Background: There is conflicting data regarding the use of hydroxychloroquine (HCQ) in COVID-19 hospitalized patients Objective: To assess the efficacy of HCQ in increasing SARS-CoV-2 viral clearance Design: Retrospective observational study Setting: Cleveland Clinic Abu Dhabi Participants: Hospitalized adult patients with confirmed SARS-CoV-2 infection Intervention: None Measurements: The primary outcome was the time from a confirmed positive nasopharyngeal swab to turn negative. A negative nasopharyngeal swab conversion was defined as a confirmed SARS-CoV-2 case followed by two negative results using RT-PCR assay with samples obtained 24 hours apart Results: 34 confirmed COVID-19 patients were included. Nineteen (55.9%) patients presented with symptoms, and 14 (41.2%) had pneumonia. Only 21 (61.8%) patients received HCQ. The time to SARS-CoV-2 negativity nasopharyngeal test was significantly longer in patients who received HCQ compared to those who did not receive HCQ (17 [13-21] vs. 10 [4-13] days, p=0.023). HCQ was independently associated with time to negativity test after adjustment for potential confounders (symptoms, pneumonia or oxygen therapy) in multivariable linear regression analysis.On day 14, 47.8% (14/23) patients tested negative in the HCQ group compared to 90.9% (10/11) patients who did not receive HCQ (p=0.016).Limitations: Small sample size and retrospective design with a potential risk of selection bias Conclusion: HCQ was associated with a slower viral clearance in COVID-19 patients with mild to moderate disease. Data from ongoing randomized clinical trials with HCQ should provide a definitive answer regarding the efficacy and safety of this treatment.

Background Pulmonary radiological findings of the novel coronavirus disease 2019 (COVID-19) have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, lung cavitation has not been commonly described in these patients. The objective of this study was to assess the incidence of pulmonary cavitation in patients with COVID-19 and describe its characteristics and evolution. Methods We conducted a retrospective review of all patients admitted to our institution with COVID-19 and reviewed electronic medical records and imaging to identify patients who developed pulmonary cavitation. Results Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n = 12/359) of patients who developed COVID-19 pneumonia, and 11% (n = 12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died, and six discharged home. Conclusion Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.

Background: Pulmonary radiological findings of the novel coronavirus disease 2019 (COVID-19) have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, lung cavitation has not been commonly described in these patients. The objective of this study was to assess the incidence of pulmonary cavitation in patients with COVID-19 and describe its characteristics and evolution. Methods: We conducted a retrospective review of all patients admitted to our institution with COVID-19 and reviewed electronic medical records and imaging to identify patients who developed pulmonary cavitation. Results: Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n=12/359) of patients who developed COVID-19 pneumonia, and 11% (n=12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died, and six discharged home. Conclusion: Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.

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Background: Radiological findings of the novel coronavirus disease 2019 (COVID-19) pulmonary disease have been well documented and range from scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill, however, lung cavitation has not been described in these patients. Objectives: To assess the incidence of pulmonary cavitation and describe its characteristics and evolution. Methods: A retrospective review of all patients admitted to our institution with COVID-19 was undertaken and imaging reviewed to identify patients who developed pulmonary cavitation. Results: Twelve out of 689 (1.7%) patients admitted to our institution with COVID-19 developed pulmonary cavitation, comprising 3.3% (n=12/359) of those with COVID-19 pneumonia, and 11% (n=12/110) of those admitted to the intensive care unit. We describe the imaging characteristics of the cavitation and present the clinical, pharmacological, laboratory, and microbiological parameters for these patients. In this cohort six patients have died while another remains critically ill and unlikely to survive. Conclusion: Cavitary lung disease in patients with severe COVID-19 disease is not uncommon, and is associated with a high level of morbidity and mortality.

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Background: The optimal treatment for coronavirus disease 2019 (COVID-19) remains unclear. Favipiravir, an RNA polymerase inhibitor, has been used for COVID-19 but its clinical role and safety have not been established. Methods: We evaluated the outcomes of hospitalized adults with COVID-19 on favipiravir as part of combination therapy between March 1 and June 1, 2020. Favipiravir was given at a loading dose of 1600 mg orally every 12 hours for 2 doses, followed by a maintenance dose of 600 mg orally every eight hours. We performed a retrospective assessment of virologic clearance, improvement in oxygenation, clinical improvement and possible adverse effects. Results: One hundred and nine patients received favipiravir for a mean duration of 5.32 days. Mean time from symptom onset to initiation of favipiravir (day 0) was 4.89 days. Quick Sequential Organ Failure Assessment score was <2 in 83 patients (76.1%), and 17 patients (15.6%) were on invasive mechanical ventilation at day 0. All patients received at least one additional antiviral, 50 patients (45.9%) received tocilizumab and 14 patients (12.8%) received convalescent plasma. Mean clinical and oxygenation improvement at day 28 were 79.8% and 81.6%, respectively, including 10/17 patients (58.8%) who were extubated. There was no statistically significant difference in mean viral RNA clearance time between patients that received >7 days and those receiving <7 days of favipiravir. Mortality was 9.2%. Main adverse events leading to early favipiravir discontinuation were QTc interval prolongation (11%) and hypertriglyceridemia (8.3%). Conclusion: Early use of favipiravir as part of combination therapy was associated with improved outcomes, a low mortality rate and a high rate of clinical and oxygenation improvement in patients with mild, moderate, and severe COVID-19. There was no impact on virologic clearance. No severe adverse effects were recorded. The effect of favipiravir as monotherapy and as part of early combination therapy need to be elucidated further in randomized clinical trials.

BackgroundAntimicrobial stewardship programs (ASPs) are pivotal in healthcare facilities to curb antimicrobial resistance, improve patient outcomes and decrease healthcare costs. There is lack of literature on integrating the electronic medical record and electronic surveillance into antimicrobial stewardship in the Middle East. We describe our experience with implementing an advanced antimicrobial stewardship program using computerized clinical decision support system (CDSS) and electronic real-time surveillance software at a newly operated quaternary care hospital in the United Arab Emirates.MethodsThe ASP was implemented at hospital inception in April 2015. ASP utilized strategies described in the IDSA/SHEA guidelines including the use of rapid diagnostics, CDSS and electronic real-time surveillance. Antimicrobial therapy consumption was monitored monthly and reported in days of therapy per (DOT) per 1,000 inpatient days. Antimicrobial cost was analysed as total antimicrobials dispensed (AED) per 1,000 inpatient days. Antimicrobial therapy consumption and cost were analysed from the third-quarter of 2015 until the first quarter of 2017.ResultsAlthough our program has only been active for a little over 2 years, it has achieved significant decrease in the use of targeted antimicrobials. Carbapenem use decreased by 32%, from 105 to 71 DOT/1,000 inpatient days (P = 0.05). Anti-MRSA agents use decreased by 57% from 109 to 46 DOT/1,000 inpatient days (P = 0.003), and anti-pseudomonal β-lactam use decreased by 49% from 84 to 43 DOT/1,000 inpatient days (P = 0.015). Total cost of antimicrobial therapy decreased as well by 67% from 323 AED/1,000 inpatient days to 105 AED/1,000 inpatient days, (P = 0.01), with a hard cost total saving of 943,324 AED (256,338 USD) since program inception. There was no change in the severity of illness scores as measured by the hospital Case Mix Index (CMI) during the study period.ConclusionTo our knowledge this is the first advanced ASP program in the United Arab Emirates utilizing CDSS and electronic real-time surveillance. Our program demonstrated a significant decrease in the use and total cost of antimicrobials since hospital inception despite a significant increase in patient volume.Disclosures All authors: No reported disclosures.