IGOR CARMO BORGES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina - Docente
P ICHC, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
P ICHC, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
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- Impact of Discontinuing Levofloxacin Prophylaxis on Bloodstream Infections in Neutropenic Hematopoietic Stem Cell Transplantation Patients(2022) GUIMARAES, Thais; BORGES, Igor Carmo; SPADAO, Fernanda de Souza; MARIANO, Livia; NASCIMENTO, Marina de Mattos; HIGASHINO, Hermes; ROSSI, Flavia; ROCHA, Vanderson; COSTA, Silvia FigueiredoMultidrug-resistant pathogens have emerged worldwide. We have driven the hypothesis that the non-use of fluoroquinolone prophylaxis during neutropenia could reduce antibiotic resistance in Gram-negative bacteria that cause bloodstream infections (BSIs) in hematopoietic stem cell transplantation (HSCT) patients and that this change in resistance pattern could lead to an impact on BSI mortality. This is a quasi-experimental study comparing BSI incidence, resistance patterns of bacteria that cause BSI, and BSI mortality when levofloxacin prophylaxis was routine for neutropenic HSCT patients (2016-2018) to when fluoroquinolone prophylaxis was discontinued in our center (2019). Bivariate comparisons and multivariate logistic regression models were used for analyses. A total of 310 HSCTs (66 (21%) allogeneic and 244 (79%) autologous) were performed during the study period. Sixty (19%) patients had BSIs, 30 in each evaluated period. The discontinuation of levofloxacin prophylaxis was associated with an increase in BSI incidence and a decrease in the resistance rates of causative BSI bacteria and in BSI 30-day mortality. The increase in the rate of resistant bacteria causing BSI and in BSI mortality might outweigh the benefits of a decrease in BSI incidence caused by fluoroquinolone prophylaxis in neutropenic HSCT patients. We suggest that the routine use of fluoroquinolone in this context be revisited.
- Predictors of mortality in patients with yellow fever: an observational cohort study(2019) KALLAS, Esper G.; ZANELLA, Luiz Gonzaga F. A. B. D'Elia; V, Carlos Henrique Moreira; BUCCHERI, Renata; DINIZ, Gabriela B. F.; CASTINEIRAS, Anna Carla P.; COSTA, Priscilla R.; DIAS, Juliana Z. C.; MARMORATO, Mariana P.; SONG, Alice T. W.; MAESTRI, Alvino; BORGES, Igor C.; JOELSONS, Daniel; CERQUEIRA, Natalia B.; SOUZA, Nathalia C. Santiago e; CLARO, Ingra Morales; SABINO, Ester C.; LEVI, Jose Eduardo; I, Vivian Avelino-Silva; HO, Yeh-LiBackground Yellow fever virus infection results in death in around 30% of symptomatic individuals. The aim of this study was to identify predictors of death measured at hospital admission in a cohort of patients admitted to hospital during the 2018 outbreak of yellow fever in the outskirts of Sao Paulo city, Brazil. Methods In this observational cohort study, we enrolled patients with yellow fever virus from two hospitals in Sao Paolo-the Hospital das Clinicas, University of Sao Paulo and the Infectious Diseases Institute ""Emilio Ribas"". Patients older than 18 years admitted to hospital with fever or myalgia, headache, arthralgia, oedema, rash, or conjunctivitis were consecutively screened for inclusion in the present study. Consenting patients were included if they had travelled to geographical areas in which yellow fever virus cases had been previously confirmed. Yellow fever infection was confirmed by real-time PCR in blood collected at admission or tissues at autopsy. We sequenced the complete genomes of yellow fever virus from infected individuals and evaluated demographic, clinical, and laboratory findings at admission and investigated whether any of these measurements correlated with patient outcome (death). Findings Between Jan 11, 2018, and May 10, 2018, 118 patients with suspected yellow fever were admitted to Hospital das Clinicas, and 113 patients with suspected yellow fever were admitted to Infectious Diseases Institute ""Emilio Ribas"". 95 patients with suspected yellow fever were included in the study, and 136 patients were excluded. Three (3%) of 95 patients with suspected yellow fever who were included in the study were excluded because they received a different diagnosis, and 16 patients with undetectable yellow fever virus RNA were excluded. Therefore, 76 patients with confirmed yellow fever virus infection, based on detectable yellow fever virus RNA in blood (74 patients) or yellow fever virus confirmed only at the autopsy report (two patients), were included in our analysis. 27 (36%) of 76 patients died during the 60 day period after hospital admission. We generated 14 complete yellow fever virus genomes from the first 15 viral load-detectable samples. The genomes belonged to a single monophyletic clade of the South America I genotype, sub-genotype E. Older age, male sex, higher leukocyte and neutrophil counts, higher alanine aminotransferase, aspartate transaminase (AST), bilirubin, and creatinine, prolonged prothrombin time, and higher yellow fever virus RNA plasma viral load were associated with higher mortality. In a multivariate regression model, older age, elevated neutrophil count, increased AST, and higher viral load remained independently associated with death. All 11 (100%) patients with neutrophil counts of 4000 cells per mL or greater and viral loads of 5.1 log(10) copies/mL or greater died (95% CI 72-100), compared with only three (11%) of 27 (95% CI 2-29) among patients with neutrophil counts of less than 4000 cells per mL and viral loads of less than 5.1 log(10) copies/mL. Interpretation We identified clinical and laboratory predictors of mortality at hospital admission that could aid in the care of patients with yellow fever virus. Identification of these prognostic markers in patients could help clinicians prioritise admission to the intensive care unit, as patients often deteriorate rapidly. Moreover, resource allocation could be improved to prioritise key laboratory examinations that might be more useful in determining whether a patient could have a better outcome. Our findings support the important role of the virus in disease pathogenesis, suggesting that an effective antiviral could alter the clinical course for patients with the most severe forms of yellow fever.
- Characterization of Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant Shedding and Predictors of Viral Culture Positivity on Vaccinated Healthcare Workers With Mild Coronavirus Disease 2019(2022) LUNA-MUSCHI, Alessandra; NOGUERA, Saidy Vasconez; BORGES, Igor C.; V, Anderson De Paula; CORTES, Marina Farrel; LAROCCA, Carolina; MARI, Julia Ferreira; GUIMARAES, Lara Silva Pereira; TORRES, Pablo Munoz; SCACCIA, Nazareno; VILLAS-BOAS, Lucy S.; JR, Almir Ribeiro da Silva; ANDRADE, Pamela S.; TEIXEIRA, Juliana C.; ESCADAFAL, Camille; OLIVEIRA, Vitor Falcao de; TOZETTO-MENDOZA, Tania R.; MENDES-CORREA, Maria Cassia; LEVIN, Anna S.; SABINO, Ester C.; COSTA, Silvia F.We evaluated the duration of viral culture positivity compared to rapid antigen test (RAT) and real-time reverse-transcription polymerase chain reaction (RT-PCR) in mild Omicron infection. Vaccinated persons are potentially transmissible up to day 7. RAT and RT-PCR are predictors of viral culture positivity. In this prospective cohort of 30 vaccinated healthcare workers with mild Omicron variant infection, we evaluated viral culture, rapid antigen test (RAT), and real-time reverse-transcription polymerase chain reaction (RT-PCR) of respiratory samples at days 5, 7, 10, and 14. Viral culture was positive in 46% (11/24) and 20% (6/30) of samples at days 5 and 7, respectively. RAT and RT-PCR (Ct <= 35) showed 100% negative predictive value (NPV), with positive predictive values (PPVs) of 32% and 17%, respectively, for predicting viral culture positivity. A lower RT-PCR threshold (Ct <= 24) improved culture prediction (PPV = 39%; NPV = 100%). Vaccinated persons with mild Omicron infection are potentially transmissible up to day 7. RAT and RT-PCR might be useful tools for shortening the isolation period.
- Clinical features of COVID-19 by SARS-CoV-2 Gamma variant: A prospective cohort study of vaccinated and unvaccinated healthcare workers(2022) LUNA-MUSCHI, Alessandra; BORGES, Igor C.; FARIA, Elizabeth de; BARBOZA, Antonio S.; MAIA, Fernando L.; LEME, Mariana D.; GUEDES, Ana Rubia; MENDES-CORREA, Maria Cassia; KALLAS, Esper G.; SEGURADO, Aluisio C.; DUARTE, Alberto J. S.; LAZARI, Carolina S.; ANDRADE, Pamela S.; SALES, Flavia C. S.; CLARO, Ingra M.; SABINO, Ester C.; LEVIN, Anna S.; COSTA, Silvia F.
- Risk factors for reduction in adherence to protective measures following coronavirus disease 2019 (COVID-19) vaccination and vaccine perceptions among healthcare workers, in Sao Paulo, Brazil(2023) LOPEZ, Andres Mello; BORGES, Igor Carmo; LUNA-MUSCHI, Alessandra; PERES, Carlos Henrique Mesquita; CARRENO, Paolo Gripp; OLIVEIRA, Arthur Magalhaes de; ALMEIDA, Humberto Bertola Siqueira de; MARQUES, Vivian Helena de Castro; CORCHS, Felipe; LEVIN, Anna Sara; COSTA, Silvia Figueiredo; SARTORI, Ana Marli ChristovamA survey evaluated 2,300 healthcare workers following the first dose of a coronavirus disease 2019 (COVID-19) vaccine in a tertiary-quaternary hospital in Sao Paulo, Brazil. Adherence to protective measures following vaccination was compared to previous non-work-related behaviors. Younger age, previous COVID-19, and burnout symptoms were associated with reduced adherence to mitigation measures.
- SARS-Cov-2 seroprevalence and risk factors among health care workers: Estimating the risk of COVID-19 dedicated units(2021) OLIVEIRA, Maura Salaroli de; LOBO, Renata Desordi; DETTA, Felippe Pires; VIEIRA-JUNIOR, Mauro; CASTRO, Thiago Lucas de Souza; ZAMBELLI, Daniella Bosco; CARDOSO, Luiz Francisco; BORGES, Igor Carmo; TOZETTO-MENDOZA, Tania Regina; COSTA, Silvia Figueiredo; MENDES-CORREA, Maria CassiaWe evaluated the seroprevalence of SARS-CoV-2 and risk factors among 1,996 oligo/asymptomatic health care workers. The seroprevalence was 5.5% and risk factors associated with being infected with SARS-CoV-2 was professional category of cleaning (adj odds ratio 2.22, 95% confidence interval: 1.12-4.44, P: .023) and male gender (adj odds ratio: 1.54, 95% confidence interval: 1.03-2.32, P:.035).Working at dedicated COVID-19 units (high-risk group) was not an independent risk factor for seropositivity.
- Healthcare-associated infections on the intensive care unit in 21 Brazilian hospitals during the early months of the coronavirus disease 2019 (COVID-19) pandemic: An ecological study(2023) PORTO, Ana Paula M.; BORGES, Igor C.; BUSS, Lewis; MACHADO, Anna; BASSETTI, Bil R.; COCENTINO, Brunno; BICALHO, Camila S.; CARRILHO, Claudia; RODRIGUES, Cristhieni; NETO, Eudes A. S.; GIRAO, Evelyne S.; PIASTRELLI, Filipe; SAPIENZA, Giovanna; VARKULJA, Glaucia; KOLBE, Karin; PASSOS, Luciana; ESTEVES, Patricia; GITIRANA, Pollyana; FEIJO, Regia D. F.; COUTINHO, Rosane L.; GUIMARAES, Thais; FERRAZ, Tiago L. L.; LEVIN, Anna S.; COSTA, Silvia F.Objective: The coronavirus disease 2019 (COVID-19) pandemic has caused a global health crisis and may have affected healthcare-associated infection (HAI) prevention strategies. We evaluated the impact of the COVID-19 pandemic on HAI incidence in Brazilian intensive care units (ICUs). Methods: In this ecological study, we compared adult patients admitted to the ICU from April through June 2020 (pandemic period) with the same period in 2019 (prepandemic period) in 21 Brazilian hospitals. We used the Wilcoxon signed rank-sum test in a pairwise analysis to compare the following differences between the pandemic and the prepandemic periods: microbiologically confirmed central-line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) incidence density (cases per 1,000 central line and ventilator days, respectively), the proportion of organisms that caused HAI, and antibiotic consumption (DDD). Results: We detected a significant increase in median CLABSI incidence during the pandemic: 1.60 (IQR, 0.44-4.20) vs 2.81 (IQR, 1.35-6.89) (P = .002). We did not detect a significant difference in VAP incidence between the 2 periods. In addition, we detected a significant increase in the proportion of CLABSI caused by Enterococcus faecalis and Candida spp during the pandemic, although only the latter retained statistical significance after correction for multiple comparisons. We did not detect a significant change in ceftriaxone, piperacillin-tazobactam, meropenem, or vancomycin consumption between the studied periods. Conclusions: There was an increase in CLABSI incidence in Brazilian ICUs during the first months of COVID-19 pandemic. Additionally, we detected an increase in the proportion of CLABSI caused by E. faecalis and Candida spp during this period. CLABSI prevention strategies must be reinforced in ICUs during the COVID-19 pandemic.
- Impact of human immunodeficiency virus infection on mortality of patients who acquired healthcare associated-infection in critical care unit(2019) CASTRO-LIMA, Victor Augusto Camarinha de; BORGES, Igor C.; JOELSONS, Daniel; SALES, Vivian V. T.; GUIMARAES, Thais; HO, Yeh Li; COSTA, Silvia F.; MOURA, Maria Luisa N.To evaluate 30-day mortality in human immunodeficiency virus (HIV) and non-HIV patients who acquired a healthcare-associated infection (HAI) while in an intensive care unit (ICU), and to describe the epidemiological and microbiological features of HAI in a population with HIV. This was a retrospective cohort study that evaluated patients who acquired HAI during their stay in an Infectious Diseases ICU from July 2013 to December 2017 at a teaching hospital in Brazil. Data were obtained from hospital infection control committee reports and medical records. Statistical analysis was performed using SPSS and a multivariate model was used to evaluate risk factors associated with 30-day mortality. Epidemiological, clinical, and microbiological characteristics of HAI in HIV and non-HIV patients and 30-day mortality were also evaluated. Among 1045 patients, 77 (25 HIV, 52 non-HIV) patients acquired 106 HAI (31 HIV, 75 non-HIV patients). HIV patients were younger (45 vs 58 years, P=.002) and had more respiratory distress than non-HIV patients (60.0% vs 34.6%, P=.035). A high 30-day mortality was observed and there was no difference between groups (HIV, 52.0% vs non-HIV, 54.9%; P=.812). Ventilator-associated pneumonia (VAP) was more frequent in the HIV group compared with the non-HIV group (45.2% vs 26.7%, P=.063), with a predominance of Gram-negative organisms. Gram-positive agents were the most frequent cause of catheter associated-bloodstream infections in HIV patients. Although there was a high frequency of HAI caused by multidrug-resistant organisms (MDRO), no difference was observed between the groups (HIV, 77.8% vs non-HIV, 64.3%; P=.214). Age was the only independent factor associated with 30-day mortality (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.1, P=.017), while diabetes mellitus (OR: 3.64, 95% CI: 0.84-15.8, P=.085) and the Sequential Organ-Failure Assessment (SOFA) score (OR: 1.16, 95% CI: 0.99-1.37, P=.071) had a tendency to be associated with death. HIV infection was not associated with a higher 30-day mortality in critical care patients with a HAI. Age was the only independent risk factor associated with death. VAP was more frequent in HIV patients, probably because of the higher frequency of respiratory conditions at admission, with a predominance of Gram-negative organisms.