BackgroundNosocomial infections caused by Pseudomonas aeruginosa presenting resistance to beta-lactam drugs are one of the most challenging targets for antimicrobial therapy, leading to substantial increase in mortality rates in hospitals worldwide. In this context, P. aeruginosa harboring acquired mechanisms of resistance, such as production of metallo-beta-lactamase (MBLs) and extended-spectrum beta-lactamases (ESBLs) have the highest clinical impact. Hence, this study was designed to investigate the presence of genes codifying for MBLs and ESBLs among carbapenem resistant P. aeruginosa isolated in a Brazilian 720-bed teaching tertiary care hospital.MethodsFifty-six carbapenem-resistant P. aeruginosa strains were evaluated for the presence of MBL and ESBL genes. Strains presenting MBL and/or ESBL genes were submitted to pulsed-field gel electrophoresis for genetic similarity evaluation.ResultsDespite the carbapenem resistance, genes for MBLs (blaSPM-1 or blaIMP-1) were detected in only 26.7% of isolates. Genes encoding ESBLs were detected in 23.2% of isolates. The blaCTX-M-2 was the most prevalent ESBL gene (19.6%), followed by blaGES-1 and blaGES-5 detected in one isolate each. In all isolates presenting MBL phenotype by double-disc synergy test (DDST), the blaSPM-1 or blaIMP-1 genes were detected. In addition, blaIMP-1 was also detected in three isolates which did not display any MBL phenotype. These isolates also presented the blaCTX-M-2 gene. The co-existence of blaCTX-M-2 with blaIMP-1 is presently reported for the first time, as like as co-existence of blaGES-1 with blaIMP-1.ConclusionsIn this study MBLs production was not the major mechanism of resistance to carbapenems, suggesting the occurrence of multidrug efflux pumps, reduction in porin channels and production of other beta-lactamases. The detection of blaCTX-M-2,blaGES-1 and blaGES-5 reflects the recent emergence of ESBLs among antimicrobial resistant P. aeruginosa and the extraordinary ability presented by this pathogen to acquire multiple resistance mechanisms. These findings raise the concern about the future of antimicrobial therapy and the capability of clinical laboratories to detect resistant strains, since simultaneous production of MBLs and ESBLs is known to promote further complexity in phenotypic detection. Occurrence of intra-hospital clonal dissemination enhances the necessity of better observance of infection control practices.

Introduction Early diagnosis and identification of potential critical cases for timely treatment are crucial for COVID‐19 patients. The aim of this study was to analyze the diagnostic and prognostic implications of WBC and cell population data (CPD) abnormalities related to COVID‐19 at disease onset. Methods Baseline WBC counts and CPD data were analyzed in one hundred COVID‐19 patients presenting to emergency department and subsequently discharged (n = 49), admitted (n = 51) or deceased (n = 22), and in 47 healthy subjects. Results Lymphopenia and eosinopenia were observed in all COVID‐19 patients, with more intensity in the admitted and deceased groups, that also presented increased WBC and neutrophil counts. On CPD analysis, COVID‐19 was associated with increased volume of neutrophils, lymphocytes, and monocytes, whereas conductivity was decreased for neutrophils and increased for lymphocytes. The ROC curve analysis showed good performance for lymphocyte counts in predicting COVID‐19 diagnosis (AUC = 0.858), for neutrophil counts in predicting admission for COVID‐19 (AUC = 0.744) and for monocytes volume in predicting COVID‐19 diagnosis (AUC = 0.837). Conclusion WBC counts and CPD parameters at disease onset in COVID‐19 patients can improve diagnostic characterization and aid in the discrimination between severe and nonsevere presentations.

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Introdução: A Coronavirus Disease (COVID-19) apresenta variado espectro clínico em pacientes pediátricos e têm sido observado que crianças e adolescentes podem desenvolver a Síndrome Inflamatória Multissistêmica Pediátrica (SIMP) após a infecção pelo SARS-CoV-2. Objetivo: Descrever o manejo da SIMP em crianças após infecção pelo SARS-CoV-2. Material e métodos: Realizou-se uma revisão bibliográfica da literatura nas bases de dados Scientific Electronic Library Online (SciELO) e PubMed. Para a realização da busca, foram utilizados os descritores ”COVID-19”,”Síndrome inflamatória multissistêmica pediátrica”,”Criança”, “Inflamação”. Resultados: A SIMP é caracterizada por uma resposta inflamatória exacerbada com potencial lesão sistêmica. No geral possui bom prognóstico, porém alguns pacientes podem evoluir para quadros mais graves e até fatais com o desenvolvimento de disfunção pulmonar, cardiovascular, hematológica e renal. A partir da revisão realizada constatou-se a inexistência de diretrizes específicas, bem como de estudos comparativos avaliando os protocolos de tratamento desta patologia. A literatura mostra que a partir da suspeita ou confirmação da SIMP, tratam-se os sintomas específicos ou utiliza-se protocolos de enfermidades semelhantes, como a doença de Kawasaki. O uso de glicocorticoides, como Dexametasona e Metilprednisolona, é recomendado em pacientes com choque refratário e febre persistente, a fim de suprimir a resposta imune e controlar o estado inflamatório. O emprego de de imunomoduladores como o Infliximabe, Anakinra, Canacinumabe e Tocilizumabe age interferindo no sistema imunológico e é indicado principalmente em quadros clínicos graves ou que apresentam resistência ao tratamento inicial com imunoglobulina e pulsoterapia com corticoides. Em casos clínicos com sepse, a antibioticoterapia empírica deve ser instituída. Ainda não há comprovações de eficácia total dos fármacos para crianças contra o vírus, porém, em casos graves com infecção de SARS-CoV-2 ativa, considera-se o Remdsivir mediante atenção aos efeitos colaterais associados ao comprometimento da função renal. Conclusão: A equipe médica deve ser capaz de reconhecer a SIMP e tratá-la precocemente a fim de reduzir complicações e mortalidade. Uma vez que o manejo desta patologia ainda não está padronizado devido a baixa manifestação de casos e pelas variáveis acerca da resposta distinta do vírus, mais estudos são necessários a fim de estabelecer o tratamento mais adequado.