RESUMO
BACKGROUND: In Japan, the supply of one generic meropenem product was restricted from August 2022 to March 2023. OBJECTIVE: To determine the effects of meropenem (MEPM) restriction. METHODS: We conducted a multicenter retrospective study comparing antimicrobial use, bacteremia mortality, and drug-resistant bacteria detected before the restriction of MEPM (control period), from September 2021 to February 2022, and after the restriction of MEPM (MEPM supply restriction period), from September 2022 to February 2023, in five institutions. RESULTS: The number of carbapenem days of therapy (DOTs) were decreased in all five institutions. Fourth-generation cephalosporin DOTs increased in all facilities, and piperacillin/tazobactam DOTs increased in four facilities. The 30-day and 90-day mortality rates were significantly higher during the MEPM supply restriction period than those during the control period. Moreover, survival time was significantly shorter during the MEPM supply restriction period than that during the control period. Multivariable analysis revealed that MEPM supply restriction, age >80 years, Pitt Bacteremia Score ≥4, platelet count <10 × 104/µL, serum albumin level <2.5 g/dL, and methicillin-resistant Staphylococcus aureus bloodstream infection were independent risk factors for 30-day mortality. The detection rates of carbapenem-resistant Pseudomonas aeruginosa and Enterobacteriaceae did not differ significantly between the two periods. CONCLUSIONS: MEPM supply restriction decreased the use of carbapenems and increased the use of other broad-spectrum antimicrobial agents, which worsened the prognosis of bacteremia. Overall, carbapenems are important drugs for the treatment of infectious diseases and are difficult to replace in unforeseen situations such as drug supply outages.
RESUMO
Objective: This study aimed to investigate the clinical features of long COVID cases presenting with upper respiratory symptoms, a topic not yet fully elucidated. Study Design: Prospective cohort study. Setting: A multicenter study involving 26 medical facilities in Japan. Methods: Inclusion criteria were patients aged ≥18 years old with a confirmed COVID-19 diagnosis via severe acute respiratory syndrome coronavirus 2 polymerase chain reaction or antigen testing, who were hospitalized at the participating medical facilities. Analyzing clinical information and patient-reported outcomes from 1009 patients were analyzed. The outcome measured the degree of initial symptoms for taste or olfactory disorders and assessed the likelihood of these symptoms persisting as long COVID, as well as the impact on quality of life if the upper respiratory symptoms persisted as long COVID. Results: Patients with high albumin, low C-reactive protein, and low lactate dehydrogenase in laboratory tests tended to experience taste or olfactory disorders as part of long COVID. Those with severe initial symptoms had a higher risk of experiencing residual symptoms at 3 months, with an odds ratio of 2.933 (95% confidence interval [CI], 1.282-6.526) for taste disorders and 3.534 (95% CI, 1.382-9.009) for olfactory disorders. Presence of upper respiratory symptoms consistently resulted in lower quality of life scores. Conclusion: The findings from this cohort study suggest that severe taste or olfactory disorders as early COVID-19 symptoms correlate with an increased likelihood of persistent symptoms in those disorders as long COVID.