Daptomycin-treated patients more frequently required a therapeutic change due to worse microbiological and clinical response, although mortality was not increased. Our findings do not support the use of daptomycin as single therapy in the treatment of EIE. Its role in combined strategies should be further investigated.
Background
Patients with COVID-19 receiving mechanical ventilation may become aggravated with a secondary respiratory infection. The aim of this study was to describe secondary respiratory infections, their predictive factors, and outcomes in patients with COVID-19 requiring mechanical ventilation.
Methods
A cohort study was carried out in a single tertiary hospital in Santiago, Chile, from 1st June to 31st July 2020. All patients with COVID-19 admitted to the intensive care unit that required mechanical ventilation were included.
Results
A total of 175 patients were enrolled, of which 71 (40.6%) developed at least one secondary respiratory infection during follow-up. Early and late secondary infections were diagnosed in 1.7% and 31.4% respectively. Within late secondary infections, 88% were bacterial, 10% were fungal, and 2% were of viral origin. One-third of isolated bacteria were multidrug-resistant. Bivariate analysis showed that the history of corticosteroids used before admission and the use of dexamethasone during hospitalization were associated with a higher risk of secondary infections (p = 0.041 and p = 0.019 respectively). Multivariate analysis showed that for each additional day of mechanical ventilation, the risk of secondary infection increases 1.1 times (adOR = 1.07; 95% CI 1.02–1.13, p = 0.008)
Conclusions
Patients with COVID-19 admitted to the intensive care unit and requiring mechanical ventilation had a high rate of secondary infections during their hospital stay. The number of days on MV was a risk factor for acquiring secondary respiratory infections.
The content of free amino acids in the cerebrospinal fluid from 52 children in different age groups with febrile seizures were determined and compared to 88 age matched children without seizures. We found that the concentrations of some amino acids in CSF in the control group decreased slowly with age, reaching the concentrations found in adults at the age of 3 to 6 years, and that the free amino acid levels were no significantly altered by temperature. The free amino acids in the CSF from patients with febrile seizures showed a different pattern of change with age. These results suggest that the same type of convulsive disorder may show a different alteration in amino acids in CSF depending on the patient's age, and that the degree of elevation of body temperature is not implicated in these changes.
Background
To describe respiratory coinfections, predictive factors and outcomes in patients requiring mechanical ventilation (MV) with COVID-19.
Methods
Cohort study, carried out in a Chilean single tertiary Hospital. All patients with COVID-19 admitted to ICU that required MV were included between 1 June and 31 July 2020.
Results
175 patients were admitted to ICU and required MV. Of these, 71 patients developed at least one respiratory coinfection (40.6 %). Early coinfections and late coinfections were diagnosed in 1.7% and 31.4% of all patients admitted to ICU respectively. Within late coinfections, 88% were bacterial, 10% were fungal, and 2% were viral coinfections. One third of isolated bacteria were multidrug-resistant. Multivariate analysis showed that the risk for coinfection was 7.7 times higher for patients with history of corticosteroids (adOR = 7.65, CI 95%: 1.04-56.2, p=0,046) and 2.7 times higher for patients that received dexamethasone during hospitalization (adOR=2.69; CI 95%: 1.14-6.35, p=0,024) than patients that were not exposed. For each additional day in MV, the risk of coinfection increases 1.1 times (adOR=1.06; CI 95%: 1.01-1.11, p=0,025).
Conclusions
Patients in ICU with COVID-19 that require MV had a high rate of coinfections during their stay, but not at admission. Major predisposing factors are the history of corticosteroids, the use of dexamethasone during hospitalization and days in MV.
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