The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Bacterial co-infections are associated with unfavourable outcomes in respiratory viral infections; however, microbiological and antibiotic data related to COVID-19 are sparse. Adequate use of antibiotics in line with antibiotic stewardship (ABS) principles is warranted during the pandemic. We performed a retrospective study of clinical and microbiological characteristics of 140 COVID-19 patients admitted between February and April 2020 to a German University hospital, with a focus on bacterial co-infections and antimicrobial therapy. The final date of follow-up was 6 May 2020. Clinical data of 140 COVID-19 patients were recorded: The median age was 63.5 (range 17–99) years; 64% were males. According to the implemented local ABS guidelines, the most commonly used antibiotic regimen was ampicillin/sulbactam (41.5%) with a median duration of 6 (range 1–13) days. Urinary antigen tests for Legionella pneumophila and Streptococcus peumoniae were negative in all cases. In critically ill patients admitted to intensive care units (n = 50), co-infections with Enterobacterales (34.0%) and Aspergillus fumigatus (18.0%) were detected. Blood cultures collected at admission showed a diagnostic yield of 4.2%. Bacterial and fungal co-infections are rare in COVID-19 patients and are mainly prevalent in critically ill patients. Further studies are needed to assess the impact of antimicrobial therapy on therapeutic outcome in COVID-19 patients to prevent antimicrobial overuse. ABS guidelines could help in optimising the management of COVID-19. Investigation of microbial patterns of infectious complications in critically ill COVID-19 patients is also required.

Background: Coronavirus disease 2019 (COVID-19) has become a pandemic. Bacterial superinfections seem to be associated with higher mortality in COVID-19 patients in intensive care units (ICUs). However, details on the prevalence and species distribution of secondary infections are limited. Moreover, the increasing use of dexamethasone may pose an additional risk of superinfections.Methods: We performed a single-center retrospective study of the clinical and microbiological characteristics of 154 COVID-19 patients admitted to the ICU between March 2020 and January 2021, focusing on bacterial infections, use of antimicrobial agents and dexamethasone therapy.Results: The median age was 68 years; 67.5% of the patients were men. Critically ill COVID-19 patients were treated with dexamethasone since July 2020 (second wave), which was not common during the first wave of the pandemic. In the dexamethasone group (n=90, 58.4%), respiratory pathogens were detected more frequently, as were multidrug-resistant pathogens. The number of patients with polymicrobial detection of respiratory pathogens was significantly increased (p=0.013). The most frequently detected species were Enterobacterales, Staphylococcus aureus, and Aspergillus fumigatus. The rates of bloodstream infections did not differ between the groups. The use of dexamethasone in ICU COVID-19 patients was associated with higher rates of respiratory infectious complications.Conclusions: Secondary infections are present in a substantial fraction of critically ill COVID-19 patients. Respiratory pathogens were detectable in the majority of COVID-19 ICU patients. The use of dexamethasone poses a potential risk of secondary pulmonary infections. Infectious complications in patients with dexamethasone therapy could be associated with worse outcomes.

Background: Little is known about what people are interested in when they search the web for psoriasis. The monitoring of online search behaviour allows the assessment of interest in a disease on a more representative level by including people outside of medical settings.Objectives: This study aims to reveal relevant aspects regarding psoriasis for people consulting the web.Methods: Google Ads Keyword Planner was used to select and evaluate relevant German keywords for 'psoriasis' in the study period from September 2016 to August 2020 on German territory. All keywords were qualitatively reviewed and descriptively analysed in 11 categories. One-way analysis of variance, Welch test and Pearson's correlation coefficient were used to assess differences within Germany, annual search volumes and seasons. Results: Overall, 11,170,740 German language Google searches on the topic of psoriasis were made. In the general category, the most commonly searched disease aspect was related to the possible contagiousness of psoriasis (n = 122,040). 'Head' (51.1%), followed by 'nails' (15.9%), 'hands' (8.8%), 'feet' (7.8%), and 'genital/anal area' (6.1%), was the most frequently searched for localization. Pustular forms of psoriasis were overrepresented in the search volume. Almost half of the search terms for therapy were represented by keywords related to alternative care and phytotherapy, while less than 1% related to biologics. Differences between the federal states for search volume on treatment options (p < 0.001) and between annual search volumes (p < 0.001) were found. Conclusions: Queries on pustular forms and difficult-to-treat areas gained high online interest, which suggests higher disease impact or underdiagnosis. The high interest in alternative therapy options suggests possible therapy dissatisfaction, lack of patient information or lack of access to guideline-conform therapy options. The

BACKGROUND Little is known about what people with psoriasis are interested in when they search the web. As the Internet is becoming increasingly relevant as a source of information for health-related questions, the monitoring of online search behavior allows the assessment of interest in a disease on a more representative level by including people outside of medical settings. OBJECTIVE This study aims to reveal relevant aspects regarding psoriasis for people consulting the web. METHODS Google Ads Keyword Planner was used to select and evaluate relevant keywords for ‘psoriasis’ in the study period from September 2016 to August 2020. All keywords were qualitatively reviewed and descriptively analyzed in eleven categories. The study considered the search volume for all of Germany with German as the language preference. One-way analysis of variance and Pearson’s correlation coefficient were used to assess differences in the German states. RESULTS Among 11,170,740 German language Google searches on the topic of psoriasis, the keyword with the overall highest search volume was the German lay term for psoriasis “Schuppenflechte” (n=3,634,000; 32.5%), followed by “psoriasis” (n=2,675,600; 24.0%) and “psoriasis scalp” (n=369,200; 3.3%). In the general category, the most commonly searched for disease aspect related to the possible contagiousness of psoriasis (n=122,040). “Head” (51.1%), followed by “nails” (15.9%), “hands” (8.8%), “feet” (7.8%), and “genital/anal area” (6.1%), was the most frequently searched for localization. Pustular forms of psoriasis were overrepresented in the search volume relative to their frequency in the literature. Almost half of the search terms for therapy were represented by keywords related to alternative care and phytotherapy. Less than one percent of queries on therapy dealt with biologics. Significant differences between the federal states could be established for search volumes on treatment options (P<.001). CONCLUSIONS Queries on pustular forms and difficult-to-treat areas gained high online interest, which suggests a subjectively higher burden of disease or underdiagnosis. Concerning therapy, people most notably consulted the web for alternative therapy options instead of guideline-conform therapies. This suggests possible therapy dissatisfaction, lack of patient information, or lack of access to guideline-conform therapy options. The possible infectiousness of psoriasis seems to remain an issue in the general population and should be continously addressed to reduce stigmatization.

Background Herpes zoster (HZ) and its complication postherpetic neuralgia (PHN), whose incidence are both expected to increase with an ageing population, have demonstrated high costs on healthcare systems and burden on individual quality of life. Previous studies have shown the possibility of assessing public interest in a disease and factors that influence search behaviour using internet search data. The aim of this study was to analyze internet search data for HZ in Germany to evaluate public interest in the disease and relevant influential temporal and geographic factors that modify search behavior. Methods Google Ads Keyword Planner was used to generate a list of HZ-related keywords including their search volume for Germany as a whole and its sixteen federal states from October 2016 to September 2020. All keywords were qualitatively categorized, and changes over time and correlations with population density, physician density, and vaccination rates were assessed using Welch’s ANOVA, Bonferroni correction for post-hoc analyses, and Pearson’s correlation. Results A total of 1,651 relevant keywords with a search volume of 20,816,210 searches were identified. Overall, national search volume increased each year of the study period with a peak in August 2020. More than half of the total search volume related to general queries (55.1%). The highest average monthly search volumes were observed in the states of Hamburg, Saarland, and Bremen. Average monthly search volume showed strong positive correlations with population density (r = .512, p = .043) and a strong negative correlation with the number of inhabitants per working physician (r = -.689, p = .003). Conclusions The study demonstrated that evaluating internet search data is a viable method for assessing public interest in HZ, thereby identifying areas of unmet need to support targeted public health campaigns.