This study investigates the care provision and the role of infectious disease (ID) specialists during the coronavirus disease-2019 (COVID-19) pandemic. A survey was conducted at German study sites participating in the Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS). Hospitals certified by the German Society of Infectious diseases (DGI) were identified as ID centers. We compared care provision and the involvement of ID specialists between ID and non-ID hospitals. Then we applied a multivariable regression model to analyse how clinical ID care influenced the mortality of COVID-19 patients in the LEOSS cohort. Of the 40 participating hospitals in the study, 35

Critically ill COVID-19 patients are at high risk for venous thromboembolism (VTE), namely deep vein thrombosis (DVT) and/or pulmonary embolism (PE), and death. The optimal anticoagulation strategy in critically ill patients with COVID-19 remains unknown. This study investigated the ante mortem incidence as well as postmortem prevalence of VTE, the factors predictive of VTE, and the impact of changed anticoagulation practice on patient survival. We conducted a consecutive retrospective analysis of postmortem COVID-19 (n = 64) and non-COVID-19 (n = 67) patients, as well as ante mortem COVID-19 (n = 170) patients admitted to the University Medical Center Hamburg-Eppendorf (Hamburg, Germany). Baseline patient characteristics, parameters related to the intensive care unit (ICU) stay, and the clinical and autoptic presence of VTE were evaluated and statistically compared between groups. The occurrence of VTE in critically ill COVID-19 patients is confirmed in both ante mortem (17%) and postmortem (38%) cohorts. Accordingly, comparing the postmortem prevalence of VTE between age- and sex-matched COVID-19 (43%) and non-COVID-19 (0%) cohorts, we found the statistically significant increased prevalence of VTE in critically ill COVID-19 cohorts (p = 0.001). A change in anticoagulation practice was associated with the statistically significant prolongation of survival time (HR: 2.55, [95% CI 1.41–4.61], p = 0.01) and a reduction in VTE occurrence (54% vs. 25%; p = 0.02). In summary, in the autopsy as well as clinical cohort of critically ill patients with COVID-19, we found that VTE was a frequent finding. A change in anticoagulation practice was associated with a statistically significantly prolonged survival time.

Purpose of review This review summarizes infectious diseases involving the small bowel (SB) with a focus on recent literature related to diagnosis and pathophysiology. Recent findings Typical symptom for SB infections is diarrhea, mostly self-limiting. Pathogens include bacteria, viruses, fungi, protozoan parasites, and helminths. Host–pathogen interaction is of special interest in infections with potentially severe or prolonged course. Research uses increasingly enterocyte cell culture systems. SARS-CoV2 can also infect enterocytes via angiotensin converting enzyme 2 (ACE2) receptor and causes gastrointestinal complaints in some patients. Chronic SB infections as tuberculosis, Cytomegalovirus, or Epstein–Barr virus have to be differentiated from Crohn's and other diseases. Severe rare fungal and protozoan parasitic infections can cause relevant morbidity in immunocompromised patients. Soil-transmitted helminthic infections are a special issue in endemic areas. Summary Many infections involve the SB, typically causing mild and self-limiting diarrhea. Symptomatic therapy, hygiene, and isolation are the mainstay of management. However, some patients develop severe or chronic disease. Immunosuppression is a major cause for severe, but also for rare opportunistic systemic infections that can also affect the SB.

The development of new capsules now allows endoscopic diagnosis in all segments of the gastrointestinal tract and comes with new needs for differentiated preparation regimens. Although the literature is steadily increasing, the results of the conducted trials on preparation are sometimes conflicting. The ingestion of simethicone before gastric and small bowel capsule endoscopy for prevention of air bubbles is established. The value of a lavage before small bowel capsule endoscopy (SBCE) is recommended, although not supported by all studies. Ingestion in the morning before the procedure seems useful for the improvement of mucosa visualization. Lavage after swallowing of the capsule seems to improve image quality, and in some studies also diagnostic yield. Prokinetics has been used with first generation capsules to shorten gastric transit time and increase the rate of complete small bowel visualization. With the massively prolonged battery capacity of the new generation small bowel capsules, prokinetics are only necessary in significantly delayed gastric emptying as documented by a real-time viewer. Lavage is crucial for an effective colon capsule or pan-intestinal capsule endoscopy. Mainly high or low volume polyethylene glycol (PEG) is used. Apart from achieving optimal cleanliness, propulsion of the capsule by ingested boosts is required to obtain a complete passage through the colon within the battery lifetime. Boosts with low volume sodium picosulfate (NaP) or diatrizoate (gastrografin) seem most effective, but potentially have more side effects than PEG. Future research is needed for more patient friendly but effective preparations, especially for colon capsule and pan-intestinal capsule endoscopy.

bei unbekanntem Erreger.Die primäre Zielgröße war der mittlere totale SOFA-Score bis Tag 10 (Sequential Organ Failure Assessment).Ergebnisse: Insgesamt wurden 124 Patienten in der Kontroll-und 125 Patienten in der TDM-Gruppe analysiert.Das mittlere Alter betrug 66,2 Jahre, 74,3 % der Patienten hatten einen septischen Schock.Es zeigte sich kein Unterschied im mittleren SOFA-Score zwischen den beiden Gruppen ( TDM 7,9 Punkte vs. kein TDM 8,2, ∆ SOFA = 0,3, 95 % CI 0,4-1,0, p = 0,39).Auch zeigte sich kein Unterschied in den weiteren sekundären Endpunkten, inkl.28-Tage Sterblichkeit ( TDM 21,6 % vs. kein TDM 25,8 %, p = 0,44).Das PK/ PD-Ziel wurde häufiger in der TDM-Gruppe erreicht.Bereinigt um den Schweregrad der Erkrankung war die an Tag 1 nach Randomisierung gemessene Piperacillin-Konzentration mit der Sterblichkeit an Tag 28 assoziiert.Die Sterblichkeit war bei Patienten mit einer Konzentration von >96 mg/L (35/104) signifikant höher als bei einer Konzentration von 32-64 mg/L (4/48) (33,7 % vs. 8,3 %, OR 4,21, 95 % CI 1,42-12,48, p = 0,01) bzw.64-96 mg/L (12/61) (33,7 % vs. 19,7 %, OR 2,53, 95 % CI 1,10-5,81, p = 0,03).Die Sterblichkeit war ebenfalls höher bei einer Piperacillin-Konzentration von <32 mg/l (4/26) als bei einer Konzentration von 32-64 mg/L (15,4 % vs. 8,3 %, OR 1,84, 95 % CI 0,38-8,81, p = 0,45).

BACKGROUND:There are large uncertainties with regard to the outcome of patients with coronavirus disease 2019 (COVID-19) and mechanical ventilation (MV). High mortality (50-97%) was proposed by some groups, leading to considerable uncertainties with regard to outcomes of critically ill patients with COVID-19. OBJECTIVES:The aim was to investigate the characteristics and outcomes of critically ill patients with COVID-19 requiring intensive care unit (ICU) admission and MV. METHODS:A multicentre retrospective observational cohort study at 15 hospitals in Hamburg, Germany, was performed. Critically ill adult patients with COVID-19 who completed their ICU stay between February and June 2020 were included. Patient demographics, severity of illness, and ICU course were retrospectively evaluated. RESULTS:A total of 223 critically ill patients with COVID-19 were included. The majority, 73% (n = 163), were men; the median age was 69 (interquartile range = 58-77.5) years, with 68% (n = 151) patients having at least one chronic medical condition. Their Sequential Organ Failure Assessment score was a median of 5 (3-9) points on admission. Overall, 167 (75%) patients needed MV. Noninvasive ventilation and high-flow nasal cannula were used in 31 (14%) and 26 (12%) patients, respectively. Subsequent MV, due to noninvasive ventilation/high-flow nasal cannula therapy failure, was necessary in 46 (81%) patients. Renal replacement therapy was initiated in 33% (n = 72) of patients, and owing to severe respiratory failure, extracorporeal membrane oxygenation was necessary in 9% (n = 20) of patients. Experimental antiviral therapy was used in 9% (n = 21) of patients. Complications during the ICU stay were as follows: septic shock (40%, n = 90), heart failure (8%, n = 17), and pulmonary embolism (6%, n = 14). The length of ICU stay was a median of 13 days (5-24), and the duration of MV was 15 days (8-25). The ICU mortality was 35% (n = 78) and 44% (n = 74) among mechanically ventilated patients. CONCLUSION:In this multicentre observational study of 223 critically ill patients with COVID-19, the survival to ICU discharge was 65%, and it was 56% among patients requiring MV. Patients showed high rate of septic complications during their ICU stay.

AIM:To evaluate the ability of PillCamColon2 to visualize colonic segments missed by incomplete optical colonoscopy (OC) and to assess the diagnostic yield.METHODS:This prospective multicentre study included 81 patients from nine centres who underwent second-generation colon capsule endoscopy (CCE) following incomplete OC performed by an experienced gastroenterologist (> 1000 colonoscopies). Patients with stenosis were excluded. According to patient preferences, CCE was performed the following day (protocol A) after staying on clear liquids and 0.75 L Moviprep in the morning or within 30 d after new split-dose Moviprep (protocol B). Boosts consisted of 0.75 L and 0.25 L Moviprep, and phospho-soda was given as a rescue if the capsule was not excreted after seven hours.RESULTS:Seventy-four patients were analysed (51% of them in group A; 49% in group B). Bowel cleansing was adequate in 67% of cases, and CCE could visualize colonic segments missed by incomplete colonoscopy in 90% of patients under protocol A and 97% of patients under protocol B (P = 0.35, n.s.). Significant polyps including adenocarcinoma were detected in 24% of cases. Detection rates for all polyps and significant polyps per patient were similar in both protocols. Polyps were found predominantly in the right colon (86%) in segments that were not reached by OC. Extracolonic findings - such as reflux esophagitis, suspected Barrett esophagus, upper GI-bleeding, gastric polyps, gastric erosions and angiectasia - were detected in eight patients. PillCamColon2 capsule was retained in the ileum of one patient (1.4%) without symptoms and removed during an uneventful resection for unknown Crohn's disease that was diagnosed as the cause of anemia, which was the indication for colonoscopy. CCE was well tolerated. One patient suffered from self-limiting vomiting after consuming the phospho-soda.CONCLUSION:Second-generation CCE using a low-volume preparation is useful after incomplete OC, and it allows for the detection of additional relevant findings, but cleansing efficiency could be improved.

Colonoscopy is the gold standard for colorectal diseases but may be incomplete e.g. in redundant colon, severe inflammation or intolerance to sedation. PillCam Colon1 has been used to complement colonoscopy, low volume lavage (2 x 1 liter Moviprep) has been reported effective for colon capsule endoscopy (CCE). We report data from a prospective multi-center study using CCE with PillCam Colon2 after incomplete colonoscopy. Primary endpoint of this study was the ability of CCE to complement incomplete colonoscopy. Secondary endpoint were cleansing levels after low volume lavage and additional findings with CCE including polyp detection. Patients with incomplete colonoscopy performed by an experienced gastroenterologist and without stenosis were included. CCE was performed either on the day after colonoscopy with additional Moviprep lavage in the morning. Alternatively, CCE was performed within 30 days using new bowel cleansing (Clear liquids day before + split-dose Moviprep). Additional boosts consisted of 0.75 or 0.25 l Moviprep and NaP only as additional rescue boost if capsule was not excreted after 9 hours. According to other studies significant polyps were defined by size (≥ 6 mm) or number (≥ 3). 81 patients were enrolled, 7 patients were excluded due to technical failure (n=1) or non-compliance to preparation protocol (n=6). Finally data of 74 patients (44 female, 30 male, median age 67 years) could be analyzed. CCE visualized missing colonic segments in 95% while complete CCE was achieved in 65%. An additional intention-to-treat analysis of all 81 patients showed a completion rate of 63% and a complementation rate of 91%. In 36/74 patients (49%) polyps were detected, and significant polyps in 28% of all patients, respectively. In 27 of the 36 patients with polyps (75%) the polyps were located in segments not reached by colonoscopy. In one case an adenocarcinoma was diagnosed after detection of a 26 mm cecal polyp. Other findings like erosions or diverticula were seen in 76%. One capsule was retained temporarily in the small bowel. Surgical resection lead to the previously unknown diagnosis of stenosing and fistulating Crohn`s disease. Cleansing levels were adequate in 65% in CCE and in 68% in standard colonoscopy. In our study complementation of incomplete colonoscopy with PillCam Colon2 and Moviprep regimen was in concordance with previous data for PillCam Colon1 and for device assisted colonoscopy, also showing a relevant amount of additional findings. Complementation rates of CCE were high. CCE and colonoscopy had similarly moderate cleansing levels, probably caused by unfavourable anatomy. Nevertheless, CCE showed a high diagnostic yield. Slow transit due to functional stenosis or motility disorder may be a risk factor for incomplete CCE. In conclusion CCE seems to be a safe and beneficial tool after incomplete colonoscopy.