Objective: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. Methods: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model. Results: During the study period, 120 patients with TB/HIV coinfection were admitted to the ICU. The mean age was 37.0 ± 11.7 years. Of the 120 patients evaluated, 94 (78.3%) died and 62 (66.0%) of those deaths having occurred within the first week after admission. Data on invasive mechanical ventilation (IMV) and ARDS were available for 86 and 67 patients, respectively Of those 86, 75 (87.2%) underwent IMV, and, of those 67, 48 (71.6%) presented with ARDS. The factors found to be independently associated with mortality were IMV (p = 0.002), hypoalbuminemia (p = 0.013), and CD4 count < 200 cells/mm3 (p = 0.002). Conclusions: A high early mortality rate was observed among TB/HIV coinfected ICU patients. The factors predictive of mortality in this population were IMV, hypoalbuminemia, and severe immunosuppression.

Keywords: Mycobacterium tuberculosis; Critical care; Respiration, artificial; Acquired immunodeficiency syndrome.

Background: Tracheostomy is a procedure commonly required in the intensive care unit. In the last two decades, the use of the percutaneous method has increased in parallel with improvements in the technique. Objective: To describe our experience in employing the percutaneous method over the last 3.5 years. Methods: We created, retrospectively, a database of prospective tracheostomy data related to 78 patients evaluated between January 2000 and July 2003. We used the percutaneous tracheostomy techniques of either progressive dilatation (in 36 patients) or forceps dilatation (in 42 patients). Data are expressed as number of occurrences or median with interquartile ranges. Results: The mean age of the patients was 66 (range, 43-75), and the median APACHE II score was 16 (range, 12-21). The median time spent on mechanical ventilation prior to tracheostomy was 14 days (range, 10-17 days). Of the 78 patients studied, 18 (23%) died while in the intensive care unit. The most common cause of admission was acute central nervous system disturbance (in 45%). Most of the tracheostomies performed were indicated due to difficulty in weaning from mechanical ventilation (in 50%) or to Glasgow Coma scores consistently lower than 8 (in 49%). Bronchoscopy was used in all but 6 of the procedures. There were complications in 33% of the procedures. The most common complication was light bleeding, without need for transfusion. No patient died due to complications arising from the procedure. Conclusion: Percutaneous tracheostomy is reasonable and safe when performed in an intensive care unit.

Keywords: Tracheostomy/methods. Respiration, Artificial/methods. Respiratory insufficiency/therapy. Respiratory insufficiency/complications.

Objective: To compare the performance of Charlson Comorbidity Index (CCI) with those of the mental Confusion, Urea, Respiratory rate, Blood pressure, and age = 65 years (CURB-65) score and the Pneumonia Severity Index (PSI) as predictors of all-cause in-hospital mortality in patients with community-acquired pneumonia (CAP). Methods: This was a cohort study involving hospitalized patients with CAP between April of 2014 and March of 2015. Clinical, laboratory, and radiological data were obtained in the ER, and the scores of CCI, CURB-65, and PSI were calculated. The performance of the models was compared using ROC curves and AUCs (95% CI). Results: Of the 459 patients evaluated, 304 met the eligibility criteria. The all-cause in-hospital mortality rate was 15.5%, and 89 (29.3%) of the patients were admitted to the ICU. The AUC for the CCI was significantly greater than those for CURB-65 and PSI (0.83 vs. 0.73 and 0.75, respectively). Conclusions: In this sample of hospitalized patients with CAP, CCI was a better predictor of all-cause in-hospital mortality than were the PSI and CURB-65.

Keywords: Pneumonia, ROC curve; Predictive value of tests; Severity of illness index.

Objective: Mycobacteriosis is frequently diagnosed among HIV-infected patients. In Mozambique, where few patients are under antiretroviral therapy and the prevalence of tuberculosis is high, there is need for better characterization of mycobacteria at the species level, as well as for the identification of patterns of resistance to antituberculous drugs. Methods: We studied a sample of 503 HIV-infected individuals suspected of having pulmonary tuberculosis. Of those 503, 320 tested positive for mycobacteria through sputum smear microscopy or culture of bronchoalveolar lavage fluid. Results: Acid-fast bacilli were observed in the sputum of 73% of the individuals presenting positive cultures. Of 277 isolates tested, only 3 were nontuberculous mycobacteria: 2 were identified as Mycobacterium avium and one was identified as M. simiae. Strains initially characterized as M. tuberculosis complex through polymerase chain reaction restriction analysis (PRA) of the hsp65 gene were later confirmed as such through PRA of the gyrB gene. Among the M. tuberculosis isolates, resistance patterns were as follows: to isoniazid, 14%; to rifampin, 6%; and multidrug resistance, 5%. Previously treated cases showed significantly higher rates of resistance to first-line antituberculous drugs. The most common radiological pattern was interstitial infiltrate (in 67%), followed by mediastinal lymph node enlargement (in 30%), bronchiectasis (in 28%), miliary nodules (in 18%) and cavitation (in 12%). Patients infected with nontuberculous mycobacteria presented clinical profiles indistinguishable from those of other patients. The median CD4 lymphocyte count in this group was 134 cells/mm3. Conclusions: There is a strong association between tuberculosis and AIDS in Mozambique, as expected in a country with a high prevalence of tuberculosis. Although drug resistance rates are high, the isoniazid-rifampin regimen continues to be the appropriate choice for initial therapy.

Keywords: Tuberculosis; Mycobacteria, atypical; HIV; Acquired immunodeficiency syndrome; Drug Resistance, Multiple; Mozambique.

Objective: To identify factors associated with prolonged weaning and mortality in critically ill COVID-19 patients admitted to ICUs and under invasive mechanical ventilation. Methods: Between March of 2020 and July of 2021, we retrospectively recorded clinical and ventilatory characteristics of critically ill COVID-19 patients from the day of intubation to the outcome. We classified the patients regarding the weaning period in accordance with established criteria. A logistic regression analysis was performed to identify variables associated with prolonged weaning and mortality. Results: The study involved 303 patients, 100 of whom (33.0%) had a prolonged weaning period. Most of the patients were male (69.6%), 136 (44.8%) had more than 50% of pulmonary involvement on chest CT, and 93 (30.6%) had severe ARDS. Within the prolonged weaning group, 62% died within 60 days. Multivariate analysis revealed that lung involvement greater than 50% on CT and delay from intubation to the first separation attempt from mechanical ventilation were significantly associated with prolonged weaning, whereas age and prolonged weaning were significantly associated with mortality. Conclusions: Prolonged weaning can be used as a milestone in predicting mortality in critically ill COVID-19 patients. Lung involvement greater than 50% on CT and delay from intubation to the first separation attempt from mechanical ventilation were identified as significant predictors of prolonged weaning. These results might provide valuable information for healthcare professionals when making clinical decisions regarding the management of critically ill COVID-19 patients who are on mechanical ventilation.

Keywords: COVID-19; Pneumonia, viral; Respiratory distress syndrome; Respiration, artificial; Ventilator weaning; Cohort studies; Hospital mortality; Patient outcome assessment.

Poor sleep quality is a consistently reported by patients in the ICU. In such a potentially hostile environment, sleep is extremely fragmented and sleep architecture is unconventional, with a predominance of superficial sleep stages and a limited amount of time spent in the restorative stages. Among the causes of sleep disruption in the ICU are factors intrinsic to the patients and the acute nature of their condition, as well as factors related to the ICU environment and the treatments administered, such as mechanical ventilation and drug therapy. Although the consequences of poor sleep quality for the recovery of ICU patients remain unknown, it seems to influence the immune, metabolic, cardiovascular, respiratory, and neurological systems. There is evidence that multifaceted interventions focused on minimizing nocturnal sleep disruptions improve sleep quality in ICU patients. In this article, we review the literature regarding normal sleep and sleep in the ICU. We also analyze sleep assessment methods; the causes of poor sleep quality and its potential implications for the recovery process of critically ill patients; and strategies for sleep promotion.

Keywords: Sleep; Sleep deprivation; Intensive care units.

Objective: To establish the incidence of acute lung injury and acute respiratory distress syndrome, as well as related risk factors and mortality in an intensive care unit. To compare patients developing lung injury with at-risk patients not presenting acute lung injury or acute respiratory distress syndrome. Methods: The study was conducted in the intensive care unit of the Ribeirão Preto Hospital das Clínicas Emergency Room. All patients admitted between May 2001 and April 2002 were monitored prospectively. Clinical data, Acute Physiologic and Chronic Health Evaluation II score, complications, length of stay in the intensive care unit and lung injury data were recorded. Results: Of the 524 patients admitted, 175 (33.4%) presented risk factors for acute lung injury and acute respiratory distress syndrome, 33 (6.3%) developed acute respiratory distress syndrome, and 12 (2.3%) developed acute lung injury. The main risk factors were pneumonia (37.7%), shock (32.0%), multiple trauma (24.6%) and sepsis (21.1%). Patients developing acute lung injury had higher Acute Physiologic and Chronic Health Evaluation II scores (p < 0.05), more frequently presented sepsis (p = 0.001), developed more complications (p = 0.001) and presented greater mortality (p = 0.001). The main cause of death was multiple organ failure (38.5%). Conclusion: The incidence of acute lung injury and acute respiratory distress syndrome was 2.3% and 6.3%, respectively.

Keywords: Respiratory distress syndrome, adult/epidemiology; Respiratory distress syndrome, adult/mortality;

Objectives: To identify the degree of risk and the practice of prophylaxis to venous thromboembolism (VTE) in an intensive care unit (ICU). Methods: The subjects were patients admitted to the ICU between December 1997 and February 1998. Patients were excluded if they were in anticoagulant therapy or presented contra-indication to heparin. Determination of risk factors and classification of the degree of risk for VTE were done according to international consensus. The ICU medical staff did not know about the study. Results: The authors evaluated one hundred and eighty patients with a mean age of 58 years (±16.5). Risk factors more frequently found were: age ³ 40 years (85.0%), surgery (47.8%), thoracic or abdominal infection (22.8%). Two or more risk factors were present in 146 (81%) cases. In the evaluation of VTE risk, 142 (79%) patients were classified as moderate/high risk. Prophylactic measures were prescribed to 102 patients (57%), and heparin was used in 60% of moderate/high risk cases. There was a significant association between risk level and the number of risk factors with the use of prophylaxis (p < 0.05). Conclusion: VTE risk factors were frequent in the sample analyzed. However, 40% of patients considered moderate/high risk did not receive pharmacological prophylaxis for VTE.

Keywords: thromboembolism, prevention & control

Introduction: The diagnosis of diffuse lung disease is still a challenge for the pediatric intensive care physician. Routine clinical examinations and laboratory tests are frequently negative. The objective of this study was to evaluate the diagnostic potential, the impact on therapy and the rate of complications of open lung biopsy in children with undiagnosed diffuse lung disease, respiratory failure and inappropriate response to initial therapy. Methods: From January 1987 to January 1997, 29 children with diffuse pulmonary disease of unknown etiology, respiratory failure (PaO2 /FiO2 < 300) and no response to previous treatments were considered for open lung biopsy. Newborns, children with known chronic pulmonary disease and children with untreatable shock or coagulopathy were excluded. All biopsies were performed by a thoracic surgeon by a microthoracotomy in the lung shown to be the most affected by X-ray examination. Tissue samples were analyzed in terms of cultures, light microscopy, electron microscopy and immunofluorescence microscopy, according to the pathologist's decision. Results: All biopsies (100%) resulted in at least one histological diagnosis and in 20 patients (68.9%) it was obtained a specific diagnosis. The most frequent histological patterns found were: non-specific interstitial pneumonitis with variable degrees of fibrosis in 18 cases; bronchiolitis in eight cases and pulmonary hypertension in three cases. Regarding the most frequent specific diagnosis, six children were found with cytomegalovirus infection, three with Pneumocystis carinii, three with adenovirus and three with respiratory syncytial virus infection. These data induced a change in therapy in 20 children (68.9%). The most frequent changes in therapy were the use of corticosteroids in 14 children and a review of the antibiotic regimen in six patients. Seven patients (24.1%) presented with complications that were easily resolved. There were 13 deaths, probably due to the critical conditions of these patients, all unrelated to the procedure. Conclusions: Open lung biopsy, though an invasive procedure, should be considered in the evaluation of selected children with undiagnosed diffuse lung disease, respiratory failure and with no satisfactory response to previous therapies.

The objective of this study was to determine the prevalence of HIV infection among individuals ≥ 15 years of age with a confirmed diagnosis of tuberculosis and treated at family health care clinics in the city of Fortaleza, Brazil. We evaluated a random sample of 110 patients with tuberculosis, treated at a total of 26 family health care clinics between January and May of 2009. All of the participants completed a questionnaire regarding sociodemographic and clinical data, and all underwent HIV testing. In this sample, the prevalence of tuberculosis/HIV co-infection was 3.6% (95% CI: 0.2-7.0).

Keywords: Tuberculosis; HIV seroprevalence; Primary health care.

Objective: To compare the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index scores and its individual components between COPD patients with and without severe physical inactivity, as well as to correlate the number of steps/day with scores of physical activity questionnaires, age, and the BODE index (including its components). Methods: We included 30 patients, who were evaluated for body composition, pulmonary function (FEV1), perception of dyspnea (modified Medical Research Council scale), and exercise capacity (six-minute walk distance [6MWD]). The patients also completed the International Physical Activity Questionnaire (IPAQ), short version, and the modified Baecke questionnaire (mBQ). The level of physical activity was assessed by the number of steps/day (as determined by pedometer), using the cut-off of 4,580 steps/day to form two groups: no severe physical inactivity (SPI−) and severe physical inactivity (SPI+). We used the Mann-Whitney test or t-test, as well as Pearson's or Spearman's correlation tests, in the statistical analysis. Results: In comparison with the SPI− group, the SPI+ group showed more advanced age, higher mBQ scores (leisure domain), lower 6MWD (in m and % of predicted), and lower IPAQ scores (metabolic equivalent-walk/week domain and total). The IPAQ scores showed weak correlations with steps/day (r = 0.399), age (r = −0.459), and 6MWD-in m (r = 0.446) and in % of predicted (r = 0.422). Conclusions: In our sample, the cut-off of 4,580 steps/day was not sensitive enough to identify differences between the groups when compared with the predictors of mortality. The IPAQ, short version score correlated with steps/day.

Keywords: Pulmonary disease, chronic obstructive/mortality; Pulmonary disease, chronic obstructive/ prevention and control; Motor activity.

Objective: To describe baseline characteristics of outpatients with a positive RT-PCR for SARS-CoV-2 and to define whether "red flags" (new-onset fever, dyspnea, and chest pain) can predict clinical worsening during the isolation period. Methods: This was an epidemiological, observational, descriptive study. Between March and September of 2020, all outpatients who tested positive for SARS-CoV-2 at a tertiary medical center located in Santiago de Chile were included. Demographic variables, comorbidities, red flags, and other symptoms were compiled using follow-up surveys at specific time points. The risk of clinical worsening (hospitalization) and adjusted hazard ratios (HRs) were calculated. Results: A total of 7,108 patients were included. The median age was 38 years (range, 0-101), and 52% were men. At baseline, 77% of the patients reported having characteristic symptoms of SARS-CoV-2 infection. The most prevalent onset symptoms were headache (53%), myalgia (47%), and fever (33%). According to the follow-up surveys, the incidence of symptoms decreased during the isolation period; however, 28% of the patients still presented with symptoms on day 14. The risk of hospitalization for patients with new-onset fever and dyspnea during the follow-up period was HR = 7.43 (95% CI, 3.85-14.3, p<0.01) and HR = 5.27 (95% CI, 1.52-18.30; p < 0.01 for both), respectively. New-onset chest pain showed no association with clinical worsening. Conclusions: In this sample of outpatients with a recent diagnosis of SARS-CoV-2 infection, a survey-based monitoring of symptoms was useful to identify those at risk of clinical worsening. New-onset fever and dyspnea during the isolation period were considered as red flags associated with clinical worsening and warrants prompt medical evaluation.

Keywords: Ambulatory care; COVID-19; Follow-up studies; Hospitalization; Outpatients.

Objective: To translate the Richards-Campbell Sleep Questionnaire (RCSQ) and Sleep in the Intensive Care Unit Questionnaire (SICUQ) to Portuguese, making the appropriate cross-cultural adaptations for their use in Brazil, as well as to determine the interobserver reliability of the instruments. Methods: In this study, we evaluated medical and surgical patients admitted to the adult ICU of the Federal University of Paraná Hospital de Clínicas, in the city of Curitiba, Brazil, between June of 2017 and January of 2018. The translation and cross-cultural adaptation of the questionnaires involved the following steps: translation, synthesis, back-translation, revision by an expert panel, approval of the back-translation by the original authors, pretesting, and creation of the final versions. Two researchers applied the Portuguese-language versions in the evaluation of critically ill patients. Interobserver reliability was assessed by calculating the intraclass correlation coefficient (ICC) and 95% CI. Results: The sample comprised 50 patients, of whom 27 (54%) were women. The mean age was 47.7 ± 17.5 years. The main reason for ICU admission, in 10 patients (20%), was cancer. The interobserver reliability of the questionnaires ranged from good to excellent. For the RCSQ, the ICC was 0.84 (95% CI: 0.71-0.90). For SICUQ domains 1-5 (sleep quality and daytime sleepiness), the ICC was 0.75 (95% CI: 0.55-0.86), whereas it was 0.86 (95% CI: 0.76-0.92) for SICUQ domains 6 and 7 (causes of sleep disruption). Conclusions: The cross-culturally adapted, Portuguese-language versions of the RCSQ and SICUQ appear to have good interobserver reliability.

Keywords: Sleep; Intensive care units; Sleep deprivation; Surveys and questionnaires; Translations; Cross-cultural comparison.

Objective: To translate the Perme Intensive Care Unit Mobility Score and the ICU Mobility Scale (IMS) into Portuguese, creating versions that are cross-culturally adapted for use in Brazil, and to determine the interobserver agreement and reliability for both versions. Methods: The processes of translation and cross-cultural validation consisted in the following: preparation, translation, reconciliation, synthesis, back-translation, review, approval, and pre-test. The Portuguese-language versions of both instruments were then used by two researchers to evaluate critically ill ICU patients. Weighted kappa statistics and Bland-Altman plots were used in order to verify interobserver agreement for the two instruments. In each of the domains of the instruments, interobserver reliability was evaluated with Cronbach's alpha coefficient. The correlation between the instruments was assessed by Spearman's correlation test. Results: The study sample comprised 103 patients-56 (54%) of whom were male-with a mean age of 52 ± 18 years. The main reason for ICU admission (in 44%) was respiratory failure. Both instruments showed excellent interobserver agreement (κ > 0.90) and reliability (α > 0.90) in all domains. Interobserver bias was low for the IMS and the Perme Score (−0.048 ± 0.350 and −0.06 ± 0.73, respectively). The 95% CIs for the same instruments ranged from −0.73 to 0.64 and −1.50 to 1.36, respectively. There was also a strong positive correlation between the two instruments (r = 0.941; p < 0.001). Conclusions: In their versions adapted for use in Brazil, both instruments showed high interobserver agreement and reliability.

Keywords: Physical therapy modalities; Intensive care units; Translations; Validation studies.

Objective: To evaluate the impact that the implementation of therapeutic guidelines has on the empirical treatment of nosocomial pneumonia. Methods: A clinical trial, using historical controls and involving current ICU patients who had acquired nosocomial pneumonia, was carried out from June of 2002 to June of 2003. All were treated according to therapeutic guidelines developed by the Commission for Nosocomial Infection Control of the institution (group with intervention). As controls, the medical charts of the patients who acquired nosocomial pneumonia between June of 2000 and June of 2001 (group without intervention) were analyzed. Mortality and mean treatment period, as well as the length of hospital and ICU stays, were determined for the patients who acquired nosocomial pneumonia. Results: Mortality associated with pneumonia was lower in the group treated according to the therapeutic guidelines (26 vs. 53.6%; p = 0.00). As for overall mortality, there was no statistically significant difference between the two periods (51 vs. 57.9%; p = 0.37). There was also no difference in the type of microorganisms isolated, treatment period, length of hospital stay or length of ICU stay. Conclusion: The implementation of therapeutic guidelines for the treatment of nosocomial pneumonia acquired in the ICU can be efficacious in decreasing mortality rates.

Keywords: Pneumonia/treatment; Cross infection; Intensive care units; Mortality.

Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) continue to challenge physicians and public health specialists. Global treatment outcomes continue to be unsatisfactory, positive outcomes being achieved in only 54% of patients. Overall outcomes are even worse in patients infected with highly resistant strains. Treating MDR-/XDR-TB is difficult because of frequent adverse events, the long duration of drug regimens, the high costs of second-line drugs, chronic post-infectious sequelae, and loss of organ function. Ongoing research efforts (studies and trials) have various aims: increasing the rates of treatment success; understanding the potentialities of new and repurposed drugs; shortening the treatment duration; and reducing the rates of adverse events. It is hoped that better access to rapid diagnostics, increased awareness, and treatments that are more effective will reduce the rate of complications and of lung function impairment. This article aims to discuss the management of severe tuberculosis (defined as that which is potentially life threatening, requiring higher levels of care) and its sequelae, from intensive care to the postoperative period, rehabilitation, and recovery. We also discuss the nonpharmacological interventions available to manage chronic sequelae and improve patient quality of life. Because the majority of MDR-/XDR-TB cases evolve to lung function impairment (typically obstructive but occasionally restrictive), impaired quality of life, and low performance status (as measured by walk tests or other metrics), other interventions (e.g., smoking cessation, pulmonary rehabilitation, vaccination/prevention of secondary bacterial infections/exacerbations, complemented by psychological and nutritional support) are required.

Keywords: Extensively drug-resistant tuberculosis; Tuberculosis, multidrug-resistant; Critical care; Smoking cessation.

Objective: To determine whether the use of a set of preoperative variables can predict the need for postoperative ICU admission. Methods: This was a prospective observational cohort study of 120 patients undergoing elective pulmonary resection between July of 2009 and April of 2012. Prediction of ICU admission was based on the presence of one or more of the following preoperative characteristics: predicted pneumonectomy; severe/very severe COPD; severe restrictive lung disease; FEV1 or DLCO predicted to be < 40% postoperatively; SpO2 on room air at rest < 90%; need for cardiac monitoring as a precautionary measure; or American Society of Anesthesiologists physical status ≥ 3. The gold standard for mandatory admission to the ICU was based on the presence of one or more of the following postoperative characteristics: maintenance of mechanical ventilation or reintubation; acute respiratory failure or need for noninvasive ventilation; hemodynamic instability or shock; intraoperative or immediate postoperative complications (clinical or surgical); or a recommendation by the anesthesiologist or surgeon to continue treatment in the ICU. Results: Among the 120 patients evaluated, 24 (20.0%) were predicted to require ICU admission, and ICU admission was considered mandatory in 16 (66.6%) of those 24. In contrast, among the 96 patients for whom ICU admission was not predicted, it was required in 14 (14.5%). The use of the criteria for predicting ICU admission showed good accuracy (81.6%), sensitivity of 53.3%, specificity of 91%, positive predictive value of 66.6%, and negative predictive value of 85.4%. Conclusions: The use of preoperative criteria for predicting the need for ICU admission after elective pulmonary resection is feasible and can reduce the number of patients staying in the ICU only for monitoring.

Keywords: Thoracic surgery; Risk factors; Intensive care units.

Objective: In July of 2021, the Brazilian National Ministry of Health integrated three months of once-weekly isoniazid plus rifapentine (3HP) into the National Guidelines for Tuberculosis Control as a first-line tuberculosis preventive therapy (TPT) option for people living with HIV (PLHIV) and tuberculosis household contacts (HHCs). As part of the Unitaid-sponsored Increasing Market and Public Health Outcomes through Scaling up Affordable Access Models of Short Course Preventive Therapy for TB project to implement short-course TPT, we evaluated 3HP uptake, completion, and tolerability among PLHIV and pediatric HHCs in Brazil. Methods: We conducted a multicenter single-arm pragmatic project to roll out 3HP for PLHIV and HHCs in the 2- to 14-year age bracket in the cities of Rio de Janeiro and Manaus, Brazil. Participants were identified, treated, and monitored in accordance with Brazilian national tuberculosis guidelines. De-identified patient-level data on treatment initiation, adverse events, and completion were collected and analyzed. Results: From October of 2021 to March of 2023, 380 PLHIV (77.6% of whom were male; median age, 40 years [IQR, 31-51]) and 74 HHCs (54.1% of whom were male; median age, 8.6 years [IQR, 5.1-11.8]) were enrolled in the study. Treatment completion rates were 83.7% among PLHIV and 82.4% among HHCs. Completion rates were higher in Rio de Janeiro than in Manaus (PLHIV: 86.0% vs. 79.6%; HHCs: 85.2% vs. 80.9%), although completion of 10 doses was similar (PLHIV: 86.4% vs. 86.1%). Adverse event-related discontinuation was low (PLHIV: 2.4%; HHCs: 2.7%). One person living with HIV developed active tuberculosis during treatment. At six months of follow-up, 99.6% of the PLHIV remained free of tuberculosis. Conclusions: The 3HP regimen was successfully introduced, had high treatment completion rates, and was well tolerated. Widespread use of 3HP for TPT may accelerate tuberculosis elimination in Brazil.

Keywords: Tuberculosis; Latent tuberculosis; HIV infections; Isoniazid; Rifapentine; Treatment adherence and compliance.

Objective: To determine the prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections (LRTI) in patients in an ICU. Methods: This was an observational cohort study involving patients with nosocomial LRTI (health care-associated pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia). Data were prospectively collected between 2015 and 2019. The multidrug-resistant pathogens (MDRPs) identified in the isolates studied included resistant to extended-spectrum cephalosporin-resistant and carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus at microbiological diagnosis. Results: During the study period, 267 patients in the ICU were diagnosed with LRTI, microbiological confirmation of LRTI having been obtained in 237. Of these, 146 (62%) had at least one MDRP isolate. Patients infected with MDRP were found to have poorer outcomes than patients infected with susceptible strains, such as prolonged mechanical ventilation (18.0 days vs. 12.0 days; p < 0.001), prolonged ICU length of stay (23.0 days vs.16.0 days; p < 0.001), and higher mortality (73% vs. 53%; p < 0.001) when compared with patients infected with susceptible strains. Hospital length of stay = 5 days (OR = 3.20; 95% CI: 1.39-7.39; p = 0.005) and prolonged use vasoactive drugs (OR = 3.15; 95% CI: 1.42-7.01; p = 0.004) were independent predictors of LRTI caused by MDRPs (LRTI-MDRP). The presence of LRTI-MDRP was found to be an independent predictor of death (OR = 2.311; 95% CI: 1.091-4.894; p = 0.028). Conclusions: Prolonged use of vasoactive drugs and prolonged hospital length of stay were independent predictors of LRTI-MDRP in this population of critically ill patients with very poor outcomes.

Keywords: Drug resistance, multiple; Healthcare-associated pneumonia; Pneumonia, ventilator-associated; Cross infection; Intensive care units.