PATRICIA RODRIGUES BONAZZI
Índice h a partir de 2011
7
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
2 resultados
Resultados de Busca
Agora exibindo 1 - 2 de 2
- Carbapenem-Resistant Enterobacteriaceae Acquired Before Liver Transplantation: Impact on Recipient Outcomes(2017) FREIRE, Maristela Pinheiro; OSHIRO, Isabel C. V. S.; PIERROTTI, Ligia C.; BONAZZI, Patricia R.; OLIVEIRA, Larissa M. de; SONG, Alice T. W.; CAMARGO, Carlos H.; HEIJDEN, Inneke M. van der; ROSSI, Flavia; COSTA, Silvia F.; D'ALBUQUERQUE, Luiz A. C.; ABDALA, EdsonBackground. Carbapenem-resistant Enterobacteriaceae (CRE) is an emergent microorganism of infections after liver transplant (LT). The aim of this study was to analyze the risk factors for CRE acquisition and infection after LT. Methods. This was a prospective cohort study involving patients who underwent LT in the 2010 to 2014 period. Surveillance cultures for CRE were collected immediately before LT and weekly thereafter until hospital discharge. Results. We analyzed 386 patients undergoing a total of 407 LTs. Before LT, 68 (17.6%) patients tested positive for CRE, 11 (16.2%) of those patients having CRE infection, whereas 119 (30.8%) patients acquired CRE after LT. Post-LT CRE infection was identified in 59 (15.7%) patients: Klebsiella pneumoniae was isolated in 83.2%; surgical site infection was the most common type of infection (46.7%). Multivariate analysis showed that post-LT dialysis was the only risk factor for post-LT CRE acquisition. Eighty-two percent of patients who underwent 3 or more post-LT dialysis sessions and acquired CRE before LT evolved with post-LT CRE infection. Other risk factors for CRE infection were acquisition of CRE post-LT, Model for End-Stage Liver Disease score greater than 32, combined transplantation, and reoperation. Patients who acquired CRE before LT had a high risk of developing CRE infection (P < 0.001). Conclusions. Measures for minimizing that risk, including altering the antibiotic prophylaxis, should be investigated and implemented.
- Surveillance culture for multidrug-resistant gram-negative bacteria: Performance in liver transplant recipients(2017) FREIRE, Maristela Pinheiro; OSHIRO, Isabel Cristina Villela Soares; BONAZZI, Patricia Rodrigues; PIERROTTI, Ligia Camera; OLIVEIRA, Larissa Marques de; MACHADO, Anna Silva; HEIJDENN, Inneke Marie Van Der; ROSSI, Flavia; COSTA, Silvia Figueiredo; D'ALBUQUERQUE, Luiz Augusto Carneiro; ABDALA, EdsonBackground: The prevalence of infection with multidrug-resistant gram-negative bacteria (MDR-GNB) after solid-organ transplantation is increasing. Surveillance culture (SC) seems to be an important tool for MDR-GNB control. The goal of this study was to analyze the performance of SC for MDR-GNB among liver transplant (LT) recipients. Methods: This was a prospective cohort study involving patients who underwent LT between November 2009 and November 2011. We screened patients for extended spectrum beta-lactamase-producing Escherichia coli, extended spectrum beta-lactamase-producing Klebsiella pneumoniae, and carbapenemresistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenemresistant Acinetobacter baumannii (CRAB). We collected SC samples immediately before LT and weekly thereafter, until hospital discharge. Samples were collected from the inguinal-rectal area, axilla, and throat. The performance of SC was evaluated through analysis of its sensitivity, negative predictive value, and accuracy. Results: During the study period, 181 patients were evaluated and 4,110 SC samples were collected. The GNB most often identified was CRAB, in 45.9% of patients, followed by CRKP in 40.3%. For all microorganisms, the positivity rate was highest among the inguinal-rectal samples. If only samples collected from this area were considered, the SC would fail to identify 34.9% of the cases of CRAB colonization. The sensitivity of SC for CRKP was 92.5%. The performance of SC was poorest for CRAB (sensitivity, 80.6%). Conclusions: Our data indicate that SC is a sensitive tool to identify LT recipients colonized by MDR-GNB.