Effect of Caring of Critically Sick Patients with COVID-19 Pneumonia at Undesignated ICU Wards on Secondary Infections

<b><i>Introduction:</i></b> COVID-19 has caused high rates of mortality. During pandemic peak, a significant number of patients were admitted to undesignated ICU areas before transferring to designated ICU, owing to unavailability of ICU beds. We aimed to record the effect of care of critically sick patients with COVID-19 on prevalence of secondary bacterial infection. <b><i>Methods:</i></b> We retrospectively studied all critically ill patients with COVID-19 pneumonia meeting ICU admission criteria who were admitted to Dubai hospital between January 1, 2020, and June 30, 2020. All the patients who transferred to wards other than designated ICU constitute category as cases. All patients who directly admitted to the designated ICU ward from emergency department constitute controls. The demographics, clinical parameters, and treatment profile of these patients were recorded and compared. Prevalence of secondary bacterial infection was calculated. <b><i>Results:</i></b> Patients with COVID-19 had high prevalence of secondary bacterial infection. Patients who stayed at undesignated ICU wards had higher occurrence of inpatient fever, hypoxemia, and they were more likely to be sedated and paralyzed than patients who stayed in designated ICU wards. Multiple logistic regression analysis showed care outside designated ICU ward does not predict increase in secondary nonviral microbial infections. <b><i>Conclusion:</i></b> Care of patients at undesignated ICU wards prior to admission to designated ICU does not impact prevalence of secondary bacterial infection.

Microcirculation disorders in patients with severe COVID-19 and development of bacterial sepsis

It is believed that microcirculation dysfunction in sepsis primarily caused by damage of the endothelium by infectious agents and pro-inflammatory cytokines. Mechanisms of impaired microcirculation in the severe course of COVID-19 and sepsis likely to be similar. However, there are few reports studied microcirculation disorders in patients with COVID-19, and their results are sometimes contradictory. Objective. To assess the microcirculation of patients with severe Covid-19 and the development of bacterial sepsis using nail bed microscopy and laser Doppler flowmetry. Materials and methods. 16 intensive care unit COVID-19 patients subsequently diagnosed with bacterial sepsis were examined. Patients underwent vital capillaroscopy and an occlusive test using laser Doppler flowmetry. The average rate of capillary blood flow, the size of the perivascular zone, the density of capillaries, the presence of intravascular aggregates, the increase in the amplitude of the maximum post-occlusive blood flow and the average value of postocclusive blood flow relative to the initial one were valuated. Additionally, the level of serum proadrenomedullin was evaluated. Studies were performed on the day of admission and in dynamics. Results. By the capillaroscopy analysis, microcirculation disorders were detected in the form of a decrease in the linear speed of capillary blood flow (<400 μm/s), an extention of the perivascular zone (>100 μm), the circulation of microaggregates; the absence of postocclusive hyperemia was determined by an occlusive test. Secondary bacterial infection led to an even greater aggravation of microcirculation disorders: an increase of the perivascular zone, the progression of intravascular aggregation resulting in microthrombosis with a decrease of the density of the capillary network (according to capillaroscopy), as well as a sharp decrease of amplitude maximal increment of blood flow of post-осclusive circulation at the time of an occlusive sample. We also revealed a trend of negative correlation between the level of serum proadrenomedullin and the maximum increase in blood flow during the occlusive test. Conclusion. The secondary bacterial infection in patients with COVID-19 leads to a significant aggravation of microcirculation disorders with the development of perfusion deficiency and interstitial edema. The increased plasma proadrenomedullin level supports the concept of the significant role of endothelial dysfunction in the pathogenesis of severe COVID-10 and bacterial sepsis.

Comparative Efficacy of Two Antibiotics for the Management of Secondary Bacterial Infection in Goats Clinically Affected by Peste des Petits Ruminants

Aims: Peste des petits Ruminants (PPR) is a major viral disease that poses a challenge to small ruminant farming. Its natural occurrence has been complicated by secondary bacterial infection which has led to an increase in morbidity and mortality rates. This study reports the management outcome of natural PPR-infected goats using two types of antibiotics in Nsukka metropolis of Enugu State Nigeria. Methodology: Goats (N=24) were confirmed to be suffering from PPR based on clinical signs and using polymerase chain reaction (PCR). The animals were divided into two groups. Group A was treated with 20% oxytetracycline (N= 10) and group B with procaine penicillin and streptomycin combination (penstrept) (N= 14) injection. Clinical signs, recovery and survivability, temperature, haematology [Packed cell volume (PCV); haemoglobin concentration (Hbconc); red blood cell (RBC) and white blood cell (WBC) counts] and some serum biochemical profiles [alanine aminotransferase (ALT); aspartate transaminase (AST); total protein (TP); Albumin; urea; creatinine; potassium and sodium] were used to assess the efficacy of the antibiotics using standard techniques. Results: The mean temperature, RBC, WBC and urea values of the PPR-infected goats were above their reference ranges, mean albumin values were below the reference range while mean Hbconc, PCV, AST, ALT, TP and creatinine values were within their reference range before the commencement of treatment. Following treatment, clinical signs cleared in 20% and 35.7% of the goats treated with oxytetracycline and penstrep respectively. Death was recorded in 20% and 15% of goats treated with oxytetracycline and penstrep respectively before the end of treatment. Penstrep-treated group showed improvement in their haematological profile. Conclusion: Based on our findings, the use of penstrep in the management of PPR-infected goats gave a better result.

Procalcitonin Increase Is Associated with the Development of Critical Care-Acquired Infections in COVID-19 ARDS

Secondary bacterial infection in COVID-19 patients is associated with increased mortality and disproportionately affects critically ill patients. This single-centre retrospective observational study investigates the comparative efficacy of change in procalcitonin (PCT) and other commonly available biomarkers in revealing or predicting microbiologically proven secondary infection in critical COVID-19 patients. Adult patients admitted to an intensive care unit (ICU) with confirmed SARS-CoV-2 infection between 9 March 2020 and 5 June 2020 were recruited to the study. For daily biomarker and secondary infection, laboratory-confirmed bloodstream infection (LCBI) and ventilator-associated pneumonia/tracheobronchitis (VAP/VAT) data were collected. We observed a PCT rise in 53 (81.5%) of the patients, a C-reactive protein (CRP) rise in 55 (84.6%) and a white blood cell count (WBC) rise in 61 (93.8%). Secondary infection was confirmed in 33 (50.8%) of the patients. A PCT rise was present in 97.0% of patients with at least one confirmed VAP/VAT and/or LCBI event. CRP and WBC rises occurred in 93.9% and 97.0% of patients with confirmed VAP/VAT and/or LCBI, respectively. Logistic regression analysis found that, when including all biomarkers in the same model, there was a significant association between PCT rise and the occurrence of LCBI and/or VAP/VAT (OR = 14.86 95%CI: 2.20, 342.53; p = 0.021). Conversely, no statistically significant relationship was found between either a CRP rise (p = 0.167) or a WBC rise (p = 0.855) and the occurrence of VAP/VAT and/or LCBI. These findings provide a promising insight into the usefulness of PCT measurement in predicting the emergence of secondary bacterial infection in ICU.

A comparative study of Bacterial culture isolates, site of infections and drug resistance pattern between COVID and non COVID patients admitted in a tertiary care hospital: A Pilot study

IntroductionSARS-CoV2 which is a corona virus also predisposes patient to secondary bacterial infection by various mechanisms like-damaging the respiratory epithelium, profoundly affecting the innate and adaptive immunity, antagonising Interferon responses that enhance bacterial adherence, colonisation and invasion to respiratory tissue. In addition, prolonged hospital stay, invasive therapeutic devices, widespread use of empiric antibiotics and most importantly use of immune-suppressants like Steroid or Tocilizumab further increases the chances of bacterial infection. As opposed to this concept-physical distancing, frequent hand washing and use of gloves and protective gear by the healthcare workers also diminishes the chance of secondary bacterial infection. The present study is done to delineate the bacteriological profile, infection site predisposition or to gain knowledge on antibiotic sensitivity pattern.MethodRetrospective data will be analyzed from June 2020, when the first COVID wave came to June 2021, corresponding to second COVID wave. The present study is a pilot study before collecting and analyzing the whole data Only those samples which were positive for bacterial isolates were randomly selected and the COVID status and drug resistance patterns were checked.Results and discussionThe most common organism found was Klebsiella. Acinetobacter was also found in few patients. But most striking finding was that COVID positive patients showed higher incidence of antibiotic resistance with Acinetobacter. Though E Coli was also found commonly in COVID positive patients, they were not drug resistant.ConclusionMDR infections are common in COVID patients. Acinetobacter and Klebsiella are prone to develope MDR infections. While E.Coli is also common in COVID patients, chance of drug resistance is less among them.

PREVALENCE OF PSEUDOMONAS CAUSING SECONDARY INFECTION IN PULMONARY TUBERCULOSIS PATIENTS

Background: Secondary bacterial infection is one of the most common complications in pulmonary tuberculosis (PTB) patients. Gram negative bacteria were commonly isolated from from adults hospitalized with secondary bacterial infection. So we conducted this study to assess the prevalence of secondary infection caused by Pseudomonas among active pulmonary tuberculosis patients. Materials and Method: It is a single centre hospital based observational study. 115 pulmonary tuberculosis patients aged above 14 years, with suspicion of secondary infection clinically or having complaints of fever, productive cough, chest pain, shortness of breath, and increased sputum purulence, inspite of taking antitubercular therapy or pulmonary tuberculosis patients with high total leucocyte counts were included. Results: Out of 115 samples sent for sputum pyogenic culture, approximately one fth (17.39%) were positive for Pseudomonas. Mean age was 46.69 ± 16.40 years in our study. Conclusion: Pseudomonas species are a major cause of secondary bacterial infection in patients with PTB on treatment.

Acute Late-Stage Myocarditis in the Crab-Eating Macaque Model of Hemorrhagic Smallpox

Hemorrhagic smallpox, caused by variola virus (VARV), was a rare but nearly 100% lethal human disease manifestation. Hemorrhagic smallpox is frequently characterized by secondary bacterial infection, coagulopathy, and myocardial and subendocardial hemorrhages. Previous experiments have demonstrated that intravenous (IV) cowpox virus (CPXV) exposure of macaques mimics human hemorrhagic smallpox. The goal of this experiment was to further understand the onset, nature, and severity of cardiac pathology and how it may contribute to disease. The findings support an acute late-stage myocarditis with lymphohistiocytic infiltrates in the CPXV model of hemorrhagic smallpox.

A Retrospective Study: Risk Factor Analysis of Secondary Bacterial Infection in Pediatric Atopic Dermatitis Patients

Background: Atopic Dermatitis (AD) is a complex multifactorial disease that includes defects in skin architecture, immune dysregulation, and changes of skin flora, and it predominantly occurs in infancy and childhood. The defects in skin barrier structures are mentioned as one of the factors that facilitates bacterial colonization. Bacterial infection in AD can worsen the inflammation. It requires treatment with antibiotics, which takes longer therapy time, higher costs, and ultimately affects the patient’s quality of life and his/her family members. Purpose: To find out the epidemiology, diagnosis, management of AD, and analyze the risk factors of secondary bacterial infection in new AD patients at the Pediatric Dermatology Division, Dermatovenereology Outpatient Clinic, Dr. Soetomo General Academic Hospital. Methods: This was a retrospective study with a total sampling method. The research data were medical records of new AD patients at the Pediatric Dermatology Division, Dermatovenereology Outpatient Clinic, Dr. Soetomo General Academic Hospital Surabaya from January 2012 to December 2018. Result: There were 404 new patients with AD at the Pediatric Dermatology Division from January 2012 to December 2018, and 210 of them were accompanied by secondary bacterial infection. There was a correlation between a history of dry skin (p=0.000) with the incidence of secondary bacterial infection in AD patients. Conclusion: In this study, AD patients with a history of dry skin had a risk of complication such as bacterial secondary infection.