MIRIAN DE FREITAS DAL BEN CORRADI
Projetos de Pesquisa
Unidades Organizacionais
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
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- The changing epidemiology of Acinetobacter spp. producing MA. carbapenemases causing bloodstream infections in Brazil: a BrasNet report(2015) VASCONCELOS, Ana Tereza R.; BARTH, Afonso L.; ZAVASCKI, Alexandre P.; GALES, Ana C.; LEVIN, Anna S.; LUCAREVSCHI, Bianca R.; CABRAL, Blenda G.; BRASILIENSE, Danielle M.; ROSSI, Flavia; FURTADO, Guilherme H. C.; CARNEIRO, Irna Carla R. S.; SILVA, Juliana O. da; RIBEIRO, Julival; LIMA, Karla V. B.; CORREA, Luci; BRITTO, Maria H.; SILVA, Mariama T.; CONCEICAO, Marilia L. da; MOREIRA, Marina; MARTINO, Marines D. V.; FREITAS, Manse R. de; OLIVEIRA, Maura S.; DALBEN, Mirian F.; GUZMAN, Ricardo D.; CAYO, Rodrigo; MORAIS, Rosangela; SANTOS, Sania A.; MARTINS, Willames M. B. S.We evaluated the epidemiology of Acinetobacter spp. recovered from patients diagnosed with bloodstream infections in 9 tertiary hospitals located in all Brazilian geographic regions between April and August 2014. Although OXA-23-producing Acinetobacter baumannii clones were disseminated in most hospitals, it was observed for the first time the spread of OXA-72 among clonally related A. baumannii isolated from distinct hospitals. Interestingly, Acinetobacter pittii was the most frequent species found in a Northern region hospital. Contrasting with the multisusceptible profile displayed by A. pittii isolates, the tetracyclines and polymyxins were the only antimicrobials active against all A. baumannii isolates.
- Erratum in «High rate of virologic supression with darunavir/ritonavir plus optimazed background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in São Paulo, Brazil»(2013) VIDAL, José Ernesto; SONG, Alice Tung Wan; MATOS, Maria Laura; BARTMANN, Daniel; ANJOS, Guilherme dos; MIRANDA, Érique José Peixoto de; FREITAS, Ângela Carvalho; DALBEN, Mirian de Freitas; SANTANA, Claudinei; SEGURADO, Aluísio Cotrim; BARRETO, Cláudia Cortese; HERNÁNDEZ, Adrián Vladimir
- POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY Burkholderia cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT OUTPATIENT UNITS(2014) BOSZCZOWSKI, Icaro; PRADO, Gladys Villas Boas do; DALBEN, Mirian F.; TELLES, Roberto C. P.; FREIRE, Maristela Pinheiro; GUIMARAES, Thais; OLIVEIRA, Maura S.; ROSA, Juliana F.; SOARES, Robson E.; LLACER, Pedro Enrique Dorlhiac; DULLEY, Frederico Luiz; COSTA, Silvia F.; LEVIN, Anna S.Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc) in bone marrow transplant and hematology outpatients. Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW) hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC) care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units. Findings: 14 patients had B. multivorans (one patient had also B. cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30%) were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication), no new cases occurred. Conclusions: This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A) of multi-dose vials.
- A Model-Based Strategy to Control the Spread of Carbapenem-Resistant Enterobacteriaceae: Simulate and Implement(2016) DALBEN, Mirian de Freitas; MENDES, Elisa Teixeira; MOURA, Maria Luisa; RAHMAN, Dania Abdel; PEIXOTO, Driele; SANTOS, Sania Alves dos; FIGUEIREDO, Walquiria Barcelos de; MENDES, Pedro Vitale; TANIGUCHI, Leandro Utino; COUTINHO, Francisco Antonio Bezerra; MASSAD, Eduardo; LEVIN, Anna SaraOBJECTIVE. To reduce transmission of carbapenem-resistant Enterobacteriaceae (CRE) in an intensive care unit with interventions based on simulations by a developed mathematical model. DESIGN. Before-after trial with a 44-week baseline period and 24-week intervention period. SETTING. Medical intensive care unit of a tertiary care teaching hospital. PARTICIPANTS. All patients admitted to the unit. METHODS. We developed a model of transmission of CRE in an intensive care unit and measured all necessary parameters for the model input. Goals of compliance with hand hygiene and with isolation precautions were established on the basis of the simulations and an intervention was focused on reaching those metrics as goals. Weekly auditing and giving feedback were conducted. RESULTS. The goals for compliance with hand hygiene and contact precautions were reached on the third week of the intervention period. During the baseline period, the calculated R0 was 11; the median prevalence of patients colonized by CRE in the unit was 33%, and 3 times it exceeded 50%. In the intervention period, the median prevalence of colonized CRE patients went to 21%, with a median weekly Rn of 0.42 (range, 0-2.1). CONCLUSIONS. The simulations helped establish and achieve specific goals to control the high prevalence rates of CRE and reduce CRE transmission within the unit. The model was able to predict the observed outcomes. To our knowledge, this is the first study in infection control to measure most variables of a model in real life and to apply the model as a decision support tool for intervention.
- High rate of virologic suppression with darunavir/ritonavir plus optimized background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in Sao Paulo, Brazil(2013) VIDAL, Jose Ernesto; SONG, Alice Tung Wan; MATOS, Maria Laura; BARTMANN, Daniel; ANJOS, Guilherme dos; MIRANDA, Erique Jose Peixoto de; FREITAS, Angela Carvalho; DALBEN, Mirian de Freitas; SANTANA, Claudinei; SEGURADO, Aluisio Cotrim; BARRETO, Claudia Cortese; HERNANDEZ, Adrian VladimirObjectives: To assess the virologic and immunological response of darunavir/ritonavir plus optimized background therapy in highly antiretroviral-experienced HIV-infected patients in Brazil. Methods: Prospective cohort study carried out in a tertiary center in Sao Paulo, Brazil. Three-class antiretroviral-experienced patients with confirmed virologic failure began darunavir/ritonavir plus optimized background therapy (nucleoside/tide reverse transcriptase inhibitors +/- raltegravir +/- enfuvirtide +/- maraviroc) after performing a genotypic resistance assay. Clinical evaluation and laboratory tests were collected at baseline and at weeks 12, 24, and 48. Multivariate analysis was performed to identify predictors of virologic response at 48 weeks. Results: Ninety-two patients were included. The median of darunavir resistant mutation was 1 (range 0-6). The median genotypic sensitivity score in the optimized background therapy was 2 (interquartile range 1-2). At week 48, 83% (95% CI: 75-90%) had an HIV RNA level <50 copies/mL and the median CD4 cell count was 301 (interquartile range 224-445) cells/mm(3). Baseline HIV RNA >100 000 copies/mL was inversely associated with virologic success at week 48 (HR: 0.22, 95% CI: 0.06-0.85, p=0.028). Conclusions: Darunavir/ritonavir plus optimized background therapy was a highly effective salvage regimen under clinical routine conditions in a referral center in Brazil, which is similar to the reported in high-income countries.