Comparison between available early antiviral treatments in outpatients with SARS-CoV-2 infection: a real-life study.

PURPOSE: To investigate the clinical impact of three available antivirals for early COVID-19 treatment in a large real-life cohort. METHODS: Between January and October 2022 all outpatients tested positive for SARS-CoV-2 referring to IRCCS S. Orsola hospital treated with an early antiviral therapy were enrolled. A comparison between patients treated with nirmatrelvir/ritonavir (NTV/r), molnupiravir (MPV) and remdesivir (RDV) was conducted in term of indications and outcome. To account for differences between treatment groups a propensity score analysis was performed. After estimating the weights, we fitted a survey-weighted Cox regression model with inverse-probability weighting with hospital admission/death versus clinical recovery as the primary outcome. RESULTS: Overall 1342 patients were enrolled, 775 (57.8%), 360 (26.8%) and 207 (15.4%) in MPV, NTV/r and RDV group, respectively. Median age was 73 (59-82) years, male sex was 53.4%. Primary indication was immunosuppression (438, 32.6%), the median time from symptom onset to drug administration was 3 [2-4] days. Overall, clinical recovery was reached in 96.9% of patients, with hospital admission rate of 2.6%. No significant differences were found in clinical recovery nor hospitalization. Cox regression showed a decreased probability of hospital admission/ death among prior vaccinated patients compared with unvaccinated (HR 0.31 [95%CI 0.14-0.70], p = 0.005]). No difference in hospitalization rates in early treatment compared to late treatment were found. CONCLUSIONS: No differences among MPV, NTV/r and RDV in terms of clinical recovery or hospitalization were found. Patients not vaccinated had a significant increased risk of hospitalization.

Impact on clinical outcome of follow-up blood cultures and risk factors for persistent bacteraemia in patients with gram-negative bloodstream infections: a systematic review with meta-analysis.

BACKGROUND: The clinical usefulness of follow-up blood cultures (FUBCs) in gram-negative bloodstream infections (GN-BSIs) represents a debated issue. OBJECTIVE: To assess the impact on the clinical outcome of FUBCs in patients with GN-BSI and to predict risk factors for persistent bacteraemia. DATA SOURCES: PubMed-MEDLINE, Scopus, and the Cochrane Library Database were independently searched until 24 June, 2022. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials, prospective, or retrospective observational studies, including patients affected by GN-BSIs. Primary endpoints were in-hospital mortality rate, and persistent blood stream infections were defined as FUBC-positive for the same pathogen isolated from index blood cultures (BCs). PARTICIPANTS: Hospitalized patients with documented GN-BSIs. INTERVENTION: Performance of FUBCs (defined as subsequent BCs collected at least 24 hours after index BCs). ASSESSMENT OF RISK OF BIAS: Quality of included studies was independently assessed according to the Cochrane Risk of Bias Tool and the Risk Of Bias In Non-randomized Studies of Interventions. METHODS OF DATA SYNTHESIS: Meta-analysis was performed by pooling odds ratio (OR) retrieved from studies providing adjustment for confounders using random-effect model with the inverse variance method. Risk factors for persistent blood stream infections were also assessed. RESULTS: A total of 3747 articles were screened, and 11 observational studies (6 assessing impact on outcome (N = 4631), and 5 investigating risk factors for persistent GN-BSI (N = 2566)), conducted between 2002 and 2020 were included. The execution of FUBCs was associated with a significantly lower risk of mortality (OR, 0.58; 95% CI, 0.49-0.70; I2 = 0.0%). The presence of end-stage renal disease (OR, 2.99; 95% CI, 1.77-5.05), central venous catheter (OR, 3.30; 95% CI, 1.82-5.95), infections due to extended-spectrum ß-lactamase-producing strains (OR, 2.25; 95% CI, 1.18-4.28), resistance to empirical treatment (OR, 2.70; 95% CI, 1.65-4.41), and unfavourable response at 48 hours (OR, 2.99; 95% CI, 1.44-6.24) emerged as independent risk factors for persistent bacteraemia. CONCLUSIONS: The execution of FUBCs is associated with a significantly low risk of mortality in patients with GN-BSIs. Our analysis could be useful to stratify patients at a high risk of persistent bacteraemia to optimize the use of FUBCs.

Mortality of patients with bullous pemphigoid in Italy: a retrospective study of a monocentric experience.

BACKGROUND: Mortality of bullous pemphigoid (BP) is a variable parameter, depending especially on the area where the study was conducted. The 1-year mortality rate and the identification of clinic-therapeutic factors with potential prognostic value in patients with BP were evaluated in a cohort from a single referral center. METHODS: We have reviewed medical records of patients with BP diagnosed at the Sant' Orsola-Malpighi Hospital in Bologna (Italy) between 2005 and 2019. Data collected included sex, age at diagnosis, laboratory findings, severity of disease, dosage of systemic treatments, age at death and comorbidities. Only patients who had at least 1 year of follow-up were included. RESULTS: Eighty-five patients were included; the mortality rate was 7.1%. The mortality rate of patients treated with a moderate dosage of corticosteroids was no higher than that of patients treated with a low dosage. The log-rank test showed a statistically significant correlation between mortality and patients aged ≥85, BP230 positive, and CCIS≥4. CONCLUSIONS: Compared with similar studies, our results show a lower 1-year mortality rate. Advanced age at diagnosis and CCIS were confirmed as major independent factors associated with poor prognosis in BP. Administration of moderate dosage of oral corticosteroids seems to have an overall positive benefit-risk ratio, providing a good control of the disease and minimizing the risk of hospitalization, possible related complications and the mortality rate.