Objectives: To determine the clinical features, outcomes, and factors associated with the emergence of colistin-resistant gram-negative rods isolated from patients admitted to intensive care units. Methods: This cross-sectional study was conducted at the intensive care units of Liaquat National Hospital, from April 2019 to February 2020. Gram-negative rods resistant to colistin with minimum inhibitory concentrations ⩾ 4 mcg/mL according to Clinical and Laboratory Standards Institute criteria as reported in cultures were included. Clinical, demographical data and treatment given were recorded and analyzed using SPSS version 25. Results: A total of 93 patients were included; 58.1% were males. The mean age of patients was 59.48 ± 18.36 years. The most common organism isolated was Klebsiella pneumoniae (91.4%). The most common specimen was the tracheal (62.4%). Ventilator-acquired pneumonia was seen in 38.7%. The most common co-morbid disease seen in patients was diabetes (41%); 77% had a symptomatic infection and were treated with a combination of 2 or more antibiotics, most commonly meropenem plus fosfomycin. The most common susceptible antibiotics were fosfomycin (72%) and tigecycline (50.5%). Mean intensive care unit stay and total duration of hospital stay were prolonged (16.83 ± 12.93 and 23.34 ± 17.52 days, respectively). Forty-eight (62.3%) patients with symptomatic infection with colistin-resistant isolates were treated and discharged, and mortality was seen in 23 (29.9%). A significant association was found between mortality and symptomatic infection, endotracheal intubation with mechanical ventilation (p = 0.003), and a prolonged hospital stay of >20 days (p = 0.041). Conclusion: Colistin-resistant gram-negative rods pose a significant problem especially in developing countries because of limited therapeutic options. Stringent infection control and comprehensive antimicrobial stewardship programs are needed to overcome this challenge.

Aim: To assess the usefulness of Remdesivir in mild-moderate COVID-19 and its effects on clinical outcomes and mortality. Methodology: This was observational study conducted at Sindh Infectious Diseases Hospital. July 2020 to March 2022. Demographic and clinical data were collected retrospectively from the patient's medical records. Patients > 18 years of age and admitted with confirmed SARS-COV 2 of the mild-moderate category were included. For analysis, patients were divided into two groups to compare those who received Remdesivir plus Standard of Care (SOC) and those receiving only Standard of Care. Outcome variables included progression to severe disease, duration of hospital stay, respiratory support, and mortality. Results: A total of 789 patients were admitted, of which 435 (54.5%) had mild and 363 (45.5%) had moderate COVID-19 infection. Out of these, 46.13% received Remdesivir, while 55% of patients received SOC. The median age of patients in the Remdesivir group was 62 (IQR 50-72) years (p0.05). Patients in the SOC group exhibited a significant risk of disease progression [61(14%) vs23(6.3%), odds ratio (OR):2.425 95% CI: 1.45-4.06, p<0.05]. A significantly longer hospital stay in the SOC group was seen in both mild and moderate disease categories (p<0.05). Conclusion: Remdesivir can be effective in patients with mild to moderate COVID-19 to halt the progression to severe disease and shorten the hospital stay, leading to early recovery and reduced risk of complications. Keywords: Mild-moderate COVID-19, Remdesivir, low-flow oxygen, decreased severity, reduced mortality

Background: Each coronavirus disease 2019 (COVID-19) wave is unique in its clinical presentation and outcome. In this study, we compared the clinical characteristics and outcomes of COVID waves 2–5 in inpatient settings. Methods: A retrospective study was conducted at the Sindh Infectious Diseases Hospital and Research Center on adult patients who were admitted with a positive COVID polymerase chain reaction from July 2020 to March 2022. SPSS 26 was used to analyze the data. Results: A total of 3190 COVID-19 patients were admitted. Wave 2 had the highest percentage of discharges compared with mortality (81%; P = .0001). Cytokine release syndrome was most common in wave 3 (32.7%; P = .0001). Severe COVID on admission was predominant in wave 4 (79.4%; P = .0001), with the highest rates of intubation (27.1%; P = .0001), septic shock (24.3%; P = .0001), and disease progression (50.8%; P = .0001). In wave 5, the majority were elderly (median age, 68 years) and had mild COVID (22.4%; P = .0001), most had comorbidities (84.6%; P = .0001), and the ratio of acute kidney injury was high (29.2%; P = .0001). Mortality was lowest in wave 2 (18.9%; P = .0001) and highest in wave 4 (42.5%; P = .0001; odds ratio, 3.18; 95% CI, 2.6–3.8; compared with wave 2). Conclusions: Each wave had some unique characteristics compared with other waves, with wave 4, driven by the Delta variant, being the deadliest one in terms of disease severity and outcomes.