Surging bloodstream infections and antimicrobial resistance during the first wave of COVID-19: a study in a large multihospital institution in the Paris region.

OBJECTIVES: This study measured the impact of the first wave of COVID-19 pandemic (COVID-19) (March-April 2020) on the incidence of bloodstream infections (BSIs) at Assistance Publique - Hôpitaux de Paris (APHP), the largest multisite public healthcare institution in France. METHODS: The number of patient admission blood cultures (BCs) collected, number of positive BCs, and antibiotic resistance and consumption were analysed retrospectively for the first quarter of 2020, and also for the first quarter of 2019 for comparison, in 25 APHP hospitals (ca. 14 000 beds). RESULTS: Up to a fourth of patients admitted in March-April 2020 in these hospitals had COVID-19. The BSI rate per 100 admissions increased overall by 24% in March 2020 and 115% in April 2020, and separately for the major pathogens (Escherichia coli, Klebsiella pneumoniae, enterococci, Staphylococcus aureus, Pseudomonas aeruginosa, yeasts). A sharp increase in the rate of BSIs caused by microorganisms resistant to third-generation cephalosporins (3GC) was also observed in March-April 2020, particularly in K. pneumoniae, enterobacterial species naturally producing inducible AmpC (Enterobacter cloacae...), and P. aeruginosa. A concomitant increase in 3GC consumption occurred. CONCLUSIONS: The COVID-19 pandemic had a strong impact on hospital management and also unfavourable effects on severe infections, antimicrobial resistance, and laboratory work diagnostics.

Pentoxifylline in heart failure: a meta-analysis of clinical trials.

BACKGROUND: Pentoxifylline possess antiinflammatory and rheological properties and has been tested in heart failure (HF). METHODS: A comprehensive search was performed from 1980 until July 2013 in PubMed, to identify randomized controlled trials evaluating pentoxifylline versus placebo in HF, to determine impact on mortality. Search strategy is as follows: "Pentoxifylline" AND "heart" AND "trial". Study selection of six randomized controlled trials evaluating mortality as outcome. Then, we conducted a meta-analysis of randomized controlled trials versus placebo in HF. Determination of Mantel-Haenszel fixed effect and random-effect pooled odds ratios for all-cause mortality and corresponding 95% confidence intervals. RESULTS: Data from a total of 221 patients with LVEF ≤40% from six randomized controlled trials were included in this analysis. Pentoxifylline 1200 mg per day was administered during 6 months, except in one study (administered during 1 month for severe acute HF). The use of pentoxifylline was not significantly associated with a reduction in mortality in HF in individual studies. The pooled data including 221 patients showed a nearly fourfold reduction in mortality (5.4% vs. 18.3%; OR 0.29; CI 0.12-0.74; P < 0.01) with homogenous results (I² 0%). CONCLUSION: A meta-analysis evaluating pentoxifylline versus placebo in HF suggested a significant nearly fourfold decrease in all-cause mortality in the pentoxifylline group.

[Use and misuse of intravenous drug administration in a department of internal medicine]. / Usage et mésusage de la voie intraveineuse pour l'administration de médicaments en médecine interne.

AIM: Numerous intravenously-administered medications are also available in equally effective oral forms. To assess the number of avoidable intravenous infusions, we retrospectively analyzed consecutive infusions prescribed in a department of internal medicine. METHODS: Between November and December 2004, we analyzed all patients who received at least one intravenous drug during hospitalization. Intravenous administration was considered unavoidable when prescribed for no more than 2 days in a patient unstable at admission, when oral administration or feeding was impossible, or when the drug was not available in oral form. RESULTS: During the study period 133 patients were admitted to the department. In all, 65 infusions were prescribed, 30% of which lasted more than 2 days for no medical reason. Four intravenous antibiotics were prescribed in patients when their antibiotic susceptibility tests indicated that another oral antibiotic could easily be given. Infusions for 16 other patients continued longer than 48 hours, although the oral route was not contraindicated in these patients and the medication was available in oral form. CONCLUSION: Systematic analysis of the daily prescriptions may be helpful in preventing or shortening use of intravenous medications and thereby decreasing iatrogenic infections and injuries, length of hospitalization, and costs.