CRISTHIENI RODRIGUES
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- Bacteroides fragilis endocarditis: a case report and review of literature(2012) RODRIGUES, Cristhieni; SICILIANO, Rinaldo Focaccia; ZEIGLER, Rogerio; STRABELLI, Tania Mara VarejaoEndocarditis due to Bacteroides fragilis is a rare disorder. This article describes a case of Bacteroides fragilis endocarditis associated with portal and superior mesenteric venous thrombosis in a patient without preexisting valvular heart disease and review the cases of endocarditis due to this anaerobic bacterium in medical literature since 1980.
- Hydroxychloroquine plus azithromycin early treatment of mild COVID-19 in an outpatient setting: a randomized, double-blinded, placebo-controlled clinical trial evaluating viral clearance(2021) RODRIGUES, Cristhieni; FREITAS-SANTOS, Rodrigo S.; LEVI, Jose Eduardo; SENERCHIA, Andreza A.; LOPES, Ana Tarina A.; SANTOS, Sergio R.; SICILIANO, Rinaldo F.; PIERROTTI, Ligia C.Background: Hydroxychloroquine has shown potential to block viral replication of SARS-CoV-2 in some in vitro studies. This randomised, double-blinded, placebo controlled clinical trial evaluated the efficacy of hydroxychloroquine plus azithromycin (HCQ/AZT) in reducing viral loads in patients with early and mild SARS-CoV-2 infection. Methods: A single-centre randomised placebo-controlled clinical trial was conducted with outpatients with early and mild SARS-CoV-2 infection. Inclusion criteria were: patients aged 18-65 years with symptoms suggestive of COVID-19 for < 5 days, no significant comorbidities, and positive nasopharyn-geal/oropharyngeal swab screening tests (POCT-PCR). Randomised patients received either hydroxychloro-quine for 7 days plus azithromycin for 5 days or placebo. The primary endpoint was viral clearance within a 9-day period. Secondary endpoints included viral load reduction, clinical evolution, hospitalization rates, chest computed tomography evolution, and adverse effects. Results: From 107 potential trial participants, 84 were enrolled following predetermined criteria. Statisti-cal analyses were performed on an intention-to-treat (N = 84) and per-protocol (PP) basis (N = 70). On the PP analysis, the treatment (N = 36) and placebo (N = 34) groups displayed similar demographic char-acteristics. At 95% CI, no statistically significant between-group differences were found in viral clearance rates within 9 days following enrolment ( P = 0.26). Conclusions: This randomised, double-blinded, placebo-controlled clinical trial evaluating outpatients with early and mild COVID-19 showed that viral clearance rates within a 9-day period from enrolment did not change with HCQ/AZT treatment compared with placebo, although no major cardiovascular events were observed in participants without comorbidities. Secondary outcomes were also not significantly im -proved with HCQ/AZT treatment compared with placebo. These findings do not support use of HCQ/AZT in this setting.
- The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: a randomized clinical trial(2019) RODRIGUES, Cristhieni; SICILIANO, Rinaldo Focaccia; CAIAFFA FILHO, Helio; CHARBEL, Cecilia Eugenia; SILVA, Luciane de Carvalho Sarahyba da; REDAELLI, Martina Baiardo; PASSETTI, Ana Paula de Paula Rosa; FRANCO, Maria Renata Gomes; ROSSI, Flavia; ZEIGLER, Rogerio; BACKER, Daniel De; FRANCO, Rafael Alves; ALMEIDA, Juliano Pinheiro de; RIZK, Stephanie Itala; FUKUSHIMA, Julia Tizue; LANDONI, Giovanni; UIP, David Everson; HAJJAR, Ludhmila Abrahao; STRABELLI, Tania Mara VarejaoBackground: Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test-SeptiFast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared with conventional blood cultures (BCs). Methods: This was a prospective, randomized, superiority, controlled trial conducted at Sao Paulo Heart Institute in the period October 2012-May 2016. Adult patients admitted to the hospital for at least 48h with a diagnosis of nosocomial sepsis underwent microorganism identification by both SF test and BCs. Patients randomized into the intervention group received antibiotic therapy adjustment according to the results of SF. Patients randomized into the control group received standard antibiotic adjustment according to the results of BCs. The primary endpoint was antimicrobial consumption during the first 14days after randomization. Results: A total of 200 patients were included (100 in each group). The intention to treat analysis found no significant differences in median antibiotic consumption. In the subgroup of patients with positive SF and blood cultures (19 and 25 respectively), we found a statistically significant reduction in the median antimicrobial consumption which was 1429 (1071-2000) days of therapy (DOT)/1000 patients-day in the intervention group and 1889 (1357-2563) DOT/1000 patients-day in the control group (p=0.017), in the median time of antimicrobial de-escalation (8 versus 54h-p<0.001), in the duration of antimicrobial therapy (p=0.039) and in anti-gram-positive antimicrobial costs (p=0.002). Microorganism identification was possible in 24.5% of patients (45/184) by SF and 21.2% (39/184) by BC (p=0.45). Conclusion: This randomized clinical trial showed that the use of a rapid molecular-based pathogen identification test does not reduce the median antibiotic consumption in nosocomial sepsis. However, in patients with positive microbiological tests, the use of SeptiFast reduced antimicrobial consumption through early de-escalation compared to conventional blood cultures. These results were driven by a reduction in the consumption of antimicrobials used for Gram-positive bacteria.