Androgen suppression not tied to better COVID-19 outcomes in men
A randomized controlled trial found that suppressing androgen hormones in male COVID-19 patients hospitalized with the virus did not improve outcomes. The study was published yesterday in JAMA Network Open.
The data come from the Hormonal Intervention for the Treatment in Veterans With COVID-19 Requiring Hospitalization (HITCH) phase 2 trial, which was conducted at 14 Department of Veterans Affairs hospitals from Jul 22, 2020, to Apr 8, 2021. A total of 96 men were included in the phase 2 trial, which compared the efficacy of degarelix—a hormone-based chemotherapy used to treat prostate cancer—plus standard care to the effect of placebo plus standard care.
Degarelix has a rapid effect on circulating testosterone, reducing the hormone within 48 hours. Researchers hypothesized that medical castration would limit COVID-19 mortality. Mouse studies suggested medical castration reduced viral severity.
However, "There was no statistically significant difference between groups for the primary composite end point. At 15 days after randomization, 19 veterans (30.6%) in the degarelix group were either still hospitalized, had died, or required mechanical ventilation, compared with 9 veterans (26.5%) in the placebo group," the authors said.
The study was stopped for futility.
Eleven veterans (17.7%) in the degarelix group and 6 veterans (17.6%) in the placebo group died before discharge. Fifteen veterans (24.2%) in the degarelix group, compared with 7 veterans (20.6%) in the placebo group required mechanical ventilation.
Apr 19 JAMA Netw Open study
Five groups issue guidance for preventing catheter-related infections
Updated practical guidance from five large US healthcare organizations published yesterday in Infection Control and Hospital Epidemiology highlights practices for preventing central line–associated bloodstream infections (CLABSIs) in hospitals that include detailed infection-control steps in inserting catheters and a caution against the routine use of preventive antibiotics.
The recommendations come from efforts of more than 100 global experts. The guidance was produced by Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission.
The previous version was published in 2014.
"Data show that despite the heroic and unceasing efforts of infection prevention teams and frontline workers during the past two years, the rates of CLABSIs and several other healthcare-associated infections have substantially worsened during the COVID-19 pandemic, reversing years of progressive improvement," said Deborah Yokoe, MD, MPH, chair of SHEA's efforts to prevent healthcare-associated infections in acute-care hospitals, in a SHEA news release. "These infections seriously threaten patients' lives and recovery, and the rising rates are further evidence for the need to build more resilient systems of care."
Some highlights of the guidance include advice that the subclavian vein is now preferred for central venous catheter insertion in intensive care unit patients, and chlorhexidine-containing dressings are now considered an "essential practice" in patients older than 2 months. The experts recommend against using antimicrobial prophylaxis for short-term or tunneled catheter insertion or while catheters are in situ.
Apr 19 Infect Control Hosp Epidemiol guidance
Apr 19 SHEA news release
Israel examining 12 unexplained pediatric hepatitis cases
In the wake of unexplained hepatitis cases reported in young children by a number of countries, Israel's Ministry of Health (MOH) said yesterday on Twitter that a request for information to hospitals has turned up 12 cases in recent months.
It said the 12 cases that fit the definition and are under investigation are from two hospitals—Shaare Zedek Medical Center and Schneider Children's Medical Center.
The children are under the age of 5, came from various parts of the country, and aren't from any specific ethnic or religious group, according to the Jerusalem Post. Two involved transplants of liver lobes, which occurred a year ago.
Clusters of acute hepatitis in young kids, some of whom needed liver transplants, were reported recently by the United Kingdom, and since then similar cases have been reported in other countries, including the United States in Alabama. Scientists suspect an infectious cause. Adenovirus has been detected in several cases, and some had active or recent COVID-19 infections.
Apr 19 Israel MOH tweet
Apr 20 Jerusalem Post story
Apr 15 CIDRAP News story
Apr 19 CIDRAP News scan