New approaches in providing care to surgical patients under conditions of COVID-19 pandemic on the basis of Military medical clinical center of Central region

Annotation. Nowadays, in coronavirus disease pandemic, the conditions for emergency surgery have changed. The aim of the work was to improve the provision of emergency surgical care under conditions of COVID-19 pandemic by developing and implementing clinical pathway of patients, using the remodeled infectious disease unit with a specially equipped operating room. To improve emergency surgical care under conditions of coronavirus pandemic, clinical pathways have been developed and implemented for management of patients with acute surgical pathology: the pathway of the patient requiring emergency surgery with suspected COVID-19 during self-presentation, the patient delivered by ambulance, in mass admission of patients, in admission of servicemen. Part of the hospital stock was restructured into isolated off-line infectious disease unit for treatment of patients with COVID-19 in a separate two-story building. Specially equipped operating room of the off-line infectious disease unit has separate entrances for patients and medical staff, which ensures the distribution of patient flows in the operating room. Clinical pathways for providing emergency care to patients with acute surgical pathology, developed by the authors, made it possible to divide them into flows and minimize possible risks of coronavirus infection in medical staff and other groups of patients. Under pandemic conditions, restructuring of hospital stock along with creation of off-line units with the use of existing staff seems to be warranted. Appropriate training of medical personnel in the restructured units working with COVID-19 infection as well as the development of rotational system mechanism for medical personnel are urgently required. Clinical results of treatment of patients with acute surgical pathology in the off-line infectious disease unit for patients with COVID-19 will be the object of future studies.

Pyogenic lung abscess in an infectious disease unit: a 20-year retrospective study

Background: Pyogenic lung abscesses are rare and poorly described infections. This study aimed to describe their prognostic factors. Methods: We retrospectively included all patients hospitalized between 1 January 1998 and 1 June 2018, with an International Classification of Diseases, version 10 (IDC-10) diagnosis of pyogenic lung abscess, from the Diamm based medical records (Micro6, Nancy, France). Parasitic, fungal, or mycobacterial lung abscesses were excluded. Results: A total of 64 patients were included. Abscesses were associated with immunosuppression in 28 patients, including HIV infection and immunosuppressive therapy for eight and 12 patients, respectively. Bacterial identification was obtained for 36 patients. Nine patients (14%) developed lung abscesses after hematogenous dissemination. They differed from bronchogenic abscesses by their younger age ( p = 0.03), the absence of smoking or emphysema ( p = 0.05), Staphylococcus aureus ( p = 0.001) or Streptococcus spp. ( p = 0.05) isolation, and the smaller size of their abscess ( p = 0.02). Overall, evolution was marked by radiological sequelae (46.9%), relapse (12.5%), and death (4.8%). Radiological sequelae occurred more frequently during the course of bronchogenic abscesses ( p = 0.02), particularly when they spontaneously discharged ( p = 0.04). Relapses were more frequent in patients with emphysema ( p = 0.04) and when Haemophilus influenzae was isolated ( p = 0.04). In multivariate analysis, poor outcomes, including death, sequelae, and relapse occurred more frequently in patients who had bronchogenic abscess ( p = 0.02), and in those who received antibiotics during less than 6 weeks ( p = 0.05). Conclusion: A duration of antibiotic treatment of less than 6 weeks and bronchogenic presentation were globally associated with poor outcome of pyogenic lung abscesses. These data should be considered when proposing guidelines for the care of pyogenic lung abscesses. The reviews of this paper are available via the supplemental material section.

Pyogenic Lung Abscess in an Infectious Disease Unit, a 20-year Retrospective Study

Rationale: Pyogenic lung abscesses are rare and poorly described infections. This study aimed to describe their prognostic factors.Methods: We retrospectively included all patients hospitalized between January 1st, 1998 and June 1st, 2018, with a IDC-10 diagnosis of pyogenic lung abscess, from the Diamm ® based medical records (Micro6, Nancy; France). Parasitic, mycological, or mycobacterial lung abscesses were excluded.Results: A total of 64 patients were included. Abscesses were associated with immunosuppression in 28 patients, including HIV infection and immunosuppressive therapy for 8 and 12 patients, respectively. Bacterial identification was obtained for 36 patients. Nine patients (14%) developed lung abscesses after haematogenous dissemination. They differed from bronchogenic abscesses by their younger age (p=0.03), the absence of smoking or emphysema (p=0.05), S. aureus (p=0.001) or Streptococcus spp (p=0.05) isolation, and the smaller size of their abscess (p=0.02). Overall, evolution was marked by radiological sequelae, relapse, and death. Radiological sequelae occurred more frequently during the course of bronchogenic abscesses (p=0.02), particularly when they spontaneously discharged (p=0.04). Relapses were more frequent in patients with emphysema (p=0.04) and when H. influenzae was isolated (p=0.04). In multivariate analysis, poor outcomes, including death, sequelae, and relapse occurred more frequently in patients who had bronchogenic abscess (p=0.02), and in those who received antibiotics during less than 6 weeks (p=0.05). Conclusion: Duration of antibiotic treatment of less than six weeks and bronchogenic presentation were globally associated with poor outcome of pyogenic lung abscesses. These data should be considered when proposing guidelines for the care of pyogenic lung abscesses.

A prospective pharmacovigilance study in the infectious diseases unit of a tertiary care hospital

Introduction: The frequency, causality, severity, preventability and risk factors of ADRs (adverse drug reactions) in infectious disease units are not well defined in the literature. Thus, the aim of this study was to determine the characteristics of the ADRs encountered in an infectious disease unit of a tertiary teaching hospital. Methodology: The patients who were admitted to the infectious disease unit of a tertiary teaching hospital longer than 24 hours between January and December of 2016 were followed prospectively. Patients were observed and questioned for any sign of ADRs. The proportion of ADRs and patient characteristics were investigated. Causality was evaluated by the Naranjo algorithm, severity was determined using the Hartwig classification, and preventability was assessed using the Schumock and Thornton scale. Results: 210 patients were admitted to the unit during the study period, of whom 44 patients (20.9%) experienced 51 ADRs. 5.9% of ADRs were found to be serious according to the Hartwig severity classification. In addition, 88.1% of ADRs were not preventable. The most frequently detected ADR was skin and subcutaneous tissue reactions (33.3%), and systemic antimicrobials were the most common type of drugs that caused an ADR. Prolonged hospitalization (p < 0.001) and usage of an increased number of drugs (p < 0.001) were found to be significant risk factors for ADR development. Conclusions: Prolonged hospital stay and polypharmacy are significant risk factors that increase the incidence of ADRs in infectious disease units. The likelihood of unavoidable ADRs should arouse the attention of clinicians when prescribing antimicrobials.

Proposal of nursing care plan in people hospitalized with AIDS

OBJECTIVE to elaborate and validate a proposal for a nursing care plan in people hospitalized with AIDS, in an infectious disease unit, using ICNP® version 2015. METHODS A cross-sectional study, followed by validation of content, performed with 20 nurses and 120 people, living with AIDS in an infectious disease unit of a hospital of infectious diseases in Northeast Brazil. The methodological trajectory was carried out in the following stages: elaboration of the diagnosis, nursing outcomes; Initial proposal of nursing interventions; Preparation of a care plan; And validation of the plan by field experts. RESULTS 42 diagnoses were elaborated and validated, 33 presented CVI > 0.80 (55.42%) among field experts. From this quantitative, 228 interventions were elaborated and 41 obtained a CVI > 0.80 (44.78%), considered validated. CONCLUSION The study allowed us to identify and validate nursing diagnoses, outcomes and interventions for the use in clinical practice, aiming to subsidize the process of care for people with AIDS.