Cytomegalovirus reactivation in patients diagnosed with severe COVID-19: A point prevalence study in a general hospital / Reactivación de citomegalovirus en pacientes diagnosticados de COVID-19 grave: Un estudio de prevalencia en un hospital general

Purpose: To determine the prevalence of CMV reactivation in a population admitted for severe COVID-19 to a general hospital. Methods: Point prevalence study in all hospitalized patients with severe COVID-19 (admitted either to general wards or ICU). Determination of the presence of CMV DNA in circulating blood. COVID-19 was confirmed in patients with compatible clinical manifestations, usually with pneumonia and a positive nasopharyngeal PCR test. Results: We included 140 hospitalized patients with COVID-19 who consented to participate. A total of 16 patients (11.42%), had circulating CMV-DNA in peripheral blood at the time of the study. Patients with positive CMV viral load were mainly ICU patients (11/37 -29,7%) and only 5/103 cases (4,85%) were hospitalized into general wards. The accumulated doses of corticosteroids (prednisone equivalents) in the study day were (median and IQR) 987.50 mg (396.87-2,454.68) and 187.50 mg (75.00-818.12) respectively in CMV positive and negative patients (p < 0.001). A significant proportion of CMV positive patients were discovered because of the study and were clinically unsuspected by their physicians. The coinfected COVID-CMV positive population had a higher risk of accumulated secondary nosocomially-acquired infections and a worse prognosis. Conclusion: CMV reactivation should be systematically searched in patients in COVID-19 cases admitted to the ICU. (AU)

Objetivo: Determinar la prevalencia de reactivación del CMV en una población ingresada por COVID-19 grave en un hospital general. Métodos: Estudio de prevalencia en todos los pacientes hospitalizados con COVID-19 (ingresados en salas generales o UCI). Determinación de la presencia de ADN de CMV en sangre. COVID-19 fue confirmado en pacientes con manifestaciones clínicas compatibles, generalmente con neumonía y una prueba de PCR nasofaríngea positiva. Resultados: Se incluyeron 140 pacientes hospitalizados con COVID-19 que firmaron el consentimiento. Un total de 16 pacientes (11,42%), tenían ADN-CMV circulante en sangre periférica en el momento del estudio. Los pacientes con carga viral CMV positiva eran principalmente pacientes de UCI 11/37 (29,7%) y solo 5/103 casos (4,85%) fueron hospitalizados en salas generaleres. Las dosis acumuladas de corticoides (equivalentes de prednisona), en el día del estudio fueron (mediana y RIQ) 987,50 mg (396,87-2.454,68) y 187,50 mg (75,00-818,12) respectivamente en pacientes con CMV positivo y negativo (p< 0,001). Una proporción significativa de pacientes con CMV positivos fueron descubiertos debido al estudio y fueron clínicamente insospechados por sus médicos. La población coinfectada con COVID-CMV positivo tuvo un mayor riesgo de infecciones nosocomiales secundarias acumuladas y un peor pronóstico. Conclusión: La reactivación de CMV debe buscarse sistemáticamente en pacientes con COVID-19 ingresados en la UCI. (AU)

Extracorporeal membrane oxygenation (ECMO) in adults with acute respiratory distress syndrome (ARDS): A 6-year experience and case-control study.

PURPOSE: To evaluate the development of an extracorporeal membrane oxygenation (ECMO) program for the treatment of acute respiratory distress syndrome (ARDS) in adults. METHODS: a) Descriptive study of 15 cases treated since the program approval from 2010 to 2016. b) Case-control study matching the 15 ECMO cases with the 52 severe ARDS treated between 2005 and 2011 in which alternative rescue treatments (prone ventilation, tracheal gas insufflation (TGI) and/or the administration of inhaled nitric oxide (iNO)) were used. RESULTS: ECMO experience: Mortality 47% (7/15). Four patients died due to complications directly related to ECMO therapy. ICU stay 46.6 ± 45 days (range 4-138). Hospital stay 72.4 ± 98 days (range 4-320). Case-control: The mortality in the control group was 77% (44/52). The ECMO group practically doubled the mean days of ICU and hospital stay (p < 0.05). The multivariate analysis demonstrated an OR of 0.13 (0.02-0.73) for mortality associated with ECMO treatment. The following were also independent predictors of mortality: age (OR 1.05, 95% CI 1-11), SOFA score (OR 1.34, 95% CI 1.04-1.7), and the need for renal replacement therapy (OR 1.3, 95% CI 1.04-1.7). Economic analysis: The hospital cost per patient in the ECMO group doubled compared to that of the control group (USD 77,099 vs USD 37,660). However, the cost per survivor was reduced by 4% (USD 144,560 vs USD 150,640, respectively). CONCLUSIONS: Our results endorse the use of ECMO as a rescue therapy in adults with ARDS, although there are some risks associated with a learning curve as well as an important increase in the days of patient stay. The justification for the maintenance of an ECMO program in adults should be based on future studies of efficacy and cost effectiveness.