Purpose Hyperinflammation in severe COVID-19 infection increases the risk of respiratory failure and one of the cogent reasons of mortality associated with COVID-19. Baricitinib, a janus kinases inhibitor, can potentially suppress inflammatory cascades in severe COVID-19 pneumonia. Methods The objective of this study was to compare the clinical outcomes of high dose of baricitinib with its usual dose in patients with severe COVID-19 pneumonia. This prospective cohort study was conducted on 238 adult patients with severe COVID-19 pneumonia. Eight milligram and 4 mg of baricitinib was given orally to 122 patients in the high dose (HD) group and 116 patients the usual dose (UD) group, respectively daily for 14 days, and clinical outcomes were compared among the groups. Results Blood oxygen saturation level was stabilized (≥94% on room air) earlier in the HD group compared to the UD group [5 (IQR: 4–5)/8 (IQR: 6–9), P < 0.05]. Patients in the HD group required intensive care unit (ICU) and intubation supports more in the UD group than that in patients of the HD group [17.2%/9%, P < 0.05; 11.2%/4.1%, P > 0.05; N = 116/122, respectively]. The 30-day mortality and 60-day rehospitalization rate were higher in the UD group than the HD group [6%/3.3%, P < 0.01; 11.9%/7.6%, P > 0.05; N = 116/122, respectively]. Conclusion The daily high dose of baricitinib in severe COVID-19 results in early stabilization of the respiratory functions, declined requirements of critical care supports, reduced rehospitalization with mortality rate compared to its daily usual dose.

Pneumonia associated with coronavirus disease 2019 (COVID-19) has been accounted for high mortality rate in severe COVID-19 worldwide, and additional serious scarcity of standard and effective anti-inflammatory drug in COVID-19 pneumonia management is a big challenge. Baricitinib, a Janus kinase (JAK) inhibitor, is a promising drug in COVID-19 pneumonia. This study aims to compare the clinical outcome of moderate-to-severe COVID-19 pneumonia treated with baricitinib with or without a loading dose. This prospective case-control study enrolled 37 adult patients where 17 patients (control) received baricitinib at 4 mg oral daily dose and 20 patients (case) received an additional single 8 mg oral loading dose. The median day to gain blood oxygen saturation level ≥95% (in room air) and return in normal breathing function were lower in case group than the control group. The requirement of intensive care unit and mechanical ventilation support was higher in the control group than in the case group [29.4% (N = 17)/10% (N = 20), P < 0.05; 11.8% (N = 17)/5% (N = 20), P > 0.05), respectively]. Thus, an additional loading dose of baricitinib revealed better clinical outcome of patients with COVID-19 pneumonia.

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp . (20.3%), Escherichia coli (15.8%), and Pseudomonas spp . (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06944-2.

Background: Urinary tract infections (UTIs) remain the common infections in outpatients as well as hospitalized patients. Current knowledge on antimicrobial sensitivity pattern is essential for appropriate therapy. The aim of the study is to determine the changing pattern of antibiotic sensitivity among uropathogens causing UTI. Methods: Urinary isolates from symptomatic UTI cases attending in Square hospital were processed in the Microbiology lab. Antimicrobial susceptibility testing was performed by Kirby Bauer’s disc diffusion method. Extended spectrum beta lactamase (ESBL) production was determined by double disk synergy test method. Results: Of the 200 tested sample 110 samples showed growth of pathogens among which the most prevalent were E.coli (58.18%) followed by Enterococci (13.6%). The majority (68.18%) of the isolates were from female. ESBL production was observed in 46.87% o E.coli strains and 25% of Klebsiella strains. More than 98% of the isolates are sensitive to Imipenem, Meropenem , while 86.36% are sensitive to Amikacin, 73.63% to Nitrofurantoin and 74.54% to Gentamicin. Very high rate of resistance is seen against amoxicillin (88.19%), cefixime (65.46%), cotrimoxazole (68.19%) and ceftriaxone (63.63%). E. coli showed high sensitivity to meropenem, imipenem and amikacin (100%) followed by Gentamicin (94.1%). Conclusion: The study revealed that E.coli was the predominant bacterial pathogens of UTIs. An increasing trend in the production ESBLs among UTI pathogens in the community was noted. Nitrofurantoin should be used as empirical therapy for primary, uncomplicated UTIs. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19952 Bangladesh Crit Care J March 2014; 2 (1): 21-24

Introduction Alcaligenes faecalis is a species of gram-negative, rod-shaped, aerobic bacteria commonly found in the environment. A. faecalis -associated nosocomial infections are common in hospitalized patients, but serious life threatening infections are rare. Here, we report a rare case of BSI with A. faecalis resistant to all available antibiotics; successfully treated with double-dose of tigecycline. Presentation of case A 60-year-old female presented with A. faecalis bloodstream infection, where the organism was completely resistant to all commercially available antibiotics including polymyxins and tigecycline. The physical condition of the patient was deteriorating and there were no active antibiotics available to prescribe based on sensitivities. Despite the organism’s resistance to tigecycline, double-dose of tigecycline therapy (100 mg twice daily, intravenously after a 200 mg single intravenous loading dose) was prescribed intentionally for the treatment of this infection. The organism was completely eradicated from the bloodstream of that patient within the 5 days of therapy-initiation. Discussion Double-dose of tigecycline maintains a higher serum drug concentration rather than the standard dose, and in this case, double-dose of tigecycline completely cleared the pandrug-resistant A. faecalis from the blood where initially, that organism was resistant to tigecycline. Previously, A. faecalis isolates were found resistant to fluoroquinolones, but here it was found very rarely resistant to even reserve antibiotics, polymyxins, carbapenems and tigecycline. Conclusion Pandrug-resistant A. faecalis- associated bloodstream infection is a very uncommon case and double-dose of tigecycline may be an effective option to treat it.

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We report a case of expanded dengue syndrome, where two different presentations occurred subsequently. A patient of dengue haemorrhagic fever initially was admitted with acute pancreatitis, complicated with left pancreatic effusion, but later on, during resolution of pancreatitis and effusion, developed spontaneous right haemothorax. Such presentations, besides being rare themselves, have not been reported to occur subsequently, in the same patient, during the same disease process.

Teicoplanin is a drug of choice for treating infections by gram positive microorganisms. Teicoplanininduced thrombocytopenia is an adverse drug reaction found in critically ill patients receiving teicoplanin. The aim of this observational study was to analyze the increased risk of occurring teicoplanin-induced thrombocytopenia in patients with severe hypoalbuminemia than the patients having normal blood-albumin level. A 5-month long study was conducted in an adult-ICU department on 42 critically ill adult patients. In this study, 17 (40.48%, n=42) patients developed teicoplanin-induced thrombocytopenia and among them, 14 patients (60.87%, n=23) were suffering from severe hypoalbuminemia during the initiation of teicoplanin therapy. All the events were normalized within 48 hours after discontinuing the teicoplanin. In this study, we found that teicoplanin-induced thrombocytopenia is one of the most common adverse drug reaction developed in critically ill adult patients and concurrent severe hypoalbuminemia may enormously increase the risk of this adverse drug reaction. Dhaka Univ. J. Pharm. Sci. 18(2): 153-157, 2019 (December)