Predictive biomarkers of mortality in patients with severe COVID-19 hospitalized in intensive care unit.

Objectives: This study was performed to identify predictive markers of worse outcomes in patients with severe COVID-19 in an intensive care unit. Methods: Sixty patients with severe COVID-19, hospitalized in the Intensive Care Unit (ICU) between March and July 2021, were stratified into two groups according to the outcome survivors and non-survivors. After admission to the ICU, blood samples were collected directly for biomarker analysis. Routine hematological and biochemical biomarkers, as well as serum levels of cytokines, chemokines, and immunoglobulins, were investigated. Results: Lymphopenia, neutrophilia, and thrombocytopenia were more pronounced in non-surviving patients, while the levels of CRP, AST, creatinine, ferritin, AST, troponin I, urea, magnesium, and potassium were higher in the non-surviving group than the survival group. In addition, serum levels of IL-10, CCL2, CXCL9, and CXCL10 were significantly increased in patients who did not survive. These changes in the biomarkers evaluated were associated with increased mortality in patients with severe COVID-19. Conclusion: The present study confirmed and expanded the validity of laboratory biomarkers as indicators of mortality in severe COVID-19.

Evaluation of alternative RNA extraction methods for detection of SARS-CoV-2 in nasopharyngeal samples using the recommended CDC primer-probe set.

Background: The efficiency of isolation and purification of the viral genome is a critical step to the accuracy and reliability of RT-qPCR to detect SARS-CoV-2. However, COVID-19 testing laboratories were overwhelmed by a surge in diagnostic demand that affected supply chains especially in low and middle-income facilities. Objectives: Thus, this study compares the performance of alternative methods to extraction and purification of viral RNA in samples of patients diagnosed with COVID-19. Study design: Nasopharyngeal swabs were submitted to three in-house protocols and three commercial methods; viral genome was detected using the primer-probe (N1 and N2) described by CDC and viral load of samples were determined. Results: The in-house protocols resulted in detection of virus in 82.4 to 86.3% of samples and commercial methods in 94.1 to 98%. The disagreement results were observed in samples with low viral load or below the estimated limit of detection of RT-qPCR. Conclusion: The simplified methods proposed might be less reliable for patients with low viral load and alternative commercial methods showed comparable performance.

Genomic surveillance of SARS-CoV-2 tracks early interstate transmission of P.1 lineage and diversification within P.2 clade in Brazil.

The sharp increase of COVID-19 cases in late 2020 has made Brazil the new epicenter of the ongoing SARS-CoV-2 pandemic. The novel viral lineages P.1 (Variant of Concern Gamma) and P.2, respectively identified in the Brazilian states of Amazonas and Rio de Janeiro, have been associated with potentially higher transmission rates and antibody neutralization escape. In this study, we performed the whole-genome sequencing of 185 samples isolated from three out of the five Brazilian regions, including Amazonas (North region), Rio Grande do Norte, Paraíba and Bahia (Northeast region), and Rio de Janeiro (Southeast region) in order to monitor the spread of SARS-CoV-2 lineages in Brazil in the first months of 2021. Here, we showed a widespread dispersal of P.1 and P.2 across Brazilian regions and, except for Amazonas, P.2 was the predominant lineage identified in the sampled states. We estimated the origin of P.2 lineage to have happened in February, 2020 and identified that it has differentiated into new clades. Interstate transmission of P.2 was detected since March, but reached its peak in December, 2020 and January, 2021. Transmission of P.1 was also high in December and its origin was inferred to have happened in August 2020. We also confirmed the presence of lineage P.7, recently described in the southernmost region of Brazil, to have spread across the Northeastern states. P.1, P.2 and P.7 are descended from the ancient B.1.1.28 strain, which co-dominated the first phase of the pandemic in Brazil with the B.1.1.33 strain. We also identified the occurrence of a new lineage descending from B.1.1.33 that convergently carries the E484K mutation, N.9. Indeed, the recurrent report of many novel SARS-CoV-2 genetic variants in Brazil could be due to the absence of effective control measures resulting in high SARS-CoV2 transmission rates. Altogether, our findings provided a landscape of the critical state of SARS-CoV-2 across Brazil and confirm the need to sustain continuous sequencing of the SARS-CoV-2 isolates worldwide in order to identify novel variants of interest and monitor for vaccine effectiveness.

Coagulase-negative staphylococci in outpatient routines: the implications of switching from CLSI to BrCAST/EUCAST guidelines.

Coagulase-negative staphylococci (CoNS) are frequently isolated in clinical specimens and are important reservoirs of resistance genes. In 2019, the Brazilian government set the BrCAST/EUCAST (Brazilian Committee on Antimicrobial Susceptibility Testing) guidelines as the national standard, resulting in changes in the interpretation of CoNS susceptibility tests. From outpatients, disk-diffusion susceptibility of 65 CoNS cultures were evaluated and compared using classification criteria from both CLSI and BrCAST/EUCAST. The isolates were identified using matrix assisted laser desorption ionization-time of flight (MALDI-TOF), and the presence of the mecA gene was determined. The most prevalent species were Staphylococcus saprophyticus (32.3%), S. haemolyticus (18.5%), and S. epidermidis (9.2%). Almost perfect agreement was seen between the guidelines, except concerning oxacillin and gentamicin, and the prevalence of multidrug resistant isolates increased with the use of BrCAST/EUCAST. Of all, 15 (23.1%) isolates, mainly S. epidermidis and S. haemolyticus, were positive for the mecA gene, and only three were detected when using CLSI or BrCAST/EUCAST disk-diffusion screening. This, using either guideline, could reveal the difficulty of determining oxacillin resistance. Using warning zones or molecular methods might well be indicated for CoNS. In conclusion, adoption of the BrCAST/EUCAST guidelines will result in certain artificial changes in epidemiological susceptibility profiles, and clinicians and institutions should be aware of the possible implications.

Alternative workflow for COVID-19 diagnosis using direct RT-PCR screening

Objective: COVID-19 is presently the most serious public health concern and diagnosis is a principal tool for controlling and monitoring the spread of the disease. This study aimed to evaluate the efficiency of direct RT-PCR (dRT-PCR) for detection of SARS-CoV-2. Methods: Twenty-seven nasopharyngeal swabs from symptomatic individuals were evaluated. Standard RT-PCR was conducted, and for dRT-PCR the samples were preheated before amplification. Results: Positive agreement was 63.2% and negative agreement was 100%, being moderately in accord. Conclusion: dRT-PCR may be an alternative for screening symptomatic patients and a reliable option during an eventual shortage of viral RNA purification kits.

Objetivo: A COVID-19 é atualmente um sério problema de saúde pública e o diagnóstico é a principal ferramenta para controlar e monitorar a propagação da doença. Este estudo teve como objetivo avaliar a eficiência da RT-PCR direta (dRT-PCR) para detecção do SARS-CoV-2. Métodos: Vinte e sete amostras de swab nasofaríngeo de indivíduos sintomáticos foram avaliados. A RT-PCR padrão foi realizada e para a dRT-PCR as amostras foram pré-aquecidas antes da amplificação. Resultados: A concordância positiva foi de 63,2% e a concordância negativa foi de 100%, sendo moderadamente concordante. Conclusão: A dRT-PCR pode ser uma alternativa para a triagem de pacientes sintomáticos e uma opção confiável durante uma eventual escassez de kits de purificação de RNA viral.

Suscetibilidade antimicrobiana de Streptococcus agalactiae isolados de gestantes em um hospital materno infantil de Porto Alegre, Rio Grande do Sul / Antimicrobial susceptibility of Streptococcus agalactiae isolated from pregnant women at a maternity hospital in Porto Alegre, Rio Grande do Sul, Brazil

OBJETIVOS: Caracterizar o perfil de suscetibilidade antimicrobiana de Streptococcus agalactiae isolados de gestantes atendidas em um hospital público. MÉTODOS: O estudo foi realizado em um hospital materno-infantil público de Porto Alegre, RS, no qual a pesquisa de S. agalactiae em gestantes faz parte da rotina obstétrica. Foram incluídas no estudo as pesquisas por swab anal/vaginal realizadas no período de julho de 2015 a fevereiro de 2016. Os isolados bacterianos foram identificados por testes fenotípicos e foi determinada a suscetibilidade aos antimicrobianos ampicilina, clindamicina, eritromicina e ofloxacino. Foram investigados também os genes de resistência à eritromicina ermB e mefA. RESULTADOS: No total, 294 coletas foram incluídas e destas, 26 (8%) foram positivas para S. agalactiae. Todos os isolados avaliados foram sensíveis à ampicilina e foram observadas resistências à eritromicina (21,4%), clindamicina (14,3%) e ofloxacino (7,1%), sendo que 66% dos isolados resistentes à eritromicina apresentaram o genótipo mefA. CONCLUSÕES: Os resultados deste estudo corroboram com o consenso de que em gestantes colonizadas com S. agalactiae é aconselhada a antibioticoprofilaxia intraparto com penicilina G ou ampicilina. A expressiva proporção de isolados resistentes à eritromicina e clindamicina, indicados para a antibioticoprofilaxia intraparto em caso de alergia aos antibióticos beta-lactâmicos, enfatiza a importância da determinação do perfil de suscetibilidade antimicrobiana prévia desses isolados, medida que ainda não faz parte da rotina de exames pré-natais em muitas instituições.

AIMS: To characterize the antimicrobial susceptibility profile of Streptococcus agalactiae isolated from pregnant women attended at a public hospital. METHODS: The study was carried out in a public maternal and child hospital in Porto Alegre, RS, Brazil, in which the screening for S. agalactiae in pregnant women is part of the obstetrics routine. The study was carried out on anal/vaginal swab tests performed from July 2015 to February 2016. Bacterial isolates were identified by phenotypic tests, and the susceptibility to ampicillin, clindamycin, erythromycin and ofloxacin was determined. The erythromycin resistance genes ermB and mefA were also investigated. RESULTS: A total of 294 samples were included, and of these, 26 (8%) were positive for S. agalactiae. All isolates were susceptible to ampicillin, and resistance to erythromycin (21.4%), clindamycin (14.3%) and ofloxacin (7.1%) were observed. The mefA genotype was observed in 66% of the erythromycin resistant isolates. CONCLUSIONS: Results of this study corroborate the consensus that in pregnant women colonized with S. agalactiae, intrapartum antibiotic prophylaxis with penicillin G or ampicillin is indicated. The relevant proportion of isolates resistant to erythromycin and clindamycin, indicated for intrapartum antibiotic prophylaxis in case of allergy to beta-lactam antibiotics, emphasizes the importance of determining the profile of antimicrobial susceptibility of these isolates, a measure that is not yet part of routine prenatal tests in many institutions.