The Relationship of Comorbid Diseases and Empirical Antibiotic Usage with Superinfection in COVID-19 Patients.

OBJECTIVE: To identify the microorganisms responsible for superinfections in patients admitted with COVID-19 and evaluate the impact of empirical antibiotic regimen and comorbid disease on superinfections comparing COVID-19 patients with and without secondary infection. STUDY DESIGN: A descriptive study. Place and Duration of the Study: Department of Microbiology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkiye, from March to July 2020. METHODOLOGY: This study was conducted with patients diagnosed with COVID-19 disease based on radiological or quantitative RT-PCR test results. Culture results, demographic characteristics, clinical variables, and therapeutic regimen were collected from medical records. RESULTS: Superinfection developed in 48 (26.96%) of 178 cultures (24 of 101 patients) followed up in the COVID-19 clinics. Infections were determined as 25 (52.08%) bloodstream, 11 (22.9%) urinary tract, 10 (20.8%) respiratory tract and 2 (4.16%) soft tissue infections, respectively. Secondary infectious agents were E.coli in 11 (22.9%), A.baumannii in 8 (16.7%), S.homminis in 7 (14.6%), S.epidermidis in 6 (12.5%), K.pneumoniae in 4 (8.3%), C.albicans in 2 (4.1%), and other bacterial and fungal agents in 10 (20.8%). The median range from admission to the hospital to detecting microorganism growth was the longest with piperacillin/tazobactam with moxifloxacin and azithromycin. Secondary microorganism detection was delayed, mostly due to the empirical use of moxifloxacin, azithromycin, and piperacillin/tazobactam. CONCLUSION: Demographic characteristics, comorbidity and antibiotic use of patients were not directly related to secondary infections. In addition, the empirical use of azithromycin and moxifloxacin with piperacillin/tazobactam appeared to delay the development of superinfection. KEY WORDS: Superinfection, COVID-19, Comorbidity.

Unique presentations of epidermal growth factor receptor inhibitor-induced papulopustular eruption related to bacterial superinfection.

Epidermal growth factor receptor (EGFR) inhibitors have been reported to induce numerous cutaneous side effects, the most notable of which is a papulopustular eruption on the face, scalp, and central chest. The typical presentation consists of inflamed papules, often with pustules, favoring a seborrheic distribution. The pustules of the EGFR inhibitor-induced papulopustular eruption are commonly sterile but bacterial superinfection is not uncommon. We report two unique presentations of the papulopustular eruption that were found to be associated with Staphylococcus aureus superinfection. One patient presented with an abrupt onset of nearly confluent red plaques on the cheeks, forehead, chin, and neck, with innumerable studded pinpoint pustules. The other patient had a long-standing untreated papulopustular eruption on the scalp, which resulted in widespread erythema, large thick plaques of serous crust, pustular exudate, and associated alopecia. Both patients quickly resolved with non-tetracycline oral antibiotics combined with topical steroid treatment.

[High risk of strongyloïdes hyperinfection in a patient with sarcoidosis]. / Risque d'anguillulose maligne chez un patient présentant une sarcoïdose.

Strongyloïdes stercoralis infection is a polymorphic and non specific clinical presentation. Often asymptomatic, it can be not seen. However, in patients with immunodeficiency, high parasite load can be observed, consequence of self-infestation cycle, and can spread throughout the body. This presentation of malignant strongyloidiasis presents a mortality rate of 70%. The case report presents a 45 years old patient of Caribbean origin, long time treated with corticosteroids for sarcoidosis, and hospitalized for Strongyloïdes stercoralis colitis with high parasite load, raising fears an evolution to hyperinfection. His last visit to endemic area was in 2002. In conclusion, the potential severity of strongyloidiasis is strongly increased by immunosuppression, including corticosteroids. This risk should be notified prior to initiation of any treatment with corticosteroids, firstly by looking at a stay in endemic areas. The case of our patient illustrates the fact that a long time between risk of contamination and clinical manifestations is not a sufficient criterion for excluding an asymptomatic chronic infection with Strongyloïdes stercoralis. It is therefore recommended for patients who have lived in endemic areas to search the parasite in stool by a sensitive method.

Risk factors of superinfection following imipenem/cilastatin therapy in hospitalised patients with acute exacerbations of severe chronic obstructive pulmonary disease.

Imipenem is often used in treatment of acute exacerbations of severe chronic obstructive pulmonary disease (COPD). Superinfection following imipenem therapy is a common cause of treatment failure and high economic burden. This study is aimed to explore any clinical factors which determine the risk of superinfection after imipenem treatment in acute exacerbations of severe COPD. A prospective observational study was conducted in a 5-bed respiratory intensive care unit of a Chinese University hospital. Fifty-one patients with acute exacerbations of severe COPD who were hospitalised and treated with imipenem for more than 3 days were enrolled during 1.5 year. The associations between the risk of superinfection and potential factors were analysed by logistic regression. Forty-seven out of 51 patients (92.2%) had their symptoms and signs improved at the end of imipenem treatment. Superinfections were developed in 12 patients, and the superinfection rate was as high as 30.8% (12 out of 39 patients with definite bacteriologic responses). The frequent superinfecting organisms were Stenotrophomonas maltophilia and Pseudomonas aeruginosa. Among a wide range of potential risk factors, we found that lower blood pH, previous cephalosporines treatment and longer period of imipenem treatment are independently associated with a higher risk of superinfection. The risk of superinfection following imipenem treatment in hospitalised patients with acute exacerbations of COPD was high. Lower blood pH, previous cephalosporines treatment and longer period of imipenem treatment all increased the risk of superinfection.

[Risk of superinfection related to antibiotic use. Are all antibiotics the same?]. / Riesgo de sobreinfección asociado con el uso de antibióticos. Todos los antibióticos son iguales?

The aim of this study was to analyze the effect of using different antibiotics on the risk of acquiring a bacterial or fungal superinfection in hospital-acquired infections. A systematic review of the literature using the PubMed (Medline) database from January 1990 to December 2003 was performed. We selected only those studies with at least 25 patients in each arm in which the clinical efficacy of several antibiotics (third generation cephalosporins, fluorquinolones, piperacillin-tazobactam and carbapenems) were evaluated for the treatment of severe infections, and which specifically reported the rate of superinfection. The microorganisms most frequently implicated in the development of superinfection were: Candida spp. (42.3%), Enterococcus spp. (18.8%), enterobacteria (13.8%), Staphylococcus spp. (9.5%), Pseudomonas aeruginosa (6.6%), and Clostridium difficile (4.1%). The antibiotic most frequently related to superinfection was ciprofloxacin (38.1%), followed by cefotaxime (23.3%), imipenem (12%), meropenem (10.2%), and cefepime (6.1%). The lowest percentage of superinfection was observed with the use of piperacillin-tazobactam (5.4%).

[Immunostimulating activity of eubiotic bioflor in intestinal dysbacteriosis of various origin]. / Immunostimuliruiushchaia aktivnost' éubiotika "Bioflor" pri dizbakterioze kishechnika pazlichnogo proiskhozhdeniia.

The data are reported on novel eubiotic biofor's effects on immune status of 213 patients with intestinal dysbacteriosis (39 surgical gastroenterological patients, 43 patients with diarrheal infections, 50 AIDS patients, 81 cancer patients exposed to radiation and chemotherapy). It was found that bioflor acts as an antidysbacteriosis drug and as an immunostimulator. It stimulates T-cell immunity, phagocytosis, B-cell immunity. Immunostimulating effect of bioflor depends on dysbacteriosis degree and is maximal at its first stages.

[The efficacy of flonivin BS in the treatment of intestinal dysbacteriosis]. / Znachenie flonivina BS v lechenii disbakterioza kishechnika.

The paper presents results of intestinal dysbacteriosis (ID) treatment with flonivin in 25 patients. The diagnosis was made clinically and bacteriologically (fecal examinations). Flonivin BS proved to be an effective biological preparation for management of ID stage I and II. It is composed of bacteria which do not conflict with macroorganism, contribute to normalisation of intestinal biocenosis, is especially beneficial in ID induced by long-term administration of antibiotics.

Gastrointestinal complications of immunosuppression.

The gastrointestinal manifestations of drug-induced immunosuppression may result from direct drug effects, from infectious complications, or both. Graft-versus-host disease (GVHD) is a third mechanism whereby immunosuppressive agents are linked with gastrointestinal injury. This article reviews individual immuno-suppressive medications, first concentrating on their reported gastrointestinal side effects, then reviewing other gastrointestinal phenomena, which may represent side effects of immunosuppressive agents but have not been reported yet.

[Case reports of antibiotic complications]. / Do kazuistyki powiklan po antybiotykoterapii.

A case of 30 year old male with the severe course of generalised mycosis after a few days antibiotic treatment. The diagnostics and procedure have been considered.