PLoS ONE (Jan 2018)

Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study.

  • Sarah Shalhoub,
  • Fahad Al-Hameed,
  • Yasser Mandourah,
  • Hanan H Balkhy,
  • Awad Al-Omari,
  • Ghaleb A Al Mekhlafi,
  • Ayman Kharaba,
  • Basem Alraddadi,
  • Abdullah Almotairi,
  • Kasim Al Khatib,
  • Ahmed Abdulmomen,
  • Ismael Qushmaq,
  • Ahmed Mady,
  • Othman Solaiman,
  • Abdulsalam M Al-Aithan,
  • Rajaa Al-Raddadi,
  • Ahmed Ragab,
  • Abdulrahman Al Harthy,
  • Eman Al Qasim,
  • Jesna Jose,
  • Ghassan Al-Ghamdi,
  • Laura Merson,
  • Robert Fowler,
  • Frederick G Hayden,
  • Yaseen M Arabi

DOI
https://doi.org/10.1371/journal.pone.0206831
Journal volume & issue
Vol. 13, no. 11
p. e0206831

Abstract

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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.