Low Resilience Was a Risk Factor of Mental Health Problems during the COVID-19 Pandemic but Not in Individuals Exposed to COVID-19: A Cohort Study in Spanish Adult General Population

Background: The aim is to analyze whether people with low resilience are at higher risk of mental health problems during the COVID-19 pandemic in Spanish adults. Methods: a longitudinal cohort study was carried out. Resilience was measured with the CD-RISC. Mental health problems that were assessed included: Major Depressive Episode (MDE), Generalized Anxiety Disorder (GAD), Suicidal Thoughts and Behaviors (STB), and Posttraumatic Stress Disorder (PTSD) symptoms. Results: we found statistically significant differences between groups and resilience scores in MDE [F (3; 48.40) = 19.55], GAD [F (3; 19.63) = 6.45] and STB [F (3; 111.74) = 31.94]. Multivariable analyses showed individuals with very low resilience were at a 5-fold risk of Incidence of MDE and a 4-fold risk of STB. Persistent group presented a 21-fold risk of MDE and 54-fold risk of STB. No evidence of higher risk was found for GAD. Individuals with low resilience and exposed to COVID-19 were not at higher risk. Individuals with low resilience were at higher risk of PTSD in general population [β(95% CI) = −3.25 (−3.969 to −2.54)], but not for individuals with COVID-19. Conclusions: in the general population, having low or very low resilience increases the risk of suffering MDE, STB, and PTSD, but not GAD during the COVID-19 pandemic, and not in the population with COVID-19

Programa de vigilància de les infeccions nosocomials als hospitals de Catalunya (programa VINCat): document de competències dels equips de control d’infeccions

Infeccions nosocomials; Equips de control d'infeccions; ECI; Competències professionalsInfecciones nosocomiales; Equipos de control de infecciones; ECI; Competencias profesionalesNosocomial infections; Infection control equipment; ECI; Professional skillsThis document sets out the professional competencies of the infection control teams to carry out their work, with the intention of: Standardizing the infection control competencies in the hospitals participating in the VINCat program; Be a guide to designing infection control training courses; Contribute to self-assessment of ECI performance; Provide a professional planning and development model and Orient the centers on the appropriate needs and resources to carry out daily infection control activities.Aquest document recull les competències professionals dels equips de control d'infeccions per desenvolupar la seva tasca amb la intenció de: Estandarditzar les competències de control d’infecció als hospitals que participen en el programa VINCat; Ser una guia per dissenyar cursos de formació en control d’infeccions; Contribuir a l’autoavaluació del rendiment dels ECI; Proporcionar un model de planificació i desenvolupament professional i Orientar els centres sobre les necessitats i els recursos adients per portar a terme les activitats de control d’infeccions diària.Este documento recoge las competencias profesionales de los equipos de control de infecciones para desarrollar su tarea con la intención de: Estandarizar las competencias de control de infección en los hospitales que participan en el programa VINCat; Ser una guía para diseñar cursos de formación en control de infecciones; Contribuir a la autoevaluación del rendimiento de los ECI; Proporcionar un modelo de planificación y desarrollo profesional y Orientar a los centros sobre las necesidades y los recursos adecuados para llevar a cabo las actividades de control de infecciones diarias

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Socio-economic and psychological impact of COVID-19 pandemic in a Spanish cohort BIOVAL-D-COVID-19 study protocol

Objective: SARS-CoV-2 outbreak has a negative psychological impact among general population. Data comparing mental health status before and during the outbreak is needed. The BIOVAL-D-COVID-19 study assess the socio-economic and psychological impact of the COVID-19 pandemic and lockdown in a representative sample of non-institutionalized Spanish adult population, and estimate the incidence of mental health disorders, including suicidal behaviours, and possible related factors. Method: Observational longitudinal study including two online surveys: baseline survey (T0) performed during 2019 and follow-up survey (T1) conducted 12-month later. The latter included nine sections: socio-demographic, health status, mental health, employment conditions and status, material deprivation, use of healthcare services, intimate partner violence and resilience. Four of the nine sections are administered in T0 and T1 assessments. Longitudinal data analyses will estimate adjusted incidence rates of mental health disorders using Poisson regression models. Risk and protective factors will be analysed through multiple logistic regression models

Programa de vigilància de les infeccions nosocomials als hospitals de Catalunya (programa VINCat): document de competències dels equips de control d’infeccions

Infeccions nosocomials; Equips de control d'infeccions; ECI; Competències professionalsInfecciones nosocomiales; Equipos de control de infecciones; ECI; Competencias profesionalesNosocomial infections; Infection control equipment; ECI; Professional skillsThis document sets out the professional competencies of the infection control teams to carry out their work, with the intention of: Standardizing the infection control competencies in the hospitals participating in the VINCat program; Be a guide to designing infection control training courses; Contribute to self-assessment of ECI performance; Provide a professional planning and development model and Orient the centers on the appropriate needs and resources to carry out daily infection control activities.Aquest document recull les competències professionals dels equips de control d'infeccions per desenvolupar la seva tasca amb la intenció de: Estandarditzar les competències de control d’infecció als hospitals que participen en el programa VINCat; Ser una guia per dissenyar cursos de formació en control d’infeccions; Contribuir a l’autoavaluació del rendiment dels ECI; Proporcionar un model de planificació i desenvolupament professional i Orientar els centres sobre les necessitats i els recursos adients per portar a terme les activitats de control d’infeccions diària.Este documento recoge las competencias profesionales de los equipos de control de infecciones para desarrollar su tarea con la intención de: Estandarizar las competencias de control de infección en los hospitales que participan en el programa VINCat; Ser una guía para diseñar cursos de formación en control de infecciones; Contribuir a la autoevaluación del rendimiento de los ECI; Proporcionar un modelo de planificación y desarrollo profesional y Orientar a los centros sobre las necesidades y los recursos adecuados para llevar a cabo las actividades de control de infecciones diarias

A Prospective Multicentre Study of the Epidemiology and Outcomes of Bloodstream Infection in Cirrhotic Patients

OBJECTIVE: The aim of this study was to describe the current epidemiology of BSI in patients with cirrhosis, analyse predictors of 30-day mortality, and risk factors for antibiotic resistance. METHODS: Cirrhotic patients developing a BSI episode were prospectively included at 19 centres in five countries from September 2014 to December 2015. The discrimination of mortality risk scores for 30-day mortality were compared by area under the receiver operator-risk and Cox-regression models. Risk factors for multidrug-resistant organisms (MDRO) were assessed with a logistic regression model. RESULTS: We enrolled 312 patients. Gram-negative bacteria, Gram-positive bacteria and Candida spp. were the cause of BSI episodes in 53%, 47% and 7% of cases, respectively. The 30-day mortality rate was 25% and best predicted by the SOFA and CLIF-SOFA score. In a Cox-regression model, delayed (>24h) antibiotic treatment [HR 7.58 (95%CI 3.29-18.67), P<.001], inadequate empirical therapy [HR 3.14 (95%CI 1.93-5.12), P<.001] and CLIF-SOFA score [HR 1.35 (95%CI 1.28-1.43), P<.001] were independently associated with 30-day mortality. Independent risk factors for MDRO (31% of BSIs) were previous antimicrobial exposure [OR 2.91 (95%CI 1.73-4.88), P<.001] and previous invasive procedures [OR 2.51 (95%CI 1.48-4.24), P=.001], whereas spontaneous bacterial peritonitis as BSI source was associated with a lower odds of MDRO [OR 0.30 (95%CI 0.12-0.73), P=.008). CONCLUSIONS: MDRO account for nearly one-third of BSI in cirrhotic patients and often resulting in delayed or inadequate empirical antimicrobial therapy and increased mortality rates. Our data suggest that improved prevention and treatment strategies for MDRO are urgently needed in the liver cirrhosis patients

Extended infusion of \u3b2-lactams for bloodstream infection in patients with liver cirrhosis: an observational multicenter study

The BICRHOME study was a prospective, multicenter study enrolling 312 cirrhotic patients with BSI. In this secondary analysis we selected patients receiving TZP or carbapenems as adequate empiric treatment. The 30-day mortality of patients receiving C/EI or intermittent infusion of TZP or carbapenems was assessed with Kaplan-Meier curves, Cox-regression model and estimation of the average treatment effect (ATE) using propensity score matching

Extended Infusion of beta-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study

Background. We analyzed the impact of continuous/extended infusion (C/EI) vs intermittent infusion of piperacillin-tazobactam (TZP) and carbapenems on 30-day mortality of patients with liver cirrhosis and bloodstream infection (BSI). Methods. The BICRHOME study was a prospective, multicenter study that enrolled 312 cirrhotic patients with BSI. In this secondary analysis, we selected patients receiving TZP or carbapenems as adequate empirical treatment. The 30-day mortality of patients receiving C/EI or intermittent infusion of TZP or carbapenems was assessed with Kaplan-Meier curves, Cox-regression model, and estimation of the average treatment effect (ATE) using propensity score matching. Results. Overall, 119 patients received TZP or carbapenems as empirical treatment. Patients who received C/EI had a significantly lower mortality rate (16% vs 36%, P = .047). In a Cox-regression model, the administration of C/EI was associated with a significantly lower mortality (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.11-0.936; P = .04) when adjusted for severity of illness and an ATE of 25.6% reduction in 30-day mortality risk (95% CI, 18.9-32.3; P = 25 (HR, 0.26; 95% CI, 0.08-0.92). At competing risk analysis, C/EI of beta-lactams was associated with significantly higher rates of hospital discharge (subdistribution hazard [95% CI], 1.62 [1.06-2.47]). Conclusions. C/EI of beta-lactams in cirrhotic patients with BSI may improve outcomes and facilitate earlier discharge