GABRIELA TAKESHIGUE LEMOS

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FMUSP, Hospital das Clínicas, Faculdade de Medicina
P ICHC, Hospital das Clínicas, Faculdade de Medicina - Médico

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Autor: ABDALA, Edson ×

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  • article 0 Citação(ões) na Scopus
    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.
  • article 4 Citação(ões) na Scopus
    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, Maddalena
    Background: 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