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
33 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 33
- 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.
- Carbapenem-resistant Enterobacteriaceae among kidney transplant recipients - insights on the risk of acquisition and CRE infection(2021) FREIRE, Maristela P.; CARVALHO, Laina B.; REUSING JR., Jose Otto; SPADAO, Fernanda; LOPES, Max Igor B. F.; NAHAS, William C.; DAVID-NETO, Elias; PIERROTTI, Ligia C.Background Kidney transplant recipients are a risk group for carbapenem-resistant Enterobacteriaceae infection. Objectives This study aimed to identify risk factors for CRE acquisition and infection among kidney transplant recipients. Methods We conducted a case-control study; we defined the case as kidney transplant recipient with positive culture for carbapenem-resistant Enterobacteriaceae identified between January 2010 and February 2019. Controls were chosen among kidney transplant recipients hospitalized in the same period of cases (1:2). Surveillance culture for carbapenem-resistant Enterobacteriaceae was performed at admission and weekly during hospital stay. The risk factors analysis for carbapenem-resistant Enterobacteriaceae infection was performed among patients colonized by these bacteria. Results We identified 331 patients colonized with carbapenem-resistant Enterobacteriaceae; The median time from transplantation to first carbapenem-resistant Enterobacteriaceae positive culture was 42 days (range from 3 to 7399 days); 125(37.8%) patients developed infection; the most common site was urinary tract. Risk factors for carbapenem-resistant Enterobacteriaceae acquisition were recipient age >45-year, diabetes nephropathy, donor age >55-year, ureteral stent at kidney transplantation, delay of graft function, median lymphocytes count <800cells/mm(3), and acute cellular rejection. Risk factors for carbapenem-resistant Enterobacteriaceae infection were recipient age at CRE acquisition >50-year; median lymphocytes count <= 700 cells/mm(3), carbapenem use, and colonization by polymyxin-resistant strain. Patients colonized by polymyxin and carbapenem resistant Enterobacteriaceae strain who used carbapenem had a 93.8% probability of developing infection by this agent. Conclusion Carbapenem-resistant Enterobacteriaceae acquisition after kidney transplant is related to graft conditions, immunosuppression degree. Among carbapenem-resistant Enterobacteriaceae colonized patients, special attention is needed for those harbouring polymyxin-resistant strains.
- Institutional protocol adherence in the incidence of recurrent urinary tract infection after kidney transplantation(2020) FREIRE, Maristela P.; MARTINHO, Lorena; V, Clara Mendes; SPADAO, Fernanda; PAULA, Flavio Jota De; NAHAS, William C.; DAVID-NETO, Elias; PIERROTTI, Ligia C.Objectives: Recurrent urinary tract infections (rUTIs) occur frequently after kidney transplantation (KT), however their optimal management remains undefined. This study aimed to identify risk factors for rUTI and to validate a protocol for UTI and rUTI treatment after KT. Methods: This retrospective cohort study involved patients undergoing KT between January 2013 and July 2016. Patients were followed-up from day of KT until graft loss, death or end of follow-up (31 December 2018). We analysed all episodes of symptomatic UTI. The main outcome measure was rUTI after KT. Analysis was done per episode in a multilevel approach; patient features were considered in the distal level and UTI features in the proximal level. Univariate and multivariate analyses were performed by Cox regression. A propensity score was used to adjust the risk of patients with carbapenem-resistant Enterobacteriaceae. Results: During the study period, 787 patients underwent KT, of whom 152 (19.3%) developed 356 UTI episodes. The most common micro-organisms wereEscherichia coli (165/356; 46.3%) and Klebsiella pneumoniae (101/356; 28.4%). Multidrug-resistant micro-organisms were isolated in 161 UTIs (45.2%). Risk factors for rUTI were diabetic nephropathy as the cause of end-stage renal disease (P = 0.02), UTI in first 180 days after KT (P = 0.04), anatomic alteration of the urinary tract at UTI diagnosis (P = 0.004) and length of time to effective therapy (P = 0.002); UTI treatment duration according to institutional protocol (P = 0.04) was the only protective factor identified. Conclusion: Appropriate therapy duration has an impact on rUTI prevention after KT. (C) 2020 The Authors.
- 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.
- Critical points and potential pitfalls of outbreak of IMP-1-producing carbapenem-resistant Pseudomonas aeruginosa among kidney transplant recipients: a case-control study(2021) FREIRE, M. P.; CAMARGO, C. H.; YAMADA, A. Y.; NAGAMORI, F. O.; JUNIOR, J. O. Reusing; SPADAO, F.; CURY, A. P.; ROSSI, F.; NAHAS, W. C.; DAVID-NETO, E.; PIERROTTI, L. C.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.
- 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
- 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.
- Prediction models for carbapenem-resistant Enterobacterales carriage at liver transplantation: A multicenter retrospective study(2022) FREIRE, Maristela Pinheiro; RINALDI, Matteo; TERRABUIO, Debora Raquel Benedita; FURTADO, Mariane; PASQUINI, Zeno; BARTOLETTI, Michele; OLIVEIRA, Tiago Almeida de; NUNES, Nathalia Neves; LEMOS, Gabriela Takeshigue; MACCARO, Angelo; SINISCALCHI, Antonio; LAICI, Cristiana; CESCON, Matteo; DT'ALBUQUERQUE, Luiz Augusto Carneiro; MORELLI, Maria Cristina; SONG, Alice T. W.; ABDALA, Edson; VIALE, Pierluigi; CHIAVEGATTO FILHO, Alexandre Dias Porto; GIANNELLA, MaddalenaBackground: Carbapenem-resistant Enterobacterales (CRE) colonisation at liver transplantation (LT) increases the risk of CRE infection after LT, which impacts on recipients' survival. Colonization status usually becomes evident only near LT. Thus, predictive models can be useful to guide antibiotic prophylaxis in endemic centres. Aims: This study aimed to identify risk factors for CRE colonisation at LT in order to build a predictive model. Methods: Retrospective multicentre study including consecutive adult patients who underwent LT, from 2010 to 2019, at two large teaching hospitals. We excluded patients who had CRE infections within 90 days before LT. CRE screening was performed in all patients on the day of LT. Exposure variables were considered within 90 days before LT and included cirrhosis complications, underlying disease, time on the waiting list, MELD and CLIF-SOFA scores, antibiotic use, intensive care unit and hospital stay, and infections. A machine learning model was trained to detect the probability of a patient being colonized with CRE at LT. Results: A total of 1544 patients were analyzed, 116 (7.5%) patients were colonized by CRE at LT. The median time from CRE isolation to LT was 5 days. Use of antibiotics, hepato-renal syndrome, worst CLIF sofa score, and use of beta-lactam/beta-lactamase inhibitor increased the probability of a patient having pre-LT CRE. The proposed algorithm had a sensitivity of 66% and a specificity of 83% with a negative predictive value of 97%. Conclusions: We created a model able to predict CRE colonization at LT based on easyto-obtain features that could guide antibiotic prophylaxis
- Surgical site infection after liver transplantation in the era of multidrug-resistant bacteria: what new risks should be considered?(2021) FREIRE, Maristela P.; SONG, Alice T. Wan; OSHIRO, Isabel Cristina Vilela; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz Augusto Carneiro; ABDALA, EdsonSurgical site infection (SSI) is a frequent infection site after liver transplantation (LT), and multidrug-resistant bacteria are common agents of those infections. This study aimed to analyze risk factors for SSI, including SSI caused by a multidrug-resistant microorganism (MDRO) after LT. We performed a cohort study of patients who underwent an LT from 2010 to 2018. The outcomes were SSI and SSI caused by MDRO. We analyzed features related to surgical procedure, patients' characteristics, and post-LT intercurrence. Surveillance for carbapenemresistant Enterobacteriaceae (CRE), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant Acinetobacter baumannii (CRAB) was performed through rectal swab at the LT admission and weekly until hospital discharge during all study periods. SSI was identified in 30.1% (229/762) of LTs. We observed a decline in the SSI rate from 37.5% in 2014 to 16.7% in 2018 (P 0.02). SSI caused by MDRO occurred in 109 (14.3%) patients. Klebsiella pneumoniae was the most common agent of both SSI and SSI caused by MDRO. The pre-LT colonization was 98 (12.9%) by CRE, 73 (9.6%) by VRE, and 28 (3.7%) by CRAB. Risk factors for SSI caused by MDRO identified were dialysis after LT (P 0.01), CRAB acquisition before LT (0.03), and CRE acquisition before LT (P 0.004); use of adjusted prophylaxis by MDRO risk was the only protective factor identified (P 0.01). MDROs were frequent agents of SSI after LT, and the carbapenem-resistant Gram-negative colonization before LT increased the risk of SSI by these agents.
- Efficacy of beta-lactam/beta-lactamase inhibitors to treat extended-spectrum beta-lactamase-producing Enterobacterales bacteremia secondary to urinary tract infection in kidney transplant recipients (INCREMENT-SOT Project)(2021) PIERROTTI, Ligia C.; PEREZ-NADALES, Elena; FERNANDEZ-RUIZ, Mario; GUTIERREZ-GUTIERREZ, Belen; TAN, Ban Hock; CARRATALA, Jordi; ORIOL, Isabel; PAUL, Mical; COHEN-SINAI, Noa; LOPEZ-MEDRANO, Francisco; SAN-JUAN, Rafael; MONTEJO, Miguel; FREIRE, Maristela P.; CORDERO, Elisa; DAVID, Miruna D.; MERINO, Esperanza; STEINKE, Seema Mehta; GROSSI, Paolo A.; CANO, Angela; SEMINARI, Elena M.; VALERIO, Maricela; GUNSEREN, Filiz; RANA, Meenakshi; MULARONI, Alessandra; MARTIN-DAVILA, Pilar; DELDEN, Christian van; DEMIRKAYA, Melike Hamiyet; TUFAN, Zeliha Kocak; LOECHES, Belen; IYER, Ranganathan N.; SOLDANI, Fabio; ERIKSSON, Britt-Marie; PILMIS, Benoit; RIZZI, Marco; COUSSEMENT, Julien; CLEMENTE, Wanessa T.; ROILIDES, Emmanuel; PASCUAL, Alvaro; MARTINEZ-MARTINEZ, Luis; RODRIGUEZ-BANO, Jesus; TORRE-CISNEROS, Julian; AGUADO, Jose MariaBackground Whether active therapy with beta-lactam/beta-lactamase inhibitors (BLBLI) is as affective as carbapenems for extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) bloodstream infection (BSI) secondary to urinary tract infection (UTI) in kidney transplant recipients (KTRs) remains unclear. Methods We retrospectively evaluated 306 KTR admitted to 30 centers from January 2014 to October 2016. Therapeutic failure (lack of cure or clinical improvement and/or death from any cause) at days 7 and 30 from ESBL-E BSI onset was the primary and secondary study outcomes, respectively. Results Therapeutic failure at days 7 and 30 occurred in 8.2% (25/306) and 13.4% (41/306) of patients. Hospital-acquired BSI (adjusted OR [aOR]: 4.10; 95% confidence interval [CI]: 1.50-11.20) and Pitt score (aOR: 1.47; 95% CI: 1.21-1.77) were independently associated with therapeutic failure at day 7. Age-adjusted Charlson Index (aOR: 1.25; 95% CI: 1.05-1.48), Pitt score (aOR: 1.72; 95% CI: 1.35-2.17), and lymphocyte count <= 500 cells/mu L at presentation (aOR: 3.16; 95% CI: 1.42-7.06) predicted therapeutic failure at day 30. Carbapenem monotherapy (68.6%, primarily meropenem) was the most frequent active therapy, followed by BLBLI monotherapy (10.8%, mostly piperacillin-tazobactam). Propensity score (PS)-adjusted models revealed no significant impact of the choice of active therapy (carbapenem-containing vs any other regimen, BLBLI- vs carbapenem-based monotherapy) within the first 72 hours on any of the study outcomes. Conclusions Our data suggest that active therapy based on BLBLI may be as effective as carbapenem-containing regimens for ESBL-E BSI secondary to UTI in the specific population of KTR. Potential residual confounding and unpowered sample size cannot be excluded (ClinicalTrials.gov identifier: NCT02852902).