MARINA FARREL CORTES

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 12 Citação(ões) na Scopus
    Alternative drugs against multiresistant Gram-negative bacteria
    (2020) PERDIGAO NETO, Lauro Vieira; OLIVEIRA, Maura Salaroli; ORSI, Tatiana D'Annibale; PRADO, Gladys Villas Boas do; MARTINS, Roberta Cristina Ruedas; LEITE, Gleice Cristina; MARCHI, Ana Paula; LIRA, Esther Sant'Ana de; CORTES, Marina Farrel; ESPINOZA, Evelyn Patricia Sanchez; CARRILHO, Claudia Maria Dantas de Maio; BOSZCZOWSKI, Icaro; GUIMARAES, Thais; COSTA, Silvia Figueiredo; LEVIN, Anna S.
    Objectives: Enterobacterales and other non-fermenting Gram-negative bacteria have become a threat worldwide owing to the frequency of multidrug resistance in these pathogens. On the other hand, efficacious therapeutic options are quickly diminishing. The aims of this study were to describe the susceptibility of 50 multiresistant Gram-negative bacteria, mostly pan-resistant, against old and less-used antimicrobial drugs and to investigate the presence of antimicrobial resistance genes. Methods: A total of 50 genetically distinct isolates were included in this study, including 14 Acinetobacter baumannii (belonging to ST79, ST317, ST835 and ST836), 1 Pseudomonas aeruginosa (ST245), 8 Serratia marcescens and 27 Klebsiella pneumoniae (belonging to STII, ST340, ST258, ST16, ST23, ST25, ST101, ST234, ST437 and ST442). The isolates were submitted to antimicrobial susceptibility testing and whole-genome sequencing to evaluate lineages and resistance genes. Results: Our results showed that some strains harboured carbapenemase genes, e.g. bla(K)(PC-)(2) (28/50; 56%) and bla(OXA-23) (11/50; 22%), and other resistance genes encoding aminoglycoside-modifying enzymes (49/50; 98%). Susceptibility rates to tigecycline (96%) in all species (except P. aeruginosa), to minocycline (100%) and doxycycline (93%) in A. baumannii, to ceftazidime/avibactam in S. marcescens (100%) and K. pneumoniae (96%), and to fosfomycin in S. marcescens (88%) were high. Chloramphenicol and quinolones (6% susceptibility each) did not perform well, making their use in an empirical scenario unlikely. Conclusions: This study involving genetically distinct bacteria showed promising results for tigecycline for all Gram-negative bacteria (except P. aeruginosa), and there was good activity of minocycline against A. baumannii, ceftazidime/avibactam against Enterobacterales, and fosfomycin against S. marcescens. (C) 2020 The Author(s).
  • article 0 Citação(ões) na Scopus
    Performance Evaluation of VIDAS(& REG;) Diagnostic Assays Detecting Anti-Chikungunya Virus IgM and IgG Antibodies: An International Study
    (2023) PEREIRA, Geovana M.; MANULI, Erika R.; COULON, Laurie; CORTES, Marina F.; RAMUNDO, Mariana S.; DROMENQ, Loic; LARUE-TRIOLET, Audrey; RAYMOND, Frederique; TOURNEUR, Carole; LAZARI, Carolina dos Santos; BRASIL, Patricia; FILIPPIS, Ana Maria Bispo de; PARANHOS-BACCALA, Glaucia; BANZ, Alice; SABINO, Ester C.
    Chikungunya (CHIK) is a debilitating mosquito-borne disease with an epidemiology and early clinical symptoms similar to those of other arboviruses-triggered diseases such as dengue or Zika. Accurate and rapid diagnosis of CHIK virus (CHIKV) infection is therefore challenging. This international study evaluated the performance of the automated VIDAS(& REG;) anti-CHIKV IgM and IgG assays compared to that of manual competitor IgM and IgG ELISA for the detection of anti-CHIKV IgM and IgG antibodies in 660 patients with suspected CHIKV infection. Positive and negative agreements of the VIDAS(& REG;) CHIKV assays with ELISA ranged from 97.5% to 100.0%. The sensitivity of the VIDAS(& REG;) CHIKV assays evaluated in patients with a proven CHIKV infection confirmed reported kinetics of anti-CHIKV IgM and IgG response, with a positive detection of 88.2-100.0% for IgM & GE; 5 days post symptom onset and of 100.0% for IgG & GE; 11 days post symptom onset. Our study also demonstrated the superiority of ELISA and VIDAS(& REG;) assays over rapid diagnostic IgM/IgG tests. The analytical performance of VIDAS(& REG;) anti-CHIKV IgM and IgG assays was excellent, with a high precision (coefficients of variation & LE; 7.4%) and high specificity (cross-reactivity rate & LE; 2.9%). This study demonstrates the suitability of the automated VIDAS(& REG;) anti-CHIKV IgM and IgG assays to diagnose CHIKV infections and supports its applicability for epidemiological surveillance and differential diagnosis in regions endemic for CHIKV.
  • article 7 Citação(ões) na Scopus
    Risk factors for bloodstream infection by multidrug-resistant organisms in critically ill patients in a reference trauma hospital
    (2022) CAMPOS, Luciana Rodrigues Pires de; CORTES, Marina Farrel; DEO, Beatriz; RIZEK, Camila; SANTOS, Sania; PERDIGAO, Lauro; COSTA, Silvia Figueiredo
    Background: Bloodstream infections (BSI) by multidrug-resistant (MDR) organisms are responsible for significant mortality in critically ill trauma patients. Our objective is to identify the risk factors for BSI by MDR agents and their resistance mechanisms in a trauma reference hospital. Methods: During 18 months, all patients admitted in our Intensive Care Unit (ICU) were enrolled in this prospective cohort. We included the first episode of BSI by carbapenem-resistant Gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus. Demographic and clinical data were compared among patients with and without BSI and variables with P <.05 were tested in a multivariate analysis. We performed PCR for identification of carbapenemase and SCC mec genes and Pulsed-field gel electrophoresis for clonality. Results: Out of 1,528 patients, 302 (19.8%) were trauma and 66 (4.3%) had a MDR-BSI ( 19.5% were trauma). The multivariate analysis showed that mechanical ventilation (OR3.16; 95% CI 1-8; P =.02), hemodialysis (OR3.16; 95% CI 1-5; P =.0003) and surgery (OR1.76; 95% CI 1-3; P =.04) were independent risk factors for MDR- BSI. The most frequent MDR were Klebsiella pneumoniae (n = 26) and MRSA (n = 27). Regarding K pneumoniae strains (n = 24), 20 ( 83.8%) harbored bla KPC gene and 1 bla NDM. The majority of KPC isolates belonged to a predominant clone; while the MRSA were polyclonal and SCC mec type II. Conclusions: Mechanical ventilation, surgery and hemodialysis were independent risk factors for MDR-BSI in our cohort, but trauma was not. KPC was the main mechanism of resistance among carbapenem-resistant K pneumoniae that belonged to a predominant clone which could indicate cross-transmission.
  • article 2 Citação(ões) na Scopus
    Epidemiologic case investigation on the zoonotic transmission of Methicillin-resistant Staphylococcus pseudintermedius among dogs and their owners
    (2023) GUIMARAES, Luciana; TEIXEIRA, Izabel Mello; SILVA, Isabella Thomaz da; ANTUNES, Milena; PESSET, Camilla; FONSECA, Carolina; SANTOS, Ana Luiza; CORTES, Marina Farrel; PENNA, Bruno
    Dogs often carry methicillin-resistant Staphylococci asymptomatically. These bacteria are frequently linked to conditions such as canine pyoderma and otitis. Close interaction between dogs and humans can facilitate the exchange of resistant strains, particularly Methicillin-resistant Staphylococcus pseudintermedius (MRSP). This represents a public health issue, since these strains, in addition to occasionally causing infections in humans, can also serve as a source of resistance and virulence genes for strains of greater importance in human medicine, such as Staphylococcus aureus. Furthermore, MRSP strains are often multidrug resistant, which ends up compromising the treatment of infections. This study aimed to assess the potential transmission of Staphylococcus pseudintermedius among dogs and their owners. We examined a total of one hundred canine samples collected from cases of pyoderma and otitis to detect the presence of staphylococci. Simultaneously, we conducted evaluations on all dog owners. Staphylococci strains were identified using MALDI-TOF MS and PCR targeting the nuc gene. Methicillin resistance screening was also performed by detecting the mecA gene using PCR. Among the sampled dogs, 64 carried S. pseudintermedius. Nine were identified as MRSP. In six instances, dogs and their owners exhibited S. pseudintermedius. These samples underwent genome sequencing and were screened for antimicrobial resistance genes, SCCmec typing, MLST characterization, and Single Nucleotide Polymorphisms (SNP) analyses. The results of the phylogenetic analysis revealed that in three cases, dogs and owners had closely related isolates, suggesting interspecies transmission. Two of these cases involved MRSP and one MSSP. Moreover, in the two MRSP cases, the same SCCmec type (type V) was detected. Additionally, the sequence type was consistent across all three cases involving dogs and owners (MSSP ST2277, MRSP ST2282, and ST2286). These findings strongly indicate a transmission event. Since Staphylococcus pseudintermedius is primarily isolated from canine samples, it is plausible that dogs may have acted as a potential source. In the remaining three cases, despite identifying the same species in both samples, they had notable phylogenetic differences. (c) 2023 The Author(s).
  • article 2 Citação(ões) na Scopus
    Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort
    (2023) LAZARI, Carolina dos Santos; RAMUNDO, Mariana Severo; TEN-CATEN, Felipe; BRESSAN, Clarisse S.; FILIPPIS, Ana Maria Bispo de; MANULI, Erika Regina; MORAES, Isabella de; PEREIRA, Geovana Maria; CORTES, Marina Farrel; CANDIDO, Darlan da Silva; GERBER, Alexandra L.; GUIMARAES, Ana Paula; FARIA, Nuno Rodrigues; NAKAYA, Helder I.; VASCONCELOS, Ana Tereza R.; BRASIL, Patricia; PARANHOS-BACCALA, Glaucia; SABINO, Ester Cerdeira
    BackgroundChikungunya-fever (CHIKF) remains a public health major issue. It is clinically divided into three phases: acute, post-acute and chronic. Chronic cases correspond to 25-40% individuals and, though most of them are characterized by long-lasting arthralgia alone, many of them exhibit persistent or recurrent inflammatory signs that define post-Chikungunya chronic inflammatory joint disease (pCHIKV-CIJD). We aimed to identify early clinical markers of evolution to pCHIKV-CIJD during acute and post-acute phases. Methodology/Principal findingsWe studied a prospective cohort of CHIKF-confirmed volunteers with longitudinal clinical data collection from symptoms onset up to 90 days, including a 21-day visit (D21). Of 169 patients with CHIKF, 86 (50.9%) completed the follow-up, from whom 39 met clinical criteria for pCHIKV-CIJD (45.3%). The relative risk of chronification was higher in women compared to men (RR = 1.52; 95% CI = 1.15-1.99; FDR = 0.03). None of the symptoms or signs presented at D0 behaved as an early predictor of pCHIKV-CIJD, while being symptomatic at D21 was a risk factor for chronification (RR = 1.31; 95% CI = 1.09-1.55; FDR = 0.03). Significance was also observed for joint pain (RR = 1.35; 95% CI = 1.12-1.61; FDR = 0.02), reported edema (RR = 3.61; 95% CI = 1.44-9.06; FDR = 0.03), reported hand and/or feet small joints edema (RR = 4.22; 95% CI = 1.51-11.78; FDR = 0.02), and peri-articular edema observed during physical examination (RR = 2.89; 95% CI = 1.58-5.28; FDR = 0.002). Furthermore, patients with no findings in physical examination at D21 were at lower risk of chronic evolution (RR = 0.41, 95% CI = 0.24-0.70, FDR = 0.01). Twenty-nine pCHIKV-CIJD patients had abnormal articular ultrasonography (90.6% of the examined). The most common indings were synovitis (65.5%) and joint effusion (58.6%). ConclusionThis cohort has provided important insights into the prognostic evaluation of CHIKF. Symptomatic sub-acute disease is a relevant predictor of evolution to chronic arthritis with synovitis, drawing attention to joint pain, edema, multiple articular involvement including small hand and feet joints as risk factors for chronification beyond three months, especially in women. Future studies are needed to accomplish the identification of accurate and early biomarkers of poor clinical prognosis, which would allow better understanding of the disease's evolution and improve patients' management, modifying CHIKF burden on global public health. Author summaryChikungunya fever (CHIKF) is a vector-borne viral disease first described in 1952 in Africa, which recently reached the Americas, where it then originated epidemics of unprecedented magnitude. Its acute phase is characterized by fever associated with joint pain and edema, which resolve in about seven days for most patients. However, 25-40% of these patients develop chronic musculoskeletal and arthritic symptoms, which may be incapacitating and lead to permanent joint damage. We have conducted a prospective longintudinal cohort of CHIKF confirmed individuals, in Brazil, which aimed to identify clinical early markers of evolution to post-Chikungunya chronic inflammatory joint disease (pCHIKV-CIJD) after 90 days, using objective physical examination to define pCHIKV-CIJD. We have also performed joint ultrasonography to improve evaluation of chronic arthritis. We found that 45.3% of patients who completed the follow-up met criteria for pCHIKV-CIJD. Women were at higher risk of chronification, as well as individuals who remain symptomatic 21 days after the onset of symptoms. Abnormal ultrasonography results were seen in 90.6% of examined pCHIKV-CIJD patients, in whom synovitis and joint effusion were the most commom songraphic signs, affecting mostly ankles and knees. The adoption of objective criteria to define pCHIKV-CIJD is crucial to estimate accurately the proportion of patients who evolve to chronic rheumatism, and to indentify early risk factors to this outcome, which may add important information to tailor therapeutic strategies for this particular population. It may also help to understand the burden of CHIKF in developing countries, measuring either its impact in individual's quality of life, or its communitary repercussion after widespread outbreaks.
  • article 1 Citação(ões) na Scopus
    Evaluation of loop-mediated isothermal amplification assay for detection of Clostridioides difficile infection: A prospective diagnostic performance study
    (2021) GIRA, Evelyne Santana; NOGUERA, Saidy Liceth Vasconez; ESPINOZA, Evelyn Patricia Sanchez; BEZERRA, Camila Loredana Pereira Alves Madeira; LINO, Fernando Molina; CORTES, Marina Farrel; SANTOS, Sania Alves dos; PARANHOS-BACCALA, Glaucia; PERDIGA, Lauro Vieira; COSTA, Silvia Figueiredo
    A novel Loop-mediated isothermal amplification (LAMP) assay, HiberGene's CD was evaluated with 82 unformed stools from patients suspected of C. difficile infection (CDI). Compared to glutamate dehy-drogenase (GDH) toxins A/B test (C.diff Quik Chek (R)), HiberGene's LAMP showed 100% of sensitivity and 95,8% of specificity; and compared to FilmArrayTM GI panel (R) (BioFire), a sensitivity of 81,2% and a specificity of 100%, with 96.38% of agreement.
  • article 4 Citação(ões) na Scopus
    Phenotypic and genotypic characteristics of a carbapenem-resistant Serratia marcescens cohort and outbreak: describing an opportunistic pathogen
    (2022) PRADO, Gladys; MENDES, Elisa Teixeira; MARTINS, Roberta Cristina Ruedas; PERDIGAO-NETO, Lauro Vieira; FREIRE, Maristela Pinheiro; MARCHI, Ana Paula; CORTES, Marina Farrel; LIMA, Victor Augusto Camarinha de Castro; ROSSI, Flavia; GUIMARAES, Thais; LEVIN, Anna Sara; COSTA, Silvia Figueiredo
    Serratia marcescens is an emerging opportunistic pathogen with high genetic diversity. This article describes the microbiological characteristics of isolates and the risk factors for infections caused by carbapenem-resistant S. marcescens. A retrospective study of patients colonized (n=43) and infected (n= 20) with carbapenem-resistant S. marcescens over a 3-year period was conducted. Polymerase chain reaction for carbapenemase genes and molecular typing of all available strains was performed. Forty-two isolates were analysed, including three environmental samples identified during an outbreak. Thirty-five carbapenem-resistant S. marcescens carried bla KPC-2, one isolate was bla(NDM)-positive and four isolates carried bla(OXA)-101. The genomes were grouped into three clusters with 100% bootstrap; three patterns of mutations on ompC and ompF were found. The strains carried virulence genes related to invasion and haemolysis, and the environmental strains presented fewer mutations on the virulence genes than the clinical strains. Multi-variate analysis showed that previous use of polymyxin (P= 0.008) was an independent risk factor for carbapenem-resistant S. marcescens infection. This study highlighted that bla KPC-2 in association with ompC or ompF mutation was the most common mechanism of resistance in the study hospital, and that previous use of polymyxin was an independent risk factor for carbapenem-resistant S. marcescens. There was a predominant clone, including the environmental isolates, suggesting that crosstransmission was involved in the dissemination of this pathogen.
  • article 6 Citação(ões) na Scopus
    Are mobile phones part of the chain of transmission of SARS- CoV-2 in hospital settings?
    (2021) ESPINOZA, Evelyn Patricia Sanchez; CORTES, Marina Farrel; NOGUERA, Saidy Vasconez; PAULA, Anderson Vicente de; GUIMARAES, Thais; BOAS, Lucy Santos Villas; PARK, Marcelo; SILVA, Cristina Carvalho da; MORALES, Ingra; NETO, Lauro Vieira Perdigao; TOZETTO-MENDOZA, Tania Regina; BOSZCZOWSKI, Icaro; SABINO, Ester Cerdeira; MENDES-CORREA, Maria Cassia; LEVIN, Anna Sara; COSTA, Silvia Figueiredo
    Mobile phones (MPs) have become an important work tool around the world including in hospitals. We evaluated whether SARS-CoV-2 can remain on the surface of MPs of first-line healthcare workers (HCW) and also the knowledge of HCWs about SARS-CoV-2 cross-transmission and conceptions on the virus survival on the MPs of HCWs. A crosssectional study was conducted in the COVID-19 Intensive Care Unit of a teaching hospital. An educational campaign was carried out on cross-transmission of SARS-CoV-2, and its permanence in fomites, in addition to the proper use and disinfection of MPs. Herewith an electronic questionnaire was applied including queried conceptions about hand hygiene and care with MP before and after the pandemic. The MPs were swabbed with a nylon FLOQ SwabTM, in an attempt to increase the recovery of SARS-CoV-2. All MP swab samples were subjected to SARS-CoV-2 RT-PCR; RT-PCR positive samples were subjected to viral culture in Vero cells (ATCC (R) CCL-81TM). Fifty-one MPs were swabbed and a questionnaire on hand hygiene and the use and disinfection of MP was applied after an educational campaign. Most HCWs increased adherence to hand hygiene and MP disinfection during the pandemic. Fifty-one MP swabs were collected and two were positive by RT-PCR (4%), with Cycle threshold (Ct ) values of 34-36, however, the cultures of these samples were negative. Although most HCWs believed in the importance of cross-transmission and increased adherence to hand hygiene and disinfection of MP during the pandemic, SARS-CoV-2 RNA was detected in MPs. Our results suggest the need for a universal policy in infection control guidelines on how to care for electronic devices in hospital settings.
  • article 4 Citação(ões) na Scopus
    Characterization of Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant Shedding and Predictors of Viral Culture Positivity on Vaccinated Healthcare Workers With Mild Coronavirus Disease 2019
    (2022) LUNA-MUSCHI, Alessandra; NOGUERA, Saidy Vasconez; BORGES, Igor C.; V, Anderson De Paula; CORTES, Marina Farrel; LAROCCA, Carolina; MARI, Julia Ferreira; GUIMARAES, Lara Silva Pereira; TORRES, Pablo Munoz; SCACCIA, Nazareno; VILLAS-BOAS, Lucy S.; JR, Almir Ribeiro da Silva; ANDRADE, Pamela S.; TEIXEIRA, Juliana C.; ESCADAFAL, Camille; OLIVEIRA, Vitor Falcao de; TOZETTO-MENDOZA, Tania R.; MENDES-CORREA, Maria Cassia; LEVIN, Anna S.; SABINO, Ester C.; COSTA, Silvia F.
    We evaluated the duration of viral culture positivity compared to rapid antigen test (RAT) and real-time reverse-transcription polymerase chain reaction (RT-PCR) in mild Omicron infection. Vaccinated persons are potentially transmissible up to day 7. RAT and RT-PCR are predictors of viral culture positivity. In this prospective cohort of 30 vaccinated healthcare workers with mild Omicron variant infection, we evaluated viral culture, rapid antigen test (RAT), and real-time reverse-transcription polymerase chain reaction (RT-PCR) of respiratory samples at days 5, 7, 10, and 14. Viral culture was positive in 46% (11/24) and 20% (6/30) of samples at days 5 and 7, respectively. RAT and RT-PCR (Ct <= 35) showed 100% negative predictive value (NPV), with positive predictive values (PPVs) of 32% and 17%, respectively, for predicting viral culture positivity. A lower RT-PCR threshold (Ct <= 24) improved culture prediction (PPV = 39%; NPV = 100%). Vaccinated persons with mild Omicron infection are potentially transmissible up to day 7. RAT and RT-PCR might be useful tools for shortening the isolation period.
  • article 1 Citação(ões) na Scopus
    Procalcitonin as a biomarker for ventilator associated pneumonia in COVID-19 patients: Is it an useful stewardship tool? (vol 101, 115344, 2021)
    (2022) CORTES, Marina Farrel; ALMEIDA, Bianca Leal de; ESPINOZA, Evelyn Patricia Sanchez; CAMPOS, Aleia Faustina; MOURA, Maria Luiza do Nascimento; SALOMAO, Matias C.; BOSZCZOWSKI, Icaro; FREIRE, Maristela Pinheiro; CARVALHO, Laina Bubach de; PARANHOS-BACCALA, Glaucia; COSTA, Silvia Figueiredo; GUIMARAES, Thais