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Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study.
PLoS One. 2018; 13(11):e0206831.Plos

Abstract

BACKGROUND

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes.

AIM

We aimed to describe the clinical course and functional outcomes of critically ill healthcare workers (HCWs) with MERS.

METHODS

Data on HCWs was extracted from a multi-center retrospective cohort study on 330 critically ill patients with MERS admitted between (9/2012-9/2015). Baseline demographics, interventions and outcomes were recorded and compared between survivors and non-survivors. Survivors were approached with questionnaires to elucidate their functional outcomes using Karnofsky Performance Status Scale.

FINDINGS

Thirty-Two HCWs met the inclusion criteria. Comorbidities were recorded in 34% (11/32) HCW. Death resulted in 8/32 (25%) HCWs including all 5 HCWs with chronic renal impairment at baseline. Non-surviving HCW had lower PaO2/FiO2 ratios 63.5 (57, 116.2) vs 148 (84, 194.3), p = 0.043, and received more ECMO therapy compared to survivors, 9/32 (28%) vs 4/24 (16.7%) respectively (p = 0.02).Thirteen of the surviving (13/24) HCWs responded to the questionnaire. Two HCWs confirmed functional limitations. Median number of days from hospital discharge until the questionnaires were filled was 580 (95% CI 568, 723.5) days.

CONCLUSION

Approximately 10% of critically ill patients with MERS were HCWs. Hospital mortality rate was substantial (25%). Patients with chronic renal impairment represented a particularly high-risk group that should receive extra caution during suspected or confirmed MERS cases clinical care assignment and during outbreaks. Long-term repercussions of critical illness due to MERS on HCWs in particular, and patients in general, remain unknown and should be investigated in larger studies.

Authors+Show Affiliations

Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada, Department of Medicine, Division of Infectious Diseases, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia.Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.Department of Infection Prevention and Control, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.Department of Intensive Care, Alfaisal University, Dr Sulaiman Al-Habib Group Hospitals, Riyadh, Saudi Arabia.Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.Department of Critical Care, King Fahad Hospital, Ohoud Hospital, Al-Madinah Al-Monawarah, Saudi Arabia.Department of Medicine, Alfaisal University, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.Department of Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia.Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia.Department of Medicine, Alfaisal University, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia.Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.Intensive Care Department, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia.Department of Family and Community Medicine, King Abdulaziz University Hospital, Ministry of Health, Jeddah, Saudi Arabia.Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia.Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia.Department of intensive care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.Department of intensive care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.Department of intensive care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.Infectious Diseases Data Observatory, Oxford University, Headiington, United Kingdom.Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.Department of Medicine, Division of Infectious Diseases and International Health University of Virginia School of Medicine, Charlottesville, Virginia, United States of America.Department of intensive care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

30439974

Citation

Shalhoub, Sarah, et al. "Critically Ill Healthcare Workers With the Middle East Respiratory Syndrome (MERS): a Multicenter Study." PloS One, vol. 13, no. 11, 2018, pp. e0206831.
Shalhoub S, Al-Hameed F, Mandourah Y, et al. Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study. PLoS ONE. 2018;13(11):e0206831.
Shalhoub, S., Al-Hameed, F., Mandourah, Y., Balkhy, H. H., Al-Omari, A., Al Mekhlafi, G. A., Kharaba, A., Alraddadi, B., Almotairi, A., Al Khatib, K., Abdulmomen, A., Qushmaq, I., Mady, A., Solaiman, O., Al-Aithan, A. M., Al-Raddadi, R., Ragab, A., Al Harthy, A., Al Qasim, E., ... Arabi, Y. M. (2018). Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study. PloS One, 13(11), e0206831. https://doi.org/10.1371/journal.pone.0206831
Shalhoub S, et al. Critically Ill Healthcare Workers With the Middle East Respiratory Syndrome (MERS): a Multicenter Study. PLoS ONE. 2018;13(11):e0206831. PubMed PMID: 30439974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study. AU - Shalhoub,Sarah, AU - Al-Hameed,Fahad, AU - Mandourah,Yasser, AU - Balkhy,Hanan H, AU - Al-Omari,Awad, AU - Al Mekhlafi,Ghaleb A, AU - Kharaba,Ayman, AU - Alraddadi,Basem, AU - Almotairi,Abdullah, AU - Al Khatib,Kasim, AU - Abdulmomen,Ahmed, AU - Qushmaq,Ismael, AU - Mady,Ahmed, AU - Solaiman,Othman, AU - Al-Aithan,Abdulsalam M, AU - Al-Raddadi,Rajaa, AU - Ragab,Ahmed, AU - Al Harthy,Abdulrahman, AU - Al Qasim,Eman, AU - Jose,Jesna, AU - Al-Ghamdi,Ghassan, AU - Merson,Laura, AU - Fowler,Robert, AU - Hayden,Frederick G, AU - Arabi,Yaseen M, Y1 - 2018/11/15/ PY - 2018/02/17/received PY - 2018/10/19/accepted PY - 2018/11/16/entrez PY - 2018/11/16/pubmed PY - 2019/4/16/medline SP - e0206831 EP - e0206831 JF - PloS one JO - PLoS ONE VL - 13 IS - 11 N2 - BACKGROUND: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes. AIM: We aimed to describe the clinical course and functional outcomes of critically ill healthcare workers (HCWs) with MERS. METHODS: Data on HCWs was extracted from a multi-center retrospective cohort study on 330 critically ill patients with MERS admitted between (9/2012-9/2015). Baseline demographics, interventions and outcomes were recorded and compared between survivors and non-survivors. Survivors were approached with questionnaires to elucidate their functional outcomes using Karnofsky Performance Status Scale. FINDINGS: Thirty-Two HCWs met the inclusion criteria. Comorbidities were recorded in 34% (11/32) HCW. Death resulted in 8/32 (25%) HCWs including all 5 HCWs with chronic renal impairment at baseline. Non-surviving HCW had lower PaO2/FiO2 ratios 63.5 (57, 116.2) vs 148 (84, 194.3), p = 0.043, and received more ECMO therapy compared to survivors, 9/32 (28%) vs 4/24 (16.7%) respectively (p = 0.02).Thirteen of the surviving (13/24) HCWs responded to the questionnaire. Two HCWs confirmed functional limitations. Median number of days from hospital discharge until the questionnaires were filled was 580 (95% CI 568, 723.5) days. CONCLUSION: Approximately 10% of critically ill patients with MERS were HCWs. Hospital mortality rate was substantial (25%). Patients with chronic renal impairment represented a particularly high-risk group that should receive extra caution during suspected or confirmed MERS cases clinical care assignment and during outbreaks. Long-term repercussions of critical illness due to MERS on HCWs in particular, and patients in general, remain unknown and should be investigated in larger studies. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/30439974/Critically_ill_healthcare_workers_with_the_middle_east_respiratory_syndrome__MERS_:_A_multicenter_study_ L2 - http://dx.plos.org/10.1371/journal.pone.0206831 DB - PRIME DP - Unbound Medicine ER -