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Szabo BG, Lenart KS, Petrik B, Gaspar Z, Kiss-Dala N, Szlavik J, Valyi-Nagy I, Lakatos B. Favipiravir treatment does not influence disease progression among adult patients hospitalized with moderate-to-severe COVID-19: a prospective, sequential cohort study from Hungary. GeroScience 2021; 43:2205-2213. [PMID: 34476717 PMCID: PMC8413073 DOI: 10.1007/s11357-021-00452-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022] Open
Abstract
Data suggests that favipiravir (FVP) could be used against SARS-CoV-2. Our aim was to investigate the role of FVP in COVID-19 treatment. A prospective sequential cohort study was performed among adults hospitalized at our center between March and August 2020 with moderate-to-severe, PCR-confirmed COVID-19. For diagnosis and severity, ECDC and WHO definitions were utilized. Patients were screened for inclusion by a priori criteria and included in the FVP cohort if standard-of-care (SOC) + FVP or the non-FVP cohort if SOC ± other antivirals without FVP were administered for > 48 h from diagnosis. Treatment allocation was done per national guidelines, based on severity and drug availability. Primary endpoint was disease progression, a composite of 14-day all-cause death, need for mechanical ventilation, or immunomodulatory therapy. The impact of FVP exposure on disease progression was analyzed by binomial logistic regression. In all, 150 patients were included, 75 in each cohort. Disease progression (17/75, 22.7% vs. 10/75, 13.3%, p = 0.13), 14-day all-cause death (9/75, 12.0% vs. 10/75, 13.3%, p = 0.8), and need for mechanical ventilation (8/75, 10.7% vs. 4/75, 5.3%, p = 0.22) were similar, while immunomodulatory therapies were required more frequently among patients receiving FVP (10/75, 13.3% vs. 1/75, 1.3%, p < 0.01). The use of favipiravir was not retained as a protective factor against disease progression in multivatiate analysis. Time to antiviral therapy from PCR positivity, disease severity, need for oxygen supportation, and ICU admittance rates did not differ statistically between cohorts. In this study, favipiravir did not seem to positively affect disease progression.
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Affiliation(s)
- Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, H-1097 Albert Florian ut 5‑7., Budapest, Hungary. .,Doctoral School of Clinical Medicine, Semmelweis University, H-1085 Ulloi ut 26, Budapest, Hungary.
| | - Katalin Szidonia Lenart
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, H-1097 Albert Florian ut 5‑7., Budapest, Hungary
| | - Borisz Petrik
- Faculty of Medicine, Semmelweis University, H-1085 Ulloi ut 26, Budapest, Hungary
| | - Zsofia Gaspar
- Faculty of Medicine, Semmelweis University, H-1085 Ulloi ut 26, Budapest, Hungary
| | - Noemi Kiss-Dala
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, H-1097 Albert Florian ut 5‑7., Budapest, Hungary.,Doctoral School of Clinical Medicine, Semmelweis University, H-1085 Ulloi ut 26, Budapest, Hungary
| | - Janos Szlavik
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, H-1097 Albert Florian ut 5‑7., Budapest, Hungary
| | - Istvan Valyi-Nagy
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, H-1097 Albert Florian ut 5‑7., Budapest, Hungary
| | - Botond Lakatos
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, H-1097 Albert Florian ut 5‑7., Budapest, Hungary
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Szabo BG, Duma L, Lenart KS, Kiss R, Vad E, Petrik BR, Ostorhazi E, Kadar B. Characteristics and predictors of treatment failure with intravenous tigecycline monotherapy among adult patients with severe Clostridioides (Clostridium) difficile infection: a single-centre observational cohort study. Diagn Microbiol Infect Dis 2020; 99:115231. [PMID: 33099134 DOI: 10.1016/j.diagmicrobio.2020.115231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 12/15/2022]
Abstract
Our aim was to analyze characteristics of treatment failure with intravenous tigecycline monotherapy among adults with severe Clostridioides (Clostridium) difficile infection (CDI). A single-centre observational cohort study was performed between 2014 and 2018. Data were collected by charts review, diagnosis and severity were determined by ESCMID guidelines. Primary outcome was treatment failure, secondary outcomes were in-hospital mortality, relapse, colectomy, and complication rates. Independent predictors of failure were identified using logistic regression. Altogether 110 patients were included, failure occurred in 37.3%. Patients with failure frequently had chronic heart and pulmonary co-morbidities, peritonitis, higher CRP levels, ICU admittance rates and need for total parenteral nutrition and vasopressors. Mostly, CDI-specific mortality and complications contributed to failure. Relapse rates were similar. Chronic pulmonary disease, ileus, total parenteral nutrition, and duration of tigecycline therapy were predictors of failure. We conclude that severe CDI cases with higher risk for tigecycline monotherapy failure might be identified by contributing factors.
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Affiliation(s)
- Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary; Semmelweis University, School of PhD Studies, Budapest, Hungary.
| | - Lilla Duma
- Semmelweis University, Faculty of Medicine, Medical Doctor Programme, Budapest, Hungary
| | - Katalin Szidonia Lenart
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Rebeka Kiss
- Markhot Ferenc Teaching Hospital, Eger, Hungary
| | - Eszter Vad
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Borisz Raban Petrik
- Semmelweis University, Faculty of Medicine, Medical Doctor Programme, Budapest, Hungary
| | - Eszter Ostorhazi
- Semmelweis University, Institute of Medical Microbiology, Budapest, Hungary
| | - Bela Kadar
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary; Semmelweis University, Institute of Medical Microbiology, Budapest, Hungary
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Szabo BG, Kiss R, Lenart KS, Marosi B, Vad E, Lakatos B, Ostorhazi E. Clinical and microbiological characteristics and outcomes of community-acquired sepsis among adults: a single center, 1-year retrospective observational cohort study from Hungary. BMC Infect Dis 2019; 19:584. [PMID: 31349818 PMCID: PMC6659200 DOI: 10.1186/s12879-019-4219-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022] Open
Abstract
Background Community-acquired sepsis is a life-threatening systemic reaction, which starts within ≤72 h of hospital admittance in an infected patient without recent exposure to healthcare risks. Our aim was to evaluate the characteristics and the outcomes concerning community-acquired sepsis among patients admitted to a Hungarian high-influx national medical center. Methods A retrospective, observational cohort study of consecutive adult patients hospitalized with community-acquired sepsis during a 1-year period was executed. Clinical and microbiological data were collected, patients with pre-defined healthcare associations were excluded. Sepsis definitions and severity were given according to ACCP/SCCM criteria. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were intensive care unit (ICU) admittance, length-of-stay (LOS), source control and bacteraemia rates. Statistical differences were explored with classical comparison tests, predictors of in-hospital all-cause mortality were modelled by multivariate logistic regression. Results 214 patients (median age 60.0 ± 33.1 years, 57% female, median Charlson score 4.0 ± 5.0) were included, 32.7% of them (70/214) had severe sepsis, and 28.5% (61/214) had septic shock. Prevalent sources of infections were genitourinary (53/214, 24.8%) and abdominal (52/214, 24.3%). The causative organisms were dominantly E. coli (60/214, 28.0%), S. pneumoniae (18/214, 8.4%) and S. aureus (14/214, 6.5%), and bacteraemia was documented in 50.9% of the cases (109/214). In-hospital mortality was high (30/214, 14.0%), and independently associated with shock, absence of fever, male gender and the need for ICU admittance, but source control and de-escalation of empirical antimicrobial therapy were protective. ICU admittance was 27.1% (58/214), source control was achieved in 18.2% (39/214). Median LOS was 10.0 ± 8.0, ICU LOS was 8.0 ± 10.8 days. Conclusions Community-acquired sepsis poses a significant burden of disease with characteristic causative agents and sources. Patients at a higher risk for poor outcomes might be identified earlier by the contributing factors shown above.
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Affiliation(s)
- Balint Gergely Szabo
- Semmelweis University, School of PhD Studies, H-1085 Ulloi ut 26., Budapest, Hungary. .,Department of Infectious Diseases, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, H-1097 Albert Florian ut 5-7., Budapest, Hungary. .,Infectious Disease Specialist Training, Semmelweis University, Faculty of Medicine, H-1085 Ulloi ut 26., Budapest, Hungary.
| | - Rebeka Kiss
- Department of Infectious Diseases, Markhot Ferenc Teaching Hospital, H-3300 Szechenyi utca 27-29., Eger, Hungary
| | - Katalin Szidonia Lenart
- Department of Infectious Diseases, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, H-1097 Albert Florian ut 5-7., Budapest, Hungary.,Infectious Disease Specialist Training, Semmelweis University, Faculty of Medicine, H-1085 Ulloi ut 26., Budapest, Hungary
| | - Bence Marosi
- Faculty of Medicine, Students' Scientific Association, Semmelweis University, H-1085 Ulloi ut 26., Budapest, Hungary
| | - Eszter Vad
- Semmelweis University, School of PhD Studies, H-1085 Ulloi ut 26., Budapest, Hungary.,South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Core Microbiology Laboratory, H-1097 Albert Florian ut 5-7., Budapest, Hungary
| | - Botond Lakatos
- Department of Infectious Diseases, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, H-1097 Albert Florian ut 5-7., Budapest, Hungary
| | - Eszter Ostorhazi
- Semmelweis University, Institute of Medical Microbiology, H-1098 Nagyvarad ter 4., Budapest, Hungary
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Szabo BG, Lenart KS, Tirczka T, Ostorhazi E. Clinical and microbiological characteristics of adult invasive Haemophilus influenzae infections: results of a 14-year single-center experience from Hungary. Infection 2018; 46:855-860. [PMID: 30191513 DOI: 10.1007/s15010-018-1213-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/04/2018] [Indexed: 11/24/2022]
Abstract
To describe the characteristics of adult invasive H. influenzae disease, 34 patients diagnosed at a single tertiary center between 2004 and 2017 were analyzed in a retrospective case series study. The annual estimated incidence was 0.1 cases/100.000 inhabitants. Dominant source of infection was pneumonia accompanied by sepsis (62%) and caused by nontypeable strains (74%) with low ampicillin resistance (14%). Survival (94%) and complication rates were high (35%). Main empirical treatments were ceftriaxone or levofloxacine.
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Affiliation(s)
- Balint Gergely Szabo
- Department of Infectious Diseases, Saint Ladislaus Campus, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, Budapest, 1097, Hungary. .,Faculty of Medicine, Infectious Disease Specialist Training, Semmelweis University, Ulloi ut 26, Budapest, 1085, Hungary. .,School of PhD Studies, Doctoral School of Clinical Medicine, Semmelweis University, Ulloi ut 26, Budapest, 1085, Hungary.
| | - Katalin Szidonia Lenart
- Department of Infectious Diseases, Saint Ladislaus Campus, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Albert Florian ut 5-7, Budapest, 1097, Hungary.,Faculty of Medicine, Infectious Disease Specialist Training, Semmelweis University, Ulloi ut 26, Budapest, 1085, Hungary
| | - Tamas Tirczka
- National Public Health Institute, Albert Florian ut 2-6, Budapest, 1097, Hungary
| | - Eszter Ostorhazi
- Institute of Medical Microbiology, Semmelweis University, Nagyvarad ter 4, Budapest, 1098, Hungary
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