Objectives: To evaluate the effect of adjunct treatment with Octagam, an intravenous immunoglobulin (IVIG) product, on clinical outcomes and biomarkers in critically ill COVID-19 patients. Methods: Data from a single center was analyzed retrospectively. Patients had received preliminary standard of intensive care (SIC) according to a local treatment algorithm, either alone or along with Octagam 5% at 30 g/day for 5 days. Both groups were compared regarding baseline characteristics, survival, and changes in inflammation markers. Imbalance in baseline APACHE II scores was addressed by propensity score matching. Otherwise, Kaplan-Meier and multiple logistic regression models were used. Results: Out of 93 patients, 51 had received Octagam and 42 had not. About 75% of patients were male and both groups had comparable body mass index and AB0 blood type distribution. Octagam-treated patients were younger (mean 65 ± 15 versus 71 ± 15 years, p = 0.066) and had slightly lower baseline disease scores (APACHE II: 20.6 versus 22.4, p = 0.281; SOFA: 5.0 versus 7.0, p = 0.006). Overall survival was 61% in the SIC + Octagam and 38% in the SIC only group (odds ratio: 2.2, 95% confidence interval: 0.9-5.4, p = 0.091 after controlling for baseline imbalances). Octagam significantly prolonged median survival time (68 versus 18 days, p = 0.014) and significantly reduced plasma levels of C-reactive protein (median change from baseline -71.5 versus -0.3 mg/L, p = 0.049). Conclusion: Clinically relevant benefits through adjunct Octagam treatment in COVID-19 need to be confirmed in a randomized, controlled trial.

Residual paralysis following the use of neuromuscular blocking drugs (NMBDs) without neuromuscular monitoring remains a clinical problem, even when NMBDs are used. This study surveys postoperative residual curarization and critical respiratory events in the recovery room, as well as the clinical approach to PORC of anesthesiologists in our institution. This observational study included 415 patients who received general anesthesia with intermediate-acting NMBDs. Anesthesia was maintained by non-participating anesthesiologists who were blinded to the study. Neuromuscular monitoring was performed upon arrival in the recovery room. A CRE was defined as requiring airway support, peripheral oxygen saturation 20 breaths/min, accessory muscle usage, difficulty with swallowing or speaking, and requiring reintubation. The clinical approach of our anesthesiologists toward reversal agents was examined using an 8-question mini-survey shortly after the study. The incidence of PORC was 43% (n = 179) for TOFR < 0.9, and 15% (n = 61) for TOFR < 0.7. The incidence of TOFR < 0.9 was significantly higher in women, in those with ASA physical status 3, and with anesthesia of short duration (p < 0.05). In addition, 66% (n = 272) of the 415 patients arriving at the recovery room had received neostigmine. A TOFR < 0.9 was found in 46% (n = 126) of the patients receiving neostigmine. When routine objective neuromuscular monitoring is not available, PORC remains a clinical problem despite the use of NMBDs. The timing and optimal antagonism of the neuromuscular blockade, and routine objective neuromuscular monitoring is recommended to enhance patient safety.

The defective interplay between coagulation and inflammation may be the leading cause of intravascular coagulation and organ dysfunction in COVID-19 patients. Abnormal coagulation profiles were reported to be associated with poor outcomes. In this study, we assessed the prognostic values of antithrombin (AT) activity levels and the impact of fresh frozen plasma (FFP) treatment on outcome. Conventional coagulation parameters as well as AT activity levels and outcomes of 104 consecutive critically ill acute respiratory distress syndrome (ARDS) patients with laboratory confirmed COVID-19 disease were retrospectively analyzed. Patients with AT activity below 75% were treated with FFP. Maximum AT activity levels achieved in those patients were recorded. Significantly low levels of admission AT activity were recorded in non-surviving patients (73%). The cutoff level for admission AT activity was 79% and 58% for the lowest AT for survival. The outcome in those patients who had AT activity levels above 75% after FFP treatment was better than the nonresponding group. As well as AT, admission values of d-dimer, C-reactive protein, and procalcitonin were coagulation and inflammatory parameters among the mortality risk factors. AT activity could be used as a prognostic marker for survival and organ failure in COVID-19 associated ARDS patients. Antithrombin supplementation therapy with FFP in patients with COVID-19 induced hypercoagulopathy may improve thrombosis prophylaxis and thus have an impact on survival.

Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear.Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19.Study Design: Multicenter prospective observational clinical study.Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged >= 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated.Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 +/- 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004).Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

Candida auris has emerged as a significant global health threat due to its resistance to multiple antifungal agents and its prominent role in healthcare-associated infections. This study aims to compare the clinical characteristics, risk factors, antifungal resistance profiles, and mortality rates of candidemia caused by C. auris and non-auris Candida spp. (NACS). This retrospective cohort study was conducted at a tertiary care hospital from 2021 to 2024. Patients aged 18 years and older with positive blood cultures for Candida spp. were included. Demographic data, comorbidities, risk factors, mortality rates, and treatment protocols were analyzed. A total of 1,088 candidemia cases were included in the study (C. auris: 126 cases, NACS: 962 cases). The length of hospital stay was significantly longer in the C. auris group compared to the NACS group (50.98 ± 38.79 vs. 33.05 ± 25.57 days, p < 0.001). Independent risk factors for C. auris candidemia included longer hospitalization before candidemia (OR 1.01, 95% CI 1.01-1.02, p < 0.001), chronic obstructive pulmonary disease (OR 1.89, 95% CI 1.07-3.31, p = 0.026), prior antifungal use within 30 days (OR 1.92, 95% CI 1.22-3.03, p = 0.005), and ICU admission (OR 2.08, 95% CI 1.10-3.92, p = 0.023). Antifungal resistance rates among C. auris isolates were 96.49% for fluconazole, 72.81% for amphotericin B, and 25.89% for caspofungin. The 30-day mortality rate was lower in the C. auris group (48.4%) compared to the NACS group (60.2%) (p = 0.012). Although crude 30-day mortality was lower in the C. auris group, adjusted analysis showed comparable 30-day mortality between the C. auris and NACS groups. These findings highlight the increasing clinical burden of C. auris and support accurate species identification, local antifungal susceptibility surveillance, and rigorous infection-control measures. Not applicable.

Central and peripheral nervous system involvement of COVID-19 has been reported in 25% of cases. COVID-19 is associated with encephalitis and most often presenting with confusion and disorientation, and mortality decreases with early diagnosis and treatment.The patient who was admitted with confusion and fever and found COVID-19 PCR positivity in both cerebrospinal fluid (CSF) and the nasopharyngeal swab is presented here. A 71-year-old female patient who underwent transsphenoidal pituitary tumor surgery 4 months ago, was in an acute confusional state with fluctuations in consciousness and agitation. It was suggested that bilateral temporal areas of the brain and paramedian region of the pons compatible with encephalitis in the T2 and FLAIR axial sections of magnetic resonance imaging (MRI). Nasopharyngeal and CSF SARS-CoV-2 RNA PCR was studied since thorax CT was compatible with COVID-19 pneumonia and in both samples, PCR was found positive. Encephalitis for toxic and metabolic causes was excluded. In this case, COVID-19 encephalitis was treated with dual antiviral (favipiravir and acyclovir) and steroid therapy. The uniqueness of this case is not only the presence of a very few reported cases of both Nasopharyngeal and CSF SARS-CoV-2 RNA PCR positivity but also previous history of transsphenoidal pituitary surgery 4 months ago.