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Purpose: The aim of the study is to evaluate the effect of metformin in complication improvement of hospitalized patients with COVID-19. Methods: This was a randomized clinical trial that involved 189 patients with confirmed COVID-19 infection. Patients in the intervention group received metformin-500 mg twice daily. Patients who received metformin before admission were excluded from the control group. Patients who were discharged before taking at least 2000 mg of metformin were excluded from the study. Primary outcomes were vital signs, need for ICU admission, need for intubation, and mortality. Results: Data showed that patients with diabetes with previous metformin in their regimen had lower percentages of ICU admission and death in comparison with patients without diabetes (11.3% vs. 26.1% (P=0.014) and 4.9% vs. 23.9% (P≤0.001), respectively). Admission time characteristics were the same for both groups except for diabetes and hyperlipidemia, which were significantly different between the two groups. Observations of naproxen consumption on endpoints, duration of hospitalization, and the levels of spO2 did not show any significant differences between the intervention and the control group. The adjusted OR for intubation in the intervention group versus the control group was 0.21 [95% CI, 0.04-0.99 (P=0.047)]. Conclusion: In this trial, metformin consumption had no effect on mortality and ICU admission rates in non-diabetic patients. However, metformin improved COVID-19 complications in diabetic patients who had been receiving metformin prior to COVID-19 infection, and it significantly lowered the intubation rates.

Objective: Resistance against a wide variety of antibiotics is one of the prominent characteristics of Acinetobacter baumannii. The purpose of this study was to investigate the in vitro susceptibility testing of A. baumannii isolates to rifampin and the examination of the value of routine antibiogram with disk diffusion, E-test, and agar dilution methods on collected isolates from a tertiary hospital in north-west Iran. Materials and Methods: Susceptibility of 68 clinically isolated A. baumannii against rifampin using three in vitro methods was investigated. For the E-test method, the Pachon–Ibanez's and Saballs's study criteria were used. The Pachon–Ibamez criteria were used for agar dilution method. For disk diffusion, the standard Kirby–Bauer diffusion method was used. The area under curve (AUC) was used to determine the appropriate methods. The methods were interpreted using sensitivity, specificity, and negative and positive predictive values. Results: A. baumannii susceptibility to the rifampin according to the E-test was 41.2% (Panchon–Ibanez criteria) and 32.4% (Saballs's criteria). The susceptibility was 29.4% according to the agar dilution method for the Panchon–Ibanez criteria, 2.9% according to the agar dilution method for the Saballs's criteria and, and 1.5% according to the disk diffusion methods. The results of the E-test method according to Pachon–Ibanez's and Saballs's criteria in comparison with the result of the agar dilution method according to Pachon–Ibanez's criteria had the highest AUC. Conclusion: According to the susceptibility testing of rifampin against A. baumannii, the E-test method has a higher diagnostic value than the agar dilution and disk diffusion methods.

Background: Carbapenems are beta-lactam antibiotics with broad-spectrum activity for Gram-positive, Gram-negative and anaerobic bacteria and have become the antibiotics of last resort for many serious bacterial infections. The irrational use of carbapenems (imipenem or meropenm) has increased the risk of multi-drug resistant pathogens. The aim of this study was to evaluate the pattern of carbapenem utilization within 9 months and measure compliance with references in Imam Reza Hospital, Tabriz, Iran. Methods: During 9 months, 100 patients who received carbapenems randomly get selected under the supervision of the attending physician in Imam Reza Hospital affiliated to the Tabriz university of Medical sciences. After coordination with supervisor of each ward, the necessary information was extracted and American Hospital Formulary System (AHFS) and UpToDate 21.3 references were used to assess appropriate indication and accurate dosage of carbapenems. Results:: The most common cause of prescribing was lower respiratory tract infection (29%). Carbapenems were prescribed for 64% of patients as an appropriate indication. The dose of carbapenems was correct in 74% of patients and duration of carbapenems therapy was correct in 84% of cases. Dose readjustment was necessary for 28 patients, although for 25 of whom it was performed. Only 19 patients had positive culture results. Conclusion: Despite the global guidelines, carbapenem consumption in health care systems is incorrect. So, comprehensive programs for rational drug use in all medical centers conducted by a clinical pharmacist seems necessary to be employed.