HealthDay News — Intravenous antibiotics do not achieve greater sustained eradication of Pseudomonas aeruginosa in patients with cystic fibrosis compared with oral therapy, according to a study published in the October issue of The Lancet Respiratory Medicine.

Simon C. Langton Hewer, M.D., from the University of Bristol in the United Kingdom, and colleagues compared the effectiveness and safety of 14 days of intravenous ceftazidime and tobramycin (137 patients) versus 12 weeks of oral ciprofloxacin (149 patients) among randomly assigned patients seen at cystic fibrosis centers and with an isolate of P. aeruginosa. Both treatments were combined with 12 weeks of inhaled colistimethate sodium.

The researchers found that 44 percent of 125 participants in the intravenous group and 52 percent of 130 participants in the oral group achieved the primary outcome. Participants assigned to the intravenous group were less likely to achieve eradication of P. aeruginosa at three months and remain free of infection to 15 months, although the difference between the groups was not significant (relative risk, 0.84; 95 percent confidence interval, 0.65 to 1.09; P = 0.18). There were 11 serious adverse events reported, which occurred in 8 percent of patients in each group.

“Admission for intravenous therapy in the context of early P. aeruginosa infection (and without the presence of a significant pulmonary exacerbation), in adults and children with cystic fibrosis, should not be recommended,” the authors write.


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Two authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text

During the coronavirus disease 2019 (COVID-19) pandemic, healthcare providers have increasingly noted the potential of incorporating telemedicine into their pediatric rheumatology practices, according to survey results presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.

The COVID-19 pandemic has forced healthcare teams to transition from in-person to virtual telemedicine visits, many of whom had limited knowledge, infrastructure, and experience. Study authors sought to collect data on the adoption of telemedicine, understand its usage, and how healthcare teams have accepted telemedicine during the pandemic.

PR-COIN, a collaborative of 20 North American pediatric rheumatology centers, conducted the current observational study by collecting data about healthcare providers’ telemedicine experience. A REDCap® survey was sent to a representative from each site of the collaborative and the resulting quantitative data was analyzed with descriptive statistics.


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Of the 19 sites that responded to the survey, all transitioned to telemedicine in response to the COVID-19 pandemic and most reported to using both telephone and videoconferencing for visits. A total of 13 (68%) PR-COIN sites reported that at least 50% of their providers documented musculoskeletal exams in patients with juvenile idiopathic arthritis by using the Gait Arms Legs and Spine Regarding telemedicine visits, 11 (58%) centers reported collecting information on pain intensity, morning stiffness, and patient global assessment. All centers reported having both new and follow-up patients over telemedicine.

Survey results showed that that height, weight, treatment targets, and disease activity were not well-documented. Two centers reported that they did not collect any patient-reported outcome measures; however, 3 centers collected more complex ones.

A total of 7 centers (37%) noted that they conducted research-related activity during virtual visits, of which 2 (29%) reported that they were able to consent patients over telemedicine. Overall, 6 (86%) sites reported that they conducted follow-up visits for observational study purposes. Of the 19 centers, 15 (79%) and 14 (74%) reported that they would be willing to see new and follow-up patients, respectively, using telemedicine.

Every center agreed on the ability of telemedicine to meet provider needs. In addition, all but 1 center agreed that telemedicine could meet patient needs.

Convenience, no travel, and continuity of care were reported to be some of the benefits of telemedicine use. Challenges included limited physical exams, access to technology, and limited ability to assess disease activity.

Study authors concluded that, ultimately, centers “supported the continued use of telemedicine after the pandemic,” and that “PR-COIN plans on identifying best practices and creating tools to address existing barriers” to its use.

In addition to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated lymphopenia, changes in frequency and activation of granulocyte subsets may be predictive of clinical worsening during coronavirus disease 2019 (COVID-19), according to study results published in the The Journal of Infectious Diseases.

A sudden deterioration 7 to 10 days after the onset of symptoms in 10% to 20% of patients is the hallmark of COVID-19 and can lead to an increased risk for acute respiratory distress syndrome, intensive care unit (ICU) admission, and death. Previous studies have explored the immune response in patients with COVID-19 and suggested that SARS-CoV-2 may induce unique patterns of immune dysregulation. However, no systemic approach of SARS-CoV-2-induced immune dysregulation at the phenotypic level has been performed to date.

In the current observational, prospective, multicenter study, researchers aimed to identify previously unreported immune markers able to categorize patients with COVID-19 from healthy control participants and to predict mild and severe disease.

In total, 26 patients with confirmed COVID-19 were included in the study (mild/moderate, 7 patients; severe, 19 patients) along with 25 healthy control participants. All participants received immunophenotyping of whole blood leukocytes via a multiparametric flow cytometry approach on hospital or ICU admission. Unsupervised analysis and mapping of leukocyte surface markers were performed to identify clinically relevant associations. The primary objective was to identify immunophenotypic patterns that were most accurately associated with COVID-19 diagnosis and severity.


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There were notable demographic differences between the mild and severe COVID-19 groups. When compared with the mild group, the severe group had an elevated body mass index (29 vs 24 kg/m2; P =.005), more frequent cases of hypertension (15 [79%] vs 2 [29%]; P =.03), increased levels of C-reactive protein (150 vs 17 mg/L; P =.0003), and significantly higher severity scores, including the World Health Organization (WHO) progression score (P <.0001) and the Sepsis-related Organ Failure Assessment (SOFA) score (P =.005).

Results suggested that phenotypic markers of circulating granulocytes could be used as strong discriminators between severity stages and individuals infected and uninfected with COVID-19. Unsupervised mapping of leukocyte surface markers identified a distinct granulocytic COVID-19 signature. Compared with control participants, patients with COVID-19 showed downregulation of eosinophil and basophil CRTH2, increased counts of CD15+CD16+ neutrophils, and a decreased expression of granulocytic CD11b. Furthermore, COVID-19 severity was associated with a more profound imbalance of granulocyte subsets and functional markers of the disease. The frequency of CD15+ granulocytes and CD15+CD16+ neutrophils were significantly increased (P =.002) and eosinophil CRTH2 expression significantly decreased in the severe vs mild group.

 Compared to mild COVID-19, severe COVID-19 disease was associated with the emergence of unique markers, including significantly increased expression of PDL1 checkpoint inhibitor in basophils and eosinophils. Both WHO and SOFA scores positively correlated (R2=0.567) with innate immune checkpoints like PDL1 expression and negatively correlated with neutrophil CD11b and eosinophil CRTH2 expression.

Study limitations included variable timing of blood sampling between the mild and severe COVID-19 groups and the small population size, which may preclude definitive conclusions; however, results in this study were homogenous in each subgroup and were consistent with published literature.

Researchers concluded, “Taken together, our data show an early and deep impairment of the immune response, and question the use of drugs that could alleviate the immune response in patients [with] COVID-19, especially in the most severe forms requiring intensive care unit admission.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Vitte J, Diallo AB, Boumaza A, et al. A granulocytic signature identifies COVID-19 and its severity. Published online September 17, 2020. J Infect Dis. doi:10.1993/infdis/jiaa591/5907982

Reference

Goh YI, Pan N, Harris J, et al. Telemedicine in pediatric rheumatology during COVID-19: the PR-COIN experience. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0597.

This article originally appeared on Rheumatology Advisor