COVID-19-related mortality and hospital admissions in the VIVALDI study cohort: October 2020 to March 2023.

BACKGROUND: Long-term-care facilities (LTCFs) were heavily affected by COVID-19 early in the pandemic, but the impact of the virus has reduced over time with vaccination campaigns and build-up of immunity from prior infection. OBJECTIVES: To evaluate the mortality and hospital admissions associated with SARS-CoV-2 in LTCFs in England over the course of the VIVALDI study, from October 2020 to March 2023. METHODS: We included residents aged ≥65 years from participating LTCFs who had available follow-up time within the analysis period. We calculated incidence rates (IRs) of COVID-19-linked mortality and hospital admissions per calendar quarter, along with infection fatality ratios (IFRs, within 28 days) and infection hospitalization ratios (IHRs, within 14 days) following positive SARS-CoV-2 test. RESULTS: A total of 26,286 residents were included, with at least one positive test for SARS-CoV-2 in 8513 (32.4%). The IR of COVID-19-related mortality peaked in the first quarter (Q1) of 2021 at 0.47 per 1000 person-days (1 kpd) (around a third of all deaths), in comparison with 0.10 per 1 kpd for Q1 2023 which had a similar IR of SARS-CoV-2 infections. There was a fall in observed IFR for SARS-CoV-2 infections from 24.9% to 6.7% between these periods, with a fall in IHR from 12.1% to 8.8%. The population had high overall IRs for mortality for each quarter evaluated, corresponding to annual mortality probability of 28.8-41.3%. CONCLUSIONS: Standardized real-time monitoring of hospitalization and mortality following infection in LTCFs could inform policy on the need for non-pharmaceutical interventions to prevent transmission.

[Efficacy of clinical-serologic diagnosis of wound infection in burned patients]. / Izuchenie éffektivnosti kliniko-serologicheskoi diagnostiki ranevoi infektsii u obozhzhennykh.

Titer of antibodies to microorganisms obtained from wound and blood of 46 patients with burns of IIIAB--IV degree was studied. The majority of the burned patients have ability to synthesize antibodies. Agglutination of the bacteria by antibodies promoted location of infectious agent in primary focus and impeded bacteria to spread into blood and generalization of process. Not all microorganisms of wound provoke antibodies synthesis, i.e. wound infection. Therefore bacteriologic study must be supplemented by serum diagnosis. Detection of bacteria in the blood without serologic data do not permit to consider these bacteria as etiologic factor of wound infection.

[Prediction and diagnosis of drug intolerance in patients with purulent infection and burn disease]. / K voprosu prognozirovaniia i diagnostiki lekarstvennoi neperenosimosti u bol'nykh s gnoinoi infektsiei i ozhogovoi bolezn'iu.

The immunological study was made in which the drug sensitivity index according to S. M. Demyanenko was estimated in 76 patients (24 women and 52 men aged 17-73 years): in patients with soft tissue purulent infection (group 1, n = 46) and surface thermal burns (degree III-IV) of 40% body surface (group 2, n = 30). Patients with satisfactory drug tolerance served control (16 patients of group 1 and 10 ones of group 2). Correlations between humoral and cellular immunity parameters and drug sensitivity index were studied. The results may serve a basis for development of early and adequate correction of immunological disorders in the above patients, of drug-related complications caused by immunological imbalance.

[Morphological examinations of infected burn wounds]. / Morfologicheskoe izuchenie infitsirovaniia ozhogovykh ran.

Electron microscopical and electron radioautographic methods have been used for morphological examination. This allowed to raise sensitivity of the tests facilitating detection of living solitary bacterial cells (by intensive mark above them). Radioautography showed functional status of wound bacteria (the intensity of the metabolism and reproduction). It was determined that in living tissues, not damaged by the burn and unchanged morphologically bacteria do not penetrate. Especially massive accumulations of the microorganisms are found in necrotic tissues, under the scab, at the external border of demarcation protuberance, and they represent colonization of the wound. When modern methods of treatment and early necrectomy are used, morphological examination usually does not reveal pathogenic microorganisms. Only inflammatory reaction of the wound tissues could be seen: oedema, hyperemia, hemorrhages, cellular infiltrates. The development of granulation tissue indicated cessation of wound infection. Especially favourable feature, demonstrating healing of the wound, was appearance and reproduction of young cells of fat tissue (indusion of labelled thymidine). The results of the study have confirmed the advantage of new electronic methods for microscopy in infected burn wounds.

[The clinical laboratory assessment of vancomycin (Edicin) efficacy in treating suppurative wounds of the skin and soft tissues, burn wounds and the infectious complications of burns]. / Kliniko-laboratornaia otsenka éffektivnosti vankomitsina (Editsin) pri lechenii gnoinykh ran kozhi i miagkikh tkanei, ozhogovykh ran i infektsionnykh oslozhnenii ozhogovoi bolezni.

Clinical and bacteriological efficacies of vancomycin (Edicin, LEK) in the treatment of 17 patients with wound infection and 13 patients with thermal affections were studied. The clinical efficacy in the group of the patients with purulent wounds of the soft tissues amounted to 94.1 per cent and that in the patients with thermal affections was 92.3 per cent. The bacteriological effect was recorded in 86.6 per cent of the patients with purulent wounds of the soft tissues and in 69.3 per cent of the patients with burn infections. The drug intolerability was observed in two cases.

[Clinical and laboratory efficacy of the novel difluoroquinolone Sparflo (sparfloxacin) in therapy of skin and soft tissue infections]. / Kliniko-laboratornaia éffektivnost' novogo diftorokhinolona Sparflo (sparfloksatsina) pri lechenii infektsii kozhi i miagkikh tkanei.

Results of clinical trial of new difluoroquinolone--Sparflo (sparfloxacin, Dr. Reddy's Laboratories Ltd) are presented. Sparfloxacin was used in the treatment of 24 patients at the Department of Wounds and Wounds infections (11 patients) and at the Department of burn wounds (13 patients) of the A.V. Vishnevsky Institute of Surgery. After the treatment with sparfloxacin pathogen eradication was stated in 18 patients, eradication with superinfection--in 13 patients, persistence--in 3 patients. Thus bacteriological efficacy amounted to 87.5 per cent. Pharmacokinetic data demonstrates long-term sparfloxacin circulation in the organism of patients with burns--elimination half-life amounted to 20 hours. Overall after the sparfloxacin use the favourable clinical effect was stated in 100 per cent patients--18 patients (75%) had clinical cure and 6 (25%)--clinical improvement. The drug tolerance was good. It is concluded that clinical and laboratory investigation demonstrated high efficacy of sparfloxacin (Sparflo, Dr. Reddy's Laboratories Ltd) in the treatment of patients with skin and tissue wounds of different localization and genesis, complicated with infections.

[Efficacy of lomefloxacin and ofloxacin in complex therapy of infections in patients with burns]. / Effektivnost' lomefloksatsina i ofloksatsina v kompleksnom lechenii infektsii u obozhzhennykh.

The experience with lomefloxacin and ofloxacin respectively in the complex therapy of 26 and 40 patients with burns is described. The drugs were shown to be highly active in the treatment of burn wound infections and infectious complications of burn disease. The clinical efficacy of lomefloxacin and ofloxacin amounted to 88 and 77.5 per cent and the bacteriological efficacy amounted to 81 and 80 per cent respectively.

[Clinical and laboratory study of cefodizime (Modivid) in prophylaxis and treatment of surgical patients]. / Kliniko-laboratornaia otsenka tsefodizima (modivida) pri profilakticheskom i lechebnom primenenii v khirurgii.

The results of the clinical and laboratory study of the efficacy of the prophylactic and therapeutic use of cefodizime (modivid) in patients with chronic calculous cholecystitis and burns are presented. Expediency of the preoperative prophylactic use of the drug and its significance in the treatment of infectious complications of the burn disease were verified. The immunological investigation gave evidence of an increase of the phagocytosis functional activity when cefodizime (modivid) was used prophylactically in cholecystectomy.

[The causative agent of wound infection and sepsis in burn patients]. / Vozbuditel' ranevoi infektsii i sepsisa u obozhzhennykh.

The content of antibodies to the autostrains of bacteria isolated from the wound and blood of burn patients was studied. Antibodies were found not to all species and strains isolated from the wound, but only to 1 or 2 of them. Usually Staphylococcus aureus and Pseudomonas were detected. The appearance or sharp rise of the titer of antibodies even to one of all strains contaminating the wound was observed in all examined burn patients, including those having septic complications, i.e. all these patients retained their capacity of antibody formation. The causative agent of wound infection and sepsis, determined by a high titer of antibodies to it, was seldom detected in the blood. This was due to the fact that bacteria were agglutinated by antibodies or retained in tissues on the level of the histo-hematic barrier. In cases of the development of septic endocarditis the inhibiting role of antibodies was not manifested, and the causative agent of this infection was often detected in the blood.

[Use of pefloxacin in the treatment of infected burn wounds]. / Primenenie pefloksatsina dlia lecheniia infitsirovannykh ozhogovykh ran.

The efficacy of a home-made pefloxacin was estimated in clinico-laboratory trials including 25 patients with wound infection. The fluoroquinolone was used in a dose of 400 mg administered orally twice a day for 4-16 days. Good and satisfactory results were stated in 24 patients (96 per cent). The isolates from the patients were mainly susceptible to the drug (86.2 per cent). The bacteriological efficacy amounted to 92 per cent. No side effects to the use of pefloxacin were observed.

[Ofloxacin in comprehensive treatment of infections in burn patients]. / Ofloksatsin v kompleksnom lechenii infektsii u obozhzhennykh.

The experience with ofloxacin in the prophylaxis and treatment of infected burn wounds in 40 patients was investigated. High clinical and microbiological efficacy of the drug was stated (82.5 and 83 per cent respectively). The highest efficacy of ofloxacin was observed when the burned area did not exceed 25 per cent of the body surface. It was concluded that the prophylactic use of the drug during acute burn toxemia was not expedient.

[Use of cefpirome in the treatment of patients with skin and soft tissue infections]. / Primenenie tsefpiroma pri lechenii bol'nykh s infektsiiami kozhi i miagkikh tkanei.

The efficacy of cefpirome was estimated in the treatment of 25 patients: 15 patients with pyo-necrotic wounds of the soft tissue of various genesis and localization and 10 patients with deep thermal burns involving 8 to 40 per cent of the body surface. The clinical and bacteriological efficacies of the treatment in the patients with the wound infection amounted to 100 and 80 per cent respectively. In the patients with the burn infection the respective values were 90 and 80 per cent. The drug tolerance was good. Adverse reactions were observed in 1 patient. Bolus intravenous administration of the drug was preferable by comparison with the injections.

[A trial of using sulperazone (cefoperazone/sulbactam) in the combined treatment of patients with a burn infection]. / Opyt primeneniia sul'perazona (tsefoperazon/sul'baktam) v kompleksnom lechenii bol'nykh s ozhogovoi infektsiei.

The experience with the use of sulperazone (a combination of cefoperazone, a 3rd generation cephalosporin, and sulbactam, a beta-lactamase inhibitor, Pfizer, USA) in the treatment of 25 patients with burns and deep burns (1 to 85 and 1 to 70 per cent of the body surface affection respectively) is described. The drug showed high clinical efficacy in the treatment of the infected burn wounds and infectious complications of the burns. Excellent and good results of the treatment were stated in 84 per cent of the patients. The extended affections and wound dissemination by multicomponent associations of polyresistant microbial strains lowered the microbiological efficacy of the treatment which amounted to 58 per cent. Rapid development of resistance to the drug in staphylococci was noted. The tolerance of sulperazone was good. The side effects were observed only in 1 patient.

[Experience in the use of ofloxacin in the prevention and treatment of wound infection in burns]. / Opyt primeneniia ofloksatsina dlia profilaktiki i lecheniia infektsii ozhogovykh ran.

Ofloxacin has been used for prevention and treatment of burn infection in 40 burnt subjects. Clinical response and microbiological efficacy reached 82.5 and 83%, respectively. The highest efficacy was observed in patients with burnt body surface area not more than 25%. The drug is recommended as a prophylactic modality in acute burn toxemia.

[A trial of using Cefobid (cefoperazone) in treating infections of the skin and soft tissues]. / Opyt primeneniia tsefobida (tsefoperazona) pri lechenii infektsii kozhi i miagkikh tkanei.

A clinical laboratory investigation of cefoperazon in the treatment of 27 patients with burn traumata and purulent necrotic wounds of the soft tissues of various genesis and localization was carried out. The clinical efficacy of the treatment was 75-86.6 per cent. 4 patients with extended purulent wounds of the soft tissues and bone affections were treated with cefoperazon and local application of gentacicol (a dosage form of gentamicin based on collagen with prolonged action) which provided the clinical effect in all the cases. 226 isolates from the wounds, urine, blood, sputum, pleural fluid and other substrates were tested and a rather high activity of cefoperazon against many strains of gram-positive and gram-negative organisms including Staphylococcus spp., Pseudomonas aeruginosa, Escherichia coli, Providencia sp. and Proteus spp. was revealed. The tolerance of the drug in all the cases was good.