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Multidrug-Resistant Infections and Outcome of Critically Ill Patients with Coronavirus Disease 2019: A Single Center Experience

Karruli et al., Microbial Drug Resistance, doi:10.1089/mdr.2020.0489
Sep 2021  
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Mortality 5% Improvement Relative Risk HCQ for COVID-19  Karruli et al.  ICU PATIENTS Is very late treatment with HCQ beneficial for COVID-19? Retrospective 32 patients in Italy (March - May 2020) No significant difference in mortality Karruli et al., Microbial Drug Resista.., Sep 2021 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments.
Retrospective 32 ICU patients, showing no significant difference with HCQ treatment in unadjusted results.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.
Study covers HCQ and aspirin.
risk of death, 4.8% lower, RR 0.95, p = 1.00, treatment 20 of 28 (71.4%), control 3 of 4 (75.0%), NNT 28.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Karruli et al., 1 Sep 2021, retrospective, Italy, peer-reviewed, 13 authors, study period March 2020 - May 2020.
This PaperHCQAll
Multidrug-Resistant Infections and Outcome of Critically Ill Patients with Coronavirus Disease 2019: A Single Center Experience
Arta Karruli, Filomena Boccia, Massimo Gagliardi, Fabian Patauner, Maria Paola Ursi, Pino Sommese, Rosanna De Rosa, Patrizia Murino, Giuseppe Ruocco, Antonio Corcione, Roberto Andini, Rosa Zampino, Emanuele Durante-Mangoni
Microbial Drug Resistance, doi:10.1089/mdr.2020.0489
Background: The aim of this study was to assess the drivers of multidrug-resistant (MDR) bacterial infection development in coronavirus disease 2019 (COVID-19) and its impact on patient outcome. Methods: Retrospective analysis on data from 32 consecutive patients with COVID-19, admitted to our intensive care unit (ICU) from March to May 2020. Outcomes considered were MDR infection and ICU mortality. Results: Fifty percent of patients developed an MDR infection during ICU stay after a median time of 8 [4-11] days. Most common MDR pathogens were carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii, causing bloodstream infections and pneumonia. MDR infections were linked to a higher length of ICU stay ( p = 0.002), steroid therapy ( p = 0.011), and associated with a lower ICU mortality (odds ratio: 0.439, 95% confidence interval: 0.251-0.763; p < 0.001). Low-dose aspirin intake was associated with both MDR infection ( p = 0.043) and survival ( p = 0.015). Among MDR patients, mortality was related with piperacillintazobactam use ( p = 0.035) and an earlier onset of MDR infection ( p = 0.042). Conclusions: MDR infections were a common complication in critically ill COVID-19 patients at our center. MDR risk was higher among those dwelling longer in the ICU and receiving steroids. However, MDR infections were not associated with a worse outcome.
Ethics Approval The study and its observational procedures were approved by our institutional ethics committee. Authors' Contributions All authors have contributed to and agreed on the content of the article, and the respective roles of each author are as follows: A.K., F.B., R.Z., and E.D.-M. worked on concept of the study; M.G., F.P., M.P.U., and P.S. worked on data collection and data interpretation; A.K., R.Z., and E.D.-M. drafted the article. All authors read, critically revised, and approved the final version of the article. Disclosure Statement Authors have no conflict of interest to disclose relevant to the content of this study. E.D.-M. received grant support and personal fees, outside of this study, from Roche, Pfizer, MSD, Angelini, Bio-Merieux, Abbvie, Nordic Pharma, Sanofi-Aventis, Medtronic, and DiaSorin. R.Z. and R.A. received personal fees, outside of this study, from Nordic Pharma. Supplementary Material Supplementary Table S1
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Late treatment
is less effective
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