(Fonte: Lattes)
Índice h a partir de 2011
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/03 - Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina

Resultados de Busca

Agora exibindo 1 - 10 de 18
  • article 6 Citação(ões) na Scopus
    Critical points and potential pitfalls of outbreak of IMP-1-producing carbapenem-resistant Pseudomonas aeruginosa among kidney transplant recipients: a case-control study
    Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection after kidney transplantation (KT) is associated with high mortality. Aim: To analyse an outbreak of infection/colonization with IMP-1-producing CRPA on a KT ward. Methods: A case-control study was conducted. Cases were identified through routine surveillance culture and real-time polymerase chain reaction for carbapenemase performed directly from rectal swab samples. Controls were randomly selected from patients hospitalized on the same ward during the same period, at a ratio of 3:1. Strain clonality was analysed through pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing was performed for additional strain characterization. Findings: CRPA was identified in 37 patients, in 51.4% through surveillance cultures and in 49.6% through clinical cultures. The median persistence of culture positivity was 42.5 days. Thirteen patients (35.1%) presented a total of 15 infections, of which seven (46.7%) were in the urinary tract; among those, 30-day mortality rate was 46.2%. PFGE analysis showed that all of the strains shared the same pulsotype. Multilocus sequence typing analysis identified the sequence type as ST446. Risk factors for CRPA acquisition were hospital stay >10 days, retransplantation, urological surgical reintervention after KT, use of carbapenem or ciprofloxacin in the last three months and low median lymphocyte count in the last three months.
  • article 56 Citação(ões) na Scopus
    Emergence of colistin resistance in the largest university hospital complex of Sao Paulo, Brazil, over five years
    (2017) ROSSI, Flavia; GIRARDELLO, Raquel; CURY, Ana Paula; GIOIA, Thais Sabato Romano Di; ALMEIDA JR., Joao Nobrega de; DUARTE, Alberto Jose da Silva
    Colistin resistance involving Gram-negative bacilli infections is a challenge for health institutions around of the world. Carbapenem-resistance among these isolates makes colistin the last therapeutic option for this treatment. Colistin resistance among Enterobacteriaceae, Acinetobacter spp., and Pseudomonas spp. was evaluated between 2010 and 2014 years, at Hospital das Clinicas, Sao Paulo, Brazil. Over five years 1346 (4.0%) colistin resistant Gramnegative bacilli were evaluated. Enterobacteriaceae was the most frequent (86.1%) pathogen isolated, followed by Acinetobacter spp. (7.6%), and Pseudomonas spp. (6.3%). By temporal analysis there was a trend for an increase of colistin resistance among Enterobacteriaceae, but not among non-fermentative isolates. Among 1346 colistin resistant isolates, carbapenem susceptibility was observed in 21.5%. Colistin resistance in our hospital has been alarmingly increased among Klebsiella pneumoniae isolates in both KPC positive and negative, thus becoming a therapeutic problem. (C) 2016 Sociedade Brasileira de Infectologia.
  • article 31 Citação(ões) na Scopus
    Plasmid-mediated mcr-1 in carbapenem-susceptible Escherichia coli ST156 causing a blood infection: an unnoticeable spread of colistin resistance in Brazil?
    (2017) ROSSI, Flavia; GIRARDELLO, Raquel; MORAIS, Carlos; CURY, Ana Paula; MARTINS, Layla Farage; SILVA, Aline Maria da; ABDALA, Edson; SETUBAL, Joao Carlos; DUARTE, Alberto Jose da Silva
    OBJECTIVE: We describe an IncX4 pHC891/16mcr plasmid carrying mcr-1 in a colistin-resistant and carbapenem-susceptible E. coli isolate (HC891/16), ST156, which caused a blood infection in a Brazilian patient with gallbladder adenocarcinoma. METHODS: Strain HC891/16 was subjected to whole genome sequencing using the MiSeq Platform (Illumina, Inc., USA). Assembly was performed using Mira and ABACAS. RESULTS: The isolates showed resistance only to ciprofloxacin, ampicillin and cefoxitin, and whole-genome sequencing revealed the presence of aac(6')Ib-cr and bla(TEM1). CONCLUSION: Our findings warn of the possible silent dissemination of colistin resistance by carbapenem-susceptible mcr-1 producers, as colistin susceptibility is commonly tested only among carbapenem-resistant isolates.
  • article 5 Citação(ões) na Scopus
    KPC-producing Enterobacterales with uncommon carbapenem susceptibility profile in Vitek 2 system
    (2020) CURY, Ana Paula; GIRARDELLO, Raquel; DUARTE, Alberto Jose da Silva; ROSSI, Flavia
    KPC-producing K. pneumoniae is an endemic challenge. Seven KPC-producing Enterobacterales showed unusual carbapenems susceptibility profile. These strains were resistance at least one carbapenem and the ertapenem MIC was lower than imipenem and/or meropenem MICs using Vitek 2 (TM) system (bioMerieux). When E-test (TM) and disk diffusion methods were performed the carbapenems showed susceptible results. (C) 2020 The Authors.
  • article 47 Citação(ões) na Scopus
    Carbapenem-resistant Enterobacteriaceae in patients admitted to the emergency department: prevalence, risk factors, and acquisition rate
    Background: Carbapenem-resistant Enterobacteriaceae (CRE) have been reported worldwide and are associated with high mortality rates. Intestinal colonization acts as a reservoir and fosters exchange of resistance mechanisms. Aim: To investigate the prevalence of patients harbouring CRE on hospital admission, risk factors associated, and the acquisition rate within the emergency department (ED). Methods: This was a cross-sectional survey with 676 patients consecutively admitted to the ED study during the months of May to July 2016. A questionnaire was performed and rectal swabs were collected from patients on admission, for culture and for multiplex real-time polymerase chain reaction (PCR). If the patient was hospitalized for more than one week in the ED, samples were taken again to determine the acquisition rate of CRE. Findings: Forty-six patients were colonized; all positive PCR were Klebsiella pneumoniae carbapenemase. The acquisition rate was 18%. Previous exposure to healthcare in the last year, liver disease, and use of antibiotics in the last month were risk factors for colonization. Six patients with no previous exposure to healthcare were CRE-colonized on admission, suggesting transmission of CRE within the community. Conclusion: Screening of high-risk patients on admission to the ED is a strategy to early identify CRE carriage and may contribute to control CRE dissemination.
  • 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 23 Citação(ões) na Scopus
    Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil
    (2019) BOSZCZOWSKI, Icaro; SALOMAO, Matias Chiarastelli; MOURA, Maria Luisa; FREIRE, Maristela Pinheiro; GUIMARAES, Thais; CURY, Ana Paula; ROSSI, Flavia; RIZEK, Camila Fonseca; MARTINS, Roberta Cristina Ruedas; COSTA, Silvia Figueiredo
    Increased resistance to polymyxin in Klebsiella pneumoniae (ColRKP) has been observed. Molecular epidemiology, as well as the clinical impact of these difficult to treat pathogens need to be better characterized. We present the clinical outcomes of 28 patients infected by ColRKP in a tertiary hospital. Isolates with MIC >2 by Vitek 2 were confirmed by the microdilution broth test. Polymerase chain reaction (PCR) was performed for bla(KPC), bla(NDM), bla(OXA-48), and bla(mcr-1) genes in the isolates, and Whole Genome Sequencing (WGS) was performed in six isolates. Seventeen (61%) patients were female and the mean age was 50 years old. In-hospital and 30-day mortality were 64% (18/28) and 53% (15/28), respectively. Central line-associated bloodstream infection in addition to bacteremia episodes due to other sources were the most frequent (61%). Mean APACHE and Charlson comorbidity index were 16 and 5, respectively. Twenty patients (71%) received at least one active drug and ten (35%) received two drugs: tigecycline 46% (13/28); amikacin 21% (6/28) and fosfomycin 3% (1 case). Twenty-six out of 28 tested cases were positive for bla(KPC) Eight different clusters were identified. Four STs were detected (ST1, ST23, ST340, and ST437). Mutations on pmrA, arnB udg, and yciM genes were present in all six isolates submitted to WGS; /pxMand mgrB mutations were also detected in all but one isolate. In conclusion, we observed resistance to polymyxin in severely ill patients mostly from intensive care units and/or immunosuppressed patients with high mortality rates in whom a diversity of ColRKP clusters was identified and might indicate selective pressure.
  • article 13 Citação(ões) na Scopus
    Diagnostic performance of the Xpert Carba-R (TM) assay directly from rectal swabs for active surveillance of carbapenemase-producing organisms in the largest Brazilian University Hospital
    (2020) CURY, Ana Paula; ALMEIDA JUNIOR, J. N.; COSTA, Silvia F.; SALOMAO, Matias C.; BOSZCZOWSKI, Icaro; DUARTE, Alberto J. S.; ROSSI, Flavia
    Background: The global spread of carbapenemase-producing organisms (CPO) has been considered by international health authorities as a critical public health concern. Brazil has a high CPO prevalence according to distinct publications but many routine microbiology laboratories have only phenotypic resources to evaluate this epidemiological situation, which is time-consuming and detects only carbapenem-resistant isolates missing CPO susceptible expressing a slightly decreased susceptibility. New molecular platforms can detect CPO faster but a local evaluation is essential. Aim: To evaluate the performance of CPO detection direct from rectal swabs with the Xpert Carba-R (TM) assay (Cepheid, Sunnyvale, CA) in the largest Brazilian University Hospital. Methods: A prospective diagnostic accuracy study of CPO was performed with the collection of rectal swabs from patients admitted into the Intensive Care Unit (ICU) and into the Emergency Department (ED) between April and July 2016. The Xpert Carba-R assay results were compared with carbapenem-resistant Enterobacterales (CRE) surveillance cultures plus in-house PCR carbapenemase detection (reference method). In case of discordant results between methods, additional tests were performed. The limit of detection (LoD) for the CRE culture and the Xpert Carba-R (TM) assay were performed with contrived isolates of known carbapenemases genes. Results: A total of 921 clinical rectal swabs were analyzed being 21% (196/921) from the ICU and 79% (725/921) from the ED. Overall, the Xpert Carba-R (TM) assay detected 9.9% (91/921) of CPOs being 9.5% (87/921) positive only for bla(KPC) and 0.4% (4/921) positive only for bla(NDM). The reference method detected 9.1% (84/921) CPO being 77 (8.4%) bla(KPC), 5 bla(VIM) (0.5%) and 2 bla(NDM) (0.2%). No IMP or OXA-48 like gene was detected. Overall, twelve samples, 1.3% (10 bla(KPC), 2 bla(NDM)) were Xpert Carba-R (TM) positive but negative by the reference method. Five isolates (0.5%) were positive for bla(VIM) only by in-house PCR and confirmed to be bla(VIM-2) by DNA sequencing. The Kappa value, sensitivity, specificity, positive/negative predictive values and accuracy of the Xpert Carba-R (TM) assay were; 0.893 (95% confidence interval [CI], 0.842-0.944), 94% (86.7-98.0), 98.6% (97.5-99.3), 86.8% (78.1-93.0), 99.4% (98.6-99.8) and 98.2% (97.3-99.1), respectively. The LoD for bla(KPC) of the Xpert Carba-R (TM) assay and the CRE cultures were 10(1) CFU/swab. Conclusion: The Xpert Carba-R (TM) assay is an accurate test to detect CPO directly from the rectal swabs with significant lower turnaround time (TAT) when compared to the reference method (CRE culture plus in-house PCR). Xpert Carba-R (TM) may, therefore, be regarded as a good and fast epidemiological tool.
  • article 7 Citação(ões) na Scopus
    Capnocytophaga sputigena bloodstream infection in hematopoietic stem cell transplantations: two cases report and review of the literature
    (2020) MENDES, Fernanda Rodrigues; BRUNIERA, Felipe Ribeiro; SCHMIDT, Jayir; CURY, Ana Paula; RIZECK, Camila; HIGASHINO, Hermes; OLIVEIRA, Fernando Nivaldo; ROSSI, Flavia; ROCHA, Vanderson; COSTA, Silvia Figueiredo
    Capnocytophaga is a group of facultative anaerobic gram-negative bacteria present in the oral cavity of humans, dogs and cats, as part of their normal oral flora. Here, we described two cases of bloodstream infections (BSI) caused by Capnocytophaga in neutropenic autologous hematopoietic stem cell transplantation (auto-HSCT) patients with mucositis (Grade I and Grade III) identified by Maldi-Tof. They were successfully treated with beta-lactam (meropenem and piperacillin-tazobactam). The species C. sputigena was confirmed by 16S rRNA gene sequencing in one patient. The review of literature showed that C. ochraceae was the most frequent species causing BSI in auto-HSCT patients and that the patients usually presented mucositis and were neutropenic at the onset of the infection.
  • article 15 Citação(ões) na Scopus
    The in vitro activity of ceftazidime-avibactam against 417 Gram-negative bacilli collected in 2014 and 2015 at a teaching hospital in Sao Paulo, Brazil
    (2017) ROSSI, Flavia; CURY, Ana P.; FRANCO, Maria R. G.; TESTA, Raymond; NICHOLS, Wright W.