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Introduction: Patients with COVID‑19 may develop concomitant viral, bacterial, or fungal infections. Such patients are at a higher risk of death, especially from a critical illness. Although much attention has been recently given to fungal infections that may have devastating consequences, data on this issue are scarce., Objectives: The aim of the study was to assess the impact and prevalence of fungal infections in critically ill patients with COVID 19., Methods: We systematically searched for studies that focused on critically ill adults diagnosed with COVID‑19 and a fungal coinfection. Mortality was our outcome of interest. The search was conducted within MEDLINE, Web of Science, clinicaltrials.gov, Embase, and Cochrane Library on January 8, 2022., Results: We reviewed 38 papers covering 17 695 patients, 1182 (6.7%) of whom had an acquired fungal infection. The overall mortality in the papers retrieved for a systematic review (n = 38) varied from 29% to 100% (median [IQR], 56% [40%-77%]). In a meta‑analysis (19 studies), the patients with a fungal infection were more likely to die than the controls (odds ratio [OR], 2.987; 95% CI, 2.369-3.767; P <0.001; I2 = 26.63%). Subgroup analyses showed that COVID‑19-associated pulmonary aspergillosis (CAPA) increased mortality by 3 times (OR, 3.279; 95% CI, 2.692-3.994; P <0.001; I2 = 0%), and that COVID‑19-associated candidiasis (CAC) increased mortality by 2 times (OR, 2.254; 95% CI, 1.322-3.843; I2 = 26.14%)., Conclusions: In critically ill patients with COVID‑ 19, CAPA is rather common and significantly increases mortality. The evidence regarding other fungal infections is weaker, with CAC occurring less frequently but also impacting mortality. Therefore, clinical awareness and screening are needed, followed by personalized antifungal therapy stewardship, which is strongly recommended in order to improve the patients' prognosis.

Introduction. Inappropriate antibiotic therapy is responsible for the selection of multi-drug resistant strains and may pose a significant public health problem. During the COVID-19 pandemic, due to lack of evidence-based knowledge, the approach to antibiotic therapy varied between hospitals and predominantly depended on local protocols and individual physicians' decisions. The aim of this study was to assess antibiotic consumption during the COVID-19 pandemic compared to the pre-pandemic period in critically ill subjects in a tertiary intensive care unit (ICU). Methods. The annual changes in antibiotic consumption from 2018 until 2022 in a multidisciplinary ICU was analyzed retrospectively. Data on antibiotic consumption were obtained from the hospital pharmacy and calculated as daily defined dose (DDD) for individual groups of drugs. Results. During the pandemic period, fewer hospitalizations were observed, but they were longer. The overall antibiotic consumption in critically ill patients decreased compared to the pre-pandemic period. Among particular group of drugs, only aminoglycosides and clindamycin were prescribed more frequently. Conclusions. During COVID-19, the overall antibiotic consumption decreased, requiring further research to determine the reasons for this favorable trend. [ABSTRACT FROM AUTHOR]

Background. Immune dysregulation and hypoxemia are two important pathophysiological problems in patients with COVID-19 that affect peripheral blood count parameters. We hypothesized that assessment of the neutrophil–lymphocyte ratio (NLR) and red blood cell distribution width index (RDW-SD) could predict death in patients with severe and critical COVID-19. Methods. Seventy patients admitted to the intensive care unit (ICU) for COVID-19 acute respiratory failure were included in the study. RDW-SD and NLR on the day of ICU admission and peak values during the entire hospitalization were assessed. The primary endpoint was death before ICU discharge. Results. Patients who died had higher NLR on admission (20.3, IQR 15.3–30.2 vs. 11.0, IQR 6.8–16.9; p = 0.003) and higher RDW-SD (48.1 fL; IQR 43.1–50.5 vs. 43.9 fL; IQR 40.9–47.3, p = 0.01) than patients discharged from the ICU. NLR and RDW-SD values on ICU admission accurately predicted death in 76% (AUC = 0.76; 95%CI 0.65–0.86; p = 0.001; cut-off > 14.38) and 72% of cases (AUC = 0.72; 95%CI 0.60–0.82; p = 0.003; cut-off > 44.7 fL), respectively. Multivariable analysis confirmed that NLR > 14.38 on the day of ICU admission was associated with a 12-fold increased risk of death (logOR 12.43; 95%CI 1.61–96.29, p = 0.02), independent of other blood counts, clinical and demographic parameters. Conclusions. Neutrophil–lymphocyte ratio determined on the day of ICU admission may be a useful biomarker predicting death in patients with severe and critical COVID-19. [ABSTRACT FROM AUTHOR]