COINFECÇÕES BACTERIANAS MULTIRRESISTENTES E PRÁTICA DE PRESCRIÇÃO DE ANTIBIÓTICOS EM ADULTOS COM COVID-19: UM ESTUDO CASO CONTROLE

The emerging situation in health services caused by coronavirus has resulted in a strenuous increase in ICU admissions, as well as the use of antimicrobials, often indicated for treatment of co-infections acquired in the hospital environment. The present study aims to describe the factors associated with bacterial co-infections with a multidrug resistance (MR) profile compared to patients without a multidrug resistance profile. For this purpose, a case-control study was conducted containing 127 patients who were hospitalized with a diagnosis of COVID-19 and admitted to the Intensive Care Unit (ICU) of the reference hospital for the 8th Health Regional of Francisco Beltrão-PR, Brazil, with laboratory and clinical evidence of coinfection. The mean age was 55.22 years, ranging from 24 to 86 years, 85% of patients were admitted in the year 2021, 52.8% were male, stayed an average of 17.72 days in the ICU and 79.5% had at least one comorbidity, especially obesity, diabetes and hypertension. Of 66.1% COVID-19 patients who died, 52.4% had at least one multidrug-resistant bacteria (MR) coinfection. Patients with MR had a greater number of comorbidities, stayed more days in the ICU, used antimicrobials longer, and ventilator-associated pneumonia was variably associated with the presence of MR in patients with COVID-19.La situación emergente en los servicios sanitarios provocada por el coronavirus ha provocado un aumento extenuante de los ingresos en las UCI, así como del uso de antimicrobianos, a menudo indicados para el tratamiento de las coinfecciones adquiridas en el entorno hospitalario. Este estudio pretende describir los factores asociados a las coinfecciones bacterianas con perfil multirresistente (MR) en comparación con los pacientes sin perfil multirresistente. Para ello, se realizó un estudio de casos y controles con 127 pacientes hospitalizados con diagnóstico de COVID-19 e ingresados en la Unidad de Cuidados Intensivos (UCI) del hospital de referencia de la 8ª Regional de Salud de Francisco Beltrão-PR, Brasil, con evidencia clínica y de laboratorio de coinfección. La edad media fue de 55,22 años, con un rango de 24 a 86 años, el 85% de los pacientes ingresaron en el año 2021, el 52,8% eran hombres, permanecieron una media de 17,72 días en la UCI y el 79,5% tenían al menos una comorbilidad, especialmente obesidad, diabetes e hipertensión. Del 66,1% de los pacientes de COVID-19 que murieron, el 52,4% tenía al menos una coinfección por bacterias multirresistentes (MR). Los pacientes con RM tenían un mayor número de comorbilidades, permanecían más días en la UCI, utilizaban antimicrobianos durante más tiempo y la neumonía asociada a la ventilación se asociaba de forma variable a la presencia de RM en los pacientes con COVID-19.A situação emergente nos serviços de saúde causada pelo coronavírus resultou em um aumento extenuante nas internações em UTI, assim como o uso de antimicrobianos, muitas vezes indicado para tratamento de coinfecções adquiridas no ambiente hospitalar. O presente estudo pretende descrever os fatores associados a coinfecções bacterianas com perfil de Multirresistência Microbiana (MR) comparando com pacientes sem perfil de multirresistência. Para isso, foi feito um estudo caso controle contendo 127 pacientes que foram hospitalizados com diagnóstico de COVID-19 e internados em Unidade de Terapia Intensiva (UTI) do hospital de referência para 8ª Regional de Saúde de Francisco Beltrão-PR, Brasil, com evidência laboratorial e clínica de coinfecção. A idade média foi de 55,22 anos, variando de 24 a 86 anos, 85% dos pacientes foram internados no ano de 2021, 52,8% eram do sexo masculino, ficaram em média 17,72 dias internados em UTI e 79,5% possuíam pelo menos uma comorbidade, com destaque para a obesidade, diabetes e hipertensão arterial. De 66,1% pacientes com COVID-19 que foram a óbito, 52,4% tiveram pelo menos uma coinfecção por bactéria multirresistente (MR). Os pacientes com MR apresentaram um número maior de comorbidades, ficaram mais dias internados na UTI, usaram antimicrobianos por mais tempo, e a pneumonia associada à ventilação mecânica foi variável, associada à presença de MR em pacientes com COVID-19.A situação emergente nos serviços de saúde causada pelo coronavírus resultou em um aumento extenuante nas internações em UTI, assim como o uso de antimicrobianos, muitas vezes indicado para tratamento de coinfecções adquiridas no ambiente hospitalar. O presente estudo pretende descrever os fatores associados a coinfecções bacterianas com perfil de Multirresistência Microbiana (MR) comparando com pacientes sem perfil de multirresistência. Para isso, foi feito um estudo caso controle contendo 127 pacientes que foram hospitalizados com diagnóstico de COVID-19 e internados em Unidade de Terapia Intensiva (UTI) do hospital de referência para 8ª Regional de Saúde de Francisco Beltrão-PR, Brasil, com evidência laboratorial e clínica de coinfecção. A idade média foi de 55,22 anos, variando de 24 a 86 anos, 85% dos pacientes foram internados no ano de 2021, 52,8% eram do sexo masculino, ficaram em média 17,72 dias internados em UTI e 79,5% possuíam pelo menos uma comorbidade, com destaque para a obesidade, diabetes e hipertensão arterial. De 66,1% pacientes com COVID-19 que foram a óbito, 52,4% tiveram pelo menos uma coinfecção por bactéria multirresistente (MR). Os pacientes com MR apresentaram um número maior de comorbidades, ficaram mais dias internados na UTI, usaram antimicrobianos por mais tempo, e a pneumonia associada à ventilação mecânica foi variável, associada à presença de MR em pacientes com COVID-19

Propofol infusion syndrome as a cause for CRRT circuit malfunction: a case report with literature review

Abstract Background Propofol is commonly used for sedation in the Intensive Care Unit (ICU). When administered in high doses and for a prolonged time, it can cause a rare but hazardous complication: Propofol Infusion Syndrome (PRIS). Along with other findings, PRIS can cause lipemia and clotting of the Continuous Renal Replacement Therapy (CRRT) circuit. Case presentation A 62-year-old woman admitted to the ICU after an acute ischemic stroke was sedated with Propofol for neuroprotection. On the sixteenth day of infusion (mean daily dose: 4 mg/kg/h), she presented with hyperlactatemia (7.7 mg/dL), acute kidney injury, metabolic acidosis (pH: 7.23 / HCO3–: 12.2 mEq/L), hyperkalemia (6.9 mEq/L), and hypotension requiring high doses of norepinephrine. CRRT and corticosteroids were initiated. After 15 min of CRRT, the blood in the circuit had a milky color, and the therapy was interrupted because of high transmembrane pressure, despite adequate anticoagulation with heparin. Laboratory tests showed hypertriglyceridemia (782 mg/dL), increased transaminases, and creatine phosphokinase (5008 U/L), suggesting the rare and fatal PRIS. Conclusion There is no established guideline for treating PRIS other than early discontinuation of Propofol and supportive care. Although CRRT is an important tool in managing PRIS, hypertriglyceridemia can cause circuit malfunction. Clinical hypervigilance and serial monitoring in at-risk patients are advised to minimize potentially lethal complications

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally