scholarly journals Black Fungus an Add on Epidemic to Cosvid-19 Pandemic

2021 ◽  
pp. 178-188
Author(s):  
Shilpi Tiwari ◽  
Parimala Kulkarni ◽  
Shikha Mali ◽  
Sanjana Bhargava ◽  
Nandini Jaiswal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
T Cells ◽  
Intensive Care ◽  
Fungal Infection ◽  
Intensive Care Units ◽  
Cd8 T Cells ◽  
Clinical Manifestations ◽  
Virulence Traits

COVID-19 patients have lower immunosuppressive CD4+ T and CD8+ T cells and henceforth patients in intensive care units (ICU) need mechanical ventilation, henceforward they stay in hospitals. These patients have been exposed to advances in fungal co-infections. COVID-19 patients progress towards mucormycosis a black fungal infection that is deadly leading to loss of sight and hearing and eventually death. This article discusses the clinical manifestations, risk factors and emphases on virulence traits and management of black fungus.

Mucormycosis: A Black Fungus- Post Covid Complications

2021 ◽  
Author(s):  
Prithiv Kumar KR
Keyword(s):  
Mechanical Ventilation ◽  
T Cells ◽  
Intensive Care ◽  
Fungal Infection ◽  
Intensive Care Units ◽  
Respiratory System ◽  
Cd8 T Cells ◽  
Transmitted Disease ◽  
Global Pandemic

Human to human transmitted disease is the game of coronavirus disease (COVID-19) transmission and it had been declared an emergency global pandemic that caused major disastrous in the respiratory system to more than five million people and killing more than half a billion deaths across the globe. Besides lower acute respiratory syndrome, there is damage to the alveolar with severe inflammatory exudation. COVID-19 patients often have lower immunosuppressive CD4+ T and CD8+ T cells and most patients in intensive care units (ICU) need mechanical ventilation, hence longer stay in hospitals. These patients have been discovered to develop fungal co-infections. COVID-19 patients develop what is known as mucormycosis a black fungal infection that is deadly leading to loss of sight and hearing and eventually death. This chapter will focus on mucormycosis, a black fungus caused during post covid complications.

scholarly journals Incidence Of Central Line-associated Bloodstream Infections In Intensive Care Units In A Private Hospital (Cairo, Egypt)

2018 ◽  
Vol 11 (1) ◽  
pp. 562-571
Author(s):  
Amira M. Malek ◽  
Hasnaa A. Abouseif ◽  
Khaled M. Abd Elaziz ◽  
Mohamed F. Allam ◽  
Hoda I. Fahim
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Private Hospital ◽  
Bloodstream Infections ◽  
Central Line ◽  
Incidence Density ◽  
Icu Stay

Objective: The study aimed to measure the incidence, risk factors and most frequent causative organisms of central line-associated bloodstream infections (CLA-BSI) in the Medical/Coronary and Surgical Intensive Care Units (ICUs) at a private hospital. Methods: This prospective study included 499 patients and was conducted between April 2014 and September 2014 in the Medical/Coronary ICU and Surgical ICU of a private hospital in Cairo, Egypt. Results: Approximately 44% of all the patients admitted to the ICUs underwent Central Venous Catheter (CVC) insertion. The overall incidence density rate of CLA-BSI was 6 cases per 1000 central line-days. The central line utilization rate was 0.94 per 1000 patient-days. The mortality rate among cases with CLA-BSI was 16.8% (95% CI: 13.6% – 20.4%) during the study period. Risk factors for CLA-BSI were detected by univariate analysis and included associated co-morbidities such as heart failure, APACHE II scores of >15, an ICU stay of 5 days or more, duration of CVC placement, subclavian insertion of CVCs, and mechanical ventilation. Additionally, logistic regression analysis identified a long ICU stay of 5 days or more, mechanical ventilation and the presence of heart failure as the only significant predictors. Gram-negative bacteria, especially Enterobacter (36.8%: 95% CI: 16.3%– 61.6%), Pseudomonas aeruginosa (21.1%: 95% CI: 16.0% - 45.5%) were the predominant organisms detected in CLA-BSI cases. Conclusion: CLA-BSI is an important cause of mortality in ICU patients. The infection rate is considerably higher than that in recent studies from developed counties, but it is still lower than the rates reported in comparable published studies in Egypt. Strict adherence to the standard infection prevention practices for critically ill patients is highly recommended.

scholarly journals Incidence, risk factors and outcome of nosocomial pneumonia in patients with central nervous system infections

2011 ◽  
Vol 139 (7-8) ◽  
pp. 476-480 ◽  
Author(s):  
Olgica Gajovic ◽  
Zoran Todorovic ◽  
Zeljko Mijailovic ◽  
Predrag Canovic ◽  
Ljiljana Nesic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Mechanical Ventilation ◽  
Nervous System ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Nosocomial Pneumonia ◽  
Central Nervous System Infections ◽  
Mechanical Ventilation Duration ◽  
Gcs Score

Introduction. Pneumonia is the most frequent nosocomial infection in intensive care units. The reported frequency varies with definition, the type of hospital or intensive care units and the population of patients. The incidence ranges from 6.8-27%. Objective. The objective of this study was to determine the frequency, risk factors and mortality of nosocomial pneumonia in intensive care patients. Methods. We analyzed retrospectively and prospectively the collected data of 180 patients with central nervous system infections who needed to stay in the intensive care unit for more than 48 hours. This study was conducted from 2003 to 2009 at the Clinical Centre of Kragujevac. Results. During the study period, 54 (30%) patients developed nosocomial pneumonia. The time to develop pneumonia was 10?6 days. We found that the following risk factors for the development of nosocomial pneumonia were statistically significant: age, Glasgow Coma Scale (GCS) score <9, mechanical ventilation, duration of mechanical ventilation, tracheostomy, presence of nasogastric tube and enteral feeding. The most commonly isolated pathogens were Klebsiella-Enterobacter spp. (33.3%), Pseudomonas aeruginosa (24.1%), Acinetobacter spp. (16.6%) and Staphylococcus aureus (25.9%). Conclusion. Nosocomial pneumonia is the major cause of morbidity and mortality of patients with central nervous system infections. Patients on mechanical ventilation are particularly at a high risk. The mortality rate of patients with nosocomial pneumonia was 54.4% and it was five times higher than in patients without pneumonia.

scholarly journals A multirezisztens infekciók rizikófaktorainak vizsgálata két intenzív osztályon

2017 ◽  
Vol 158 (32) ◽  
pp. 1259-1268 ◽  
Author(s):  
Marcell Szabó ◽  
Noémi Kanász ◽  
Katalin Darvas ◽  
János Gál
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Units ◽  
Illness Severity ◽  
Resistant Bacteria ◽  
Acute Surgery ◽  
Multiresistant Bacteria ◽  
Severity Scores

Abstract: Introduction: Intensive care units are favourable environment for infections, many of them are caused by antibiotic resistant bacteria. Aim: Identifying risk factors of ICU-acquired multiresistant infections. Method: We performed observational study on two academic intensive care units (a multidisciplinary and a surgical ICU) between 01/09/2014 and 30/11/2015. Patients with a first infection caused by predefined organisms (P. aeruginosa, E. coli, K. pneumoniae, A. baumanni, S. aureus, S. epidermidis, E. faecium, E. faecalis or their multiresistant homologues) verified ≥48 h following admission were divided into two groups according to multiresistant (MRB) and non-multiresistant (n-MRB) bacteria. Prevalence of diabetes, COPD, smoking, alcoholism, acute surgery, malignancy were recorded. Their role was evaluated on pooled populations. Illness severity was marked by SAPS-II at admission and SOFA-score on day of positive culture. We also noted the length of stay, mechanical ventilation, antibiotic treatment. Results: Multidisciplinary ICU had 627, the surgical 1096 admissions. On the formal unit MRB group had 41 (48.1%), the n-MRB had 38 (51.9%) patients. On the latter unit 31 (54.4%) and 26 (45.6%) patients were involved. Smoking favoured multiresistant bacteria (RR 1.44 CI95% 1.04–2.0; p = 0.048). In case of malignancies n-MRB were more prominent (RR of MRB 0.68 CI95% 0.47–0.97; p = 0.026), other comorbidities had no significant impact. Illness severity scores did not differ at any of the ICUs. Preceding length of stay, days on mechanical ventilation or on antibiotics were similar in each group on both ICUs. Conclusion: Smoking was revealed as a risk factor for MRB on our ICUs. We were not able to identify time-dependent risk factors. Orv Hetil. 2017; 158(32): 1259–1268.

scholarly journals Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?

2021 ◽  
Vol 9 (7) ◽  
pp. 1505
Author(s):  
Claire Roger ◽  
Benjamin Louart
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Manifestations ◽  
Acute Interstitial Nephritis ◽  
Convulsive Status Epilepticus ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Drug Induced ◽  
Icu Patients

Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10–15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals.

scholarly journals POS1252 COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES ON CHRONIC USE OF HYDROXYCHLOROQUINE IN A LARGE BRAZILIAN COHORT – A 24-WEEK PROSPECTIVE STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 909-910
Author(s):  
G. Salviato Pileggi ◽  
G. Ferreira ◽  
A. P. Gomides ◽  
E. Reis Neto ◽  
M. Abreu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Heart Disease ◽  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Fisher Exact Test ◽  
Specific Information ◽  
Phone Calls ◽  
Chronic Use

Background:The role of chronic use of hydroxychloroquine (HCQ) in rheumatic disease (RD) patients during the SARS-CoV-2 pandemic is still subject of discussion.Objectives:To compare the occurrence of COVID-19 and its outcomes between RD patients on HCQ use with individuals from the same household not taking the drug during community viral transmission in an observational prospective multicenter study in Brazil.Methods:Participants were enrolled and monitored through 24-week (From March 29th to Sep 30th, 2020) regularly scheduled phone calls performed by trained medical professionals. Epidemiological and demographic data, as well as RD disease activity status and current treatment data, specific information about COVID-19, hospitalization, need for intensive care, and death was recorded in both groups and stored in the Research Electronic Data Capture (REDCap) database. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. The statistical analysis was performed using IBM-SPSS v.20.0 software. Group comparisons were made using the Man-Whitney, Chi-Square and Fisher Exact Test, as well as multivariate regression models adjusted to confounders. Survival curves were performed using Kaplan-Meier analysis.Results:A total of 10,427 participants mean age (SD) of 44.04 (14.98) years were enrolled, including 6004 (57.6%) rheumatic disease patients, of whom 70.8% had systemic lupus erythematosus (SLE), 6.7% rheumatoid arthritis (RA), 4% primary Sjögren’s syndrome (pSS), 1.8% mixed connective tissue disease (DMTC), 1% systemic sclerosis (SSc) and others (15.9), including overlap syndromes. In total, 1,132 (10.8%) participants fulfilled criteria for COVID-19, being 6.7% RD patients and 4.1% controls (p=0.002). A recent influenza vaccination had a protective role (p<0.001). Moderate and severe COVID-19 included the need for hospitalization, intensive care, mechanical ventilation or death. Infection severity was not different between groups (p=0.391) (Table 1). After adjustments for multiple confounders, the main risk factors significantly associated with COVID-19 were higher education level (OR=1.29 95%CI 1.05-1.59), being healthcare professionals (OR=1.91; 95%CI 1.45-2.53), presence of two comorbidities (OR=1.31; 95%CI 1.01-1.66) and three or more comorbidities associated (OR=1.69; 95%CI 1.23-2.32). Interestingly, age >=65 years (OR=0.20; 95%CI 0.11-0.34) was negatively associated. Regarding RD, the risk factors associated with COVID-19 diagnosys were SLE (OR= 2.37; 95%CI 1.92-293), SSc (OR=2.25; 95%CI 1.05-4.83) and rituximab use (OR=1.92; 95%CI 1.13-3.26). In addition, age >=65 years (OR=5.47; 95%CI 1.7-19.4) and heart disease (OR=2.60; 95%CI 1.06-6.38) were associated with hospitalization. Seven female RD patients died, six with SLE and one with pSS, and the presence of two or more comorbidities were associated with higher mortality rate.Conclusion:Chronic HCQ use did not prevent COVID-19 in RD compared to their household cohabitants. Health care profession, presence of comorbidities LES, SSc and rituximab were identified as main risk factors for COVID-19 and aging and heart disease as higher risk for hospitalization. Our data suggest these outcomes could be considered to manage them in clinical practice.Table 1.Frequency and severity of COVID-19 in patients with rheumatic diseases on chronic use of hydroxychloroquine compared to their household controlsCOVID-19 outcomesTotal(%)GroupsPPatients(%)Controls (%)DiagnosisNo9256 (89.1)5300 (88.3)3956 (90.2)0.002Yes1132 (10.9)704 (11.7)428 (9.8)SeverityMild1059 (93.6)662 (94.0)397 (92.8)0.391Moderate52 (4.6)32 (4.5)20 (4.7)Severe21 (1.9)10 (1.4)11 (2.6)HCQ: hydroxychloroquine.Moderate and severe COVID-19 included the need for any of the following: hospitalization, intensive care, mechanical ventilation or death.Acknowledgements:To the Brazilian Society of Rheumatology for technical support and rapid nationwide mobilization.To all the 395 interviewers (medical students and physicians) who collaborated in the study and the participantsTo CNPq (Number 403442/2020-6)Disclosure of Interests:None declared

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