Clinical Characteristics and Outcomes of Acute Kidney Injury in Hospitalized Patients with Coronavirus Disease 2019: Experience at a Major Tertiary Care Center in Pakistan.

Limited data exist on acute kidney injury (AKI) in patients hospitalized with coronavirus disease 2019 (COVID-19), its risk factors, and the outcomes from lower and middle-income countries. We determined the epidemiology of AKI and its outcomes in a retrospective observational study at a tertiary care center in Karachi, Pakistan, from October to December 2020. Demographic data, presenting clinical symptoms, laboratory results, and patient outcomes were collected from the medical records. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria. Of 301 COVID-19 patients, AKI developed in 188 (62.5%). The peak stages of AKI were Stage 1 in 57%, Stage 2 in 14.9%, and Stage 3 in 27.7%. Of these, 15 (8%) required kidney replacement therapy (KRT). Patients admitted to the intensive care unit (63.8% vs. 34.5%), and those needing vasopressors (31.9% vs. 5.3%) or mechanical ventilation (25% vs. 2.7%) had a higher risk of AKI. Independent predictors of AKI were elevated blood urea nitrogen and creatinine (Cr) at presentation, mechanical ventilation, and the use of anticoagulants. AKI, the presence of proteinuria, elevated serum Cr at presentation, use of vasopressors, and a need for KRT were significantly associated with in-hospital death, and the likelihood of mortality increased with advanced stages of AKI. Compared with other countries, AKI occurred more frequently among hospitalized patients with COVID-19 in this Pakistani cohort and was associated with 7.7-fold higher odds of in-hospital death. Patients with severe AKI had a greater likelihood of mortality than those in earlier stages or without AKI.

Enterococcal Meningitis/Ventriculitis: A Tertiary Care Experience.

CONTEXT: Enterococcal meningitis is very rare among bacterial meningitis and has variable clinical outcomes. AIMS: The purpose of the current study is to evaluate clinical features, therapeutic options with susceptibility profile, and outcomes of enterococcal meningitis in a tertiary care hospital. SETTINGS AND DESIGN: We retrospectively reviewed medical records of all patients with enterococcal meningitis over the periods of 4 years. SUBJECTS AND METHODS: The clinical and laboratory data of all patients with enterococcal meningitis were evaluated between 2013 and 2016. RESULTS: Six cases of enterococcal meningitis were found (three infant and three adults). All patients developed meningitis after neurosurgical procedures, and majority of patients (four out of six) had central nervous system (CNS) devices in situ at the time of development of meningitis. The causative organism isolated from cerebrospinal fluid (CSF) culture of all patients was Enterococcus species only. All Enterococcus spp. were resistant to ampicillin, Amoxicillin-clavulanate, and oxytetracycline and two isolates were also resistant to vancomycin. Four patients with vancomycin-sensitive Enterococcus spp. were treated with vancomycin alone for mean periods of 18 days (14-21 days). One patient with vancomycin-resistant Enterococcus (VRE) meningitis was treated with linezolid alone, and another one requires combination with rifampicin to achieve microbiological clearance of CSF. CNS devices were removed in all patients. No mortality was reported in current case series. CONCLUSIONS: Enterococcal meningitis is very uncommon, mostly associated with neurosurgical intervention. Early treatment is associated with favorable outcomes. Removal of CNS devices is recommended to achieve a clinical cure.