INNEKE MARIE VAN DER HEIJDEN NATARIO
Projetos de Pesquisa
Unidades Organizacionais
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- An outbreak of invasive fusariosis in a children's cancer hospital(2015) LITVINOV, Nadia; SILVA, Mariama Tomaz N. da; HEIJDEN, Inneke M. van der; GRACA, Mariana G.; OLIVEIRA, Larissa Marques de; FU, Liang; GIUDICE, Mauro; AQUINO, Maria Zilda de; ODONE-FILHO, Vicente; MARQUES, Heloisa Helena; COSTA, Silvia F.; LEVIN, Anna S.Fusarium is considered an emerging pathogen, and there are few reports of fusariosis in children. The objective of this study was to describe an outbreak of invasive fusariosis in a children's cancer hospital. A neutropenic 17-year-old male patient hospitalized for 10 days for a relapse of acute myeloid leukaemia, under chemotherapy, presented fever without any other symptoms; a thoracic computerized tomography showed bilateral pulmonary nodules. During voriconazole treatment, 1-cm reddened and painful subcutaneous nodules appeared on arms and legs and the culture of a skin biopsy revealed F. solani. Another case occurred 11 days later and started an outbreak investigation. Water samples for cultures were collected from taps, showers and water reservoirs. Air from all patient rooms was sampled. Faucets and the drains of sinks and showers were swabbed and cultured. Environmental and clinical isolates were typed. There were 10 confirmed cases of infection caused by Fusarium spp. F. oxysporum and F. solani were isolated from water, swabs and air in patient rooms. Many control measures were instituted, but the outbreak was only controlled 1 year after the first case, when water filters filtering 0.2 mu m were installed at the exit of all faucets and showers in all patient rooms (points-of-use). Typing demonstrated that clinical isolates of F. oxysporum were similar to those of the environment. In conclusion, to our knowledge this is the first reported outbreak of invasive fusariosis in children with oncohaematologic disease. It was controlled using 0.2-mu m filters in all tap faucets and showers. Clinical Microbiology and Infection (C) 2014 European Society of Clinical Microbiology and Infectious Diseases.
- 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.
- Staphylococcus aureus isolates colonizing and infecting cirrhotic and liver-transplantation patients: comparison of molecular typing and virulence factors(2015) OLIVEIRA, Larissa Marques de; HEIJDEN, Inneke Marie van der; GOLDING, George R.; ABDALA, Edson; FREIRE, Maristela P.; ROSSI, Flavia; D'ALBURQUERQUE, Luiz C.; LEVIN, Anna S.; COSTA, Silvia F.Background: S. aureus is an important agent of colonization and infection in liver transplant patients. It harbors several virulence factors that can increase its pathogenicity. However, studies of virulence and molecular typing of MRSA in cirrhotic and liver transplantation patients are scarce. Results: Here we use SCCmec, PFGE, spa typing, MLST and virulence factors to characterize MRSA isolates in pre and post liver transplantation patients. Sixteen (13 %) of 126 cirrhotic and 15 of the 64 liver-transplanted patients (23 %) were colonized by MRSA (p = 0.091). SCCmec types I, II and III that are generally associated with nosocomial infections were identified in 91 % of the isolates. None of the isolates carried PVL, adhesion factors and fib gene. Only three MRSA colonized isolates carried tst gene and were characterized as SCCmec type I and t149. Ten spa types and five STs were identified; t002 and ST105 were the most frequent profiles. Spa types and ST1510 never described in Brazil and a new spa type t14789 were identified. Nineteen PFGE subtypes were found and grouped into nine types. There was a predominant cluster, which was related to the New York/Japanese epidemic clone and harboured SCCmec type II identified in both cirrhotic and post-transplantation patients. Based on SCCmec and virulence factors the MRSA isolates belonged to NY/Jpn clone seen be more similar to the USA100 MRSA isolates. Conclusions: Although without significance, liver-transplantation was more frequently colonized by MRSA than cirrhotic patients. The most frequent SCCmec was type II, and the predominant cluster was related to the New York/Japanese clone. A new spa t14789, and ST1510 never reported in Brazil were identified.
- Candida parapsilosis candidaemia in a neonatal unit over 7 years: a case series study(2012) MIRANDA, Lourdes das Neves; RODRIGUES, Eliete C. A.; COSTA, Silvia F.; HEIJDEN, Inneke Marie van der; DANTAS, Katia C.; LOBO, Renata D.; BASSO, Mariusa; VARKULJA, Glaucia F.; KREBS, Vera Lucia Jornada; GIBELLI, Maria Augusta Bento Cicaroni; CRIADO, Paulo R.; LEVIN, Anna SaraObjective: To evaluate Candida parapsilosis candidaemia in a neonatal unit over 7 years. Design: Case series study. Setting: A 2000-bed tertiary-care university hospital at Sao Paulo, Brazil. Participants: Neonates hospitalised in a 63-bed neonatal unit. Primary and secondary outcome measures: We evaluated the incidence of C parapsilosis fungemia in a neonatal unit from 2002 through 2008 and the main microbiological, clinical and epidemiological aspects of this disease in neonates. During the study period an outbreak occurred, an infection control programme was implemented, and isolates from blood and hand healthcare workers (HCWs) were submitted to molecular typing. Results: During 7 years, there were 36 cases of C parapsilosis fungaemia and annual incidence varied from 0 to 19.7 per 1000 admissions. Evaluating 31 neonates with fungemia, the mean age at diagnosis was 19 days. All children except for one were premature; all had received total parenteral nutrition and all but one had used central venous catheter. Three neonates had received antifungal treatment previously to the diagnosis. Thirty-day mortality was 45%. Only lower birthweight was associated with mortality. C parapsilosis species complex was isolated from hand cultures in eight (11%) of the HCWs (one isolate was identified as C orthopsilosis). By molecular typing no HCW isolate was similar to any of the blood isolates. Conclusions: The incidence of C parapsilosis fungemia in a neonatal unit varied widely over 7 years. We observed in our series a higher death rate than that reported in European countries and the USA.
- 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.
article 8 Citação(ões) na Scopus Outbreak of vancomycin-resistant Enterococcus in a renal transplant unit(2011) TUON, Felipe Francisco; PENTEADO-FILHO, Sergio Ricardo; CAMILOTTI, Janaina; HEIJDEN, Inneke Marie van der; COSTA, Silvia Figueiredo