3 research outputs found
Bloodstream Infections in a COVID-19 Non-ICU Department: Microbial Epidemiology, Resistance Profiles and Comparative Analysis of Risk Factors and Patients’ Outcome
Background: Bloodstream infections (BSI) caused by highly resistant pathogens in non-ICU COVID-19 departments pose important challenges. Methods: We performed a comparative analysis of incidence and microbial epidemiology of BSI in COVID-19 vs. non-COVID-19, non-ICU departments between 1 September 2020-31 October 2021. Risk factors for BSI and its impact on outcome were evaluated by a case-control study which included COVID-19 patients with/without BSI. Results: Forty out of 1985 COVID-19 patients developed BSI. The mean monthly incidence/100 admissions was 2.015 in COVID-19 and 1.742 in non-COVID-19 departments. Enterococcus and Candida isolates predominated in the COVID-19 group (p < 0.001 and p = 0.018, respectively). All Acinetobacter baumannii isolates were carbapenem-resistant (CR). In the COVID-19 group, 33.3% of Klebsiella pneumoniae was CR, 50% of Escherichia coli produced ESBL and 19% of Enterococcus spp. were VRE vs. 74.5%, 26.1% and 8.8% in the non-COVID-19 group, respectively. BSI was associated with prior hospitalization (p = 0.003), >2 comorbidities (p < 0.001), central venous catheter (p = 0.015), severe SARS-CoV-2 pneumonia and lack of COVID-19 vaccination (p < 0.001). In the multivariate regression model also including age and multiple comorbidities, only BSI was significantly associated with adverse in-hospital outcome [OR (CI95%): 21.47 (3.86–119.21), p < 0.001]. Conclusions: BSI complicates unvaccinated patients with severe SARS-CoV-2 pneumonia and increases mortality. BSI pathogens and resistance profiles differ among COVID-19/non-COVID-19 departments, suggesting various routes of pathogen acquisition
Early Start of Oral Clarithromycin Is Associated with Better Outcome in COVID-19 of Moderate Severity: The ACHIEVE Open-Label Single-Arm Trial
Introduction The anti-inflammatory effect of macrolides prompted the
study of oral clarithromycin in moderate COVID-19. Methods An open-label
non-randomized trial in 90 patients with COVID-19 of moderate severity
was conducted between May and October 2020. The primary endpoint was
defined at the end of treatment (EOT) as no need for hospital
re-admission and no progression into lower respiratory tract infection
(LRTI) for patients with upper respiratory tract infection and as at
least 50% decrease of the respiratory symptoms score without
progression into severe respiratory failure (SRF) for patients with
LRTI. Viral load, biomarkers, the function of mononuclear cells and
safety were assessed. Results The primary endpoint was attained in
86.7% of patients treated with clarithromycin (95% CIs 78.1-92.2%);
this was 91.7% and 81.4% among patients starting clarithromycin the
first 5 days from symptoms onset or later (odds ratio after multivariate
analysis 6.62; p 0.030). The responses were better for patients infected
by non-B1.1 variants. Clarithromycin use was associated with decreases
in circulating C-reactive protein, tumour necrosis factor-alpha and
interleukin (IL)-6; by increase of production of interferon-gamma and
decrease of production of interleukin-6 by mononuclear cells; and by
suppression of SARS-CoV-2 viral load. No safety concerns were reported.
Conclusions Early clarithromycin treatment provides most of the clinical
improvement in moderate COVID-19