Surveillance of multi-resistant microrganisms and epidemiological investigation of intensive care unit patients: Análise de parâmetros relevantes em culturas de vigilância epidemiológica de pacientes internados no centro de tratamento intensivo e colonizados por microrganismos multirresistentes

It is of great importance to detect the presence of microorganisms in healthcare services. On this basis, strategies should be developed to maintain safety inside the hospital environment by preventing the transmission of microorganisms, thus preventing healthcare-associated infections (HAI). In the Intensive Care Unit (ICU), the precocious detection of infection and/or colonization by multidrug-resistant (MDR) microorganisms is key. For this reason, the routine monitoring of patients that are infected or colonized by MDR microorganisms is mandatory. In this context, this study aimed to evaluate the performance of epidemiological surveillance swabs and microbiological cultures in ICU patients in a university public hospital in Belo Horizonte, Minas Gerais State, Brazil. Medical records of patients admitted to the ICU from January 1st, 2018 to December 31st, 2020, submitted to epidemiological surveillance cultures, and presenting factors correlated to the development of HAI were evaluated. This was a descriptive, retrospective and observational, non-interventional study. The study population was composed mainly of male patients (66.3%), with a mean age of 59 years, coming from the Medical Clinic department, and septicemia was the main cause of hospitalization in the ICU. The analyses showed that 9.5% of the patients were colonized by MDR microorganisms. The samples were collected at the ICU, and a higher frequency of gram-negative bacteria was observed, including A. baumannii, P. aeruginosa, K. pneumoniae, and carbapenem-resistant Enterobacteriaceae. The most frequently prescribed antimicrobials were β-lactams and glycopeptides, and the same patient was treated using more than one class of antimicrobials. The surveillance culture is key to understanding the microbiological profile of the institution. The collection of swabs and microbiological cultures from different sites could be used to adopt routines and recommend measures aimed at controlling and reducing the HAI rates as well as the emergence of MDR outbreaks. These procedures could contribute to the creation and maintenance of a safe and effective healthcare service

Relationship between clinical-epidemiological parameters and outcomes of patients with COVID-19 admitted to the intensive care unit: a report from a Brazilian hospital

BackgroundPeople in low-income countries, especially those with low socio-economic conditions, are likelier to test positive for SARS-CoV-2. The unequal conditions of public health systems also increase the infection rate and make early identification and treatment of at-risk patients difficult. Here, we aimed to characterize the epidemiological profile of COVID-19 patients in intensive care and identify laboratory and clinical markers associated with death.Materials and methodsWe conducted an observational, descriptive, and cross-sectional study in a reference hospital for COVID-19 treatment in the Southern Region of Bahia State, in Brazil, to evaluate the epidemiological, clinical, and laboratory characteristics of COVID-19 patients admitted to the intensive care unit (ICU). Additionally, we used the area under the curve (AUC) to classify survivors and non-survivors and a multivariate logistic regression analysis to assess factors associated with death. Data was collected from the hospital databases between April 2020 and July 2021.ResultsThe use of bladder catheters (OR 79.30; p < 0.0001) and central venous catheters (OR, 45.12; p < 0.0001) were the main factors associated with death in ICU COVID-19 patients. Additionally, the number of non-survivors increased with age (p < 0.0001) and prolonged ICU stay (p < 0.0001). Besides, SAPS3 presents a higher sensibility (77.9%) and specificity (63.1%) to discriminate between survivors and non-survivor with an AUC of 0.79 (p < 0.0001).ConclusionWe suggest that multi-laboratory parameters can predict patient prognosis and guide healthcare teams toward more assertive clinical management, better resource allocation, and improved survival of COVID-19 patients admitted to the ICU

Expression profile of immunological and vascular mediators in an unusual case of paravertebral primary cutaneous non-Hodgkin lymphoma

Primary cutaneous follicle center lymphoma (PCFCL) is a rare type of indolent, low-grade cutaneous B-cell lymphoma, most frequent in trunk, particularly the head and scalp. Differential diagnosis for exclude other pathologies is needed. Here, we describers a detailed analysis on the expression profile of immunological and vascular mediators in tumor microenvironment that contribute to the knowledge, prognostic and diagnostic aid in a rare case of paravertebral PCFCL mimicking clinical appearance and localization of an unusual sebaceous cyst in a 48-year-old woman without history of neoplasia.</p

Congenital CMV infection in a Brazilian neonatal intensive care unit: high prevalence among twin newborns

Abstract Background Cytomegalovirus (CMV) is one of the most important pathogens associated with congenital infection worldwide. Most congenital CMV-infected infants are asymptomatic at birth; however, some can develop delayed sequelae, especially hearing loss. Methods This study aimed to investigate the prevalence of congenital CMV infection in a neonatal intensive care unit in a low-income region of Brazil. The objectives extended to identifying associated factors, assessing the clinical status of infected newborns, and undertaking a two-year follow-up to discern potential long-term consequences in the affected infants. This cross-sectional prospective study enrolled newborns up to three weeks of life requiring intensive medical care. We employed a convenience sampling method to include 498 newborns and 477 mothers in the study. Categorical variables underwent analysis employing Fisher’s exact test, whereas the examination of continuous variables involved the Mann‒Whitney test. Results CMV DNA was detected in saliva/urine samples from 6 newborns (1.21%), confirming congenital infection. We noted a significantly greater incidence (OR: 11.48; 95% CI: 2.519–52.33; p = 0.0094) of congenital infection among twins (7.14%) than among nontwins (0.66%). The twin patients exhibited discordant infection statuses, suggesting that only one of the babies tested positive for CMV. Most of the infected children were born to mothers who initiated sexual activity at a younger age (p = 0.0269). Only three out of the six newborns diagnosed with CMV infection underwent comprehensive clinical assessments and received continuous follow-up until they reached two years of age. Only one of the children had weight and height measurements below the norm for their age, coupled with developmental delays. Conclusions The prevalence of congenital CMV infection among newborns admitted to the NICU was low and similar to that in the general population. However, we found a significantly greater incidence of congenital CMV infection in twins than in singletons. Interestingly, the twin-infected patients exhibited discordant infection statuses, suggesting that CMV was present in only one of the babies. We also found that most of the infected children were born to mothers who initiated sexual activity at a younger age. Diagnostic accessibility and comprehensive surveillance programs are imperative for effectively managing and preventing congenital CMV infections

AVALIAÇÃO DE NOVOS FÁRMACOS PARA O TRATAMENTO DE KLEBSIELLA PNEUMONIAE MULTIRRESISTENTE ISOLADA DO AMBIENTE HOSPITALAR

Introdução/Objetivo: Bactérias da espécie Klebsiella pneumoniae são responsáveis por infecções em pacientes debilitados e imunocomprometidos. A K.pneumoniae pertence à família das enterobactérias, as quais a Organização Mundial de Saúde classificou como risco crítico a população devido a resistência aos betalactâmicos, este estudo buscou por novos agentes terapêuticos com atividade antimicrobiana frente a K. pneumoniae nosocomial (ESBL positiva) isolada da UTI previamente pelo nosso de grupo de pesquisa. Métodos: A Klebsiella quasipneumoniae ATCC™700603 foi utilizada como controle nos experimentos por apresentar betalactamase de espectro estendido (ESBL). A K. pneumoniae nosocomial (ESBL positiva) teve seu perfil de resistência determinado previamente pelo sistema automatizado Vitek2 e confirmado por disco difusão segundo BRCAST 2017. As bactérias foram descongeladas e posteriormente incubadas em caldo Mueller-Hinton (MH)em aerobiose por 24h a 37°C, a turbidez do inoculo foi ajustada a 0,5 na escala de McFarland. Após ensaio prévio de disco difusão para determinação das concentrações foram utilizadas acetilcisteína com bromelina a 1,56 ug/mL a 250 ug/mL. Foram realizados ensaios de Concentração Inibitória e Bactericida Mínima (CIM e CBM, respectivamente). Para determinação da CIM, foi utilizada placa de 96 poços, onde foram colocados 70 uL de caldo MH + 20 uL dos fármacos com 10 uL da suspenção bacteriana e após 24h de incubação a 37°C foram adicionados 20 uL de resazurina 0,01% e depois de 2h foi realizada a leitura visual e em leitor de microplaca a 570 nm. Para determinação da CBM, foram colocados 10 uL de cada poço em placas contendo ágar MH e incubação a 37°C por 24h, posteriormente as placas foram analisadas. As análises estatísticas foram feitas pelo GraphPad Prism 8.0. Resultados: A acetilcisteína associada a bromelina demonstrou ação bacteriostática na linhagem nosocomial. As concentrações de 125 ug/mL; 12,5 ug/mL e 6,25 ug/mL foram capazes de reduzir o crescimento de K.pneumoniae nosocomial quando comparado ao controle sem tratamento. Não houve diferença significativa na cepa padrão tratada e sem tratamento. Conclusão: A associação dos fármacos testados demonstrou ação bacteriostática em linhagem nosocomial ESBL positiva

PARÂMETROS CLÍNICOS E EPIDEMIOLÓGICOS NA COVID-19 E SUA CORRELAÇÃO COM ÓBITO EM PACIENTES ATENDIDOS EM UNIDADE DE TERAPIA INTENSIVA (UTI)

Introdução/Objetivo: Uma estratégia para compreender a forma grave da COVID-19 está voltada para avaliação de marcadores epidemiológicos, laboratoriais e clínicos capazes de predizer óbito. O presente estudo analisou marcadores epidemiológicos, biomarcadores clínicos e laboratoriais em participantes com COVID-19 grave internados em hospital de referência para tratamento da COVID-19 em Ilhéus/BA, com objetivo de determinar quais marcadores poderiam ser usados como preditores do óbito. Métodos: O estudo foi submetido ao CEP/UESC, aprovado sob CAAE n° 40671720.4.0000.5526. Realizado entre 11/06/2020 a 30/07/2021, onde foram coletados dados epidemiológicos, laboratoriais e clínicos dos prontuários de pacientes internados na UTI de um hospital de referência para COVID-19 em Ilhéus e cidades vizinhas, situadas no Sul da Bahia. Os dados foram registrados no software Epimed Monitor, passando por tratamento estatístico, respeitando categoria da variável: quantitativa ou categórica. As análises foram realizadas por softwares GraphPad Prism 9.0 e Statistical Package for Social Sciences 26.0. A classificação de sobreviventes e não sobreviventes foi analisada via curva ROC pelo método de Wilson/Brown. O estudo englobou 218 participantes com média de idade de 64,37SD± 15,16, 123 do sexo masculino e 95 do sexo feminino. 77 vieram a óbito. Resultados: As análises estatísticas evidenciaram idade superior a 65 anos (ponto de corte >66.5; p 40.5; p 0,895; p 19.4; p 1.350, p = 0.0035.) dosagem de pH arterial (ponto de corte 10.03; p 11,5; p < 0,001) foram associados ao óbito, correlacionados a injúria sistêmica. Conclusão: Os marcadores epidemiológicos, laboratoriais e clínicos encontrados neste estudo podem ser usados pela equipe clínica como preditores para óbito em pacientes com COVID-19

Table_1_Relationship between clinical-epidemiological parameters and outcomes of patients with COVID-19 admitted to the intensive care unit: a report from a Brazilian hospital.DOCX

BackgroundPeople in low-income countries, especially those with low socio-economic conditions, are likelier to test positive for SARS-CoV-2. The unequal conditions of public health systems also increase the infection rate and make early identification and treatment of at-risk patients difficult. Here, we aimed to characterize the epidemiological profile of COVID-19 patients in intensive care and identify laboratory and clinical markers associated with death.Materials and methodsWe conducted an observational, descriptive, and cross-sectional study in a reference hospital for COVID-19 treatment in the Southern Region of Bahia State, in Brazil, to evaluate the epidemiological, clinical, and laboratory characteristics of COVID-19 patients admitted to the intensive care unit (ICU). Additionally, we used the area under the curve (AUC) to classify survivors and non-survivors and a multivariate logistic regression analysis to assess factors associated with death. Data was collected from the hospital databases between April 2020 and July 2021.ResultsThe use of bladder catheters (OR 79.30; p ConclusionWe suggest that multi-laboratory parameters can predict patient prognosis and guide healthcare teams toward more assertive clinical management, better resource allocation, and improved survival of COVID-19 patients admitted to the ICU.</p