scholarly journals Clinical outcomes in patients co-infected with COVID-19 and Staphylococcus aureus: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jenna R. Adalbert ◽  
Karan Varshney ◽  
Rachel Tobin ◽  
Rafael Pajaro
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Scoping Review ◽  
Bacterial Infections ◽  
Final Analysis ◽  
Mortality Rates ◽  
Hospital Environment ◽  
Review Of The Literature ◽  
The Impact

Abstract Background Endemic to the hospital environment, Staphylococcus aureus (S. aureus) is a leading bacterial pathogen that causes deadly infections such as bacteremia and endocarditis. In past viral pandemics, it has been the principal cause of secondary bacterial infections, significantly increasing patient mortality rates. Our world now combats the rapid spread of COVID-19, leading to a pandemic with a death toll greatly surpassing those of many past pandemics. However, the impact of co-infection with S. aureus remains unclear. Therefore, we aimed to perform a high-quality scoping review of the literature to synthesize the existing evidence on the clinical outcomes of COVID-19 and S. aureus co-infection. Methods A scoping review of the literature was conducted in PubMed, Scopus, Ovid MEDLINE, CINAHL, ScienceDirect, medRxiv, and the WHO COVID-19 database using a combination of terms. Articles that were in English, included patients infected with both COVID-19 and S. aureus, and provided a description of clinical outcomes for patients were eligible. From these articles, the following data were extracted: type of staphylococcal species, onset of co-infection, patient sex, age, symptoms, hospital interventions, and clinical outcomes. Quality assessments of final studies were also conducted using the Joanna Briggs Institute’s critical appraisal tools. Results Searches generated a total of 1922 publications, and 28 articles were eligible for the final analysis. Of the 115 co-infected patients, there were a total of 71 deaths (61.7%) and 41 discharges (35.7%), with 62 patients (53.9%) requiring ICU admission. Patients were infected with methicillin-sensitive and methicillin-resistant strains of S. aureus, with the majority (76.5%) acquiring co-infection with S. aureus following hospital admission for COVID-19. Aside from antibiotics, the most commonly reported hospital interventions were intubation with mechanical ventilation (74.8 %), central venous catheter (19.1 %), and corticosteroids (13.0 %). Conclusions Given the mortality rates reported thus far for patients co-infected with S. aureus and COVID-19, COVID-19 vaccination and outpatient treatment may be key initiatives for reducing hospital admission and S. aureus co-infection risk. Physician vigilance is recommended during COVID-19 interventions that may increase the risk of bacterial co-infection with pathogens, such as S. aureus, as the medical community’s understanding of these infection processes continues to evolve.

scholarly journals Staphylococcus aureus Bacteremia in Patients Infected With COVID-19: A Case Series

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Jaclyn A Cusumano ◽  
Amy C Dupper ◽  
Yesha Malik ◽  
Elizabeth M Gavioli ◽  
Jaspreet Banga ◽  
...  
Keyword(s):  
New York ◽  
Staphylococcus Aureus ◽  
New York City ◽  
Hospital Mortality ◽  
Bacterial Infections ◽  
Case Series ◽  
Mortality Rates ◽  
Day Hospital ◽  
Staphylococcus Aureus Bacteremia ◽  
The Impact

Abstract Background Previous viral pandemics have shown that secondary bacterial infections result in higher morbidity and mortality, with Staphylococcus aureus being the primary causative pathogen. The impact of secondary S. aureus bacteremia on mortality in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Methods This was a retrospective observational case series of patients with coronavirus disease 2019 (COVID-19) who developed secondary S. aureus bacteremia across 2 New York City hospitals. The primary end point was to describe 14-day and 30-day hospital mortality rates of patients with COVID-19 and S. aureus bacteremia. Secondary end points included predictors of 14-day and 30-day hospital mortality in patients with COVID-19 and S. aureus bacteremia. Results A total of 42 patients hospitalized for COVID-19 with secondary S. aureus bacteremia were identified. Of these patients, 23 (54.8%) and 28 (66.7%) died at 14 days and 30 days, respectively, from their first positive blood culture. Multivariate analysis identified hospital-onset bacteremia (≥4 days from date of admission) and age as significant predictors of 14-day hospital mortality and Pitt bacteremia score as a significant predictor of 30-day hospital mortality (odds ratio [OR], 11.9; 95% CI, 2.03–114.7; P = .01; OR, 1.10; 95% CI, 1.03–1.20; P = .02; and OR, 1.56; 95% CI, 1.19–2.18; P = .003, respectively). Conclusions Bacteremia with S. aureus is associated with high mortality rates in patients hospitalized with COVID-19. Further investigation is warranted to understand the impact of COVID-19 and secondary S. aureus bacteremia.

scholarly journals A Viewpoint on Accent Services: Framing and Terminology Matter

2021 ◽  
pp. 1-10
Author(s):  
Vikas Grover ◽  
Aravind Namasivayam ◽  
Nidhi Mahendra
Keyword(s):  
Scoping Review ◽  
Linguistic Diversity ◽  
Speech Language Pathology ◽  
Review Of The Literature ◽  
Speech Language Pathologists ◽  
Critical Attention ◽  
Language Pathology ◽  
Accent Modification ◽  
The Impact ◽  
The Way

Purpose: The purpose of this article is to offer a contemporary viewpoint on accent services and contend that an equity-minded reframing of accent services in speech-language pathology is long overdue. Such reframing should address directly the use of nonpejorative terminology and the need for nurturing global linguistic diversity and practitioner diversity in speech-language pathology. The authors offer their perspective on affirmative and least-biased accent services, an in-depth scoping review of the literature on accent modification, and discuss using terms that communicate unconditional respect for speaker identity and an understanding of the impact of accent services on accented speakers. Conclusions: Given ongoing discussions about the urgent need to diversify the profession of speech-language pathology, critical attention is needed toward existing biases toward accented speakers and how such biases manifest in the way that accent services are provided as well as in how clinicians conceptualize their role in working with accented speakers. The authors conclude with discussing alternate terms and offer recommendations for accent services provided by speech-language pathologists.

scholarly journals Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections

2015 ◽  
Vol 53 (7) ◽  
pp. 2262-2270 ◽  
Author(s):  
Tyler E. Warkentien ◽  
Faraz Shaikh ◽  
Amy C. Weintrob ◽  
Carlos J. Rodriguez ◽  
Clinton K. Murray ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Wound Closure ◽  
Fungal Infections ◽  
Combat Trauma ◽  
Content Type ◽  
Transfusion Requirements ◽  
Severity Of Injury ◽  
Significant Difference ◽  
The Impact

Combat trauma wounds with invasive fungal infections (IFIs) are often polymicrobial with fungal and bacterial growth, but the impact of the wound microbiology on clinical outcomes is uncertain. Our objectives were to compare the microbiological features between IFI and non-IFI wounds and evaluate whether clinical outcomes differed among IFI wounds based upon mold type. Data from U.S. military personnel injured in Afghanistan with IFI wounds were examined. Controls were matched by the pattern/severity of injury, including blood transfusion requirements. Wound closure timing was compared between IFI and non-IFI control wounds (with/without bacterial infections). IFI wound closure was also assessed according to mold species isolation. Eighty-two IFI wounds and 136 non-IFI wounds (63 with skin and soft tissue infections [SSTIs] and 73 without) were examined. The time to wound closure was longer for the IFI wounds (median, 16 days) than for the non-IFI controls with/without SSTIs (medians, 12 and 9 days, respectively;P< 0.001). The growth of multidrug-resistant Gram-negative rods was reported among 35% and 41% of the IFI and non-IFI wounds with SSTIs, respectively. Among the IFI wounds, times to wound closure were significantly longer for wounds withMucoralesgrowth than for wounds with non-Mucoralesgrowth (median, 17 days versus 13 days;P< 0.01). When wounds withMucoralesandAspergillusspp. growth were compared, there was no significant difference in wound closure timing. Trauma wounds with SSTIs were often polymicrobial, yet the presence of invasive molds (predominant types: orderMucorales,Aspergillusspp., andFusariumspp.) significantly prolonged the time to wound closure. Overall, the times to wound closure were longest for the IFI wounds withMucoralesgrowth.

scholarly journals 60. Evaluation of Outcomes Associated with Intermittent Versus Extended Infusion of Piperacillin/tazobactam in Acutely Ill Veterans

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S50-S51
Author(s):  
Marianne Angeli Encarnacion ◽  
Ariel Ma ◽  
Scott T Johns
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Final Analysis ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Protocol Group ◽  
Elevated Liver Enzymes ◽  
The Impact ◽  
Extended Infusion

Abstract Background Antibiotic dosing optimization is a key principle of antimicrobial stewardship. This study evaluated the impact of an extended infusion piperacillin/tazobactam dosing protocol on clinical outcomes in acutely ill veterans treated for infections at VA San Diego. Methods This retrospective cohort study looked at veterans admitted to the medical-surgical unit who were treated with piperacillin/tazobactam for at least 48 hours. The control group included patients who received treatment between 12/14/2017 to 7/22/2018, and the “protocol” or after protocol implementation group included patients who received treatment between 7/23/2018 to 2/28/2019. Excluded from the study were veterans with microbiological cultures showing intermediate sensitivity or resistance to piperacillin/tazobactam, those who experienced interruption in therapy, or those who required dialysis. Primary clinical outcomes included in-hospital mortality rate, 30-day mortality rate, hospital length of stay (LOS), and 30-day readmission rates. Rates of adverse effects such as elevated liver enzymes, thrombocytopenia, acute kidney impairment (AKI), and Clostridium difficile infection were also collected. χ 2, Fisher’s exact, and Mann-Whitney U tests were used for statistical analysis. Results 260 veterans were included in the final analysis: 96% male, mean age 65 years, mean BMI 29, 84 met SIRS criteria for sepsis, and 55% received at least 48 hours of concomitant vancomycin. Groups had similar outcomes for median LOS, in-hospital mortality, and 30-day mortality. The incidence of AKI was significantly lower in the protocol group (39.2% vs. 56.9%, p=0.004), in veterans on concomitant vancomycin (42.3% vs. 63.2%, p=0.011), and in veterans with obesity (36.4% vs. 70.8%, p=0.001). Rates of liver enzyme elevation, thrombocytopenia, and C. difficile infection were lower in the protocol group though these were not significant. Conclusion There was a significantly lower rate of AKI with EI dosing which supports enhanced patient safety. This may be the preferred method of administration for obese patients and/or those receiving vancomycin concurrently. This is the first study to demonstrate that EI piperacillin/tazobactam dosing significantly reduces rates of AKI in patients on concomitant vancomycin. Disclosures All Authors: No reported disclosures

scholarly journals Educational Podcasts in Kinesiology: A Scoping Review

2020 ◽  
pp. 1-13
Author(s):  
Scott W.T. McNamara ◽  
Matthew Shaw ◽  
Kylie Wilson ◽  
Angela Cox
Keyword(s):  
Instrument Development ◽  
Scoping Review ◽  
Data Driven ◽  
College Courses ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Full Inclusion ◽  
Rigorous Research ◽  
Scoping Reviews ◽  
The Impact

Educational podcasts are developed specifically for learning purposes. Preliminary research suggests that many college courses and practitioners regularly use educational podcasts and that this medium is a beneficial tool to use to supplement the learning process. However, there is limited scholarly work examining the use of educational podcasts within kinesiology fields. Thus, the purpose of this study was to conduct a scoping review of the literature on the use of educational podcasts in the field of kinesiology. The Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews Checklist guided this investigation. Six databases were searched. Fourteen articles met the full inclusion criteria. Of these, 11 were data-driven research articles, and three were practitioner articles. Much of the research identified lacked critical information related to research design, instrument development, and findings. Thus, the authors recommend that more rigorous research in this area be conducted to discern the impact of educational podcasts within the field of kinesiology.

Association of use of remote patient monitoring (RPM) with reduced hospitalizations in cancer patients with COVID-19.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1503-1503
Author(s):  
Joshua Pritchett ◽  
Aakash Desai ◽  
Bijan J Borah ◽  
Zhuoer Xie ◽  
Antoine N Saliba ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Patient Monitoring ◽  
Severe Illness ◽  
Remote Patient Monitoring ◽  
Hospital Admission Rate ◽  
Icu Admission ◽  
Remote Patient ◽  
The Impact

1503 Background: Patients with cancer and COVID-19 are at risk for poor clinical outcomes. An established multi-site remote patient monitoring (RPM) service was rapidly adapted to support a novel, interdisciplinary COVID-19 program for outpatient management of patients at high-risk for severe illness. The goal of this study was to assess the impact of the RPM program on clinical outcomes and acute care utilization in cancer patients diagnosed with COVID-19. Methods: This is a cross-sectional analysis following a multi-site prospective observational study performed at Mayo Clinic Cancer Center (MCCC). All adult patients with active cancer – defined as currently receiving cancer-directed therapy or in recent remission on active surveillance – and PCR-confirmed SARS-CoV-2 infection between March 18 and July 31, 2020 were included. RPM was comprised of in-home technology to assess symptoms and physiologic data with centralized nurse and physician oversight. Results: During the study timeframe 224 cancer patients were diagnosed with COVID-19 at MCCC. Initial management included urgent hospitalization (within 48 hours of diagnosis) in 34 patients (15%). Of the remaining 190 patients (85%) initially managed in the outpatient setting, those who did not receive RPM were significantly more likely to experience hospitalization than those receiving RPM (OR 3.6, 95% CI 1.036 to 12.01, P = 0.044). Following balancing of patient characteristics by inverse propensity weighting, rates of hospital admission for RPM and non-RPM patients were 3.1% and 11% respectively, implying that RPM was associated with an 8% reduction in hospital admission rate (-0.077; 95% CI: -0.315 to -0.019, P = 0.009). Use of RPM was also associated with lower rates of prolonged hospitalization, ICU admission, and mortality, though these trends did not reach statistical significance. Conclusions: In the midst of a global pandemic associated with inpatient bed, ventilator, and PPE shortages, the RPM program provided an effective strategy for outpatient clinical management and was associated with decreased rates of hospitalization, ICU admission, and mortality in cancer patients with COVID-19. This care model enabled simultaneous opportunity to mitigate the increased risks of exposure, transmission, and resource utilization associated with conventional care.

Empirical Antimicrobial Prescriptions in Patients with Clostridium difficile Infection at Hospital Admission and Impact on Clinical Outcome

2012 ◽  
Vol 33 (11) ◽  
pp. 1101-1106 ◽  
Author(s):  
Aurora Pop-Vicas ◽  
Eman Shaban ◽  
Cecile Letourneau ◽  
Angel Pechie
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Prolonged Exposure ◽  
Adverse Outcomes ◽  
Concurrent Use ◽  
Independent Risk Factors ◽  
The Impact

Objective.To determine, among patients with Clostridium difficile infection (CDI) at hospital admission, the impact of concurrent use of systemic, non-CDI-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing.Design.Retrospective cohort study.Setting.University-affiliated community hospital.Methods.We reviewed computerized medical records for all patients with CDI at hospital admission during a 24-month period (January 1, 2008, through December 31, 2009). Colectomy, discharge to hospice, and in-hospital mortality were considered to be adverse outcomes. Antimicrobial use was considered unnecessary in the absence of physical signs and laboratory or radiological findings suggestive of an infection other than CDI or in the absence of antimicrobial activity against the organism(s) recovered from clinical cultures.Results.Among the 94 patients with CDI at hospital admission, 62% received at least one non-CDI-related antimicrobial during their hospitalization for CDI. Severe complicated CDI (odds ratio [OR], 7.1 [95% confidence interval {CI}, 1.8–28.5]; P = .005), duration of non-CDI-related antimicrobial exposure (OR, 1.2 [95% CI, 1.03–1.36]; P = .016), and age (OR, 1.1 [95% CI, 1.0–1.1]; P = .043) were independent risk factors for adverse clinical outcomes. One-third of the patients received unnecessary antimicrobial therapy. Sepsis at hospital admission (OR, 5.3 [95% CI, 1.8–15.8]; P = .003) and clinical suspicion of urinary tract infection (OR, 9.7 [95% CI, 2.9–32.3]; P< .001) were independently associated with unnecessary antimicrobial prescriptions.Conclusions.Empirical use of non-CDI-related antimicrobials was common. Prolonged exposure to non-CDI-related antimicrobials was associated with adverse clinical outcomes, including increased in-hospital mortality. Minimizing non-CDI-related antimicrobial exposure in patients with CDI seems warranted.

scholarly journals 67. Impact of a Pharmacist-Driven Collaborative Initiative on Staphylococcus aureus Bacteremia Management

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S52-S53
Author(s):  
Wesley D Kufel ◽  
Keri A Mastro ◽  
Dongliang Wang ◽  
Jeffrey Steele ◽  
Scott W Riddell ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Outcomes ◽  
Panel Member ◽  
Evidence Based ◽  
Post Intervention ◽  
Review Panel ◽  
Staphylococcus Aureus Bacteremia ◽  
The Impact ◽  
Collaborative Initiative ◽  
Research Grant

Abstract Background Infectious diseases (ID) consultation has been associated with improved outcomes for Staphylococcus aureus bacteremia (SAB) largely by providing guidance to follow widely accepted standards. However, ID consultation may be delayed due to numerous factors. ID pharmacists may be able to facilitate timely and optimal management of SAB in collaboration with ID providers and microbiology. The primary outcome of this study was to evaluate the impact of a pharmacist-driven collaborative initiative for SAB. Methods This was a single-center, quasi-experimental study of patients with SAB before (8/1/16–7/31/17) and after (8/1/18-7/31/19) implementation of pharmacist-driven collaborative initiative for SAB management. After direct notification of SAB and penicillin-binding protein assay results from microbiology personnel, the ID pharmacist promptly contacted the primary team to facilitate ID consultation and identified opportunities to optimize treatment or diagnosis prior to consult. Recommendations were also collaboratively discussed with the ID consult service. Included patients were ≥18 years old with SAB. Excluded patients were &lt; 18 years old, under palliative care or expired prior to S. aureus speciation, refused care against medical advice, pregnant, incarcerated, or had polymicrobial bacteremia. Results Ninety and 111 patients were included in the pre- and post-intervention cohort, respectively. Demographic data were similar between cohorts. Most SAB cases were community-acquired (72% vs 81%, p=0.137), complicated (83% vs 71%, p=0.059), and methicillin-susceptible (57% vs 65%, p=0.236). The most common sources were catheter (23%) and skin and soft tissue (30%) in pre- and post-intervention cohorts, respectively. Table 1 displays compliance with evidence-based SAB measures and clinical outcomes. Compliance with the SAB bundle was significantly higher in the post-intervention cohort (91% vs 50%, p&lt; 0.001). Table 1. Compliance with Evidence-Based Staphylococcus aureus Bacteremia Management Bundle Elements and Clinical Outcomes Conclusion Increased compliance with evidence-based SAB recommendations decreased SAB duration, time to targeted antibiotics, and infection-related hospital length of stay after implementation of a pharmacist-driven collaborative initiative for SAB. Disclosures Wesley D. Kufel, PharmD, Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member) Jeffrey Steele, PharMD, Paratek Pharmaceuticals (Advisor or Review Panel member)

scholarly journals Acute SARS-CoV-2 infection is associated with an expansion of bacteria pathogens in the nose including Pseudomonas aeruginosa

2021 ◽  
Author(s):  
Nicholas S Rhoades ◽  
Amanda Pinski ◽  
Alisha N Monsibais ◽  
Allen Jankeel ◽  
Brianna M Doratt ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Health Care Providers ◽  
Bacterial Infections ◽  
Neuronal Damage ◽  
Medical Center ◽  
Bacterial Pathogens ◽  
Hospital Environment ◽  
Respiratory Pathogens ◽  
Care Providers ◽  
The Impact

Much of the research conducted on SARS-CoV-2 and COVID-19 has focused on the systemic host response, especially that generated by severely ill patients. Very few studies have investigated the impact of acute SARS-CoV-2 within the nasopharynx, the site of initial infection and viral replication. In this study we profiled changes in the nasal microbial communities as well as in host transcriptional profile during acute SARS-CoV-2 infection using 16S amplicon sequencing and RNA sequencing. These analyses were coupled to viral genome sequencing. Our microbiome analysis revealed that the nasal microbiome of COVID patients was unique and was marked by an expansion of bacterial pathogens. Some of these microbes (i.e. Acinetobacter) were shared with COVID negative health care providers from the same medical center but absent in COVID negative outpatients seeking care at the same institutions suggesting acquisition of nosocomial respiratory pathogens. Specifically, we report a distinct increase in the prevalence and abundance of the pathogen Pseudomonas aeruginosa in COVID patients that correlated with viral RNA load. These data suggest that the inflammatory environment caused by SARS-CoV-2 infection and potentially exposure to the hospital environment leads to an expansion of bacterial pathogens in the nasal cavity that could contribute to increased incidence of secondary bacterial infections. Additionally, we observed a robust host transcriptional response in the nasal epithelia of COVID patients, indicative of an antiviral innate immune repones and neuronal damage. Finally, analysis of viral genomes did not reveal an association between viral loads and viral sequences.

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