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.

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.

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.