Immunocompromised patients with SARS-CoV-2 infection in intensive care units, outcome and mortality

Background: The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak severely hit Northeastern France from March to May 2020. The massive arrival of SARS-CoV-2 positive patients in the intensive care units (ICU) raised the question of how immunocompromised patients would be affected. Therefore, we analyzed the clinical, biological and radiological features of 24 immunocompromised ICU patients with severe SAR-CoV-2 infection. Results: The mortality rate was significantly higher for immunocompromised patients compared with other patients (41.7% versus 27.3%, respectively, p = 0.021). Mortality occurred in the first 2 weeks of intensive care, highlighting the possible interest in prolonged full-code managnement of these patients. Finally, patients with lymphoid malignancies appeared to be particularly affected, mostly with monoclonal gamma-pathology. Conclusion: Mortality rate of SARS-CoV-2 acute respiratory syndrome in immuno-compromised patient is high. No treatment was associated with survival improvement. Prolonged full-code management is required for these patients.

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SARS-CoV-2 aerosol generation during respiratory equipment reprocessing

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00955-2 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Camila Quartim de Moraes Bruna ◽

Caroline Lopes Ciofi-Silva ◽

Anderson Vicente de Paula ◽

Lucy Santos Villas Boas ◽

Noely Evangelista Ferreira ◽

...

Keyword(s):

Intensive Care ◽

Severe Acute Respiratory Syndrome ◽

Intensive Care Units ◽

Medical Devices ◽

Aerosol Generation ◽

Surface Samples ◽

Tertiary Hospitals ◽

Air Sample ◽

Sterile Processing

AbstractAerosolization may occur during reprocessing of medical devices. With the current coronavirus disease 2019 pandemic, it is important to understand the necessity of using respirators in the cleaning area of the sterile processing department. To evaluate the presence of severe acute respiratory syndrome coronavirus (SARS-CoV-2) in the air of the sterile processing department during the reprocessing of contaminated medical devices. Air and surface samples were collected from the sterile processing department of two teaching tertiary hospitals during the reprocessing of respiratory equipment used in patients diagnosed with coronavirus disease 2019 and from intensive care units during treatment of these patients. SARS-CoV-2 was detected only in 1 air sample before the beginning of decontamination process. Viable severe acute respiratory syndrome coronavirus 2 RNA was not detected in any sample collected from around symptomatic patients or in sterile processing department samples. The cleaning of respiratory equipment does not cause aerosolization of SARS-CoV-2. We believe that the use of medical masks is sufficient while reprocessing medical devices during the coronavirus disease 2019 pandemic.

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Otolaryngology activity in two hospitals in northern and central Italy differently affected by COVID-19 pandemic

Science Progress ◽

10.1177/0036850421998487 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042199848

Author(s):

Antonio Minni ◽

Francesco Pilolli ◽

Massimo Ralli ◽

Niccolò Mevio ◽

Luca Roncoroni ◽

...

Keyword(s):

Intensive Care ◽

Severe Acute Respiratory Syndrome ◽

Intensive Care Units ◽

Healthcare System ◽

Central Italy ◽

Northern Italy ◽

Public Hospitals ◽

Geographical Differences ◽

Italian Regions

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic had a significant impact on the Italian healthcare system, although geographical differences were present; regions in northern Italy have been the most severely affected while regions in the south of the country were relatively spared. Otolaryngologists were actively involved in the management of the pandemic. In this work, we analyzed and compared the otolaryngology surgical activity performed during the pandemic in two large public hospitals located in different Italian regions. In northern Italy, otolaryngologists were mainly involved in performing surgical tracheotomies in COVID-19 positive patients and contributed to the management of these patients in intensive care units. In central Italy, where the burden of the infection was significantly lower, otolaryngologists focused on diagnosis and treatment of emergency and oncology patients. This analysis confirms the important role of the otolaryngology specialists during the pandemic, but also highlights specific differences between two large hospitals in different Italian regions.

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Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study

Journal of Patient Experience ◽

10.1177/23743735211007359 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110073

Author(s):

Reza Norouzadeh ◽

Mohammad Abbasinia ◽

Zahra Tayebi ◽

Ehsan Sharifipour ◽

Alireza Koohpaei ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Health Care Providers ◽

Spiritual Support ◽

Care Providers ◽

Structured Interviews ◽

Icu Patients ◽

Life Challenges ◽

Care Models ◽

The Face

This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.

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Estimating the Case Fatality Risk of COVID-19 using Cases from Outside China

10.1101/2020.02.15.20023499 ◽

2020 ◽

Cited By ~ 6

Author(s):

Nick Wilson ◽

Amanda Kvalsvig ◽

Lucy Telfar Barnard ◽

Michael G Baker

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Meta Analysis ◽

Case Fatality ◽

Large Uncertainty ◽

Icu Patients ◽

Fatality Risk ◽

Case Fatality Risk ◽

Respiratory Conditions

AbstractThere is large uncertainty around the case fatality risk (CFR) for COVID-19 in China. Therefore, we considered symptomatic cases outside of China (countries/settings with 20+ cases) and the proportion who are in intensive care units (4.0%, 14/349 on 13 February 2020). Given what is known about CFRs for ICU patients with severe respiratory conditions from a meta-analysis, we estimated a CFR of 1.37% (95%CI: 0.57% to 3.22%) for COVID- 19 cases outside of China.

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Colonization of central venous catheter in the intensive care units at the Institute of Cardiovascular Disease "Dedinje": One year study

Acta chirurgica iugoslavica ◽

10.2298/aci0503033c ◽

2005 ◽

Vol 52 (3) ◽

pp. 33-37

Author(s):

Ivana Cirkovic ◽

Vera Mijac ◽

Milena Svabic-Vlahovic ◽

S. Dukic ◽

I. Ilic ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Antimicrobial Agents ◽

Microbial Colonization ◽

Central Venous ◽

Candida Spp ◽

Icu Patients ◽

Gram Negative ◽

Microbiological Methods ◽

Increased Risk

Objectives: The application of Central Venous Catheters (CVC) is associated with increased risk of microbial colonization and infection. The aim of present study was to assess the frequency of pathogens colonizing CVC and to determine their susceptibility pattern to various antimicrobial agents. Materials and methods: A total of 253 samples of CVC from intensive care units (ICU) patients were received for culture during 2003. All microorganisms were identified by standard microbiological methods and the susceptibility to antimicrobial agents was determined according to NCCLS recommendations. Results: A total of 184 (72.7%) cultures were positive and 223 pathogens were isolated. Coagulase negative staphylococci (CNS) were the dominant isolates (24.7%), followed by Enterobacter spp. (12.1%), Pseudomonas spp. (11.7%), Enterococcus spp. (9.9%), Klebsiella spp. (8.6%), Candida spp. (7.6%), Acinetobacter spp. (7.6%), other Gram negative nonfermentative bacilli (5.8%), Serratia spp. (4.5%), Staphylococcus aureus (2.6%), Proteus mirabilis (2.2%), E. coli (1.8%) and Citrobacter spp. (0.9%). Meropenem (84.5%) and vancomycin (100%) remain the most effective antimicrobial agents against Gram negative and Gram positive bacteria, respectively. Conclusion: Gram negative bacilli and CNS are the commonest microorganisms colonizing CVC from ICU patients. The increasing resistance of the bacteria to antimicrobial agents is the major problem in spite of restricted policy of using antimicrobial agents in ICU.

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Neutrophil-to-lymphocyte Ratio as a Predictor of Mortality in ICU Patients: An Analysis of MIMIC-III Database

10.21203/rs.3.rs-88295/v1 ◽

2020 ◽

Author(s):

Xie Wu ◽

Zhanhao Su ◽

Qipeng Luo ◽

Yinan Li ◽

Hongbai Wang ◽

...

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Hospital Mortality ◽

Predictive Power ◽

Inflammatory Marker ◽

Survival Group ◽

Icu Patients ◽

Lymphocyte Ratio ◽

Saps Ii ◽

Death Group

Abstract Background: Identifying high-risk patients in intensive care unit (ICU) is very important because of the high mortality rate. Existing scoring systems are numerous but lack effective inflammatory markers. Our objective was to identify and evaluate a low-cost, easily accessible and effective inflammatory marker that can predict mortality in ICU patients.Methods: We conducted a retrospective study using data from the Medical Information Mart for Intensive Care III database. We first divided the patients into the survival group and the death group based on in-hospital mortality. Receiver operating characteristic analyses were performed to find the best inflammatory marker (i.e. neutrophil-to-lymphocyte ratio, NLR). We then re-divided the patients into three groups based on NLR levels. Univariate and multivariate logistic regression were performed to evaluate the association between NLR and mortality. The area under the curve (AUC), Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) were used to assess whether the incorporate of NLR can improve the predictive power of existing predictive model. Results: A total of 21,822 patients were included in this study, with an in-hospital mortality rate of 14.43%. Among all inflammatory marker in routine blood test results, NLR had the best predictive ability, with a median (interquartile range) NLR of 5.40 (2.95, 10.46) in the survival group and 8.32 (4.25, 14.75) in the death group. We then re-divided the patients into low (≤1), medium (1-6) and high (≥6) groups based on NLR levels. Compared with the median NLR group, the in-hospital mortality rates were significantly higher in the low (odds ratio [OR] = 2.09; 95% confidence interval [CI], 1.64 to 2.66) and high (OR=1.64; 95%CI, 1.50-1.80) NLR groups. The addition of NLR to Simplified Acute Physiology Score II (SAPS II) improved the AUC from 0.789 to 0.798 (P<0.001), with NRI of 16.64% (P<0.001) and IDI of 0.27% (P<0.001).Conclusion: NLR is a good predictor of mortality in ICU patients, both low and high levels of NLR are associated with elevated mortality rate. The inclusion of NLR might improve the predictive power of SAPS II.

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Assessment of Respiratory Bacterial Coinfections Among Severe Acute Respiratory Syndrome Coronavirus 2-Positive Patients Hospitalized in Intensive Care Units Using Conventional Culture and BioFire, FilmArray Pneumonia Panel Plus Assay

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa484 ◽

2020 ◽

Vol 7 (11) ◽

Author(s):

Camille Kolenda ◽

Anne-Gaëlle Ranc ◽

Sandrine Boisset ◽

Yvan Caspar ◽

Anne Carricajo ◽

...

Keyword(s):

Intensive Care ◽

Severe Acute Respiratory Syndrome ◽

Intensive Care Units ◽

Bacterial Infections ◽

Early Stage ◽

Bacterial Load ◽

Empiric Antibiotic Therapy ◽

Molecular Diagnostic ◽

Oral Flora ◽

Conventional Culture

Abstract Background Approximately 15% of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) present with severe forms of the disease and require hospitalization in intensive care units, which has been associated with high mortality rates. The prevalence of bacterial infections in these patients is not well established, and more data are needed to guide empiric antibiotic therapy and improve patient outcomes. Methods In this prospective multicenter study, we assessed bacterial coinfections identified in culture from 99 French patients infected by SARS-Cov-2 and hospitalized in intensive care units. We concomitantly evaluated an innovative molecular diagnostic technology technique, the BioFire, FilmArray Pneumonia Panel plus (FA-pneumo) assay, to identify these coinfections at an early stage, and its concordance with conventional culture. Results We showed that a bacterial coinfection was detected in 15% of patients based on conventional culture. Staphylococcus aureus and Haemophilus influenzae were the most prevalent pathogens. The sensitivity of FA-pneumo compared with culture was 100%. In contrast, the specificity varied between 88.4% and 100% according to the pathogen, and our results highlighted that 60.5% of bacterial targets reported using this assay were not recovered by culture; 76.9% of discordant results corresponded to bacteria belonging to commensal oral flora and/or reported with ≤105 copies/mL bacterial nucleic acids. Conclusions Based on its excellent sensitivity, the FA-pneumo assay is useful to rule out bacterial coinfections in the context of severe SARS-CoV-2 infection and avoid the inappropriate prescription of antibiotics. However, positive tests should be interpreted carefully, taking into consideration deoxyribonucleic acid bacterial load and all clinical and biological signs.

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Chlorhexidine-Related Mortality Rate in Critically Ill Subjects in Intensive Care Units: A Systematic Review and Meta-Analysis

Respiratory Care ◽

10.4187/respcare.06434 ◽

2019 ◽

Vol 64 (3) ◽

pp. 337-349

Author(s):

Sojung Lee ◽

Nima Laghapour Lighvan ◽

Victoria McCredie ◽

Petros Pechlivanoglou ◽

Murray Krahn ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Mortality Rate ◽

Intensive Care Units ◽

Critically Ill ◽

Meta Analysis ◽

Related Mortality

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Clinical evolution of adult, elderly and very elderly patients admitted in Intensive Care Units

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692011000600010 ◽

2011 ◽

Vol 19 (6) ◽

pp. 1344-1351 ◽

Cited By ~ 3

Author(s):

Verônica Cunha Rodrigues de Oliveira ◽

Lilia de Souza Nogueira ◽

Rafaela Andolhe ◽

Katia Grillo Padilha ◽

Regina Marcia Cardoso de Sousa

Keyword(s):

Intensive Care ◽

Mortality Rate ◽

Elderly Patients ◽

Comparative Study ◽

Clinical Outcomes ◽

Intensive Care Units ◽

The Elderly ◽

Simplified Acute Physiology Score ◽

Adult Patients ◽

Very Elderly

This study compared clinical outcomes among adult, elderly and very elderly patients admitted to Intensive Care Units (ICUs) located in São Paulo, Brazil. This retrospective, longitudinal and comparative study included 279 adult (≥18 and <60 years), 216 elderly (≥60 and <80 years) and 105 very elderly (≥80 years) patients. Adult patients differed from other groups regarding the unit to which they were referred and severity, according to the Simplified Acute Physiology Score II. Adults were most frequently sent to hospitalization wards; elderly and very elderly patients who survived hospitalization in critical units showed sharper improvement before discharge. There were differences in relation to mortality between adult and elderly patients, with a higher rate in the elderly group; however, the mortality rate of very elderly and adult patients was similar. In general, the results indicated that older age was not associated with undesirable outcomes in ICUs.

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Prioritization to ensure care in COVID-19 pandemic

Revista Brasileira de Saúde Materno Infantil ◽

10.1590/1806-9304202100s200011 ◽

2021 ◽

Vol 21 (suppl 2) ◽

pp. 519-527

Author(s):

Mirella Rebello Bezerra ◽

Maria Júlia Gonçalves de Mello ◽

Jurema Telles de Oliveira Lima ◽

Zilda do Rêgo Cavalcanti ◽

Guacyra Magalhães Pires Bezerra ◽

...

Keyword(s):

Health Care ◽

Palliative Care ◽

Intensive Care ◽

Severe Acute Respiratory Syndrome ◽

Healthcare System ◽

Clinical Situation ◽

Final Phase ◽

Icu Patients ◽

Delphi Methodology ◽

Modified Delphi

Abstract Objectives: to develop a flow to ensure care for all people with severe acute respiratory syndrome Coronavirus 2, offering from intensive care to palliative care, in an equitable and fair manner. Methods: the modified Delphi methodology was used to reach consensus on a flow and a prioritization index among specialists, the regional council of medicine, members of the healthcare system and the local judicial sector. Results: the score was incorporated into the flow as the final phase for building the list of patients who will be referred to intensive care, whenever a ventilator is available. Patients with lower scores should have priority access to the ICU. Patients with higher scores should receive palliative care associated with available curative measures. However, curative measures must be proportionate to the severity of the overall clinical situation and the prognosis. Conclusions: this tool could and will prevent patients from being excluded from access to the necessary health care so that their demands are assessed, their suffering is reduced, and their illnesses are cured, when possible.

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