Impact of SARS-CoV-2 RNAemia and other risk factors on long-COVID: A prospective observational multicentre cohort study

As the COVID-19 pandemic has progressed, long-COVID has emerged as a major problem that poses a significant challenge for attending physicians and health care policy makers. Therefore, we read with much interest the recently published unicentre study in the Journal of Infection by Righi et al.,1 carried out on 465 adult COVID-19 patients (235 [50.5%] hospital-admitted) followed-up during nine months, concluding that those with advanced age, intensive care unit (ICU) admission, and multiple symptoms at onset were more likely to have long-term COVID-19 symptoms, with negative impact on physical and mental wellbeing. Other studies have found that female gender, age, longer hospital stay, pre-existing hypertension, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, smoking, obesity, and chronic alcoholism increase the likelihood of long-COVID.2,3 It is known that SARS-CoV-2 RNAemia is a predictor of COVID-19 severity and in-hospital complications.4,5 However, to the best of our knowledge, only two studies have assessed, up to one or three months after the acute COVID-19 onset, whether SARS-CoV-2 RNAemia may have an impact on long-COVID,6,7 both finding that RNAemia at presentation might predict the persistence of symptoms. However, these studies did not provide information regarding long-COVID symptoms nor the association with SARS-CoV-2 RNAemia beyond three months, and could not differentiate between “true” long-COVID and the convalescence phase of the SARS-CoV-2 infection.A.R. has received a predoctoral research grant from the Instituto de Salud Carlos III, Spanish Ministry of Science, Innovation and Universities, (PFIS grant FI18/00183). G.A.A. reports a predoctoral research grant from the 201808-10 project, funded by La Marató de TV3. This study was supported by the Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, the Spanish Network for Research in Infectious Diseases (REIPI, RD16/0016/0001, RD16/0016/0005, RD16/0016/0009, RD16/0016/0013)-co-financed by the European Development Regional Fund, A way to achieve Europe, Operative program Intelligent Growth 2014-2020, and the Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC) [CB21/13/00009; CB21/13/00006], Madrid, Spain. J.S.C. and E.C. received grants from the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Proyectos de Investigación sobre el SARS-CoV-2 y la enfermedad COVID-19 (COV20/00580; COV20/00370). J.S.C. is a researcher belonging to the program “Nicolás Monardes” (C-0059–2018), Servicio Andaluz de Salud, Junta de Andalucía, Spain. Samples and data from patients included in this study from the Hospital Universitario Cruces (Bizkaia, Spain) were provided by the Basque Biobank (www.biobancovasco.org) and were processed following standard operation procedures with appropriate approval of the Ethical and Scientific Committees.Peer reviewe

Outpatient Parenteral Antibiotic Treatment vs Hospitalization for Infective Endocarditis: Validation of the OPAT-GAMES Criteria

Abstract Background Outpatient parenteral antibiotic treatment (OPAT) programs are increasingly used to manage infective endocarditis (IE), but current criteria for indicating OPAT are markedly conservative. We aimed to investigate whether more liberal criteria for indicating OPAT in IE can be safely used. Methods This was a prospective multicenter nationwide cohort study (2008–2018). Rates of readmission, recurrences, and 1-year mortality were compared between hospital-based antibiotic treatment (HBAT) and OPAT. Risk factors for readmission and mortality in OPAT patients were investigated by logistic regression. Patients did not fulfill OPAT-GAMES (Grupos de Apoyo al Manejo de la Endocarditis en ESpaña) criteria if they had any of the following: cirrhosis, severe central nervous system emboli, undrained abscesses, severe conditions requiring cardiac surgery in nonoperable patients, severe postsurgical complications, highly difficult-to-treat microorganisms, or intravenous drug use. Results A total of 2279 HBAT patients and 1268 OPAT patients were included. Among OPAT patients, 307 (24.2%) did not fulfill OPAT-GAMES criteria. Overall, OPAT patients presented higher rates of readmission than HBAT patients (18.2% vs 14.4%; P = .004), but no significant differences were found in the propensity analysis. Patients not fulfilling OPAT-GAMES criteria presented significantly higher rates of readmission than HBAT and OPAT-GAMES (23.8%, 14.4%, 16.4%; P &amp;lt; .001), whereas no significant differences were found in mortality (5.9%, 8%, 7.4%; P = .103) or recurrences (3.9%, 3.1%, 2.5%; P = .546). Not fulfilling OPAT-GAMES criteria was associated with higher risk of readmission (odds ratio [OR], 1.43; 95% CI, 1.03–1.97; P = .03), whereas cardiac surgery was associated with lower risk (OR, 0.72; 95% CI, 0.53–0.98; P = .03). Conclusions OPAT-GAMES criteria allow identification of IE patients at higher risk of long-term complications to whom OPAT cannot be safely administered. </jats:sec

Non-diagnostic anti-C. burnetii phase I IgG titres: Should they be discarded in elderly patients?

Background: High anti-Coxiella burnetii phase I IgG titres are associated with chronic Q fever; an infectious disease with high mortality. Prognostic significance of lower or medium IgG phase I titres remain uncertain. The aim of this study was to explore this issue in a high-risk population. Methods: Sero-epidemiological and prospective study of 456 hospitalised patients aged 65 and older (Burgos; Spain). Serum IgG antibody phase I and II were determined by immunofluorescence assay. Results: A lower or medium IgG phase I titres (<1:1024) was observed in 180 (39.4%) patients. Atherosclerotic cardiovascular disease was associated with these titres, but not the traditional risk factors of chronic Q fever (cardiac valve disease, and vascular grafts or valvular prosthesis) (adjusted OR 1.75, 95% CI 1.18-2.61). Lower or medium IgG phase I titres were also associated with decreased survival at 30 months follow-up in patients with atherosclerotic cardiovascular disease (but not in the total sample) after adjusting for others comorbidities: IgG phase I titres ≥ 1:32 (HR 1.77; 95% CI 1.14 4–2.74), ≥1:64 (HR 1.90; 95% CI 1.21-2.99)–3.25), and ≥1:128 (HR 2.00; 95% CI 1.23–3.25). Conclusion: Lower or medium IgG phase I titres against C. burnetii, even the lowest, should not be discarded in elderly patients with atherosclerotic cardiovascular disease. Serological follow-up should be recommended in this group of patients. Keywords: Q fever, Serology, Coxiella burnetii, Atherosclerosis, Cardiovascular disease, Surviva

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective