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Paracoccidioidomycosis (PCM) is one of the main endemic systemic mycoses in Latin America, usually occurring in rural areas. When PCM occurs simultaneously with underlying immunosuppressive conditions, it can present as an opportunistic disease. Between 2000 and 2017, literature reported around 200 PCM cases in people living with HIV/AIDS (PLWHA). To address research gaps on this co-infection and to study its possible temporal changes in the last decade, we performed an active co-infection case search on the HIV/AIDS and PCM cohorts from a Brazilian reference center database from 1989 to 2019. We found 20 PLWHA among 684 PCM patients (2.92%), predominantly male (70.0%) and urban workers (80.0%). The median age of patients was higher in the 2010-2019 decade (p = 0.006). The occurrence of PCM in PLWHA was lower when compared with other fungal diseases. Although 50.0% of the patients had already been diagnosed with HIV infection and presented CD4+ T cell counts greater than 200/mm3 at the time of PCM diagnosis, the suspicion of immunosuppression in the context of atypical and more severe clinical forms of PCM revealed the diagnosis of HIV infection in 35.0% of the patients. Two (10.0%) patients had an evolution compatible with immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral therapy (ART).We highlight the importance of considering a PCM diagnosis in PLWHA to prevent a late-onset treatment and progression to severe manifestations and unfavorable outcomes. In addition, HIV investigation is recommended in PCM patients, especially those with atypical and more severe clinical presentations.

Objective: The stewardship strategy refers to a consistent practice to promoting responsible antimicrobial use. Optimizing the use of antibiotics is critical to mitigating adverse effects and combating bacterial resistance. The pillars of a stewardship program include: i) clinical pharmacist and infectologist with expertise; ii) educational measures for prescribers, nurses and pharmacists; iii) prophylaxis and therapeutic protocol; iv) monitoring of indicators. In this scenario of antimicrobial rational use, the older population are more susceptible to infection because immunocenescence and, therefore, greater use of antimicrobials is expected. Thus, the aim of the present study is to evaluate the prescription compliance of antimicrobial whose use is restricted in a hospitalized elderly population. Method: observational, controlled study in a Brazilian hospital, from January 2021 to January 2022. Based on the electrotonic antimicrobial form, the compliance of the prescriptions was evaluated. The definition used for elderly corresponded to individuals over 60 years old, according to the Brazilian Nation Principles for Older Persons, ordinance number 2528, of October 2006. Restricted drugs were considered: carbapenems, polymyxin, ceftazidime-avibactam, linezolid, tigecycline, ceftaroline, echinocandins and amphotericin. Results: A total of 1.688 requests for restricted use were received, of which 53% corresponded use in elderly group. Neutropenic fever was more common in young people and the inpatient unit was the sector with the highest percentage of antimicrobials. Furthermore, teicoplanin was the main drug that required intervention. Conclusion: Faced with the increase in bacterial resistance, the rational use of antimicrobials is extremely important, especially in older age group.