Association between race and risk of ICU mortality in mechanically ventilated COVID-19 patients at a safety net hospital

Purpose

To determine racial differences in intensive care unit (ICU) mortality outcomes among mechanically ventilated patients with severe coronavirus disease 2019 (COVID-19) infection in a safety net hospital.

Methods

We retrospectively analyzed a cohort of patients ≥ 18 years old with confirmed severe acute respiratory syndrome-CoV-2 disease associated respiratory failure who were treated with invasive mechanical ventilation and admitted to the ICU from May 1, 2020 – July 30 -2020 at Grady Memorial Hospital, Atlanta, Georgia – a safety net hospital. We evaluated the association between mortality and demographics, co-morbidities, inpatient laboratory, and radiological parameters.

Results

Among 181 critically ill mechanically ventilated African American patients treated at a safety net hospital, the mortality rate was 33%. On stratified analysis by race (Table 2), mortality rates were significantly higher in African Americans (39%) and Hispanics (26.3%), compared to Whites (18.9%). On multivariate regression, African Americans were 3 times more likely to die in the ICU compared to Whites (OR 3.1 95% CI 1.6 -5.5). Likewise, the likelihood of mortality was higher in Hispanics compared to Whites (OR 1.3 95% CI 1.0 -3.9).

Conclusions

Our study demonstrated a high ICU mortality rate in a cohort of mechanically ventilated patients with severe COVID-19 infection treated at a safety net hospital. African Americans and Hispanics had significantly higher risks of ICU mortality compared to Whites. These study findings further elucidate the disproportionately higher burden of COVID-19 infection in African Americans and Hispanics.

Potential of entomopathogenic nematodes for biological control of Acalymma vittatum (Coleoptera: Chrysomelidae) in cucumbers grown in conventional and organic soil management systems

Acalymma vittatum (F.) is the primary insect pest of fresh-market cucumber and melon crops in much of the eastern United States because of their herbivory and interactions with several diseases, most notably bacterial wilt. A study was conducted to determine how soil management affects viability and infectivity of an entomopathogenic nematode that may be used for the control of A. vittatum. Dose-mortality curves under laboratory conditions suggested several Steinernema spp. as potential biocontrol agents. Field injections combined with soil bioassays showed that Steinernema riobravis Cabanillas, Poinar & Raulston (Rhabditus: Steinernematidae) longevity exceeded A. vittatum immature development time in both conventional and organic soil management systems. Mean root length densities of cucumbers increased in both soil management systems with the inclusion of nematodes. Soil management alone also influenced A. vittatum larval survivorship, with higher survival rates in the organic compared with the conventional soil management system. A 50% reduction in A. vittatum larval survival rates in both soil management systems, as determined by adult A. vittatum emergence, demonstrated the potential of incorporation of entomopathogenic nematodes for integrated pest management of diabroticites in commercial cucumber production.

Catheter infection. A comparison of two catheter maintenance techniques

Incidence of catheter-related infections was studied using two techniques: changing catheters over a guide-wire or placing a new catheter at a new site every 3 days. Patients were randomized into two groups: Group 1 (new site) and Group 2 (guide-wire). Of the 105 catheterization sites (20 arterial and 85 central lines) in patients of Group 1, none were considered infected (i.e., having 15 or more colonies at the time of semi-quantitative microbiology analysis and clinical signs of infection at the catheter site). Of the 274 catheterization sites (56 arterial and 218 central) of patients of Group 2, eight (2.9%) were infected (chi 2 = 1.89, p greater than 0.05). Colonization (15 or more cultures without clinical signs of infection) occurred in three of 105 (2.9%) and in four of 274 (1.5%) of the catheterization sites of Groups 1 and 2, respectively (chi 2 = 0.23, p greater than 0.05). Study results indicate no significant difference in infection or colonization rates between the two methods of catheter replacement.

Transmission of hepatitis B virus to classroom contacts of mentally retarded carriers

The risk of the spread of hepatitis B virus infection from deinstitutionalized, mentally retarded carriers to pupil and staff school contacts in the New York City public school system was measured serologically in a three-phase study from 1978 to 1982. In the third phase, undertaken in 1982, blood samples were drawn and questionnaires were completed on students and staff tested in either of the first two phases and on comparison groups with intermediate and no known school exposure to deinstitutionalized carriers. Univariate and logistic regression analyses revealed that staff and pupils with a history of classroom exposure to a hepatitis B virus carrier had significantly increased prevalences of hepatitis B virus infection (13.4%, odds ratio = 1.9; 9.3%, odds ratio = 2.5, respectively). Similarly, yearly seroconversion rates of 1.3% and 0.67% indicate that staff and, to a lesser extent, pupils are at increased risk of infection.