Maria Helena Rigatto

Extreme climate events favor the spread of waterborne diseases. This study analyzes the impact of the historic floods occurred in Rio Grande do Sul State, Brazil, in 2024 on leptospirosis incidence. This is a descriptive cross-sectional study based on secondary data from official health information systems, comparing confirmed cases, hospitalizations, and deaths between April and July 2023 and the same period in 2024. Monthly trends, sociodemographic characteristics, and spatial distribution of cases were examined. From April to July, the number of cases increased from 117 in 2023 to 1,007 in 2024, a 7.6-fold rise, with a peak in May 2024 (516 cases). Hospitalizations increased from 89 to 228, with June showing a marked rise (76 in 2024 and 15 in 2023), and deaths rose from seven to 35, with the sharpest increase in May (one in 2023 and 20 in 2024). Despite the absolute increase, mortality rates declined from 6% in 2023 to 3.5% in 2024. In 2024, the most affected groups remained young white men, consistent with the 2023 profile. Over 200 municipalities reported cases in 2024, particularly Porto Alegre, Alvorada, Canoas, and São Leopoldo (all located in the Porto Alegre Metropolitan Area), which together accounted for nearly half of cases. The findings suggest that floods contributed to intensified transmission, increased hospital burden, and higher leptospirosis-related mortality. These results underscore the need for integrated epidemiological surveillance, resilient urban infrastructure, and preventive strategies to reduce population vulnerability to future climate-related disasters.

Background: Peripheral venous catheters (PVCs) are widely used vascular access devices and can cause significant adverse events, including bloodstream infections (BSIs). Aim/Objectives: To map the scientific literature on PVC-BSI. Methods: A scoping review including 67 studies, from MEDLINE/PubMed, SciELO, EMBASE, and LILACS/BIREME, was conducted, synthesizing data on incidence rates, microbiology, risk factors, preventive strategies, and economic burden. Findings/Results: PVC-BSI incidence shows marked geographic and clinical variation, with rates ranging from 0.1 to 0.5 cases per 1,000 catheter-days in high-income countries, contrasting with significantly higher averages in developing regions such as Latin America (2.06) and the Middle East (2.32). Effective preventive strategies included staff education, bundle implementation, active surveillance, multimodal interventions, chlorhexidine–alcohol skin antisepsis, and use of innovative devices. Staphylococcus spp. accounted for 20% to 70.7% of infections, but the proportion of Gram-negative bacilli might be increasing. Identified risk factors included the insertion site (hand punctures were protective), parenteral nutrition, catheter gauge (larger than 16G), and material contamination. Only one study addressed costs, estimating an additional expenditure exceeding €5,000 per infected patient. Discussion: Although less frequent than central venous catheter infections, PVC-related bloodstream infections represent an important public health concern due to their widespread use. Incidence is likely underestimated because of limited reporting and variable diagnostic criteria. Standardized definitions, systematic surveillance, continued professional training, and more research—especially in low- and middle-income settings—are needed to improve prevention and management.

Background: Urinary tract infections (UTIs) in kidney transplant (KT) recipients are frequent and associated with increased morbidity and mortality. Traditional outcome measures may underestimate its true clinical burden. The Desirability of Outcome Ranking (DOOR), developed by the Antibacterial Resistance Leadership Group, is a patient‐centered composite outcome designed to capture the full spectrum of infectious complications. Methods: We refined the DOOR framework for complicated UTIs by incorporating transplant‐specific variables and evaluated its application in a cohort of KT recipients with UTIs between 2013 and 2023. Results: Ninety‐seven patients with carbapenem‐resistant (CR) UTIs were matched 1:1 by infection year to patients with carbapenem‐susceptible (CS) infections. Compared with the standard cUTI DOOR, the KT‐UTI DOOR reclassified 41 patients to worse outcome ranks. Using the KT‐UTI DOOR, the probability of a more favorable outcome in CR versus CS infections was 41.3% (95% CI: 34.2%–48.7%, p = 0.02) in the unadjusted analysis and 43.4% (95% CI: 36.2%–50.9%, p = 0.08) after adjustment. Transplant‐related complications were the only events independently associated with CR infections. In contrast, using the established cUTI DOOR, the corresponding probability was 45.8% (95% CI: 38.8%–52.9%, p = 0.24) in the adjusted analysis. Conclusion: Incorporating transplant‐related variables improves the clinical relevance of DOOR in KT recipients. image

Despite the effectiveness of vaccination in preventing severe COVID-19, some individuals remain at risk. The study goal was to determine risk factors for COVID-19 requiring hospital admission. A case-control study was conducted in Porto Alegre, Brazil. Vaccinated adults with confirmed SARS-CoV-2 infection from February 2021 to March 2023 were eligible. Hospitalized patients (cases) and outpatients with non-severe infections (control group) were time-matched in a 1:1 ratio. Moreover, we followed hospitalized patients (cases) to evaluate factors related to 30-day mortality and/or ventilation support. We included 364 patients: 182 cases and 182 controls. Age > 60 years (odds ratio [OR] 3.98 [95% confidence interval{CI} 2.23-7.19]), male sex (OR 3.07 [95%CI 1.78-5.40]), diabetes mellitus (OR 4.61 [95% CI 2.08-11.08]), cardiovascular disease (OR 4.07 [95%CI 1.73-10.64]), lung disease (OR 3.06 [95%CI 1.39-6.94]), obesity (OR 3.39 [95%CI 1.29-9.73]), and previous infection (OR 0.19 [95%CI 0.06-0.51]) were independently related to COVID-19 hospital admission. In the arm of hospitalized patients, the number of vaccine doses (OR 0.53 [95%CI 0.39-0.73]) was a protective factor against 30-day mortality and/or ventilation support, whereas obesity (OR1.62 [95%CI 1.19-2.20]) was a risk factor. Health policies should consider focusing on these risk populations for targeted interventions, such as additional boosters, early treatment and prophylaxis.

A tuberculose drogarresistente (TB-DR) representa um desafio crescente à saúde pública global. Apesar de avanços terapêuticos recentes, como os esquemas totalmente orais com bedaquilina e pretomanida, sua eficácia depende do diagnóstico rápido e preciso da resistência aos tuberculostáticos. O diagnóstico laboratorial evoluiu de métodos fenotípicos convencionais, baseados em cultura, para tecnologias moleculares rápidas e, mais recentemente, o sequenciamento genético. Os testes fenotípicos, como o método de proporções em meio sólido e o MGIT 960 em meio líquido, são considerados padrão-ouro, mas apresentam longa duração e exigem uma cultura primária. Métodos moleculares como o Xpert MTB/RIF, incorporado ao SUS em 2014, permitem a detecção simultânea da TB e da resistência à rifampicina diretamente da amostra clínica, com alta acurácia e liberação de resultado em cerca de duas horas. Versões mais recentes, como o Xpert MDR/XDR, ampliam o espectro de detecção de resistência, mas ainda não estão disponíveis no SUS. O Line Probe Assay (LPA) oferece diagnóstico rápido de mutações nos genes rpoB, katG, inhA, gyrA/B, rrs e eis, mas geralmente requer cultura prévia e tem rendimento subótimo em amostras paucibacilares. Já os métodos de sequenciamento, como o de Sanger e o sequenciamento de nova geração (NGS), oferecem agilidade, maior abrangência genômica e detecção de heterorresistência, embora sua aplicação clínica ainda seja limitada no Brasil. Neste artigo, revisaremos os principais métodos laboratoriais para o diagnóstico da resistência aos tuberculostáticos, com ênfase em suas bases técnicas, vantagens, limitações e perspectivas de incorporação ao sistema de saúde.

Polymyxins are still widely used for the treatment of carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa bloodstream infections (BSIs). This study seeks to evaluate the impact of polymyxin B versus colistin on mortality and nephrotoxicity in BSI caused by these bacteria. We conducted a retrospective cohort study from 2014 to 2021 in Porto Alegre, Brazil. We included patients aged ≥18 years and excluded patients with polymicrobial infection or treatment for ≤48 h. The 30-day mortality was the primary outcome evaluated through Cox regression. We included 259 patients with BSI episodes: 78.8% caused by A. baumannii and 21.2% caused by P. aeruginosa. Polymyxin B did not impact mortality compared to colistin (adjusted hazard ratio (aHR), 0.82; 95% confidence interval (CI), 0.52–1.30; p = 0.40 (when adjusted for COVID-19 comorbidity, p = 0.05), Pitt bacteremia score, p < 0.01; Charlson comorbidity index, p < 0.001; time to start active antimicrobial therapy, p = 0.02). Results were maintained in the subgroups of BSI caused by A. baumannii (aHR, 0.92; 95% CI, 0.55–1.54; p = 0.74), P. aeruginosa (aHR, 0.47; 95% CI, 0.17–1.32; p = 0.15) and critical care patients (aHR, 0.77; 95% CI, 0.47–1.26; p = 0.30). Treatment with polymyxin B or colistin did not impact 30-day mortality in patients with carbapenem-resistant A. baumannii or P. aeruginosa BSI.

Background: Ideal therapy duration for Pseudomonas aeruginosa or Acinetobacter baumannii-calcoaceticus complex (ABC) bloodstream infections (BSI) is not defined, especially in the context of carbapenem resistance. In this study, we compared short- (≤7 days) and long-term (>7 days) antimicrobial therapy duration for these infections. Methods: We performed a retrospective cohort study in two tertiary-care hospitals in Porto Alegre, Brazil, from 2013 to 2019. Eligible patients aged ≥18 years were included and excluded for the following criteria: polymicrobial infections, treatment with non-susceptible antibiotics, complicated infections, or early mortality (ABC and 48.5% by Pseudomonas aeruginosa. Short-term therapy was not associated with 30-day mortality, adjusted hazard ratio 1.01, 95% confidence interval 0.47–2.20, p = 0.98, when adjusted for Pitt score (p = 0.02), Charlson Comorbidity Index score (p < 0.01), and carbapenem resistance (p < 0.01). Among patients who survived, short-term therapy was associated with shorter hospital stay (p < 0.01). Results were maintained in the subgroups of BSI caused by carbapenem-resistant bacteria (p = 0.76), ABC (p = 0.61), and Pseudomonas aeruginosa (p = 0.39). Conclusions: Long-term therapies for non-complicated Pseudomonas aeruginosa and ABC BSI were not superior to short-term therapy for 30-day mortality.