INNEKE MARIE VAN DER HEIJDEN NATARIO
Projetos de Pesquisa
Unidades Organizacionais
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
3 resultados
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- Carbapenem-Resistant Acinetobacter baumannii Acquired Before Liver Transplantation: Impact on Recipient Outcomes(2016) FREIRE, Maristela Pinheiro; PIERROTTI, Ligia Camera; OSHIRO, Isabel Cristina Villela Soares; BONAZZI, Patricia Rodrigues; OLIVEIRA, Larissa Marques de; MACHADO, Anna Silva; HEIJDEN, Inneke Marie Van der; ROSSI, Flavia; COSTA, Silvia Figueiredo; D'ALBUQUERQUE, Luiz Augusto Carneiro; ABDALA, EdsonInfection with carbapenem-resistant Acinetobacter baumannii (CRAB) after liver transplantation (LT) is associated with high mortality. This study aimed to identify risk factors for post-LT CRAB infection, as well as to evaluate the impact of pre-LT CRAB acquisition on the incidence of post-LT CRAB infection. This was a prospective cohort study of all patients undergoing LT at our facility between October 2009 and October 2011. Surveillance cultures (SCs) were collected immediately before LT and weekly thereafter, until discharge. We analyzed 196 patients who were submitted to 222 LTs. CRAB was identified in 105 (53.6%); 24 (22.9%) of these patients were found to have acquired CRAB before LT, and 85 (81.0%) tested positive on SCs. Post-LT CRAB infection occurred in 56 (28.6%), the most common site being the surgical wound. Multivariate analysis showed that the risk factors for developing CRAB infection were prolonged cold ischemia, post-LT dialysis, LT due to fulminant hepatitis, and pre-LT CRAB acquisition with pre-LT CRAB acquisition showing a considerable trend toward significance (P = 0.06). Among the recipients with CRAB infection, 60-day mortality was 46.4%, significantly higher than among those without (P < 0.001). Mortality risk factors were post-LT infection with multidrug-resistant bacteria, LT performed because of fulminant hepatitis, retransplantation, prolonged cold ischemia, longer LT surgical time, and pre-LT CRAB acquisition, the last showing a trend toward significance (P = 0.08). In conclusion, pre-LT CRAB acquisition appears to increase the risk of post-LT CRAB infection, which has a negative impact on recipient survival.
bookPart Estafilococcias(2016) PERDIGãO NETO, Lauro Vieira; OLIVEIRA, Maura Salaroli de; HEIJDEN, Inneke Marie van der; MENDES, Elisa Donalisio Teixeira; LEVIN, Anna Sara S.; COSTA, Silvia Figueiredo- Virulence and resistance profiles of MRSA isolates in pre- and post-liver transplantation patients using microarray(2016) HEIJDEN, Inneke Marie van der; OLIVEIRA, Larissa Marques de; BRITO, Glauber Costa; ABDALA, Edson; FREIRE, Maristela Pinheiro; ROSSI, Flavia; D'ALBUQUERQUE, Luiz Augusto Carneiro; LEVIN, Anna Sara Shafferman; COSTA, Silvia FigueiredoMethicillin-resistant Staphylococcus aureus (MRSA) screening plays a great role in preventing infections in surgical patients. This study aims to evaluate clonality, virulence and resistance of MRSA in pre- and post-liver transplantation (LT) patients. Nasal and groin swabs of 190 patients were collected. PCR for virulence genes and staphylococcal cassette chromosome mec (SCCmec) types, microarray, PFGE, multilocus sequence typing and MIC were performed. MRSA carriers were detected in 20.5% (39/190) of the patients. However, only three colonized patients developed infections post-LT. Sixty-nine MRSA isolates were identified, and the most frequent SCCmec type was type II (29/69; 42.0 %). Most isolates (57/69; 82.6 %) were susceptible to trimethoprim-sulfamethoxazole (TMP/SMX) and harboured the lukD, lukE, clf and fnbA genes as determined by PCR. Five sequence types (ST) were identified among nine clones; 36.2% (25/69) isolates belonged to a predominant clone (ST105 and SCCmec type II) that was susceptible to TMP/SMX, mupirocin and chlorhexidine, which had 87.9% similarity with the New York/Japan clone. The array showed virulence difference in isolates of the same clone and patients and that colonized isolates (pre-LT patients) were less virulent than those post-LT and those infected. Therefore, despite the high frequency of MRSA colonization, infection due to MRSA was uncommon in our LT unit. MRSA isolates presented great diversity. Isolates of the same clone expressed different virulence factors by array. Colonizing isolates pre-LT expressed less virulent factors than post-LT and infecting isolates.