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Ventilator associated pneumonia(VAP) is a severe complication that can lead to high mortality when not early identified or when therapy is delayed. The aim of this study was to evaluate procalcitonin(PCT) as a biomarker for VAP development. In total, 73 hospitalized patients with COVID-19 were analyzed. PCT levels greater than 0.975ng/mL were more related to VAP. No association was found for C-reactive protein (CRP). The results show that procalcitonin may be a pertinent biomarker for VAP diagnosis and can be a helpful tool for antibiotic withdrawal., Competing Interests: Conflicts of interest On behalf of all authors, the corresponding author states that there is no conflict of interest to declare., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The global spread of carbapenemase-producing organisms (CPO) has been considered by international health authorities as a critical public health concern. Brazil has a high CPO prevalence according to distinct publications but many routine microbiology laboratories have only phenotypic resources to evaluate this epidemiological situation, which is time-consuming and detects only carbapenem-resistant isolates missing CPO susceptible expressing a slightly decreased susceptibility. New molecular platforms can detect CPO faster but a local evaluation is essential., Aim: To evaluate the performance of CPO detection direct from rectal swabs with the Xpert Carba-R™ assay (Cepheid, Sunnyvale, CA) in the largest Brazilian University Hospital., Methods: A prospective diagnostic accuracy study of CPO was performed with the collection of rectal swabs from patients admitted into the Intensive Care Unit (ICU) and into the Emergency Department (ED) between April and July 2016. The Xpert Carba-R™ assay results were compared with carbapenem-resistant Enterobacterales (CRE) surveillance cultures plus in-house PCR carbapenemase detection (reference method). In case of discordant results between methods, additional tests were performed. The limit of detection (LoD) for the CRE culture and the Xpert Carba-R™ assay were performed with contrived isolates of known carbapenemases genes., Results: A total of 921 clinical rectal swabs were analyzed being 21% (196/921) from the ICU and 79% (725/921) from the ED. Overall, the Xpert Carba-R™ assay detected 9.9% (91/921) of CPOs being 9.5% (87/921) positive only for bla KPC and 0.4% (4/921) positive only for bla NDM. The reference method detected 9.1% (84/921) CPO being 77 (8.4%) bla KPC, 5 bla VIM (0.5%) and 2 bla NDM (0.2%). No IMP or OXA-48 like gene was detected. Overall, twelve samples, 1.3% (10 bla KPC , 2 bla NDM ) were Xpert Carba-R™ positive but negative by the reference method. Five isolates (0.5%) were positive for bla VIM only by in-house PCR and confirmed to be bla VIM-2 by DNA sequencing. The Kappa value, sensitivity, specificity, positive/negative predictive values and accuracy of the Xpert Carba-R™ assay were; 0.893 (95% confidence interval [CI], 0.842-0.944), 94% (86.7-98.0), 98.6% (97.5-99.3), 86.8% (78.1-93.0), 99.4% (98.6-99.8) and 98.2% (97.3-99.1), respectively. The LoD for bla KPC of the Xpert Carba-R™ assay and the CRE cultures were 10 1  CFU/swab., Conclusion: The Xpert Carba-R™ assay is an accurate test to detect CPO directly from the rectal swabs with significant lower turnaround time (TAT) when compared to the reference method (CRE culture plus in-house PCR). Xpert Carba-R™ may, therefore, be regarded as a good and fast epidemiological tool., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The objective was to evaluate the performance of surveillance cultures at various body sites for Staphylococcus aureus colonization in pregnant women and newborns (NB) and the factors associated with nasal colonization. For NB, 4 sites were evaluated: nares, oropharynx, perineum, and umbilical stump (birth, third day, and weekly). For pregnant women, 4 sites during labor: anterior nares, anus, perineum, and oropharynx. Nasally colonized patients were compared with colonized only extranasally. Colonization was 53% of 392 pregnant women (methicillin-resistant S. aureus [MRSA]: 4%) and 47% of 382 NB (MRSA: 9%). For newborn patients, the best body site was the umbilical stump (methicillin-susceptible S. aureus [MSSA]: 64%; MRSA: 68%) and the combination of nares + umbilical (MSSA: 86%; MRSA: 91%). Among pregnant women, the best body site was the anterior nares (MSSA: 59%; MRSA: 67%) and the combination of nares + oropharynx (MSSA: 83%; MRSA: 80%). A smaller number of household members were associated with MRSA carriage in pregnant women (2.2 ± 0.6 versus 3.6 ± 1.8; P = 0.04). In conclusion, multiple culture sites are needed. Control programs based on surveillance cultures may be compromised., (Copyright © 2012 Elsevier Inc. All rights reserved.)