1
|
Rinaldi M, Bonazzetti C, Gallo M, Ferraro G, Freire M, Terrabuio DRB, Tandoi F, Romagnoli R, De Rosa FG, Mularoni A, Ferrarese A, Burra P, Halpern M, Balbi E, Simkins J, Abbo L, Morrás I, Cantero M, Alagna L, Bandera A, Clemente WT, Valerio M, Fernández A, Muñoz P, Statlender L, Yahav D, Camargo LFA, Girão ES, Grossi P, Viale P, Curti S, Giannella M. Validation of the INCREMENT-SOT-CPE score in a large cohort of liver transplant recipients with carbapenem-resistant Enterobacterales infection. Transpl Infect Dis 2023; 25:e14036. [PMID: 36880576 DOI: 10.1111/tid.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Management of infections due to carbapenemase-resistant Enterobacterales (CRE) in solid organ transplant (SOT) recipients remains a difficult challenge. The INCREMENT-SOT-CPE score has been specifically developed from SOT recipients to stratify mortality risk, but an external validation is lacking. METHODS Multicenter retrospective cohort study of liver transplant (LT) recipients colonized with CRE infection who developed infection after transplant over 7-year period. Primary endpoint was all-cause 30-day mortality from infection onset. A comparison between INCREMENT-SOT-CPE and other selected scores was performed. A two-level mixed effects logistic regression model with random effects for the center was fitted. Performance characteristics at optimal cut-point were calculated. Multivariable Cox regression analysis of risk factors for all-cause 30-day mortality was carried out. RESULTS Overall, 250 CRE carriers developed infection after LT and were analyzed. The median age was 55 years (interquartile range [IQR]: 46-62) and 157 were males (62.8%). All-cause 30-day mortality was 35.6%. A sequential organ failure assessment (SOFA) score ≥ 11 showed a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 69.7%, 76.4%, 62.0%, 82.0%, and 74.0%, respectively. An INCREMENT-SOT-CPE ≥ 11 reported a sensitivity, specificity, PPV, NPV, and accuracy of 73.0%, 62.1%, 51.6%, 80.6% and 66.0%, respectively. At multivariable analysis acute renal failure, prolonged mechanical ventilation, INCREMENT-SOT-CPE score ≥ 11 and SOFA score ≥ 11 were independently associated with all-cause 30-day mortality, while a tigecycline-based targeted regimen was found to be protective. CONCLUSIONS Both INCREMENT-SOT-CPE ≥ 11 and SOFA ≥ 11 were identified as strong predictors of all-cause 30-day mortality in a large cohort of CRE carriers developing infection after LT.
Collapse
Affiliation(s)
- Matteo Rinaldi
- Infectious Diseases Unit, IRCCS Sant'Orsola Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cecilia Bonazzetti
- Infectious Diseases Unit, IRCCS Sant'Orsola Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Mena Gallo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giuseppe Ferraro
- Infectious Diseases Unit, IRCCS Sant'Orsola Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maristela Freire
- Working Committee for Hospital Epidemiology and Infection Control, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil
| | | | - Francesco Tandoi
- Department of Surgical Sciences, Liver Transplant Center, General Surgery Unit, AOU Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Renato Romagnoli
- Department of Surgical Sciences, Liver Transplant Center, General Surgery Unit, AOU Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | | | | | - Alberto Ferrarese
- Department of Surgery Oncology and Gastroenterology, Multivisceral Transplant Unit (Gastroenterology), Surgical and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Department of Surgery Oncology and Gastroenterology, Multivisceral Transplant Unit (Gastroenterology), Surgical and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Marcia Halpern
- Liver Transplant Unit, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Elizabeth Balbi
- Liver Transplant Unit, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Jacques Simkins
- Transplant Infectious Diseases and Immunocompromised Host Service, Division of Infectious Diseases, University of Miami/Miami Transplant Institute, Miami, Florida, USA
| | - Lilian Abbo
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miami, Florida, USA
| | - Ignacio Morrás
- Servicio de Medicina Interna, HU Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Mireia Cantero
- Servicio de Medicina Preventiva, HU Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Laura Alagna
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Wanessa Trinidade Clemente
- Transplant Unit and Infection Control Commission, Hospital das Clínicas - Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maricela Valerio
- Department of Clinical Microbiology and Infectious Diseases, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ainhoa Fernández
- Department of Gastroenterology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Dafna Yahav
- Infectious Disease Unit, Beilinson Hospital, Petah Tikva, Israel
| | | | - Evelyne Santana Girão
- Infectious Diseases Unit and Liver Transplant Unit of Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Paolo Grossi
- Infectious Disease Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, IRCCS Sant'Orsola Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefania Curti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, IRCCS Sant'Orsola Hospital, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | |
Collapse
|
2
|
Vieira MLC, Afonso TR, Oliveira AJ, Stangenhaus C, Dantas JCD, Santos LOA, de França LA, do Prado RR, Cordovil A, Monaco CG, Lira Filho EB, Rodrigues ACT, Bacal F, de Matos GFJ, Antunes T, Camargo LFA, Fischer CH, Morhy SS. A risk score for predicting death in COVID-19 in-hospital infection: A Brazilian single-center study. J Clin Ultrasound 2022; 50:604-610. [PMID: 35355290 PMCID: PMC9088307 DOI: 10.1002/jcu.23195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/17/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is a paucity of information about Brazilian COVID-19 in-hospital mortality probability of death combining risk factors. OBJECTIVE We aimed to correlate COVID-19 Brazilian in-hospital patients' mortality to demographic aspects, biomarkers, tomographic, echocardiographic findings, and clinical events. METHODS A prospective study, single tertiary center in Brazil, consecutive patients hospitalized with COVID-19. We analyzed the data from 111 patients from March to August 2020, performed a complete transthoracic echocardiogram, chest thoracic tomographic (CT) studies, collected biomarkers and correlated to in-hospital mortality. RESULTS Mean age of the patients: 67 ± 17 years old, 65 (58.5%) men, 29 (26%) presented with systemic arterial hypertension, 18 (16%) with diabetes, 11 (9.9%) with chronic obstructive pulmonary disease. There was need for intubation and mechanical ventilation of 48 (43%) patients, death occurred in 21/111 (18.9%) patients. Multiple logistic regression models correlated variables with mortality: age (OR: 1.07; 95% CI 1.02-1.12; p: 0.012; age >74 YO AUC ROC curve: 0.725), intubation need (OR: 23.35; 95% CI 4.39-124.36; p < 0.001), D dimer (OR: 1.39; 95% CI 1.02-1.89; p: 0.036; value >1928.5 ug/L AUC ROC curve: 0.731), C-reactive protein (OR: 1.18; 95% CI 1.05-1.32; p < 0.005; value >29.35 mg/dl AUC ROC curve: 0.836). A risk score was created to predict intrahospital probability of death, by the equation: 3.6 (age >75 YO) + 66 (intubation need) + 28 (C-reactive protein >29) + 2.2 (D dimer >1900). CONCLUSIONS A novel and original risk score were developed to predict the probability of death in Covid 19 in-hospital patients concerning combined risk factors.
Collapse
|
3
|
Gonçalves CDB, Requião-Moura LR, de Menezes FG, Morgado SR, de Rezende MB, Felga GEG, Corrêa L, Camargo LFA. IMPACTO DA IMPLEMENTAÇÃO DE BUNDLES DE PREVENÇÃO DE INFECÇÕES RELACIONADOS À ASSISTÊNCIA À SAÚDE (IRAS) EM PACIENTES SUBMETIDOS À TRANSPLANTE DE FÍGADO: RESULTADOS DE ESTUDO QUASE-EXPERIMENTAL DE CENTRO ÚNICO BRASILEIRO. Braz J Infect Dis 2022. [DOI: 10.1016/j.bjid.2021.102212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
4
|
Giannella M, Freire M, Rinaldi M, Abdala E, Rubin A, Mularoni A, Gruttadauria S, Grossi P, Shbaklo N, Tandoi F, Ferrarese A, Burra P, Fernandes R, Aranha Camargo LF, Asensio A, Alagna L, Bandera A, Simkins J, Abbo L, Halpern M, Santana Girao E, Valerio M, Muñoz P, Fernandez Yunquera A, Statlender L, Yahav D, Franceschini E, Graziano E, Morelli MC, Cescon M, Viale P, Lewis R. Development of a Risk Prediction Model for Carbapenem-Resistant Enterobacteriaceae Infection after Liver Transplantation: A Multinational Cohort Study. Clin Infect Dis 2021; 73:e955-e966. [PMID: 33564840 DOI: 10.1093/cid/ciab109] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients colonized with carbapenem resistant Enterobacteriaceae (CRE) are at higher risk of developing CRE infection after liver transplantation (LT) with associated high morbidity and mortality. Prediction model for CRE infection after LT among carriers could be useful to target preventive strategies. METHODS Multinational multicenter cohort study of consecutive adult patients underwent LT and colonized with CRE before or after LT, from January 2010 to December 2017. Risk factors for CRE infection were analyzed by univariate analysis and by Fine-Gray sub-distribution hazard model, with death as competing event. A nomogram to predict 30- and 60-day CRE infection risk was created. RESULTS 840 LT recipients found to be colonized with CRE before (n=203) or after (n=637) LT were enrolled. CRE infection was diagnosed in 250 (29.7%) patients within 19 (IQR 9-42) days after LT. Pre-and post-LT colonization, multisite post-LT colonization, prolonged mechanical ventilation, acute renal injury, and surgical re-intervention were retained in the prediction model. Median 30 and 60-day predicted risk was 15% (IQR 11-24%) and 21% (IQR 15-33%), respectively. Discrimination and prediction accuracy for CRE infection was acceptable on derivation (AUC 74.6, Brier index 16.3) and bootstrapped validation dataset (AUC 73.9, Brier index 16.6). Decision-curve analysis suggested net benefit of model-directed intervention over default strategies (treat all, treat none) when CRE infection probability exceeded 10%. The risk prediction model is freely available as mobile application at https://idbologna.shinyapps.io/CREPostOLTPredictionModel/. CONCLUSIONS Our clinical prediction tool could enable better targeting interventions for CRE infection after transplant.
Collapse
Affiliation(s)
- Maddalena Giannella
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maristela Freire
- Working Committee for Hospital Epidemiology and Infection Control, Hospital das Clinicas, Universidade de São Paulo, Brazil
| | - Matteo Rinaldi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Edson Abdala
- Infectious diseases department, Hospital das Clinicas, Universidade de São Paulo, Brazil
| | - Arianna Rubin
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | | | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS, ISMETT-UPMC, Palermo, Italy
| | - Paolo Grossi
- Infectious and Tropical Diseases Department, University of Insubria, Varese, Italy
| | - Nour Shbaklo
- Infectious Disease, Department of Medical Sciences University of Turin AOU Città della salute e della Scienza, Turin, Italy
| | - Francesco Tandoi
- Liver Transplant Center, General Surgery Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Alberto Ferrarese
- Multivisceral Transplant Unit (Gastroenterology), Department of Surgery Oncology and Gastroenterology, Surgical and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit (Gastroenterology), Department of Surgery Oncology and Gastroenterology, Surgical and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Ruan Fernandes
- Infectious Diseases Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Angel Asensio
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Madrid, Spain
| | - Laura Alagna
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jacques Simkins
- Transplant Infectious Diseases and Immunocompromised Host Service, Division of Infectious Diseases, University of Miami/Miami Transplant Institute, Miami, Florida, USA
| | - Lilian Abbo
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miami, Florida, USA
| | - Marcia Halpern
- Liver Transplant Unit, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Evelyne Santana Girao
- Infectious Diseases Unit and Liver Transplant Unit of Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza- Brazil
| | - Maricela Valerio
- Department of Clinical Microbiology and Infectious Diseases, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ainhoa Fernandez Yunquera
- Department of Gastroenterology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Dafna Yahav
- Infectious Disease Unit, Beilinson Hospital, Petah Tikva, Israel
| | - Erica Franceschini
- Infectious Diseases Unit, Department of Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | | | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Liver and Multiorgan Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Russell Lewis
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| |
Collapse
|
5
|
Zamperlini-Netto G, Fernandes JF, Garcia JL, Ribeiro AAF, Camargo LFA, de Moraes Terra C, Hamerschlak N. COVID-19 after hematopoietic stem cell transplantation: report of two children. Bone Marrow Transplant 2020; 56:713-715. [PMID: 32934304 DOI: 10.1038/s41409-020-01041-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Gabriele Zamperlini-Netto
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Juliana Folloni Fernandes
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Julia Lopes Garcia
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | | | - Luis Fernando Aranha Camargo
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Celso de Moraes Terra
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Nelson Hamerschlak
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil.
| |
Collapse
|
6
|
Pola-Dos-Reis F, Camargo LFA, Afonso-Junior JE, Samano MN, Pego-Fernandes PM. First lung transplantation in a HIV patient in Brazil. Braz J Infect Dis 2020; 24:268-269. [PMID: 32553467 PMCID: PMC9392105 DOI: 10.1016/j.bjid.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Flávio Pola-Dos-Reis
- Hospital Israelita Albert Einstein, Lung Transplant Group, São Paulo, SP, Brazil.
| | | | | | | | | |
Collapse
|
7
|
Menezes FG, Corrêa L, Medina-Pestana JO, Aguiar WF, Camargo LFA. A randomized clinical trial comparing Nitrofurazone-coated and uncoated urinary catheters in kidney transplant recipients: Results from a pilot study. Transpl Infect Dis 2018; 21:e13031. [PMID: 30451342 DOI: 10.1111/tid.13031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urinary tract infections are frequent complications early after kidney transplantation, and the use of antimicrobial coated catheters in settings other than transplantation has shown promising results for infection prevention. The purpose of this study was to compare the efficacy of Nitrofurazone-coated silicone urinary catheters with non-impregnated silicone urinary catheters in reducing bacteriuria and urinary tract infections in kidney transplant recipients. METHODS This single-center study, randomized controlled trial at the Hospital do Rim, a tertiary referral center in kidney transplantation, located in São Paulo, Brazil. Subjects involved living donor kidney transplant recipients, and were randomized 1:1 ratio with a computer-generated system to a Nitrofurazone-coated silicone urinary catheter and non-impregnated silicone urinary catheter from March 2013 to December 2014. Patients with asymptomatic bacteriuria or urinary tract infection at baseline, deceased kidney transplant donors, patients with known hypersensitivity to nitrofurantoin, pregnancy, and those refusing to sign the informed consent form were excluded from the study. RESULTS Two hundred fourteen subjects were randomized and one hundred seventy-six completed the study. There were no differences in the rates of asymptomatic bacteriuria (12.5% in the Nitrofurazone group and 11.4% in the control group, P = 0.99) and urinary tract infection (8% and 6.8%, P = 0.99) and the incidence of side effects was more frequent in the Nitrofurazone-impregnated silicone urinary catheter group (46.6% and 26.1%, P = 0.007). CONCLUSION The study suggests that there is no beneficial effect of the employment of Nitrofurazone-coated urinary catheter. TRIAL REGISTRATION NUMBER ISRCTN57888785.
Collapse
Affiliation(s)
- Fernando Gatti Menezes
- Infection Control and Prevention Service, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Luci Corrêa
- Infectious Diseases Division, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Luis Fernando Aranha Camargo
- Infectious Diseases Division, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
Santos DWCL, Viana LA, Cristelli MP, Silva‐Junior HT, Medina‐Pestana JO, Camargo LFA, Colombo AL. INFECÇÕES PELO COMPLEXO SCEDOSPORIUM/PSEUDALLESCHERIA NO TRANSPLANTE DE RIM: RELATO DE 5 CASOS EM UM CENTRO DE REFERÊNCIA NO BRASIL. Braz J Infect Dis 2018. [DOI: 10.1016/j.bjid.2018.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
9
|
Doi AM, Pignatari ACC, Edmond MB, Marra AR, Camargo LFA, Siqueira RA, da Mota VP, Colombo AL. Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program. PLoS One 2016; 11:e0146909. [PMID: 26808778 PMCID: PMC4726651 DOI: 10.1371/journal.pone.0146909] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 12/23/2015] [Indexed: 01/06/2023] Open
Abstract
Candidemia is a growing problem in hospitals all over the world. Despite advances in the medical support of critically ill patients, candidiasis leads to prolonged hospitalization, and has a crude mortality rate around 50%. We conducted a multicenter surveillance study in 16 hospitals distributed across five regions of Brazil to assess the incidence, species distribution, antifungal susceptibility, and risk factors for bloodstream infections due to Candida species. From June 2007 to March 2010, we studied a total of 2,563 nosocomial bloodstream infection (nBSI) episodes. Candida spp. was the 7th most prevalent agent. Most of the patients were male, with a median age of 56 years. A total of 64 patients (46.7%) were in the ICU when candidemia occurred. Malignancies were the most common underlying condition (32%). The crude mortality rate of candidemia during the hospital admission was 72.2%. Non-albicans species of Candida accounted for 65.7% of the 137 yeast isolates. C. albicans (34.3%), Candida parapsilosis (24.1%), Candida tropicalis (15.3%) and Candida glabrata (10.2%) were the most prevalent species. Only 47 out of 137 Candida isolates were sent to the reference laboratory for antifungal susceptibility testing. All C. albicans, C. tropicalis and C. parapsilosis isolates were susceptible to the 5 antifungal drugs tested. Among 11 C. glabrata isolates, 36% were resistant to fluconazole, and 64% SDD. All of them were susceptible to anidulafungin and amphotericin B. We observed that C. glabrata is emerging as a major player among non-albicans Candida spp. and fluconazole resistance was primarily confined to C. glabrata and C. krusei strains. Candida resistance to echinocandins and amphotericin B remains rare in Brazil. Mortality rates remain increasingly higher than that observed in the Northern Hemisphere countries, emphasizing the need for improving local practices of clinical management of candidemia, including early diagnosis, source control and precise antifungal therapy.
Collapse
Affiliation(s)
- André Mario Doi
- Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Michael B. Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | | | - Luis Fernando Aranha Camargo
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ricardo Andreotti Siqueira
- Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- * E-mail:
| |
Collapse
|
10
|
Camargo LFA, Marra AR, Pignatari ACC, Sukiennik T, Behar PPP, Medeiros EAS, Ribeiro J, Girão E, Correa L, Guerra C, Brites C, Pereira CAP, Carneiro I, Reis M, Souza MA, Barata CU, Edmond MB. Nosocomial bloodstream infections in a nationwide study: comparison between solid organ transplant patients and the general population. Transpl Infect Dis 2015; 17:308-13. [PMID: 25726707 DOI: 10.1111/tid.12356] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/04/2014] [Accepted: 12/11/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND The incidence of bloodstream infection (BSI) varies according to the transplanted organ. Mortality can be as high as 24%, with a significant impact on graft survival. Transplantation is a risk factor for multidrug-resistant (MDR) organisms, but comparison with a non-transplanted population in a single large cohort has not been described. METHODS This is a prospective nationwide study (16 centers) reporting data on 2364 monomicrobial nosocomial BSIs, comparing 83 episodes in solid organ transplant patients with 2447 BSIs occurring in the general hospital population. RESULTS The prevalence of groups of infecting organisms (gram-positive, gram-negative, and fungi) was similar between transplant patients and the general population and a similar crude mortality rate was observed (34.9% in transplant vs. 43.3% in non-transplant patients). Staphylococcus aureus was the single most frequently isolated organism in both groups, and Acinetobacter species was more frequently isolated in the general population. Regarding MDR organisms, Klebsiella species, and Enterobacter species resistant to cefepime, as well as Acinetobacter species resistant to meropenem, were significantly more frequent in transplant patients. CONCLUSION Antimicrobial resistance is higher, particularly among gram-negative bacteria in the transplant population, although the overall mortality rate between transplant and non-transplant patients with nosocomial BSI is similar.
Collapse
Affiliation(s)
- L F A Camargo
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Perini GF, Camargo LFA, Lottenberg CL, Hamerschlak N. Disseminated fusariosis with endophthalmitis in a patient with hematologic malignancy. Einstein (Sao Paulo) 2014; 11:545-6. [PMID: 24488401 PMCID: PMC4880399 DOI: 10.1590/s1679-45082013000400026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
12
|
Todaro J, Bollmann PW, Nussbacher A, Camargo LFA, Santos BFCD, Alvarenga D, Rosemberg LA, Le Bihan DCDS, Fischer CH, Giglio AD. Multiple myeloma complicated with pseudomonas endocarditis. Einstein (Sao Paulo) 2013; 10:498-501. [PMID: 23386092 DOI: 10.1590/s1679-45082012000400017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 10/30/2012] [Indexed: 11/21/2022] Open
Abstract
Patients diagnosed with multiple myeloma are more susceptible to infections which are the major causes of morbidity and mortality associated to this disease. The main infectious agents involved are Gram-positive bacteria. However, after chemotherapy an increase in the incidence of Gram-negative strains is observed. These bacteria are also responsible for most cases of urinary tract infections. Here is reported a rare case in a 73-year-old man with multiple myeloma who developed endocarditis due to pseudomonas.
Collapse
Affiliation(s)
- Juliana Todaro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
Pereira CAP, Marra AR, Camargo LFA, Pignatari ACC, Sukiennik T, Behar PRP, Medeiros EAS, Ribeiro J, Girão E, Correa L, Guerra C, Carneiro I, Brites C, Reis M, de Souza MA, Tranchesi R, Barata CU, Edmond MB. Nosocomial bloodstream infections in Brazilian pediatric patients: microbiology, epidemiology, and clinical features. PLoS One 2013; 8:e68144. [PMID: 23861860 PMCID: PMC3701648 DOI: 10.1371/journal.pone.0068144] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 05/26/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. METHODS We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project). RESULTS In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem. CONCLUSIONS In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.
Collapse
Affiliation(s)
| | - Alexandre R. Marra
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Luis Fernando Aranha Camargo
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | | | | | | | | | - Luci Correa
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Hospital do Rim e Hipertensão, São Paulo, Brazil
| | | | | | | | - Marise Reis
- Hospital do Coração, Natal, Brazil
- Hospital da UNIMED, Natal, Brazil
| | | | | | - Cristina U. Barata
- Universidade Federal do Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Michael B. Edmond
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | | |
Collapse
|
15
|
Colombo AL, Garnica M, Aranha Camargo LF, Da Cunha CA, Bandeira AC, Borghi D, Campos T, Senna AL, Valias Didier ME, Dias VC, Nucci M. Candida glabrata: an emerging pathogen in Brazilian tertiary care hospitals. Med Mycol 2013; 51:38-44. [DOI: 10.3109/13693786.2012.698024] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
16
|
Zicker M, Colombo AL, Ferraz-Neto BH, Camargo LFA. Epidemiology of fungal infections in liver transplant recipients: a six-year study of a large Brazilian liver transplantation centre. Mem Inst Oswaldo Cruz 2011; 106:339-45. [PMID: 21655823 DOI: 10.1590/s0074-02762011000300014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 04/08/2011] [Indexed: 01/11/2023] Open
Abstract
Liver transplant seems to be an effective option to prolong survival in patients with end-stage liver disease, although it still can be followed by serious complications. Invasive fungal infections (ifi) are related to high rates of morbidity and mortality. The epidemiology of fungal infections in Brazilian liver transplant recipients is unknown. The aim of this observational and retrospective study was to determine the incidence and epidemiology of fungal infections in all patients who underwent liver transplantation at Albert Einstein Israeli Hospital between 2002-2007. A total of 596 liver transplants were performed in 540 patients. Overall, 77 fungal infections occurred in 68 (13%) patients. Among the 77 fungal infections, there were 40 IFI that occurred in 37 patients (7%). Candida and Aspergillus species were the most common etiologic agents. Candida species accounted for 82% of all fungal infections and for 67% of all IFI, while Aspergillus species accounted for 9% of all fungal infections and for 17% of all IFI. Non-albicans Candida species were the predominant Candida isolates. Invasive aspergillosis tended to occur earlier in the post-transplant period. These findings can contribute to improve antifungal prophylaxis and therapy practices in Brazilian centres.
Collapse
|
17
|
Fernandes JF, Kerbauy FR, Ribeiro AAF, Kutner JM, Camargo LFA, Stape A, Troster EJ, Zamperlini-Netto G, Azambuja AMPD, Carvalho B, Dorna MDB, Vilela MDS, Jacob CMA, Costa-Carvalho BT, Cunha JM, Carneiro-Sampaio MM, Hamerschlak N. Allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies: Hospital Israelita Albert Einstein experience. Einstein (Sao Paulo) 2011; 9:140-4. [PMID: 26760806 DOI: 10.1590/s1679-45082011ao2007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report the experience of a tertiary care hospital with allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies. METHODS Seven pediatric patients with primary immunodeficiencies (severe combined immunodeficiency: n = 2; combined immunodeficiency: n = 1; chronic granulomatous disease: n = 1; hyper-IgM syndrome: n = 2; and IPEX syndrome: n = 1) who underwent eight hematopoietic stem cell transplants in a single center, from 2007 to 2010, were studied. RESULTS Two patients received transplants from HLA-identical siblings; the other six transplants were done with unrelated donors (bone marrow: n = 1; cord blood: n = 5). All patients had pre-existing infections before hematopoietic stem cell transplants. One patient received only anti-thymocyte globulin prior to transplant, three transplants were done with reduced intensity conditioning regimens and four transplants were done after myeloablative therapy. Two patients were not evaluated for engraftment due to early death. Three patients engrafted, two had primary graft failure and one received a second transplant with posterior engraftment. Two patients died of regimen related toxicity (hepatic sinusoidal obstruction syndrome); one patient died of progressive respiratory failure due to Parainfluenza infection present prior to transplant. Four patients are alive and well from 60 days to 14 months after transplant. CONCLUSION Patients' status prior to transplant is the most important risk factor on the outcome of hematopoietic stem cell transplants in the treatment of these diseases. Early diagnosis and the possibility of a faster referral of these patients for treatment in reference centers may substantially improve their survival and quality of life.
Collapse
Affiliation(s)
| | | | | | - Jose Mauro Kutner
- Blood Bank, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | | | - Adalberto Stape
- Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | | | | | | | - Bruna Carvalho
- Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | - Mayra de Barros Dorna
- Children's Institute, Hospital da Clínicas of Medial College, Unversidade de São Paulo - USP, São Paulo, SP, BR
| | | | - Cristina Miuki Abe Jacob
- Children's Institute, Hospital da Clínicas of Medial College, Unversidade de São Paulo - USP, São Paulo, SP, BR
| | | | - Jose Marcos Cunha
- Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, BR
| | | | | |
Collapse
|
18
|
Sampaio Camargo TZ, Marra AR, Silva CV, Cardoso MFS, Martino MDV, Camargo LFA, Correa L. Secular trends of candidemia in a tertiary care hospital. Am J Infect Control 2010; 38:546-51. [PMID: 20736114 DOI: 10.1016/j.ajic.2009.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 12/15/2009] [Accepted: 12/20/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Candidemias account for 8% to 15% of hospital-acquired bloodstream infections. They have been associated with previous exposure to antimicrobials and are considered high-morbidity infections with high treatment costs. This study characterizes candidemias in a tertiary care hospital and assesses their incidence rates, clinical and microbiological features, and use of antifungals. METHODS We assessed hospital-acquired candidemias in the period from January 1997 to July 2007 in a high-complexity private hospital. RESULTS There were 151 cases of candidemia in 147 patients. The incidence rate was 0.74 episodes/1000 admissions. The mean age of the patients was 60 years (standard deviation +/- 24.9), and the mean length of hospital stay before the blood culture identified candidemia was 40.9 days (standard deviation +/- 86.3). The in-hospital mortality rate was 44.2%. C albicans was isolated in 44% (n = 67) of the cases, and no difference in mortality rates was found between species (Candida albicans vs C non-albicans, P = .6). The average use of antifungals in the period was 104.0 defined daily dose/1000 patient-days. CONCLUSION We found a high mortality rate associated to candidemia events and an increasingly important role of Candida non-albicans. New approaches to health care-related infection control and to defining prophylactic and preemptive therapies should change this scenario in the future.
Collapse
|
19
|
Bacal F, Neto JDDS, Fiorelli AI, Mejia J, Marcondes-Braga FG, Mangini S, Oliveira JDL, de Almeida DR, Azeka E, Dinkhuysen JJ, Moreira MDCV, Neto JMR, Bestetti RB, Fernandes JR, Cruz FDD, Ferreira LP, da Costa HM, Pereira AAM, Panajotopoulos N, Benvenuti LA, Moura LZ, Vasconcelos GG, Branco JNR, Gelape CL, Uchoa RB, Ayub-Ferreira SM, Camargo LFA, Colafranceschi AS, Bordignon S, Cipullo R, Horowitz ESK, Branco KC, Jatene M, Veiga SL, Marcelino CAG, Teixeira Filho GF, Vila JH, Montera MW. [II Brazilian Guidelines for Cardiac Transplantation]. Arq Bras Cardiol 2010; 94:e16-e76. [PMID: 20625634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
|
20
|
Abstract
BACKGROUND The development of guidelines for sepsis management has improved disease survival and reduced treatment costs. Adequate antibiotic therapy is the cornerstone of sepsis treatment. Specific rules should be established in every institution according to its profiles. OBJECTIVES To review the current knowledge about the best drugs to be used as empiric treatment for sepsis based on their clinical efficacy and costs. METHODS Medline 1950 - 2008 was searched using the following terms: sepsis, organ failure, system failure, SIRS, septic shock, antibiotic, pneumonia, urinary tract infection, urosepsis, catheter-related infection, bloodstream, abdominal infection, and surgical wound. RESULTS/CONCLUSION For most septic shock patients, monotherapy is adequate and treatment should be initiated in the first hour after first sepsis-induced organ dysfunction. The drug of choice varies in different situations and choosing the right antibiotic enables better survival, fewer complications and shorter stays in intensive care.
Collapse
Affiliation(s)
- Diogo Diniz Gomes Bugano
- 5th year University of São Paulo, Medical School, Rua Antônio Carlos Salles Filho 57, 05745-250 São Paulo, São Paulo, Brasil
| | | | | | | |
Collapse
|
21
|
Ozaki KS, Câmara NOS, Nogueira E, Pereira MG, Granato C, Melaragno C, Camargo LFA, Pacheco-Silva A. The use of sirolimus in ganciclovir-resistant cytomegalovirus infections in renal transplant recipients. Clin Transplant 2007; 21:675-80. [PMID: 17845644 DOI: 10.1111/j.1399-0012.2007.00699.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The widespread use of prophylactic ganciclovir and anti-lymphocyte/thymocyte therapies are associated with increased induction of ganciclovir-resistant cytomegalovirus (CMV) strains. The use of sirolimus has been associated with a lower incidence of CMV infection in transplant recipients. We questioned whether it could also be effective as a therapeutic treatment of resistant CMV infection. METHODS Patients with ganciclovir-resistant CMV infections determined clinically and by DNA sequencing analysis were enrolled. Antigenaemia and DNA sequencing were used to diagnosis and follow the mutations. RESULTS Nine transplant patients were given sirolimus plus mycophenolate mofetil (n = 4) or a calcineurin inhibitor (n = 5). Seven out of nine recipients were CMV IgG negative before transplantation. We observed a rapid decrease in antigenaemia levels, reaching zero in eight out of nine (88.9%) patients within a median of 20.3 +/- 10.1 d. Graft function remained stable and no patient presented acute rejection or recurrence of the CMV infection. CONCLUSIONS This suggests that the use of sirolimus plus ganciclovir therapy could be useful in ganciclovir-resistant CMV infections.
Collapse
Affiliation(s)
- Kikumi Suzete Ozaki
- Laboratório de Imunologia Clínica e Experimental, Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Erlichman M, Caiuby A, Silva A, Camargo L, Cal R, Taub A, Andreoli P, Almeida F, Knobel E. Crit Care 2005; 9:P107. [DOI: 10.1186/cc3651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
23
|
Camargo LFA, De Marco FV, Barbas CSV, Hoelz C, Bueno MAS, Rodrigues Jr M, Amado VM, Caserta R, Martino MDV, Pasternak J, Knobel E. Ventilator associated pneumonia: comparison between quantitative and qualitative cultures of tracheal aspirates. Crit Care 2004; 8:R422-30. [PMID: 15566587 PMCID: PMC1065063 DOI: 10.1186/cc2965] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Revised: 08/19/2004] [Accepted: 09/02/2004] [Indexed: 11/17/2022] Open
Abstract
Introduction Deferred or inappropriate antibiotic treatment in ventilator-associated pneumonia (VAP) is associated with increased mortality, and clinical and radiological criteria are frequently employed to establish an early diagnosis. Culture results are used to confirm the clinical diagnosis and to adjust or sometimes withdraw antibiotic treatment. Tracheal aspirates have been shown to be useful for these purposes. Nonetheless, little is known about the usefulness of quantitative findings in tracheal secretions for diagnosing VAP. Methods To determine the value of quantification of bacterial colonies in tracheal aspirates for diagnosing VAP, we conducted a prospective follow-up study of 106 intensive care unit patients who were under ventilatory support. In total, the findings from 219 sequential weekly evaluations for VAP were examined. Clinical and radiological parameters were recorded and evaluated by three independent experts; a diagnosis of VAP required the agreement of at least two of the three experts. At the same time, cultures of tracheal aspirates were analyzed qualitatively and quantitatively (105 colony-forming units [cfu]/ml and 106 cfu/ml) Results Quantitative cultures of tracheal aspirates (105 cfu/ml and 106 cfu/ml) exhibited increased specificity (48% and 78%, respectively) over qualitative cultures (23%), but decreased sensitivity (26% and 65%, respectively) as compared with the qualitative findings (81%). Quantification did not improve the ability to predict a diagnosis of VAP. Conclusion Quantitative cultures of tracheal aspirates in selected critically ill patients have decreased sensitivity when compared with qualitative results, and they should not replace the latter to confirm a clinical diagnosis of VAP or to adjust antimicrobial therapy.
Collapse
Affiliation(s)
| | | | | | - Cristiane Hoelz
- Assistant Physican, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | | | - Milton Rodrigues Jr
- Assistant Physican, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Verônica Moreira Amado
- Assistant Physican, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Raquel Caserta
- Respiratory Therapist, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | | | - Jacyr Pasternak
- Microbiology Laboratory, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Elias Knobel
- Head, Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brasil
| |
Collapse
|
24
|
Ozaki KS, Pestana JOM, Granato CFH, Pacheco-Silva A, Camargo LFA. Sequential cytomegalovirus antigenemia monitoring in kidney transplant patients treated with antilymphocyte antibodies. Transpl Infect Dis 2004; 6:63-8. [PMID: 15522106 DOI: 10.1111/j.1399-3062.2004.00054.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antilymphocyte antibodies (ALA) use is related to disseminated cytomegalovirus (CMV) disease after kidney transplantation. Strict surveillance of CMV infection, preemptive antiviral treatment or concomitant ganciclovir and ALA use are proposed as an attempt to prevent related clinical complications. Our objective was to describe the pattern of CMV infection, based on sequential antigenemia detection, after ALA treatment. PATIENTS AND METHODS Thirty renal transplant patients were prospectively screened for CMV infection after ALA treatment. CMV antigenemia (pp65 antigen detection) was monitored twice a week in the first month and weekly until 60 days after the beginning of ALA therapy. Any positive value of antigenemia was considered CMV infection. RESULTS Twenty-eight (93.3%) patients were CMV positive (IgG) before transplantation. The mean duration of ALA treatment was 12.1+/-2.4 days. Positive antigenemia was detected in 24 (80%) patients, a mean of 52.5+/-15 days after transplant and 44.7+/-14 days after the beginning of ALA treatment. The median antigenemia count was 7 positive cells/300,000 neutrophils (range: 1-227). Antigenemia preceded clinical symptoms by 5.8 days (0-28 days). Eighteen (75%) of 24 positive patients received ganciclovir treatment: 8 patients (26.7%) for viral syndrome, 2 patients (33.3%) for invasive disease, and 8 patients (26.7%) as part of preemptive therapy, asymptomatic with high antigenemia values. Six pp65-positive patients with low counts were followed up until a negative result and remained asymptomatic without any specific treatment. CONCLUSION CMV infection was frequent after ALA treatment in this group and generally occurred late after completion of treatment. Antigenemia was a reliable tool to guide preemptive treatment in these patients, and such strategy is an alternative option compared to the prophylactic use of ganciclovir with ALA treatment.
Collapse
Affiliation(s)
- K S Ozaki
- Division of Nephrology, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
25
|
Buchele G, Camargo L, Marra A, Cal R, Sousa J, Vasconcelos P, Martino M, Pasternak J, Knobel E. Crit Care 2003; 7:P60. [DOI: 10.1186/cc2256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
26
|
Buchele G, Sogayar A, Camargo L, Marra A, Cal R, Sousa J, Michels Jr V, Silva E, Machado F, Poli L, Martino M, Knobel E. Crit Care 2003; 7:P63. [DOI: 10.1186/cc2259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
27
|
Marra AR, Camargo LFA, Moura D, Guerra MR, Moreira E, Ilzuka IJ, Laselva CR, Yamashita MAA, Lamblet LC, Knobel E. Multidrug Resistant Bacteria in an Intensive Care Unit: relationship between excessive workload and increasing requirement of contact isolation. Crit Care 2001. [PMCID: PMC3300962 DOI: 10.1186/cc1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
28
|
Laselva CR, Camargo LFA, Moura D, Yamashita MAA, Silva CV, Oliveira C, Bork AM, Knobel E. Quality improvement tools (PDCA cycle) enhances compliance to nosocomial infection preventive measures: experience of a medical-surgical ICU. Crit Care 2001. [PMCID: PMC3300964 DOI: 10.1186/cc1397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
29
|
Moura D, Camargo LFA, Laselva CR, Yamashita MAA, Silva CV, Oliveira C, Bork AM, Knobel E. Contact precautions for multidrug resistant bacteria: positive impact on handwashing compliance in an intensive care unit. Crit Care 2001. [PMCID: PMC3300963 DOI: 10.1186/cc1396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
30
|
De Marco FVC, Camargo LFA, Barbas CSV, Hoelz C, Pasternack J, Bueno MAS, Martino M, Rodrigues M, Caserta R, Amado V, Knobel E. Comparison between quantitative and qualitative culture of tracheal aspirates in the diagnosis of ventilator associated pneumonia. Crit Care 2001. [PMCID: PMC3333234 DOI: 10.1186/cc1114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|