BackgroundThe incidence of nosocomial infections from extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality.MethodsWe retrospectively studied a cohort of adult, hospitalized patients with P. aeruginosa (PA) infections between April and December 2014.ResultsOf the 255 patients with PA infections, 56 (22%) were due to XDR-PA, 32 (12.5%) to multidrug resistant Pseudomonas aeruginosa (MDR-PA), and 167 (65.5%) to non-MDR PA. Receiving total parenteral nutrition (adjusted OR [aOR] 6.21; 95% CI 1.05–36.70), prior carbapenem use (aOR 4.88; 95% CI 2.36–10.08), and prior fluoroquinolone use (aOR 3.38; 95% CI 1.44–7.97) were independently associated with the XDR-PA infections. All XDR-PA remained susceptible to colistin. Factors associated with mortality attributable to the infections were the presence of sepsis/septic shock (aOR 11.60; 95% CI 4.66–28.82), admission to a medical department (aOR 4.67; 95% CI 1.81–12.06), receiving a central venous catheter (aOR 3.78; 95% CI 1.50–9.57), and XDR-PA infection (aOR 2.73; 95% CI 1.05–7.08).ConclusionThe prevalence of XDR-PA infections represented almost a quarter of Pseudomonas aeruginosa hospital-acquired infections and rendered a higher mortality. The prompt administration of an appropriate empirical antibiotic should be considered when an XDR-PA infection is suspected.

Background. Favipiravir is a broad−spectrum oral antiviral agent that shows in vitro activity against SARS−CoV−2. Presently, data on the effectiveness and optimal dosage of favipiravir for treating COVID−19 is limited. Methods. We conducted a retrospective observational study of hospitalized adult patients with COVID-19 at five tertiary care hospitals in Thailand. We reviewed patient charts to obtain all necessary data. Results. Among 247 COVID-19 patients, 63 (23.0%) received ≥1 dose of favipiravir. Of these, 27.0% required an O2−nasal cannula, 9.5% required non−invasive ventilation and/or high−flow O2−therapy, and 6.4% required invasive mechanical ventilation and/or ECMO. The median baseline NEWS2 score was 5(0−16). The Day−7 clinical improvement rate [95%CI] was 66.7%[53.7−78.0%] in all patients, 92.5%[75.7%−99.1%] in patients who did not require O2−supplementation, and 47.2%[0.4%−64.5%] in patients who required O2−supplementation. No life-threatening adverse events were identified. The 28-day mortality rate was 4.8%. Multivariate analysis revealed three poor prognostic factors for Day−7 clinical improvement [odds ratio (95%CI); p−value]: older age [0.94 (0.89 to 0.99); p=0.04], higher baseline NEWS2 score [0.64 (0.47 to 0.88); p=0.006], and lower favipiravir loading dose (≤45 mg/kg/day) [0.04 (0.005 to 0.4); p=0.006]. Conclusions. Our study reports the promising effectiveness of favipiravir for treating COVID−19 patients. In addition to older age and a high baseline NEWS2 score, a low loading dose of favipiravir (≥45 mg/kg/day) was also identified as a poor prognostic factor for early clinical improvement. Further studies to explore the optimal dose and the optimal timing of drug initiation for favipiravir should be performed.

Favipiravir is a broad-spectrum oral antiviral agent that shows in vitro activity against SARS-CoV-2. Presently, data on the real-world effectiveness and optimal dosage of favipiravir for treating COVID-19 are limited. We conducted a retrospective observational study of hospitalized adult patients with COVID-19 at five tertiary care hospitals in Thailand. We reviewed patient charts to obtain all necessary data. Among 247 COVID-19 patients, 63 (23.0%) received ≥1 dose of favipiravir. Of these 63 patients, 61.9% were male with a median age of 48 years (range 22–85 years), 27.0% required an O2 nasal cannula, 9.5% required non-invasive ventilation and/or high-flow O2 therapy, and 6.4% required invasive mechanical ventilation and/or ECMO. The median baseline NEWS2 score was 5 (0–16). The Day-7 clinical improvement rate [95%CI] was 66.7% [53.7–78.0%] in all patients, 92.5% [75.7–99.1%] in patients who did not require O2 supplementation, and 47.2% [0.4–64.5%] in patients who required O2 supplementation. No life-threatening adverse events were identified. The 28-day mortality rate was 4.8%. A multivariate analysis revealed three poor prognostic factors for Day-7 clinical improvement (odds ratio (95%CI); p-value): older age (0.94 (0.89–0.99); p = 0.04), a higher baseline NEWS2 score (0.64 (0.47–0.88); p = 0.006), and a lower favipiravir loading dose (≤45 mg/kg/day) (0.04 (0.005–0.4); p = 0.006). In conclusion, our study reports the promising effectiveness of favipiravir for treating COVID-19 patients. In addition to older age and a high baseline NEWS2 score, a low loading dose of favipiravir (≤45 mg/kg/day) was also identified as a poor prognostic factor for early clinical improvement. Further studies to explore the optimal dose and the optimal timing of drug initiation for favipiravir should be performed.

Lupus pleuritis is still the most common cause of pleural effusion in SLE and often reflects its disease activity. The diagnosis of lupus pleuritis is a clinical diagnosis or is performed by excluding other conditions. The treatment outcomes of lupus pleuritis are generally good.