risk of the two groups was observed based on different follow-up periods. Subgroup analyses on sex, age, antivirals use, COVID-19 virus variant epidemic period were also conducted.

RESULTS

Our study included 2,776 patients in each group (COVID vs. non-COVID). The primary outcome was mortality at 14-day and 90-day follow-ups. COVID-19 patients had a lower 14-day mortality (HR 0.82, 95% CI: 0.76-0.88) but higher 90-day mortality (HR 1.16, 95% CI: 1.09-1.24) compared to non-COVID-19 patients. Secondary outcomes included higher mortality in COVID-19 patients under 65, and this trend persisted in those aged 65 and over. Male COVID-19 patients had elevated mortality risk. The Alpha and Delta variant period showed a higher mortality rate for COVID-19 patients than non-COVID-19 patients.

CONCLUSION

COVID-19 was associated with a higher risk of mortality in OHCA patients.

Clinical characteristics and prognosis of COVID-19- associated invasive pulmonary aspergillosis in critically patients: a single-center study

Objective

A single-center retrospective study was conducted according to the latest diagnostic criteria of the European Consortium for Mycology in Medicine/International Society for Human and Animal Mycoses (ECMM/ISHAM) Consensus, which describes the clinical characteristics, factors influencing and prognosis of a group of patients with COVID-19 (Omicron variant) combined with invasive pulmonary mycoses with onset of disease at the end of 2022.

Methods

This study retrospectively analyzed data related to 58 hospitalized patients with severe pneumonia due to COVID-19 infection admitted to the ICU of critical care medicine, respiratory ICU, and ICU of the Department of Infections at the First Affiliated Hospital of Soochow University from December 1, 2022, to January 31, 2023. CAPA was defined according to the ECMM/ISHAM consensus criteria. Our study compared the clinical and microbiological characteristics and associated risk factors of fungal infections and pulmonary fungal infections and performed univariate and multivariate analyses of factors associated with mortality in patients with COVID-19-Associated Pulmonary Aspergillosis (CAPA).

Results

17 (29.3%) of the 58 critically ill patients were diagnosed with CAPA, of which 10 (58.82%) patients were Probable CAPA and 7 (41.18%) patients were Possible CAPA. Among this Aspergillus strains, Aspergillus fumigatus strains were found in 13 cases (76.47%) and Aspergillus niger strains in 4 cases (23.53%). 7 (41.18%) patients had concomitant bacterial fungal infections with a mortality rate of 57.14% (4/7), of which Acinetobacter baumannii was the most common pathogen. Among the patients with CAPA, galactomannan assay of bronchoalveolar lavage fluid (BALF) was performed in 5 patients with a 100% (5/5) positivity rate, and two or more serum galactomannan (GM) assays were performed in 17 patients, with a probability of favorable results in both cases of 41.2% (7/17). The 60-day mortality rate in patients with CAPA was 52.9% (9/17), whereas the non-CAPA patients had a 60-day mortality rate of 24.4% (10/41), which was statistically different (P = 0.035). Diabetes mellitus (P = 0.018, OR: 5.040 (95% CI: 1.314-19.337)), renal insufficiency (P=0.002, OR: 11.259 (95% CI: 2.480-51.111)), chronic obstructive pulmonary disease (COPD) (P = 0.003, OR: 6.939 (95% CI: 1.963-24.531)), elevated interleukin-6 (IL-6) (P = 0.022, OR: 4.160 (95% CI: 1.226~14.113)), mechanical ventilation (P = 0.002, OR: 8.100 (95%CI: 2.132~30.777)), increased duration of steroids use (P = 0.022, OR: 1.071 (95%CI: 1.010~1.135)), increased cumulative dose of steroids use ((P < 0.001, OR: 1.012 (95%CI: 1.009~1.015)), use of tocilizumab (P = 0.020, OR: 11.480 (95%CI: 2.480~51.111)), and increased length of hospitalization in ICU (P = 0.021, OR: 1.038 (95% CI: 1.006 to 1.071)), and increase in the type of antibiotics used (P = 0.002, OR: 1.603 (95% CI: 1.181 to 2.176)) were the risk factors for the occurrence of fungal infections, whereas the use of steroids or not, the use of baricitinib or not, and hypertension did not have a significant effect on the occurrence of fungal infections (P > 0.05). Patients with CAPA had a higher mortality rate, and their hospitalization was prolonged compared to non-CAPA patients. The all-cause mortality rate for patients with CAPA was 52.9%. We also performed univariate and multivariate analyses of potential factors associated with mortality, including the use of mechanical ventilation (P = 0.040 OR: 10.500, (95% CI: 1.115 to 98.914)), advanced age (P = 0.043 OR: 1.212, (95% CI: 1.006 to 1.460)), and a significantly higher CRP level (P = 0.042 OR: 1.043, (95% CI: 1.002~1.078)) had a worse prognosis. Steroids use, gender, and diabetes mellitus were not associated with patient death (P > 0.05).

Prevalence and risk factors associated with multidrug-resistant bacteria in COVID-19 patients

Bacterial coinfection among patients with confirmed coronavirus disease 2019 (COVID-19) is a critical medical concern that increases the disease severity and mortality rate. The current study is aimed at evaluating the effects of bacterial coinfections among COVID-19 patients, especially in relation to degree of severity and mortality. A retrospective study was conducted for patients with positive COVID-19 test, admitted to a regional COVID-19 hospital in Jeddah, Saudi Arabia, between May and August 2020. A specimen (e.g., blood, urine, or sputum) was collected from patients with confirmed COVID-19, and was cultured to determine bacterial coinfection caused by multidrug resistant (MDR) bacteria. COVID-19 patients were categorized into 2 groups based on the result of bacterial coinfection culture, as COVID-19 patients with coinfection and COVID-19 patients without coinfection. Independent sample t test or Mann-Whitney U test was used to compare age and hospitalization period between these groups. In addition, binominal logistic regression was applied to identify risk factors associated with mortality and bacterial coinfection. The study included 342 patients with laboratory confirmed COVID-19. Eighty (23.3%) patients were diagnosed with bacterial coinfection, while the remaining 262 (76.6%) patients did not test positive for bacterial coinfection. Length of hospital stay was prolonged among COVID-19 patients diagnosed with bacterial coinfection (16.01 ± 11.36 days) when compared with patients without bacterial coinfection (6.5 ± 6.12 days). Likewise, the mortality rate was significantly higher among COVID-19 patients with bacterial coinfection (90%) compared to those without bacterial coinfection (49.2%). Gram-negative bacteria were predominant compared to gram-positive, as Klebsiella pneumoniae (35 [43.8%]) and Acinetobacter baumanni (32 [40%]). On the other hand, Staphylococcus aureus (4 [5%]), Enterococcus faecalis (1 [1.3%]), and Enterococcus faecium (1 [1.3%]) were identified as gram-positive bacterial species from recruited patients. The findings of the current study showed that prolong hospitalization is the main risk factor associated with bacterial coinfection and death. Thus, health care providers should minimize hospitalization as well as following a continuous monitoring for bacterial coinfection among COVID-19 patients, to control the spread of infection and reducing the severity and mortality rate among COVID-19 patients.