Convalescent Plasma for Patients With Severe Coronavirus Disease 2019 (COVID-19): A Matched Cohort Study.

BACKGROUND: The efficacy of convalescent plasma (CP) for the treatment of coronavirus disease 2019 (COVID-19) remains unclear. METHODS: In a matched cohort analysis of hospitalized patients with severe COVID-19, the impact of CP treatment on in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on time to hospital discharge was assessed using a stratified log-rank analysis. RESULTS: In total, 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. The incidence of in-hospital mortality was 12.5% and 15.8% in the CP and control groups, respectively (P = .52). There was no significant difference in the risk of in-hospital mortality between the 2 groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] .39-2.20). The overall rate of hospital discharge was not significantly different between the 2 groups (rate ratio [RR] 1.28, 95% CI .91-1.81), although there was a significantly increased rate of hospital discharge among patients 65-years-old or greater who received CP (RR 1.86, 95% CI 1.03-3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused). CONCLUSIONS: We did not demonstrate a significant difference in risk of mortality or rate of hospital discharge between the CP and control groups. There was a signal for improved outcomes among the elderly, and further adequately powered randomized studies should target this subgroup when assessing the efficacy of CP treatment.

Impact of mandatory nucleic acid amplification test (NAAT) testing approval on hospital-onset Clostridioides difficile infection (HO-CDI) rates: A diagnostic stewardship intervention.

Misclassification of Clostridioides difficile colonization as hospital-onset C. difficile infection (HO-CDI) can lead to unnecessary treatment of patients and substantial financial penalties for hospitals. We successfully implemented mandatory C. difficile PCR testing approval as a strategy to optimize testing, which was associated with a significant decline in the monthly incidence of HO-CDI rates and lowering of our standardized infection ratio to 0.77 (from 1.03) 18 months after this intervention. Approval request served as an educational opportunity to promote mindful testing and accurate diagnosis of HO-CDI.

Characteristics and outcomes of Hispanic/Latinx patients with coronavirus disease 19 (COVID-19) requiring hospitalization in Rhode Island: a retrospective cohort study.

OBJECTIVE: Explore potential racial/ethnic differences, describe general clinical characteristic, and severe outcomes (intensive care unit [ICU] admission, mechanical ventilation [intubation], and death) between Hispanic/Latinx (hereafter: Hispanics or Latinx community) and non-Hispanic patients hospitalized with COVID-19. METHODS: Retrospective cohort of 326 patients hospitalized with COVID-19 through April 19, 2020. Sociodemographic and hospital course data were collected and analyzed. A multivariate logistic regression analysis was implemented to examine associations. RESULTS: Compared with non-Hispanic Whites (NHW), Hispanics were younger (53 years, median age) and had higher rates of Medicaid and less commercial/HMO/PPO coverage (P < .001). Similarly, in the age sub-grouped multivariate analysis for outcomes, Hispanics ≥65-year-old were 2.66 times more likely to be admitted to ICU (95% CI: 1.07-6.61; P = .03), and 3.67 times more likely to get intubated (95% CI: 1.29-10.36; P = .01). CONCLUSIONS: Hospitalized Hispanic patients of ≥65-year-old with COVID-19 were more likely to have higher risk of more severe outcomes (ICU admission and intubation) compared with NHW. Hispanic patient's social determinants of health and underlying medical conditions may explain the heightened risk for severe outcomes. Further studies are necessary to more accurately identify and address health disparities in Hispanics and other vulnerable populations amidst COVID-19 and future pandemics.

Co-infection with SARS-CoV-2 and Human Metapneumovirus.

The novel coronavirus (now called SARS-CoV-2) initially discovered in Wuhan, China, has now become a global pandemic. We describe a patient presenting to an Emergency Department in Rhode Island on March 12, 2020 with cough and shortness of breath after a trip to Jamaica. The patient underwent nasopharyngeal swab for a respiratory pathogen panel as well as SARS-CoV-2 RT-PCR. When the respiratory pathogen panel was positive for human metapneumovirus, the patient was treated and discharged. SARS-CoV-2 RT-PCR came back positive 24 hours later. Although respiratory viral co-infection is thought to be relatively uncommon in adults, this case reflects that SARS-CoV-2 testing algorithms that exclude patients who test positive for routine viral pathogens may miss SARS-CoV-2 co-infected patients.

Hydroxychloroquine use in hospitalised patients with COVID-19: An observational matched cohort study.

AIM: To assess the efficacy and safety of hydroxychloroquine with or without azithromycin) in hospitalized adult patients with COVID-19. METHODS: We utilized a hospital based prospective data registry. The primary end point was to assess the impact of hydroxychloroquine with or without azithromycin, on outcome, length of hospitalization, and time to clinical improvement. We utilized treatment effects with inverse-probability-weighting and Cox proportional hazards models. All analyses accounted for age, gender, race, severity on admission, days from symptoms onset and chronic comorbidities. RESULTS: 36 patients received hydroxychloroquine and were age- and sex-matched to 72 patients with COVID-19 who received supportive care. Compared to supportive care, the use of HCQ did not shorten the time to clinical improvement (+0.23 days; 95% CI: -1.8-2.3 days) nor did it shorten the duration of hospital stay (+0.91 days; 95% CI: -1.1-2.9 days). Additionally, HCQ did not decrease the risk of COVID-19 in-hospital death (aHR 1.67; 95% CI: 0.29-9.36). Finally, we observed a slight QTc prolongation from a baseline of 444 ± 26 ms to 464 ± 32 ms (mean±SD) among patients receiving hydroxychloroquine with or without azithromycin. CONCLUSION: This study did not yield benefits from hydroxychloroquine use in patients with COVID-19 and monitoring for adverse events is warranted. Nevertheless, the treatment was safely studied under the guidance of an antimicrobial stewardship program.

Total Joint Arthroplasty in Patients with Human Immunodeficiency Virus.

With the advent of highly active antiretroviral therapy (HAART), total joint arthroplasty has become a safe and effective procedure for patients infected with the human immunodeficiency virus (HIV). A correlation between a low CD4+ count (<200 cells/mm3) and major postoperative complications such as deep joint infection has been postulated, although high-level studies are not available in the literature. As most studies have not demonstrated an increase in the incidence of deep-vein thrombosis in patients with HIV/AIDS (acquired immunodeficiency syndrome), our recommendation is to use the standard prophylaxis that is followed by the operating surgeon.

Care at the Crossroads: Navigating the HIV, HCV, and Substance Abuse Syndemic.

For patients with both HIV/HCV coinfection and substance addiction, multidisciplinary teams can facilitate coordination of care and improve clinical outcomes. Such teams should include HIV/HCV treatment providers, mental health specialists, case managers, social workers, and substance abuse counselors.

Monitored viral load: a measure of HIV treatment outcomes in an outpatient setting in Rhode Island.

Community viral load measurements have been postulated to be a population-based biomarker of HIV disease. We propose the use of the monitored community viral load (mCVL) as an aggregate measure of viral load among persons receiving HIV care with available HIV-1 plasma viral loads and applied it to our clinic population from 2003-2010. We demonstrated a reduction in mCVL from 16,589 copies/ml to 11,992 copies/ml that correlated with a rising rate of antiretroviral use and HIV viral suppression; however, differences among risk populations were observed. The mCVL is a useful measure of HIV burden among patients in-care; it may reflect the HIV transmission risk in the community and help target preventive interventions.

Outpatient parenteral antibiotic therapy in an academic practice in Rhode Island.

Outpatient parenteral antimicrobial therapy (OPAT) is an increasingly utilized treatment modality that has been proven to be safe and cost effective for treating infections that require prolonged antimicrobial treatment. Adequate patient selection, a structured OPAT team with an effective communication system, and routine clinical monitoring are key elements to establish a successful OPAT program. The Miriam Hospital Infectious Diseases Clinic offers a multidisciplinary OPAT model coordinated by infectious diseases specialists and serves as a major referral center in Rhode Island.