The risk factors for development of fibrotic-like radiographic abnormalities after severe COVID-19 are incompletely described and the extent to which CT findings correlate with symptoms and physical function after hospitalisation remains unclear. At 4 months after hospitalisation, fibrotic-like patterns were more common in those who underwent mechanical ventilation (72%) than in those who did not (20%). We demonstrate that severity of initial illness, duration of mechanical ventilation, lactate dehydrogenase on admission and leucocyte telomere length are independent risk factors for fibrotic-like radiographic abnormalities. These fibrotic-like changes correlate with lung function, cough and measures of frailty, but not with dyspnoea.

We identified time to appropriate antibiotic therapy in patients with sepsis to be an independent determinant of postinfection ICU and hospital lengths of stay. Clinicians should implement local strategies aimed at timely delivery of appropriate antibiotic therapy to improve outcomes and reduce length of stay.

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IntroductionBlood cultures are of limited utility in non-severe community-acquired pneumonia, though routinely recommended for severe community-acquired pneumonia or healthcare-associated pneumonia, due to perceived greater bacteremia risk, particularly with multidrug resistant organisms. The utility of this practice is unknown. MethodsIn this observational cohort study, we abstracted data from medical records for consecutive hospitalizations for pneumonia by adults to an academic medical center from 2014-2015. The primary outcomes included bacteremia, multidrug resistant organism bacteremia, and appropriate management changes attributed to culture results, stratified by pneumonia classification (non-severe community-acquired pneumonia, severe community-acquired pneumonia, or healthcare-associated pneumonia) and likelihood the bacteremia was due to pneumonia versus another infection. We assessed the diagnostic test performance of ≥1 guideline-defined risk factors for bacteremia in non-severe community-acquired pneumonia, for whom cultures are routinely recommended. ResultsOf 456 pneumonia hospitalizations, 30 (6.6%) had bacteremia, with a greater incidence in severe community-acquired pneumonia (14.7%) than non-severe communityacquired pneumonia (7.8%) and healthcare-associated pneumonia (6.6%; p=0.12). Seventeen bacteremia cases were likely due to pneumonia (3.7%). Only 2 (0.4%) had multidrug resistant organisms (both healthcare-associated pneumonia), 1 of whom was due to pneumonia. Appropriate management changes occurred in 8 cases (1.8%; 7 deescalation and 1 escalation of antibiotics); only 1 with bacteremia likely due to pneumonia (de-escalation). The one case of appropriate antibiotic escalation occurred in a patient with vancomycin-resistant enterococcus unrelated to pneumonia. Having ≥1 guideline-defined risk factors did not identify bacteremia in non-severe communityacquired pneumonia (positive likelihood ratio, 1.10, 95% CI, 0.61-1.99). ConclusionRoutine blood cultures in pneumonia have extremely low yield and utility irrespective of severity and risk.