FLAVIO JOTA DE PAULA

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13
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Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • conferenceObject
    Treatment of Carbapenem resistant Enterobacteriaceae with reduced susceptibility to polymyxin among kidney transplant recipients experience during an outbreak period
    (2016) FREIRE, Maristela; PAULA, Flavio J. De; AZEVEDO, Luiz Sergio; LAZARO, Ana Carolina; ROSSI, Flavia; DAVID-NETO, Elias; NAHAS, Willian; PIERROTTI, Ligia C.
  • article 14 Citação(ões) na Scopus
    Outbreak of IMP-producing carbapenem-resistant Enterobacter gergoviae among kidney transplant recipients
    (2016) FREIRE, Maristela Pinheiro; GARCIA, Doroti de Oliveira; CURY, Ana Paula; SPADAO, Fernanda; GIOIA, Thais S. R. Di; FRANCISCO, Gabriela Rodrigues; BUENO, Maria Fernanda Campagnari; TOMAZ, Mariama; PAULA, Flavio Jota de; FARO, Lorena Brito de; PIOVESAN, Affonso C.; ROSSI, Flavia; LEVIN, Anna Sara; DAVID NETO, Elias; NAHAS, William C.; PIERROTTI, Ligia Camera
    The objective of this study was to investigate a prolonged outbreak of carbapenem-resistant Enterobacter gergoviae (CREG) involving kidney transplant recipients (KTRs) between 2009 and 2014. A case-control study was undertaken. Controls (naEuroS=aEuroS52) were selected from CREG-negative KTRs. Surveillance cultures for CREG were collected weekly. Colonization was defined as isolation of CREG from surveillance samples or from clinical specimens, with no evidence of infection. We also investigated infection control practices at the facility. Of 26 identified cases, 13 had had no known contact with another CREG-positive patient before the first positive culture. Seven patients (27%) developed infection. The site most often colonized was the urinary tract. During the study period two clusters were identified, one in 2009 and another in 2013-14. DNA sequencing revealed bla(IMP-1) in all CREG tested. No environmental or hand cultures tested positive for CREG. An audit of infection control practices detected flaws in the handling and cleaning of urinary tract devices. Multivariate analysis identified advanced age, ureteral stent use, retransplantation and male gender as risk factors for CREG acquisition. An outbreak among KTRs caused by an unusual species of MDR bacteria may have resulted from a common source of contamination related to urinary tract devices.
  • article 1 Citação(ões) na Scopus
    Unexplained fever and acute kidney injury in a kidney transplant patient
    (2016) PAULA, Flavio J.; NEVES, Precil D. M. M.; LAZARI, Carolina S.; RAMOS, Rafael G.; FREDIANI, Marcella M.; SILVA, Marcelo V. A.; MFINDA, Nzuzi; PIERROTTI, Ligia C.; DAVID, Daisa S. R.; TESTAGROSSA, Leonardo A.; DAVID-NETO, Elias
  • conferenceObject
    Graft Survival in Sensitized and Non-Sensitized Patients: Role of the Combination of Donor-Specific Antibodies and Acute Rejection
    (2016) SOUZA, P.; AGUIRRE, A.; BEZERRA, G.; RODRIGUES, H.; AGENA, F.; DAVID, D.; PAULA, F. de; DAVID-NETO, E.; CASTRO, M.
  • conferenceObject
    Which Post-Transplant Complications Are More Common in Elderly Renal Recipients?
    (2016) AGENA, F.; PAULA, F.; REICHERT, B.; NEVES, P.; PIOVESAN, A.; NAHAS, W.; DAVID-NETO, E.
  • article 28 Citação(ões) na Scopus
    Coronary Artery Disease Assessment and Intervention in Renal Transplant Patients: Analysis from the KiHeart Cohort
    (2016) LIMA, Jose J. G. De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; MUELA, Henrique Cotchi S.; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.
    Background. The value of coronary artery disease (CAD) assessment and coronary intervention in the prognosis of patients who undergo renal transplantation is controversial. We investigated whether pretransplant identification of patients with CAD is helpful for defining prognosis and whether preemptive coronary intervention reduces the incidence of cardiovascular events and death after engraftment. Methods. We analyzed the impact of coronary assessment by clinical stratification and coronary angiography and of coronary intervention on prognosis in 535 chronic kidney disease patients on the transplantation waiting list who underwent renal transplantation. Results. Patients with 70% or greater narrowing experienced more coronary events than patients with less significant lesions (P = 0.01) and subjects at low risk (P = 0.001). Coronary assessment did not discriminate between the risk of death in patients with or without significant CAD, and the independent predictors of death were age (hazards ratio, 1.04; 95% confidence interval, 1.01-1.06, P = 0.001) and diabetes (hazards ratio, 1.63; 95% confidence interval, 1.11-2.39, P = 0.01). No difference occurred in events and mortality between patients treated medically or by intervention, but the severity of CAD was higher in the latter. Conclusions. Coronary assessment identified patients at increased risk of posttransplant coronary events and was also useful to define a low-risk population that may be safely transplanted without in-depth cardiovascular evaluation. However, it did not differentiate between the risk of death in patients with and those without significant CAD. Survival was similar in patients undergoing either medical or interventional treatment for CAD.