LATENT CLASS ANALYSIS: AN INNOVATIVE APPROACH FOR IDENTIFICATION OF CLINICAL AND LABORATORY MARKERS OF DISEASE SEVERITY AMONG COVID-19 PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

Evidence about the phenotypic profile of COVID-19 ICU patients in sub- Saharan Africa remains insufficient. Our study aimed to identify clinical and laboratory phenotype distribution patterns and their usefulness as prognostic markers in COVID-19 patients admitted to the intensive care unit (ICU) in South Africa. We used a latent class analysis (LCA) model in a prospective cohort study of clinical and laboratory data collected from 343 COVID-19 patients between 27 March 2020 and 10 February 2021. A sub-analysis was performed to determine sub-phenotypes associated with clinical outcomes among COVID-19 patients and their impact on survival. Data from 343 COVID-19 patients were analysed. Two distinct phenotypes 1 and 2, comprising 68.46 % and 31.54% patients respectively, were identified. The phenotype 2 patients were characterized by increased coagulopathy markers (D-dimer, median value 1.73 ng/L vs 0.94 ng/L, p <0.001), end-organ dysfunction (creatinine, median 79 umol/L vs 69.5 umol/L, p <0.003), under-perfusion marker (lactate, median value 1.60 mmol/L, vs 1.20 mmol/L, p <0.001), abnormal cardiac function markers (median N‐terminal pro‐brain natriuretic peptide (NT-proBNP) 314 pg/ml vs 63.5 pg/ml, p <0.001 and median high‐sensitivity cardiac troponin (Hs-TropT) 39 ng/l vs 12 ng/ l, p<0.001) and acute inflammatory syndrome (median neutrophil-to-lymphocyte ratio 15.08 vs value 8.68, p <0.001 and monocyte, median value 0.68 × 109/L vs 0.45 × 109/L, p <0.001). Females in class 2 had lower mean haemoglobin levels than females in class 1 (11.88g/dL vs 12.67g/dL, p = 0.014). In a sub-analysis, mortality and survival were characterized in two sub-phenotypes with increased acute inflammatory syndrome, under-perfusion, end-organ dysfunction, and cardiac function markers in sub-phenotype 2. The identification of COVID-19 phenotypes and sub-phenotypes among ICU patients could be used as prognostic markers in day-to-day management of patients. Future studies are required in sub-Sahara Africa to elucidate pathophysiological mechanisms underlying these phenotypes. [ FROM AUTHOR] Copyright of International Journal of Infectious Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Clinical manifestations and laboratory findings and mortality rate of kidney transplant recipients infected with COVID-19

Introduction: The emergence of a novel coronavirus (COVID-19) in late December 2019 and its rapid global spread has led World Health Organization (WHO) to introduce it as a very dangerous pandemic. People with underlying disease and a history of organ transplantation are at higher risk for COVID-19 disease compared with healthy people. Objectives: In the present study, clinical and laboratory manifestations in the patients with COVID-19 with a history of kidney transplantation has been investigated. Patients and Methods: This study conducted on 103 COVID-19-positive kidney transplant patients as a descriptive epidemiological study. Clinical and laboratory symptoms of hospitalized renal transplanted patients have been assessed. Statistical analysis of the collected data conducted using SPSS (Statistical Package for Social Sciences, version 22). Results: This study consisted of 103 COVID-19 patients with a history of kidney transplant, of which 64 males (62.1%) and 39 females (37.9%) with an average age of 48.5 ± 13.1 years. The most common clinical manifestations were headache (67%) and shortness of breath (66%). Elevated lactate dehydrogenase (LDH) levels, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) has been observed in 100%, 98.1% and 93.2% of patients, respectively. In 12.6% and 41.7% of patients, the degree of lung involvement was above 75% and 50%-75%, respectively. Moreover, 79.6% of patients has been discharged after improved, while 20.4% of patients died. Conclusion: We found, kidney transplantation may increase COVID-19-related mortality when compared to COVID-19-related mortality in the general population. [ FROM AUTHOR]

Distribution of anaerobic bacteria and their sensitivity pattern to several antibiotics at the clinical microbiology laboratory of school of medicine, universitas Indonesia, Jakarta in 2019-2020

Background and Objectives: Anaerobic bacteria are a common cause of endogenous infections, some of which can be life threatening. These bacteria are not easily cultured and isolated and often cannot even found from infected sites. Delayed or inappropriate treatment of these microorganisms can lead to failure in eradicating these infections. The purpose of this study was to determine the diversity of anaerobic bacteria at present and their pattern of sensitivity to several antibiotics. Materials and Methods: A retrospective study was conducted over a period of two years on various specimens. Specimens derived from body fluids are inoculated on a BacT/Alert (bioMérieux). Anaerobic isolates were identified by Gram staining and continued identification using Vitek 2® automated system. Antibiotic sensitivity examination was carried out using ATBTM ANA (bioMérieux). Results: A total of 440 specimens were received in microbiology laboratory for anaerobic culture from patients with multiple infections from 13 hospitals in Jakarta. Our research was able to identify 18 species on anaerobic bacteria, consisting 52.5% Gram positive and 47.5% Gram negative bacteria. The most common bacteria found were Clostridium perfringens (15%) from Gram positive and Provetella bivia (10%) from Gram negative. The sensitivity pattern shows that antibiotic piperacilline-tazobactam is 100% effective against anaerobic bacteria, while metronidazole as the drug of choice is only 75% effective. Against Gram positive, several antibiotics such as piperacilline-tazobactam, ticarcilin-clavunic acid, cefoxitin, cefotetan, imipenem and chloramphenicol were 100% effective, however metronidazole occupied the lowest position (61.9%). Meanwhile against Gram negative antibiotics piperacilline-tazobactam is 100% effective and chloramphenicol in the second position (94.75%). Conclusion: Clostridium perfringens and Provetella bivia are the most common bacteria found. The antibiotics piperacilline-tazobactam is 100% effective against both Gram positive and negative. The accuracy of specimen management, isolation, identification and sensitivity examination will determine the successful microbiological investigations. [ FROM AUTHOR] Copyright of Iranian Journal of Microbiology is the property of Tehran University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)