THAIS GUIMARAES
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
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- Ceftazidime-Avibactam as Salvage Therapy for Infections Caused by Enterobacteriales Coresistant to Carbapenems and Polymyxins(2019) GUIMARAES, Thais; NOUER, Simone A.; MARTINS, Roberta C. R.; V, Lauro Perdigao Neto; MARTINS, Willames M. B. S.; BARBOSA, Ana Clara Narciso; FERREIRA, Adriana L. P.; COSTA, Silvia F.; GALES, Ana C.In this article, we report a case series of patients with infections caused by Enterobacteriales coresistant to carbapenems and polymyxins who were treated with ceftazidime/avibactam (CAZ-AVI) salvage therapy on a compassionate-use protocol. We enrolled 29 adult patients in 3 centers that had an infection due to a resistant microorganism and for whom the treatments available were considered ineffective, treated them with CAZ-AVI, and assessed clinical and microbiological cure at the end of treatment and all-cause mortality at 14 days and 30 days. The antimicrobial susceptibility profile was determined using broth microdilution, and total genomic DNA was sequenced. Twelve (41.4%) patients had bacteremia, and 48.3% (14/29) of the infections were treated with combination therapy. All strains were producers of KPC-2 and were susceptible to CAZ-AVI (MIC90, 1 mu g/ml). Clinical success was high (24/29 [82.7%; 95% confidence interval, 64.2 to 94.2%]), even for the bacteremic cases (75%). The 14-day and 30-day mortality rates were 9/29 (31%) and 15/29 (51.7%), respectively. The 14-day mortality rate for pneumonia was the same as that for bloodstream infections (33.3%) and although not significant, we found that patients with renal impairment that received adjusted doses of CAZ-AVI had high mortality (4/9 (44%); P = 0.22). We concluded that CAZ-AVI is an option for the treatment of severe infections due to difficult-to-treat drug-resistant Enterobacteriales.
- Colistin-resistant Klebsiella pneumoniae co-harboring KPC and MCR-1 in a Hematopoietic Stem Cell Transplantation Unit(2019) HIGASHINO, Hermes Ryoiti; MARCHI, Ana Paula; MARTINS, Roberta Cristina Ruedas; BATISTA, Marjorie Vieira; PERDIGAO NETO, Lauro Vieira; LIMA, Victor Augusto Camarinha de Castro; ROSSI, Flavia; GUIMARAES, Thais; LEVIN, Anna Sara; ROCHA, Vanderson; COSTA, Silvia Figueiredo
- 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 FigueiredoIncreased 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.
- 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.
- Synergistic Effect of Ceftazidime-Avibactam with Meropenem against Panresistant, Carbapenemase-Harboring Acinetobacter baumannii and Serratia marcescens Investigated Using Time-Kill and Disk Approximation Assays(2019) GAUDERETO, Juliana Januario; PERDIGAO NETO, Lauro Vieira; LEITE, Gleice Cristina; MARTINS, Roberta Ruedas; PRADO, Gladys Villas Boas do; ROSSI, Flavia; GUIMARAES, Thais; LEVIN, Anna Sara; COSTA, Silvia FigueiredoSusceptibility of ceftazidime-avibactam and in vitro synergy with meropenem were investigated using disk approximation and time-kill assays against 11 multiresistant Acinetobacter baumannii isolates harboring oxacillinases and 5 Serratia marcescens isolates carrying bla(KPC-2). Ceftazidime-avibactam was very active and synergistic with meropenem against multiresistant S. marcescens isolates. On the other hand, only the A. baumannii isolates coharboring bla(OXA-23) and bla(OXA-117) displayed synergy. The disk approximation technique presented good sensitivity for synergism in S. marcescens infection.
- Simultaneous colonization by Escherichia coli and Klebsiella pneumoniae harboring mcr-1 in Brazil(2019) PERDIGAO NETO, Lauro Vieira; CORSCADDEN, Louise; MARTINS, Roberta Cristina Ruedas; NAGANO, Debora Satie; CUNHA, Marcos Paulo Vieira; NEVES, Patricia Regina; FRANCO, Lucas Augusto Moyses; MOURA, Maria Luisa Nascimento; RIZEK, Camila Fonseca; GUIMARAES, Thais; BOSZCZOWSKI, Icaro; ROSSI, Flavia; LEVIN, Anna S.; STABLER, Richard A.; COSTA, Silvia F.Case presentationWe present a case report of a woman, concurrently colonized by polymyxin-resistant E. coli and K. pneumoniae. A Brazilian female patient, in her mid-fifties, was hospitalized with schistosomiasis. During hospitalization, polymyxin-resistant E. coli and K. pneumoniae were isolated from surveillance cultures.MethodsIdentification, antimicrobial susceptibility testings, PCR for mcr-1, plasmid transfer by conjugation and whole genome sequencing were performed.ResultsE. coli ST744 and K. pneumoniae ST101 carrying mcr-1 gene were described. Transconjugant E. coli was positive for mcr-1 and IncX4 by PCR. The plasmid is a 33,304-base pair plasmid, and the mcr-1 gene was the only antimicrobial resistance gene present in the plasmid.ConclusionsThis study presents a case report of a hospitalized woman, concurrently colonized by mcr-1-harboring E. coli ST744, a different ST from previously described in Brazil, and a K. pneumoniae ST101.
- Carbapenem-resistant Pseudomonas aeruginosa carrying bla(VIM-36) assigned to ST308: Indicated non-virulence in a Galleria mellonella model(2019) NEVES, Patricia R.; PERDIGAO NETO, Lauro Vieira; MARTINS, Roberta Cristina Ruedas; RAMOS, Jessica F.; LEITE, Gleice; ROSSI, Flavia; SANABANI, Sabri Saeed; ROCHA, Vanderson; BATISTA, Marjorie Vieira; GUIMARAES, Thais; LEVIN, Anna S.; COSTA, Silvia F.Objectives: Based on pulsed-field gel electrophoresis (PFGE) profile, whole-genome sequencing (WGS) of eight carbapenem-resistant Pseudomonas aeruginosa isolates from a bone marrow transplant unit in Sao Paulo, Brazil, was performed to investigate the presence of resistance and virulence genes as well as to determine the sequence type (ST) by multilocus sequence typing (MLST). Methods: The initial phenotypic susceptibility pattern of the isolates was determined by VITEK (R) 2. Minimum inhibitory concentrations (MICs) were determined by the broth microdilution method for amikacin, meropenem and colistin. WGS was performed using an Illumina MiSeq system. A Galleria mellonella infection model was used to evaluate the virulence of the strains. Results: WGS demonstrated that mutations in genes encoding outer membrane proteins and efflux pumps in an isolate harbouring bla(VIM-36) (ST308) differed from those in isolates harbouring bla(SPM)(ST277). The mexTgene harboured a mutation resulting in a frameshift in all isolates; in addition, the oprD gene of the bla(VIM-36)-carrying isolate had an insertion leading to a frameshift. Virulence genes did not differ between ST277 and ST308 strains. Moreover, only two isolates harbouring bla(SPM) showed virulence in the G. mellonella model, killing 100% of larvae after 18-24 h. Conclusions: P. aeruginosa carrying bla(VIM-36) belonging to ST308 was identified for the first time in our hospital. Although the virulence gene profiles were similar in isolates carrying bla(SPM )and the isolate carrying bla(VIM-36), only two isolates harbouring bla(SPM )showed virulence in the G. mellonella model.