“COVID-19 PANDEMÝSÝNDE BAKTERÝYEL, FUNGAL, VÝRAL KAYNAKLI SÜPERENFEKSÝYONLAR” CANLI KONSEYÝNÝN VÝDEO KAYDI-SLAYTLARI HASTA VE SAÐLIK ÇALIÞANI GÜVENLÝÐÝ PLATFORMU, ONLINE TV-SUNU MERKEZÝ’NDE...

Hasta ve Saðlýk Çalýþaný Güvenliði Platformu (www.hscgp.org)’nda konuþmacýlarýmýz Prof. Dr. Serhat ÜNAL, Prof. Dr. Alpay AZAP ve Prof. Dr. Zeynep Ceren KARAHAN TÜRKÝYE’den, Dr. Patrick MURRAY’nin ise AMERÝKA BÝRLEÞÝK DEVLETLERÝ’nden online olarak kendi bilgisayarlarýyla BÝLÝMSEL BÝLÝÞÝM CANLI KONSEY MODÜLÜ’ne baðlanarak gerçekleþtirdikleri “COVID-19 Pandemisinde Bakteriyel, Fungal, Viral Kaynaklý Süperenfeksiyonlar” Canlý Konseyimiz 23 Haziran 2020 Salý günü yapýldý.

Çift yönlü simultane çevirili olarak gerçekleþen konseyi dileyen izleyicilerimiz Türkçe, dileyen izleyicilerimiz ise Ýngilizce olarak izlediler.

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Canlý Konsey sýrasýnda izleyiciler tarafýndan sorulanlara Dr. Patrick MURRAY’nin  verdiði yanýtlar aþaðýdadýr.

Question: When we go to the urban for screening, are we going to refer every patient to the hospital with a fever to test? Because even if it's a simple viral upper respiratory tract infection, it feels like we can't be sure 100%?
Answer: COVID-19 complicates the workup of patients with fever. It would be impractical to refer all patients to the hospital, which would not be able to handle the increased volume of patients. I believe the decision to send a patient to the hospital has to be made by carefully accessing the patient's condition. If the patient is critically ill on presentation or is deteriorating, these patients would always be referred to the hospital. In this situation, the collection of a proper blood culture and other diagnostic tests as appropriate, and the use of broad-spectrum empiric antibiotics should be done quickly.

Question: While co-infetion in both Spanish flu and swine flu is significantly high, in covid-19 it is not so high, can only the diagnostic method deficiencies be attributed or is that a specific effect of the disease?
Answer: Influenza viruses infect and damage ciliated epithelial cells which normally protect individuals from aspiration of oral secretions. SAR-CoV-2 virus infects globlet cells. So the physiologic damage caused by the viruses would favor pulmonary co-infections with influenza virus. However, in both patient populations, the use of mechanical ventilation is widespread and this puts patients at increased risk. In the situation of co-infections in influenza patients, Streptococcus pneumoniae and Staphylococcus aureus are the most common pathogens. In the case of SARS-CoV-2, patients are in the hospital for a week or more before mechanical ventilation is used, which increases their risk for infections with hospital-acquired pathogens such as multidrug resistant gram-negative rods.

Question: September comes, when other flu infections, influenza and so on appear, there will be more fear. So how to separate them from each other?
Answer: Clinical signs and symptoms will not reliably separate these infections which is why diagnostic companies are working very hard to develop rapid, point-of-care assays that can identify the most common respiratory pathogens.

Question: Especially in Europe, there is an increase in super infection due to the overuse of antibiotics during this period?
Answer: I actually do not think the overuse of antibiotics increase the risk of infections. In many cases these antibiotics will reduce the number of infected individuals. However, use of antibiotics come with well-defined problems. Antibiotics can select for infections with organisms resistant to the antibiotics so the use of antibiotics increases the difficulties in treating these infections as well as fosters the spread of resistant organisms in the hospital. Additionally, all antibiotics are toxic, at least to the patient's microbial population that is necessary to maintain health. For these reasons, it is important to use diagnostics to limit the use of antibiotics by provide a rapid, specific diagnosis of the pathogen and guidance for the appropriate antibiotics to be used for treatment.

Question: Should we include COVID-19 PCR to preop teting?
Answer: In many US hospitals COVID-19 PCR testing has been added to the preop testing protocols in order to protect the healthcare workers and minimize complications for the patients.

Question: When compared to the early stages of the disease, the number of cases and intensive care treatments in all countries appears to have decreased. What do you see as the cause of the positive progress here? Is it also likely that the numbers will increase dramatically with the autumn season?
Answer: We have learned a great deal about the pathogenesis of COVID-19 and how to best manage patients. Placing patients on respirators frequently caused complications including secondary infections so this approach to managing the patients have been modified. Additionally, most of the early deaths were in the elderly and patients with other risk factors. In the US, 40% of the deaths occurred in nursing homes. We are seeing a shifting to infections in younger populations and with that a decrease in serious complications. I do not believe the clinical improvements were are seeing is due to decreased virulence of SARS-CoV-2 or availability of antivirals. I also believe we will see infections increase (already occurring in many countries) and serious complications including death increase until effective antivirals are available to treat patients and vaccines are available to prevent the spread of this virus.

 

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