FLAVIO JOTA DE PAULA

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13
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico

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Autor: DAVID-NETO, Elias ×

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Agora exibindo 1 - 10 de 27
  • article 5 Citação(ões) na Scopus
    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.
  • conferenceObject
    Treatment of Carbapenem resistant Enterobacteriaceae with reduced susceptibility to polymyxin among kidney transplant recipients experience during an outbreak period
    (2016) FREIRE, Maristela; PAULA, Flavio J. De; AZEVEDO, Luiz Sergio; LAZARO, Ana Carolina; ROSSI, Flavia; DAVID-NETO, Elias; NAHAS, Willian; PIERROTTI, Ligia C.
  • article
    First Report of Granulicatella sp. Endocarditis in a Kidney Transplant Patient
    (2017) PAULA, Flávio Jota de; NEVES, Precil Diego Miranda de Menezes; BRIDI, Ramaiane Aparecida; SONG, Alice Tung Wan; DAVID-NETO, Elias
    Abstract Granulicatella and Abiotrophia are genera of fastidious Gram-positive cocci commensal of the oral, genitourinary, and intestinal flora. We report the first case of infective endocarditis caused by Granulicatella sp. in a kidney transplant recipient. A 67-year-old male kidney transplant recipient was admitted to the hospital for investigation of fever, abdominal pain, and diarrhea. On physical examination, he was dehydrated. Laboratory tests identified impaired renal function (creatinine level of 15.5 mg/dl; reference, 3.0 mg/dl), metabolic acidosis, and electrolyte disturbances. Cryptosporidium sp. was identified as the cause of the diarrhea, and the infection was treated with nitazoxanide. On admission, cultures of blood, urine, and stool samples were negative. Echocardiography results were normal. Despite the antimicrobial treatment, the fever persisted. A transthoracic echocardiogram revealed infective endocarditis of the mitral valve, and Granulicatella spp. were isolated in blood cultures. Although the patient was treated with penicillin and amikacin, he evolved to septic shock of pulmonary origin and died. Infective endocarditis caused by Granulicatella sp. should be suspected in cases of culture-negative endocarditis.
  • article 3 Citação(ões) na Scopus
    Coronary events in obese hemodialysis patients before and after renal transplantation
    (2015) LIMA, Jose Jayme G. De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; MUELA, Henrique Cotchi S.; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.
    We examined the impact of obesity (BMI 30 kg/m(2), n = 357) on prognosis in 1696 hemodialysis (HD) patients before and after renal transplantation (TX). End-points were coronary events, composite cardiovascular (CV) events, and death. Obese HD patients were older (55.9 +/- 9.2 vs. 54.2 +/- 11), had more diabetes (54% vs. 40%), dyslipidemia (49% vs. 30%), altered myocardial scan (38% vs. 31%), myocardial infarction (MI) (16% vs. 10%), coronary intervention (11% vs. 7%), higher total cholesterol (186 +/- 52 vs. 169 +/- 47), and triglycerides (219 +/- 167 vs. 144 +/- 91). Obese undergoing TX had more dyslipidemia (46% vs. 31%), angina (23% vs. 14%), MI (18% vs. 5%), increased total cholesterol (185 +/- 56 vs. 172 +/- 48), and triglycerides (237 +/- 190 vs. 149 +/- 100). Obesity was independently associated with coronary events (log-rank = 0.008, HR 2.55% CI 1.27-5.11) and death (log-rank 0.046, HR 1.52, % CI 1.007-2.30) in TX but not in HD. Obese HD patients had more risk factors and ischemic heart disease, but these characteristics did not interfere with prognosis. In TX patients, obesity predicts coronary events and death.
  • conferenceObject
    Risk Factors for Mortality among Kidney Transplant Recipients with Pneumocystis Jirovecii Infection
    (2018) MORTARI, Naima; FREIRE, Maristela; AZEVEDO, Luis Sergio; PAULA, Flavio Jota De; CAIAFFA-FILHO, Helio; NAHAS, William; DAVID-NETO, Elias; PIERROTTI, Ligia C.
  • conferenceObject
    KIDNEY TRANSPLANTATION IN PATIENTS WITH BLADDER AUGMENTATION: LONG TERM OUTCOMES
    (2017) YAMACAKE, Kleiton; PIOVESAN, Affonso; FALCI, Renato; MESSI, Gustavo; ANTONOPOULOS, Ioannis; PAULA, Flavio Jota de; LOCALI, Rafael; DAVID-NETO, Elias; NAHAS, William
  • conferenceObject
    TRANSPLANTABILITY EVALUATION IN HIGH RISK PATIENTS WITH END STAGE RENAL DISEASE ENROLLED IN THE WAITING LIST OF KIDNEY TRANSPLANTATION. AN OBSERVATIONAL COHORT STUDY
    (2017) IZQUIERDO, Andrea Andrade; ONUSIC, Vivian L.; OTTO JR., Jose; LEMOS, Francine Bc; PAULA, Flavio J. De; NAHAS, William C.; DAVID-NETO, Elias
  • article 9 Citação(ões) na Scopus
    Cardiovascular risk reduction with periodontal treatment in patients on the waiting list for renal transplantation
    (2019) SANTOS-PAUL, Marcela A.; NEVES, Ricardo Simoes; GOWDAK, Luis Henrique W.; PAULA, Flayio J. de; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.; RAMIRES, Jose Antonio F.; LIMA, Jose Jayme G. De
    Background Cardiovascular mortality is increased in chronic kidney disease, a condition with a high prevalence of periodontal disease. Whether periodontitis treatment improves prognosis is unknown. Methods The effect of periodontal treatment on the incidence of cardiovascular events and death in 206 waitlist hemodialysis subjects was compared with that in 203 historical controls who did not undergo treatment. Patients were followed up for 24 months or until death or transplantation. Results The prevalence of moderate/severe periodontitis was 74%. Coronary artery disease correlated with the severity of periodontal disease (P = .02). Survival free of cardiovascular events (94% vs 83%, log-rank 0.009), coronary events (97% vs 89%, log-rank = 0.009), and cardiovascular death (96% vs 87%, log-rank = 0.037) was higher in the evaluated group. Death by any cause did not differ between groups. Multivariate analysis showed that treatment was associated with reduction in cardiovascular events (HR 0.43; 95% CI 0.22-0.87), coronary events (HR 0.31; 95% CI 0.12-0.83), and cardiovascular deaths (HR 0.43; 95% CI 0.19-0.98). Conclusion Periodontal treatment reduced the 24-month incidence of cardiovascular events and cardiovascular death, suggesting that periodontal treatment may improve cardiovascular outcomes. We suggest that periodontal screening and eventual treatment may be considered in patients with advanced renal disease.
  • article 54 Citação(ões) na Scopus
    Risk factors and outcome of infections with Klebsiella pneumoniae carbapenemase-producing K-pneumoniae in kidney transplant recipients
    (2015) FREIRE, Maristela P.; ABDALA, Edson; MOURA, Maria L.; PAULA, Flavio Jota de; SPADAO, Fernanda; CAIAFFA-FILHO, Helio H.; DAVID-NETO, Elias; NAHAS, William C.; PIERROTTI, Ligia C.
    Solid organ transplant recipients are especially susceptible to healthcare-associated infections with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp-HAIs). The aim of the study was to evaluate risk factors and outcome of these infections in kidney transplant recipients. This was a retrospective cohort of kidney transplant (KTx) recipients between January 2009 and December 2013. Cases were defined as patients who developed KPC-Kp-HAI, confirmed by PCR for bla (KPC) gene after KTx during the study period. We analysed variables related to recipient; induction immunosuppressant therapy; delayed graft function; use of invasive devices; SOFA score on the first day of infection; type of therapy; time from positive culture to appropriate antimicrobial therapy; bacteraemia; and concomitant infection. Outcome measures were the occurrence of KPC-Kp-HAI and 30-day mortality after KPC-Kp-HAI. A total of 1,101 were submitted to KTx in the period, 21 patients were classified as infected with KPC-Kp. Another ten patients had KPC-Kp-HAI in the period and were transplanted before 2009. Of those 31 patients, 48.4 % showed evidence of prior colonization and 38.7 % had bacteraemia. The most common site of infection was the surgical wound. Risk factors for KPC-Kp-HAI were multi-organ transplantation and the use of a ureteral stent. Eight of the infected patients experienced recurrence of the infection. The 30-day mortality rate was 41.9 %. Survival was significantly lower among the patients with KPC-Kp-HAI (72 vs. 89.1 %; P = 0.002). The only risk factor independently associated with 30-day mortality was an elevated SOFA score on the first day of infection. In KTx recipients, the occurrence of KPC-Kp-HAI was related to invasive devices and type of transplant; these infections had a high rate of recurrence and reduced survival after KTx.
  • article 26 Citação(ões) na Scopus
    Amikacin Prophylaxis and Risk Factors for Surgical Site Infection After Kidney Transplantation
    (2015) FREIRE, Maristela P.; ANTONOPOULOS, Ioannis M.; PIOVESAN, Affonso Celso; MOURA, Maria L.; PAULA, Flavio Jota de; SPADAO, Fernanda; GUIMARAES, Thais; DAVID-NETO, Elias; NAHAS, William C.; PIERROTTI, Ligia C.
    Background. Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs. Methods. We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation. Results. A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function. Conclusion. Amikacin prophylaxis is a useful strategy for preventing SSIs.