Epidemiological and clinical characteristics of COVID-19 in a Brazilian public hospital

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become a major health concern worldwide.In that context,the understanding of epidemiological and clinical features associated with the disease and its severity is crucial for the establishment of strategies aimed at disease control and remedy.AIM To describe epidemiological features,signs,symptoms,and laboratory findings among severely ill COVID-19 patients from an inten-sive care unit in northeastern Brazil as well as to evaluate predictor factors for disease outcomes.METHODS This is a prospective single-center study that evaluated 115 patients admitted to the intensive care unit in a northeastern Brazilian hospital.RESULTS The patients had a median age of 65.60±15.78 years.Dyspnea was the most frequent symptom,affecting 73.9%of the patients,followed by cough(54.7%).Fever was reported in approximately one-third of patients and myalgia in 20.8%of the patients.At least two comorbidities were found in 41.7%of the patients,and hypertension was the most prevalent(57.3%).In addition,having two or more comorbidities was a predictor of mortality,and lower platelet count was positively associated with death.Nausea and vomiting were two symptoms that were predictors of death,and the presence of a cough was a protective factor.CONCLUSION This is the first report of a negative correlation between cough and death in severely ill severe acute respiratory syndrome coronavirus 2-infected individuals.The associations between comorbidities,advanced age,and low platelet count and the outcomes of the infection were similar to the results of previous studies,highlighting the relevance of these features.

Streptococcus agalactiae:Identification methods,antimicrobial susceptibility, and resistance genes in pregnant women

BACKGROUND Group B Streptococcus(GBS)is a normal component of the gastrointestinal and genital microbiota in humans and can lead to important infections in newborns.AIM To compare GBS isolation and identification methods as well as to assess the antibiotic susceptibility and to identify resistance genes in GBS strains from pregnant women attended in healthcare services from the city of Vitória da Conquista,in Bahia State,Brazil.METHODS From January 2017 to February 2018,vaginorectal swabs were obtained from 186 participants and the samples were seeded onto chromogenic agar for GBS before and after inoculation in selective broth.Confirmatory identification using 3 CAMP and latex tests was performed in samples with GBS-suggestive colonies.Then,disk diffusion antibiograms were performed in GBS-positive samples,and the detection of the resistance genes ermB,ermTR,mefA,and linB in the clindamycin and/or erythromycin-resistant samples was carried out.RESULTS Thirty-two samples(17.2%)were GBS-positive.The culture in chromogenic agar after sample incubation in selective broth was the most sensitive method(96.9%)for GBS detection.All isolates were susceptible to penicillin,ampicillin,cefotaxime,and vancomycin.Clindamycin resistance was observed in 6 samples(18.8%),while 8 samples(25%)were erythromycin-resistant.All erythromycin and/or clindamycin-resistant GBS strains had negative D-tests.Two strains(25%)presented an M phenotype and 6 isolates(75%)presented a cMLSB phenotype.The ermB gene was identified in 4 samples(44.4%),the mefA gene was also found in 4 samples(44.4%),the ermTR gene was identified in 1 isolate(11.1%),and the linB gene was not found in any isolate.CONCLUSION This study evidenced that the screening for SGB can be performed by means of various methods,including chromogenic media,and that the chemoprophylaxis for pregnant women who cannot use penicillin must be susceptibility-guided.

Relationship between Mollicutes and spontaneous abortion:An epidemiological analysis

BACKGROUND Abortion is of great importance in public health,as it is among the main causes of maternal morbidity and mortality.In addition to sociodemographic-and lifestylerelated factors,studies have associated infections of the genital tract with higher rates of abortion.Therefore,the exacerbated presence and rise of Mollicutes in the genitourinary tract may be related to higher rates of abortion.AIM To perform an epidemiological analysis of women who had spontaneous abortions and placental colonization by Mollicutes in a maternity hospital.METHODS This cross-sectional study involved the collection of data and biological material from women hospitalized due to spontaneous abortion or term delivery.The sample consisted of 89 women who miscarried and 20 women who had full term pregnancy.Data collection was carried out in three stages:(1)Conducting research on the information and clinical data in medical records of patients hospitalized due to abortion;(2)Application of a semi-structured questionnaire to identify the patient's epidemiological profile and(3)Collection of placental tissue.Placental samples were collected after the curettage procedure(abortion)and after placental expulsion(delivery),both performed by an obstetrician.Microbial identification in the fragments was performed by real-time polymerase chain reaction.In this study,the following explanatory variables were considered:(1)Sociodemographic variables;(2)Variables related to access to health services;(3)Variables related to lifestyle;and(4)Variables related to sexual and reproductive health,all of which were used to perform descriptive,univariate and multivariate analyses.RESULTS In the final model,placental colonization by Mollicutes was independently associated with the variables age[odds ratio(OR)=7.55;CI:2.37-24.03]and menarche(OR=3.43;CI:1.03-11.44).In this investigation,the prevalence of Mollicutes colonization by at least one of the following three species:Mycoplasma hominis,Ureaplasma urealyticum,Ureaplasma parvum in women who had spontaneous abortion was 73.0%.When comparing colonization between the two groups of participating women,there was an 8.12-fold risk of placental colonization by at least one Mollicutes species in the women who had an abortion,compared to those who completed pregnancy.The final multivariate analysis model revealed a statistically significant association between placental colonization by Mollicutes in abortion with the following variables:age,as women up to 29 years old had a 7.55-fold risk of spontaneous abortion,compared to those who were older than 29 years;menarche,where women who had menarche up to 13 years old had a 3.43-fold risk of miscarriage compared to those who had menarche over 13 years old;and a change in eating habits,after the discovery of pregnancy,was a protective factor(OR=0.16).CONCLUSION These findings revealed a positive association between spontaneous abortion and placental colonization by Mollicutes.This indicates the need for further investigation of this issue,to guide decision-making for the prevention of abortion.

Identification and characterization of resistance and pathogenicity of Enterococcus spp.in samples of donor breast milk

BACKGROUND Breast milk is the primary source of nutrition for newborns.Hospitalized babies frequently need nutritional support from Human Milk Banks.As bacterial species of the genus Enterococcus are part of the microbiota of healthy donors,they may contaminate samples of pumped breast milk.AIM To identify and characterize the bacterial virulence and resistance in samples isolated from the nipple-areolar region,hands,and breast milk aliquots from donors at the Human Milk Bank of Municipal Hospital EsauMatos in the city of Vitória da Conquista,Bahia State,Brazil.METHODS The personal hygiene and sanitation of donors were analyzed with the aim of identifying possible reasons for contamination of pumped milk.Cutaneous samples as well as aliquots of unpasteurized and pasteurized milk from 30 participants were obtained.Each Enterococcus spp.isolate underwent a disk diffusion susceptibility test and molecular biology techniques to determine resistance and virulence genes.RESULTS Enterococcus spp.were identified in 30%of donors(n=9),and 11 specimens were isolated.Resistance to tetracycline was highly prevalent,being detectable in 63%of the isolates(n=7)and followed by intermediate sensitivity to ciprofloxacin,observed in 27%of the specimens(n=3).The efaA gene was found in 63%(n=7)of the isolates,while the ace gene was detected in 27%(n=3).CONCLUSION This study illustrates the importance of microbiological monitoring by Human Milk Banks and the need for alternatives to prevent the presence of Enterococcus spp.in hospital settings.