Development of a quadruple qRT-PCR assay for simultaneous identification of hypervirulent and carbapenem-resistant Klebsiella pneumoniae.

IMPORTANCE: Globally, the increasing number of hypervirulent Klebsiella pneumoniae (hvKp) and carbapenem-resistant Kp (CR-Kp) infections poses a huge public health challenge with high morbidity and mortality. Worrisomely, due to the mobility of elements carrying virulence and drug-resistance genes, the increasing prevalence of CR-hvKp has also been found with an overwhelming mortality rate in recent years. However, the current detection methods for hvKp and CR-Kp have many disadvantages, such as long turnaround time, complex operation, low sensitivity, and specificity. Herein, a more sensitive, rapid, single-reaction, and multiplex quantitative real-time PCR was developed and validated to differentiate the circulating lineages of Kp with excellent performance in sensitivity and specificity, providing a useful tool for the differential diagnosis and the surveillance of the circulating Kp.

Symptomatic and optimal supportive care of critical COVID-19: A case report and literature review.

BACKGROUND: Coronavirus disease 2019 (COVID-19) severity is classified as asymptomatic, mild, moderate, severe, and critical. Mild cases account for a large percentage of cases in the epidemic and typically exhibit a favorable prognosis. However, a 49%-67% mortality is noted in critical cases. No COVID-19-specific drug has been reported to date, and symptomatic and optimal supportive care, including oxygenation, anti-coinfection treatments, and ventilation, represent the mainstay of treatment for this disease, especially in critical patients. CASE SUMMARY: In the above-mentioned context, we share our experience with the treatment of one critical COVID-19 case and review the relevant literature. CONCLUSION: Timely tracheal intubation, reasonable mechanical ventilation support, appropriate anti-infection treatment, and early anticoagulation and immunity support are key factors in the successful treatment of this case.

Association of acute kidney injury and clinical outcomes in patients with COVID-19 in Shenzhen, China: a retrospective cohort study.

BACKGROUND: Acute kidney injury (AKI) was found in some patients with COVID-19 pneumonia and accompanied with poor outcomes. The objective of this study was to investigate the association of AKI with clinical outcomes in COVID-19 patients. METHODS: In this cohort study, we reviewed electronic medical data from patients with COVID-19 in Shenzhen from January 11 to February 19, 2020. Clinical features and clinical outcomes in COVID-19 patients with and without AKI were analyzed. Further, we evaluated the association between AKI development and clinical outcomes. RESULTS: In this study, 9.6% patients developed AKI during hospitalization. Those with AKI presented older age, severer pneumonia, more comorbidity and lower lymphocyte count. Totally, more patients (77.5%) had primary composite outcomes (intensive care unit (ICU) admission, use of high-flow nasal cannula (HFNC) and mechanical ventilation) in AKI group compared to non-AKI group (2.9%) during the observation period. The median length of stay (LOS) and ICU stay were longer among those with AKI. After adjusted for related covariates, AKI development was independently correlated with LOS (ß (95% CI): 9.16 (3.87-14.46)), rather than primary outcomes (HR (95% CI): 1.34 (0.56-3.21)) in COVID-19 patients. CONCLUSIONS: The development of AKI was not one of the reasons for ICU admission, use of HFNC and mechanical ventilation, but a kind of manifestation of severe illness in COVID-19 hospitalized patients.