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Our case vignette assembly and expert review method is efficient, but improvements in both technical and human performance are needed to be able to yield valid estimates of the prevalence of inappropriate antimicrobial use. Assessments of antimicrobial appropriateness require validation.

Background Healthcare workers (HCWs) are at the front line of the ongoing coronavirus pandemic. Comprehensively evaluating SARS-CoV-2 seroprevalence among HCWs in a large healthcare system could help identify the impact that epidemiological factors and presence of symptoms have on immune response to the infection over time. Aim To determine the seroprevalence of SARS-CoV-2 specific antibodies among healthcare workers (HCWs), to identify associated epidemiological factors and to study antibody kinetics. Methods We completed a longitudinal evaluation of the seroprevalence and epidemiology of SARS-CoV-2 specific antibodies in approximately 30,000 HCWs in the largest healthcare system in the State of Connecticut. Findings The baseline prevalence of SARS-CoV-2 antibody among 6,863 HCWs was 6.3% (95% CI: 5.7%-6.9%) and was highest among patient care support (16.7%), medical assistants (9.1%), and nurses (8.2%) and lower for physicians (3.8%) and advanced practice providers (4.5%). Seroprevalence was significantly higher among African Americans (OR 3.26 compared to Caucasians, 95% CI 1.77-5.99), in participants with at least one COVID symptom (OR 3.00, 95% CI 1.92-4.68), and in those reporting prior quarantine (OR 3.83, 95% CI 2.57-5.70). No symptoms were reported in 24% of the seropositive participants. Among the 47% who returned for a follow-up serology test, the seroreversion rate was 39.5% and the seroconversion rate was 2.2%. The incidence of reinfection in the seropositive group was zero. Conclusion Although there is a decline in the IgG antibody signal over time, 60.5% of the seropositive HCWs maintain their seroconversion status after a median time of 5.5 months.

Background The frequency of coinfections and their association with outcomes have not been adequately studied among patients with cancer and COVID-19, a high-risk group for coinfection. Methods We included adult (≥18 years) patients with active or prior hematologic or invasive solid malignancies and laboratory-confirmed SARS-CoV-2 infection, using data from the COVID-19 and Cancer Consortium (CCC19, NCT04354701). We captured coinfections within ±2 weeks from diagnosis of COVID-19, identified factors cross-sectionally associated with risk of coinfection, and quantified the association of coinfections with 30-day mortality. Results Among 8,765 patients (hospitalized or not, median age 65 years, 47.4% male), 16.6% developed coinfections: 12.1% bacterial, 2.1% viral, 0.9% fungal; An additional 6.4% only had clinical diagnosis of a co-infection. The adjusted risk of any coinfection was positively associated with age among patients >50 years, male sex, cardiovascular, pulmonary and renal comorbidities, diabetes, hematologic malignancy, multiple malignancies, ECOG performance status, progressing cancer, recent cytotoxic chemotherapy, baseline corticosteroids; the adjusted risk of superinfection was positively associated with tocilizumab administration. Among hospitalized patients, high neutrophil count and CRP were positively associated with bacterial coinfection risk and high or low neutrophil count with fungal coinfection risk. Adjusted mortality rates were significantly higher among patients with bacterial (OR 1.61, 95%CI 1.33-1.95) and fungal (OR 2.20, 95%CI 1.28-3.76) coinfections. Conclusion Viral and fungal coinfections are infrequent among patients with cancer and COVID-19 with the latter associated with very high mortality rates. Clinical and laboratory parameters can be used to guide early empiric antimicrobial therapy, which may improve clinical outcomes.