Omicron hospital illness 54% deadlier than flu hospital cases, study finds

News brief

Adults hospitalized with SARS-CoV-2 Omicron infections in Switzerland died at 1.5 times the rate of those diagnosed as having influenza A or B, shows a multicenter study published yesterday in JAMA Network Open.

A team led by University of Lucerne researchers analyzed surveillance data from a national database on 3,066 COVID-19 Omicron patients admitted to 1 of 14 hospitals from Jan 15 to Mar 15, 2022, and 2,146 flu patients admitted from Jan 1, 2018, to Mar 15, 2022. The team compared rates of 30-day all-cause death and intensive care unit (ICU) admission in the two groups.

Roughly 80% of both groups had underlying medical conditions, but fewer COVID-19 patients reported respiratory comorbidities than those with flu (13.1% vs 24.6%). Among the flu patients, 96.2% had type A, and 3.8% had type B. Of the COVID-19 patients, 51.9% had received at least one vaccine dose, and 25.2% had received three doses. 

COVID not tied to higher ICU rates

A total of 214 COVID-19 patients (7.0%) died in the hospital, compared with 95 flu patients (4.4%). The final adjusted subdistribution hazard ratio (sdHR) for in-hospital COVID-19 death relative to flu was 1.54 (54% higher). Risk factors for death in both groups before versus after ICU admission were older age (median, 85 vs 71 years) and dementia (33 of 160 [22.8%] vs 3 of 54 [5.6%]).

A total of 250 COVID-19 patients (8.6%) were admitted to an ICU, compared with 169 flu patients (8.3%), but after adjustment, the rates were similar (sdHR, 1.08).

Analysis of a subgroup of patients hospitalized primarily for COVID-19 or flu found that the risk of death was 2.5 times higher, and the likelihood of ICU admission was 1.7 times higher, among Omicron than flu patients.

Patients with the SARS-CoV-2 Omicron variant had a higher risk of in-hospital mortality than those with influenza.

"These findings suggest that, despite virus evolution and improved management strategies, patients with the SARS-CoV-2 Omicron variant had a higher risk of in-hospital mortality than those with influenza," the researchers wrote.

Moderna announces plan for no-cost COVID vaccine

News brief

Moderna yesterday announced that it will offer no-cost access to its COVID-19 vaccine for Americans after the government phases out covering them when the Public Health Emergency winds down in May.

In a press release, it said, "Moderna remains committed to ensuring that people in the United States will have access to our COVID-19 vaccines regardless of ability to pay." It said people with insurance will continue to receive them for free at doctor's offices and pharmacies. People without insurance or who are underinsured will receive COVID-19 vaccines at no cost through Moderna's patient assistance program.

On Jan 30, the Biden Administration announced that it would end the public health and national emergencies for COVID-19 on May 11, which comes at a transition time as the United States and the rest of the world moves from the acute phase of the pandemic to a more endemic pattern.

White House officials have said the nation is in a better position and has tools to manage the virus. They noted that ending the emergencies will eventually result in a transition away from the government buying vaccines and treatments toward the regular healthcare market providing them.

Adherence to treatment guidelines may improve candidemia survival rates

News brief

A study of patients with candidemia at hospitals in 20 European countries revealed that adherence to clinical guideline recommendations may improve survival rates, researchers reported yesterday in The Lancet Infectious Diseases.

To assess how adherence to clinical guidelines is associated with outcomes in patients with culture-proven candidemia, researchers with the European Confederation of Medical Mycology (ECMM) Candida III Study Group collected data on the epidemiology, risk factors, treatment, and outcomes of 623 patients treated at 64 participating European hospitals. They assessed guideline adherence using ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores.

The overall mortality rate was 46%, with a 90-day mortality rate of 43%; 37% of deaths were directly attributable to candidemia. Increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent predictors of mortality.

Death rates decline with guideline adherence

After adjustment for baseline risk factors, adherence to clinical guidelines was identified as a major protective factor. With every one point decrease in the EQUAL Candida score (reflecting a decrease in guideline adherence), the risk of death increased by 8% (adjusted hazard ratio [aHR], 1.08; 95% confidence interval [CI], 1.04 to 1.11) for patients with a central venous catheter (CVC) and 9% (aHR, 1.09; 95% CI, 1.05 to 1,13) for patients without a CVC.

Additionally, mortality in patients for whom guideline-recommended diagnostic or therapeutic measures were not performed was higher (51% to 71%) than in the overall cohort (46%). Initial echinocandin treatment was associated with lower overall mortality but also longer hospital stays among survivors than treatment with other antifungals.

"Not-performing or not-completing each diagnostic or therapeutic measure (including initial echinocandin treatment) was associated with increased mortality compared with mortality in the overall cohort, emphasizing the importance of every single guideline recommendation in the successful management of candidaemia," the study authors wrote.

Antibiotics linked to rare, drug-associated skin conditions

News brief

A systematic review and meta-analysis found that antibiotics may be associated with more than a quarter of cases of rare, serious drug reactions that affect the skin and mucous membranes, researchers reported yesterday in JAMA Dermatology.

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are severe-drug-associated reactions that start with flu-like symptoms and progress to a painful rash and blisters on the skin and mucous membranes of the mouth, nose, eyes, and genitals. While SJS/TEN cases are rare (affecting 1 to 10 individuals per million population per year), they are considered the most severe form of drug hypersensitivity reaction, with mortality rate of up to 50%. Antibiotics are among the commonly implicated drugs, but the level of risk associated with antibiotics is not known.

To assess the risk, researchers with the University of Toronto and Vanderbilt University conducted a review and meta-analysis of experimental and observational studies that described SJS/TEN risk factors. The primary outcome was the prevalence of antibiotic-associated SJS/TEN presented as pooled proportions.

The study highlights the importance of using antibiotics judiciously.

Of the 64 studies reviewed, 38 studies with 2,917 patients described patient-level associations. A single drug was associated with 86% (95% confidence interval [CI], 80% to 92%) of all SJS/TEN cases, and 14% were associated with multiple potential drug triggers, unknown drug names, infections, or unknown causes. The pooled proportion of antibiotics associated with SJS/TEN was 28% (95% CI, 24% to 33%), with moderate certainty of evidence. The prevalence of antibiotics triggering drug-associated SJS/TEN was 35% (95% CI, 29% to 40%).

Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% (95% CI, 22% to 44%) of cases, followed by penicillins (22%; 95% CI, 17% to 28%), cephalosporins (11%; 95% CI, 6% to 17%), fluoroquinolones (4%; 95% CI, 1% to 7%), and macrolides (2%; 95% CI, 1% to 5%).

"The study highlights the importance of using antibiotics judiciously and limiting sulfonamide antibiotics to only specific indications and durations, as well as early recognition and prompt discontinuation of the implicated drugs to reduce morbidity and mortality associated with SJS/TEN," the study authors wrote. 

This week's top reads