Species distribution and susceptibility profile of Candida species in a Brazilian public tertiary hospital

<p>Abstract</p> <p>Background</p> <p>Species identification and antifungal susceptibility tests were carried out on 212 <it>Candida </it>isolates obtained from bloodstream infections, urinary tract infections and dialysis-associated peritonitis, from cases attended at a Brazilian public tertiary hospital from January 1998 to January 2005.</p> <p>Findings</p> <p><it>Candida albicans </it>represented 33% of the isolates, <it>Candida parapsilosis </it>31.1%, <it>Candida tropicalis </it>17.9%,<it>Candida glabrata </it>11.8%, and others species 6.2%. In blood culture, <it>C. parapsilosis </it>was the most frequently encountered species (48%). The resistance levels to the antifungal azoles were relatively low for the several species, except for <it>C. tropicalis </it>and <it>C. glabrata</it>. Amphotericin B resistance was observed in 1 isolate of <it>C. parapsilosis</it>.</p> <p>Conclusions</p> <p>The species distribution and antifungal susceptibility herein observed presented several epidemiological features common to other tertiary hospitals in Latin American countries. It also exhibited some peculiarity, such as a very high frequency of <it>C. parapsilosis </it>both in bloodstream infections and dialysis-associated peritonitis. <it>C. albicans </it>also occurred in an important number of case infections, in all evaluated clinical sources. <it>C. glabrata </it>presented a high proportion of resistant isolates. The data emphasize the necessity to carry out the correct species identification accompanied by the susceptibility tests in all tertiary hospitals.</p

O enfermeiro na prevenção de infecção no cateter central de inserção periférica no neonato

Introduction: As the Peripherally Inserted Central Catheter (PICC) is the first choice of prolonged vascular access in preterm infants, to recognize the risk factors for infection related to its use contributes to the establishment of procedures that qualify care. Objective: To evaluate the production of knowledge available in the literature about the work of nurses in the prevention of infection related to PICC. Method: An integrative literature review according to Ganong’s assumptions, was performed in the SciELO, LILACS, BDENF, MEDLINE and PubMed databases. Data collection took place in October 2017, including original articles made available in full from 2001. Results were organized using Bardin’s content analysis. Results: Only eleven articles met the inclusion criteria and four thematic categories emerged: 1) Theoretical and practical knowledge assessment of the nurse to prevent infection in the insertion and maintenance of PICC, 2) Permanent education of the nursing team, 3) Implementation and use of protocols, and 4) Constant monitoring of quality indicators. Conclusions: The present work, through the analysis of the collected studies, signals the need to create institutional protocols, training and permanent and continuing education, to use de indicators in the prevention of infection, aiming at patient care and safety and, consequently, resulting in lower incidence of bloodstream infections through the use of PICC.Introdução: Como o cateter central de inserção periférica (PICC) é a primeira escolha de acesso vascular prolongado em neonatos, reconhecer os fatores de risco associados a infecções relacionadas ao seu uso contribui para estabelecer critérios de manuseio e manutenção do dispositivo que qualifiquem a assistência do enfermeiro e de sua equipe. Objetivo: Avaliar a produção do conhecimento científico na literatura acerca da atuação do enfermeiro na prevenção de infecção de corrente sanguínea pelo uso do PICC. Método: Revisão integrativa da literatura seguindo os pressupostos de Ganong, nas bases de dados SciELO, LILACS, BDENF, MEDLINE e PubMed. A coleta de dados ocorreu em outubro de 2017, incluindo artigos disponibilizados na íntegra a partir de agosto de 2001 a outubro de 2017. Para a organização dos resultados, foi utilizada a análise de conteúdo de Bardin. Resultados: Onze artigos preencheram os critérios de inclusão, emergindo quatro categorias temáticas: 1) Conhecimento teórico-prático do enfermeiro para prevenção de infecção na inserção e manutenção do PICC, 2) Educação permanente da equipe de enfermagem, 3) Implantação e utilização de protocolos e 4) Vigilância constante de indicadores de qualidade. Conclusões: O presente trabalho observou o despreparo do profissional da enfermagem quanto ao dispositivo PICC e demonstrou a necessidade de elaboração de protocolos institucionais, treinamento e educação continuada permanente e o uso de indicadores, direcionados às medidas preventivas contra a infecção do PICC. Essas medidas visam melhorar a qualidade da assistência e segurança do paciente e consequentemente, resultar em menor incidência de infecções de corrente sanguínea pelo uso do PICC

Emergence and Persistence of High-Risk Clones Among MDR and XDR A. baumannii at a Brazilian Teaching Hospital

Dissemination of carbapenem-resistant Acinetobacter baumannii is currently one of the priority themes discussed around the world, including in Brazil, where this pathogen is considered endemic. A total of 107 carbapenem-resistant A. baumannii (CRAB) isolates were collected from patients with bacteraemia attended at a teaching hospital in Brazil from 2008 to 2014. From these samples, 104 (97.2%) carried blaOXA−23−like, all of them associated with ISAba1 The blaOXA−231 (1.9%) and blaOXA−72 (0.9%) genes were also detected in low frequencies. All isolates were susceptible to minocycline, and 38.3% of isolates presented intermediate susceptibility to tigecycline (MIC = 4 μg/ml). Molecular typing assessed by multi-locus sequence typing demonstrated that the strains were mainly associated with clonal complexes CC79 (47.4%), followed by CC1 (16.9%), and CC317 (18.6%), belonging to different pulsotypes and in different prevalences over the years. Changes in the clones' prevalence reinforce the need of identifying and controlling CRAB in hospital settings to preserve the already scarce therapeutic options available

Carriers of ADAMTS13 Rare Variants Are at High Risk of Life-Threatening COVID-19

Thrombosis of small and large vessels is reported as a key player in COVID-19 severity. However, host genetic determinants of this susceptibility are still unclear. Congenital Thrombotic Thrombocytopenic Purpura is a severe autosomal recessive disorder characterized by uncleaved ultra-large vWF and thrombotic microangiopathy, frequently triggered by infections. Carriers are reported to be asymptomatic. Exome analysis of about 3000 SARS-CoV-2 infected subjects of different severities, belonging to the GEN-COVID cohort, revealed the specific role of vWF cleaving enzyme ADAMTS13 (A disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13). We report here that ultra-rare variants in a heterozygous state lead to a rare form of COVID-19 characterized by hyper-inflammation signs, which segregates in families as an autosomal dominant disorder conditioned by SARS-CoV-2 infection, sex, and age. This has clinical relevance due to the availability of drugs such as Caplacizumab, which inhibits vWF-platelet interaction, and Crizanlizumab, which, by inhibiting P-selectin binding to its ligands, prevents leukocyte recruitment and platelet aggregation at the site of vascular damage

An explainable model of host genetic interactions linked to COVID-19 severity

We employed a multifaceted computational strategy to identify the genetic factors contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing (WES) dataset of a cohort of 2000 Italian patients. We coupled a stratified k-fold screening, to rank variants more associated with severity, with the training of multiple supervised classifiers, to predict severity based on screened features. Feature importance analysis from tree-based models allowed us to identify 16 variants with the highest support which, together with age and gender covariates, were found to be most predictive of COVID-19 severity. When tested on a follow-up cohort, our ensemble of models predicted severity with high accuracy (ACC = 81.88%; AUCROC = 96%; MCC = 61.55%). Our model recapitulated a vast literature of emerging molecular mechanisms and genetic factors linked to COVID-19 response and extends previous landmark Genome-Wide Association Studies (GWAS). It revealed a network of interplaying genetic signatures converging on established immune system and inflammatory processes linked to viral infection response. It also identified additional processes cross-talking with immune pathways, such as GPCR signaling, which might offer additional opportunities for therapeutic intervention and patient stratification. Publicly available PheWAS datasets revealed that several variants were significantly associated with phenotypic traits such as "Respiratory or thoracic disease", supporting their link with COVID-19 severity outcome.A multifaceted computational strategy identifies 16 genetic variants contributing to increased risk of severe COVID-19 infection from a Whole Exome Sequencing dataset of a cohort of Italian patients

The polymorphism L412F in TLR3 inhibits autophagy and is a marker of severe COVID-19 in males

The polymorphism L412F in TLR3 has been associated with several infectious diseases. However, the mechanism underlying this association is still unexplored. Here, we show that the L412F polymorphism in TLR3 is a marker of severity in COVID-19. This association increases in the sub-cohort of males. Impaired macroautophagy/autophagy and reduced TNF/TNFα production was demonstrated in HEK293 cells transfected with TLR3L412F-encoding plasmid and stimulated with specific agonist poly(I:C). A statistically significant reduced survival at 28 days was shown in L412F COVID-19 patients treated with the autophagy-inhibitor hydroxychloroquine (p = 0.038). An increased frequency of autoimmune disorders such as co-morbidity was found in L412F COVID-19 males with specific class II HLA haplotypes prone to autoantigen presentation. Our analyses indicate that L412F polymorphism makes males at risk of severe COVID-19 and provides a rationale for reinterpreting clinical trials considering autophagy pathways. Abbreviations: AP: autophagosome; AUC: area under the curve; BafA1: bafilomycin A1; COVID-19: coronavirus disease-2019; HCQ: hydroxychloroquine; RAP: rapamycin; ROC: receiver operating characteristic; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; TLR: toll like receptor; TNF/TNF-α: tumor necrosis factor

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

A first update on mapping the human genetic architecture of COVID-19

peer reviewe