Wave Of COVID-19 Research Articles

Unveiling pandemic patterns: a detailed analysis of transmission and severity parameters across four COVID-19 waves in Bogotá, Colombia

BackgroundDespite a wealth of data from high-income countries, there is limited information on the distinct epidemiological patterns observed in diverse, densely populated regions within Latin America. This retrospective analysis of COVID-19’s four major waves in Bogotá, Colombia, evaluates 1.77 million cases in detail.MethodsA comprehensive suite of statistical methods was employed. Transmission dynamics were assessed by estimating the instantaneous reproduction number R(t), while variant-specific transmission advantages were estimated using multinomial logistic regression models. Disease severity was assessed through a suite of indicators: Hospitalisation Case Ratio (HCR), intensive care unit case ratio (ICU-CR), case fatality ratio (CFR), hospitalisation fatality ratio (HFR), and ICU fatality ratio (ICU-FR). Additionally, we analysed the distribution of hospitalisations, ICU admissions, and fatalities by age group and wave. We employed a Bayesian hierarchical model to capture epidemiological delays—such as onset-to-death, hospitalisation, and ICU admission durations to estimate hospital and ICU stay durations.ResultsOur findings reveal substantial variation in R(t), with peaks exceeding 2.5 during the ancestral and Omicron waves. Over the course of the pandemic, we observed a 78% reduction in CFR, underscoring shifts in clinical severity. The third wave, associated with the Mu variant, recorded the highest case and death counts, alongside a decreased CFR, an elevated HFR, and a shift in the most affected age group towards younger populations. In contrast, the fourth wave, driven by the Omicron variant, exhibited the highest reproduction number and the lowest overall severity. This wave was characterised by a significant increase in pediatric hospitalisations. The study reveals a continued decline in the mean durations of hospital and ICU stays across the four waves, with hospital stays decreasing from 10.84 to 7.85 days and ICU stays dropping from 16.2 to 12.4 days.ConclusionsThis study reveals significant shifts in transmission and severity metrics—including mortality, hospitalisation, and ICU rates and stays—across age groups during Bogotá’s four COVID-19 waves. These insights underscore the value of retrospective analyses to understand the pandemic’s varied impact and inform public health strategies in diverse urban settings.

Complex Thrombo-Inflammatory Responses versus Outcomes of Non-COVID-19 Community-Acquired Pneumonia and COVID-19

Introduction: The thrombo-inflammatory response and outcomes of community-acquired pneumonia (CAP) due to various organisms (non-COVID-19 CAP) versus CAP due to a single virus, SARS-CoV-2 (i.e., COVID-19) may differ. Methods: Adults hospitalized with non-COVID-19 CAP (December 1, 2021–June 15, 2023) or COVID-19 (March 2, 2020–June 15, 2023) in Canada. We compared non-COVID-19 CAP and COVID-19 baseline, thrombo-inflammatory response, and mortality. We measured plasma cytokine and coagulation factor levels in a sample of patients, did hierarchical clustering, and compared cytokine and coagulation factor levels. Results: In 2,485 patients (non-COVID-19 CAP, n = 719; COVID-19 patients, n = 2,157), non-COVID-19 CAP patients had significantly lower 28-day mortality (CAP vs. COVID-19 waves 1 and 2; 10% vs. 18% and 16%, respectively), intensive care unit admission (CAP vs. all waves; 15% vs. 39%, 37%, 33%, and 24%, respectively), invasive ventilation (CAP vs. waves 1, 2, and 3 patients; 11% vs. 25%, 20%, and 16%), vasopressor use (CAP 12% vs. 23%, 21%, and 18%), and renal replacement therapy use (CAP 3% vs. Omicron 7%). Complexity of hierarchical clustering aligned directly with mortality: COVID-19 wave 1 and 2 patients had six clusters at admission and higher mortality than non-COVID-19 CAP and Omicron that had three clusters at admission. Pooling all COVID-19 waves increased complexity with seven clusters on admission. Conclusion: Complex thrombo-inflammatory responses aligned with mortality of CAP. At a fundamental level, the human thrombo-inflammatory response to a brand new virus was “confused” whereas humans had eons of time to develop a more concise efficient thrombo-inflammatory host response to CAP.

Exploring the nasopharyngeal tract phageome dynamics and its correlation with disease severity and patient age across three COVID-19 waves

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A Personalist Approach to the Just Allocation of Resources in the Midst of a Pandemic

This paper examines the ethical implications of healthcare resource allocation during the first wave of COVID-19 in Italy, from 21 February to 31 May 2020, with a focus on the utilitarian principles that prioritized age-based resource allocation. By comparing this approach to an ontological personalist bioethics framework, the study aims to offer a more equitable strategy for healthcare allocation applicable to any pandemic. Data from governmental reports, healthcare policies, and ethical guidelines were analyzed, revealing that Italy’s utilitarian method led to significant ethical concerns, particularly regarding age discrimination. In contrast, the ontological personalist approach emphasizes the dignity and intrinsic worth of each individual, irrespective of age or health condition. The findings demonstrate that this personalist framework fosters a more balanced and fair allocation of resources, respecting human dignity and offering a universally applicable alternative to age-based prioritization. Ultimately, the study suggests that integrating ontological personalist principles into healthcare policies could enhance ethical decision-making in future pandemics, ensuring that resource allocation practices align more closely with human rights and individual dignity.

Ferritin at admission as a prognostic marker in older adults hospitalized for COVID-19: A retrospective cohort study

Background: Older adults remain vulnerable to COVID-19 waves, particularly in low-income countries with health disparities, so the discovery and validation of accessible clinical tools are required. Despite the expected changes associated with aging, little has been studied on ferritinemia as a prognostic marker, specifically in this population. Objective: Evaluate the use of serum ferritin levels at hospital admission as a prognostic marker in older adults hospitalized for COVID-19. Material and methods: This monocentric study included people over 60 hospitalized for COVID-19 between 2021 and 2022. Disease presence was assessed with polymerase chain reaction and ferritin with spectrophotometry. Multiple logistic regression models, as well as ROC and Kaplan-Meier curves, were used. Results: In 239 older adults, the association between serum ferritin and mortality was modified by the presence of clinical severity data at admission, being a poor prognosis factor only for those with severe COVID-19 (OR=2.82, p = 0.028, controlling for age and immunization doses). The best cut-off point was 355 ng/dl (Sensitivity: 88.3 %; Specificity: 27.4 %). However, there were no differences in survival curves. Conclusions: Serum ferritin levels could help guide therapeutic decisions in older adults with severe COVID-19 but do not predict mortality independently.

Impact of vaccination and testing levels on the COVID-19 waves

Introduction: Record numbers of new COVID-19 cases and deaths registered in Japan, Europe, and other countries in 2022 aroused questions about efficacy of vaccination and testing. The pandemic waves in Japan, Ukraine, USA, Hong Kong, mainland China, South Korea, the UK, New Zealand, Africa, and Europe in 2020, 2021, and 2022 will be compared. Influence of vaccination and testing levels will be investigated. Methods: The smoothed daily numbers of new cases and deaths per capita, case fatality risks as the ratio of these characteristics and accumulated numbers of deaths and cases, the tests per case ratio, and the non-linear correlation were used. Results: As in other countries, new severe waves of the COVID-19 pandemic occurred in Japan in 2022 despite of very high vaccination level. Non-linear correlation revealed, that the daily number of new cases drastically decreases with the increase of the tests per case ratio. Discussion: Increasing the test per case ratio and application of quarantine restrictions for the entire population, including vaccinated people, can be recommended to reduce the negative consequences of epidemics.

Development of a metabolome-based respiratory infection prognostic during COVID-19 arrival.

In a new respiratory virus pandemic, optimizing allocation of scarce medical resources becomes an urgent challenge. Infection prognosis takes on particular importance when allocating scarce antiviral antibodies and drugs, which are most effective when administered before the onset of severe disease. During arrival of the COVID-19 pandemic to the United States in 2020, we conducted a prognostic biomarker discovery and validation effort based upon metabolomic profiling with a liquid-chromatography-mass spectrometer (LC-MS) type used clinically for rapid toxicology. We obtained urine specimens from 163 patients presenting for evaluation. We obtained LC-MS profiles in the initial cohort and used machine learning methods to define a simplified urine metabolomic signature associated with respiratory failure or death by 90 days. This signature was composed of three metabotypes linked to intestinal microbiome metabolism and anticonvulsant use, with a receiver-operator characteristic area under the curve (ROC AUC) of 89.4%. Blinded application of this signature to the subsequent validation cohort yielded a ROC AUC of 81.2%. A model trained on the two baseline metabotypes present before intubation exhibited similar performance in the validation cohort. This study demonstrates the plausibility and promise of rapid metabolome-based prognostic discovery and validation in the opening wave of a pandemic. The approach used here could be used to inform therapeutic and resource allocation decisions early in a future epidemic.IMPORTANCEIn a new respiratory virus pandemic, the ability to identify patients at greatest risk for severe disease is essential to direct scarce medical resources to those most likely to benefit from them. Tools to predict disease severity are best developed early in a pandemic, but laboratory-based resources to develop these may be limited by available technology and by infection precautions. Here, we show that an accessible metabolic profiling approach could identify a prognostic signature of severe disease in the initial wave of COVID-19, when patients presenting for care often exceeded the available doses of convalescent plasma and remdesivir. In a future pandemic, this approach, alongside efforts to identify clinical disease severity predictors, could improve patient outcomes and facilitate therapeutic trials by identifying individuals at high risk for severe disease.

Pre-exposure immunohematologic features of heart failure associate with COVID-19 mortality

Chronic heart failure, like diabetes, is a pro-inflammatory cardiometabolic condition, but its association with immunodeficiency is less well established. We conducted a retrospective cohort study of US Veterans infected during the first wave of COVID-19 (n = 92,533) to identify relationships between comorbidities, pre-infection immunohematologic (IH) features (based on complete blood cell count parameters), and 60-day mortality. A biomarker sub-analysis of anti-SARS CoV2 antibodies and cytokine levels was also performed (n = 44). Heart failure was independently associated with higher COVID-19 mortality and with the specific IH alterations (especially relative anemia, anisocytosis, and lymphopenia) which themselves predicted non-survival or protracted inflammation. Over half the risk conferred by heart failure was mediated by its anticipatory IH features whereas diabetes risk was unrelated to its associated IH profile. These findings indicate that heart failure is associated with a COVID-19 immunodeficiency distinct from that of diabetes which correlates with antecedent erythrocyte and lymphocyte dyshomeostasis.

Burnout components, perceived stress and hair cortisol in healthcare professionals during the second wave of COVID 19 pandemic

This study evaluates the impact of the COVID-19 pandemic on healthcare workers in Argentina, during the second wave in 2021. The aim is to assess stress and burnout, incorporating the assessment of hair cortisol levels as a biomarker of chronic stress. A total of 496 healthcare workers from three different hospitals were included in this study. Two of these hospitals depend on the Buenos Aires City Ministry of Health and the third hospital belongs to Buenos Aires University. Hair samples were obtained using scissors from the posterior vertex, as close to the scalp as possible. Each sample was weighed, and cortisol was extracted and then measured using an automated chemiluminescent method. Notably, 10% of the population exhibited hair cortisol levels above 128 pg/mg. Associations were found between high hair cortisol levels and age, workload, emotional exhaustion, and depersonalization. In addition, burnout, identified in 11% of participants, correlated with higher perceived stress and lower social support. Binary logistic regression revealed associations between burnout and perceived stress, and age. Finally, mediation analysis showed depersonalization as a mediating variable in the relationship between hair cortisol concentration and emotional exhaustion. In conclusion, this study highlights the complex relationships between stress, cortisol levels, and burnout. Prioritizing interventions and research is essential to support the well-being of frontline healthcare professionals, ensuring their resilience during challenging times.

Work engagement of hospital workers in times of pressure: do nonclinical hospital workers react differently from their well-studied clinical colleagues?

While prevalence and value of nonclinical hospital workers, like quality or education professionals, increase, their work engagement is understudied. Work engagement of nonclinical and clinical hospital workers is critical considering the pressure of major challenges in healthcare. The pandemic was a natural experiment for this. We conducted an observational survey study among all nonclinical and clinical hospital workers of the Jeroen Bosch Hospital, the Netherlands. In an employee satisfaction survey, we measured work engagement under acute pressure (just after the first COVID-19 wave in July 2020) and chronic pressure (within the second COVID-19 wave in November 2020) and to what extent psychological demands and co-worker support were related to work engagement. For all hospital staff, "average" levels of work engagement were found under acute (response rate 53.9%, mean 3.94(0.81)) and chronic pressure (response rate 34.0%, mean 3.88(0.95)). Under acute pressure, nonclinical hospital workers scored lower on the subcategory dedication than clinical workers (mean 4.28(1.05) vs mean 4.45(0.99), p<0.001). Under chronic pressure, no differences were found. For both nonclinical and clinical hospital workers, co-worker support was positively related to overall work engagement (beta 0.309 and 0.372). Psychological demands were positively related to work engagement for nonclinical hospital workers (beta 0.130), whereas in clinical hospital workers, psychological demands were negatively related to vigor (beta -0.082). Hospitals face times of pressure. Fostering co-worker support under pressure may be vital for hospital management. Work engagement of nonclinical hospital workers is understudied.

The importance of socio-emotional skills obtained before the COVID-19 pandemic in supporting study engagement during the pandemic and transition to higher education

This study investigated the development of study engagement from the end of upper secondary school through the first and second years of higher education. The participants experienced the challenges related to the first wave of the COVID-19 pandemic while they were either university students or preparing for university entrance exams. The study employed a person-oriented approach to determine what kind of developmental trajectories emerge in study engagement when following the student participants from the end of upper secondary school through the first and second years of higher education. Furthermore, the study investigated whether socio-emotional skills obtained by the end of secondary school and before the pandemic play a role in more adaptive development through demanding restrictions related to the worldwide pandemic and general changes in the learning environment. The 852 participants answered questionnaires on study engagement and socio-emotional skills in spring 2019, and of them, 426 individuals who continued their education answered regarding study engagement again in spring 2020 and winter 2020/2021. The grades in math and Finnish language were also included. The results indicated that most students tended to experience a drop in study engagement during the first wave of COVID-19 compared to the pre-pandemic level; however, they managed to boost their engagement back to previous levels approximately 6 months later. Students who managed to recover their engagement also tended to have higher socio-emotional skills than students who were struggling with study engagement before the pandemic or who started to struggle during the pandemic.

One-year ecological momentary assessment of alcohol use, mood, and stress among individuals with alcohol use disorder during SARS-CoV-2 pandemics: a gender-specific reflection.

Alcohol consumption (AC) is a leading risk factor for death, morbidity, and disability worldwide. Gender-specific differences in AC and its moderators, which may serve as markers for preventing severe alcohol use disorders (AUD), showed inconsistent results. Additionally, the impact of COVID-19-related lockdowns on these differences remains unclear. We examined gender-specific differences in short- and long-term factors affecting AC in individuals at risk for alcohol dependence, focusing on mood, stress, and the influence of restriction-dependent lockdown phases. 358 subjects with AUD aged 16 to 65 were studied over one year. Daily electronic diaries and monthly questionnaires were conducted from 10/01/2020 to 09/30/2021, assessing real-world trajectories of AC, mood (MDMQ), and stress (PSS-10) during Germany's second COVID-19 wave. Multi-level models were used to assess associations between these measures and with several within- and between-subject variables. During lockdown, women experienced lower and even decreasing mood (valence: β = -0.2, p < .039; calmness: β = -0.3, p < .010), while men's mood increased from the most restrictive lockdown phase (valence: β = 0.2, p < .001; calmness: β = 0.3, p < .001) to post-lockdown (valence: β = 0.5, p < .001; calmness: β = 0.6, p < .001). Stress increased earlier (β = 0.8, p < .001) and more prolonged (β = 0.4, p = .021) in women than in men. For both genders, daily mood was positively associated with daily AC (valence: β = 0.6, p = .004; calmness: β = 0.4, p = .013), leading to stronger drinking on days with elevated mood. Conversely, average mood was negatively associated with average AC (valence: β = -1.6, p = .011; calmness: β = -1.2, p = .041), indicating higher overall consumption with worse overall mood. Our findings highlight the need for interventions targeting mental distress in women with AUD during pandemics, as this group faces increased mental burden during social isolation and increased risk of alcohol dependence during persistent distress.

Uncovering the toll of the first three COVID-19 waves: excess mortality and social patterns in Belgium

BackgroundThis study aims to assess which population groups experienced the heaviest mortality burden during the first three COVID-19 waves in Belgium; and investigate potential changes in social differences in all-cause mortality during the epidemic and compared to the pre-COVID period.MethodsExhaustive all-cause mortality information (2015–2021) from the Belgian population register was linked to demographic and socioeconomic census and register data. Annual cohorts consisting of 6.5 million to 6.8 million persons were created selecting persons aged 35 and older. Excess mortality was investigated comparing the 137,354 deaths observed during the first three COVID-19 waves with mortality in the reference period 2015–2019. Methods of analysis include direct standardization and Poisson regression analyses.ResultsElderly men experienced the highest absolute mortality burden during all three COVID-waves, followed by elderly women, middle-aged men, and middle-aged women. Care home residents consistently experienced higher mortality rates during the first and second wave compared to peers living in other living arrangements. In wave 3, care home residents showed significant absolute mortality deficits compared to the reference period. When adjusting for all demographic and socioeconomic factors, the traditional pattern of educational and income mortality inequalities was found among the elderly population during the COVID-waves. In contrast, the educational mortality gap among middle-aged persons deepened during COVID-waves 2 and 3 with excess mortality between 19 and 30% observed among mainly lower-educated persons. Income mortality inequalities among middle-aged women and men remained stable or even diminished for some specific groups in some waves.ConclusionThe widening educational mortality gap among middle-aged persons in successive waves suggest an important role of knowledge and associated educational resources during the COVID-19 epidemic. Belgium’s broad implementation of public health control and prevention measures may have successfully averted a further widening of social mortality inequality between income groups and among the elderly population.

#COVIDSOS: health support during the second wave of COVID-19 in India

ABSTRACT This study examines the role of Twitter 1 (now X) in facilitating health support during India’s second wave of COVID-19. Drawing from the theoretical framework of social support in computer-mediated contexts, it employs a close reading of 1,478 downloaded tweets (now X posts) from March 2021 to December 2021, associated with the hashtag #COVIDSOS. In doing so, the study analyses the health support provided via computer-mediated communication through the following four support categories – informational, emotional, esteem, and network support. Textual analysis of the tweets found that Indians used the hashtag #COVIDSOS on Twitter as a powerful tool to amplify distress calls about medical assistance within and through their online networks, and exchanged information, enabling individuals to receive help effectively. This study contributes to the broader literature on effective social media use during crises by offering a contextual understanding of the second-wave COVID-19 crisis in India through an affective lens.

Personality Traits and Sociodemographic Variables' Effects on Parental Burnout During the Second and Fourth COVID-19 Waves in Italian Parents.

(1) Background: Since the COVID-19 pandemic was a source of stress for families, this study aimed to investigate the influence of dispositional factors, such as personality traits and sociodemographic variables, on parental burnout among Italian parents during two waves of the COVID-19 pandemic. Therefore, the study assessed personality traits and sociodemographic variables as protective or risk factors for parental burnout levels. (2) Methods: The study consisted of two cross-sectional samples collected during the second and fourth waves of the Italian pandemic. The participants included 600 Italian parents: 245 from the second wave (average age = 37.12, SD = 2.78) and 355 from the fourth wave (average age = 36.89, SD = 3.14). The measures used were the Balance between Risks and Resources, the Personality Inventory, and a sociodemographic questionnaire. (3) Results: The t-test showed that parents in the fourth wave had lower parental burnout levels. Moreover, stepwise multiple linear regression revealed that sociodemographic variables did not have an effect, while significant effects of personality traits were found. Specifically, neuroticism was identified as a risk factor for parental burnout, while agreeableness and openness were identified as protective factors. (4) Conclusions: The findings indicated that similar stress levels were reported between the two waves of parents and that personality traits play a crucial role in facilitating or limiting the management of parental competencies during a risk condition.

Natural immunity and protection against variants in South African children through five COVID-19 waves: A prospective study

ObjectivesChildren have been largely spared from serious disease through the COVID-19 pandemic despite a high exposure to SARS-CoV-2. Antibody responses to exposure and their role in protecting children from subsequent variant infection remain poorly understood. MethodsThis is a prospective cohort study of children in a South African community through ancestral/Beta/Delta/Omicron BA.1/BA.2 and BA.4/BA.5 SARS-CoV-2 waves (March 2020-October 2022). Health seeking behavior/illness was recorded and postwave serum samples measured for immunoglobulin (Ig) G to spike (S) (CoV2-S-IgG) by electrochemiluminescent immunosorbent assay. To estimate the protective CoV2-S-IgG threshold levels, logistic functions were fit to describe the correlation of CoV2-S-IgG measured before a wave and the probability for seroconversion/boosting thereafter. ResultsDespite little disease, 125 per 366 (34.2%) children (median age 6.7 years [interquartile range 5.99-7.4 years]) were seropositive after wave I, rising to 53.6%, 76.0%, and 96.2% and 99.2% after waves II (Beta), III (Delta), and IV and V (Omicron variants), respectively. CoV2-S-IgG induced by natural exposure protected against subsequent SARS-CoV-2 infection, with the greatest protection for Beta and least for Omicron. The levels of IgG specific for ancestral S antigen that provided a 50% protective threshold for the subsequent wave were lowest for the Beta and highest for the Omicron BA.1/BA.2 wave. In the multivariate analysis, maternal seropositivity (adjusted odds ratio = 2.57 [95% confidence interval: 1.72-3.82]) was strongly associated with child seropositivity. ConclusionChildren responded robustly to successive waves of SARS-CoV-2, mounting IgG responses to S antigen that were protective against subsequent waves. In the absence of vaccination, almost all children were seropositive after wave V but none were hospitalized, suggesting that natural immunity alone may be sufficient to protect children in a pandemic setting.

Non-attendance in randomized remote mental health clinical trial during the COVID-19 pandemic

During the COVID-19 pandemic, a significant increase in psychiatric symptoms was found among essential service professionals (professionals or interns from the health and educational sector) who were exposed to high-risk contamination areas. These symptoms impair functionality, impacting quality of life, work, autonomy, and relationships. Recent data show that brief interventions are effective; however, between 20 and 30% of those individuals often do not attend their scheduled appointments. This study aimed to identify variables related to non-attendance for remote telepsychotherapy among participants with COVID-19-related emotional distress compared to those who initiated treatment. We included 2097 essential service professionals with PROMIS (Patient-Reported Outcomes Measurement Information System) T-scores ≥70 for anxiety, depression, or irritability who scheduled a remote mental health appointment. Participants completed clinical and sociodemographic data, mental health risk and protective factors, and PROMIS subscales. We conducted a binary logistic regression, using attendance vs. non-attendance as the dependent variable and these demographic and clinical characteristics as independent variables. Of the 2097 participants, 230 (11%) did not attend the first session despite three rescheduling attempts. Non-attendance was associated with the presence of irritability and seeking treatment during the second COVID-19 wave. In contrast, anxious symptoms, older age, and coping mechanisms that typically include intellectual and reading activities were associated with attendance. Our findings shed light on non-attendance patterns in mental health services, revealing that personal characteristics and environmental factors significantly contribute to missed appointments. Understanding these dynamics can improve patient engagement and adherence to mental health treatments, particularly in the context of telepsychotherapy during the COVID-19 pandemic.

Depression, anxiety, and help-seeking among Slovenian postsecondary students during the COVID-19 pandemic.

The COVID-19 pandemic has faced students with many challenges, contributing to their mental distress. This article explores the role of demographic characteristics, psychological status, year of study, and social support during the COVID-19 pandemic in explaining Slovenian university students' mental health problems and help-seeking behavior. In February and March 2021, data were collected on 5,234 full-time Slovenian postsecondary students who were enrolled in public and concessionary independent higher education institutions. Participants completed a questionnaire, which included The Patient Health Questionnaire (PHQ-9), General Anxiety Disorder questionnaire (GAD-7), Oslo Social Support Scale (OSSS-3), and items measuring psychological status, help-seeking behavior and demographics. Data were analyzed using multiple linear regression and hypothesis testing for differences. Factors, such as gender, age, psychological status and social support, contributed to experiencing anxiety and depression among Slovenian students during the COVID-19 pandemic, with year of study additionally contributing to experiencing depression. Similarly, gender, age, psychological status and social support contributed to help-seeking behavior. Higher levels of depression and anxiety were reported by female students, students with prior mental disorders, and students with lower social support levels. Female students and students with lower social support levels reported more frequent help-seeking behaviors. The results provide insight into the mental state of the Slovenian student population in the context of imposed public health measures at the end of the second COVID-19 wave in Slovenia. The findings can help identify vulnerable groups within the student population to whom we must be particularly attentive in times of crisis.

Comparative Analysis of Epidemiological &amp; Clinical Trends Across the First, Second and Third Waves of COVID-19: Insights from a Tertiary Care Hospital

Comparative Analysis of Epidemiological &amp; Clinical Trends Across the First, Second and Third Waves of COVID-19: Insights from a Tertiary Care Hospital

Bacteriuria and antibiotic use during the third wave of COVID-19 intensive care in Sweden

Background Urinary tract infections (UTIs) are prevalent among patients carrying indwelling catheters in the intensive care unit (ICU). This study investigates antibiotic use and bacterial colonisation among ICU patients during the third wave of the COVID-19 pandemic, building on our prior discovery of increased Enterococcus colonisation associated with increased cephalosporin use in early COVID-19. Methods Longitudinal urine samples from COVID-19 patients (n = 109) with transurethral catheterisation were analysed for bacterial prevalence, further identified via MALDI-TOF. Microbiological results were combined with clinical data obtained daily, assessed and compared with COVID-19 waves 1 and 2. Results Patients in wave 3 exhibited improved outcomes compared to those in waves 1 and 2, alongside a decrease in antibiotic use. Staphylococcus emerged as the primary bacterium and early colonizer of the urinary tract, potentially due to the absence of antibiotic treatment. Our results imply that length of stay (LOS) correlates solely with enteric pathogens and that antibiotic treatment correlates with colonisation by certain uropathogens, whereas the absence of antimicrobial therapy is associated with rapid colonisation of skin flora. Polymicrobial colonisation was common, predominantly involving Gram-positive bacteria. Conclusion Our findings underscore the complexity of bacteriuria in ICU patients, advocating for targeted surveillance and tailored antibiotic approaches to mitigate UTI risk. Insights into antibiotic use and bacterial colonisation are vital for optimising stewardship practices, combating antimicrobial resistance, and enhancing ICU patient outcomes.