Trajectories of Hospitalization in COVID-19 Patients: An Observational Study in France.

Describing the characteristics of COVID-19 patients in the hospital is of importance to assist in the management of hospital capacity in the future. Here, we analyze the trajectories of 1321 patients admitted to hospitals in northern and eastern France. We found that the time from onset to hospitalization decreased with age, from 7.3 days in the 20-65 year-olds to 4.5 in the >80 year-olds (p < 0.0001). Overall, the length of stay in the hospital was 15.9 days, and the death rate was 20%. One patient out of four was admitted to the intensive care unit (ICU) for approximately one month. The characteristics of trajectories changed with age: fewer older patients were admitted to the ICU and the death rate was larger in the elderly. Admission shortly after onset was associated with increased mortality (odds-ratio (OR) = 1.8, Confidence Interval (CI) 95% [1.3, 2.6]) as well as male sex (OR = 2.1, CI 95% [1.5, 2.9]). Time from admission within the hospital to the transfer to ICU was short. The age- and sex-adjusted mortality rate decreased over the course of the epidemic, suggesting improvement in care over time. In the SARS-CoV-2 epidemic, the urgent need for ICU at admission and the prolonged length of stay in ICU are a challenge for bed management and organization of care.

Fidaxomicin for treatment of Clostridium difficile infection in clinical practice: a prospective cohort study in a French University Hospital.

PURPOSE: Two randomized controlled trials (RCTs) showed the non-inferiority of fidaxomicin compared with vancomycin for Clostridium difficile infection (CDI) treatment and its superiority regarding recurrence rate. The aim of this study was to evaluate fidaxomicin's efficacy in clinical practice. METHODS: This single-center prospective cohort study included hospitalized patients treated with fidaxomicin for CDI. Demographic, clinical and biological data were collected. Primary outcome was efficacy of fidaxomicin (clinical cure, recurrence and global cure) at 10 weeks. Secondary outcome was efficacy among different subgroups. RESULTS: Ninety-nine patients were included: 42 severe CDI, 16 complicated CDI and 41 recurrent CDI. Rates of clinical cure, recurrence and global cure were 87, 15 and 59%, respectively. Subgroup analysis showed a higher recurrence rate for patients with recurrent CDI compared with first episode (8 vs. 26%; p = 0.04). Binary toxin was associated with severe/complicated CDI (80 vs. 50%; p < 0.01) and recurrence (32 vs. 7%; p < 0.01). Fidaxomicin was used as a first line for 83% of the patients with recurrence and for only 52% of first episodes even though 86% had recurrence's risk factors. CONCLUSION: Compared with RCTs, fidaxomicin in real world is used for patients with more severe and recurrent CDI, but clinical cure and recurrence rates were similar. Comparative studies are needed in these specific subgroups. Our data also illustrate clinicians' difficulty to define a "patient at risk for recurrence" among the first episodes. Finally, we showed that binary toxin could be important in the screening for severity and recurrence risks.

FITC-albumin as a marker for assessment of endothelial permeability in mice: comparison with 125I-albumin.

Transvascular transport of labeled-albumin is used to study endothelial permeability in experimental murine models of pulmonary infections. But radio-tagged albumin necessitates heavy safety procedures in terms of storage, manipulation and evacuation. The authors tested fluorescein isothiocyanate-tagged albumin (FITC-albumin) as a new marker for determination of endothelial permeability in a murine model of lung infection by Pseudomonas aeruginosa PAO1, in comparison with a standard method with (125)I-albumin. The mean permeability +/- SEM measured with (125)I-albumin was 2.45%/2 h +/- 0.37 for the control mice and 6.65%/2 h +/- 0.77 for the infected ones (P < .0001). With FITC-albumin, results obtained for both groups were respectively 4.96%/2 h +/- 0.64 and 11.5%/2 h +/- 1.2 (P < .0001). Spearman's rank coefficient was equal to .88 (P < .0001), showing a very strong correlation between both methods of measurement. The Bland-Altman analysis of bias revealed that there was no significant bias between FITC-albumin-derived and (125)I-albumin-derived values. The correction of the values obtained in plasma and lung homogenate supernatants by the subtraction of natural spontaneous fluorescence measured in these samples was crucial for the calculation of endothelial permeability in this new method. We believe that FITC-albumin can be useful for assessment of endothelial permeability in murine models of pulmonary diseases.