Bacterial infections may complicate the course of COVID-19 patients. The rate and predictors of bacterial infections were examined in patients consecutively admitted with COVID-19 at one tertiary hospital in Madrid between March 1st and April 30th, 2020. Among 1594 hospitalized patients with COVID-19, 135 (8.5%) experienced bacterial infectious events, distributed as follows: urinary tract infections (32.6%), bacteremia (31.9%), pneumonia (31.8%), intra-abdominal infections (6.7%) and skin and soft tissue infections (6.7%). Independent predictors of bacterial infections were older age, neurological disease, prior immunosuppression and ICU admission (p < 0.05). Patients with bacterial infections who more frequently received steroids and tocilizumab, progressed to lower Sap02/FiO2 ratios, and experienced more severe ARDS (p < 0.001). The mortality rate was significantly higher in patients with bacterial infections as compared to the rest (25% vs 6.7%, respectively; p < 0.001). In multivariate analyses, older age, prior neurological or kidney disease, immunosuppression and ARDS severity were associated with an increased mortality (p < 0.05) while bacterial infections were not. Conversely, the use of steroids or steroids plus tocilizumab did not confer a higher risk of bacterial infections and improved survival rates. Bacterial infections occurred in 8.5% of patients hospitalized with COVID-19 during the first wave of the pandemic. They were not independently associated with increased mortality rates. Baseline COVID-19 severity rather than the incidence of bacterial infections seems to contribute to mortality. When indicated, the use of steroids or steroids plus tocilizumab might improve survival in this population.
Background. SARS-CoV-2 has spread worldwide with different dynamics in each region. We aimed to describe the clinical characteristics and to explore risk factors of death, critical care admission, and use of invasive mechanical ventilation in hospitalized patients with SARS-CoV-2 pneumonia in a high-altitude population living in Bogotá, Colombia. Methods. We conducted a concurrent cohort study of adult patients with laboratory-confirmed SARS-CoV-2 pneumonia. Demographic, clinical, and treatment data were extracted from electronic records. Univariate and multivariable methods were performed to investigate the relationship between each variable and outcomes at 28 days of follow-up. Results. 377 adults (56.8% male) were included in the study, of whom 85 (22.6%) died. Nonsurvivors were older on average than survivors (mean age, 56.7 years [SD 15.8] vs. 70.1 years [SD 13.9]; p ≤ 0.001 ) and more likely male (28 [32.9%] vs. 57 [67.1%]; p = 0.029 ). Most patients had at least one underlying disease (333 [88.3%]), including arterial hypertension (149 [39.5%]), overweight (145 [38.5%]), obesity (114 [30.2%]), and diabetes mellitus (82 [21.8%]). Frequency of critical care admission (158 [41.9%]) and invasive mechanical ventilation (123 [32.6%]) was high. Age over 65 years (OR 9.26, 95% CI 3.29–26.01; p ≤ 0.001 ), ICU admission (OR 12.37, 95% CI 6.08–25.18; p ≤ 0.001 ), and arterial pH higher than 7.47 (OR 0.25, 95% CI 0.08–0.74; p = 0.01 ) were independently associated with in-hospital mortality. Conclusions. In this study of in-hospital patients with SARS-CoV-2 pneumonia living at high altitude, frequency of death was similar to what has been reported. ICU admission and use of invasive mechanical ventilation were high. Risk factors as older age, ICU admission, and arterial pH were associated with mortality.
BackgroundEnterococcus faecium is ranked worldwide as one of the top ten pathogens identified in healthcare-associated infections (HAI) and is classified as one of the high priority pathogens for research and development of new antibiotics worldwide. Due to molecular biology techniques’ higher costs, the approach for identifying and controlling infectious diseases in developing countries has been based on clinical and epidemiological perspectives. Nevertheless, after an abrupt vancomycin-resistant Enterococcus faecium dissemination in the Méderi teaching hospital, ending up in an outbreak, further measures needed to be taken into consideration. The present study describes the vancomycin-resistant Enterococcus faecium pattern within Colombian’s largest installed-bed capacity hospital in 2016.MethodsThirty-three vancomycin-resistant Enterococcus faecium isolates were recovered during a 5-month period in 2016. Multilocus variable-number tandem-repeat analysis was used for molecular typing to determine clonality amongst strains. A modified time-place-sequence algorithm was used to trace VREfm spread patterns during the outbreak period and estimate transmission routes.ResultsFour clonal profiles were identified. Chronological clonal profile follow-up suggested a transitional spread from profile “A” to profile “B”, returning to a higher prevalence of “A” by the end of the study. Antibiotic susceptibility indicated high-level vancomycin-resistance in most isolates frequently matching vanA gene identification.DiscussionTransmission analysis suggested cross-contamination via healthcare workers. Despite epidemiological control of the outbreak, post-outbreak isolates were still being identified as having outbreak-related clonal profile (A), indicating reduction but not eradication of this clonality. This study supports the use of combined molecular and epidemiological strategies in an approach to controlling infectious diseases. It contributes towards a more accurate evaluation of the effectiveness of the epidemiological measures taken regarding outbreak control and estimates the main cause related to the spread of this microorganism.Electronic supplementary materialThe online version of this article (10.1186/s12879-019-3877-7) contains supplementary material, which is available to authorized users.
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