ABSTRACTThis retrospective cohort study investigated whether Paxlovid (nirmatrelvir/ritonavir) use during the acute phase of mild‐to‐moderate COVID‐19 reduces the risk of ischemic or hemorrhagic stroke occurring more than 3 months post‐diagnosis, a condition classified as long COVID. Utilizing TriNetX electronic health records comprising 118 million patients in the United States, adults aged 18 years or older with confirmed COVID‐19 diagnoses from 2022 to 2023 were categorized into Paxlovid (administered within 5 days of diagnosis) and non‐Paxlovid groups. Exclusion criteria included prior cerebrovascular disease, mortality within 3 months, use of specific antivirals, and severe clinical conditions such as ICU admission, intubation, mechanical support, SpO₂ < 90%, respiratory rate > 30/min, sepsis, systemic inflammatory response syndrome, and acute respiratory distress syndrome. The index date was the initial COVID‐19 diagnosis. Propensity score matching in a 1:1 ratio controlled for confounding factors, and stroke (ischemic or hemorrhagic) and mortality were analyzed using Kaplan–Meier survival curves and Cox proportional hazards models. Among 181 992 matched pairs, Paxlovid use was associated with a significantly reduced risk of ischemic and hemorrhagic stroke (hazard ratio [HR] 0.85; 95% confidence interval [CI]: 0.80–0.89) and all‐cause mortality (HR 0.68; 95% CI: 0.63–0.73) during the long COVID period, defined as more than 90 days post‐diagnosis. Subgroup analyses demonstrated consistent protective effects across age, sex, BMI, comorbidities such as hypertension, diabetes, and hyperlipidemia, and vaccination status. Notably, older adults (HR 0.81; 95% CI: 0.76–0.86) and individuals with metabolic conditions, including obesity (HR 0.86; 95% CI: 0.78–0.96), exhibited pronounced benefits, and the protective effects were observed irrespective of vaccination status. These findings highlight that Paxlovid use during the acute phase of COVID‐19 significantly reduces the risk of long‐term cerebrovascular events and mortality, emphasizing its critical role in mitigating long‐term complications associated with COVID‐19.

01 Mar 2025·Pediatric Infectious Disease Journal

Antiviral Treatment and Risk of Hearing Loss in Asymptomatic and Mild Symptomatic Infants With Congenital Cytomegalovirus

Article

Author: Fortuny-Guasch, Claudia ; Lombardi, Giuseppina ; Moliner, Elisenda ; Syridou, Garyfallia ; Couceiro, Jose A. ; Lyall, Hermione ; de Vergas, Joaquín ; Frick, Marie Antoinette ; Rodríguez-Molino, Paula ; Karagiannidou, Sofia ; Blázquez-Gamero, Daniel ; Baquero-Artigao, Fernando ; Gkentzi, Despoina ; Payne, Helen ; Saavedra-Lozano, Jesús ; Bringué, Xavier ; Sánchez-Mateos, Miguel ; Pedrero-Tomé, Roberto ; Soler-Palacín, Pere ; Villaverde, Serena ; Rojo, Pablo ; Muga, Oihana ; Rios-Barnés, Maria ; Tagarro, Alfredo ; Colino, Elena ; Papaevangelou, Vassiliki ; Castells, Laura ; Vives-Oños, Isabel

Background:To assess hearing outcomes at 24 months of age in infants with mild congenital cytomegalovirus (cCMV) infection, depending on whether they have received antiviral treatment or not.Methods:A retrospective study within the European Registry of Children with cCMV was performed. Included children had cCMV diagnosed in utero/in the first 21 days of life, with normal physical examination, alanine aminotransferase <80 U/L and platelets >100,000 cs/mm3 and absence of hearing loss (HL) at birth. Cranial ultrasound (cUS) and/or cranial magnetic resonance imaging was normal or with minor findings (isolated lenticulostriate vasculopathy and/or germinolysis/caudothalamic or subependymal cysts, and/or focal/multifocal white matter involvement). The main outcome was the presence of HL at 24 months of age.Results:One hundred ninety-six patients met inclusion criteria. A total of 34.7% received antiviral treatment with valganciclovir/ganciclovir. Children treated had lower gestational age, birth weight and head circumference, and maternal primary infection was less frequent. Among treated children, 21.3% presented minor findings in cUS versus 6.3% in nontreatment group (P = 0.003). Nine patients (4.6%) developed HL at 24 months. Among children with HL, 20% presented minor findings in cUS versus 11.3% in non-HL group (P = NS). HL rate was similar in treated and nontreated groups (4.6% vs. 6.3%; P = 0.6).Conclusions:One-third of the children were treated with antivirals and infants with minor neuroimaging findings at birth were more likely to receive antiviral. There were no differences in the prevalence of HL at 2 years of age between treated and not-treated children. Minor neuroimaging findings were not clearly associated with an increased risk of delayed onset HL.

01 Feb 2025·Journal of Hospital Infection

Early antiviral use and supplemental oxygen decrease the risk of secondary bacterial infections: a multi-centre, nested, case–control study

Article

Author: Dela Cruz, C S ; Zhu, Y ; Li, D ; Hu, H ; Chang, D ; Zhang, H ; Sharma, L ; Guo, X ; Xie, W ; Xie, L

BACKGROUNDThe purpose of this study was to evaluate the treatment strategies that dictate the host susceptibility to secondary bacterial infections during coronavirus disease 2019 (COVID-19).METHODSThis nested, case-control study was conducted in three general hospitals in China between 1^st December 2022 and 1^st March 2023. A total of 456 confirmed COVID-19 patients matched 1:2 (152 cases and 304 controls) based on age, sex, disease severity and age-adjusted Charlson Comorbidity Index (aCCI) using propensity-score matching (PSM) were included. Association of secondary bacterial infections with treatment strategies including the supportive measures, antiviral, and antibacterial therapies were the main outcome measures.FINDINGSConditional logistic regression analyses demonstrated that among categorical variables, use of antibiotics, antivirals, intravenous injection of human immunoglobulin, glucocorticoids or anticoagulants were not associated with the risk of secondary bacterial infections in the COVID-19 patients. The use of supplemental oxygen by either low (odds ratio (OR): 0.18, P<0.001) or high flow (OR: 0.06, P<0.001), but not through ventilators were associated with significant protection against secondary bacterial infection. In contrast, feeding through gastric tube (OR: 10.97, P<0.001) or parenteral nutrition (OR: 3.97, P=0.002) was associated with significant increase in the risk of secondary bacterial infections. Similar data were obtained when data were analysed using continuous variables. Further, the early (<5 days post symptom onset, OR: 0.09, P<0.001), but not the late use of antivirals was associated with protection against secondary bacterial infections.CONCLUSIONSOxygen supplementation in non-ventilator settings and early use of antivirals were associated with decreased incidences of secondary bacterial infections, while parenteral nutrition or tube feedings were associated with increased incidences of secondary bacterial infections.

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