scholarly journals Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

Infection ◽  
2021 ◽  
Author(s):  
A. Oliva ◽  
G. Ceccarelli ◽  
C. Borrazzo ◽  
M. Ridolfi ◽  
G. D.’Ettorre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Features ◽  
Multivariable Analysis ◽  
Invasive Pulmonary Aspergillosis ◽  
Lower Percentage ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Single Centre Study ◽  
Male Sex

Abstract Background Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). Materials/methods Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. Results Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58–76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). Conclusions In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.

scholarly journals Clinical features and prognostic analysis of patients with Aspergillus isolation during acute exacerbation of chronic obstructive pulmonary disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu Gu ◽  
Xianping Ye ◽  
Yu Wang ◽  
Kunlu Shen ◽  
Jinjin Zhong ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Clinical Features ◽  
Antifungal Therapy ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Positive Culture ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background Lower respiratory tract (LRT) specimen culture is widely performed for the identification of Aspergillus. We investigated the clinical features and prognosis of patients with Aspergillus isolation from LRT specimens during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This is a 6-year single-center, real-world study. 75 cases out of 1131 hospitalized AECOPD patients were positive for Aspergillus. These patients were carefully evaluated and finally diagnosed of pulmonary aspergillosis (PA, 60 cases, 80%) or colonization (15 cases, 20%). Comparisons of clinical data were performed between these two groups. A cox regression model was used to confirm prognostic factors of Aspergillus infection. Results The PA group had worse lung function and higher rates of systemic corticosteroid use and broad-spectrum antibiotic use before admission than the colonization group. The PA group had significantly higher in-hospital mortality and 180-day mortality than the colonization group (45% (27/60) vs. 0% (0/15), p = 0.001, and 52.5% (31/59) vs. 6.7% (1/15), p < 0.001, respectively). By multivariable analysis among Aspergillus infection patients, antifungal therapy (HR 0.383, 95% CI 0.163–0.899, p = 0.027) was associated with improved survival, whereas accumulated dose of systemic steroids > 700 mg (HR 2.452, 95% CI 1.134–5.300, p = 0.023) and respiratory failure at admission (HR 5.983, 95% CI 2.487–14.397, p < 0.001) were independently associated with increased mortality. Significant survival differential was observed among PA patients without antifungals and antifungals initiated before and after Aspergillus positive culture (p = 0.001). Conclusions Aspergillus isolation in hospitalized AECOPD patients largely indicated PA. AECOPD patients with PA had worse prognosis than those with Aspergillus colonization. Empirical antifungal therapy is warranted to improve the prognosis for Aspergillus infection.

Uncommon pathogens in an immunocompetent host: respiratory isolation of Cunninghamella bertholletiae, Aspergillus niger, Staphylococcus pseudintermedius and adenovirus in a patient with necrotising pneumonia

2022 ◽  
Vol 15 (1) ◽  
pp. e240484
Author(s):  
Christian Olivo Freites ◽  
Hendrik Sy ◽  
Patricia Miguez ◽  
James Salonia
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Aspergillus Niger ◽  
Unusual Case ◽  
Chronic Obstructive ◽  
Immunocompetent Host ◽  
Staphylococcus Pseudintermedius ◽  
Obstructive Pulmonary Disease ◽  
Cunninghamella Bertholletiae

We present the unusual case of a 60-year-old immunocompetent woman with chronic obstructive pulmonary disease who developed a necrotising pneumonia with isolation of Cunninghamella bertholletiae, Aspergillus niger, Staphylococcus pseudintermedius and adenovirus. The patient recovered with antimicrobial therapy and supportive care in the intensive care unit. The current literature on diagnosis and treatment of these pathogens is reviewed.

scholarly journals Moxifloxacin in Chronic Obstructive Pulmonary Disease: Pharmacokinetics and Penetration into Bronchial Secretions in Ward and Intensive Care Unit Patients

2019 ◽  
Vol 63 (3) ◽  
Author(s):  
Maria Sionidou ◽  
Katerina Manika ◽  
Georgia Pitsiou ◽  
Paschalina Kontou ◽  
Kalliopi Chatzika ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pulmonary Disease ◽  
Pharmacokinetic Profile ◽  
Pharmacokinetic Parameters ◽  
Chronic Obstructive ◽  
Icu Patients ◽  
Obstructive Pulmonary Disease ◽  
Bronchial Secretions

ABSTRACT This study aimed to evaluate the pharmacokinetic profile of moxifloxacin (MXF) in serum and sputum/bronchial secretions of 22 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) hospitalized in the ward and intensive care unit (ICU). The data showed that ICU patients had lower concentrations in secretions (P = 0.01). However, no other statistically significant differences were observed in pharmacokinetic parameters and penetration in secretions between ward and ICU patients. MXF showed a favorable pharmacokinetic profile, and the pharmacodynamic targets for common pathogens for AECOPD were achieved.

scholarly journals Reversal of a Suspected Paradoxical Reaction to Zopiclone with Flumazenil

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Zarah Jordahn ◽  
Cheme Andersen ◽  
Anne Marie Roust Aaberg ◽  
Frank Christian Pott
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Receptor Agonist ◽  
Elderly Woman ◽  
Behavioral Changes ◽  
Chronic Obstructive ◽  
Paradoxical Reaction ◽  
Obstructive Pulmonary Disease ◽  
To Receive

We describe the care for an elderly woman who was admitted to the intensive care unit (ICU) to receive noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. After administration of the sleeping pill zopiclone, a nonbenzodiazepine receptor agonist (NBRA), the patient became agitated and was confused, a possible paradoxical reaction to benzodiazepines. These symptoms were immediately resolved after treatment with flumazenil, usually used to reverse the adverse effects of benzodiazepines or NBRAs and to reverse paradoxical reactions to benzodiazepines. This case indicates that zopiclone induced behavioral changes resembling a paradoxical reaction to benzodiazepines and these symptoms may be treated with flumazenil.

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