Background
COVID-19 co-infections have been described with different pathogens, including filamentous and yeast fungi.
Methodology
A retrospective case series study conducted from February to December 2020, at a Brazilian university hospital. Data were collected from two hospital surveillance systems: Invasive fungal infection (IFI) surveillance (Mycosis Resistance Program - MIRE) and COVID-19 surveillance. Data from both surveillance systems were cross-checked to identify individuals diagnosed with SARS-CoV-2 (by positive polymerase chain reaction (PCR)) and IFI during hospital stays within the study period.
Results
During the study period, 716 inpatients with COVID-19 and 55 cases of IFI were identified. Fungal co-infection with SARS-CoV-2 was observed in eight (1%) patients: three cases of aspergillosis; four candidemia and one cryptococcosis. The median age of patients was 66 years (IQR 58-71 years; range of 28-77 years) and 62.5% were men. Diagnosis of IFI occurred a median of 11.5 days (IQR 4.5-23 days) after admission and 11 days (IQR 6.5-16 days) after a positive PCR result for SARS-CoV-2. In 75% of cases, IFI was diagnosed in the intensive care unit (ICU). Cases of aspergillosis emerged earlier than those of candidemia: an average of 8.6 and 28.6 days after a positive PCR for SARS-CoV-2, respectively. All the patients with both infections ultimately died.
Conclusion
a low rate of COVID-19 co-infection with IFI was observed, with high mortality. Most cases were diagnosed in ICU patients. Aspergillosis diagnosis is highly complex in this context and requires different criteria.
Outpatient parenteral antimicrobial therapy (OPAT) consists of providing antimicrobial therapy by parenteral infusion without hospitalization. A systematic review was performed to compare OPAT and hospitalization as health care modalities from an economic perspective. Areas covered: We identified 1455 articles using 13 electronic databases and manual searches. Two independent reviewers identified 35 studies conducted between 1978 and 2016. We observed high heterogeneity in the following: countries, infection site, OPAT strategies and outcomes analyzed. Of these, 88% had a retrospective observational design and one was a randomized trial. With respect to economic analyses, 71% of the studies considered the cost-consequences, 11% cost minimization, 6% cost-benefit, 6% cost-utility analyses and 6% cost effectiveness. Considering all 35 studies, the general OPAT cost saving was 57.19% (from -13.03% to 95.47%). Taking into consideration only high-quality studies (6 comparative studies), the cost saving declined by 16.54% (from -13.03% to 46.86%). Expert commentary: Although most studies demonstrate that OPAT is cost-effective, the magnitude of this effect is compromised by poor methodological quality and heterogeneity. Economic assessments of the issue are needed using more rigorous methodologies that include a broad range of perspectives to identify the real magnitude of economic savings in different settings and OPAT modalities.
Introdução: As tecnologias em saúde são essenciais no centro cirúrgico (CC), na recuperação pós-anestésica (RPA) e no centro de material e esterilização(CME). Por isso, há grande pressão para sua incorporação tecnológica, o que demanda alto investimento e elevados custos operacionais. Objetivos:Refletir sobre os conceitos e princípios da avaliação de tecnologias em saúde (ATS) e discutir exemplos de sua aplicação no contexto do CC, da RPA e do CME.Resultados: A metodologia de ATS permite análise dos impactos clínicos, sociais e econômicos da incorporação de tecnologias, buscando melhorar a qualidadede atendimento e a saúde da população. O Ministério da Saúde tem patrocinado diversas iniciativas para difusão dos princípios de ATS que visam subsidiar osgestores para a tomada de decisão em incorporação tecnológica, tanto no âmbito do sistema de saúde quanto nas instituições hospitalares. Conclusão: A equipede enfermagem deve, na tomada de decisões, apropriar-se da metodologia de ATS para análise crítica do real benefício das tecnologias do bloco operatório.Palavras-chave: Avaliação da tecnologia biomédica. Centros cirúrgicos. Esterilização. Período de recuperação da anestesia.
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