Long COVID sexual dysfunction among both genders: Evaluation of a cohort of COVID-19 recoverees

OBJECTIVES

We aimed to assess Long COVID sexual dysfunction among both sexes.

PATIENTS AND METHODS

A cross-sectional study at a multidisciplinary COVID clinic. Consecutive patients answered a symptom-based questionnaire, which included sexual dysfunction. Individuals reporting any degree of sexual dysfunction were compared with those who denied. A multivariable logistic regression was conducted to identify risk factors. A principal component analysis was implemented to explore other symptoms associated with sexual dysfunction.

RESULTS

All in all, 391 individuals recovering from COVID-19 completed the questionnaire, 211 women and 180 men. Mean age was 45.2 (SD 15.4) years. Most (280, 85.9%) had mild COVID-19, assessed at a median of 3.8 (IQR 2.0) months from diagnosis. Sexual dysfunction was reported by 55 (36%) of the men and 48 (28%) of the women. Increased age [per year; men OR 1.05 (95% CI 1.02-1.08)], long COVID cough [men 2.58 (1.05-6.32)], chest pain [women 3.54 (1.28-9.80)], irritability [women 3.45 (1.28-9.29)], paresthesia [men 4.23 (1.55-10.44); women 3.08 (1.14-8.32)], and emotional distress [men 3.26 (1.36-7.82); women 4.29 (1.65-11.18)] were significantly associated with sexual dysfunction. In women, sexual dysfunction was part of the emotional pattern, while among men, it was part of the emotional and pulmonary patterns.

CONCLUSION

Sexual dysfunction is a common manifestation of long COVID in both men and women. Presence of other long COVID symptoms, and older age, are associated with this phenomenon. Further studies should explore the mechanisms for long COVID sexual dysfunction in both men and women, as well as strategies for prevention and treatment.

Population pharmacokinetics of colistin and the relation to survival in critically ill patients infected with colistin susceptible and carbapenem-resistant bacteria

OBJECTIVES

The aim was to analyse the population pharmacokinetics of colistin and to explore the relationship between colistin exposure and time to death.

METHODS

Patients included in the AIDA randomized controlled trial were treated with colistin for severe infections caused by carbapenem-resistant Gram-negative bacteria. All subjects received a 9 million units (MU) loading dose, followed by a 4.5 MU twice daily maintenance dose, with dose reduction if creatinine clearance (CrCL) < 50 mL/min. Individual colistin exposures were estimated from the developed population pharmacokinetic model and an optimized two-sample per patient sampling design. Time to death was evaluated in a parametric survival analysis.

RESULTS

Out of 406 randomized patients, 349 contributed pharmacokinetic data. The median (90% range) colistin plasma concentration was 0.44 (0.14-1.59) mg/L at 15 minutes after the end of first infusion. In samples drawn 10 hr after a maintenance dose, concentrations were >2 mg/L in 94% (195/208) and 44% (38/87) of patients with CrCL ≤120 mL/min, and >120 mL/min, respectively. Colistin methanesulfonate sodium (CMS) and colistin clearances were strongly dependent on CrCL. High colistin exposure to MIC ratio was associated with increased hazard of death in the multivariate analysis (adjusted hazard ratio (95% CI): 1.07 (1.03-1.12)). Other significant predictors included SOFA score at baseline (HR 1.24 (1.19-1.30) per score increase), age and Acinetobacter or Pseudomonas as index pathogen.

DISCUSSION

The population pharmacokinetic model predicted that >90% of the patients had colistin concentrations >2 mg/L at steady state, but only 66% at 4 hr after start of treatment. High colistin exposure was associated with poor kidney function, and was not related to a prolonged survival.

Venous thromboembolism prophylaxis with anticoagulation in septic patients: a prospective cohort study

BACKGROUND

Venous thromboembolism (VTE) is a feared complication during hospitalization. The practice of administering pharmacological prophylaxis is highly endorsed despite failure of studies to show reduction in mortality.

AIM

: To determine the benefit of VTE prophylaxis in acutely ill medical patients with sepsis.

METHODS

A prospective cohort, with enrollment between January 2010 and April 2011. Patients were detected in four medicine departments at a university-affiliated hospital and followed for 90 days for pre-specified outcomes. We included all septic patients at high VTE risk defined by Padua score ≥ 4. The primary outcome was 30-day mortality. Incidence of pulmonary embolism, deep vein thrombosis or major bleeding episodes at 30 and 90 days, and 90-day mortality were secondary outcomes.

RESULTS

A total of 1540 patients were identified, of which 720 (55%) were at high risk for VTE and included. A total of 213 (29.6%) patients received prophylaxis. VTE occurred in 6 control patients and 2 treated (0.9 and 1.2%, respectively, RR 0.79, CI: 0.16-3.95). Major bleeding events occurred in 4 (0.8%) control and 7 (3.3%) treated patients (RR 4.1, CI: 1.24-14.08, P = 0.01). After adjusting for covariates, VTE prophylaxis conferred no 30- or 90-day mortality benefit (OR 1.24, CI: 0.79-1.93 and OR 1.47, CI: 0.99-2.17, respectively). Lack of significant benefit with prophylaxis persisted after propensity-score matching (OR for 30-day mortality 1.01, CI: 0.66-1.55).

CONCLUSIONS

In acutely ill inpatients with sepsis, no significant benefit was demonstrated for VTE prophylaxis, with higher rates of bleeding. The risk-benefit ratio of this intervention should be carefully examined.

The significance of persistent fever in the treatment of suspected bacterial infections among inpatients: a prospective cohort study

Antibiotic escalations are frequently guided by fever persistence. Unnecessary antibiotic escalation is associated with resistance induction. We examined whether fever persistence is associated with adverse outcomes among medical inpatients with sepsis. In a single-center prospective cohort study, we included consecutive medical inpatients with suspected or documented bacterial infections. Data were collected on days 0, 2, 4, and 30 days from episode onset. We examined the association between fever persistence at 4 days and 30-day mortality on univariate and multivariate analysis. Inappropriate empirical antibiotic treatment (IAET) was defined for patients with microbiologically documented infections (MDIs). Odds ratios (ORs) are presented with 95% confidence intervals (CIs). A total of 1,621 patients were included. Among patients with MDIs, 38/206 (18.4%) given appropriate empiric therapy had continued fever on day 4, compared to 64/231 (27.7%) of patients receiving IAET, OR 0.59, 95% CI 0.37-0.93. Fever persistence was not associated with mortality after adjustment for other risk factors. Among patients with presumed sepsis who did not have MDIs, persistent fever was significantly associated with 30-day mortality on a multivariate analysis, adjusted OR 2.77 (95% CI 1.78-4.31). Other risk factors for mortality included older age, nosocomial infections, malignancy, dyspnea, shock, decreased albumin, and elevated creatinine. For patients with MDIs, fever persistence for up to 4 days is a marker of IAET, but is not associated with mortality, and should not, in itself, trigger antibiotic escalation. For patients without MDIs, fever persistence should trigger careful re-evaluation, as it is associated with mortality.