Background Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. Methods This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients’ medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. Results A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). Conclusions This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

BackgroundHemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients.MethodsThis is a cross-sectional study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients' medical records. A binary logistic regression analysis was performed to assess risk factors for mortality.ResultsA total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio=1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio=4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio=3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio=1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio=6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio=4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio=19.18; 95% confidence interval: 6.47, 56.83).ConclusionsThis national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

Background: A drug-oriented antibiotic stewardship intervention targeting tigecycline utilization was launched at Makassed General Hospital, Beirut, Lebanon, in 2016 as a part of a comprehensive Antibiotic Stewardship Program (ASP). In this study, we evaluated the effect of this intervention on changing tigecycline prescription behavior in different types of infections, patient outcome and mortality, along with tigecycline drug use density, when compared to an earlier period before the initiation of ASP. Methods: This is a retrospective chart review of all adult inpatients who received tigecycline for more than 72 h between Jan-2012 and Dec-2013 [period (P) 1 before ASP] and between Oct-2016 and Dec-2018 [period (P) 2 during ASP]. Results: Tigecycline was administered to 153 patients during P1 and 116 patients during P2. The proportion of patients suffering from cancer, those requiring mechanical ventilation, and those with hemodynamic failure was significantly reduced between P1 and P2. The proportion of patients who received tigecycline for FDA-approved indications increased from 19% during P1 to 78% during P2 (P < 0.001). On the other hand, its use in off-label indications was restricted, including ventilator-associated pneumonia (26.1% in P1, 3.4% in P2, P < 0.001), hospital-acquired pneumonia (19.6% in P1, 5.2% in P2, P = 0.001), sepsis (9.2% in P1, 3% in P2, P = 0.028), and febrile neutropenia (15.7% in P1, 0.9% in P2, P < 0.001). The clinical success rate of tigecycline therapy showed an overall significant increase from 48.4% during P1 to 65.5% during P2 (P = 0.005) in the entire patient population. All-cause mortality in the tigecycline-treated patients decreased from 45.1% during P1 to 20.7% during P2 (P < 0.0001). In general, mean tigecycline consumption decreased by 55% between P1 and P2 (P < 0.0001). Conclusion: The drug-oriented ASP intervention targeting tigecycline prescriptions improved its use and patient outcomes, where it helped curb the over-optimistic use of this drug in off-label indications where it is not a suitable treatment option.

COVID-19 pneumonia and community-acquired pneumonia (CAP) have been associated with morbidity and mortality. The aim of this study was to evaluate the outcome of hospitalized patients with COVID-19 pneumonia versus CAP in terms of mortality. This was a retrospective cohort study conducted between pre-COVID-19 era (May 2019–November 2019) and COVID-19 era (May 2020–November 2020). The study included all adult patients with COVID-19 pneumonia (Group 1) and adult patients with CAP but are COVID-19 negative (Group 2). A total of 106 patients were included in the study, of which 56 were in the COVID-19 pneumonia group and 50 in the CAP group. Patients who developed acute kidney injury (AKI) were 60.7% (n = 34) in Group 1 and 48% (n = 24) in Group 2. Mortality occurred in 37.5% (n = 21) patients in Group 1 and 12.0% (n = 6) in Group 2 (P = 0.003). A total of 52 patients required admission to intensive care unit (ICU), of which 44.6% (n = 25) were in Group 1 and 54.0% (n = 27) in Group 2. Of the 58 patients who developed AKI, 3 (8.8%) patients in Group 1 passed away compared to none in Group 2. Moreover, 58.8% patients (n = 20) in Group 1 and 70.8% patients (n = 17) in Group 2 required ICU admission. Mortality rate in the ICU was 80.0% (n = 16) and 35.3% (n = 6) in Groups 1 and 2, respectively (P = 0.006). The overall mortality rate was higher in case of COVID-19 patients than those with CAP. In case of patients with AKI, mortality rate in the ICU was significantly higher in COVID-19 pneumonia patients compared to CAP patients.