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Santos DW, Clemente WT. Navigating the Intersection: Fungal Infections in Transplant Recipients During COVID-19. Transplantation 2024:00007890-990000000-00726. [PMID: 38587504 DOI: 10.1097/tp.0000000000005033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Daniel Wagner Santos
- Department of Infectious Diseases of Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA/EBSERH) and Intituto D'Or de Pesquisa e Ensino, IDOR, Hospital UDI, Rede D'Or, São Luís/Maranhão, Brazil
| | - Wanessa Trindade Clemente
- Department of Laboratory Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Liver Transplant Program - Transplant Infectious Disease, Hospital das Clínicas (HC-UFMG/EBSERH), Belo Horizonte/Minas Gerais, Brazil
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2
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Radisic MV, Santoro Lopes G, Hasslocher-Moreno AM, Eichenberger EM, Hall VG, Pujato NR, Clemente WT. Interesting case from Argentina: Kidney transplant recipient with skin lesions-A Latin American perspective. Transpl Infect Dis 2024; 26:e14243. [PMID: 38407514 DOI: 10.1111/tid.14243] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 02/27/2024]
Abstract
This is a case of a kidney transplant recipient who presented with skin lesions, low-grade fevers, and pancytopenia 2 months after his transplant.
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Affiliation(s)
- Marcelo Víctor Radisic
- Departamento de Infectología, Instituto de Trasplante y Alta Complejidad, Buenos Aires, Argentina
| | - Guilherme Santoro Lopes
- Medicine School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Emily M Eichenberger
- Division of Infectious Disease, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Victoria G Hall
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Natalia Rosana Pujato
- Departamento de Infectología, Instituto de Trasplante y Alta Complejidad, Buenos Aires, Argentina
| | - Wanessa Trindade Clemente
- Department of Laboratory Medicine, Faculdade de Medicina da Universidade Federal de Minas Gerais, Liver Transplant Program-Transplant Infectious Disease, Hospital das Clínicas EBSERH/UFMG, Belo Horizonte, Minas Gerais, Brazil
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3
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Bonazzetti C, Rinaldi M, Cosentino F, Gatti M, Freire MP, Mularoni A, Clemente WT, Pierrotti LC, Aguado JM, Grossi P, Pea F, Viale P, Giannella M. Survey on the approach to antibiotic prophylaxis in liver and kidney transplant recipients colonized with "difficult to treat" Gram-negative bacteria. Transpl Infect Dis 2024; 26:e14238. [PMID: 38265107 DOI: 10.1111/tid.14238] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/23/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Performance of active screening for multidrug-resistant Gram-negative bacteria (MDR-GNB) and administration of targeted antibiotic prophylaxis (TAP) in colonized patients undergoing liver (LT) and/or kidney transplantation (KT) are controversial issues. METHODS Self-administered electronic cross-sectional survey disseminated from January to February 2022. Questionnaire consisted of four parts: hospital/transplant program characteristics, standard screening and antibiotic prophylaxis, clinical vignettes asking for TAP in patients undergoing LT and KT with prior infection/colonization with four different MDR-GNB (extended-spectrum cephalosporin-resistant Enterobacterales [ESCR-E], carbapenem-resistant Enterobacterales [CRE], multidrug-resistant Pseudomonas aeruginosa [MDR-Pa], and carbapenem-resistant Acinetobacter baumannii [CRAb]). RESULTS Fifty-five respondents participated from 14 countries, mostly infectious disease specialists (69%) with active transplant programs (>100 procedures/year for 34.5% KT and 23.6% LT), and heterogeneous local MDR-GNB prevalence from <15% (30.9%), 15%-30% (43.6%) to >30% (16.4%). The frequency of screening for ESCR-E, CRE, MDR-Pa, and CRAb was 22%, 54%, 17%, and 24% for LT, respectively, and 18%, 36%, 16%, and 11% for KT. Screening time-points were mainly at transplantation 100%, only one-third following transplantation. Screening was always based on rectal swab cultures (100%); multi-site sampling was reported in 40% of KT and 35% of LT. In LT clinical cases, 84%, 58%, 84%, and 40% of respondents reported TAP for prior infection/colonization with ESCR-E, CRE, MDR-Pa, and CRAb, respectively. In KT clinical cases, 55%, 39%, 87%, and 42% of respondents reported TAP use for prior infection/colonization with ESCR-E, CRE, MDR-Pa, and CRAb, respectively. CONCLUSION There is a large heterogeneity in screening and management of MDR-GNB carriage in LT and KT.
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Affiliation(s)
- Cecilia Bonazzetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, IRCCS Policlinico Sant'Orsola, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matteo Rinaldi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, IRCCS Policlinico Sant'Orsola, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Federica Cosentino
- Infectious Diseases Unit, IRCCS Policlinico Sant'Orsola, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maristela Pinheiro Freire
- Working Committee for Hospital Epidemiology and Infection Control, Hospital das Clinicas, Universidade de São Paulo, Sao Paulo, Brazil
| | - Alessandra Mularoni
- Unit of Infectious Diseases, IRCCS-ISMETT Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Wanessa Trindade Clemente
- Department of Laboratory Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ligia Camera Pierrotti
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Jose Maria Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), CIBERINFEC, Universidad Complutense, Madrid, Spain
| | - Paolo Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, IRCCS Policlinico Sant'Orsola, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, IRCCS Policlinico Sant'Orsola, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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4
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Clemente WT. Unanswered Questions on the Management of Nocardia Infections in Transplant Recipients. Transplantation 2023; 107:582-583. [PMID: 36413148 DOI: 10.1097/tp.0000000000004344] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Wanessa Trindade Clemente
- Department of Laboratory Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Liver Transplant Program - Transplant Infectious Disease, Hospital das Clínicas EBSERH/UFMG, Belo Horizonte, Brazil
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5
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Bruminhent J, López-Medrano F, Pogatchnik BP, Nascimento E, Namsiripongpun W, Yingchoncharoen T, Ngodngamthaweesuk M, Sukprapruet A, Naratreekoon B, Rodriguez-Goncer I, Hernández A, Polanco N, Andrés A, Aguado JM, Pouch SM, Clemente WT. Lung abscess and empyema in a heart transplant recipient from Thailand. Transpl Infect Dis 2023; 25:e13984. [PMID: 36305598 DOI: 10.1111/tid.13984] [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: 09/07/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
Abstract
The case discussed involves a 69-year-old Thai woman who underwent orthotopic heart transplantation 9 months before this event. She presented with fever without localizing signs or symptoms. However, her chest images revealed mass-like consolidation in the left upper lobe. Blood culture and lung tissue identified Rhodococcus equi. She was successfully treated with a combination of antimicrobial therapy, optimization of immunosuppressants, and surgical resection.
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Affiliation(s)
- Jackrapong Bruminhent
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ellen Nascimento
- Pulmonary Pathologist, Department of Pathology, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Warunyu Namsiripongpun
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapat Yingchoncharoen
- Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Montien Ngodngamthaweesuk
- Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Thoracic Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Araya Sukprapruet
- Somdech Phra Debaratana Medical Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Bundit Naratreekoon
- Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Isabel Rodriguez-Goncer
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.,Department of Nephrology, University Hospital 12 de Octubre, Madrid, Spain
| | - Ana Hernández
- Department of Nephrology, University Hospital 12 de Octubre, Madrid, Spain
| | - Natalia Polanco
- Department of Nephrology, University Hospital 12 de Octubre, Madrid, Spain
| | - Amado Andrés
- Department of Nephrology, University Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Spain
| | - José María Aguado
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación del Hospital 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Stephanie M Pouch
- Division of Infectious Diseases, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Wanessa Trindade Clemente
- Liver Transplant Group-IAG, Hospital das Clínicas, Department of Laboratory Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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6
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Ferguson J, Cervera C, Kaffenberger B, Salgado M, Clemente WT. Cutaneous lesions in a solid organ transplant recipient: A diagnostic dilemma. Transpl Infect Dis 2022; 24:e13918. [PMID: 35912460 DOI: 10.1111/tid.13918] [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: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 12/24/2022]
Abstract
We present the case of a 66-year-old female with a history of renal transplant in 1999 with new onset fevers and diffuse skin ulcerations. In this article, we present the diagnostic studies, differential diagnosis, and treatment decisions for the case.
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Affiliation(s)
- Jessica Ferguson
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Carlos Cervera
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, USA
| | - Benjamin Kaffenberger
- Division of Dermatology, Ohio State University Wexner Medical Center Columbus, Columbus, Ohio, USA
| | - Moises Salgado
- Department of Pathology, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Wanessa Trindade Clemente
- Hospital das Clínicas, Department of Laboratory Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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7
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Vieira CLR, Medeiros SGGB, Pinto FS, Maciel RL, Clemente WT, Miranda NRR, Ribeiro FCM, da Silva MSR, de Jesus LA, Rodrigues CL, de Oliveira AC. INFECÇÕES RELACIONADAS À ASSISTÊNCIA À SAÚDE (IRAS) E DESFECHO EM PACIENTES DE TERAPIA INTENSIVA COM COVID-19. Braz J Infect Dis 2022. [PMCID: PMC8829367 DOI: 10.1016/j.bjid.2021.102249] [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: 10/26/2022] Open
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8
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Lauar ID, Faria LC, Romanelli RMDC, Clemente WT. Latent tuberculosis: Risk factors, screening and treatment in liver transplantation recipients from an endemic area. World J Transplant 2021; 11:512-522. [PMID: 35070787 PMCID: PMC8713304 DOI: 10.5500/wjt.v11.i12.512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/25/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients undergoing solid organ transplantation, particularly those who live or have lived in tuberculosis (TB) endemic areas, are at a high risk of developing TB. The majority of post-transplantation TB cases are associated with reactivation of latent TB infection (LTBI). Brazil is in a single position with overlapping areas of high TB endemicity and high transplant activity. In liver transplant (LT), one should be aware of the potential hepatotoxicity associated with the treatment regimens for LTBI.
AIM To evaluate the frequency of LTBI in LT patients and treatment-related issues.
METHODS This was a retrospective analysis of a cohort of cirrhotic patients aged ≥ 18 years, who underwent LT at a high-complexity teaching hospital from January 2005 to December 2012.
RESULTS Overall, 429 patients underwent LT during the study period. Of these, 213 (49.7%) underwent the tuberculin skin test (TST) during the pre-transplant period, and 35 (16.4%) of them had a positive result. The treatment for LTBI was initiated after LT in 12 (34.3%) of the TST-positive patients; in 3 (25.0%), treatment was maintained for at least 6 mo.
CONCLUSION The prevalence of LTBI was lower than expected. Initiation and completion of LTBI treatment was limited by difficulties in the management of these special patients.
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Affiliation(s)
- Isabela Dias Lauar
- Medicine Department, Universidade José do Rosário Vellano, Belo Horizonte 31710030, Minas Gerais, Brazil
| | - Luciana Costa Faria
- Internal Medicine Department, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30130100, Minas Gerais, Brazil
| | - Roberta Maia de Castro Romanelli
- Pediatrics Department, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30130100, Minas Gerais, Brazil
| | - Wanessa Trindade Clemente
- Department of Laboratory Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 30130100, Minas Gerais, Brazil
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9
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Gutiérrez-Gutiérrez B, Pérez-Nadales E, Pérez-Galera S, Fernández-Ruiz M, Carratalà J, Oriol I, Cordero E, Lepe JA, Tan BH, Corbella L, Paul M, Natera AM, David MD, Montejo M, Iyer RN, Pierrotti LC, Merino E, Steinke SM, Rana MM, Muñoz P, Mularoni A, van Delden C, Grossi PA, Seminari EM, Gunseren F, Lease ED, Roilides E, Fortún J, Arslan H, Coussement J, Tufan ZK, Pilmis B, Rizzi M, Loeches B, Eriksson BM, Abdala E, Soldani F, Lowman W, Clemente WT, Bodro M, Fariñas MC, Kazak E, Martínez-Martínez L, Aguado JM, Torre-Cisneros J, Pascual Á, Rodríguez-Baño J. Propensity Score and Desirability of Outcome Ranking Analysis of Ertapenem for Treatment of Nonsevere Bacteremic Urinary Tract Infections Due to Extended-Spectrum-Beta-Lactamase-Producing Enterobacterales in Kidney Transplant Recipients. Antimicrob Agents Chemother 2021; 65:e0110221. [PMID: 34370578 PMCID: PMC8522723 DOI: 10.1128/aac.01102-21] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022] Open
Abstract
There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment with ertapenem or meropenem and clinical cure in KT recipients with nonsevere bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT, NCT02852902). The association between targeted therapy with ertapenem versus meropenem and clinical cure at day 14 (the principal outcome) was studied by logistic regression. Propensity score matching and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with meropenem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29; 95% CI 0.51 to 3.22; P = 0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14, 1.18; 95% CI 0.43 to 3.29; P = 0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95% CI, 40.4 to 59.1%) when hospital stay was considered. It ranged from 59 to 67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost was considered in addition to outcome. In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat nonsevere B-UTI due to ESBL-E in KT recipients and may have some advantages.
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Affiliation(s)
- Belén Gutiérrez-Gutiérrez
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Elena Pérez-Nadales
- Spanish Network for Research in Infectious Diseases (REIPI)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Salvador Pérez-Galera
- Clinical Unit of Internal Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Mario Fernández-Ruiz
- Spanish Network for Research in Infectious Diseases (REIPI)
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedicine Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Isabel Oriol
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedicine Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Elisa Cordero
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - José Antonio Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Laura Corbella
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Alejandra M. Natera
- Spanish Network for Research in Infectious Diseases (REIPI)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Miruna D. David
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Miguel Montejo
- Infectious Diseases Unit, Cruces University Hospital, Bilbao, Spain
| | - Ranganathan N. Iyer
- Clinical Microbiology Identification and Infection Control, Global Hospitals, Hyderabad, India
| | - Ligia Camera Pierrotti
- Infectious Diseases Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Esperanza Merino
- Unit of Infectious Diseases, General University Hospital of Alicante, ISABIAL, Alicante, Spain
| | | | | | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Christian van Delden
- Unit for Transplant Infectious Diseases, University Hospitals of Geneva and the Swiss Transplant Cohort Study (STCS), Geneva, Switzerland
| | - Paolo Antonio Grossi
- Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese. National Center for Transplantation, Rome, Italy
| | - Elena María Seminari
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | - Filiz Gunseren
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Erika D. Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Emmanuel Roilides
- Infectious Diseases Unit and 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Jesús Fortún
- Ramón y Cajal University Hospital, Madrid, Spain
| | - Hande Arslan
- Bakent University School of Medicine, Ankara, Turkey
| | - Julien Coussement
- Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Zeliha Koçak Tufan
- Infectious Diseases and Clinical Microbiology Department, Medical School of Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Benoit Pilmis
- Paris Descartes University, Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d’Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Belén Loeches
- Infectious Diseases Unit, Hospital La Paz, Madrid, Spain
| | - Britt Marie Eriksson
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Edson Abdala
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Soldani
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Warren Lowman
- Wits Donald Gordon Medical Centre, Pathcare/Vermaak, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wanessa Trindade Clemente
- Faculdade de Medicina, UFMG, Grupo de Transplante de Fígado, Instituto Alfa de Gastroenterologia, Hospital da Clínicas, Universidad de Federal Minas Gerais (HC-UFMG), Minas Gerais, Brazil
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | | | - Luis Martínez-Martínez
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Microbiology, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Department of Microbiology, University of Cordoba, Córdoba, Spain
| | - José María Aguado
- Spanish Network for Research in Infectious Diseases (REIPI)
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
| | - Julián Torre-Cisneros
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Córdoba, Spain
| | - Álvaro Pascual
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Jesús Rodríguez-Baño
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Investigators from the REIPI/ESGICH/ESGBIS/INCREMENT-SOT Group
- Spanish Network for Research in Infectious Diseases (REIPI)
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Clinical Unit of Internal Medicine, Virgen Macarena University Hospital, Seville, Spain
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedicine Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Universidad Complutense, Madrid, Spain
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Infectious Diseases Unit, Cruces University Hospital, Bilbao, Spain
- Clinical Microbiology Identification and Infection Control, Global Hospitals, Hyderabad, India
- Infectious Diseases Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
- Unit of Infectious Diseases, General University Hospital of Alicante, ISABIAL, Alicante, Spain
- Johns Hopkins University, School of Medicine, Baltimore, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- IRCCS ISMETT, Palermo, Italy
- Unit for Transplant Infectious Diseases, University Hospitals of Geneva and the Swiss Transplant Cohort Study (STCS), Geneva, Switzerland
- Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese. National Center for Transplantation, Rome, Italy
- Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
- Infectious Diseases Unit and 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Ramón y Cajal University Hospital, Madrid, Spain
- Bakent University School of Medicine, Ankara, Turkey
- Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Infectious Diseases and Clinical Microbiology Department, Medical School of Ankara Yildirim Beyazit University, Ankara, Turkey
- Paris Descartes University, Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d’Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Infectious Diseases Unit, Hospital La Paz, Madrid, Spain
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Wits Donald Gordon Medical Centre, Pathcare/Vermaak, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Faculdade de Medicina, UFMG, Grupo de Transplante de Fígado, Instituto Alfa de Gastroenterologia, Hospital da Clínicas, Universidad de Federal Minas Gerais (HC-UFMG), Minas Gerais, Brazil
- Infectious Diseases Department, Hospital Clinic – IDIBAPS, University of Barcelona, Barcelona, Spain
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
- Uludag University, Bursa, Turkey
- Clinical Unit of Microbiology, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Department of Microbiology, University of Cordoba, Córdoba, Spain
- Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Córdoba, Spain
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Taimur S, Pouch SM, Zubizarreta N, Mazumdar M, Rana M, Patel G, Freire MP, Pellett Madan R, Kwak EJ, Blumberg E, Satlin MJ, Pisney L, Clemente WT, Zervos MJ, La Hoz RM, Huprikar S. Impact of pre-transplant carbapenem-resistant Enterobacterales colonization and/or infection on solid organ transplant outcomes. Clin Transplant 2021; 35:e14239. [PMID: 33527453 DOI: 10.1111/ctr.14239] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/12/2021] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
The impact of pre-transplant (SOT) carbapenem-resistant Enterobacterales (CRE) colonization or infection on post-SOT outcomes is unclear. We conducted a multi-center, international, cohort study of SOT recipients, with microbiologically diagnosed CRE colonization and/or infection pre-SOT. Sixty adult SOT recipients were included (liver n = 30, hearts n = 17). Klebsiella pneumoniae (n = 47, 78%) was the most common pre-SOT CRE species. Median time from CRE detection to SOT was 2.32 months (IQR 0.33-10.13). Post-SOT CRE infection occurred in 40% (n = 24/60), at a median of 9 days (IQR 7-17), and most commonly due to K pneumoniae (n = 20/24, 83%). Of those infected, 62% had a surgical site infection, and 46% had bloodstream infection. Patients with post-SOT CRE infection more commonly had a liver transplant (16, 67% vs. 14, 39%; p =.0350) or pre-SOT CRE BSI (11, 46% vs. 7, 19%; p =.03). One-year post-SOT survival was 77%, and those with post-SOT CRE infection had a 50% less chance of survival vs. uninfected (0.86, 95% CI, 0.76-0.97 vs. 0.34, 95% CI 0.08-1.0, p =.0204). Pre-SOT CRE infection or colonization is not an absolute contraindication to SOT and is more common among abdominal SOT recipients, those with pre-SOT CRE BSI, and those with early post-SOT medical and surgical complications.
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Affiliation(s)
- Sarah Taimur
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Madhu Mazumdar
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meenakshi Rana
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gopi Patel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Eun Jeong Kwak
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Emily Blumberg
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Larissa Pisney
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Ricardo M La Hoz
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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11
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Osório FMF, Cançado GGL, Nardelli MJ, Vidigal PVT, Xavier MAP, Clemente WT. Hepatitis Relapse after Yellow Fever Infection: Is There Another Wave? Rev Soc Bras Med Trop 2020; 53:e20200152. [PMID: 32578715 PMCID: PMC7310355 DOI: 10.1590/0037-8682-0152-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 11/21/2022] Open
Abstract
During the yellow fever (YF) outbreak in Brazil, many cases of fulminant hepatitis were seen, although mild to moderate hepatitis was mostly observed with complete recovery. This report presents a case of late-onset hepatitis due to YF relapse. The patient sought medical attention after jaundice recurrence 40 days after the first YF hepatitis episode. This case highlights the importance of patient follow-up after the complete resolution of YF symptoms and discharge.
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12
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Pérez-Nadales E, Gutiérrez-Gutiérrez B, Natera AM, Abdala E, Reina Magalhães M, Mularoni A, Monaco F, Camera Pierrotti L, Pinheiro Freire M, Iyer RN, Mehta Steinke S, Grazia Calvi E, Tumbarello M, Falcone M, Fernández-Ruiz M, María Costa-Mateo J, Rana MM, Mara Varejão Strabelli T, Paul M, Carmen Fariñas M, Clemente WT, Roilides E, Muñoz P, Dewispelaere L, Loeches B, Lowman W, Tan BH, Escudero-Sánchez R, Bodro M, Antonio Grossi P, Soldani F, Gunseren F, Nestorova N, Pascual Á, Martínez-Martínez L, Aguado JM, Rodríguez-Baño J, Torre-Cisneros J. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia. Am J Transplant 2019; 20:S1600-6135(22)22362-4. [PMID: 31891235 DOI: 10.1111/ajt.15769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/30/2019] [Accepted: 12/22/2019] [Indexed: 01/25/2023]
Abstract
Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
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Affiliation(s)
- Elena Pérez-Nadales
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - Belén Gutiérrez-Gutiérrez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Alejandra M Natera
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - Edson Abdala
- Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Mario Tumbarello
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - José María Costa-Mateo
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | | | | | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus and Faculty of Medicine, Technion - Israel Faculty of Technology, Haifa, Israel
| | - María Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - Wanessa Trindade Clemente
- Faculty of Medicine, Liver Transplantation Program, Hospital das Clínicas -Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Emmanuel Roilides
- Infectious Diseases Unit and 3rd, Department of Pediatrics, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Laurent Dewispelaere
- Department of Microbiology, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Belén Loeches
- Infectious Diseases Unit, Hospital La Paz, Madrid, Spain
| | - Warren Lowman
- Wits Donald Gordon Medical Centre, Vermaak & Partners/Pathcare, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Rosa Escudero-Sánchez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Ramón y Cajal University Hospital, Madrid, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Fabio Soldani
- Department of Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Filiz Gunseren
- Department of Infectious Diseases, Akdeniz University Hospital, Antalya, Turkey
| | | | - Álvaro Pascual
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Luis Martínez-Martínez
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Cordoba, Cordoba, Spain
| | - José María Aguado
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain
| | - Jesús Rodríguez-Baño
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Julián Torre-Cisneros
- Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
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Abstract
INTRODUCTION The increasing number of transplants performed worldwide and the growing global mobility with migration and travel to and from developing countries and tropical areas are bringing new challenges for the management of transplant infectious diseases, previously less commonly seen, such as Leishmaniasis. However, in this scenario there is a lack of information and the current knowledge is based on a few studies. The selection of the most appropriate treatment depends on various factors, such as patient profile, Leishmania species, disease extent, drug availability, concomitant infections and previous treatments. Therapeutic options may include different formulations of amphotericin B, pentavalent antimonials, miltefosine and paromomycin, among others. These drugs can be used alone or in combination. Areas covered: This review is a practical guide for Visceral Leishmaniasis (VL) specific treatment in solid organ transplant recipients (SOT), including therapeutic options and assessment of therapy response. Expert commentary: The main challenges for treatment of leishmaniasis in SOT recipients are related to the duration of therapy, curative criteria and secondary prophylaxis. Immunosuppression dose reduction is often recommended, but such decisions must be made on an individual basis. At present, Liposomal Amphotericin B is the best choice for treatment and prophylaxis.
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Affiliation(s)
- Wanessa Trindade Clemente
- a Faculty of Medicine, Departamento de Propedêutica Complementar , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | | | - Jose María Aguado
- c Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid , Madrid , Comunidad de Madrid , Spain
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14
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Caldas Teixeira D, Martins Oliveira Diniz L, Orlandi Mourão PH, Kakehashi FM, Vaz de Macedo A, Duani H, Trindade Clemente W, de Sá Rodrigues KE, Maia de Castro Romanelli R. Infection surveillance in pediatric hematopoietic stem cell transplantation recipients. Eur J Haematol 2017; 100:69-74. [PMID: 29032585 DOI: 10.1111/ejh.12982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the profile of reported healthcare-associated infections (HAIs) in pediatric patients submitted to hematopoietic stem cell transplantation (HSCT) at a reference center. METHODS Retrospective cohort of pediatric patients who were submitted to HSCT from 2008 to 2016. The criteria for HAI were based on those established by the National Healthcare Safety Network. Data were collected by active surveillance performed daily by professionals. This study was approved by the institutional research ethics committee. RESULTS A total of 86 HSCTs were performed in 81 patients younger than 18 years of age (median, 10 years). Of these, 69 (85%) were males. Aplastic anemia and leukemia were the main diagnoses. A total of 140 HAIs were diagnosed with an incidence density of 28.2 infections/1000 patient-days. The most common HAI was laboratory-confirmed bloodstream infection (46), the majority of which was reported to be central venous catheter-associated (43). Gram-negative bacteria were the most prevalent microorganisms (58.5%). Almost all the infections occurred until 30 days after transplantation, and 17 deaths were observed within 180 days after the procedure. CONCLUSION Active surveillance of HAIs in HSCT children allowed the evaluation of the incidence and profile of HAIs, which is essential for the health care of these patients.
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Affiliation(s)
- Daniela Caldas Teixeira
- Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lilian Martins Oliveira Diniz
- Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Pediatrics Department, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Fabiana Maria Kakehashi
- Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Pediatrics Department, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Antonio Vaz de Macedo
- Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helena Duani
- Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Karla Emília de Sá Rodrigues
- Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Pediatrics Department, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Roberta Maia de Castro Romanelli
- Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Pediatrics Department, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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15
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Duani H, Moreira CM, da Silva LC, Clemente WT, Romanelli RMDC. A shorter period of therapy is associated with higher mortality in bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae in a Brazilian centre. Infect Dis (Lond) 2017; 50:156-161. [PMID: 28841082 DOI: 10.1080/23744235.2017.1370129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Helena Duani
- a Departamento de Clínica Médica , Faculdade de Medicina da Universidade Federal de Minas Gerais - UFMG , Belo Horizonte , Brazil.,b Serviço de Doenças Infecciosas e Parasitárias , Hospital das Clínicas, UFMG , Belo Horizonte , Brazil.,c Serviço de Controle de Infecção Hospitalar , Hospital das Clínicas da Faculdade de Medicina, UFMG , Belo Horizonte , Brazil
| | - Carlos Magno Moreira
- b Serviço de Doenças Infecciosas e Parasitárias , Hospital das Clínicas, UFMG , Belo Horizonte , Brazil
| | - Leandro Cesar da Silva
- b Serviço de Doenças Infecciosas e Parasitárias , Hospital das Clínicas, UFMG , Belo Horizonte , Brazil
| | - Wanessa Trindade Clemente
- c Serviço de Controle de Infecção Hospitalar , Hospital das Clínicas da Faculdade de Medicina, UFMG , Belo Horizonte , Brazil.,d Departamento de Propedêutica Complementar, Faculdade de Medicina , UFMG , Belo Horizonte , Brazil
| | - Roberta Maia de Castro Romanelli
- c Serviço de Controle de Infecção Hospitalar , Hospital das Clínicas da Faculdade de Medicina, UFMG , Belo Horizonte , Brazil.,e Departamento de Pediatria, Faculdade de Medicina , UFMG , Belo Horizonte , Brazil
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16
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Giannetti AV, Pimenta FG, Clemente WT. Does the Simultaneous Use of a Neuroendoscope Influence the Incidence of Ventriculoperitoneal Shunt Infection? World Neurosurg 2017; 98:171-175. [DOI: 10.1016/j.wneu.2016.10.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
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17
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Gudiol C, Royo-Cebrecos C, Tebe C, Abdala E, Akova M, Álvarez R, Maestro-de la Calle G, Cano A, Cervera C, Clemente WT, Martín-Dávila P, Freifeld A, Gómez L, Gottlieb T, Gurguí M, Herrera F, Manzur A, Maschmeyer G, Meije Y, Montejo M, Peghin M, Rodríguez-Baño J, Ruiz-Camps I, Sukiennik TC, Carratalà J. Clinical efficacy of β-lactam/β-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae in haematological patients with neutropaenia: a study protocol for a retrospective observational study (BICAR). BMJ Open 2017; 7:e013268. [PMID: 28115333 PMCID: PMC5278288 DOI: 10.1136/bmjopen-2016-013268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population. METHODS AND ANALYSIS A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events. SAMPLE SIZE The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2. ETHICS AND DISSEMINATION The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group for Infections in Compromised Hosts (ESGICH).
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Affiliation(s)
- C Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- Duran i Reynals Hospital, ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - C Royo-Cebrecos
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - C Tebe
- Statistics Advisory Service, Institute of Biomedical Research of Bellvitge, Rovira i Virgili University, L'Hospitalet de Llobregat, Barcelona, Spain
| | - E Abdala
- Faculty of Medicine, Instituto do Câncer do Estado de São Paulo, University of São Paulo, Sao Paulo, Brazil
| | - M Akova
- Hacettepe University School of Medicine, Ankara, Turkey
| | - R Álvarez
- Infectious Diseases Research Group, Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospitals Virgen del Rocio and Virgen Macarena, Seville, Spain
| | - G Maestro-de la Calle
- Infectious Diseases Unit, Instituto de Investigación Hospital “12 de Octubre” (i+12), “12 de Octubre” University Hospital; School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Cano
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
- Reina Sofía University Hospital-IMIBIC-UCO, Córdoba, Spain
| | - C Cervera
- University Hospital of Alberta, Edmonton, Alberta, Canada
| | - W T Clemente
- Infectious Disease Consultant, Digestive Transplant Service, Hospital das Clínicas, Universidade FederalMinas Gerais, Brazil
| | - P Martín-Dávila
- Infectious Diseases Department, Ramon y Cajal Hospital, Madrid, Spain
| | - A Freifeld
- Infectious Diseases Section, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - L Gómez
- Department of Internal Medicine, University Hospital Mútua de Terrassa, Barcelona, Spain
| | - T Gottlieb
- Department of Microbiology & Infectious Diseases, Concord Hospital, Concord, New South Wales, Australia
| | - M Gurguí
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau and Instituto de Investigación Biomédica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Herrera
- Infectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - A Manzur
- Infectious Diseases, Hospital Rawson, San Juan, Argentina
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, Berlin, Germany
| | - Y Meije
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Disease Unit, Internal Medicine Department, Barcelona Hospital, SCIAS,Barcelona, Spain
| | - M Montejo
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Unit, Cruces University Hospital, Bilbao, Spain
| | - M Peghin
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - J Rodríguez-Baño
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospitals Virgen Macarena and Virgen del Rocío—IBiS; Department of Medicine, University of Seville, Seville, Spain
| | - I Ruiz-Camps
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - T C Sukiennik
- Hospital Santa Casa de Misericórdia de Porto Alegre, Brazil
| | - J Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
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Romanelli RMDC, Anchieta LM, Fernandes JCA, Lima MAF, Souza TMD, Rosado V, Clemente WT, Camargos PAM. Serum levels of vancomycin: is there a prediction using doses in mg/kg/day or m2/day for neonates? Braz J Infect Dis 2016; 20:451-6. [PMID: 27527563 PMCID: PMC9425495 DOI: 10.1016/j.bjid.2016.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 04/10/2016] [Accepted: 06/29/2016] [Indexed: 01/19/2023] Open
Abstract
Coagulase-negative Staphylococcus has been identified as the main nosocomial agent of neonatal late-onset sepsis. However, based on the pharmacokinetics and erratic distribution of vancomycin, recommended empirical dose is not ideal, due to the inappropriate serum levels that have been measured in neonates. The aim of this study was to evaluate serum levels of vancomycin used in newborns and compare the prediction of adequate serum levels based on doses calculated according to mg/kg/day and m2/day. This is an observational reprospective cohort at a referral neonatal unit, from 2011 to 2013. Newborns treated with vancomycin for the first episode of late-onset sepsis were included. Total dose in mg/kg/day, dose/m2/day, age, weight, body surface and gestational age were identified as independent variables. For predictive analysis of adequate serum levels, multiple linear regressions were performed. The Receiver Operating Characteristic curve for proper serum vancomycin levels was also obtained. A total of 98 patients received 169 serum dosages of the drug, 41 (24.3%) of the doses had serum levels that were defined as appropriate. Doses prescribed in mg/kg/day and dose/m2/day predicted serum levels in only 9% and 4% of cases, respectively. Statistical significance was observed with higher doses when the serum levels were considered as appropriate (p < 0.001). A dose of 27 mg/kg/day had a sensitivity of 82.9% to achieve correct serum levels of vancomycin. Although vancomycin has erratic serum levels and empirical doses cannot properly predict the target levels, highest doses in mg/kg/day were associated with adequate serum levels.
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Lima SSS, Nobre V, de Castro Romanelli RM, Clemente WT, da Silva Bittencourt HN, Melo ACM, Salomão LCB, Serufo JC. Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: a randomized controlled trial. Ann Hematol 2016; 95:1169-76. [PMID: 27118539 DOI: 10.1007/s00277-016-2639-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 01/13/2015] [Accepted: 03/09/2016] [Indexed: 02/07/2023]
Abstract
Febrile neutropenia (FN) requires immediate use of antibiotics (ATB), and procalcitonin (PCT) is proven to be useful in guiding antibiotic therapy in different settings. This study investigated the use of PCT as a guide for the duration of ATB in FN. A randomized controlled trial was carried out from January-December 2010. A total of 62 hematological adult patients with FN were randomized, in 1:1 ratio, into two groups: (1) PCT group: length of ATB guided by institutional protocol plus PCT dynamics, and (2) control group: duration of ATB in accordance with institutional protocol. There was no difference between groups regarding the use of ATB for the first episode of fever (HR 1.14, 95 % CI 0.66-1.95, p = 0.641), with equivalent median duration of ATB therapy (PCT group 9.0 days and control group 8.0 days, p = 0.67), and median number of days without ATB (0 days, IQR 0-2 days for both groups, p = 0.96). We observed no difference in clinical cure rate (p = 0.68), infection relapse (p = 1.0), superinfection (p = 0.85), length of hospitalization (p = 0.64), and mortality at 28 days (p = 0.39) and at 90 days (p = 0.72). Considering the cut-off of 0.5 ng/ml, PCT was correlated with bacteremia (sensitivity of 51.9 % and specificity of 76.5 %). In this randomized controlled trial, adding a PCT-guided protocol to the standard recommendations did not reduce the use of antibiotics in febrile neutropenia, although no apparent harm was caused. PCT proved to be a marker of bacteremia in this setting.
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Affiliation(s)
- Stella Sala Soares Lima
- Graduate Program in Infectious Diseases and Tropical Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Rua Santa Catarina, 861/1302, Lourdes, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.170-080. .,Radiotherapy Department of Instituto Mario Penna, Rua Gentios, 1350, Luxemburgo, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.380-490.
| | - Vandack Nobre
- Graduate Program in Infectious Diseases and Tropical Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Rua Santa Catarina, 861/1302, Lourdes, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.170-080.,Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.130-100
| | - Roberta Maia de Castro Romanelli
- Infection Control Service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Pediatric Medicine of School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.130-100
| | - Wanessa Trindade Clemente
- Infection Control Service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Laboratory Medicine Department of School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Ana Catarina Mourão Melo
- School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 110, 1° andar ala oeste, CCIH, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.130-100
| | - Luciana Caetano Botelho Salomão
- School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 110, 1° andar ala oeste, CCIH, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.130-100
| | - José Carlos Serufo
- Graduate Program in Infectious Diseases and Tropical Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Rua Santa Catarina, 861/1302, Lourdes, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.170-080.,Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.130-100
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Lima JLDDA, de Aguiar RALP, Leite HV, Silva HHRM, de Oliveira WM, Sacramento JPTDC, Wakabayashi EA, de Souza HC, Clemente WT, Romanelli RMDC. Surveillance of surgical site infection after cesarean section and time of notification. Am J Infect Control 2016; 44:273-7. [PMID: 26686415 DOI: 10.1016/j.ajic.2015.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/11/2015] [Accepted: 10/16/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cesarean section is a surgical procedure the main complication of which is surgical site infection (SSI), which is related to maternal morbidity and mortality. OBJECTIVE To evaluate active monitoring by telephone to identify infection and time of SSI report in postpartum women and associated risk factors. METHODS We conducted a prospective observational study from 2013-2014, at a referral service for high-risk pregnancies. Surveillance was conducted via telephone at least 30 days after cesarean delivery. Incidence ratio and time of infection occurrence (days) was analyzed. Survival analysis was conducted to assess the temporal distribution of the development of infection. RESULTS Of a total of 353 patients, 14 (4%) cases of SSI were reported, and 10 (7.4%) of the reported cases occurred within 15 days after cesarean and average time of infection was12.21 days. American Society of Anesthesiologists score was the only risk factor associated with SSI after cesarean section. CONCLUSIONS The prevalence of SSI after cesarean section via telephone is similar to several services with different methods of surveillance, considering it could be used by services with limited resources. Superficial incisional SSI was the most common type of infection, time of infection report was mainly before the 15th day postprocedure, and American Society of Anesthesiologists score of 2 or less was protective against SSI. Telephone calls can be a viable method to identify women with infection briefly after discharge, particularly at-risk patients.
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Affiliation(s)
- Júnia Leonne Dourado de Almeida Lima
- Specialization in Prevention and Control of Hospital Infection, Hospital das Clínicas of Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Faculdade Dinâmica do Vale do Piranga, Ponte Nova, Minas Gerais, Brazil
| | | | - Henrique Vitor Leite
- Department of Gynecology and Obstetrics, Medical School of Universidade Federal de Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | | - Helen Cristina de Souza
- Medical School of Universidade Federal de Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
| | - Wanessa Trindade Clemente
- Propedeutics Department, Medical School of Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Pediatrics Department, Medical School of Universidade Federal de Minas Gerais, Universidade José do Rosário Vellano, Belo Horizonte, Minas Gerais, Brazil
| | - Roberta Maia de Castro Romanelli
- Pediatrics Department, Medical School of Universidade Federal de Minas Gerais, Universidade José do Rosário Vellano, Belo Horizonte, Minas Gerais, Brazil; Hospital Infection Control Committee, Hospital das Clínicas of Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Chianca LM, Romanelli RMDC, Souza TMD, Oliveira WMD, Wakabayashi EA, Rodrigues LV, Ramos SDDS, Fernandes RPP, Carvalho LMDOA, Paula ATD, Rosado V, Leite HV, Aguiar RALPD, Coimbra BB, Clemente WT. ÍNDICE DE RISCO CIRÚRGICO E INFECÇÃO DE FERIDA OPERATÓRIA EM PUÉRPERAS SUBMETIDAS A CESARIANAS. Rev Epidemiol Control Infect 2015. [DOI: 10.17058/reci.v5i1.4898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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dos Santos Silva LK, Arantes TS, Andrade KR, Lima Rodrigues RA, Miranda Boratto PV, de Freitas Almeida GM, Kroon EG, Scola BL, Clemente WT, Santos Abrahão J. High positivity of mimivirus in inanimate surfaces of a hospital respiratory-isolation facility, Brazil. J Clin Virol 2015; 66:62-5. [DOI: 10.1016/j.jcv.2015.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/05/2015] [Accepted: 03/09/2015] [Indexed: 12/19/2022]
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Romanelli RMDC, Aguiar RALPD, Leite HV, Patrício EDC, Protil KZ, Paula ATD, Rodrigues LV, Coimbra BB, Carvalho LMDOA, Jesus LAD, Armond GA, Clemente WT. FATORES DE RISCO PARA INFECÇÃO DE FERIDA CIRÚRGICA EM PUÉRPERAS SUBMETIDAS A CESARIANAS EM HOSPITAL UNIVERSITÁRIO DE REFERÊNCIA. Rev Epidemiol Control Infect 2014. [DOI: 10.17058/reci.v4i3.3992] [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: 11/23/2022] Open
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Romanelli RMDC, Anchieta LM, Carvalho EADA, Glória e Silva LFD, Nunes RVP, Mourão PH, Clemente WT, Bouzada MCF. Risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. Braz J Infect Dis 2014; 18:400-5. [PMID: 24690427 PMCID: PMC9427516 DOI: 10.1016/j.bjid.2013.12.003] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/23/2013] [Accepted: 12/18/2013] [Indexed: 11/21/2022] Open
Abstract
Background Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce. Objective To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. Methods This case–control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences. Results During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p = 0.03) and use of non-invasive ventilation was a protective factor (p = 0.048). Statistically significant difference was also observed for mechanical ventilation duration (p = 0.004), duration of non-invasive ventilation (p = 0.04), and parenteral nutrition duration (p = 0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p = 0.041). Conclusions Shortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates undergoing surgery should be considered in the assistance of these patients, with the goal of reducing Healthcare Associated Infections, especially laboratory-confirmed bloodstream infection.
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Affiliation(s)
- Roberta Maia de Castro Romanelli
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Neonatal Unit for Progressive Care, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Hospital Infection Control Committee, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil.
| | - Lêni Márcia Anchieta
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Neonatal Unit for Progressive Care, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Lorena Ferreira de Glória e Silva
- Pediatrics Infectious Diseases, Hospital Infantil João Paulo II, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Paulo Henrique Mourão
- Hospital Infection Control Committee, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Wanessa Trindade Clemente
- Hospital Infection Control Committee, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil; Department of Complementary Propedeutics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Maria Cândida Ferrarez Bouzada
- Department of Pediatrics, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Neonatal Unit for Progressive Care, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Ferreira J, Anchieta LM, Jesus LAD, Pinto FS, Armond GA, Clemente WT, Bouzada MCF, Romanelli RMDC. NOTIFICAÇÃO DE INFECÇÕES EM UNIDADE NEONATAL COM CRITÉRIOS NACIONAIS. Rev Epidemiol Control Infect 2014. [DOI: 10.17058/reci.v3i3.3954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Clemente WT, Rabello A, Faria LC, Peruhype-Magalhães V, Gomes LI, da Silva TAM, Nunes RVP, Iodith JB, Protil KZ, Fernandes HR, Cortes JRG, Lima SSS, Lima AS, Romanelli RMC. High prevalence of asymptomatic Leishmania spp. infection among liver transplant recipients and donors from an endemic area of Brazil. Am J Transplant 2014; 14:96-101. [PMID: 24369026 DOI: 10.1111/ajt.12521] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Visceral leishmaniasis is an uncommon disease in transplant recipients; however, if left untreated, the mortality can be high. If an organ donor or recipient is known to be an asymptomatic Leishmania spp. carrier,monitoring is advised. This study proposes to assess the prevalence of asymptomatic Leishmania spp.infection in liver transplant donors and recipients from an endemic area. A total of 50 liver recipients and 17 liver donors were evaluated by direct parasite search, indirect fluorescent antibody test (IFAT), anti-Leishmania rK39 rapid test and Leishmania spp.DNA detection by polymerase chain reaction (PCR).Leishmania spp. amastigotes were not observed in liver or spleen tissues. Of the 67 serum samples, IFAT was reactive in 1.5% and indeterminate for 17.9%, and the anti-Leishmania rK39 rapid test was negative for all samples. The PCR test was positive for 7.5%, 8.9%, and 5.9% of blood, liver and spleen samples, respectively(accounting for 23.5% of the donors and 8% of the recipients). Leishmania infantum-specific PCR confirmed all positive samples. In conclusion, a high prevalence of asymptomatic L. infantum was observed in donors and recipients from an endemic area, and PCR was the most sensitive method for screening these individuals.
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Rosado V, Camargos PAM, Clemente WT, Romanelli RMDC. Incidence of infectious complications associated with central venous catheters in pediatric population. Am J Infect Control 2013; 41:e81-4. [PMID: 23422229 DOI: 10.1016/j.ajic.2012.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 10/28/2012] [Accepted: 10/29/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND Central venous catheters (CVC) are essential in intensive pediatric care units (PICU). Preventive measures during insertion and maintenance reduce infection risks. METHODS A prospective cohort study was conducted from January 2010 to December 2011 in a Brazilian university hospital PICU. Patients were followed throughout hospital stay to verify the occurrence of catheter-associated infection (CAI). An active search was performed of the daily prospective data related to the practice of CVC insertion. RESULTS There was a total of 255 catheter insertions with a CAI incidence density of 13.55/1,000 CVC-days. No association was found between an increased risk for infection and surgical hand antisepsis, the use of maximum barrier precautions, or the use of chlorhexidine for skin antisepsis, which were recommended for the prevention of CAIs. A multivariate analysis showed that catheter use for less than 7 days was protective (P < .01; odds ratio, 0.29; 95% confidence interval: 0.12-0.72). CONCLUSION Health care teams responsible for CVC insertion should rigorously assess the need for CVC and remove them within 7 days when possible. For patients who have no indication for CVC removal, monitoring with clinical evaluation and requests for additional blood cultures should be scrutinized rigorously.
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Affiliation(s)
- Viviane Rosado
- Infection Control Committee of Clinics Hospital, Federal University of Minas, Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Romanelli RMDC, Anchieta LM, Mourão MVA, Campos FA, Loyola FC, Jesus LAD, Armond GA, Clemente WT. Infecções relacionadas à assistência a saúde baseada em critérios internacionais, realizada em unidade neonatal de cuidados progressivos de referência de Belo Horizonte, MG. Rev bras epidemiol 2013. [DOI: 10.1590/s1415-790x2013000100077] [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: 11/22/2022] Open
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Romanelli RMDC, Anchieta LM, Mourão MVA, Campos FA, Loyola FC, Jesus LAD, Armond GA, Clemente WT. [Notification of healthcare associated infections based on international criteria performed in a reference neonatal progressive care unity in Belo Horizonte, MG]. Rev Bras Epidemiol 2013; 16:77-86. [PMID: 23681325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 05/23/2012] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To describe occurrence of Healthcare Related Infections in a neonatal unit of public reference service in Belo Horizonte-MG, based on international criteria. METHODS This is a descriptive study, performed by active searching, in the Progressive Care Unit Neonatal Hospital das Clinicas, Federal University of Minas Gerais (HC / UFMG), from 2008 to 2009. Notification of infections was based on National Healthcare Safety Network (NHSN) criteria. The database and analysis were performed in a internal program. RESULTS A total of 325 episodes of infection in newborns were notified and overall incidence density of infections was 22.8/1,000 patient-days, with a rate of 36.7% of newborns. Sepsis was the main infection (62.5%) reported. The incidence density of infections was higher in neonates weighing lower than 750g (42.4/1,000 patient-days). There were 18.15 episodes of central venous catheter related sepsis/1,000 central venous catheter-day and 19.29 umbilical catheter related sepsis /1,000 umbilical catheter-days. Microorganisms were isolated in 122 (37.5%) cases of reported infections, mainly defined as Staphylococcus coagulase negative and Staphylococcus aureus (51 cases). Mortality and lethality rates were 4.3% and 17,12%, respectively. CONCLUSION The use of standardized criteria for reporting infections is necessary for the construction of indicators in neonatology, which are scarce in the country and highlight the need for evaluation of national criteria proposed by National Agency of Sanitary Surveillance (ANVISA).
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Romanelli RMDC, Anchieta LM, Mourão MVA, Campos FA, Loyola FC, Jesus LAD, Armond GA, Clemente WT. Infecções relacionadas à assistência a saúde baseada em critérios internacionais, realizada em unidade neonatal de cuidados progressivos de referência de Belo Horizonte, MG. Rev bras epidemiol 2013. [DOI: 10.1590/s1415-790x2013000100008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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
OBJETIVO: Descrever a ocorrência de infecções relacionadas à assistência à saúde em uma unidade neonatal de serviço público de referência em Belo Horizonte, MG, baseando-se em critérios internacionais. MÉTODOS: Trata-se de estudo descritivo, realizado por busca ativa, na Unidade Neonatal de Cuidados Progressivos do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), de 2008 a 2009. A notificação de infecções baseou-se nos critérios do National Healthcare Safety Network (NHSN). O banco de dados e análise foi realizado em programa interno do serviço. RESULTADOS: Foram notificados 325 episódios de infecção nos recém-nascidos, com densidade de incidência de 22,8/1.000 pacientes-dia e incidência proporcional geral de infecção de 36,7%. A sepse foi a principal infecção (62,5%) notificada. A densidade de incidência de infecções foi maior em neonatos com peso menor que 750g (42,4/1.000 pacientes-dia). Observou-se 18,15 episódios de Sepse Relacionada a Cateter/1.000 Cateter Venoso Central-dia e 19,29/1.000 episódios de Sepse Relacionada a Cateter Umbilical/1.000 Cateter umbilical-dia. Em 122 (37,5%) casos de infecção notificada houve isolamento de microorganismos, predominando Staphylococcus coagulase negativo e Staphylococcus aureus (51 casos). A mortalidade e letalidade foram 4,3% e 17,12%, respectivamente. CONCLUSÃO: A utilização de critérios padronizados para notificação de infecções é necessária para a construção de indicadores em neonatologia, que são escassos no país e ressaltam a necessidade de avaliação dos critérios nacionais propostos pela Agencia Nacional de Vigilância Sanitária (ANVISA).
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Lima SSS, França MS, Godoi CCG, Martinho GH, de Jesus LA, Romanelli RMDC, Clemente WT. Neutropenic patients and their infectious complications at a University Hospital. Rev Bras Hematol Hemoter 2013; 35:18-22. [PMID: 23580879 PMCID: PMC3621630 DOI: 10.5581/1516-8484.20130009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 10/03/2012] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze the characteristics and infectious complications of neutropenic patients in a referral hospital. METHODS A cross-sectional study was carried out between April and September 2008, which enrolled all neutropenic patients identified by daily blood counts in the Universidade Federal de Minas Gerais. Demographic data and information on infections were obtained from the Hospital Infection Control Committee. Statistical analysis was performed using the Statistical Package for Social Sciences. RESULTS One hundred and sixteen patients were followed up during 129 hospitalizations. The patients had a mean age of 48.7 years old. Sixty-four (55.2%) patients were male and 25 (21.6%) died during the follow-up. In 97 (75.2%) of the hospitalizations, patients had episodes of febrile neutropenia. Patients classified as low-risk had a mortality rate of 16.2% (n = 12) vs. 39.1% (n = 9) among high-risk patients (p-value = 0.02). The death rate of the patients who had been submitted to hematopoietic stem cell transplantation was 13.5% (n = 5) vs. 26.7% (n = 16) among patients not submitted to transplantation (p-value = 0.13). Of the 155 infections diagnosed, 45.5% were defined as clinically documented. The etiological agent most frequently isolated was Escherichia coli and the main topography reported was bloodstream infections. The most used antimicrobial agents were cefepime, vancomycin and fluconazole. Approximately 24% of patients evolved with impaired renal function during hospitalization. CONCLUSION Most reported infections in neutropenic patients were defined as clinically documented, which shows the importance of suspicion in patients without specific signs and symptoms for early diagnosis and the need for the classification of risk for timely interventions.
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Affiliation(s)
- Stella Sala Soares Lima
- Hospital das Clínicas, Universidade Federal de Minas Gerais - HCUFMG, Belo Horizonte, MG, Brazil
| | - Monique Sedlmaier França
- Instituto de Previdência dos Servidores do Estado de Minas Gerais - IPSEMG, Belo Horizonte, MG, Brazil
| | | | - Glaucia Helena Martinho
- Hospital das Clínicas, Universidade Federal de Minas Gerais - HCUFMG, Belo Horizonte, MG, Brazil
| | - Lenize Adriana de Jesus
- Hospital das Clínicas, Universidade Federal de Minas Gerais - HCUFMG, Belo Horizonte, MG, Brazil
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Romanelli RMDC, Aguiar RLPD, Leite HV, Silva DG, Nunes RVP, Brito JI, Fernandes HR, Protil KZ, Sousa ISE, Jesus LAD, Armond GA, Clemente WT. Estudo prospectivo da implantação da vigilância ativa de infecções de feridas cirúrgicas pós-cesáreas em hospital universitário no Estado de Minas Gerais, Brasil, 2010 a 2011. Epidemiol Serv Saúde 2012. [DOI: 10.5123/s1679-49742012000400006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Romanelli RMC, Clemente WT, Lima SSS, Rezende EM, Martinho GH, Paiva LFR, Neves FAC, Madeira JGC, Amâncio GCS, Lima AS, Faria LC, Coutinho RI. MRSA outbreak at a transplantation unit. Braz J Infect Dis 2010; 14:54-9. [PMID: 20428655 DOI: 10.1590/s1413-86702010000100011] [Citation(s) in RCA: 3] [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] [Received: 08/09/2009] [Accepted: 11/24/2009] [Indexed: 11/22/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infections frequently complicate the post-operative course of transplant recipients, and despite nasal carriage and endemic colonization, MRSA outbreaks are not commonly described. This study reports a case of MRSA outbreak and discusses infection control measures and recommendations for this situation.
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Affiliation(s)
- R M C Romanelli
- Infection Control Commission, Hospital das Clínicas, Universidade Federal de Minas Gerais
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Vilela EG, Clemente WT, Mira RRL, Torres HOG, Veloso LF, Fonseca LP, de Carvalho E Fonseca LR, Franca MDC, Lima AS. Strongyloides stercoralis hyperinfection syndrome after liver transplantation: case report and literature review. Transpl Infect Dis 2009; 11:132-6. [PMID: 18983416 DOI: 10.1111/j.1399-3062.2008.00350.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [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
Strongyloides stercoralis is an intestinal nematode that causes human infections and whose life cycle has special features, including autoinfection. Strongyloides infection may be asymptomatic for years, owing to a low parasite load. During immunosuppressive therapy, however, if cellular immunity is depressed, autoinfection can occur at a higher rate, resulting in hyperinfection syndrome. In this specific circumstance, it can become a fatal illness. We describe a case of hyperinfection syndrome in a liver transplant recipient and also review the literature.
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Affiliation(s)
- E G Vilela
- Transplant Unit, Alfa Institute of Gastroenterology, Clinic Hospital, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Lima SSS, Clemente WT, Palaci M, Rosa RV, Antunes CMDF, Serufo JC. Conventional and molecular techniques in the diagnosis of pulmonary tuberculosis: a comparative study. J Bras Pneumol 2008; 34:1056-1062. [PMID: 19180341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 05/05/2008] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To compare four laboratory methods in the diagnosis of pulmonary tuberculosis. METHODS Respiratory secretion specimens were collected from 160 patients suspected of having pulmonary tuberculosis. Direct testing for Mycobacterium tuberculosis was carried out using Ziehl-Neelsen and auramine staining. In addition, culture in Löwenstein-Jensen (LJ) medium and polymerase chain reaction (PCR) were used. The strains isolated were identified by means of a radiometric method using p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) and classical methods. The sensitivity of the methods was compared to the gold standard for the diagnosis of pulmonary tuberculosis, based on clinical, radiological and microbiological criteria. RESULTS Of the 160 patients, 142 were diagnosed with pulmonary tuberculosis according to the gold standard. The sensitivity of Ziehl-Neelsen staining, auramine staining, culture in LJ medium and PCR was 54.2%, 58.4%, 67.6% and 77.5%, respectively, when compared with the diagnostic criterion adopted. All four methods presented 100% specificity. In the identification of mycobacteria, there was high (96.8%) concordance between PCR and the radiometric method using NAP. The sensitivity of PCR was 50.8% in samples with negative sputum smear microscopy results and 98.8% in those with positive results. The sensitivity of PCR was lower in specimens with negative results in sputum smear microscopy and culture than in those with positive results (25.6% and 99.0%, respectively). CONCLUSIONS We found PCR to be a promising method for the diagnosis of pulmonary tuberculosis, even in paucibacillary specimens. Simultaneous identification and faster results are additional advantages of this method.
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Lima SSS, Clemente WT, Palaci M, Rosa RV, Antunes CMDF, Serufo JC. Métodos convencionais e moleculares para o diagnóstico da tuberculose pulmonar: um estudo comparativo. J Bras Pneumol 2008. [DOI: 10.1590/s1806-37132008001200011] [Citation(s) in RCA: 7] [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] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Comparar quatro métodos laboratoriais no diagnóstico de tuberculose pulmonar. MÉTODOS: Foram realizadas pesquisa direta pelas colorações de Ziehl-Neelsen e auramina, cultura para micobactérias em meio Löwenstein-Jensen (LJ) e polymerase chain reaction (PCR, reação em cadeia da polimerase) para Mycobacterium tuberculosis em 160 amostras de secreção respiratória de pacientes com suspeita de tuberculose pulmonar. As cepas isoladas foram identificadas por método radiométrico utilizando-se p-nitro-alfa-acetilamino-beta-hidroxipropiofenona (NAP) e métodos clássicos. A sensibilidade dos métodos foi comparada com o padrão ouro para o diagnóstico da tuberculose pulmonar, definido por critérios clínicos, radiológicos e microbiológicos. RESULTADOS: Dos 160 pacientes, 142 foram diagnosticados com tuberculose pulmonar de acordo com o padrão ouro. As técnicas de Ziehl-Neelsen e auramina, cultura em meio LJ e PCR apresentaram sensibilidade de 54,2%, 58,4%, 67,6% e 77,5%, respectivamente, quando comparados ao critério diagnóstico adotado. A especificidade dos quatro métodos foi de 100%. A concordância na identificação da micobactéria entre PCR e o método radiométrico utilizando NAP foi alta (96,8%). A sensibilidade da PCR foi de 50,8% nas amostras com baciloscopia negativa e de 98,8% naquelas com baciloscopia positiva. Nas amostras com resultados negativos na baciloscopia e cultura, a sensibilidade da PCR foi menor que nas com resultados positivos (25,6% e 99,0%, respectivamente). CONCLUSÕES: A PCR é método promissor no diagnóstico da tuberculose pulmonar, mesmo em amostras paucibacilares. Além disso, apresenta a vantagem da identificação simultânea e rapidez do resultado.
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Clemente WT, Soares Lima SS, Palaci M, Silva MSN, Sumnienski Rodrigues VF, Dalla Costa ER, Possuelo L, Cafrune PI, Ribeiro FK, Gomes HM, Serufo JC. Phenotypic and genotypic characterization of drug-resistant Mycobacterium tuberculosis strains. Diagn Microbiol Infect Dis 2008; 62:199-204. [PMID: 18687558 DOI: 10.1016/j.diagmicrobio.2008.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 06/16/2008] [Accepted: 06/17/2008] [Indexed: 10/21/2022]
Abstract
Of 142 pulmonary tuberculosis patients, 76 were considered high risk for the development of resistance, and 24 were confirmed as resistant strain carriers. Resistant isoniazid strains presented a high frequency of katG and ahpC mutations (90%) correlated with an MIC >4 microg/mL (94%). inhA mutations were not seen. rpoB mutations were identified in 78.6% of rifampicin-resistant strains, usually in codon 531 (72.7%), and 75% had an MIC >16 microg/mL. katG and rpoB mutations recognized 88.2% of multidrug-resistant strains and proved more efficient than the katG and rpoB mutations alone. Seventy percent of resistant pyrazinamide strains had pncA mutations between genes 136 and 188, 62.5% of them with an MIC >900 microg/mL. Pyrazinamidase inactivity was not an efficient resistance marker because 60% of pncA-mutated strains maintained enzymatic activity despite displaying good correlation with high resistance levels. Resistant ethambutol strains had embB mutations in codon 306, with MIC >16 microg/mL.
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Affiliation(s)
- Wanessa Trindade Clemente
- Departamento de Propedêutica Complementar da Faculdade de Medicina da Universidade Federal de Minas Gerais. Av. Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, CEP 30130-100, Brazil.
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Clemente WT, Couto CA, Ribeiro DD, de Medeiros Chaves França M, Sanches MD. An Atypical Course of Visceral Leishmaniasis (Kala-azar) in a Liver Transplant Recipient. Transplantation 2007; 83:368-9. [PMID: 17297421 DOI: 10.1097/01.tp.0000251810.61080.33] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Oliveira AC, Martins MA, Martinho GH, Clemente WT, Lacerda RA. [Comparative study of surgical wound infection diagnosed in-hospital and post discharge]. Rev Saude Publica 2002; 36:717-22. [PMID: 12488938 DOI: 10.1590/s0034-89102002000700009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/22/2022] Open
Abstract
OBJECTIVE Surgical wound infection (SWI) is a serious hospital infection due to its incidence, morbidity and mortality. Because of the short hospital stay, the majority of SWI appears post-discharge, and its incidence is often underreported when there is no follow-up of the surgical patient post discharge. The need of a surveillance system for surgical patient after discharge is critical for infection control. The study objective was to determine the incidence of SWI in surgical patients and to compare the frequency of SWI diagnosed in-hospital and after discharge. METHODS A prospective cohort study was carried out in a university hospital. Patients admitted to the general surgery unit (504) and underwent digestive tract surgery in the first semester of the year 2000 were followed up during their hospital stay and after discharge. RESULTS Of 504 surgical patients, 398 (79.0%) returned to follow up in the post discharge outpatient clinic. Of the total surgical wound infections diagnosed, most (62.9%) was detected in the post discharge outpatient clinic, and 88% of SWI diagnosed were classified as superficial, and 67% reported up to day 7 after discharge. CONCLUSIONS This study showed the importance of following up surgical patients after discharge to achieve reliable incidence data on surgical wound infection because of the late occurrence of infection in the majority of cases, which results in underreporting when the patient is followed up only during the hospital stay.
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