Predictors of in-hospital mortality in HIV-infected patients with COVID-19.

BACKGROUND: Underlying immunodeficiency is associated with severe COVID-19, but the prognosis of persons with human immunodeficiency virus (HIV) (PWH) with COVID-19 is under debate. Aim: assessment of the mortality rate and major determinants of death in HIV-infected patients hospitalized with COVID-19 in Spain before vaccine availability. Design: Retrospective nationwide public database analysis. METHODS: Nationwide, retrospective, observational analysis of all hospitalizations with COVID-19 during year 2020 in Spain. Stratification was made according to HIV status. The National Registry of Hospital Discharges was used with the ICD-10 coding list. RESULTS: A total of 117 694 adults were hospitalized with COVID-19 during 2020. Only 234 (0.2%) were HIV-positives. More than 95% were on antiretroviral therapy. Compared to HIV-negatives, PWH were younger (mean age 53.2 vs. 66.5 years old; P<0.001) and more frequently male (74.8% vs. 56.6%; P<0.001). Most co-morbidities predisposing to severe COVID-19 (diabetes, hypertension, dementia and cardiovascular disease) were more frequent in HIV-negatives. In contrast, the rate of baseline liver disease was over 6-fold higher in PWH (27.4% vs. 4.4%; P<0.001). In-hospital mortality was lower in PWH (9.4% vs. 16%; P=0.004). In multivariate analysis, older age, dementia and especially advanced liver disease (relative risk (RR): 7.6) were the major determinants of death in PWH hospitalized with COVID-19. CONCLUSION: HIV-infected patients hospitalized in Spain with COVID-19 during 2020 had better survival than HIV-negatives, most likely explained by younger age and lower rate of co-morbidities. However, advanced liver disease was a major predictor of death in PWH hospitalized with COVID-19.

18F-FDG-PET/CT in SARS-CoV-2 infection and its sequelae.

In recent months, much of the scientific efforts have focused on research on SARSCoV-2 infection and its consequences in humans. Still, many aspects remain unknown. It is known that the damage caused by SARS-CoV-2 is multifactorial and that its extension goes beyond lung inflammation and the acute phase, with the appearance of numerous complications and sequelae. To date, knowledge about the usefulness of 18F-FDG-PET/CT in the acute phase has been limited to the incidental detection of SARS-CoV-2 unsuspected pneumonia. Recent studies have been appearing collecting the findings of 18F-FDG-PET/CT in long COVID-19 or persistent COVID-19 state as well as the alterations caused after mass vaccination of the population in the metabolic studies. This work aims to review the existing literature focusing on these three issues and to briefly present our own preliminary experience.

[18F-FDG-PET/CT in SARS-CoV-2 infection and its sequelae]. / 18F-FDG-PET/TC ante la infección por SARS-CoV-2 y sus secuelas.

In recent months, much of the scientific efforts have focused on research on SARSCoV-2 infection and its consequences in humans. Still, many aspects remain unknown. It is known that the damage caused by SARS-CoV-2 is multifactorial and that its extension goes beyond lung inflammation and the acute phase, with the appearance of numerous complications and sequelae. To date, knowledge about the usefulness of 18F-FDG-PET/CT in the acute phase has been limited to the incidental detection of SARS-CoV-2 unsuspected pneumonia. Recent studies have been appearing collecting the findings of 18F-FDG- PET/CT in long COVID-19 or persistent COVID-19 state as well as the alterations caused after mass vaccination of the population in the metabolic studies. This work aims to review the existing literature focusing on these three issues and to briefly present our own preliminary experience.

[Epidemiology and clinical of infections and colonizations caused by Enterobacterales producing carbapenemases in a tertiary hospital]. / Epidemiología y clínica de las infecciones y colonizaciones causadas por enterobacterias productoras de carbapenemasas en un hospital de tercer nivel.

OBJECTIVE: To describe the epidemiology of Enterobacterales producing carbapenemases (EPC) in a tertiary hospital. METHODS: A retrospective observational study, all patients with a positive sample for EPC treated in hospitalization or in the Emergency Department were included, between January 1, 2014 and December 31, 2016. RESULTS: A total of 272 patients (316 samples) were included: 155 (57%) male. Mean age of 70.4 years (95% CI 68.2 -72.7). Mean Charlson index was 3.6 (95% CI 3.4-3.8). In 63.2% the acquisition was nosocomial, in 35.3% it was health-care associated (HA). 55.1% presented infection, the most frequent infection was urinary tract infection (UTI) (58.7%). The most frequent species were Klebsiella pneumoniae (62.7%) and Enterobacter cloacae (10.1%). The most frequent types of carbapenemase were OXA-48 (53.8%) and VIM (43%). The nosocomial acquisition was associated with the male gender, transplantation, immunosuppression, admission to the Intensive Care Unit (ICU) or surgical service, prior antibiotic treatment, Enterobacter, VIM, respiratory and intra-abdominal infections. The HA acquisition was associated with age and comorbidity, nursery home origin, bladder catheterization, greater number of outpatient procedures, previous hospital admission, K. pneumoniae and E. coli, OXA-48, coproduction of extended spectrum betalactamases, UTI and sepsis. CONCLUSIONS: Patients who acquire EPC in nursery homes frequently have an infection. Patients with nosocomial acqui-sition are colonized by EPC in the ICU, in relation to invasive procedures and transplantation. This population has a higher mortality due to developing respiratory infections by EPC.

[Infections in immunocompromised patients (II). The transplanted patient]. / Infecciones en el paciente inmunocomprometido (II). Paciente trasplantado.

Recipients of the different types of transplantation are at high risk of infection. Nosocomial infections predominate in patients who have undergone haematopoietic stem cell transplantation during the early post-engraftment period (30-100 days after the infusion); the incidence of infection is higher in graft-versus-host disease. Nodular lesions can appear in the lungs due to invasive fungal infection. A diffuse pattern is usually secondary to viral infection or P. jirovecii pneumonia. After the first 100 days a moderate risk of infection by conventional and opportunistic infections persists, such as late CMV infection. Advances in surgical techniques and the use of calcineurinics have reduced mortality from infections in recipients of solid organ transplantations. Nosocomial infections are common during the first month; opportunistic infections that are dependent on cellular immunity are more common between the first and the sixth month, from the sixth month the risk lowers and community-based infections similar to those of immunocompetent patients predominate.

[Flu virus and respiratory virus infections]. / Infecciones por virus de la gripe y virus respiratorios.

In general, respiratory infections are benign and self-limiting, but occasionally they can cause severe symptoms and become a major cause of mortality and morbidity, especially in the more vulnerable population groups. Flu epidemics occur annually, and there can be pandemics every few years, such as those caused by types H1N1 or H3N2. The main clinical manifestations are respiratory symptoms associated with fever, and complications such as pneumonia can arise. Nasopharyngeal swab and RT-PCR should be performed to confirm the diagnosis, which can yield results for other viruses as well. Treatment is generally symptomatic, reserving neuraminidase inhibitors for the more serious cases. The best preventive measure is annual vaccination of the population at risk. The coronavirus is also particularly relevant, due to its potential prognostic implications, and the respiratory syncytial virus and parainfluenza virus should be borne in mind in children.