Empirical Antibiotic Prescribing in Adult COVID-19 Inpatients over Two Years in Mexico.

Background and Objectives: Empirical antibiotic prescribing in patients with coronavirus disease 2019 (COVID-19) has been common even though bacterial coinfections are infrequent. The overuse of antibacterial agents may accelerate the antibiotic resistance crisis. We aimed to evaluate factors predicting empirical antibiotic prescribing to adult COVID-19 inpatients over 2 years (March 2020-February 2021) in Mexico. Materials and Methods: A cross-sectional analysis of a nationwide cohort study was conducted. Hospitalized adults due to laboratory-confirmed COVID-19 were included (n = 214,171). Odds ratios (OR) and 95% confidence intervals (CI), computed by using logistic regression models, were used to evaluate factors predicting empirical antibiotic prescribing. Results: The overall frequency of antibiotic usage was 25.3%. In multiple analysis, the highest risk of antibiotic prescription was documented among patients with pneumonia at hospital admission (OR = 2.20, 95% CI 2.16-2.25). Male patients, those with chronic comorbidities (namely obesity and chronic kidney disease) and longer interval days from symptoms onset to healthcare seeking, were also more likely to receive these drugs. We also documented that, per each elapsed week during the study period, the odds of receiving antibiotic therapy decreased by about 2% (OR = 0.98, 95% CI 0.97-0.99). Conclusion: Our study identified COVID-19 populations at increased risk of receiving empirical antibiotic therapy during the first two years of the pandemic.

COVID-19 vaccines provide better protection against related pneumonia than previous symptomatic infection.

OBJECTIVES: To compare, in a real-world scenario, the protective effect of vaccination and previous laboratory-confirmed symptomatic infection on the risk of COVID-19 pneumonia. METHODS: A retrospective study was conducted and 46,998 adults with laboratory-confirmed COVID-19 were enrolled. Risk ratios (RRs) and 95% confidence intervals (CIs) were used to evaluate the effect of the evaluated exposures on the risk of pneumonia. RESULTS: In multiple analysis and after adjusting by reinfection status, vaccinated participants were at reduced risk of developing pneumonia (RR = 0.974, 95% CI 0.965-0.983). The association of having had a previous infection was not significant (RR = 1.001, 95% CI 0.969-1.034). CONCLUSION: Our results suggest, and if later replicated, that COVID-19 vaccines provide better protection against pneumonia than previous symptomatic infections. Therefore, offering vaccination to all eligible subjects despite past COVID-19 infections might be relevant to reducing the pandemic-related burden.

Association of acute urinary retention in postoperative patients with a urinary catheter, with and without bladder catheter clamping. / Asociación de retención urinaria aguda en pacientes postoperados con catéter urinario, con y sin pinzamiento de catéter vesical.

INTRODUCTION: The use of a temporaryor permanent catheter is very common in clinical practice. Between 15.0% and 25.0% of hospitalized patients have in-dwelling bladder catheters, the majority of which are short-term. Bladder catheter clamping before catheter removal was generally regarded as useful in the past. Today, its utility is questionable. OBJECTIVE: To determine the association between bladder catheter clamping and spontaneous micturition or acute urinary retention (AUR) in postoperative patients with short-term indwelling bladder catheter. MATERIALS AND METHODS: A descriptive, comparative,longitudinal study was conducted at a secondary care hospital center in a western Mexican state .AUR was the outcome variable. Two study groups wereformed: patients with bladder catheter clamping (n=43) and the control patients with no bladder catheter clamping (n=41). Descriptive statistical analyses were performed, and percentage comparisons were made with the chi-squaretest. Significant predictors were subsequently added to the multivariate model. RESULTS: Fourteen percent (n=12) of all the study patients, with and without bladder catheter clamping, presented with AUR and 86% (n=72) did not. In the association analysis, there was no statistically significant difference between presenting with AUR and having or not having bladder catheter clamping (p=0.59). The associations of AUR with bladder re-catheterization (p=0.001), age (p=0.01), and the presence of lower urinary symptoms (p= 0.005) were statistically significant. CONCLUSION: Postoperative bladder catheter clamping was not associated with the presence of AUR.

INTRODUCCIÓN: El uso de un catéter urinario temporal o permanente es muy común en la práctica clínica. Entre el 15,0% y el 25,0% de los pacientes hospitalizados tienen catéteres vesicales, la mayoría a corto plazo. Durante mucho tiempo se había considerado a los ejercicios vesicales como una práctica útil antes del retiro de los mismos. En la actualidad su utilidad es muy cuestionable.OBJETIVOS: Determinar la asociación que tienen los ejercicios vesicales sobre la micción espontánea o retención aguda de orina en pacientes postoperados portadores de catéter urinario de corta duración.MATERIAL Y MÉTODOS: Se realizó un estudio comparativo, longitudinal y descriptivo en un hospital de 2º nivel de un estado de occidente de México. La variablede desenlace fue la retención aguda de orina. Se formaron dos grupos de estudio; con ejercicios vesicales y un grupo control sin ejercicios vesicales 43 sujetos vs- 41 respectivamente. Se realizaron pruebas estadísticas descriptivas y a comparación de porcentajes se realizó con la prueba Chi2. Posteriormente se agregaron predictores significativos al modelo multivariable.RESULTADOS: De los pacientes incluidos en el estudio con y sin ejercicios vesicales, 14% (12) presentaron retención aguda de orina (RAO) y 72% (86) no la presentaron. Haciendo un análisis de asociación, no hubo significancia estadística, tener RAO y hacer ejercicios vesicales o no hacerlos (p=0,59). Hubo asociación estadísticamente significativa cuando se compararon la recolocación del catéter urinario con RAO p=0,001, la edad con la RAO p=0,01 y la presencia de síntomas irritativos urinarios bajos p=0,005.CONCLUSIÓN: El realizar ejercicios vesicales en los pacientes postoperados no están asociados a la presencia de retención aguda de orina.

Asociación de retención urinaria aguda en pacientes postoperados con catéter urinario, con y sin pinzamiento de catéter vesical / Association of acute urinary retention in postoperative patients with urinary catheter, with and without bladder catheter clamping

Introducción: El uso de un catéterurinario temporal o permanente es muy común en lapráctica clínica. Entre el 15,0% y el 25,0% de los pacientes hospitalizados tienen catéteres vesicales, la mayoría a corto plazo. Durante mucho tiempo se habíaconsiderado a los ejercicios vesicales como una práctica útil antes del retiro de los mismos. En la actualidadsu utilidad es muy cuestionable. Objetivos: Determinar la asociación que tienen losejercicios vesicales sobre la micción espontánea o retención aguda de orina en pacientes postoperados portadores de catéter urinario de corta duración. MATERIAL Y MÉTODOS: Se realizó un estudio comparativo, longitudinal y descriptivo en un hospital de 2ºnivel de un estado de occidente de México. La variablede desenlace fue la retención aguda de orina. Se formaron dos grupos de estudio; con ejercicios vesicalesy un grupo control sin ejercicios vesicales 43 sujetosvs- 41 respectivamente.Se realizaron pruebas estadísticas descriptivas y a comparación de porcentajes se realizó con la prueba Chi 2.Posteriormente se agregaron predictores significativos almodelo multivariable. Resultados: De los pacientes incluidos en el estudiocon y sin ejercicios vesicales, 14% (12) presentaron retención aguda de orina (RAO) y 72% (86) no la presentaron. Haciendo un análisis de asociación, no hubosignificancia estadística, tener RAO y hacer ejerciciosvesicales o no hacerlos (p=0,59). Hubo asociación estadísticamente significativa cuando se compararon larecolocación del catéter urinario con RAO p=0,001, laedad con la RAO p=0,01 y la presencia de síntomasirritativos urinarios bajos p=0,005. Conclusion: El realizar ejercicios vesicales en lospacientes postoperados no están asociados a la presencia de retención aguda de orina.(AU)

Introduction: The use of a temporary or permanent catheter is very common in clinicalpractice. Between 15.0% and 25.0% of hospitalizedpatients have in-dwelling bladder catheters, the majorityof which are short-term. Bladder catheter clamping before catheter removal was generally regarded as usefulin the past. Today, its utility is questionable. Objetive: To determine the association between bladder catheter clamping and spontaneous micturition oracute urinary retention (AUR) in postoperative patientswith short-term indwelling bladder catheter.Materials and methods: A descriptive, comparative, longitudinal study was conducted at a secondary care hospital center in a western Mexican state.AUR was the outcome variable. Two study groups wereformed: patients with bladder catheter clamping (n=43)and the control patients with no bladder catheter clamping (n=41).Descriptive statistical analyses were performed, andpercentage comparisons were made with the chi-squaretest. Significant predictors were subsequently added tothe multivariate model. Results: Fourteen percent (n=12) of all the study patients, with and without bladder catheter clamping,presented with AUR and 86% (n=72) did not. In theassociation analysis, there was no statistically significantdifference between presenting with AUR and having ornot having bladder catheter clamping (p=0.59). Theassociations of AUR with bladder re-catheterization (p=0.001), age (p=0.01), and the presence of lower urinary symptoms (p= 0.005) were statistically significant. Conclusion: Postoperative bladder catheter clamping was not associated with the presence of AUR.(A U)