ABSTRACT
Background. The spread of carbapenem resistant Pseudomonas aeruginosa and carbapenemase-producing Enterobacterales (CPE) has had a great impact on morbidity and mortality. COVID-19 pandemic has favoured the selection of these microorganisms because of the excessive and prolonged use of broad-spectrum antibiotics and the outbreaks related to patient transfer between hospitals and inadequate use of personal protective equipment. Therefore, detection is considered essential for their control. Our aim was to compare conventional phenotypic synergy tests and two lateral flow immunoassays for detecting carbapenemases in Enterobacterales and P. aeruginosa. Methods. We analysed 100 carbapenem-resistant Gram-negative bacilli isolates, 80 Enterobacterales and 20 Pseudomonas aeruginosa, (86 isolates producing KPC, NDM, OXA-48, IMP and VIM carbapenemases and 14 non-carbapenemase-producing isolates). We performed a modified Hodge test, boronic acid and ethylenediaminetetraacetic acid (EDTA) synergy tests, and two lateral flow immunoassays: RESIST-4 O.K.N.V (Coris BioconceptR) and NG Test Carba 5R (NG BiotechR). Results. In total, 76 KPC, 7 VIM, 1 NDM, 1 OXA-48 and 1 isolate coproducing KPC + NDM enzymes were included. The concordance of different methods estimated by Kappa index was 0.432 (Standard error: 0.117), thus showing a high variability with the synergy tests with boronic acid and EDTA and reporting 16 false negatives that were detected by the two immunochromatographic methods. Co-production was only detected using immunoassays. Conclusion. Conventional phenotypic synergy tests with boronic acid and EDTA used for detecting carbapenemases are suboptimal and their routine use should be reconsidered. They depend on the degree of enzyme expression and the distance between disks. Lateral flow immunoassay tests are a rapid and cost-effective tool to detect and differentiate carbapenemases, improving clinical outcomes through targeted therapy and promoting infection prevention measures.
ABSTRACT
BACKGROUND: In December 2019, the largest pandemic we have faced in recent years began. As of the last day of August 2020 more than 25 million cases had been reported with more than 800,000 deaths worldwide caused by the disease called COVID-19. Manifestations of the disease include fever, dry cough, headache and anosmia, among others. With the advance of the pandemic, dermatologists around the world have published data on the skin manifestations of the disease, seeking to contribute to a better diagnosis. Likewise, there have been dermatological manifestations in health personnel and the general population derived from the use of personal protection and adverse effects of hygiene products. OBJECTIVES: To review dermatological manifestations related to COVID-19, as well as to review on prevention and treatment of cutaneous lesions in health professionals due to the use of personal protection equipment. METHODOLOGY: A review of the cases published from January 1st to August 29th, 2020 on the PubMed server was carried out with the keywords "Dermatology AND COVID-19". RESULTS: One hundred and sixty-two clinical cases were found in 102 publications. The average age of patients was 42.6 years with a median of 40. Regarding the sex when it was registered, the manifestations were more frequent in the female (48.76%). The skin lesions were very varied and the most frequently reported were acroischemic lesions, also described as perniosis, rashes or erythematous plaques, and urticaria. CONCLUSIONS: The role of dermatology in a pandemic of this magnitude is of vital importance in various areas;such as the investigation of possible cutaneous manifestations that facilitate the diagnosis or provide new information. to reduce or prevent injuries caused by protective equipment in health personnel.