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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- Perspectives on research needs in healthcare epidemiology, infection prevention, and antimicrobial stewardship: What's on the Horizon - Part II(2023) MARSCHALL, J.; SNYDERS, R. E.; SAX, H.; NEWLAND, J. G.; GUIMARãES, T.; KWON, J. H.In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) Transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and deimplementation, 6) healthcare outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the neighbors, 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1-5 are presented in part I of the article and chapters 6-10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the post-pandemic phase) will make healthcare systems more resilient when facing future crises.
- 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.
- Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in Sao Paulo, Brazil(2022) PALOMO, Amanda Thurler; PIRES, Ana Paula Maia; MATIELO, Marcelo Fernando; SOARES, Rafael de Athayde; PECEGO, Christiano; SACILOTTO, Roberto; PAULA, Alexandre Inacio de; HOSINO, Nair; GAMBA, Cristiano de Melo; FONSECA, Cibele Lefreve; PARASKEVOPOULOS, Daniela K. S.; YAMAGUTI, Augusto; MENDONCA, Joao Silva de; COSTA, Silvia Figueiredo; GUIMARAES, ThaisDiabetic foot infections (DFIs) are one of the causes of hospitalization in diabetic patients and, when this occurs, empirical antibiotic therapy is necessary. We have conducted a retrospective study of patients with DFI that required hospitalization to evaluate microbiologic profile and the susceptibility pattern of these infections. We evaluated 320 patients, of which 223 (69.7%) were male with a media age of 71 years with 276 isolates. Gram-positive bacteria were responsible for 188 (68.1%) of the isolates, while Gram-negative bacilli were responsible for 88 (31.9%). E. faecalis was the most prevalent pathogen, followed by S. aureus and coagulase negative Staphylococci. Among Gram-negative pathogens, P. aeruginosa was the most prevalent agent. Regarding the susceptibility profile, we found ampicillin-sensitive enterococci in 89% of the cases, oxacillin-sensitive S. aureus in 47%, but in coagulase-negative staphylococci, oxacillin was sensible only in 20%. The susceptibility profile of Gram-negatives was very good with 76% susceptibility of P. aeruginosa to ceftazidime and meropenem. The other prevalent Enterobacterales had great susceptibility to ceftazidime, piperacillin-tazobactam and 100% susceptibility to meropenem, with the exception of K. pneumoniae, which had 75% susceptibility to meropenem. Knowledge of microbiological profile and susceptibility patterns of patients with DFIs is useful to guide empirical therapy.
- Perspectives on research needs in healthcare epidemiology and antimicrobial stewardship: what's on the horizon - Part I(2023) MARSCHALL, J.; SNYDERS, R. E.; SAX, H.; NEWLAND, J. G.; GUIMARãES, T.; KWON, J. H.In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and de-implementation, 6) health care outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the neighbors, 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1-5 are presented in part I of the article, and chapters 6-10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the postpandemic phase) will make healthcare systems more resilient when facing future crises.
- Metronidazole for Treatment of Clostridioides difficile Infections in Brazil: A Single-Center Experience and Risk Factors for Mortality(2022) ALVES, Joana Darc Freitas; YAMAGUTI, Augusto; MENDONCA, Joao Silva de; GAMBA, Cristiano de Melo; FONSECA, Cibele Lefreve; PARASKEVOPOULOS, Daniela K. S.; PAULA, Alexandre Inacio de; HOSINO, Nair; COSTA, Silvia Figueiredo; GUIMARAES, ThaisWe describe the epidemiology of C. difficile infections (CDIs) focused on treatment and analyze the risk factors for mortality. This is a retrospective cohort study of CDI cases with a positive A/B toxin in the stool in 2017-2018. We analyzed the demographic data, comorbidities, previous use of antimicrobials, severity, and treatment, and we performed multivariate analysis to predict the 30-days mortality. We analyzed 84 patients, 37 (44%) of which were male, where the mean age was 68.1 years and 83 (99%) had comorbidities. The percentage of positivity of the A/B toxin was 11.6%, and the overall incidence density was 1.78/10,000 patient days. Among the patients, 65.4% had previous use of antimicrobials, with third-generation cephalosporins being the class most prescribed, and 22.6% of cases were severe. Treatment was prescribed for 70 (83.3%) patients, and there was no statistically significant difference between the initial treatment with metronidazole and vancomycin even in severe cases. The 30-day mortality was 7/84 (8.3%), and the risk factors associated with mortality was a severity score >= 2 (OR: 6.0; CI: 1.15-31.1; p = 0.03). In this cohort of CDI-affected patients with comorbidities and cancer, metronidazole was shown to be a good option for treating CDIs, and the severity score was the only independent risk factor for death.
- Impact of an Antimicrobial Stewardship Program Intervention Associated with the Rapid Identification of Microorganisms by MALDI-TOF and Detection of Resistance Genes in ICU Patients with Gram-Negative Bacteremia(2022) CAMPOS, Aleia Faustina; ARANTES, Tiago; CAMBIAIS, Amanda Magalhaes Vilas Boas; CURY, Ana Paula; TIROLI, Camila Guimaraes; ROSSI, Flavia; MALBOUISSON, Luiz Marcelo Sa; COSTA, Silvia Figueiredo; GUIMARAES, ThaisCombination of strategies for rapid diagnostics tests (RDT) with real-time intervention could improve patient outcomes. We aimed to assess the impact on clinical outcomes, antimicrobial consumption, and costs in patients with gram-negative bacteremia. We designed a quasi-experimental study among 216 episodes of gram-negative bacteremia using RDT (MALDI-TOF and detection of resistance genes) directly from blood culture bottles combined with real-time communication of results. Our study did not demonstrate impact on 30-day mortality (25% vs. 35%; p = 0.115). Hospital and ICU length of stay were significantly lower in the intervention period ((44 days vs. 39 days; p = 0.005) and (17 days vs. 13 days; p = 0.033)), respectively. The antimicrobial consumption was 1381 DOT/1000 days in the pre-intervention period compared to 1262 DOT/1000 days in the intervention period (p = 0.032). Antimicrobials against gram-positive and carbapenems had a significantly reduced consumption in the intervention period. Our intervention showed no impact on 30 days-mortality, but demonstrated an impact on hospital and ICU length of stay, as well as antimicrobials consumption and costs. Knowledge of resistance genes adds value and information for safe decision making that can result in direct and indirect benefits related to the economic burden of antibiotic overuse and bacterial resistance.
- Virulomic Analysis of Multidrug-Resistant Klebsiella pneumoniae Isolates and Experimental Virulence Model Using Danio rerio (Zebrafish)(2022) DUARTE, Edson Luiz Tarsia; RIZEK, Camila Fonseca; ESPINOZA, Evelyn Sanchez; MARCHI, Ana Paula; NOGUERA, Saidy Vasconez; CORTES, Marina Farrel; FERNANDES, Bianca H. Ventura; GUIMARAES, Thais; CARRILHO, Claudia M. D. de Maio; V, Lauro Perdigao Neto; TRINDADE, Priscila A.; COSTA, Silvia FigueiredoThis study evaluates a possible correlation between multidrug-resistant Klebsiella pneumoniae strains and virulence markers in a Danio rerio (zebrafish) model. Whole-genome sequencing (WGS) was performed on 46 strains from three Brazilian hospitals. All of the isolates were colistin-resistant and harbored bla(KPC-2). Ten different sequence types (STs) were found; 63% belonged to CC258, 22% to ST340, and 11% to ST16. The virulence factors most frequently found were type 3 fimbriae, siderophores, capsule regulators, and RND efflux-pumps. Six strains were selected for a time-kill experiment in zebrafish embryos: infection by ST16 was associated with a significantly higher mortality rate when compared to non-ST16 strains (52% vs. 29%, p = 0.002). Among the STs, the distribution of virulence factors did not differ significantly except for ST23, which harbored a greater variety of factors than other STs but was not related to a higher mortality rate in zebrafish. Although several virulence factors are described in K. pneumoniae, our study found ST16 to be the only significant predictor of a virulent phenotype in an animal model. Further research is needed to fully understand the correlation between virulence and sequence types.
- New Interventions Targeting Healthcare-Associated Infections(2018) GUIMARAES, Thais; COSTA, Silvia F.Purpose of review Healthcare-associated infections (HCAIs) are still a major cause of patient morbidity and mortality nowadays and there are evidences that these infections are highly preventable. Although many efforts have been made to prevent them, we live with a global burden of HCAIs and low- and middle-income countries reported HCAIs rates higher than in high-income countries accompanied by the problem of multidrug resistant microorganisms. Recent findings Basic measures for infection control and prevention must be put into practice and new techniques and methodologies have to be incorporated into HCAI control programs. The purpose of this review is discuss new interventions targeting HCAIs such as the use of practice bundles, behavioral change strategies, public reporting of infection rates, environmental cleaning, hand hygiene, and antimicrobial stewardship programs. We emphasize that all preventive measures require adherence by healthcare workers that depends on behavioral changes and reinforce that classical subjects as hand hygiene, environmental cleaning, and prudent use of antimicrobials need to be rethinking on the set of new technologies using electronic media for alerts, consultations, and audits.
- Detection of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the air near patients using noninvasive respiratory support devices(2023) BESEN, Bruno Adler Maccagnan Pinheiro; BRUNA, Camila Quartim de Moraes; CIOFI-SILVA, Caroline Lopes; CORREA, Maria Cassia Mendes; GRAZIANO, Kazuko Uchikawa; PAULA, Anderson Vicente de; YEH-LI, Ho; JOELSONS, Daniel; MENDES, Pedro Vitale; CARVALHO, Laina Bubach; MOURA, Maria Luisa do Nascimento; GUIMARAES, Thais; COSTA, Silvia Figueiredo