Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
Hospitalisation à Domicile (HAD), Hôpital de la Conception, Marseille, France.
Int J Antimicrob Agents. 2020 Dec;56(6):106219. doi: 10.1016/j.ijantimicag.2020.106219. Epub 2020 Nov 13.
This study aimed to report the results of SARS-CoV-2 PCR-based screening campaigns conducted on dependent elderly residents (compared with staff members) in long-term care facilities (LTCFs) in Marseille, France, and the follow-up of positive cases.
Data from 1691 elderly residents and 1000 members of staff were retrospectively collected through interviewing the medical teams in 24 LTCFs and using the hospitals' electronic health recording systems.
Elderly residents were predominantly female (64.8%) with a mean age of 83.0 years. SARS-CoV-2 detection among residents (226, 13.4%) was significantly higher than among staff members (87, 8.7%) (P < 0.001). Of the 226 infected residents, 37 (16.4%) were detected on a case-by-case basis due to their COVID-19 symptoms and 189 (83.6%) were detected through mass screening. Most (77.0%) had possible COVID-19 symptoms, including respiratory symptoms and signs (44.5%) and fever (46.5%); 23.0% were asymptomatic. A total of 116 (51.4%) patients received a course of oral hydroxychloroquine and azithromycin (HCQ-AZM) for ≥ 3 days; 47 (20.8%) died. Through multivariate analysis, the death rate was positively associated with being male (30.7% vs. 14.0%, OR = 3.95, P = 0.002), aged > 85 years (26.1% vs. 15.6%, OR = 2.43, P = 0.041) and receiving oxygen therapy (39.0% vs. 12.9%, OR = 5.16, P < 0.001) and negatively associated with being diagnosed through mass screening (16.9% vs. 40.5%, OR = 0.20, P= 0.001) and receiving HCQ-AZM treatment ≥ 3 days (15.5% vs. 26.4%, OR = 0.37, P = 0.02).
The high proportion of asymptomatic COVID-19 patients and independent factors for mortality suggest that early diagnosis and treatment of COVID-19 patients in LTCFs may be effective in saving lives.
本研究旨在报告在法国马赛的长期护理机构（LTCF）中对依赖型老年居民（与工作人员相比）进行的基于 SARS-CoV-2 PCR 的筛查活动的结果，并对阳性病例进行随访。
通过对 24 家 LTCF 的医疗团队进行访谈，并使用医院的电子健康记录系统，回顾性收集了 1691 名老年居民和 1000 名工作人员的数据。
老年居民主要为女性（64.8%），平均年龄为 83.0 岁。居民中 SARS-CoV-2 的检出率（226 例，13.4%）明显高于工作人员（87 例，8.7%）（P < 0.001）。在 226 例感染居民中，37 例（16.4%）因 COVID-19 症状而进行了个案检测，189 例（83.6%）通过大规模筛查检测到。大多数（77.0%）有 COVID-19 症状，包括呼吸道症状和体征（44.5%）和发热（46.5%）；23.0%无症状。共有 116 例（51.4%）患者接受了≥3 天的羟氯喹和阿奇霉素（HCQ-AZM）口服疗程；47 例（20.8%）死亡。通过多变量分析，死亡率与男性（30.7% vs. 14.0%，OR = 3.95，P = 0.002）、年龄>85 岁（26.1% vs. 15.6%，OR = 2.43，P = 0.041）和接受氧疗（39.0% vs. 12.9%，OR = 5.16，P < 0.001）呈正相关，与通过大规模筛查诊断（16.9% vs. 40.5%，OR = 0.20，P = 0.001）和接受 HCQ-AZM 治疗≥3 天（15.5% vs. 26.4%，OR = 0.37，P = 0.02）呈负相关。
COVID-19 无症状患者比例较高，且独立死亡因素提示，在 LTCF 中早期诊断和治疗 COVID-19 患者可能有助于挽救生命。
