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OBJECTIVES: Severe acute respiratory syndrome-coronovirus-2 is a global public health problem, in which early diagnosis is required to prevent the spread of infection. In this study, we aimed to reveal the diagnostic value of chest computed tomography (CT) imaging with respect to symptom duration. METHODS: This retrospective study involved patients from five centers, who were admitted with typical COVID-19 symptoms and found to be positive for COVID-19 real-time reverse transcription-polymerase chain reaction (rtRT-PCR) test. RESULTS: One hundred and five patients with positive COVID-19 rtRT-PCR test were involved in the study. Sixty percent of these patients had chest CT imaging findings consistent with COVID-19 pneumonia. The most common chest CT finding was bilateral and subpleural ground-glass opacity in middle-lower lobes of the lungs. Chest CT findings were detected in 85.1% of the patients with a symptom duration of more than 2 days. In receiver operating characteristic analysis of this parameter, area under the curve (AUC) was 0.869, while sensitivity and specificity were 90.5% and 76.2%, respectively. It was notable that chest CT findings were 7.17 times more common among the patients aged 60 years and older, with AUC, specificity, and positive predictive value of 0.768, 88.1%, and 84.8%, respectively. CONCLUSION: Chest CT imaging is a quite valuable tool in patients with longer than 2 days' duration of symptoms, in whom clinical and epidemiological data support the diagnosis of COVID-19 infection. We suggest that the diagnosis of COVID-19 pneumonia should be made with chest CT imaging when rtRT-PCR test cannot be performed or gives a negative result, which is important for public health and to prevent the spread of infection.

Infectious diseases are conditions with significant consequences in terms of public health while associated mortality, morbidity, and complications can be prevented. Disease severity and duration can be shortened by means of rational antimicrobial therapy. It is important to obey main rational antibiotic use rules ie. to collect and examine appropriate culture specimens before treatment, identify potential microbial agents, consider the pharmacological properties of the antibiotic, determine whether combined antibiotics are indicated, review the host factors and indications for antibiotic therapy modification, and monitor response to antibiotic therapy while planning antibiotic therapy. Once correct diagnosis has been made, the correct antibiotic must be administered via the correct route, at an effective dose, at optimum intervals, and for an appropriate length of time for rational antimicrobial therapy. However, knowledge concerning the optimal duration of treatment is limited. Patients generally receive antibiotic therapy for 10-14 days. Prolonged treatment is also common. Duration of antimicrobial therapy may be a confusing issue for clinicians due to problems of resistance and toxicity. A healthy bacterial ecosystem (i.e. a normal flora) is essential to remain healthy. Antibiotic use can alter the normal bacterial flora in humans, which generally leads to the emergence of multidrug-resistant (MDR) bacteria and side effects such as diarrhea. Infections caused by MDR bacteria result in increased disease and mortality rates and extended hospital stays, as well as increased costs. Studies aimed at shortening the duration of treatment have reported that a 3-5 day treatment period in some of the community-acquired infections and one-week period in some of the nosocomial infections may be sufficient. Based on the patients" individual characteristics and clinical responses to treatment, short-term antibiotic therapy may be administered in selected patient groups both in community-acquired and healthcare-associated infections. Rational antibiotic therapy, together with observation of response to treatment and optimal treatment durations (which remain to be determined) can prevent adverse outcomes associated with long-term antibiotic use such as antibiotic-related side effects and development of MDR bacteria.

Objectives: To evaluate the diagnostic value of the rtRT-PCR test and CT in patients presenting with typical clinical symptoms of COVID-19., Methods: The study with the participation of four center in Turkey was performed retrospectively from 20 March-15 April 2020 in 203 patients confirmed for COVID-19. The initial rtRT-PCR test was positive in 142 (70.0%) of the patients (Group-I) and negative in 61 patients (Group-II)., Results: The mean age of the patients in Group-I was 49.7±18.0 years and the time between the onset of symptoms and admission to the hospital was 3.6±2.0 days; whereas the same values for the patients in Group-II were 58.1±19.9 and 5.3±4.2, respectively (p=0.004; p=0.026). Initial rtRT-PCR was found positive with 83.5% sensitivity and 74.1% PPV in patients with symptom duration of less than five days. It was found that rtRT-PCR positivity correlated negatively with the presence of CT findings, age, comorbidity, shortness of breath, and symptom duration, while rtRT-PCR positivity correlated positively with headache. Presence of CT findings was positively correlated with age, comorbidity, shortness of breath, fever, and the symptom duration., Conclusions: It should be noted that a negative result in the rtRT-PCR test does not rule out the possibility of COVID-19 diagnosis in patients whose symptom duration is longer than five days, who are elderly with comorbidities and in particular who present with fever and shortness of breath. In these patients, typical CT findings are diagnostic for COVID-19. A normal chest CT is no reason to loosen up measures of isolation in patients with newly beginning symptoms until the results are obtained from the PCR test., (Copyright: © Pakistan Journal of Medical Sciences.)