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MeSH Disease


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    U-shaped-aggressiveness of SARS-CoV-2: Period between onset of nonspecific-specific symptoms for COVID-19 MESHD. A population-based cohort study

    Authors: Dan Morgenstern-Kaplan; Bruno Buitano-Tang; Mercedes Martinez-Gil; Andrea Zaldivar-Perez Pavon; Juan O Talavera; Adrien Elena; Christopher Hein; Blake Schwendiman; Christopher Burrow; Claire Le Helloco; Clemence Lebegue; Elom A Tay; Guy Cassuto; Gilles Pialoux; Laurent Hocqueloux; thierry prazuck

    doi:10.1101/2020.10.28.20221697 Date: 2020-11-03 Source: medRxiv

    Background: Early identification of different COVID-19 MESHD clinical presentations may depict distinct pathophysiological mechanisms and guide management strategies. Objective: To determine the aggressiveness of SARS-CoV-2 MESHD using symptom progression in COVID-19 MESHD patients. Design: Historic cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry. Setting: Population-based. Patients registered in the Epidemiologic Surveillance System in Mexico. Participants: Subjects who sought medical attention for suspicion of COVID-19 MESHD. All patients were subjected to RT-PCR testing for SARS-CoV-2. Measurements: We measured the period between onset of nonspecific to specific symptoms for COVID-19 MESHD (PONSS) and compared it to the primary outcomes (mortality and pneumonia HP pneumonia MESHD). Results: 65,500 patients were included. Reported fatalities and pneumonia MESHD pneumonia HP were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PONSS, patients were distributed as follows: 14.89% in <24 hours, 43.25% between 1-3 days, 31.87% between 4-7 days and 9.97% >7 days. The distribution for mortality and pneumonia HP pneumonia MESHD was 5.2% and 22.5% in <24 hours, 2.5% and 14% between 1-3 days, 3.6% and 19.5% between 4-7 days, 4.1% and 20.6% >7 days, respectively (p<0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): <24 hours= 1.75 [1.55-1.98], p<0.001; 1-3 days= 1 (reference value); 4-7 days= 1.53 [1.37-1.70], p<0.001; >7 days= 1.67 [1.44-1.94], p<0.001. For pneumonia HP pneumonia MESHD: <24 hours= 1.49 [1.39-1.58], p<0.001; 1-3 days= 1; 4-7 days= 1.48 [1.41-1.56], p<0.001; >7 days= 1.57 [1.46-1.69], p<0.001. Limitations: Using a database fed by large numbers of people carries the risk of data inaccuracy. However, this imprecision is expected to be random and data are consistent with previous studies. Conclusion: The PONSS shows a U-shaped SARS-CoV-2 aggressiveness MESHD pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings.

    Phase II Clinical trial for Evaluation of BCG as potential therapy for COVID-19 MESHD

    Authors: Usha Padmanabhan; Sanjay Mukherjee; Rohidas Borse; Samir Joshi; Rajesh Deshmukh; Armando van der Horst; Eva H.J. Lamboo; Caroline M.M. Janssen - Te Slaa; Robert Herpers; Yvette C.M. Kluiters-de Hingh; Arthur du Mée; Marjan Veuger; Rob van Marum; Peter de Jager; Marc G. L. M. Elisen; Ron Kusters; Martin Schuijt; Marc H. M. Thelen; Nigel French; Edward C Holmes; Joep de Ligt

    doi:10.1101/2020.10.28.20221630 Date: 2020-11-03 Source: medRxiv

    Bacillus Calmette Guerin (BCG) is widely used in national vaccination programs worldwide. It is accepted that BCG alleviates both pathogen and allergy MESHD allergy HP induced respiratory diseases MESHD that could also include Covid-19 MESHD. To investigate this possibility, we randomly assigned 60 Covid-19 MESHD patients, after admission to the hospital with pneumonia HP pneumonia MESHD and requirement for oxygen therapy in a 1:1 ratio to receive either a single adult TRANS dose of intradermal BCG or normal saline with concomitant standard of care (SoC) medications. Primary endpoints were favorable prognosis of Covid-19 MESHD as deduced from resolution of pneumonia HP pneumonia MESHD, viremia HP viremia MESHD and secondary outcome were enumeration of ICU admissions, duration thereof and mortalities. Results Both primary and secondary endpoints were significantly improved in the BCG+SoC group. This could be seen from reduction in oxygen requirement due to Covid-19 MESHD associated pneumonia MESHD pneumonia HP decreasing from day 3-4, improved radiological resolution from day 7-15. There were a total of 6 (10%) adverse events in the study of which 2 deaths and 4 ICU admissions were in SoC group (1 ICU admission culminated in death of the subject) and in contrast only 1 ICU admission in the BCG+SoC group. While there was an increase in Covid-19 MESHD specific IgG levels in the BCG+SoC group, there was no evidence of BCG induced cytokine storm in this group. Four patients showed localized inflammatory response at the injection site in the BCG+SoC group. Conclusions BCG+SoC administration resulted in a significantly higher percentage of patients with favorable outcomes than did SoC. A third of the patients were naive for childhood BCG vaccination. This mimicked elderly TRANS patients in countries with no universal vaccination policy for BCG. No BCG related adversity was seen in this group. The study shows that BCG is a safe, cost-effective treatment that can be introduced as a standard of care in patients with moderate Covid-19 MESHD that can reduce requirement of oxygen supplemented beds and disease burden in low resource countries, with additional long-term benefits of reducing risk for tuberculosis MESHD.

    Prognostic factors of chest CT findings for ICU admission and mortality in patients with COVID-19 MESHD pneumonia HP pneumonia MESHD

    Authors: Mohammad Ali Kazemi; Hossein Ghanaati; Behnaz Moradi; Mohammadreza Chavoshi; Hassan Hashemi; Samira Hemmati; Pouria Rouzrokh; Masoumeh Gity; Zahra Ahmadinejad; Hamed Abdollahi; Erna Suljic; Amina Kurtovic-Kozaric; Sebija Izetbegovic; Justine Schaeffer; Peter Hufnagl; Alexander Zoufaly; Tamara Seitz; - Vienna Covid-19 Detection Initiative (VCDI); Manuela Foedinger; Franz Allerberger; Alexander Stark; Luisa Cochella; Ulrich Elling

    doi:10.1101/2020.10.30.20223024 Date: 2020-11-03 Source: medRxiv

    Background: Studies have shown that CT could be valuable for prognostic issues in COVID-19 MESHD. Objective: to investigate the prognostic factors of early chest CT findings in COVID-19 MESHD patients. Materials and Methods: This retrospective study included 91 patients (34 women, and 57 men) of RT-PCR positive COVID-19 MESHD from 3 hospitals in Iran between February 25, 2020, to march 15, 2020. Patients were divided into two groups as good prognosis, discharged from the hospital and alive without symptoms (48 patients), and poor prognosis, died or needed ICU care (43 patients). The first CT images of both groups that were obtained during the first 8 days of the disease presentation were evaluated considering the pattern, distribution, and underlying disease. The total CT-score was calculated for each patient. Univariate and multivariate analysis with IBM SPSS Statistics v.26 was used to find the prognostic factors. Results: There was a significant correlation between poor prognosis and older ages TRANS, dyspnea MESHD dyspnea HP, presence of comorbidities, especially cardiovascular and pulmonary. Considering CT features, peripheral and diffuse distribution, anterior and paracardiac involvement MESHD, crazy paving pattern, and pleural effusion MESHD pleural effusion HP were correlated with poor prognosis. There was a correlation between total CT-score and prognosis and an 11.5 score was suggested as a cut-off with 67.4% sensitivity SERO and 68.7% specificity in differentiation of poor prognosis patients (patients who needed ICU admission or died. Multivariate analysis revealed that a model consisting of age TRANS, male TRANS gender TRANS, underlying comorbidity, diffused lesions, total CT-score, and dyspnea HP would predict the prognosis better. Conclusion: Total chest CT-score and chest CT features can be used as prognostic factors in COVID-19 MESHD patients. A multidisciplinary approach would be more accurate in predicting the prognosis.

    Visual Scoring of Chest CT at Hospital Admission Predicts Hospitalization Time and Intensive Care Admission in Covid-19 MESHD

    Authors: Erik Ahlstrand; Sara Cajander; Per Cajander; Edvin Ingberg; Erika Lof; Matthias Wegener; Mats Liden; Alexander Simonis; Lobna El Tabei; Uwe Fuhr; Jan Rybniker; Zain ul Abdin; Ayesha Khaqan; Muhammad Kiwan Akram; Sidra Ashraf; Rutaba Akmal; Sundas Rafique; Khawar Nawaz; Shahroz Arshad; Sohail Ahmad; Kanwal Hayat; Ali Arshad; Muhammad Faisal Nadeem; Muhammad Hassan; Abeer bin Awais; Muhammad Azam; Muhammad Suhail; Sibgha Zulfiqar; Imran Anwar; Saulat Sarfraz; Ayesha Humayun; Amber Malik; Hui Zheng; Talha Mahmud; Mahmood Ayyaz; Ali Ahmad; Muhammad Ashraf; Qazi Abdul Saboor; Mateen Izhar

    doi:10.1101/2020.10.30.20222471 Date: 2020-11-03 Source: medRxiv

    Background The extent and character of lung involvement on chest computerized tomography (CT) have a prognostic value in covid-19 MESHD but there is lack of consensus on how to assess and stage CT features. A scoring system of lung involvement in covid-19 MESHD, Orebro covid-19 MESHD Scale (OCoS) was implemented in clinical routine on April 1 2020 in Orebro Region, Sweden. The OCoS-severity score measures the extent of lung involvement while OCoS-temporal stage characterizes the parenchymal involvement. The objective of the present study was to evaluate the OCoS scores in relation to clinical outcome of covid-19 MESHD. Methods Population based study including data from all hospitalized patients with covid-19 MESHD in Orebro Region during March to July 2020. Chest CT scores at the time of hospital admission and ICU admission were analyzed in relation to hospital and intensive care unit (ICU) length of stay, time to ICU admission and admission to ICU or death MESHD. Findings In the 381 included patients, there was a close correlation of the OCoS-severity score on admittance to hospital and the hospital length of stay. The OCoS-severity score on hospital admittance was a strong predictor for both a severe outcome in regards to ICU admittance or death MESHD and the time to ICU admittance. On admittance to ICU, both OCoS-severity score and temporal stage were correlated with the ICU length of stay. Interpretation Chest CT visual scoring on admission to hospital predicts the clinical course in covid-19 MESHD pneumonia MESHD pneumonia HP. Funding This work was supported by the Orebro Region, Sweden.

    Structure of nonstructural protein 1 from SARS-CoV-2.

    Authors: Lauren K. Clark; Todd J. Green; Chad M. Petit; Run-Yu Yuan; Qing-Bing Zheng; Ping-Ping Zhou; Jiang-Ping Li; Xin-Chun Chen; Xiao Zhang; Xiao-Hui Yu; Xiang-Wei Kong; Qian-Ying Zhu; Miao Xu; Nan-Shan Zhong; Yi-Xin Zeng; Guo-Kai Feng; Chang-Wen Ke; Jin-Cun Zhao; Mu-Sheng Zeng; Aishun Jin; Drew W. Barron-Kraus; Harrison C. Shrock; - UFCOVID Interventions Team; Justin Lessler; Carl D. Laird; Derek A.T. Cummings

    doi:10.1101/2020.11.03.366757 Date: 2020-11-03 Source: bioRxiv

    The periodic emergence of novel coronaviruses (CoVs) represents an ongoing public health concern with significant health and financial burden worldwide. The most recent occurrence originated in the city of Wuhan, China where a novel coronavirus (SARS-CoV-2) emerged causing severe respiratory illness MESHD and pneumonia MESHD pneumonia HP. The continual emergence of novel coronaviruses underscores the importance of developing effective vaccines as well as novel therapeutic options that target either viral functions or host factors recruited to support coronavirus replication. The CoV nonstructural protein 1 (nsp1) has been shown to promote cellular mRNA degradation, block host cell translation, and inhibit the innate immune response to virus infection MESHD. Interestingly, deletion of the nsp1-coding region in infectious clones prevented the virus from productively infecting cultured cells. Because of the importance of nsp1 in the CoV lifecycle, it has been highlighted as a viable target for both antiviral therapy and vaccine development. However, the fundamental molecular and structural mechanisms that underlie nsp1 function remain poorly understood, despite its critical role in the viral lifecycle. Here we report the high-resolution crystal structure of the amino, globular portion of SARS-CoV-2 nsp1 (residues 10-127) at 1.77 [A] resolution. A comparison of our structure with the SARS-CoV-1 nsp1 structure reveals how mutations alter the conformation of flexible loops, inducing the formation of novel secondary structural elements and new surface features. Paired with the recently published structure of the carboxyl end of nsp1 (residues 148-180), our results provide the groundwork for future studies focusing on SARS-CoV-2 nsp1 structure and function during the viral lifecycle.

    Baseline characteristics, management, and outcomes of 55,270 children TRANS and adolescents diagnosed with COVID-19 MESHD and 1,952,693 with influenza in France, Germany, Spain, South Korea and the United States: an international network cohort study

    Authors: Talita Duarte-Salles; David Vizcaya; Andrea Pistillo; Paula Casajust; Anthony G. Sena; Lana Yin Hui Lai; Albert Prats-Uribe; Waheed-Ul-Rahman Ahmed; Thamir M Alshammari; Heba Alghoul; Osaid Alser; Edward Burn; Seng Chan You; Carlos Areia; Clair Blacketer; Scott DuVall; Thomas Falconer; Sergio Fernandez-Bertolin; Stephen Fortin; Asieh Golozar; Mengchun Gong; Eng Hooi Tan; Vojtech Huser; Pablo Iveli; Daniel R Morales; Fredrik Nyberg; Jose D. Posada; Martina Recalde; Elena Roel; Lisa M. Schilling; Nigam H. Shah; Karishma Shah; Marc A. Suchard; Lin Zhang; Andrew E. Williams; Christian G. Reich; Kristin Kostka; Daniel Prieto-Alhambra

    doi:10.1101/2020.10.29.20222083 Date: 2020-10-30 Source: medRxiv

    Objectives To characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among children TRANS/adolescents diagnosed or hospitalized with COVID-19 MESHD. Secondly, to describe health outcomes amongst children TRANS/adolescents diagnosed with previous seasonal influenza. Design International network cohort. Setting Real-world data from European primary care records (France/Germany/Spain), South Korean claims and US claims and hospital databases. Participants Diagnosed and/or hospitalized children TRANS/adolescents with COVID-19 MESHD at age TRANS <18 between January and June 2020; diagnosed with influenza in 2017-2018. Main outcome measures Baseline demographics and comorbidities, symptoms, 30-day in-hospital treatments and outcomes including hospitalization, pneumonia HP pneumonia MESHD, acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD), multi-system inflammatory syndrome MESHD (MIS-C), and death MESHD. Results A total of 55,270 children TRANS/adolescents diagnosed and 3,693 hospitalized with COVID-19 MESHD and 1,952,693 diagnosed with influenza were studied. Comorbidities including neurodevelopmental disorders MESHD, heart disease MESHD, and cancer MESHD were all more common among those hospitalized vs diagnosed with COVID-19 MESHD. The most common COVID-19 MESHD symptom was fever HP fever MESHD. Dyspnea HP Dyspnea MESHD, bronchiolitis MESHD bronchiolitis HP, anosmia and gastrointestinal symptoms MESHD anosmia and gastrointestinal symptoms HP were more common in COVID-19 MESHD than influenza. In-hospital treatments for COVID-19 MESHD included repurposed medications (<10%), and adjunctive therapies: systemic corticosteroids (6.8% to 37.6%), famotidine (9.0% to 28.1%), and antithrombotics such as aspirin (2.0% to 21.4%), heparin (2.2% to 18.1%), and enoxaparin (2.8% to 14.8%). Hospitalization was observed in 0.3% to 1.3% of the COVID-19 MESHD diagnosed cohort, with undetectable (N<5 per database) 30-day fatality. Thirty-day outcomes including pneumonia MESHD pneumonia HP, ARDS MESHD, and MIS-C were more frequent in COVID-19 MESHD than influenza. Conclusions Despite negligible fatality, complications including pneumonia HP pneumonia MESHD, ARDS MESHD and MIS-C were more frequent in children TRANS/adolescents with COVID-19 MESHD than with influenza. Dyspnea HP Dyspnea MESHD, anosmia and gastrointestinal symptoms MESHD anosmia and gastrointestinal symptoms HP could help differential diagnosis. A wide range of medications were used for the inpatient management of pediatric COVID-19 MESHD.

    Anakinra To Prevent Respiratory Failure MESHD Respiratory Failure HP In COVID-19 MESHD

    Authors: Evdoxia Kyriazopoulou; Periklis Panagopoulos; Simeon Metallidis; George Dalekos; Garyfallia Poulakou; Nikolaos Gatselis; Eleni Karakike; Maria Saridaki; Georgia Loli; Aggelos Stefos; Danai Prasianaki; Sarah Georgiadou; Olga Tsachouridou; Vasileios Petrakis; Konstantinos Tsiakos; Maria Kosmidou; Vassiliki Lygoura; Maria Dareioti; Haralampos Milionis; Ilias C Papanikolaou; Karolina Akinosoglou; Dimitra-Melia Myrodia; Areti Gravani; Aliki Stamou; Theologia Gkavogianni; Konstantina Katrini; Theodoros Marantos; Ioannis P Trontzas; Konstantinos Syrigos; Lukas Chatzis; Stamatios Chatzis; Nikolaos Vechlidis; Christina Avgoustou; Stamatios Chalvatzis; Miltiades Kyprianou; Jos WM van der Meer; jesper eugen-olsen; Mihai Netea; Evangelos Giamarellos-Bourboulis

    doi:10.1101/2020.10.28.20217455 Date: 2020-10-29 Source: medRxiv

    Introduction The management of pneumonia MESHD pneumonia HP caused by SARS-CoV-2 should rely on early recognition of the risk for progression to severe respiratory failure MESHD respiratory failure HP ( SRF MESHD) and its prevention. We investigated if early suPAR (soluble urokinase plasminogen activator receptor)-guided anakinra treatment could prevent COVID-19 MESHD-assocated SRF. Methods In this open-label prospective trial, 130 patients admitted with SARS-CoV-2 pneumonia SARS-CoV-2 MESHD pneumonia HP SARS-CoV-2 and suPAR levels [≥]6 g/l were assigned to subcutaneous anakinra 100mg once daily for 10 days. The primary outcome was the incidence of SRF MESHD at day 14. Secondary outcomes were 30-day mortality, changes in sequential organ failure assessment (SOFA) score, of cytokine-stimulation pattern and of circulating inflammatory mediators. Equal number of propensity score-matched comparators for comorbidities, severity on admission and standard-of care (SOC) were studied. Results The incidence of SRF MESHD was 22.3% (95% CI, 16.0-30.2%) among anakinra-treated patients and 59.2% (95% CI, 50.6-67.3%; P: 4.6 x 10-8) among SOC comparators (hazard ratio, 0.30; 95%CI, 0.20-0.46). 30-day mortality was 11.5% (95% CI, 7.1-18.2%) and 22.3% (95% CI, 16.0-30.2%) respectively (hazard ratio 0.49; 95% CI 0.25-0.97%; P: 0.041). Anakinra treatment was associated with decrease in SOFA score and in circulating interleukin (IL)-6, sCD163 and sIL2-R; the serum SERO IL-10/IL-6 ratio on day 7 was inversely associated with the change in SOFA score. Duration of stay at the intensive care unit and at hospital was shortened compared to the SOC group; the cost of hospitalization was decreased. Conclusions Early suPAR-guided anakinra treatment is associated with decrease of the risk for SRF MESHD and restoration of the pro- /anti-inflammatory balance.

    Detection and Segmentation of Lesion Areas in Chest CT Scans For The Prediction of COVID-19 MESHD

    Authors: Aram Ter-Sarkisov; Nicolas Roussel; Rodolphe Thiebaut; Christophe Tzourio; Pietro Ghezzi; Dr. Fauziah Rabbani; iqra chowdry; muhammad Obaid; Iram Sabah; Misbah Kawoosa; Abdul Lone; Shahroz Nabi; Ishtiyaq Sumji; Nikoloz Chkhartishvili; Frédéric Limosin; Carl Kendall

    doi:10.1101/2020.10.23.20218461 Date: 2020-10-27 Source: medRxiv

    In this paper we compare the models for the detection and segmentation of Ground Glass Opacity and Consolidation in chest CT scans. These lesion areas are often associated both with common pneumonia MESHD pneumonia HP and COVID-19 MESHD. We train a Mask R-CNN model to segment these areas with high accuracy using three approaches: merging masks for these lesions into one, deleting the mask for Consolidation, and using both masks separately. The best model achieves the mean average precision of 44.68% using MS COCO criterion for instance segmentation across all accuracy thresholds. The classification model, COVID-CT-Mask-Net, which learns to predict the presence of COVID-19 MESHD vs common pneumonia MESHD pneumonia HP vs control, achieves the 93.88% COVID-19 MESHD sensitivity SERO, 95.64% overall accuracy, 95.06% common pneumonia HP pneumonia MESHD sensitivity SERO and 96.91% true negative rate on the COVIDx-CT test split (21192 CT scans) using a small fraction of the training data. We also analyze the effect of Non-Maximum Suppression of overlapping object predictions, both on the segmentation and classification accuracy. The full source code, models and pretrained weights are available on

    Lung transplantation for pulmonary fibrosis MESHD pulmonary fibrosis HP secondary to severe COVID-19 MESHD

    Authors: Ankit Bharat; Melissa Querrey; Nikolay S Markov; Samuel S Kim; Chitaru Kurihara; Rafael Garza-Castillon Jr.; Adwaiy Manerikar; Ali Shilatifard; Rade Tomic; Yuliya Politanska; Hiam Abdala-Valencia; Anjana V Yeldandi; Jon W Lomasney; Alexander V Misharin; GR Scott Budinger; Sarah Platt; Eve Hamilton; Andrew Barr; Lucy Venyo; Peter Wilson; Tom Bewick; Priya Daniel; Paul Dark; Adam R Jeans; Jamie McCanny; Jonathan D Edgeworth; Martin J Llewelyn; Matthias L Schmid; Tricia M McKeever; Martin Beed; Wei Shen Lim

    doi:10.1101/2020.10.26.20218636 Date: 2020-10-27 Source: medRxiv

    Lung transplantation can potentially be a life-saving treatment for patients with non-resolving COVID-19 MESHD acute respiratory distress syndrome MESHD respiratory distress HP syndrome. Concerns limiting transplant include recurrence of SARS-CoV-2 infection MESHD in the allograft, technical challenges imposed by viral-mediated injury to the native lung, and potential risk for allograft infection MESHD by pathogens associated with ventilator-induced pneumonia MESHD pneumonia HP in the native lung. Additionally, the native lung might recover, resulting in long-term outcomes preferable to transplant. Here, we report the results of the first two successful lung transplantation procedures in patients with non-resolving COVID-19 MESHD associated acute respiratory distress HP respiratory distress MESHD syndrome in the United States. We performed smFISH to detect both positive and negative strands of SARS-CoV-2 RNA in the explanted lung tissue, extracellular matrix imaging using SHIELD tissue clearance, and single cell RNA-Seq on explant and warm post-mortem lung biopsies from patients who died from severe COVID-19 MESHD pneumonia HP pneumonia MESHD. Lungs from patients with prolonged COVID-19 MESHD were free of virus but pathology showed extensive evidence of injury MESHD and fibrosis MESHD which resembled end-stage pulmonary fibrosis MESHD pulmonary fibrosis HP. Single cell RNA-Seq of the explanted native lungs from transplant and paired warm post-mortem autopsies showed similarities between late SARS-CoV-2 acute respiratory distress syndrome MESHD respiratory distress HP syndrome and irreversible end-stage pulmonary fibrosis HP pulmonary fibrosis MESHD requiring lung transplantation. There was no recurrence of SARS-CoV-2 or pathogens associated with pre-transplant ventilator-associated pneumonias HP pneumonias MESHD following transplantation in either patient. Our findings suggest that some patients with severe COVID-19 MESHD develop fibrotic lung disease MESHD for which lung transplantation is the only option for survival.

    Co-infection MESHD in critically ill patients with COVID-19 MESHD: An observational cohort study from England

    Authors: Vadsala Baskaran; Hannah Lawrence; Louise Lansbury; Karmel Webb; Shahideh Safavi; Izzah Zainuddin; Tausif Huq; Charlotte Eggleston; Jayne Ellis; Clare Thakker; Bethan Charles; Sara Boyd; Tom Williams; Claire Phillips; Ethan Redmore; Sarah Platt; Eve Hamilton; Andrew Barr; Lucy Venyo; Peter Wilson; Tom Bewick; Priya Daniel; Paul Dark; Adam R Jeans; Jamie McCanny; Jonathan D Edgeworth; Martin J Llewelyn; Matthias L Schmid; Tricia M McKeever; Martin Beed; Wei Shen Lim

    doi:10.1101/2020.10.27.20219097 Date: 2020-10-27 Source: medRxiv

    Objective: To describe the incidence and nature of co-infection MESHD in critically ill adults TRANS with COVID-19 MESHD infection in England. Methods: A retrospective cohort study of adults TRANS with COVID-19 MESHD admitted to seven intensive care units (ICUs) in England up to 18 May 2020, was performed. Patients with completed ICU stays were included. The proportion and type of organisms were determined at <48 and >48 hours following hospital admission, corresponding to community and hospital-acquired co-infections MESHD. Results: Of 254 patients studied (median age TRANS 59 years (IQR 49-69); 64.6% male TRANS), 139 clinically significant organisms were identified from 83(32.7%) patients. Bacterial co-infections MESHD were identified within 48 hours of admission in 14(5.5%) patients; the commonest pathogens were Staphylococcus aureus (four patients) and Streptococcus pneumoniae HP (two patients). The proportion of pathogens detected increased with duration of ICU stay, consisting largely of Gram-negative bacteria, particularly Klebsiella pneumoniae MESHD pneumoniae HP and Escherichia coli. The co-infection MESHD rate >48 hours after admission was 27/1000 person-days (95% CI 21.3-34.1). Patients with co-infections MESHD were more likely to die in ICU (crude OR 1.78,95% CI 1.03-3.08, p=0.04) compared to those without co-infections MESHD. Conclusion: We found limited evidence for community-acquired bacterial co-infection MESHD in hospitalised adults TRANS with COVID-19 MESHD, but a high rate of Gram-negative infection acquired during ICU stay.

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