Post Tocilizumab Secondary Infections in Covid-19 patients”- Are we doing enough?

Abstract

Aim: To focus on the frequency of ICU-acquired infections in Sars Co-V2 Corona Virus disease (COVID 19) patients. Method: A retrospective observational study carried out in two tertiary care hospitals treating COVID 19 cases, Services Institute of Medical Sciences and Bahria International Hospital, Lahore. Data was collected from the medical records of the COVID 19 ICUs of both hospitals from May 1, 2020 to April30, 2021. All charts were reviewed for the evidence of positive cultures. The treatment given prior to positive cultures, after the availability of culture results and outcomes were also recorded. Results: A total of 432 records were reviewed and 400 cases were included while 32 cases were excluded because of incomplete data. The frequency of infections per 1,000 days of ICU stay was calculated in 90 (22.5%) patients. Gram-negative bacteria accounted for 68 cases (75.5%) with Pseudomonas in 44 cases (48.8%), Acinetobacter in 23/90 (25.5%) while 17 cases (18.8%) had gram positive infection with Enterococcus in 14/18 (77.77%) or 14/90 (15.55%), MRSA in 4/18 (22.22%) 4/90 (4.44%), while 5/90 (5.5%) had more than 2 isolates at same time. Among these 3 had both pseudomonas and Acinetobacter while 2 patients had Pseudomonas and Stenotrophomonas Maltophilia. Conclusion: There seems to be an increase in the infection rate among critically sick COVID 19 patients admitted in ICU. Use of steroids and Tocilizumab seems to play a role through their immunomodulatory effects. Keywords: Tocilizumab, Secondary infections

Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis

“…After screening, 50 studies were selected for inclusion in the review (Figure 2, Tables 1 and 2) [3,9,. Thirty-three of these were included in the MA (Table 3) [25][26][27][28][29][30][31][32][33][34][35][36][38][39][40][41][42][43][44][45][46][47][48][49][50][57][58][59][60][61]63,68,71]. The remaining 17 studies [3,9,37,[51][52][53][54][55][56]62,[64][65][66]…”

“…This could be expected to lead to worse outcomes for patients, including increased IHM, but the evidence that we found in this systematic review was mixed. While some studies suggested that EDLOS is an independent predictor of ICU mortality [3,25,[34][35][36]39,40,42,47,48,[51][52][53][54]58,67,71], others reported no adverse association [32,38,44,45,50,55,56,[59][60][61]63,69,70]. MA of the studies reporting IHM in patients admitted to the ICU showed an association with EDLOS over 24 h, with absence of heterogeneity.…”

“…The Netherlands [50], France [64], Norway [65]), 15 in North America (USA [9,30,32,33,35,36,38,40,46,55,58,60,68,72], Canada [3]), 15 in Asia (Qatar [29], Saudi Arabia [61], China [31,44,55,66], Thailand [41], India [42,72], Pakistan [48,63], Israel [57], Iran [70], South Korea [59], Turkey [69]), 7 in Australia [25][26][27][28]43,51,67], and 2 in Latin America [52,56]. The characteristics of the selected studies are listed in Tables 1 and 2.…”

“…Thirty studies examined patients who were transferred from the ED to the ICU [3,25,32,[34][35][36][38][39][40]42,44,45,47,48,[50][51][52][53][54][55][56][58][59][60][61]63,67,[69][70][71]. Twenty studies examined patients who were not admitted to the ICU, but were admitted to non-ICU wards [9,[26][27][28][29][30][31]33,37,41,43,46,49,57,62,[64][65][66]68,72].…”

“…The ICU-admitted ED population was defined as a population seen in the ED and admitted to ICU inpatient hospital ward (Table 3). Thirty studies analyzed the association between EDLOS and IHM in ED patients admitted to the ICU [3,25,32,[34][35][36][38][39][40]42,44,45,47,48,[50][51][52][53][54][55][56][58][59][60][61]63,67,[69][70][71]. Thirteen studies found an association between EDLOS and IHM [32,38,44,45,50,55,56,[59][60][61]63,70,71], while 17 did not find such an association [3,25,[34][35]…”