Of 230 COVID-19 survivors in Italy infected during the first pandemic wave, 36.1% still had symptoms at 2 years, finds a study published today in Open Forum Infectious Diseases.

A University of Insubria–led team interviewed 230 hospitalized and nonhospitalized adults followed at Udine Hospital 6, 12, and 24 months after illness onset in March to May 2020. Average patient age was 54.7 years, 53.5% were women, and 95.6% had received an mRNA vaccine booster.

55% sought medical attention

Eighty-three patients (36.1%) reported long-COVID symptoms at 2 years, the most common of which were fatigue (14.4%) and rheumatologic (14.4%) and psychiatric (9.6%) symptoms. The proportion of patients reporting long COVID was lower than that at 6 and 12 months (40.2% and 47.2%, respectively).

Forty-six (55.4%) of long-COVID patients said they sought treatment, with 20 (43.5%) seeking primary care, 6.5% visiting the emergency department, and 23 (50.0%) seeing a specialist. A total of 35.7% of patients said their symptoms had improved by 2 years compared with at 1 year, while 19.1% said their condition was unchanged, and 3.5% said it was worse.

Independent risk factors for long COVID were female sex (odds ratio [OR], 2.50), a proportional increase in the number of symptoms during acute illness (OR, 1.40), and the presence of underlying illnesses (OR, 1.57). Vaccinated and unvaccinated patients reported comparable rates of long-COVID symptoms at 2 years (30.0% and 36.4%, respectively).

An international coordinated multidisciplinary research informing tailored health-care programs is warranted.

Thirty-eight patients (16.5%) experienced reinfection, and there was no significant difference in long-COVID status at 2 years in reinfected or non-reinfected patients (39.5% vs 35.4%).

"An international coordinated multidisciplinary research informing tailored health-care programs is warranted to improve our understanding of the pathogenesis and management of this new medical challenge that seems to be still neglected by the health services but that may lead to an emerging global crisis," the study authors wrote.

Global COVID-19 indicators continue to decline in most parts of the world, apart from an uptick in deaths in the African region, the World Health Organization (WHO) said today in its latest weekly update.

With fewer countries testing and reporting cases, the WHO said that trends in hospitalizations and intensive care unit (ICU) admissions are more accurate indicators, though only small percentages of countries regularly report those levels. Hospitalizations declined 47% over the past 28 days, and, of 19 countries that consistently report their levels, only Malta and Bangladesh reported increases of 20% or more over the past month.

ICU admissions dropped 66% over the same period, and, of 15 countries that regularly report ICU data, none reported increases of 20% or more over the past 4 weeks.

Deaths in Africa were up 43%, though the rise was from a low baseline level, the WHO said.

Deaths in Africa were up 43%, though the rise was from a low baseline level.

Though tracking cases isn't a true gauge of COVID activity, the WHO said some countries are still feeling the burden of the disease. Countries that saw notable increases over the past 28 days include Zambia, some territories in the Caribbean, Bhutan, Bangladesh, and Kirbati.

Regarding variant tracking, the WHO said the proportion of the Omicron XBB.1.5 variant continue to decline steadily and is at 19.8%, while levels of XBB.1.16 are still rising, now at 22.1%. Three variants under monitoring also showed rises, including XBB, XBB.1.9.2, and XBB.2.3.

Few hot spots in Europe

In its weekly update today, the European Centre for Disease Prevention and Control said COVID activity continues to remain at decreasing or stable levels. Luxembourg was the only country to report a rise in cases, and Malta reported a rise in hospitalizations and deaths.

Of nine countries reporting an adequate volume of sequencing results, the proportion of the XBB.1.5 subvariant was 92.9%.

A study conducted at a neonatal unit in South Africa found that one third of late-onset sepsis (LOS) cases in very-low-birthweight (VLBW) infants were caused by multidrug-resistant organisms (MDROs), 41% of which proved fatal, researchers reported yesterday in Open Forum Infectious Diseases.

For the study, a team of US and South African researchers analyzed data on VLBW infants who were admitted to Charlotte Maxeke Academic Hospital in Johannesburg from March 2015 to December 2020. The data collected included demographic and clinical characteristics, length of hospital stay, risk factors for MDRO infection and mortality, and microbiology results.

Of 2,570 VLBW infants admitted during the study period, 869 (34%) were characterized as having LOS, and 287 (33%) LOS cases were caused by an MDRO. Of the infants with LOS caused by an MDRO, 119 (41%) died during their hospitalization. The highest mortality occurred among patients infected with gram-negative bacteria. The pathogens with the highest mortality rates were Acinetobacter spp. (53%), Pseudomonas spp. (45%), extended-spectrum beta-lactamase Klebsiella spp. (43%), and Escherichia coli (42%).

Research efforts should prioritize the development of new antibiotics and should include the neonatal population in the dosing evaluations.

Multivariate logistic regression analysis showed that infants with congenital infections (adjusted odds ratio [aOR], 5.13; 95% confidence interval [CI], 1.19 to 22.02) or history of necrotizing enterocolitis (aOR, 2.17; 95% CI, 1.05 to 4.49) were at significantly higher risk for MDRO infections, likely because of exposure to prolonged antimicrobial therapy during hospitalization.

Serious challenge in developing nations

The study authors say the findings highlight the serious challenge that MDROs pose to neonatal intensive care units in developing countries.

"Antimicrobial stewardship programs, infection control protocols, ongoing surveillance, rapid diagnostic tests, and novel treating agents for MDRO are crucial," they wrote. "Research efforts should prioritize the development of new antibiotics and should include the neonatal population in the dosing evaluations needed for these efforts to impact the MDRO burden among these infants."