Reports of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) have been widely published across the world since the onset of the pandemic with varying incidence rates. We retrospectively studied all patients with severe COVID-19 infection who were admitted to our tertiary care center′s intensive care units between January 2020 and March 2021, who also had respiratory cultures positive for Aspergillus species. Among a large cohort of 970 patients admitted to the ICU with severe COVID-19 infections during our study period, 48 patients had Aspergillus species growing in respiratory cultures. Based on the 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus criteria, 2 patients in the study had proven CAPA, 9 had probable CAPA, and 37 had possible CAPA. The incidence of CAPA was 5%. The mean duration from a positive COVID-19 test to Aspergillus spp. being recovered from the respiratory cultures was 16 days, and more than half of the patients had preceding fever or worsening respiratory failure despite adequate support and management. Antifungals were given for treatment in 44% of the patients for a mean duration of 13 days. The overall mortality rate in our study population was extremely high with death occurring in 40/48 patients (83%).
DISPATCHESS ince the December 2019 beginning of the coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), there have been >180 million cases and >3.9 million deaths worldwide (1). Severe bacterial and fungal co-infections are a major concern with COVID-19 and increase disease mortality (2).The genus Bordetella comprises >10 known species of small, gram-negative coccobacilli, the most common of which is Bordetella pertussis (3). Bordetella hinzii was fi rst identifi ed as a cause of respiratory infection in poultry and more rarely in rodents (4). It was fi rst reported as a human infection in a patient with HIV infection in 1994 as a cause of bacteremia (5) and has subsequently been identifi ed as a cause of soft tissue infections, pneumonia, cholangitis, urinary tract infections, bacteremia, and endocarditis, most often in immunocompromised patients (4-15; Appendix references 16,17, https://wwwnc.cdc.gov/EID/ article/27/11/21-1468-App1.pdf). We report a case of B. hinzii pneumonia and bacteremia in a patient with SARS-CoV-2 infection.
Background: Hyperglycemia in hospitalized patients is a common occurrence and is associated with adverse outcomes. Randomized trials indicated that a basal-prandial Insulin regimen (BPI) is preferred over sliding-scale insulin (SSI) alone in hospitalized patients. BPI is now considered a standard of care while the use of SSI alone has been discouraged. However, the use of a basal insulin with a sliding-scale Insulin (BSSI) instead of BPI remains prevalent. There has been no study that compared the efficacy and safety of these 2 insulin regimens: BPI vs BSSI. The aim of the study: This study was conducted to compare the efficacy and safety of the 2 insulin regimens, BPI vs BSSI, in hospitalized patients. Study design: Adult, non-pregnant patients with DM who were admitted to medical-surgical floors in a community hospital from 8/1/2015 to 8/31/2015 were included in this retrospective study. Inclusion criteria included admitting blood glucose (BG) of over 300 mg/dL or recent A1c of over 9% or home insulin use in those who were eating regular meals during the hospital stay and who were admitted for a least 3 days. Exclusion criteria were those who were NPO for longer than 48 hours, those on tube feeding or TPN and those required insulin infusion. Results and discussion: A total of 24 patients in BPI and 43 in BSSI were studied. There was no significant difference in age (55.3 vs 58.2 years), gender (female 38.5% vs 55.8%), ethnicity (Hispanics 57.7% vs 58.1%), those with T2DM (92.3% vs 100%), home insulin use (100 vs 86%) or A1c result (9.76 vs 11.4%) between BPI and BSSI (all P > 0.05). Hypoglycemia with BG <70 mg/dL was observed in 11.5% (3/26) in BPI and 27.9% (12/43) in BSSI (P=0.1128). Total days of hypoglycemia (any day with one or more episodes of hypoglycemia) was 3 (mean 0.12 day per patient) in BPI and 15 (mean 0.35 day per patient) in BSSI (p=0.0777). Therefore there was a trend towards higher hypoglycemia risk in BSSI. The 92.3% (24/26) in BPI and 69.8% (30/43) in BSSI had at least one episode of severe hyperglycemia with BG >250 (p=0.029). Total days of hyperglycemia (any day with one or more episodes of severe hyperglycemia) was 87 (mean 3.35 days per patient) in BPI and 114 (mean 2.65 days per patient) in BSSI (p=0.344). Mean BG during hospital stay was 206.7 ±41.3 in BPI and 177.5 ±44.8mg/dL in BSSI (P=0.0087). Therefore it appeared that BSSI is associated with the lower risk of hyperglycemia. There was no significant difference in mortality (0% in both groups) and total hospital length of stay (7.12 vs 6.19 days) between BPI and BSSI. Conclusions: There was a trend towards a lower risk of hypoglycemia with Basal-Bolus Insulin as compared to Basal-Sliding-Scale Insulin. However, BSSI use was associated with a lower risk of severe hyperglycemia. This study result should be confirmed with larger studies with more patient numbers. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2025 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.