O objetivo do presente estudo foi avaliar a mortalidade e as alterações de parâmetros laboratoriais na presença de culturas positivas para bactérias e fungos em pacientes COVID-19 positivos admitidos nos CTIs, em um hospital terciário de ensino de Mato Grosso do Sul. Trata-se de um estudo observacional retrospectivo realizado por meio de coleta de dados clínicos e laboratoriais de pacientes adultos admitidos nos CTIs, com diagnóstico confirmado para SARS-CoV-2, entre os meses de julho e agosto de 2020. A presença de ao menos uma cultura positiva em pacientes críticos com COVID-19 foi associada a maiores taxas de mortalidade, maiores períodos de internação, e a maiores níveis de D-dímero e PCR. Pacientes do sexo masculino foram mais propensos a culturas positivas, e idades mais avançadas foram associadas a contagens plaquetárias mais baixas. Contagens de leucócitos mais elevadas e contagens plaquetárias mais baixas foram também associadas a maiores taxas de mortalidade. As culturas que apresentaram maior taxa de positividade foram as culturas de aspirado traqueal. Os principais microrganismos encontrados nos exames de cultura foram a levedura Candida albicans e as espécies de Staphylococcus coagulase negativas. As bactérias Acinetobacter baumannii e Klebsiella pneumoniae destacaram-se por apresentarem perfis de resistência mais frequentes. Nota-se, portanto, a importância da adoção de medidas que previnam infecções hospitalares secundárias em pacientes com COVID-19 e o desenvolvimento de mecanismos de resistência por microrganismos de relevância clínica. O laboratório destaca-se na identificação desses microrganismos e no direcionamento para o uso de antibióticos e antifúngicos mais apropriados para cada caso específico.

The Curtobacterium genus is a member of the family Microbacteriaceae, and Curtobacterium species are recognized as plant pathogens. The aim of this study was to investigate a dubious result of species identification for an infection located on a catheter tip of a patient with Covid‐19. A strain isolated from a catheter tip sample, identified by VITEK® 2 as Cronobacter spp., was submitted to polyphasic analysis: Matrix‐Assisted Laser Desorption Ionization‐Time of Flight Mass Spectrometry (MALDI‐TOF MS) using VITEK® MS, real‐time polymerase chain reaction targeting dnaG gene, and 16S rRNA full gene Sanger sequencing analysis for confirmation. The strain presented negative result using qPCR and could not identified by MALDI‐TOF MS. 16S rRNA full gene Sanger sequencing analysis identified the strain as Curtobacterium spp. The Gram‐variable characteristic (Gram‐negative instead of Gram‐positive) of the isolated strain was the responsible for the misidentification by VITEK® 2 and VITEK® MS did not identify the strain. 16S rRNA full gene sequencing analysis identified the strain as Curtobacterium genus, but other complementary techniques are necessary to identify at species level.

Introduction: Paradoxical reaction in tuberculosis (TB) is defined as the reappearance of general symptoms, aggravation of pre-existing diseases, or appearance of new lesions despite adequate anti-TB therapy. It may result from the hyperactivity of the immune response, resulting in an intense inflammation. There are few cases of vertebral TB reported as paradoxical reaction, mainly among immunocompetents patients. Patient concerns: We describe a male immunocompetent patient with confirmed pulmonary and meningeal TB. He was readmitted after 60 days of adequate treatment, with vertebral TB and paravertebral abscess, despite clinical improvement of the other locations. We defined as an uncommon case of a paradoxical reaction, confirmed by nuclear magnetic resonance and molecular rapid test for TB. Diagnosis: Mycobacterium tuberculosis (MTB) was detected in cerebrospinal fluid by molecular rapid test (Gene Xpert MTB/ rifampicina method). Sputum research and culture were positive for the same agent. Lumbosacral spine nuclear magnetic resonance revealed bone destruction from T8 to T11, and a paravertebral collection was found. Gene Xpert MTB/rifampicina and culture were positive for M tuberculosis in the drained material of the paravertebral abscess. Interventions: The paravertebral abscess was drainage by tomography-guided. Treatment with 4 anti-TB drugs was extended for 60 days and 2 anti-TB drugs was maintained for 10 months. There was a complete clinical improvement. Outcome: After draining the paravertebral abscess, the patient progressively improved and was discharged for outpatient follow-up. He was on antituberculous drugs for 1 year; subsequently, complete resolution of the infection was reported. Conclusion: Paradoxical reaction may be a difficult diagnosis in immunocompetent patient. Vertebral TB as a paradoxical reaction is an uncommon presentation. Therapeutic failure or resistance to treatment should be ruled out to confirm the diagnosis of paradoxical reaction.