Summary Background COVID-19 is an ongoing threat to society. Patients who develop the most severe forms of the disease have high mortality. The interleukin-6 inhibitor tocilizumab has the potential to improve outcomes in these patients by preventing the development of cytokine release storm. Aims To evaluate the outcomes of patients with severe COVID-19 disease treated with the interleukin-6 inhibitor tocilizumab. Methods We conducted a retrospective, case–control, single-center study in patients with severe to critical COVID-19 disease treated with tocilizumab. Disease severity was defined based on the amount of oxygen supplementation required. The primary endpoint was the overall mortality. Secondary endpoints were mortality in non-intubated patients and mortality in intubated patients. Results A total of 193 patients were included in the study. Ninety-six patients received tocilizumab, while 97 served as the control group. The mean age was 60 years. Patients over 65 years represented 43% of the population. More patients in the tocilizumab group reported fever, cough and shortness of breath (83%, 80% and 96% vs. 73%, 69% and 71%, respectively). There was a non-statistically significant lower mortality in the treatment group (52% vs. 62.1%, P = 0.09). When excluding intubated patients, there was statistically significant lower mortality in patients treated with tocilizumab (6% vs. 27%, P = 0.024). Bacteremia was more common in the control group (24% vs. 13%, P = 0.43), while fungemia was similar for both (3% vs. 4%, P = 0.72). Conclusion Our study showed a non-statistically significant lower mortality in patients with severe to critical COVID-19 disease who received tocilizumab. When intubated patients were excluded, the use of tocilizumab was associated with lower mortality.

The non-tubercular mycobacterium, Mycobacterium abscessus (M. abscessus), is a resistant, opportunistic pathogen that causes lung infections that are not curable, but which can be controlled with appropriate antibiotic regimens. A new broad-spectrum tetracycline analog called omadacycline was approved in 2018 in the United States for the treatment of bacterial, community-acquired pneumonia and acute skin infections. We discuss a case to assess the effect of this novel antibiotic in the management of a nefariously resistant M. abscessus infection. Our patient had underlying chronic bronchiectasis and a long-standing M.abscessus infection, along with numerous drug allergies and previously failed antibiotic regimens. All of these factors entailed a disease process that was difficult to manage and a worsening morbidity. The utilization of omadacycline in this case addressed a multitude of problems by improving ease of administration and circumventing the patient’s allergic reaction to antibiotics; on follow-up, the patient demonstrated an improved clinical status including well-controlled symptoms and weight gain.

Background Approximately 19% of people infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) progress to severe or critical stages of the coronavirus disease 2019 (COVID-19) with a mortality rate exceeding 50%. We aimed to examine the characteristics, mortality rates, intubation rate, and length of stay (LOS) of patients hospitalized with COVID-19 disease with high oxygen requirements (critically ill). Methods We conducted a retrospective analysis in a single center in Brooklyn, New York. Adult hospitalized patients with confirmed COVID-19 disease and high oxygen requirements were included. We performed multivariate logistic regression analyses for statistically significant variables to reduce any confounding. Results A total of 398 patients were identified between March 19th and April 25th, 2020 who met the inclusion criteria, of which 247 (62.1%) required intubation. The overall mortality rate in our study was 57.3% (n = 228). The mean hospital LOS was 19.1 ± 17.4 days. Patients who survived to hospital discharge had a longer mean LOS compared to those who died during hospitalization (25.4 ± 22.03 days versus10.7 ± 1.74 days). In the multivariate analysis, increased age, intubation and increased lactate dehydrogenase (LDH) were each independently associated with increased odds of mortality. Diarrhea was associated with decreased mortality (OR 0.4; CI 0.16, 0.99). Obesity and use of vasopressors were each independently associated with increased intubation. Conclusions In patients with COVID-19 disease and high oxygen requirements, advanced age, intubation, and higher LDH levels were associated with increased mortality, while diarrhea was associated with decreased mortality. Gender, diabetes, and hypertension did not have any association with mortality or length of hospital stay.

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Acute respiratory distress syndrome (ARDS) is a life-threatening inflammatory state of lung injury that can require acute interventions including mechanical ventilation as well as emergent veno-venous extracorporeal membrane oxygenation (VV-ECMO) for management. Etiologies of ARDS are not clearly discernible in certain cases and can vary from sepsis, pneumonia, trauma and intoxication. Anti-nuclear cytoplasmic auto-antibody (ANCA)-associated vasculitis (AAV) is a group of several conditions that can have pulmonary complications including ARDS.We present a case where the primary manifestation of myeloperoxidase (MPO)-ANCA positive vasculitis was ARDS, in order to highlight the importance of investigating rare vasculitides as the underlying cause of ARDS and the importance of ECMO as an early life-saving intervention for the management of ARDS.