Acute and Critical Care

Abhijit Duggal

2 Articles

Infection
Risk factors associated with development of coinfection in critically Ill patients with COVID-19: Erica M. Orsini, Gretchen L. Sacha, Xiaozhen Han, Xiaofeng Wang, Abhijit Duggal, Prabalini Rajendram; Acute Crit Care. 2022;37(3):312-321. Published online August 29, 2022; DOI: https://doi.org/10.4266/acc.2022.00136

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Background
At outset of the coronavirus disease 2019 (COVID-19) pandemic, the significance of bacterial and fungal coinfections in individuals with COVID-19 was unknown. Initial reports indicated that the prevalence of coinfection in the general population was low, but there was uncertainty regarding the risk of coinfection in critically ill patients.
Methods
Nine hundred critically ill adult patients with COVID-19 infection were enrolled in this observational case-control study. Patients with a coinfection (case) and patients without a coinfection (control) were compared using univariate and multivariable analyses. A subgroup analysis was performed on patients with coinfection, dividing them into early (infection within 7 days) and late (infection after 7 days) infection groups.
Results
Two hundred and thirty-three patients (25.9%) had a bacterial or fungal coinfection. Vasopressor use (P<0.001) and severity of illness (higher Acute Physiology and Chronic Health Evaluation III score, P=0.009) were risk factors for the development of a coinfection. Patients with coinfection had higher mortality and length of stay. Vasopressor and corticosteroid use and central line and foley catheter placement were risk factors for late infection (>7 days). There were high rates of drug-resistant infections.
Conclusions
Critically ill patients with COVID-19 are at risk for both community-acquired and hospital-acquired infections throughout their hospitalization for COVID-19. It is important to consider the development of a coinfection in clinically worsening critically ill patients with COVID-19 and consider the likelihood of drug-resistance when choosing an empiric regimen.

Citations

Citations to this article as recorded by

Prevalence and risk factors associated with multidrug-resistant bacteria in COVID-19 patients
Abdu Aldarhami, Ahmed A. Punjabi, Abdulrahman S. Bazaid, Naif K. Binsaleh, Omar W. Althomali, Subuhi Sherwani, Omar Hafiz, Ali A. Almishaal
Medicine.2024; 103(10): e37389. CrossRef
Prevalence of secondary infections and association with mortality rates of hospitalized COVID-19 patients
Khalifa Binkhamis, Alanoud S. Alhaider, Ayah K. Sayed, Yara K. Almufleh, Ghadah A. Alarify, Norah Y. Alawlah
Annals of Saudi Medicine.2023; 43(4): 243. CrossRef
Blood Stream Infections in COVID-19 Patients From a Tertiary Care Center in Lebanon: Causative Pathogens and Rates of Multi-Drug Resistant Organisms
Sarah B. Nahhal, Johnny Zakhour, Abdel Hadi Shmoury, Tedy Sawma, Sara F. Haddad, Tamara Abdallah, Nada Kara Zahreddine, Joseph Tannous, Nisrine Haddad, Nesrine Rizk, Souha S. Kanj
Mayo Clinic Proceedings: Innovations, Quality & Outcomes.2023; 7(6): 556. CrossRef

Cardiology
Atrial fibrillation of new onset during acute illness: prevalence of, and risk factors for, persistence after hospital discharge: Abarna Ramanathan, John Paul Pearl, Manshi Li, Xiaofeng Wang, Divyajot Sadana, Abhijit Duggal; Acute Crit Care. 2021;36(4):317-321. Published online November 29, 2021; DOI: https://doi.org/10.4266/acc.2021.00577

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Abstract PDF: Background
Atrial fibrillation of new onset during acute illness (AFNOAI) has a variable incidence of 1%–44% in hospitalized patients. This study assesses the risk factors for persistence of AFNOAI in the 5 years post hospital discharge for critically ill patients.
Methods
This was a retrospective cohort study. All patients ≥18 years old admitted to the medical intensive care unit (MICU) of a tertiary care hospital from January 1st, 2012, to October 31st, 2015, were screened. Those designated with atrial fibrillation (AF) for the first time during the hospital admission were included. Risk factors for persistent AFNOAI were assessed using a Cox’s proportional hazards model.
Results
Two-hundred and fifty-one (1.8%) of 13,983 unique MICU admissions had AFNOAI. After exclusions, 108 patients remained. Forty-one patients (38%) had persistence of AFNOAI. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.08), hyperlipidemia (HR, 2.27; 95% CI, 1.02–5.05) and immunosuppression (HR, 2.29; 95% CI, 1.02–5.16) were associated with AFNOAI persistence. Diastolic dysfunction (HR, 1.46; 95% CI, 0.71–3.00) and mitral regurgitation (HR, 2.00; 95% CI, 0.91–4.37) also showed a trend towards association with AFNOAI persistence.
Conclusions
Our study showed that AFNOAI has a high rate of persistence after discharge and that certain comorbid and cardiac factors may increase the risk of persistence. Anticoagulation should be considered, based on a patient’s individual AFNOAI persistence risk.

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