MARISTELA PINHEIRO FREIRE
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
LIM/47 - Laboratório de Hepatologia por Vírus, Hospital das Clínicas, Faculdade de Medicina
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
LIM/47 - Laboratório de Hepatologia por Vírus, Hospital das Clínicas, Faculdade de Medicina
32 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 32
- A surveillance program for long-term central venous access-associated infections in outpatient chemotherapy services(2023) FREIRE, Maristela P.; ASSIS, Denise Brandao; CARLESSE, Fabianne; BELIZARIO, Juliana De Cassia; GERMANO, Priscila Costa Pimentel; VIROLLI, Juliana Monteiro; TURDO, Anna Claudia; RODRIGUES, Beatriz Quental; MACIEL, Amanda Luiz Pires; GONCALVES, Priscila; BOSZCZOWSKI, Icaro; ABDALA, Edson; LEVIN, Anna S.Objective: In this study, we described the first results of a surveillance system for infections associated with long-term central venous catheters (LT-CVC) in patients under outpatient chemotherapy. Design: This was a multicentric, prospective study. Setting: Outpatient chemotherapy services. Participants: The study included 8 referral cancer centers in the State of Sao Paulo. Intervention: These services were invited to participate in a newly created surveillance program for patients under chemotherapy. Several meetings were convened to share previous experiences on LT-CVC infection surveillance and to define the surveillance method. Once the program was implemented, all bloodstream infection (LT-CVC BSIs), tunnel infection, and exit-site infections associated with LT-CVC were reported. Data from January to May 2021 were analyzed. The median monthly number of chemotherapy sessions per clinic was 925 (IQR, 270-5,855). We used Poisson regression to analyze the association of rates with the characteristics of the services. Results: In total, 107 LT-CVC infections were reported, of which 95% were BSIs, mostly associated with totally implantable devices (76%). Infections occurred a median of 4 days after the last catheter manipulation and 116 after the LT-CVC insertion. Also, 102 microorganisms were isolated from LT-CVC BSIs; the most common pathogen was Staphylococcus epidermidis, at 22%. Moreover, 44 infections (44%) fulfilled the criteria for CVC-related LT-CVC BSI and 27 infections (27%) met the criteria for mucosal barrier injury. The 1-year cumulative LT-CVC BSI rate was 1.94 per 1,000 CVC days of use. The rates were higher in public hospitals (IRR, 6.00; P < .001) and in hospitals that already had in place surveillance for LT-CVC infections (IRR, 2.01; P < .01). Conclusion: Our study describes an applicable surveillance method for infections in cancer outpatients using LT-CVC.
- Pre-transplant multidrug-resistant infections in liver transplant recipients-epidemiology and impact on transplantation outcome(2024) LEMOS, Gabriela T.; TERRABUIO, Debora R. B.; NUNES, Nathalia N.; SONG, Alice T. W.; OSHIRO, Isabel C. V.; D'ALBUQUERQUE, Luiz Augusto C.; LEVIN, Anna S.; ABDALA, Edson; FREIRE, Maristela P.Background Cirrhotic patients are highly exposed to healthcare services and antibiotics. Although pre-liver transplantation (LT) infections are directly related to the worsening of liver function, the impact of these infections on LT outcomes is still unclear. This study aimed to identify the effect of multidrug-resistant microorganism (MDRO) infections before LT on survival after LT.Methods Retrospective study that included patients who underwent LT between 2010 and 2019. Variables analyzed were related to patients' comorbidities, underlying diseases, time on the waiting list, antibiotic use, LT surgery, and occurrences post-LT. Multivariate analyses were performed using logistic regression, and Cox regression for survival analysis.Results A total of 865 patients were included; 351 infections were identified in 259 (30%) patients, of whom 75 (29%) had >= 1 pre-LT MDRO infection. The most common infection was spontaneous bacterial peritonitis (34%). The agent was identified in 249(71%), 53(15%) were polymicrobial. The most common microorganism was Klebsiella pneumoniae (18%); the most common MDRO was ESBL-producing Enterobacterales (16%), and carbapenem-resistant (CR) Enterobacterales (10%). Factors associated with MDRO infections before LT were previous use of therapeutic cephalosporin (p = .001) and fluoroquinolone (p = .001), SBP prophylaxis (p = .03), ACLF before LT (p = .03), and days of hospital stay pre-LT (p < .001); HCC diagnosis was protective (p = .01). Factors associated with 90-day mortality after LT were higher MELD on inclusion to the waiting list (p = .02), pre-LT MDRO infection (p = .04), dialysis after LT (p < .001), prolonged duration of LT surgery (p < .001), post-LT CR-Gram-negative bacteria infection (p < .001), and early retransplantation (p = .004).Conclusion MDRO infections before LT have an important impact on survival after LT.
- Applying mucosal barrier injury laboratory-confirmed bloodstream infection criteria in patients with solid tumors and hematologic malignancies: A retrospective cohort study looking for the real source of infection(2023) SILVA, Ana Carolina Puin da; VIEIRA, Michely Fernandes; FREIRE, Maristela Pinheiro; VAZ, Lumena; BONAZZI, Patricia Rodrigues; IBRAHIM, Karim Yaqub; DIZ, Maria Del Pilar Esteves; HOFF, Paulo Marcelo; PEREIRA, Juliana; ROCHA, Vanderson Geraldo; ABDALA, EdsonWe evaluated the interference of the mucosal barrier injury (MBI) laboratory-confirmed bloodstream infection (MBI-LCBI) criteria on the central-line-associated bloodstream infection (CLABSI) incidence density, and the proportion of catheter-related bloodstream infections (CRBSIs) among those classified as MBI. We detected 339 CLABSIs: 15.0% were classified as MBI-LCBIs, and among these, 19.6% were classified as CRBSIs.
conferenceObject The Influence of Antifungal Prophylaxis in Invasive Fungal Infections in Liver Transplantation(2015) SONG, Alice T. W.; ALMEIDA JUNIOR, Joao N.; MAU, Luciana B.; FREIRE, Maristela; PROENCA, Adriana; HADDAD, Luciana; D'ALBUQUERQUE, Luiz A. C.; ABDALA, Edson- Detection of pandrug-resistant ST15 Acinetobacter baumannii causing bloodstream infection in an HSCT patient in Brazil(2020) BUENO, Mariana Sardinha; FREIRE, Maristela Pinheiro; CUNHA, Marcos Paulo Vieira; BARCELLOS, Thays Almeida Franco de; BERTANI, Amanda Maria de Jesus; SANTOS, Carla Adriana dos; CHIMARA, Erica; NAGAMORI, Filipe Onishi; TAKAGI, Elizabeth Harummyy; COSTA, Silvia Figueiredo; ITO, Raquel Keiko de Luca; ABDALA, Edson; CARVALHO, Eneas de; TIBA-CASAS, Monique Ribeiro; CAMARGO, Carlos Henrique
- Polymyxin use as a risk factor for colonization or infection with polymyxin-resistant Acinetobacter baumannii after liver transplantation(2014) FREIRE, M. P.; HEIJDEN, I. M. Van Der; PRADO, G. V. B.; CAVALCANTE, L. S.; BOSZCZOWSKI, I.; BONAZZI, P. R.; ROSSI, F.; GUIMARAES, T.; D'ALBUQUERQUE, L. A. C.; COSTA, S. F.; ABDALA, E.Introduction Acinetobacter baumannii is a leading agent of healthcare-associated infection. The objective of this study was to evaluate cases of colonization or infection with polymyxin-resistant A.baumannii (PRAB) in liver transplant recipients and to identify the risk factors for the acquisition of PRAB. Methods We evaluated all patients undergoing liver transplantation (LT) between January and November of 2011. The exclusion criterion was death within the first 72h after transplant. Patients were screened for PRAB through weekly rectal and inguinal swabs during their stay in the intensive care unit (ICU) and at ICU discharge. Patients who came from other hospitals or had been treated in the emergency room for >72h were screened at ICU admission. The minimum inhibitory concentrations (MICs) for polymyxins were determined by broth microdilution, and clonality was determined by pulsed-field gel electrophoresis. The stepwise logistic regression was used to identify risk factors related to acquisition of PRAB, and Cox forward regression used to identify risk factors for 60-day mortality. Results We evaluated 65 patients submitted to LT, among whom PRAB was isolated in 7, 4 of whom developed infection. The MICs for polymyxin E ranged from 16 to 128mg/mL. All patients with PRAB required dialysis. The median time of polymyxin use before PRAB isolation was 21days. These 4 included 1 case of primary bloodstream infection (BSI), which was treated with the carbapenem-polymyxin combination; 1 case of surgical site infection, which was treated with gentamicin, polymyxin, ampicillin-sulbactam, and tigecycline; and 2 cases of pneumonia, treated with the combination of carbapenem-polymyxin. In the case of BSI and in 1 of the cases of pneumonia, the treatment was considered successful. Mortality was 71% among the cases, compared with 33% among the non-cases. Conclusion In the final model of the survival analysis, PRAB colonization or infection after LT was independently associated with mortality. One predominant clone was identified. The only risk factor identified in the multivariate analysis was polymyxin use. PRAB was an agent with high mortality, and the most important risk factor associated with colonization or infection for such bacterium was polymyxin use.
- Efficacy of ceftazidime-avibactam in solid organ transplant recipients with bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae(2023) PEREZ-NADALES, Elena; FERNANDEZ-RUIZ, Mario; NATERA, Alejandra M.; GUTIERREZ-GUTIERREZ, Belen; MULARONI, Alessandra; RUSSELLI, Giovanna; PIERROTTI, Ligia Camera; FREIRE, Maristela Pinheiro; FALCONE, Marco; TISEO, Giusy; TUMBARELLO, Mario; RAFFAELLI, Francesca; ABDALA, Edson; BODRO, Marta; GERVASI, Elena; FARINAS, Maria Carmen; SEMINARI, Elena M.; CASTON, Juan Jose; MARIN-SANZ, Juan Antonio; GALVEZ-SOTO, Victor; RANA, Meenakshi M.; LOECHES, Belen; MARTIN-DAVILA, Pilar; PASCUAL, Alvaro; RODRIGUEZ-BANO, Jesus; AGUADO, Jose Maria; MARTINEZ-MARTINEZ, Luis; TORRE-CISNEROS, Julian; REIPI INCREMENT-SOT Study GrpWe aimed to compare the efficacy of ceftazidime-avibactam (CAZ-AVI) versus the best available therapy (BAT) in solid organ transplant (SOT) recipients with bloodstream infection caused by carbapenemase-producing Klebsiella pneumoniae (CPKP-BSI). A retrospective (2016-2021) observational cohort study was performed in 14 INCREMENT-SOT centers (ClinicalTrials.gov identifier: NCT02852902; Impact of Specific Antimicrobials and MIC Values on the Outcome of Bloodstream Infections Due to ESBL-or Carbapenemaseproducing Enterobacterales in Solid Organ Transplantation: an Observational Multinational Study). Outcomes were 14-day and 30-day clinical success (complete resolution of attributable manifestations, adequate source control, and negative follow-up blood cultures) and 30-day all-cause mortality. Multivariable logistic and Cox regression analyses adjusted for the propensity score to receive CAZ-AVI were constructed. Among 210 SOT recipients with CPKP-BSI, 149 received active primary therapy with CAZ-AVI (66/149) or BAT (83/ 149). Patients treated with CAZ-AVI had higher 14-day (80.7% vs 60.6%, P =.011) and 30 day (83.1% vs 60.6%, P = .004) clinical success and lower 30-day mortality (13.25% vs 27.3%, P =.053) than those receiving BAT. In the adjusted analysis, CAZ-AVI increased the probability of 14-day (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.036.84; P = .044) and 30-day clinical success (aOR, 3.14; 95% CI, 1.17-8.40; P = .023). In contrast, CAZ-AVI therapy was not independently associated with 30-day mortality. In the CAZ-AVI group, combination therapy was not associated with better outcomes. In conclusion, CAZ-AVI may be considered a first-line treatment in SOT recipients with CPKP-BSI.
- Carbapenem-Resistant Enterobacteriaceae Acquired Before Liver Transplantation: Impact on Recipient Outcomes(2017) FREIRE, Maristela Pinheiro; OSHIRO, Isabel C. V. S.; PIERROTTI, Ligia C.; BONAZZI, Patricia R.; OLIVEIRA, Larissa M. de; SONG, Alice T. W.; CAMARGO, Carlos H.; HEIJDEN, Inneke M. van der; ROSSI, Flavia; COSTA, Silvia F.; D'ALBUQUERQUE, Luiz A. C.; ABDALA, EdsonBackground. Carbapenem-resistant Enterobacteriaceae (CRE) is an emergent microorganism of infections after liver transplant (LT). The aim of this study was to analyze the risk factors for CRE acquisition and infection after LT. Methods. This was a prospective cohort study involving patients who underwent LT in the 2010 to 2014 period. Surveillance cultures for CRE were collected immediately before LT and weekly thereafter until hospital discharge. Results. We analyzed 386 patients undergoing a total of 407 LTs. Before LT, 68 (17.6%) patients tested positive for CRE, 11 (16.2%) of those patients having CRE infection, whereas 119 (30.8%) patients acquired CRE after LT. Post-LT CRE infection was identified in 59 (15.7%) patients: Klebsiella pneumoniae was isolated in 83.2%; surgical site infection was the most common type of infection (46.7%). Multivariate analysis showed that post-LT dialysis was the only risk factor for post-LT CRE acquisition. Eighty-two percent of patients who underwent 3 or more post-LT dialysis sessions and acquired CRE before LT evolved with post-LT CRE infection. Other risk factors for CRE infection were acquisition of CRE post-LT, Model for End-Stage Liver Disease score greater than 32, combined transplantation, and reoperation. Patients who acquired CRE before LT had a high risk of developing CRE infection (P < 0.001). Conclusions. Measures for minimizing that risk, including altering the antibiotic prophylaxis, should be investigated and implemented.
- Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria(2018) FREIRE, Maristela P.; PIERROTTI, Ligia C.; ZERATI, Antonio E.; BENITES, Luciana; MOTTA-LEAL FILHO, Joaquim Mauricio da; IBRAHIM, Karim Y.; ARAUJO, Pedro H.; ABDALA, EdsonThe management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Staphylococcus aureus. Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.
- Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients(2015) FREIRE, M. P.; PIERROTTI, L. C.; FILHO, H. H. C.; IBRAHIM, K. Y.; MAGRI, A. S. G. K.; BONAZZI, P. R.; HAJAR, L.; DIZ, M. P. E.; PEREIRA, J.; HOFF, P. M.; ABDALA, E.Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) is an emergent pathogen in healthcare-associated infections (HAIs). The aim of this study was to describe HAIs due to KPC-Kp, as well as identify mortality risk factors in cancer patients. In patients diagnosed with HAIs due to KPC-Kp between January 2009 and July 2013, we evaluated only the first infection episode of each patient, analyzing mortality separately for patients treated for a parts per thousand yen48 h with at least one antimicrobial agent proven to display in vitro activity against KPC-Kp. We evaluated variables related to the malignancy, the severity and characteristics of the HAI, and the antimicrobial therapy. We identified 83 HAIs due to KPC-Kp. The 30-day mortality was 57.8 % for all infections and 72.7 % for bacteremic infections. Of the 83 patients, 60 patients received a parts per thousand yen48 h of appropriate treatment and 44 (53 %) developed bacteremia. Ten patients (12 %) were neutropenic at HAI diagnosis and 33 (39.8 %) had infection at the tumor site. The most common HAI was urinary tract infection, seen in 26 patients (31.3 %), followed by primary bloodstream infection, seen in 24 patients (28.9 %). Forty-four patients (73.3 %) received combination antimicrobial therapy, most often including polymyxin (68.3 %). Risk factors for 30-day mortality are high sequential organ failure assessment (SOFA) score, need for intensive care stay at diagnosis of infection, and acute kidney injury; the removal of invasive devices related to infection and treatment with effective antibiotics for KPC-Kp are protective factors. In cancer patients, high mortality is associated with HAI due to KPC-Kp and mortality risk factors are more often related to acute infection than to the underlying disease.