Daily Ards Research Analysis
Analyzed 2 papers and selected 3 impactful papers.
Summary
Analyzed 2 papers and selected 3 impactful articles.
Selected Articles
1. Clostridioides difficile infection in patients with COVID-19 pneumonia - Analysis of occurrence and genetic distribution from three intensive care units.
Retrospective ICU cohort (n=343) of COVID-19 pneumonia patients found diarrhoea in 63.8% and CDI in 2.3% (8 patients); whole-genome sequencing provided superior resolution versus HMW-typing and revealed no evidence of patient-to-patient transmission.
Impact: Provides practical epidemiologic data on CDI frequency in ICU COVID-19 patients and demonstrates the added value of WGS for transmission investigation, informing infection control strategies.
Clinical Implications: Low CDI incidence suggests that routine CDI incidence did not markedly increase in these ICUs during the pandemic; adoption of WGS for outbreak/ transmission assessment can improve infection control decision-making.
Key Findings
- Among 343 ICU patients with COVID-19 pneumonia, diarrhoea occurred in 63.8% and CDI was diagnosed in 8 patients (2.3%).
- Whole-genome sequencing provided higher resolution than HMW-typing for evaluating possible transmission.
- No genomic evidence of patient-to-patient transmission of C. difficile was detected across the three ICUs.
Methodological Strengths
- ICU-wide retrospective dataset covering the first pandemic waves (14 March 2020–31 July 2021).
- Use of whole-genome sequencing (WGS) for high-resolution assessment of transmission.
Limitations
- Retrospective design with potential for missing data and limited control of confounders.
- Small absolute number of CDI cases (n=8) limits statistical power and generalizability.
Future Directions: Prospective multicenter surveillance using WGS to monitor CDI during pandemic conditions, and studies linking antibiotic exposures, infection control practices, and CDI risk in ICU COVID-19 populations.
BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic challenged several of the well-known routines to prevent Clostridioides difficile infection (CDI) in intensive care units (ICUs). There are limited data evaluating CDI in ICU patients with COVID-19 pneumonia and acute respiratory distress syndrome. The objective of this study was to determine the occurrence of CDI and possible transmission of C. difficile within three ICUs in patients with COVID-19 pneumonia.
METHODS: A retrospective analysis was conducted on all patients with confirmed COVID-19 pneumonia treated in the ICU between 14 March 2020 and 31 July 2021. All patients were assessed for the presence of diarrhoea, as well as for positive C. difficile antigen analysis. C. difficile isolates underwent high molecular weight (HMW) typing and whole genome sequencing (WGS) for the assessment of transmission.
RESULTS: A total of 343 patients were treated in the ICUs during the study period. Diarrhoea was observed in 219 (63.8%) patients, and 8 patients (2.3%) were diagnosed with CDI. No evidence of transmission between patients was seen.
CONCLUSION: This study reveals a low occurrence of CDI in ICU patients with COVID-19 pneumonia. WGS was superior to HMW-typing in evaluating potential transmission.
2. [Impact of antenatal corticosteroids on respiratory morbidities in late preterm infants born to mothers with gestational diabetes mellitus].
Retrospective review of 1,420 late preterm infants born to mothers with GDM found that antenatal corticosteroids did not reduce RDS incidence but were protective against TTN and the need for mechanical ventilation within 24 hours; a full ACS course and >7-day interval from first dose to delivery were most beneficial.
Impact: Large sample retrospective cohort provides actionable perinatal data for a high-risk subgroup (late preterm infants of GDM mothers) and identifies ACS timing/complete course as modifiers of early respiratory outcomes.
Clinical Implications: Supports consideration of ACS in selected late preterm deliveries to reduce TTN and early ventilatory support in infants of mothers with GDM, emphasizing complete course and attention to dosing-to-delivery interval; however RDS prevention is not supported.
Key Findings
- Among 1,420 late preterm infants born to mothers with GDM, ACS administration was associated with reduced need for mechanical ventilation within 24 hours after birth.
- ACS did not reduce the incidence of respiratory distress syndrome (RDS) in this population.
- A complete ACS course and an interval greater than 7 days from first dose to delivery provided the greatest reduction in TTN and early postnatal ventilation.
Methodological Strengths
- Large sample size (n=1,420) covering 2017–2023 at a single tertiary center.
- Use of multivariable logistic regression to adjust for confounders.
Limitations
- Retrospective single-center design with potential residual confounding and selection bias.
- Details on steroid regimen and neonatal clinical management (beyond ventilation within 24h) may be incompletely reported in abstract.
Future Directions: Prospective or randomized studies stratifying by glycemic control, steroid regimen, and timing-to-delivery interval are needed to confirm benefits and optimize protocols for ACS use in late preterm infants of GDM mothers.
OBJECTIVES: To investigate the effect of antenatal corticosteroids (ACS) on the risk of transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) within 24 hours after birth in late preterm infants born to mothers with gestational diabetes mellitus (GDM). METHODS: Clinical data of mothers with GDM and their late preterm infants admitted to the Department of Obstetrics, Xiamen Maternal and Child Health Hospital, from January 2017 to December 2023 were retrospectively reviewed. Based on whether mechanical ventilation was required within 24 hours after birth, infants were classified into a mechanical ventilation group ( RESULTS: A total of 1 420 infants were included. Multivariable logistic regression showed that ACS administration was a protective factor against the need for mechanical ventilation within 24 hours after birth ( CONCLUSIONS: ACS does not reduce the incidence of RDS in late preterm infants of mothers with GDM, but it effectively reduces TTN and the need for mechanical ventilation within 24 hours after birth. A complete ACS course and an interval of >7 days from the first dose to delivery provide the greatest benefit in reducing TTN and early postnatal mechanical ventilation.
3. [Impact of antenatal corticosteroids on respiratory morbidities in late preterm infants born to mothers with gestational diabetes mellitus].
Retrospective review of 1,420 late preterm infants born to mothers with GDM found that antenatal corticosteroids did not reduce RDS incidence but were protective against TTN and the need for mechanical ventilation within 24 hours; a full ACS course and >7-day interval from first dose to delivery were most beneficial.
Impact: Large sample retrospective cohort provides actionable perinatal data for a high-risk subgroup (late preterm infants of GDM mothers) and identifies ACS timing/complete course as modifiers of early respiratory outcomes.
Clinical Implications: Supports consideration of ACS in selected late preterm deliveries to reduce TTN and early ventilatory support in infants of mothers with GDM, emphasizing complete course and attention to dosing-to-delivery interval; however RDS prevention is not supported.
Key Findings
- Among 1,420 late preterm infants born to mothers with GDM, ACS administration was associated with reduced need for mechanical ventilation within 24 hours after birth.
- ACS did not reduce the incidence of respiratory distress syndrome (RDS) in this population.
- A complete ACS course and an interval greater than 7 days from first dose to delivery provided the greatest reduction in TTN and early postnatal ventilation.
Methodological Strengths
- Large sample size (n=1,420) covering 2017–2023 at a single tertiary center.
- Use of multivariable logistic regression to adjust for confounders.
Limitations
- Retrospective single-center design with potential residual confounding and selection bias.
- Details on steroid regimen and neonatal clinical management (beyond ventilation within 24h) may be incompletely reported in abstract.
Future Directions: Prospective or randomized studies stratifying by glycemic control, steroid regimen, and timing-to-delivery interval are needed to confirm benefits and optimize protocols for ACS use in late preterm infants of GDM mothers.
OBJECTIVES: To investigate the effect of antenatal corticosteroids (ACS) on the risk of transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) within 24 hours after birth in late preterm infants born to mothers with gestational diabetes mellitus (GDM). METHODS: Clinical data of mothers with GDM and their late preterm infants admitted to the Department of Obstetrics, Xiamen Maternal and Child Health Hospital, from January 2017 to December 2023 were retrospectively reviewed. Based on whether mechanical ventilation was required within 24 hours after birth, infants were classified into a mechanical ventilation group ( RESULTS: A total of 1 420 infants were included. Multivariable logistic regression showed that ACS administration was a protective factor against the need for mechanical ventilation within 24 hours after birth ( CONCLUSIONS: ACS does not reduce the incidence of RDS in late preterm infants of mothers with GDM, but it effectively reduces TTN and the need for mechanical ventilation within 24 hours after birth. A complete ACS course and an interval of >7 days from the first dose to delivery provide the greatest benefit in reducing TTN and early postnatal mechanical ventilation.