Severe illness and poor outcome are mainly associated with aging or certain medical comorbidities, especially chronic diseases. However, factors for unfavorable prognosis have not been well described owing to relatively small sample sizes and single-center reports. Therefore, this study aimed to compare the contribution of comorbidities in the development of critical conditions in coronavirus disease 2019 (COVID-19) patients. Pooled estimates of relative risks (RRs) and their 95% confidence intervals (CIs) were calculated by conducting a meta-analysis and network meta-analysis of 18 studies. Chronic obstructive pulmonary disease (COPD) was most strongly associated with the overall critical condition (RR = 4.22, 95% CI = 3.12 - 5.69), followed by cardiovascular disease (CVD) (RR = 3.00, 95% CI = 2.41 - 3.73), malignancy (RR = 2.91, 95% CI = 2.16 - 3.91), cerebrovascular accident (CVA) (RR = 2.86, 95% CI = 1.95 - 4.19), diabetes (RR = 2.10, 95% CI = 2.16 - 3.91), hypertension (RR = 2.02, 95% CI = 1.82 - 2.23), and chronic kidney disease (RR = 2.00, 95% CI = 1.36 - 2.94). The presence of comorbidities except for chronic liver disease and chronic kidney disease significantly increased the risk of severe infection, intensive care unit (ICU) admission, and cardiac injury in the subgroup analysis by types of critical conditions. Preexisting hypertension and diabetes additionally increased the risk of acute respiratory distress syndrome (ARDS). Among comorbidities, COPD had the highest probability of leading to severe COVID-19, ICU admission, and liver injury, while malignancy was most likely to cause ARDS and cardiac injury. In summary, preexisting COPD, CVD, CVA, hypertension, diabetes, and malignancy are more likely to worsen the progression of COVID-19, with severe infection, ICU admission requirement, and cardiac injury development.

Coronaviruses have caused serious Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Coronavirus Disease 2019 (COVID-19) outbreaks, and only remdesivir has been recently indicated for the treatment of COVID-19. In the line of therapeutic options for SARS and MERS, this study aims to summarize the current clinical evidence of treatment options for COVID-19. In general, the combination of antibiotics, ribavirin, and corticosteroids was considered as a standard treatment for patients with SARS. The addition of this conventional treatment with lopinavir/ritonavir, interferon, and convalescent plasma showed potential clinical improvement. For patients with MERS, ribavirin, lopinavir/ritonavir, interferon, and convalescent plasma were continuously recommended. However, a high-dose of corticosteroid was suggested for severe cases only. The use of lopinavir/ritonavir and convalescent plasma was commonly reported. There was limited evidence for the effect of corticosteroids, other antiviral drugs like ribavirin, and favipiravir. Monoclonal antibody of tocilizumab and antimalarial agents of chloroquine and hydroxychloroquine were also introduced. Among antibiotics for infection therapy, azithromycin was suggested. In conclusion, this study showed the up-to-date evidence of treatment options for COVID-19 that is helpful for the therapy selection and the development of further guidelines and recommendations. Updates of ongoing clinical trials and observational studies may confirm the current findings.

Objectives: To determine the frequency and microbiological characteristics of bacteria causing septic shock in patients with positive blood culture results. Methods: Cross-sectional descriptive study. Results: Total 100 patients diagnosed with septic shock had positive blood culture results at Nghe An General Friendship Hospital from January 2020 to December 2020. The mean age was 67.06 ± 16.42 years old. There were 57 patients ≥ 65 years old, accounting for 57%, more common than patients < 65 years old (43 patients with a rate of 43%). The proportion of Gram-negative bacteria (66%) was higher than Grampositive bacteria (34%). The respiratory tract infection (52%) was the most common source, followed by the intra-abdominal infection (23%) and the urinary tract infection (10%). E. coli was the most common pathogen (32%), followed by S. aureus (26%) and K. pneumoniae (11%). Among patients with diabetes and COPD, the most common pathogens were E. coli, S. aureus and Enterococcus faecalis. Most of the antibiotic groups were been resistant, especially cephalosporin antibiotics from 37.5% to 82.6%. Amikacin, fosmycin, vancomycin and linezolid groups were susceptible to bacteria. Conclusion: E. coli and S. aureus were two common pathogens in patients with septic shock. In particular, E. coli, S. aureus and Enterococcus faecalis were the common agents of septic shock among patients with diabetes and COPD. Amikacin, Fosmycin, Vancomycin and Linezolid groups were still susceptible to bacteria. Key words: septic shock, E. coli, S. aureus.