Outcomes in patients with severe COVID-19 disease treated with tocilizumab: a case-controlled study.

BACKGROUND: COVID-19 is an ongoing threat to society. Patients who develop the most severe forms of the disease have high mortality. The interleukin-6 inhibitor tocilizumab has the potential to improve outcomes in these patients by preventing the development of cytokine release storm. AIMS: To evaluate the outcomes of patients with severe COVID-19 disease treated with the interleukin-6 inhibitor tocilizumab. METHODS: We conducted a retrospective, case-control, single-center study in patients with severe to critical COVID-19 disease treated with tocilizumab. Disease severity was defined based on the amount of oxygen supplementation required. The primary endpoint was the overall mortality. Secondary endpoints were mortality in non-intubated patients and mortality in intubated patients. RESULTS: A total of 193 patients were included in the study. Ninety-six patients received tocilizumab, while 97 served as the control group. The mean age was 60 years. Patients over 65 years represented 43% of the population. More patients in the tocilizumab group reported fever, cough and shortness of breath (83%, 80% and 96% vs. 73%, 69% and 71%, respectively). There was a non-statistically significant lower mortality in the treatment group (52% vs. 62.1%, P = 0.09). When excluding intubated patients, there was statistically significant lower mortality in patients treated with tocilizumab (6% vs. 27%, P = 0.024). Bacteremia was more common in the control group (24% vs. 13%, P = 0.43), while fungemia was similar for both (3% vs. 4%, P = 0.72). CONCLUSION: Our study showed a non-statistically significant lower mortality in patients with severe to critical COVID-19 disease who received tocilizumab. When intubated patients were excluded, the use of tocilizumab was associated with lower mortality.

[TO THE PROTOCOL OF ANTIBIOTIC PROPHYLAXIS IN CARDIAC SURGERY.]

BACKGROUND: Guidelines recommend that duration of antibiotic prophylaxis in cardiac surgery should be no more than 48 h, but at the same time it has been suggested that a 24h or even a single dose may be sufficient. THE AIM: To define whether 24-hour antibiotic prophylaxis on the incidence of infectious complications in cardiac surgery compared to the 72-hour period. Materials andmethods. All 125 patients were operatedfrom 01.01.2014 till 01.10.2014. All preoperative, intra and postoperative data were analyzed. Group 1 (n = 56) - these patients were administered cefazolinfor 24 h antibiotic prophylaxis (3 g/day); group 2 (n = 69) -patients with cefazolin for 72 h antibiotic prophylaxis (1 g every 8 h). Pre and intraoperative characteristics were the same in both groups. RESULTS: Duration of stay in intensive care unit (ICU), postoperative hospitalization, sternomediastinitis frequency were also similar in both groups. The frequency of nosocomial pneumonia and rate ofprescription of antibiotics after antibiotic prophylaxis was significantly higher in group 1. CONCLUSION: 24-hour antibiotic prophylaxis does not increase the frequency of the surgical field's infection, but the frequency of postoperative pneumonia and change of antibiotic prophylaxis on antibiotic therapy was higher in group 1.