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Secondary Bacterial Pneumonias and Bloodstream Infections in Patients Hospitalized with COVID-19
- Max Adelman, Divya Bhamidipati, Alfonso Hernandez, Ahmed Babiker, Michael Woodworth, Chad Robichaux, David Murphy, Sara Auld, Colleen Kraft, Jesse Jacob
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, p. s46
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Group Name: The Emory COVID-19 Quality and Clinical Research Collaborative
Background: Patients hospitalized with COVID-19 are at risk of secondary infections—10%–33% develop bacterial pneumonia and 2%–6% develop bloodstream infection (BSI). We conducted a retrospective cohort study to identify the prevalence, microbiology, and outcomes of secondary pneumonias and BSIs in patients hospitalized with COVID-19. Methods: Patients aged ≥18 years with a positive SARS-CoV-2 real-time polymerase chain reaction assay admitted to 4 academic hospitals in Atlanta, Georgia, between February 15 and May 16, 2020, were included. We extracted electronic medical record data through June 16, 2020. Microbiology tests were performed according to standard protocols. Possible ventilator-associated pneumonia (PVAP) was defined according to Centers for Disease Control and Prevention (CDC) criteria. We assessed in-hospital mortality, comparing patients with and without infections using the χ2 test. SAS University Edition software was used for data analyses. Results: In total, 774 patients were included (median age, 62 years; 49.7% female; 66.6% black). In total, 335 patients (43.3%) required intensive care unit (ICU) admission, 238 (30.7%) required mechanical ventilation, and 120 (15.5%) died. Among 238 intubated patients, 65 (27.3%) had a positive respiratory culture, including 15 with multiple potential pathogens, for a total of 84 potential pathogens. The most common organisms were Staphylococcus aureus (29 of 84; 34.5%), Pseudomonas aeruginosa (16 of 84; 19.0%), and Klebsiella spp (14 of 84; 16.7%). Mortality did not differ between intubated patients with and without a positive respiratory culture (41.5% vs 35.3%; P = .37). Also, 5 patients (2.1%) had a CDC-defined PVAP (1.7 PVAPs per 1,000 ventilator days); none of them died. Among 536 (69.3%) nonintubated patients, 2 (0.4%) had a positive Legionella urine antigen and 1 had a positive respiratory culture (for S. aureus). Of 774 patients, 36 (4.7%) had BSI, including 5 with polymicrobial BSI (42 isolates total). Most BSIs (24 of 36; 66.7%) had ICU onset. The most common organisms were S. aureus (7 of 42; 16.7%), Candida spp (7 of 42; 16.7%), and coagulase-negative staphylococci (5 of 42; 11.9%); 12 (28.6%) were gram-negative. The most common source was central-line–associated BSI (17 of 36; 47.2%), followed by skin (6 of 36; 16.7%), lungs (5 of 36; 13.9%), and urine (4 of 36; 11.1%). Mortality was 50% in patients with BSI versus 13.8% without (p < 0.0001). Conclusions: In a large cohort of patients hospitalized with COVID-19, secondary infections were rare: 2% bacterial pneumonia and 5% BSI. The risk factors for these infections (intubation and central lines, respectively) and causative pathogens reflect healthcare delivery and not a COVID-19–specific effect. Clinicians should adhere to standard best practices for preventing and empirically treating secondary infections in patients hospitalized with COVID-19.
Funding: No
Disclosures: None
Exploitation of forage attribute-based variations in Sudan pearl millet [Pennisetum glaucum (L.) R. Br.] collections
- Sara A. Babiker, Mohammed A. M. Khair, Izzat S. A. Tahir
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- Journal:
- Plant Genetic Resources / Volume 12 / Issue 1 / April 2014
- Published online by Cambridge University Press:
- 28 August 2013, pp. 83-90
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Triggered by the need to develop inter-seasonal, multi-cut cereal forage crops, this study aimed at the exploitation of phenotypic variations among the rich pearl millet (Pennisetum glaucum L.) collections in Sudan for possible utilization in forage-type breeding programmes. A total of 100 pearl millet accessions were used in three field trials grown in rainy, winter and summer seasons (2008–2009) at the Gezira Research Station Farm and the Gezira University Experimental Farm. Wide diversity and highly significant differences in the total dry forage yield, days to harvest, plant height, number of tillers/plant and leaf/stem ratio were found among the accessions. At an 80% morphological similarity level, the 100 accessions of pearl millet were clustered into four main groups. In the rainy and winter seasons, 71 and 56% of the accessions produced forage yield of more than 5 t/ha, respectively. In contrast, 77% of the accessions produced less than 5 t/ha in the summer season. Among the top-ranking 25 accessions, two accessions (HSD 2190 and HSD 2236) were common in dry matter yield in the three seasons, whereas 11 accessions were identified in at least two seasons. The presence of such common accessions in more than one season is encouraging for growing pearl millet as a multi-cut crop for a longer period. These results indicated the possibility of the development of forage-suited varieties of pearl millet directly through further evaluation of those common accessions or indirectly through a crop breeding programme.