RESUMO
ABSTRACT Background: COVID-19 is a new disease and the most common complication is pneumonia. The Radiological Society of North America (RSNA) proposed an expert consensus for imaging classification for COVID-19 pneumonia. Objective: To evaluate sensitivity, specificity, accuracy, and reproducibility of chest CT standards in the beginning of the Brazilian COVID-19 outbreak. Methods: Cross-sectional study performed from March 1st to April 14th, 2020. Patients with suspected COVID-19 pneumonia submitted to RT-PCR test and chest computed tomography (CT) were included. Two thoracic radiologists blinded for RT-PCR and clinical and laboratory results classified every patient scan according to the RSNA expert consensus. A third thoracic radiologist also evaluated in case of discordance, and consensus was reached among the three radiologists. A typical appearance was considered a positive chest CT for COVID-19 pneumonia. Sensitivity, specificity, positive and negative predictive values were calculated. Cohen's kappa coefficient was used to evaluate intra- and inter-rater agreements. Results: A total of 159 patients were included (mean age 57.9 ± 18.0 years; 88 [55.3%] males): 86 (54.1%) COVID-19 and 73 (45.9%) non-COVID-19 patients. Eighty (50.3%) patients had a positive CT for COVID-19 pneumonia. Sensitivity and specificity of typical appearance were 88.3% (95%CI, 79.9-93.5) and 94.5% (95%CI, 86.7-97.8), respectively. Intra- and inter-rater agreement were assessed (Cohen's kappa = 0.924, P= 0.06; Cohen's kappa=0.772, P= 0.05, respectively). Conclusion: Chest CT categorical classification of COVID-19 findings is reproducible and demonstrates high level of agreement with clinical and RT-PCR diagnosis of COVID-19. In RT-PCR scarcity scenarios or in equivocal cases, it may be useful for attending physicians in the evaluation of suspected COVID-19 pneumonia patients attended at the emergency unit.
Assuntos
Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral , Infecções por Coronavirus , Betacoronavirus , COVID-19 , Pneumonia Viral/epidemiologia , Padrões de Referência , Brasil , Tomografia Computadorizada por Raios X , Estudos Transversais , Reprodutibilidade dos Testes , Infecções por Coronavirus/epidemiologia , Pandemias , SARS-CoV-2RESUMO
ABSTRACT A retrospective cohort study, were evaluated: polymyxin B plus aminoglycosides or polymyxin B plus other antibiotics. Any degree of acute kidney injury occurred in 26 (86.6%) patients. The median time to acute kidney injury was 6.0 (95% CI 3-14) days in the polymyxin-aminoglycoside containing regimen group, against 27.0 (95% CI 6-42) days in the polymyxin with other antimicrobial combinations group (p = 0.03). Polymyxin B with aminoglycosides group progressed faster to any degree of renal dysfunction.
Assuntos
Humanos , Masculino , Feminino , Polimixina B/uso terapêutico , Infecções por Enterobacteriaceae/tratamento farmacológico , Rim/efeitos dos fármacos , Mediastinite/microbiologia , Mediastinite/tratamento farmacológico , Antibacterianos/uso terapêutico , Testes de Sensibilidade Microbiana , Carbapenêmicos/farmacologia , Estudos Retrospectivos , Resultado do Tratamento , Estatísticas não Paramétricas , Medição de Risco , Resistência beta-Lactâmica/efeitos dos fármacos , Infecções por Enterobacteriaceae/mortalidade , Estimativa de Kaplan-Meier , Injúria Renal Aguda/induzido quimicamente , Aminoglicosídeos/uso terapêutico , Mediastinite/mortalidadeAssuntos
Adulto , Humanos , Masculino , Antibacterianos/farmacologia , Resistência beta-Lactâmica , Carbapenêmicos/farmacologia , Klebsiella pneumoniae/enzimologia , beta-Lactamases/biossíntese , Brasil , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Testes de Sensibilidade Microbiana , FenótipoAssuntos
Humanos , Infecções por Acinetobacter/diagnóstico , Acinetobacter baumannii/enzimologia , beta-Lactamases/genética , Infecções por Acinetobacter/microbiologia , DNA Bacteriano/genética , Reação em Cadeia da Polimerase em Tempo Real , Traqueia/microbiologia , Resistência beta-Lactâmica/genéticaAssuntos
Humanos , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/farmacologia , Polimixina B/farmacologia , Resistência beta-Lactâmica/efeitos dos fármacos , beta-Lactamases/biossíntese , Acinetobacter baumannii/enzimologia , Sinergismo Farmacológico , Testes de Sensibilidade MicrobianaRESUMO
The molecular epidemiology of carbapenemase-producing Klebsiella pneumoniae (KPC) has been largely investigated, but limited clinical information is available. A case-control study was performed to evaluate the risk factors for KPC bacteremia in hospitalized patients. Cases were patients with KPC bacteremia and controls were patients with non-KPC bacteremia. A total of 85 patients were included, 18 (21.2%) were KPC, and 67 (78.8%) were non-KPC (40 [59.7%] of them were extended-spectrum beta-lactamase producers). All KPC isolates were type 2 producers. These isolates belong to five distinct clones. Multivariate analysis showed that age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02 - 1.11; p = 0.004), presence of mechanical ventilation (OR, 11.1; 95% CI, 1.92 - 63.3; p = 0.007) and fluoroquinolone exposure during hospitalization (OR, 28.9; 95% CI, 1.85 - 454.6; p = 0.02) were independent risk factors for KPC in patients with K. pneumoniae bacteremia. Factors associated with severity of illness, such as age and mechanical ventilation, seem to be the main risks factors for KPC. Fluoroquinolones use might be a risk factor for KPC bacteremia. Further investigations on risk factors for KPC are warranted.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bacteriemia/microbiologia , Proteínas de Bactérias/metabolismo , Infecção Hospitalar/microbiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , beta-Lactamases/metabolismo , Bacteriemia/diagnóstico , Infecção Hospitalar/diagnóstico , Métodos Epidemiológicos , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/epidemiologiaRESUMO
A febre de origem indeterminada (FOI) é uma entidade nosológica frequentemente encontrada na prática clínica diária, mas pouco lembrada durante a graduação em medicina. O objetivo desse trabalho é fazer uma revisão sobre o tema para que frente a um caso sugestivo de FOI, esse diagnóstico seja identificado, facilitando sua abordagem diagnóstica e terapêutica.