Impact of influenza immunity on the mortality among older adults hospitalized with COVID-19: a retrospective cohort study.

It has been suggested that the outcomes of coronavirus disease 2019 (COVID-19) are better in individuals having recently received an influenza vaccine than in non-vaccinated individuals. We hypothesized that this association depends on the humoral responses against influenza viruses. We aim to assess the relationship between the humoral immunity against influenza and the 3-month all-cause mortality among hospitalized older patients with COVID-19. We performed an exploratory retrospective study of older patients (aged 65 and over) hospitalized for confirmed COVID-19 between November 2020 and June 2021. Previous humoral responses to influenza viruses were assessed using a hemagglutination inhibition assay on routinely collected blood samples. The study's primary outcome was the 3-month all-cause mortality, and the secondary outcomes were severe COVID-19 (oxygen requirement ≥ 6 L/min or ventilatory support) and complications (kidney or heart failure, thrombosis and bacterial infection). In the cohort of 95 patients with COVID-19, immunity against influenza vaccine subtypes/lineages was not significantly associated with 3-month all-cause mortality, with an OR [95%CI] of 0.22 [0.02-1.95] (p = 0.174) for the H1N1pdm09 subtype, 0.21 [0.03-1.24] (p = 0.081) for A/Hong Kong/2671/2019 H3N2 subtype, 1.98 [0.51-8.24] (p = 0.329) for the B/Victoria lineage, and 1.82 [0.40-8.45] (p = 0.437) for the B/Yamagata lineage. Immunity against influenza vaccine subtypes/lineages was also not significantly associated with severity and complication. Immunity against influenza subtypes/lineages included in the 2020-2021 vaccine was not associated with a lower 3-month all-cause mortality among COVID-19 hospitalized patients.Trial registration: The study was approved by a hospital committee with competency for research not requiring approval by an institutional review board (Tours University Medical Center, Tours, France: reference: 2021_015). All patients give the informed consent.

Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department.

Background: Around one third of older adults with infections have an atypical presentation upon admission to an emergency department (ED). Objective: To evaluate the level of agreement between experts from several disciplines on the indication for antibiotic therapy for a bacterial infection in older patients presenting at an ED, and to describe the characteristics of the infections. Methods: Based on comprehensive medical records, three experts (a geriatrician, an emergency physician (EP), and an infectious disease specialist (IDS)) determined independently and then jointly whether a patient presenting at the ED had a bacterial infection requiring antibiotic therapy. Inter-expert agreement was expressed as a fixed-marginal Fleiss' kappa (κ). Results: Of the 444 medical records included, the consensus meeting found that 114 (25.7%) had an indication for antibiotics, 327 (73.6%) did not have an indication, and 3 could not be classified. The overall level of agreement was 85.2%, and κ[95%CI] was 0.64 [0.57-0.72] (p < 0.001). The level of agreement between the geriatrician and the IDS (89.41%, κ0.73, 95%CI [0.62-0.85] (p < 0.001)) was higher than that between the geriatrician and the EP (83.56%, κ0.62, 95%CI [0.51-0.73] (p < 0.001)) and between the IDS and the EP (82.66%, κ0.59, 95%CI [0.48-0.70] (p < 0.001)). The levels of agreement between the final adjudication, was higher for the geriatrician, and IDS respectively 94.1% (κ0.85, 95%CI [0.74-0.97] (p < 0.001) and 94.4% (κ0.86, 95%CI [0.74-0.97] (p < 0.001)). 114 (25.7%) patients had a bacterial infection (mostly lung infections (n = 55, 48.2%) and urinary tract infections (n = 25, 21.9%)), and 28 patients (6.3%) had a viral infection. Conclusion: Our results highlighted substantial agreement between members of a multidisciplinary expert panel.

A Local COVID-19 Support Platform for Nursing Homes: Feedback and Perspectives.

The COVID-19 pandemic has had a major impact on nursing homes (NHs), which were not prepared to manage infections among their at-risk patient populations. In order to comply with the French government's guidelines, we rapidly set up a local support platform (LSP) to help NHs manage their cases of COVID-19. The LSP comprised multidisciplinary decision support, a specialist phone hotline, mobile geriatric medicine teams, and videoconferences on COVID-19. We first quantified the LSP's interventions in 63 local NHs since the start of the first wave of COVID-19 (March 2020): 9 instances of multidisciplinary decision support, 275 calls to the specialist phone hotline, 84 interventions by mobile geriatric medicine teams, and 16 videoconferences. The LSP had been used during and between the first and second waves of the epidemic, and all had evolved to meet the NHs' needs.