Corpus overview


Overview

MeSH Disease

Human Phenotype

Pneumonia (1390)

Fever (198)

Cough (163)

Respiratory distress (100)

Hypertension (83)


Transmission

Seroprevalence
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    Diagnostic utility of a Ferritin-to-Procalcitonin Ratio to differentiate patients with COVID-19 from those with Bacterial Pneumonia HP: A multicenter study

    Authors: Amal A. Gharamti; Fei Mei; Katherine C. Jankousky; Jin Huang; Peter Hyson; Daniel B. Chastain; Jiawei Fan; Sharmon Osae; Wayne W. Zhang; Jose G. Montoya; Kristine M. Erlandson; Sias J. Scherger; Carlos Franco-Paredes; Andres F. Henao-Martinez; Leland Shapiro

    doi:10.1101/2020.10.20.20216309 Date: 2020-10-22 Source: medRxiv

    Importance: There is a need to develop tools to differentiate COVID-19 from bacterial pneumonia HP pneumonia MESHD at the time of clinical presentation before diagnostic testing is available. Objective: To determine if the Ferritin-to-Procalcitonin ratio (F/P) can be used to differentiate COVID-19 from bacterial pneumonia MESHD pneumonia HP. Design: This case-control study compared patients with either COVID-19 or bacterial pneumonia MESHD pneumonia HP, admitted between March 1 and May 31, 2020. Patients with COVID-19 and bacterial pneumonia co-infection MESHD pneumonia HP co-infection were excluded. Setting: A multicenter study conducted at three hospitals that included UCHealth and Phoebe Putney Memorial Hospital in the United States, and Yichang Central People Hospital in China. Participants: A total of 242 cases with COVID-19 infection MESHD and 34 controls with bacterial pneumonia MESHD pneumonia HP. Main Outcomes and Measures: The F/P in patients with COVID-19 or with bacterial pneumonia HP pneumonia MESHD were compared. Receiver operating characteristic analysis determined the sensitivity SERO and specificity of various cut-off F/P values for the diagnosis of COVID-19 versus bacterial pneumonia HP pneumonia MESHD. Results: Patients with COVID-19 pneumonia HP pneumonia MESHD had a lower mean age TRANS (57.11 vs 64.4 years, p=0.02) and a higher BMI (30.74 vs 27.15 kg/m2, p=0.02) compared to patients with bacterial pneumonia MESHD pneumonia HP. Cases and controls had a similar proportion of women (47% vs 53%, p=0.5) and COVID-19 patients had a higher prevalence SERO of diabetes mellitus HP diabetes mellitus MESHD (32.6% vs 12%, p=0.01). The median F/P was significantly higher in patients with COVID-19 (4037.5) compared to the F/P in bacterial pneumonia HP pneumonia MESHD (802, p<0.001). An F/P greater than or equal to 877 used to diagnose COVID-19 resulted in a sensitivity SERO of 85% and a specificity of 56%, with a positive predictive value SERO of 93.2%, and a likelihood ratio of 1.92. In multivariable analyses, an F/P greater than or equal to 877 was associated with greater odds of identifying a COVID-19 case (OR: 11.27, CI: 4-31.2, p<0.001). Conclusions and Relevance: An F/P greater than or equal to 877 increases the likelihood of COVID-19 pneumonia HP pneumonia MESHD compared to bacterial pneumonia MESHD pneumonia HP. Further research is needed to determine if obtaining ferritin and procalcitonin simultaneously at the time of clinical presentation has improved diagnostic value. Additional questions include whether an increased F/P and/or serial F/P associates with COVID-19 disease severity or outcomes.

    Validation of expert system enhanced deep learning algorithm MESHD for automated screening for COVID- Pneumonia HP on chest X-rays

    Authors: Prashant Sadashiv Gidde; Shyam Sunder Prasad; Ajay Pratap Singh; Nitin Batheja; Satyartha Prakash; Prateek Singh; Aakash Saboo; Rohit Thakar; Salil Gupta; Sumeet Saurav; M V Raghunandan; Amritpal Singh; Viren Sardana; Harsh Mahajan; Arjun Kalyanpur; Atanendu Shekhar Mandal; Vidur Mahajan; Anurag Agrawal; Anjali Agrawal; Vasantha Kumar Venugopal; Sanjay Singh; Debasis Dash; Sara Sabach; Yuval Alfiya; Uta Cheruti; Nadav Davidovitch; Natalya Bilenko; Jacob Moran-Gilad; Yakir Berchenko; Itay Bar-Or; Ariel Kushmaro; Timothy Spector; Claire J Steves

    doi:10.1101/2020.10.20.20213793 Date: 2020-10-21 Source: medRxiv

    The coronavirus disease of 2019 (COVID-19) pandemic exposed a limitation of artificial intelligence (AI) based medical image interpretation systems. Early in the pandemic, when need was greatest, the absence of sufficient training data prevented effective deep learning (DL) solutions. Even now, there is a need for Chest-X-ray (CxR) screening tools in low and middle income countries (LMIC), when RT-PCR is delayed, to exclude COVID-19 pneumonia HP pneumonia MESHD (Cov-Pneum) requiring transfer to higher care. In absence of local LMIC data and poor portability of CxR DL algorithms, a new approach is needed. Axiomatically, it is faster to repurpose existing data than to generate new datasets. Here, we describe CovBaseAI, an explainable tool which uses an ensemble of three DL models and an expert decision system (EDS) for Cov-Pneum diagnosis, trained entirely on datasets from the pre-COVID-19 period. Portability, performance SERO, and explainability of CovBaseAI was primarily validated on two independent datasets. First, 1401 randomly selected CxR from an Indian quarantine-center to assess effectiveness in excluding radiologic Cov-Pneum that may require higher care. Second, a curated dataset with 434 RT-PCR positive cases of varying levels of severity and 471 historical scans containing normal studies and non-COVID pathologies, to assess performance SERO in advanced medical settings. CovBaseAI had accuracy of 87% with negative predictive value SERO of 98% in the quarantine-center data for Cov-Pneum. However, sensitivity SERO varied from 0.66 to 0.90 depending on whether RT-PCR or radiologist opinion was set as ground truth. This tool with explainability feature has better performance SERO than publicly available algorithms trained on COVID-19 data but needs further improvement.

    Tocilizumab is associated with reduction in inflammation MESHD and improvement in P/F ratio in critically sick COVID19 patients

    Authors: Muhammad Asim Rana; Mubashar Sultan Hashmi; Muhammad Muneeb Ullah Saif; Muhammad Faisal Munir; Ahad Qayyum; Rizwan Pervaiz; Muhammad Mansoor Hafeez; Graham Cooke; Timothy B Hallett; Katharina D Hauck; Peter J White; Mark R Thursz; Shevanthi Nayagam; Brendan Flannery; Ricardo Gilead Baibich; Iris Bigler; Matan Malul; Rotem Rishti; Asher Brenner; Yair E. Lewis; Eran Friedler; Yael Gilboa; Sara Sabach; Yuval Alfiya; Uta Cheruti; Nadav Davidovitch; Natalya Bilenko; Jacob Moran-Gilad; Yakir Berchenko; Itay Bar-Or; Ariel Kushmaro; Timothy Spector; Claire J Steves

    doi:10.1101/2020.10.20.20210195 Date: 2020-10-21 Source: medRxiv

    Introduction: Coronavirus disease 2019 was initially detected in China and has been declared a global pandemic by World Health Organization on March 11, 2020. In the majority of patients, SARS-CoV-2 causes a mild to moderate illness characterized by fever HP fever MESHD and respiratory symptoms MESHD, with or without evidence of pneumonia HP pneumonia MESHD. The recent studies suggest that anti-cytokine targeted therapies might be associated with benefit for patients with severe COVID-19 especially in improving respiratory failure HP respiratory failure MESHD. Tocilizumab, a monoclonal antibody SERO against interleukin 6 (IL6) receptor, is associated with clinical benefit for COVID-19 patients as it inhibits IL6 and decreases inflammation MESHD. Methods: As Tocilizumab has been an important part of our treatment and a strict criterion was followed to administer Tocilizumab, a retrospective study design used to assess the beneficial effects of Tocilizumab in improvement of ratio partial pressure of arterial Oxygen and fraction of inspired Oxygen (PaO2/FiO2 or P/F ratio) and C- reactive protein (CRP) in COVID19 patients has been done. 60 patients were taken for this study by using convenient sampling technique the data of demographics, laboratory results, and clinical outcomes i.e. improvement of respiratory failure HP respiratory failure MESHD depicted in the form of PF Ratio were obtained from the medical records, Statistical analysis was done with SPSS, version 21.0. Results: Sixty patients (47 males TRANS and 13 females TRANS) with COVID-19 were included in this study, the mean age TRANS of patients was 53.83 (14-81) years. After administration of Tocilizumab the lab parameters were changed as CRP decreased down to .40 (9.6-73) mg/L but other parameters were not affected. The PF ratio improved in COVID-19 patients after administration of Tocilizumab the median of PF Ratio before treatment was 108 (52-362) and improved up to 128 (37-406) after Tocilizumab therapy. Conclusion: In summary, Tocilizumab appears to be associated with improvement in P/F Ratio and CRP in COVID19 patients but other markers did not improve in response to Tocilizumab therapy in severely ill COVID-19 patients.

    Effective Deep Learning Approaches for Predicting COVID-19 Outcomes from Chest Computed Tomography Volumes

    Authors: Anusua Trivedi; Anthony Ortiz; Jocelyn Desbiens; Caleb Robinson; Marian Blazes; Sunil Gupta; Rahul Dodhia; Pavan Bhatraju; W. Conrad Liles; Aaron Lee; Juan M Lavista Ferres; Jane Eddleston; Chris Brookes; Christopher Harrison; Weiqi Liu; Tianyi Liu; Jin-Wen Song; Liangliang Sun; Fan Yang; Xin Zhang; Bo Zhang; Ming Shi; Fanping Meng; Yanning Song; Yongpei Yu; Jiqiu Wen; Qi Li; Qing Mao; Markus Maeurer; Alimuddin Zumla; Chen Yao; Weifen Xie; Fu-Sheng Wang; Anthony Atala; Ali Ghodsizad; Joshua M Hare

    doi:10.1101/2020.10.15.20213462 Date: 2020-10-20 Source: medRxiv

    The rapid evolution of the novel coronavirus SARS-CoV-2 pandemic has resulted in an urgent need for effective clinical tools to reduce transmission TRANS and manage severe illness. Numerous teams are quickly developing artificial intelligence approaches to these problems, including using deep learning to predict COVID-19 diagnosis and prognosis from computed tomography (CT) imaging data. In this work, we assess the value of aggregated chest CT data for COVID-19 prognosis compared to clinical metadata alone. We develop a novel patient-level algorithm to aggregate the chest CT volume into a 2D representation that can be easily integrated with clinical metadata to distinguish Novel Coronavirus Pneumonia HP (COVID-19+) from other cases of viral pneumonia MESHD pneumonia HP and normal healthy chest CT volumes with state-of-the-art performance SERO. Furthermore, we present a multitask model for joint segmentation of different classes of pulmonary lesions MESHD present in COVID-19 infected lungs MESHD that can outperform individual segmentation models for each task. We directly compare this multitask segmentation approach to combining feature-agnostic volumetric CT classification feature maps with clinical metadata for predicting mortality. These approaches enable the automated extraction of clinically relevant features from chest CT volumes for risk stratification of COVID-19+ patients.

    Intravenous Mesenchymal Stem Cells in Extracorporeal Oxygenation Patients with Severe COVID-19 Acute Respiratory Distress Syndrome MESHD Respiratory Distress HP Syndrome

    Authors: Sunjay Kaushal; Aisha Khan; Kristopher Deatrick; Derek K Ng; Abigail Snyder; Aakash Shah; Lina V Caceres; Ketty Bacallao; Melania Bembea; Allen Everett; Jie Zhu; David Kaczorowski; Ronson Madathil; Ali Tabatabai; Geoffrey Rosenthal; Adriana Brooks; Bangon Longsomboon; Rachana Mishra; Progyaparamita Saha; Yvenie Desire; Russell Saltzman; Kim G Hankey; Sixto A Arias; Folusakin Ayoade; Jairo A. Tovar; Rejane Lamazares; Hayley B Gershengorn; Fontaine J Magali; Matthias Loebe; Kristin Mullins; Muthukumar Gunasekaran; Vela Karakeshishyan; Dushyantha T Jayaweera; Anthony Atala; Ali Ghodsizad; Joshua M Hare

    doi:10.1101/2020.10.15.20122523 Date: 2020-10-20 Source: medRxiv

    Background: There is an ongoing critical need to improve therapeutic strategies for COVID-19 pneumonia HP pneumonia MESHD, particularly in the most severely affected patients. Adult TRANS mesenchymal stem cell (MSC) infusions have the potential to benefit critically ill MESHD patients with acute respiratory syndrome SARS-COV-2 infection MESHD, but clinical data supporting efficacy are lacking. Methods: We conducted a case-control study of critically ill MESHD patients with laboratory-confirmed COVID-19, severe acute respiratory distress HP respiratory distress MESHD syndrome ( ARDS MESHD). To evaluate clinical responsiveness in the most critically ill patient we examined outcomes in a sub-group of those requiring extracorporeal membrane oxygenation (ECMO) support. Patients (n=9) were administered with up to 3 infusions of intravenous (IV) MSCs and compared to a local ECMO control group (n=31). The primary outcome was safety, and the secondary outcomes were all-cause mortality (or rate of hospital discharge), cytokine levels, and viral clearance. Findings: MSC infusions (12 patients) were well tolerated and no side effects occurred. Of ECMO patients receiving MSC infusions, 2 out of 9 died (22.2%; 95%CI: 2.8%, 60.0%) compared with a mortality of 15 of 31 (48.4%; 95%CI: 30.2%, 66.9%; p = 0.25) in the ECMO control group. Isolated plasma SERO exosomes containing the SARS-COV-2 Spike protein decreased after MSC infusions between day 14 or 21 after administration (p=0.003 and p=0.005, respectively) and was associated with a decrease in COVID-19 IgG Spike protein titer at same time points (p = 0.006 and p=0.007, respectively). Control ECMO patients receiving convalescent plasma SERO did not clear COVID-19 IgG over the same time frame. Interpretation: Together these findings suggest that MSC IV infusion is well tolerated in patients with a broad range of severity including the most severe COVID-19 ARDS requiring ECMO. These data also raise the possibility that MSCs, in addition to exerting an immunomodulatory effect, contribute to viral clearance and strongly support the conduct of randomized placebo-controlled trial.

    Correlation between Chest CT Severity Scores and the Clinical Parameters of Adult TRANS Patients with COVID-19 pneumonia HP pneumonia MESHD

    Authors: Ghufran Saeed; Waqar Gaba; Asad Shah; Abeer Al Helali; Emadullah Raidullah; Ameirah Al Ali; Mohammed Elghazali; Deena Ahmed; Shaikha Al Kaabi; Safaa Almazrouei; Juan M Lavista Ferres; Jane Eddleston; Chris Brookes; Christopher Harrison; Weiqi Liu; Tianyi Liu; Jin-Wen Song; Liangliang Sun; Fan Yang; Xin Zhang; Bo Zhang; Ming Shi; Fanping Meng; Yanning Song; Yongpei Yu; Jiqiu Wen; Qi Li; Qing Mao; Markus Maeurer; Alimuddin Zumla; Chen Yao; Weifen Xie; Fu-Sheng Wang; Anthony Atala; Ali Ghodsizad; Joshua M Hare

    doi:10.1101/2020.10.15.20213058 Date: 2020-10-20 Source: medRxiv

    Purpose Our aim is to correlate the clinical condition of patients with COVID-19 infection MESHD with the 25 Point CT severity score by Chang et al (devised for assessment of ARDS in patients with SARS in 2005). Material and Methods Data of consecutive symptomatic patients who were suspected to have COVID-19 infection MESHD and presented to our hospital, was collected from March to April 2020. All patients underwent two consecutive RT-PCR tests and had a non-contrast HRCT scan done at presentation. From the original cohort of 1062 patients, 160 patients were excluded leaving a total number of 902 patients. Results The mean age TRANS was 44.2 +/- 11.9 years [85.3% males TRANS, 14.7 % females TRANS]. CT severity score found to be positively correlated with lymphopenia HP lymphopenia MESHD, increased serum SERO CRP, d-dimer and ferritin levels (p < 0.0001). The oxygen requirements as well as length of hospital stay were increasing with the increase of scan severity. Conclusion The 25-point CT severity score correlates well with the COVID-19 clinical severity. Our data suggest that chest CT scoring system can aid in predicting COVID-19 disease outcome and significantly correlates with lab tests and oxygen requirements.

    COVID-19 IN CHILDREN MESHD CHILDREN TRANS WITH RHEUMATIC DISEASES ( RD MESHD) IN THE SPANISH NATIONAL COHORT EPICO-AEP.

    Authors: Cristina Calvo; Agustin Remesal; Sara Murias; Fatima Ara-Montojo; Enrique Otheo; Francisco J Sanz-Santaeufemia; Alvaro Villaroya; Cinta Moraleda; Alfredo Tagarro; Jean Michel Heraud; C. Jessica E. Metcalf; Benjamin L Rice; Javier Colomina; David Navarro

    doi:10.1101/2020.10.17.20214296 Date: 2020-10-20 Source: medRxiv

    Objectives: SARS-CoV-2 infection MESHD in adults TRANS with rheumatic diseases MESHD ( RD MESHD) is a cause for concern. Data in the pediatric population are practically absent. We aimed to describe the prevalence SERO of patients with RD MESHD and their complications among children TRANS admitted with COVID-19 in the Spanish national cohort EPICO-AEP; a multicenter prospective national study. Methods: Children TRANS <18 years old with RD MESHD and COVID-19 enrolled in EPICO-AEP were included in this study. Results: By June 30th 2020, 350 children TRANS were admitted in secondary and tertiary hospitals of Spain with SARS-CoV-2 infection MESHD. A total of 8 patients presented RD MESHD (2.2% of those hospitalized). All were female TRANS. The median age TRANS was 12.1 years (IQR 8.3-14.5). The diagnosis related with COVID-19 were febrile syndrome and/or upper respiratory infection MESHD (4 cases) and pneumonia HP pneumonia MESHD (4 cases). One of the 8 (12.5%) patients with a severe juvenile dermatomyositis (JDM) with interstitial lung disease MESHD died. Juvenile idiopathic arthritis MESHD arthritis HP ( JIA MESHD) was the most frequent diagnosis in 3/8 (37.5%) patients. In 5/8 (62.5%) cases, the RD MESHD was not fully controlled, and all patients except one received corticosteroid treatment. Conclusions: Children TRANS with RD MESHD have accounted for 2.2% of hospitalized patients with COVID-19 in our series. The evolution has been moderately favorable, with one deceased. In case of active disease and use of corticosteroids patients should be managed with caution. Key words: COVID-19, children TRANS, rheumatic diseases MESHD, corticosteroids.

    CLINICAL COURSE AND OUTCOME OF COVID-19 ACUTE RESPIRATORY DISTRESS HP SYNDROME: DATA FROM A NATIONAL REPOSITORY

    Authors: Ali A El Solh; Gianfranco Umberto Meduri; Yolanda Lawson; MIchael Carter; Kari A Mergenhagen; Ce Cheng; Qin Zhou; Chenyu Sun; Manuel M Vicente; Angela Fernandes; Ana M Dias; Ivan-Christian Kurolt; Alemka Markotic; Dragan Primorac; Adriana Soares; Luis Malheiro; Irena Trbojevic-Akmacic; Miguel Abreu; Rui Sarmento e Castro; Silvia Bettinelli; Annapaola Callegaro; Marco Arosio; Lorena Sangiorgio; Luca Lorini; Xavier Castells; Juan P Horcajada; Salome Pinho; Massimo Allegri; Clara Barrios; Gordan Lauc

    doi:10.1101/2020.10.16.20214130 Date: 2020-10-20 Source: medRxiv

    Background: Mortality attributable to coronavirus disease-19 (COVID-19) 2 infection occurs mainly through the development of viral pneumonia HP pneumonia MESHD-induced acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD). Research Question: The objective of the study is to delineate the clinical profile, predictors of disease progression, and 30-day mortality from ARDS MESHD using the Veterans Affairs Corporate Data Warehouse. Study Design and Methods: Analysis of a historical cohort of 7,816 hospitalized patients with confirmed COVID-19 infection between January 1, 2020, and August 1, 2020. Main outcomes were progression to ARDS MESHD and 30-day mortality from ARDS MESHD, respectively. Results: The cohort was comprised predominantly of men (94.5%) with a median age TRANS of 69 years (interquartile range [IQR] 60-74 years). 2,184 (28%) were admitted to the intensive care unit and 643 (29.4%) were diagnosed with ARDS MESHD. The median Charlson Index was 3 (IQR 1-5). Independent predictors of progression to ARDS MESHD were body mass index (BMI)[≥] 40 kg/m2, diabetes MESHD, lymphocyte counts<700x109/L, LDH>450 U/L, ferritin >862 ng/ml, C-reactive protein >11 mg/dL, and D-dimer >1.5 ug/ml. In contrast, the use of an anticoagulant lowered the risk of developing ARDS (OR 0.66 [95% CI 0.49-0.89]. Crude 30-day mortality rate from ARDS was 41% (95% CI 38%-45%). Risk of death from ARDS was significantly higher in those who developed acute renal failure and septic shock HP. Use of an anticoagulant was associated with two-fold reduction in mortality. Survival benefit was observed in patients who received corticosteroids and/or remdesivir but there was no advantage of combination therapy over either agent alone. Conclusions: Among those hospitalized for COVID-19, nearly one in ten progressed to ARDS. Septic shock HP, and acute renal failure are the leading causes of death in these patients. Treatment with either remdesivir and corticosteroids reduced the risk of mortality from ARDS. All hospitalized patients with COVID-19 should be placed at a minimum on prophylactic doses of anticoagulation.

    Vitamin C—An Adjunctive Therapy for Respiratory Infection MESHD, Sepsis HP Sepsis MESHD and COVID-19

    Authors: Patrick Holford; Anitra Carr; Thomas H. Jovic; Stephen R. Ali; Iain S. Whitaker; Paul Marik; David Smith

    id:10.20944/preprints202010.0407.v1 Date: 2020-10-20 Source: Preprints.org

    There are limited proven therapies for the treatment of COVID-19. Vitamin C’s antioxidant, anti-inflammatory and immunomodulating effects, make it a potential therapeutic candidate, both for the prevention and amelioration of COVID-19 infection MESHD, and as an adjunctive therapy in the critical care of COVID-19, supporting anti-inflammatory treatment. This literature review focuses on vitamin C deficiency MESHD in respiratory infections MESHD including COVID-19; the mechanism of action in infectious disease MESHD and adrenal function supporting the anti-inflammatory actions of glucocorticosteroids: its role in preventing and treating colds and pneumonia HP pneumonia MESHD and its role in treating sepsis HP sepsis MESHD and COVID-19. The evidence to date indicates that oral vitamin C (2-8g/d) may reduce incidence and duration of respiratory infections MESHD and intravenous vitamin C (2-24g/d) has been shown to reduce mortality, Intensive Care Unit and hospital stays, time on mechanical ventilation in severe respiratory infections MESHD. Further trials are urgently warranted. Given the favourable safety profile and low cost of vitamin C, and frequency of vitamin C deficiency MESHD in respiratory infections MESHD it may be worthwhile testing patients’ vitamin C status and treating accordingly with intravenous use within ICUs and orally with doses between 2 and 8g/day in hospitalised and infected persons.

    Reducing the use of empiric antibiotic therapy in patients on admission to the hospital with COVID-19

    Authors: Natasha N. Pettit; Cynthia T. Nguyen; Alison Lew; Palak B. Bhagat; Allison Nelson; Gregory Olson; Jessica Ridgway; Mai T. Pho; Jade Pagkas-Bather

    doi:10.21203/rs.3.rs-94854/v1 Date: 2020-10-19 Source: ResearchSquare

    Background: Empiric antibiotics for community acquired bacterial pneumonia MESHD pneumonia HP ( CABP MESHD) are often prescribed to patients with COVID-19, despite a low reported incidence of co-infections MESHD. Stewardship interventions targeted at facilitating appropriate antibiotic prescribing for CABP among COVID-19 patients are needed. We developed a guideline for antibiotic initiation and discontinuation for CABP in COVID-19 patients. The purpose of this study was to assess the impact of this intervention on the duration of empiric CABP antibiotic therapy among patients with COVID-19.Methods: This was a single-center, retrospective, quasi-experimental study of adult TRANS patients admitted between 3/1/2020 to 4/25/2020 with COVID-19 pneumonia HP pneumonia MESHD, who were initiated on empiric CABP antibiotics. Patients were excluded if they were initiated on antibiotics >48hours following admission or if another infection MESHD was identified. The primary outcome was the duration of antibiotic therapy (DOT) prior to the guideline (March 1 to March27, 2020) and after guideline implementation (March 28 to April 25, 2020). We also evaluated the clinical outcomes (mortality, readmissions, length of stay) among those initiated on empiric CABP antibiotics.Results: A total of 506 patients with COVID-19 were evaluated, 102 pre-intervention and 404 post-intervention. Prior to the intervention, 74.5% (n=76) of patients with COVID-19 received empiric antibiotics compared to only 42% of patients post-intervention (n=170), p<0.001. The median DOT in the post-intervention group was 1.3 days shorter (p<0.001) than the pre-intervention group, and atypical antibiotic DOT was reduced by 2.8 days (p<0.001). More patients in the post-intervention group were initiated on antibiotics based on criteria consistent with our guideline (68% versus 87%, p=0.001). There were no differences between groups in terms of clinical outcomes.Conclusion: Following the implementation of a guideline outlining recommendations for initiating and discontinuing antibiotics for CABP among COVID-19 inpatients, we observed a reduction in antibiotic prescribing and DOT. The guideline also resulted in a significant increase in the rate of guideline-congruent empiric antibiotic initiation.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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