FLAVIA ROSSI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/03 - Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina
LIM/03 - Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina
8 resultados
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- Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in Sao Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines(2023) KFOURI, Renato A.; BRANDILEONE, Maria-Cristina C.; SAFADI, Marco Aurelio P.; RICHTMANN, Rosana; GILIO, Alfredo E.; ROSSI, Flavia; GUIMARAES, Thais; BIERRENBACH, Ana Luiza; MORAES, Jose C.; IPD, Sao Paulo Study Grp I. P. D. Sa Paulo Study GrpBackground: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable popula-tions. In Brazil, pneumococcal vaccines are included in the National Immunization Pro-gram (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged >= 2 years and institutionalized >= 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicro-bial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immu-nocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical condi-tions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity pre-vailed in adults >= 18 years old (> 82.0%). Presence of >= 1 risk condition was reported in >= 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological dis-eases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non -susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad preven-tion to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly. (c) 2023 Sociedade Brasileira de Infectologia.
- Prognostic Trends and Current Challenges in Candidemia: A Comparative Analysis of Two Multicenter Cohorts within the Past Decade(2023) AGNELLI, Caroline; GUIMARAES, Thais; SUKIENNIK, Teresa; LIMA, Paulo Roberto Passos; SALLES, Mauro Jose; BREDA, Giovanni Luis; QUEIROZ-TELLES, Flavio; MAGRI, Marcello Mihailenko Chaves; MENDES, Ana Verena; CAMARGO, Luis Fernando Aranha; MORALES, Hugo; DIAS, Viviane Maria de Carvalho Hessel; ROSSI, Flavia; COLOMBO, Arnaldo LopesCandidemia remains a major public health challenge due to its high mortality rates, especially in developing countries. Monitoring epidemiological trends may provide insights for better clinical outcomes. This study aimed to describe trends in the epidemiology, therapeutic practices, and mortality in candidemia through a retrospective comparative analysis between two surveillance cohorts of all candidemic adults at eleven tertiary hospitals in Brazil, from 2010-2011 (Period I) versus 2017-2018 (Period II). A total of 616 cases were diagnosed, with 247 being from Period II. These patients were more likely to have three or more coexisting comorbidities [72 (29.1%) vs. 60 (16.3%), p < 0.001], had a prior history of in-hospital admissions more often [102 (40.3%) vs. 79 (21.4%), p = 0.001], and presented with candidemia earlier after admission, within 15 days (0-328) vs. 19 (0-188), p = 0.01. Echinocandins were more frequently prescribed [102 (41.3%) vs. 50 (13.6%), p = 0.001], but time to antifungal initiation [2 days (0-14) vs. 2 (0-13), p = 0.369] and CVC removal within 48 h [90/185 (48.6%) vs. 148/319 (46.4%), p = 0.644] remained unchanged. Additionally, many patients went untreated in both periods I and II [87 (23.6%) vs. 43 (17.4%), p = 0.07], respectively. Unfortunately, no improvements in mortality rates at 14 days [123 (33.6%) vs. 93 (37.7%), p = 0.343] or at 30 days [188 (51.4%) vs. 120 (48.6%), p = 0.511] were observed. In conclusion, mortality rates remain exceedingly high despite therapeutic advances, probably associated with an increase in patients' complexity and suboptimal therapeutic interventions. Management strategies should be tailored to suit epidemiological changes, expedite diagnosis to reduce the number of untreated eligible patients and guarantee early antifungal initiation and source control.
- Performance of a Real-Time PCR Assay for the Detection of Five Candida Species in Blood Samples from ICU Patients at Risk of Candidemia(2023) FELIX, Gabriel N.; FREITAS, Vera L. T. de; SILVA JUNIOR, Afonso R. da; MAGRI, Marcello M. C.; ROSSI, Flavia; SEJAS, Odeli N. E.; ABDALA, Edson; MALBOUISSON, Luiz M. S.; GUIMARAES, Thais; BENARD, Gil; NEGRO, Gilda M. B. DelThe gold standard for diagnosing invasive candidiasis still relies on blood cultures, which are inefficient and time-consuming to analyze. We developed an in-house qPCR assay to identify the 5 major Candida species in 78 peripheral blood (PB) samples from ICU patients at risk of candidemia. Blood cultures and (1,3)-beta-D-glucan (BDG) testing were performed concurrently to evaluate the performance of the qPCR. The qPCR was positive for DNA samples from all 20 patients with proven candidemia (positive PB cultures), showing complete concordance with Candida species identification in blood cultures, except for detection of dual candidemia in 4 patients, which was missed by blood cultures. Additionally, the qPCR detected Candida species in six DNA samples from patients with positive central venous catheters blood (CB) but negative PB cultures. BDG values were similarly high in these six samples and the ones with proven candidemia, strongly suggesting the diagnosis of a true candidemia episode despite the negative PB cultures. Samples from patients neither infected nor colonized yielded negative results in both the qPCR and BDG testing. Our qPCR assay was at least as sensitive as blood cultures, but with a shorter turnaround time. Furthermore, negative results from the qPCR provided strong evidence for the absence of candidemia caused by the five major Candida species.
- In vitro activity of sanitizers against mono- and polymicrobial biofilms of C. parapsilosis and S. aureus(2023) CASTRO, Vitor de Paula; THOMAZ, Danilo Yamamoto; VIEIRA, Kayro de Lima; LOPES, Leonardo Guedes; ROSSI, Flavia; NEGRO, Gilda M. B. Del; BENARD, Gil; PIRES, Regina HelenaThe emergence of disinfectant-resistant microorganisms poses a significant threat to public health. These resilient pathogens can survive and thrive in hospital settings despite routine disinfection practices, leading to persistent infections and the potential for outbreaks. In this study, we investigated the impact of 11 different commercial sanitizers at various concentrations and exposure times on biofilms consisting of clinical and nosocomial environmental isolates of Candida parapsilosis and Staphylococcus aureus. Among the sanitizers tested, 0.5% and 2.0% chlorhexidine (CLX), 10% polyvinyl pyrrolidone (PVP-I), a disinfectant based on quaternary ammonium compound (QAC), 2% glutaraldehyde, and 0.55% orthophthalaldehyde (OPA) demonstrated efficacy against both C. parapsilosis and S. aureus in monospecies and mixed biofilms. Analysis showed that 0.5% CLX and 10% PVP-I had fungicidal and bactericidal activity against all biofilms. However, the sanitizer based on QAC and 0.55% OPA proved to be bacteriostatic and fungicidal against both monospecies and mixed biofilms. In mixed biofilms, despite the last four sanitizers exerting fungicidal action, the reduction of fungal cells was approximately 4 log(10) CFU/mL compared to monospecies biofilms, showing that the interaction provided more resistance of the yeast to the sanitizer. Formation of mixed biofilms in hospital settings can create an ecological niche that enhances the survival of pathogens against routine sanitization procedures. Therefore, effective sanitization practices, including regular cleaning with effective sanitizers, should be implemented to prevent C. parapsilosis/S. aureus biofilm formation in healthcare settings.
- Neisseria gonorrhoeae arthritis in a patient with systemic lupus: resistance and virulence profiles(2023) TONACIO, Adriana Coracini; MARCHI, Ana Paula; BAZZO, Maria Luiza; LEMOS, Gabriela Takeshigue; BAMPI, Jose Victor Bortolotto; ESPINOZA, Evelyn Patricia Sanchez; DUARTE, Edson Luiz Tarsia; MARTINS, Roberta Cristina Ruedas; COSTA-LOURENCO, Ana Paula Ramalho da; OLIVEIRA, Vitor Falcao de; CORTES, Marina Farrel; SANTOS, Sania Alves dos; NETO, Lauro Vieira Perdigao; BONELLI, Raquel Regina; ELMORE, Maria Rita; ROSSI, Flavia; HUGHES, Gwenda; COSTA, Silvia FigueiredoIn this study, we describe a case report of gonococcal arthritis in a Systemic Lupus Erythematosus patient. Although several mechanisms favor disseminated gonococcal infection (DGI) in patients immunosup-pressed by SLE, this association is rarely reported in literature. We performed whole genome sequencing (WGS) of the etiologic agent involved and molecular analysis using a global collection of Neisseria gonorrhoeae strains. Ours is the only sample derived from synovial fluid identified in this collection, the others being from the usual anatomical sites. Antimicrobial susceptibility was determined by disk diffusion and Etest, and WGS was conducted to determine multilocus sequence typing profiles, group isolates based on core genome single nucleotide polymorphisms (SNP), and identify virulence genes and antimicrobial resistance determinants. The N. gonorrhoeae samples in the global collection were highly heterogeneous. The SNP tree had a total 19,532 SNPs in 320 samples. Our sample displayed resistance to ciprofloxacin (MIC = 2 mg/mL) and tetracycline (zone diameter = 0 mm) belonged to ST 1588 and was not closely related to any isolate in the global collection of N. gonorrhoeae strains. The isolate had genetic features related to beta-lactam, tetracycline and quinolone resistance. Seventy-one virulence genes were identified in our sample, belonging to the following classes: adherence, efflux pump, immune modulator, invasion, iron uptake, protease and stress adaptation. Moreover, no virulence genes for immune evasion and toxin were identified.(c) 2022 Institut Pasteur.
- Transmission of Carbapenem-Resistant Enterobacterales in an Overcrowded Emergency Department: Controlling the Spread to the Hospital(2023) SALOMAO, Matias C.; FREIRE, Maristela P.; LAZARI, Carolina S.; CURY, Ana P.; ROSSI, Flavia; SEGURADO, Aluisio A. C.; COSTA, Silvia F.; LEVIN, Anna S.; BOSZCZOWSKI, IcaroThis quasi-experimental study shows that early contact precautions and rapid identification of patients colonized with carbapenem-resistant Enterobacterales was associated with a nonsignificant reduction of cross-transmission in emergency departments. Background Overcrowded emergency departments (EDs) may increase the risk of carbapenem-resistant Enterobacterales (CRE) transmission. Methods We conducted a quasi-experimental study divided into 2 phases (baseline and intervention) to investigate the impact of an intervention on the acquisition rate and identify risk factors for CRE colonization in an ED of a tertiary academic hospital in Brazil. In both phases, we did universal screening with rapid molecular test (bla(KPC), bla(NDM), bla(OXA48), bla(OXA23), and bla(IMP)) and culture. At baseline, both screening test results were not reported, and patients were put under contact precautions (CP) based on previous colonization or infection by multidrug-resistant organisms. During the intervention, all patients hospitalized in the ED were placed in empiric CP and the result of CRE screening was reported; if negative, patients were released from CP. Patients were rescreened if they stayed >7 days in the ED or were transferred to an intensive care unit. Results A total of 845 patients were included: 342 in baseline and 503 in intervention. Colonization at admission was 3.4% by culture and molecular test. Acquisition rates during ED stay dropped from 4.6% (11/241) to 1% (5/416) during intervention (P = .06). The aggregated antimicrobial use in the ED decreased from phase 1 to phase 2 (804 defined daily doses [DDD]/1000 patients to 394 DDD/1000 patients, respectively). Length of stay >2 days in the ED was a risk factor for CRE acquisition (adjusted odds ratio, 4.58 [95% confidence interval, 1.44-14.58]; P = .01). Conclusions Early empiric CP and rapid identification of CRE-colonized patients reduce cross-transmission in ED. Nevertheless, staying >2 days in ED compromised efforts.
- Antimicrobial Photodynamic Therapy in the Nasal Decolonization of Maintenance Hemodialysis Patients: A Pilot Randomized Trial(2023) BEZERRA, Daniella Teixeira; SELVA, Andreia La; CECATTO, Rebeca Boltes; DEANA, Alessandro Melo; PRATES, Renato Araujo; BUSSADORI, Sandra Kalil; MESQUITA-FERRARI, Raquel Agnelli; MOTTA, Lara Jansiski; FERNANDES, Kristianne Porta Santos; MARTIMBIANCO, Ana Luiza Cabrera; FROCHOT, Celine; PEREIRA, Benedito Jorge; ROSSI, Flavia; MIMICA, Marcelo Jenne; HORLIANA, Anna Carolina Ratto TempestiniRationale & Objective: Infections are an important cause of mortality among patients receiving maintenance hemodialysis. Staphylococcus aureus is a frequent etiological agent, and previous nasal colonization is a risk factor for infection. Repeated antimicrobial decolonization reduces infection in this population but can induce antibiotic resistance. We compared photodynamic therapy, a promising bactericidal treatment that does not induce resistance, to mupirocin treatment among nasal carriers of S aureus. Study Design: Randomized controlled pilot study. Setting & Participants: 34 patients receiving maintenance hemodialysis who had nasal carriage of S aureus. Interventions: Patients were randomly assigned to decolonization with a single application of photodynamic therapy (wavelength of 660 nm, 400 mW/cm2, 300 seconds, methylene blue 0.01%) or with a topical mupirocin regimen (twice a day for 5 days). Outcome: Nasal swabs were collected at time 0 (when the carrier state was identified), directly after treatment completion, 1 month after treatment, and 3 months after treatment. Bacterial isolates were subjected to proteomic analysis to identify the species present, and antimicrobial susceptibility was characterized. Results: All 17 participants randomized to photodynamic therapy and 13 of 17 (77%) randomized to mupirocin were adherent to treatment. Directly after treatment was completed, 12 participants receiving photodynamic therapy (71%) and 13 participants treated with mupirocin (77%) had cultures that were negative for S aureus (risk ratio, 0.92 [95% CI, 0.61-1.38]; P = 0.9). Of the patients who had negative cultures directly after completion of photodynamic therapy, 67% were recolonized within 3 months. There were no adverse events in the photodynamic therapy group. Limitations: Testing was restricted to assessing nasal colonization; infectious complications were not assessed. Conclusions: Photodynamic therapy is a feasible approach to treating nasal carriage of S aureus. Future larger studies should be conducted to determine whether photodynamic therapy is equivalent to the standard of care with mupirocin.
- Chlorhexidine susceptibility and Eagle effect in planktonic cells and biofilm of nosocomial isolates(2023) MARCHI, Ana Paula; CORTES, Marina Farrel; NOGUERA, Saidy Vasconez; ROSSI, Flavia; LEVIN, Anna Sara; COSTA, Silvia Figueiredo; NETO, Lauro Vieira PerdigaoThe aim of this study is to evaluate the chlorhexidine gluconate (CHG) susceptibility in both planktonic cells and biofilm of 32 Gram-negative (Gn) and 6 Gram-positive (Gp) isolates by minimal inhibitory concentration (2-256 mu g/mL for Gn and 2-32 mu g/mL for Gp), minimal bactericidal concentration (4-256 mu g/mL for Gn and 2-32 mu g/mL for Gp) in planktonic cells, and minimal biofilm elimination concentration (128 >= 16,384 mu g/mL in Gn and 32 >= 16,384 mu g/mL in Gp) in biofilm environment. Our study showed that Gn isolates have higher minimal concentrations than Gp and bacteria in biofilms are more tolerant than planktonic ones. No correlation between MBC or MBEC and biofilm formation was statistically confirmed. The Eagle effect, previously described for antimicrobials and antifungals, was evidenced in this work for CHG, an antiseptic. Besides that, the phenomenon was described in 23/38 isolates (60.5%), raising minimal concentration up to >= 16,384 mu g/mL. Our study showed that clinical isolates have a high ability to form biofilm allowing them to tolerate CHG concentrations as high as the ones used in clinical practice. Therefore, attention should be given to the occurrence of this phenomenon to avoid false susceptibility results.