LIGIA CAMERA PIERROTTI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/47 - Laboratório de Hepatologia por Vírus, Hospital das Clínicas, Faculdade de Medicina
LIM/47 - Laboratório de Hepatologia por Vírus, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- 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.
- Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia(2020) PEREZ-NADALES, Elena; GUTIERREZ-GUTIERREZ, Belen; NATERA, Alejandra M.; ABDALA, Edson; MAGALHAES, Maira Reina; MULARONI, Alessandra; MONACO, Francesco; PIERROTTI, Ligia Camera; FREIRE, Maristela Pinheiro; IYER, Ranganathan N.; STEINKE, Seema Mehta; CALVI, Elisa Grazia; TUMBARELLO, Mario; FALCONE, Marco; FERNANDEZ-RUIZ, Mario; COSTA-MATEO, Jose Maria; RANA, Meenakshi M.; STRABELLI, Tania Mara Varejao; PAUL, Mical; FARINAS, Maria Carmen; CLEMENTE, Wanessa Trindade; ROILIDES, Emmanuel; MUNOZ, Patricia; DEWISPELAERE, Laurent; LOECHES, Belen; LOWMAN, Warren; TAN, Ban Hock; ESCUDERO-SANCHEZ, Rosa; BODRO, Marta; GROSSI, Paolo Antonio; SOLDANI, Fabio; GUNSEREN, Filiz; NESTOROVA, Nina; PASCUAL, Alvaro; MARTINEZ-MARTINEZ, Luis; AGUADO, Jose Maria; RODRIGUEZ-BANO, Jesus; TORRE-CISNEROS, Julian; SONG, A. T. Wan; ANDRAUS, W.; D'ALBUQUERQUE, L. A. Carneiro; DAVID-NETO, E.; PAULA, F. Jota de; ROSSI, F.; OSTRANDER, D.; AVERY, R.; RIZZI, M.; LOSITO, A. R.; RAFFAELLI, F.; GIACOMO, P. Del; TISEO, G.; LORA-TAMAYO, J.; SAN-JUAN, R.; GRACIA-AHUFINGER, I; CASTON, J.; RUIZ, Y. A.; ALTMAN, D. R.; V, S. Campos; BAR-SINAI, N.; KOPPEL, F.; ALMAJANO, F. Arnaiz de las Revillas; RICO, C. Gonzalez; MARTINEZ, M. Fernandez; MOURAO, P. H. O.; NEVES, F. A.; FERREIRA, J.; PYRPASOPOULOU, A.; IOSIFIDIS, E.; ROMIOPOULOS, I; V, M. Minero; SANCHEZ-CARRILLO, C.; LARDO, S.; COUSSEMENT, J.; DODEMONT, M.; JIAYUN, K.; MARTIN-DAVILA, P.; FORTUN, J.; ALMELA, M.; MORENO, A.; LINARES, L.; GASPERINA, D. D.; BALSAMO, M. L.; ROVELLI, C.; CONCIA, E.; CHIESI, S.; SALERNO, D. N.; OGUNC, D.; PILMIS, B.; SEMINARI, E. M.; CARRATALA, J.; DOMINGUEZ, A.; CORDERO, E.; LEPE, J. A.; MONTEJO, M.; LUCAS, E. Merino de; ERIKSSON, B. M.; DELDEN, C. van; MANUEL, O.; ARSLAN, H.; TUFAN, Z. Kocak; KAZAK, E.; DAVID, M.; LEASE, E.; CORNAGLIA, G.; AKOVA, M.Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score >= 8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score >= 8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
conferenceObject Defining pp65 Enemia and qPCR Cut-Offs for Pre-Emptive Therapy of CMV Disease in Low-Risk, Seropositive Renal Transplanted Recipients(2013) DAVID-NETO, E.; LEMOS, A.; BOAS, L. Vilas; LATIF, A.; AGENA, F.; PAULA, F. Jota de; PIERROTI, L.; LEMOS, F.; NAHAS, W.; CAIAFFA FILHO, H.; PANUTTI, C.CMV disease mostly invasive gastro-intestinal with low viremia occurs in approximately 16% of CMV seropositive renal transplant recipients not receiving Thymoglobuline (ATG). Pre-emptive therapy (PETh) to avoid disease in this group should cover the majority of patients at risk (high Negative Predictive Value – NPV). To define cut-offs for whole blood real-time quantitative PCR (qPCR) and antigenemia (pp65) assays and use PETh for CMV disease we collected blood samples weekly from day 7 to 120 after TX in pts CMV IgG+/ IgG+ donors who did not receive ATG. Results remained blinded. A suspicion of CMV disease required new qPCR/pp65 or biopsy. The highest value of pp65 and qPCR in pts without CMV disease one week before disease were used in ROC curves. As for Nov 2012, 92 pts had completed the collections or developed disease. They were males (54%), caucasians (69%), mean age 45±14y, 61% deceased donors, all under TAC/MPA/ Prednisone. Overall 12 pts (13%) had CMV disease (11 invasive gastro-intestinal/ 1 syndrome), at 64±21 days (31-98), and 80 did not. Of these 80 pts, 45 (56%) presented at least one episode of asymptomatic viremia and cleared it spontaneously (8 (18%) had PCR+/pp65+; 26 (56%) Pp65+/qPCR- and 11 (24%) qPCR+/Pp65-). Among pts with viremia or disease there was a trend for a higher pp65+ cells for disease than for viremia (152±352vs31±131/10 6 cells, p=0.073,) detected earlier for disease than viremia (64±21vs80±25 days, p=0.049). ROC curves (area 0.902±0.036, p=0.0001) revealed that pp65 of 4 cells had 83% sensitivity and 83% specificity to predict CMV disease. Using this cut-off, the NPV was 97%. The CMV copies detected by qPCR was higher for disease than for viremia (46657±50671 vs 5438±16681 copies, p=0.001) but time for detection was similar for both (74±25 vs 59±18 days, p=NS). ROC curve (area 0.903±0.056,p=0.0001) revealed that qPCR=844 copies had 83% sensitivity and 86% specificity to predict disease with the same NPV of 97%. These data indicate that both methods are adequate to detect CMV disease prior to its development in this low-risk population. Blood samples collection should start at day 30 and then weekly until day 120. When these cut-offs are reached, starting pre-emptive therapy would lead untreated only 3% of patients who would develop CMV disease.conferenceObject Toxoplasmosis Post-Kidney Or Liver Transplantation: A Serie of Cases(2015) PIERROTTI, L.; SALLES, R.; RYTHOLZ, M.; AZEVEDO, L.; SONG, A.; D'ALBUQUERQUE, L.; DAVID-NETO, E.; NAHAS, W.; ABDALA, E.conferenceObject Defining a BKV Cutt-Off and Profile for Early Detection of BKV Associated Nephropathy(2017) NIHEI, C.; AGENA, F.; PAULA, F.; DAVID, D.; FINK, M.; PIERROTTI, L.; DAVID-NETO, E.