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      Predictors of carbapenem-resistant Enterobacteriaceae (CRE) strains in patients with COVID-19 in the ICU ward: a retrospective case–control study

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          Abstract

          Objective

          To identify carbapenem-resistant Enterobacteriaceae (CRE) in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) and to determine whether they had different risk factors for the acquisition of CRE than patients without COVID-19.

          Methods

          This retrospective single-centre, case–control study enrolled patients with and without COVID-19. The demographic, clinical, infection, colonization and mortality data were compared between the two groups.

          Results

          A total of 38 patients with COVID-19 and 26 patients without COVID-19 were enrolled. The majority of isolates detected in COVID-19 patients were Klebsiella spp. Leukopenia at admission (odds ratio [OR] 4.70; 95% confidence interval [CI] 1.37, 16.10), invasive mechanical ventilation (OR 5.74; 95% CI 1.07, 30.63), carbapenem treatment (OR 5.09; 95% CI 1.21, 21.27) and corticosteroid treatment (OR 7.06; 95% CI 1.53, 32.39) were independent risk factors for CRE acquisition in COVID-19 patients. Intensive care unit (ICU) mortality was significantly higher in COVID-19 patients compared with patients without COVID-19 (OR 20.62; 95% CI 5.50, 77.23). Length of ICU stay increased the risk of death in patients with COVID-19 (subdistribution hazard ratio 3.81; 95% CI 1.33, 10.92).

          Conclusion

          CRE strains were more common in patients with COVID-19 and they had different risks for CRE compared with patients without COVID-19.

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          Most cited references21

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          The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

          Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalizability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover 3 main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors, to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to all 3 study designs and 4 are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available at http://www.annals.org and on the Web sites of PLoS Medicine and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
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            Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions.

            The spread of Enterobacteriaceae, primarily Klebsiella pneumoniae, producing KPC, VIM, IMP, and NDM carbapenemases, is causing an unprecedented public health crisis. Carbapenemase-producing enterobacteria (CPE) infect mainly hospitalized patients but also have been spreading in long-term care facilities. Given their multidrug resistance, therapeutic options are limited and, as discussed here, should be reevaluated and optimized. Based on susceptibility data, colistin and tigecycline are commonly used to treat CPE infections. Nevertheless, a review of the literature revealed high failure rates in cases of monotherapy with these drugs, whilst monotherapy with either a carbapenem or an aminoglycoside appeared to be more effective. Combination therapies not including carbapenems were comparable to aminoglycoside and carbapenem monotherapies. Higher success rates have been achieved with carbapenem-containing combinations. Pharmacodynamic simulations and experimental infections indicate that modification of the current patterns of carbapenem use against CPE warrants further attention. Epidemiological data, though fragmentary in many countries, indicate CPE foci and transmission routes, to some extent, whilst also underlining the lack of international collaborative systems that could react promptly and effectively. Fortunately, there are sound studies showing successful containment of CPE by bundles of measures, among which the most important are active surveillance cultures, separation of carriers, and assignment of dedicated nursing staff.
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              Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2): A global pandemic and treatments strategies

              Highlights • The viral SARS-CoV-2 pandemic has led to detailed and exhaustive need to assess epidemiology • The spread of virus at global level is due to human to human transmission • Existing treatment is essentially supportive; role of antiviral agents is yet to be established • Detection of biomarker could also be useful in early screening of infection
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                Author and article information

                Journal
                J Int Med Res
                J Int Med Res
                IMR
                spimr
                The Journal of International Medical Research
                SAGE Publications (Sage UK: London, England )
                0300-0605
                1473-2300
                October 2022
                18 October 2022
                : 50
                : 10
                : 03000605221129154
                Affiliations
                [1 ]Department of Infectious Diseases, Clinical Infectious Diseases Hospital, Constanța, Romania
                [2 ]Department of Infectious Diseases, Faculty of Medicine, Ovidius University of Constanța, Constanța, Romania
                [3 ]Department of Doctoral School of Medicine, Ovidius University of Constanța, Constanta, Romania
                [4 ]Department of Epidemiology, Transilvania University of Brașov, Brașov, Romania
                [5 ]Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania
                [6 ]Department of Medical Sciences, Academy of Scientists of Romania, Bucharest, Romania
                [7 ]Academy of Medical Sciences, Bucharest, Romania
                Author notes
                [*]

                These authors contributed equally to this work.

                [*]Nicoleta Dorina Vlad, Department of Doctoral School of Medicine, Ovidius University of Constanța, 58 Ion Vodă Street, Constanta city, Constanta County, 900573, Romania. Email: nicoleta.lalescu@ 123456yahoo.com
                Author information
                https://orcid.org/0000-0003-1230-6819
                Article
                10.1177_03000605221129154
                10.1177/03000605221129154
                9583214
                36259133
                16f34387-775d-458f-88f8-4b91ae993df4
                © The Author(s) 2022

                Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 6 July 2022
                : 9 September 2022
                Categories
                Retrospective Clinical Research Report
                Custom metadata
                ts2

                carbapenem-resistant enterobacteriaceae,covid-19,risk factors

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