COVID-related hospitalization and impaired lung function strongly predict reduced physical capacity and breathlessness in unvaccinated participants for up to 3 years after infection, but even patients with less severe infections can experience long-term weakness, researchers at Umea University in Sweden report in the Journal of Infection.

The investigators evaluated lung function in 291 participants—35% of whom were hospitalized—3 to 6 months after SARS-CoV-2 infection from April 2020 to May 2021 and conducted follow-up visits for up to 3 years. 

The team used the 1-minute sit-to-stand test to measure physical capacity in 191 participants and the modified Medical Research Council scale to compare breathlessness in 179 patients with that of a reference population. All hospitalized patients were adults, while the non-hospitalized group included patients aged 15 years and older.

Physical capacity improved for up to 2 years

In total, 34.7% of patients were hospitalized and 8.9% of all patients received intensive care. Hospitalized patients were older (58 vs 48 years), had a higher body mass index (BMI) than their non-hospitalized counterparts (29.9 kilograms per square meter vs 24.9), had more chronic conditions, were men rather than women (64% vs 53%), and were more likely to have smoked (37.0% vs 18.0%).

Our findings emphasize that non-hospitalised individuals also experienced reduced physical capacity, highlighting the need for targeted rehabilitation strategies and further research to optimize recovery outcomes across all affected populations.

Physical capacity significantly improved in all participants up to 2 years after diagnosis, then plateaued. Hospitalization and impaired lung function were significantly tied to breathlessness and reduced physical capacity. While non-hospitalized patients' physical capacity improved for up to 2 years, improvement for hospitalized patients plateaued by 6 months.

"Our findings indicate that improvement in physical capacity and breathlessness may continue up to two years post-infection," the study authors wrote. "These results are encouraging, as previous research has shown that even individuals with initially mild disease may experience impaired lung function at the time of infection, with limited recovery observed two years later."

"Our findings emphasize that non-hospitalised individuals also experienced reduced physical capacity, highlighting the need for targeted rehabilitation strategies and further research to optimize recovery outcomes across all affected populations," they concluded.

Boston Children's Hospital and Tulane University have received a $25 million grant from the National Institutes of Health to establish a center that will focus on strategies to prevent infections caused by drug-resistant bacteria.

The Center of Excellence for Translational Research, housed at Boston Children's, will be called IMPACT (Immunization against Multidrug-resistant Pathogens: Activating T Cell Immunity) and will target Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae—three pathogens that are frequently resistant to broad-spectrum antibiotics.

IMPACT researchers aim to define mechanisms of host protection against the three pathogens, focusing primarily on tissue resident memory T cells, and develop non-human primate models for scale-up, toxicity, and immunogenicity studies. The goal is to generate preclinical data that could lead to subsequent clinical trials.

"We hope to gain a better understanding of how immunity in these bacteria can be harnessed to prevent infections," said Richard Malley, MD, a senior physician at Boston Children's, said in a hospital press release. "The lessons learned from these studies could lead to successful interventions against not only the three targeted pathogens but also other existing or future infectious disease threats."

A study of Veterans Affairs (VA) patients found no benefit from treatment of asymptomatic bacteriuria, researchers reported yesterday in Infection Control & Hospital Epidemiology.

The study, conducted at five sites within the VA Midsouth Healthcare Network, analyzed data on urine cultures with bacterial growth collected in the outpatient setting in 2021. The primary outcome of the study was the comparison of urinary tract infection (UTI) incidence at 30 days, 6 months, and 1 year in those untreated versus those treated with antibiotics. 

Although guidelines from the Infectious Diseases Society of America (IDSA) do not recommend treating asymptomatic bacteriuria (ASB), clinicians prescribe antibiotics for ASB in 40% t0 78% of older men.

"Unnecessary antibiotic use (AU) has well-established negative consequences including adverse drug events (ADEs) and increased antimicrobial resistance," VA researchers wrote. "The high rate of inappropriate AU in this disease state creates an area ripe for antimicrobial stewardship intervention."

More than half of ASB cases treated with antibiotics

Of the 988 urine cultures collected, 281 (28.4%) represented ASB. Of these, 154 (54.8%) were treated with antibiotics, and 127 (45.2%) went untreated. The incidence of UTI was 0.6% versus 3.1% at 30 days, 11.7% versus 9.6% at 6 months, and 11.7% versus 11.4% at 12 months in the treated and untreated cohorts, respectively. 

There was no significant difference in admissions for UTI or sepsis from UTI at 30 days between the cohorts. Two patients in the treatment group reported an adverse drug event at 30 days.

The authors say the fact that 28% of urine cultures were collected in the absence of urinary symptoms, and more than half were treated with antibiotics, highlights opportunities for diagnostic and antibiotic stewardship.

"In conclusion, there was no difference in the development of symptomatic UTI in a predominately male veteran population with untreated ASB compared to those treated with antibiotics at 30 days, 6 months, and 1 year," they wrote. "These findings align with the 2019 IDSA ASB guidelines and support avoidance of unnecessary urine screening and antibiotic use in the veteran population."

• The Wisconsin Department of Health Services (WDHS) today announced after its scientific review of the COVID-19 vaccine that Governor Tony Evers has issued a standing order that allows most Wisconsin residents to get the vaccine at pharmacies across the state without a prescription. Officials also recommended the COVID vaccine for anyone ages 6 months and older during the respiratory virus season. The WDHS also said Wisconsin’s Medicaid program will continue to cover the COVID vaccine for eligible members, including children and pregnant women, and that it expects that all health plans regulated by the Wisconsin Office of the Commissioner to cover the vaccine without cost sharing. Several states have announced similar measures to ease access to COVID vaccines following narrowed recommendations from federal health agencies that have created confusion and obstacles to vaccination.
• The first two Ebola virus patients have been released from treatment in the Democratic Republic of the Congo’s (DRC’s) latest outbreak, which is occurring in Kasai province, according to announcements today from Doctors Without Borders (MSF) and the World Health Organization (WHO). On X today, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said the outcome reflects the joint work of the WHO, MSF, the Alliance for International Medical Action (ALIMA), the community, and other health partners.
• Osivax today announced the launch of a phase 2b trial of OVX836, its broad-spectrum influenza A candidate vaccine for pandemic and seasonal flu preparedness. In a statement, the France-based company said the randomized, double-blind, multicenter trial will enroll 2,850 adults ages 18 to 59 years old at 16 sites across Europe. OVX836 targets the nucleoprotein (NP) of the influenza A virus, which is a highly conserved internal antigen and is less likely to mutate, which could provide a broader, more universal immune response. In late August, the company announced it had received a $19.5 million contract from the Biomedical Advanced Research and Development Authority (BARDA), part of the US Department of Health and Human Services (HHS), to develop a broad-spectrum influenza A candidate vaccine.