FREDERICO LUIZ DULLEY
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Unidades Organizacionais
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- Bloodstream infection in hematopoietic stem cell transplantation outpatients: risk factors for hospitalization and death(2019) RUSSO, Rachel; MENDES, Elisa Teixeira; LEVIN, Anna Sara; DULLEY, Frederico; OLIVEIRA, Maura S.; SHIKANAI-YASUDA, Maria Aparecida; COSTA, Silvia FigueiredoWe described 235 bloodstream infection (BSI) episodes in 146 hematopoietic stem cell transplantation (HSCT) outpatients and evaluated risk factors for hospitalization and death. Records of outpatients presenting with positive blood cultures over a 5-year period (January 2005 to December 2008) were reviewed. Variables with p< 0.1 in bivariate analysis were used in a regression logistic model. A total of 266 agents were identified, being 175 (66.7%) gram-negative. 80 (30.3%) gram-positive bacteria and 9 (3.4%) fungi. The most common underlying disease was acute leukemia 40 (27.4%), followed by lymphoma non-Hodgkin 26 (18%) and 87 patients (59.6%) were submitted to allogeneic hematopoietic stem cell transplant (HSCT). BSI episodes were more frequent during the first 100 days after transplantation (183 or 77.8%), and ninety-one (38.7%) episodes of BSI occurred up to the first 30 days. Hospitalization occurred in 26% of the episodes and death in 10% of cases. Only autologous HSCT was protector for hospitalization. Although. central venous catheter (CVC) withdrawal and the Multinational Association of Supportive Care in Cancer (MASCC) score up to 21 points were protector factors for death in the bivariate analysis, only MASCC remained as protector.
- Risk factor for death in hematopoietic stem cell transplantation: are biomarkers useful to foresee the prognosis in this population of patients?(2014) MASSARO, K. S. R.; MACEDO, R.; CASTRO, B. S. de; DULLEY, F.; OLIVEIRA, M. S.; YASUDA, M. A. S.; LEVIN, A. S.; COSTA, S. F.The morbidity and mortality in hematopoietic stem cell transplantation (HSCT) occur due to infectious complications and constitute the major clinical problems in HSCT recipients. The role of the use of biomarkers in post-HSCT patients is still controversial. To assess the serum values of biomarkers interleukin 6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) and risk factors for post-HSCT death. Prospective study conducted in patients submitted to HSCT at a university hospital. Biomarkers (IL-6, PCT and CRP) were assessed on the day afebrile neutropenia was detected, in the febrile event, 24 and 72 h after fever onset and 48 h or 5 days if fever persisted. Patients were compared as to the death outcome within 30 days from the HSCT. Variables with p < 0.15 were included in the multivariate analysis model (MVA) that were performed for all patients included in the study and separated for autologous and allogeneic HSCT patients. 296 patients with ages ranging between 15 and 70 years, neutropenic, submitted to HSCT, being 216 (73 %) autologous and 80 (20 %) allogeneic were assessed. One hundred and ninety (64.2 %) patients presented fever after the transplantation and infection microbiologically controlled in 78 (26.4 %). Twenty-three cases (7.8 %) evolved to death. The risk factors associated with death in the bivariate analysis were age, allogeneic transplantation, unrelated transplantation, GVHD, bloodstream infection by Gram-negative, IL-6 > 140 pg/mL and CRP a parts per thousand yen120 mg/L and the protective ones were lymphoma and hospital outpatient support. The independent variables in the MVA associated with death were allogeneic and unrelated transplantation, blood stream infection (BSI) by Gram-negative, LDH a parts per thousand yen390 UI/L, urea a parts per thousand yen25 mg/dL and CRP a parts per thousand yen120 mg/L for HSCT transplanted patients and BSI due to Gram-negative and CRP a parts per thousand yen120 mg/L for allogeneic HSCT, however, CRP a parts per thousand yen120 mg/L did not remain in the model when urea a parts per thousand yen25 mg/L was included. No independent risk factor was found for autologous patients. Out of the biomarkers assessed, only CRP a parts per thousand yen120 mg/L was independently associated with death. Other risk factors found were: type of transplantation (allogeneic and unrelated), bloodstream infection by Gram-negative, LDH a parts per thousand yen390 UI/L and urea a parts per thousand yen25 mg/dL. For allogeneic patients only CRP a parts per thousand yen120 mg/L and BSI due to Gram-negative were risk factors for death; however, CRP did not remain in the model when urea a parts per thousand yen25 mg/L was included.
- Clusters of infection due to metallo-beta-lactamase-producing Pseudomonas aeruginosa in stem cell transplant and haematology units(2011) PAEZ, J.; LEVIN, A. S.; FU, L.; BASSO, M.; FONSECA, G. H. H.; DULLEY, F. L.; ROSSI, F.; GUIMARAES, T.; COSTA, S. F.
article Bcl-2 protein in diffuse large B-cell lymphoma Response(2011) HALLACK NETO, Abrahao Elias; SIQUEIRA, Sheila Aparecida Coelho; DULLEY, Frederico Luiz; CHAUOBAH, Alfredo; BELESSO, Marcelo; SABOIA, Rosaura; RUIZ, Milton Artur; CHAMONE, Dalton Alencar Fischer; PEREIRA, JulianaconferenceObject Oral leukoplakia in chronic graft versus host disease(2012) PAVESI, V. C. S.; FRANCA, C. M.; CASTELLI, J. B.; SABOYA, R.; DULLEY, F. L.; CORACIN, F. L.Introduction: Late complications of allogeneic hematopoietic stem cell transplantation (HSCT) include a risk of secondary malignancies and early diagnosis of oral premalignant or malignant lesions requires an assessment of potential predisposing risk factors. Patients with oral epithelial dysplasia after allogeneic HSCT include oral cGVHD as a potential risk factor for oral cancer. A better understanding of the clinical features and potential factors associated with secondary oral cancer, may be benefit predicting and identifying this late complication of allogeneic HSCT. Case details: A 37 years old male who had received an allogeneic hematopoietic stem cell transplantation in October/2002 was referred to a Oral Medicine Outpatient in August 2011 with a white-plaque lesion of the oral mucosa the conditioning regimen to HSCT comprised busulfan-melphalan and graft-versus-host disease prophylaxis was cyclosporine-methotrexate. The patient developed lichenoid-oral cGVHD around day 60 and treatment comprised corticosteroid-cyclosporine. Clinical examination revealeda non-symptomatic 2 cm white-plaque of the hard palate. Exfoliative cytology was performed and no atypical cells were seen. The lesion increased in size to 4 cm long during the next 10-days. An incisional biopsy was undertaken and histopathological analysis revealed an epithelial tissue with acanthosis, hypergranulosis, hyperkeratosis, papilomatosis and apoptosis plus lymphocyte exocitosis. No atypical, cell dysplasia or koylocites were present. Mild to moderate cGVHD activity was seen. In this case, the patient was monitored in our outpatient program and no changes were noted in the lesion. Conclusion: The associationbetweenchronic graftversus host disease andoralsquamous cell carcinoma suggests a close monitoring of patients for early diagnosis of possible secondaryneoplasmsanddemonstratestheaggressivebehaviourofthislatecomplication. Relevance: Due to this aggressive behaviour and the increase number of HSCT worldwide, careful long-term follow-up by a cancer team, including oral medicine expertise, is recommended, and patients should be aware of cancer risk.- Prophylaxis of fungal infections in transplant patients(2012) ABDALA, Edson; COSTA, Silvia Figueiredo; STRABELLI, Tania Mara Varejao; PIERROTTI, Ligia Camera; CARAMORI, Marlova Luzzi; AZEVEDO, Luis Sergio Fonseca de; IBRAHIM, Karim Y.; DULLEY, Frederico Luiz; VARKULJA, Glaucia Fernanda; CASTRO JUNIOR, Gilberto de; ALMEIDA, Gisele Madeira Duboc de; MARQUES, Heloisa Helena de Souza; SHIKANAI-YASUDA, Maria Aparecida
- Healthcare-associated infection in hematopoietic stem cell transplantation patients: risk factors and impact on outcome(2012) MENDES, Elisa Teixeira; DULLEY, Frederico; BASSO, Mariusa; BATISTA, Marjorie Vieira; CORACIN, Fabio; GUIMARAES, Thais; SHIKANAI-YASUDA, Maria Aparecida; LEVIN, Anna Sara; COSTA, Silvia FigueiredoObjective: The objective of this study was to analyze the incidence of and risk factors for healthcare-associated infections (HAI) among hematopoietic stem cell transplantation (HSCT) patients, and the impact of such infections on mortality during hospitalization. Methods: We conducted a 9-year (2001-2009) retrospective cohort study including patients submitted to HSCT at a reference center in Sao Paulo, Brazil. The incidence of HAI was calculated using days of neutropenia as the denominator. Data were analyzed using EpiInfo 3.5.1. Results: Over the 9-year period there were 429 neutropenic HSCT patients, with a total of 6816 days of neutropenia. Bloodstream infections (BSI) were the most frequent infection, presenting in 80 (18.6%) patients, with an incidence of 11.7 per 1000 days of neutropenia. Most bacteremia was due to Gram-negative bacteria: 43 (53.8%) cases were caused by Gram-negative species, while 33 (41.2%) were caused by Gram-positive species, and four (5%) by fungal species. Independent risk factors associated with HAI were prolonged neutropenia (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04-1.10) and duration of fever (OR 1.20, 95% CI 1.12-1.30). Risk factors associated with death in multivariate analyses were age (OR 1.02, 95% CI 1.01-1.43), being submitted to an allogeneic transplant (OR 3.08, 95% CI 1.68-5.56), a microbiologically documented infection (OR 2.96, 95% CI 1.87-4.6), invasive aspergillosis disease (OR 2.21, 95% CI 1.1-4.3), and acute leukemias (OR 2.24, 95% CI 1.3-3.6). Conclusions: BSI was the most frequent HAI, and there was a predominance of Gram-negative microorganisms. Independent risk factors associated with HAI were duration of neutropenia and fever, and the risk factors for a poor outcome were older age, type of transplant (allogeneic), the presence of a microbiologically documented infection, invasive aspergillosis, and acute leukemia. Further prospective studies with larger numbers of patients may confirm the role of these risk factors for a poor clinical outcome and death in this transplant population. (C) 2012 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
- Bone marrow transplantation and acute myeloid leukemia: Brazilian guidelines(2013) SILLA, Lucia Mariano da Rocha; DULLEY, Frederico; SABOYA, Rosaura; PATON, Eduardo; KERBAUY, Fabio; ARANTES, Adriano de Moraes; HAMERSCHLAK, Nelson
conferenceObject Patients oral conditions before hematopoietic stem-cell transplantation in Brazil(2012) CORACIN, F. L.; SOARES JUNIOR, L. A. V.; DULLEY, F. L.; SABOYA, R.; SILVA-SANTOS, P. S. da; TINOCO-ARAUJO, J. E.; COLTURATO, V. A. R.; ANTUNES, H. S.; FERREIRA, C. G.; BOUZAS, L. F. S.; PEREIRA, S. C. M.; MONTEIRO, M. C. P.; RAMPINI, M. P.; MAYHE, R.; LIME, E. M.; TANIMOTO, H. M.; PATON, E. J. A.; SILVA, G. B. L.; SACONO, N. T.; BATISTA, A. C.; BARIANI, C.; PERES, M. P. S. M.Objectives: This prospective multicenter study aims to conduct an epidemiologic survey of oral health status of the patients waiting for the hematopoietic stem cell transplantation (HSCT) in five Brazilian Centers to identify oral needs prior to HSCT. Methods: Patients enrolled in this study were submitted to a dental clinical evaluation whilst they were awaiting for HSCT, performed by a dentist from the participating Institution. Demographic and medical data were collated together with, gingival (GI) and plaque (PI) indexes and index of decay missed and filled teeth (DMFT) were evaluated. These indexes are indicators of oral health according to the World Health Organization (WHO). Results: During the period between April 2011 and April 2012, 101 (73 male and 48 female) patients were enrolled in this prospective study at five HSCT Brazilian Centers. Underlying diseases comprised 25 multiple myeloma, 24 non-Hodgkin lymphoma, 19 acute lymphoblastic leukemia, 16 acute myelogenous leukemia, 13 severe aplastic anemia, 11 Hodgkin lymphoma, six chronic myelogenous leukemia, three myelodisplastic syndrome, one testicular tumor, one retinoblastoma, one myelofibrosis and one chronic lymphoblastic leukemia. Median age was 40 years (range: 4–67). At the time of the survey, patients presented mean GI = 0.8, mean PI = 1.2. DMFT index were evaluated in 104/121 patients and showed mean of 16.1. Conclusion: Patients undergoing HSCT need comprehensive oral care in Brazil due a poor oral health at the time of transplantation, to avoid possible infections secondary to myelosuppression and mucosal barrier injury. Relevance: The patients’ status prior-HSCT may to lead to protocols of dental treatment before HSCT suggesting an important role in the maintenance of oral integrity. Prior dental intervention can lead a better quality of life and improve the results of transplantation, reducing time of mucositis and infections.- POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY Burkholderia cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT OUTPATIENT UNITS(2014) BOSZCZOWSKI, Icaro; PRADO, Gladys Villas Boas do; DALBEN, Mirian F.; TELLES, Roberto C. P.; FREIRE, Maristela Pinheiro; GUIMARAES, Thais; OLIVEIRA, Maura S.; ROSA, Juliana F.; SOARES, Robson E.; LLACER, Pedro Enrique Dorlhiac; DULLEY, Frederico Luiz; COSTA, Silvia F.; LEVIN, Anna S.Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc) in bone marrow transplant and hematology outpatients. Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW) hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC) care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units. Findings: 14 patients had B. multivorans (one patient had also B. cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30%) were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication), no new cases occurred. Conclusions: This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A) of multi-dose vials.