Gladys Prado | FMUSP - Academia.edu (original) (raw)

Papers by Gladys Prado

SCCmec type II Brazilian endemic clone Healthcare associated infections Fifty consecutive MRSA bl... more SCCmec type II Brazilian endemic clone Healthcare associated infections Fifty consecutive MRSA blood isolates were evaluated: 30(60%) carried SCCmec type II (single PFGE clone; sequence type 5 or ST105); 12 (26%), IV; 5 (10%), III; 3 (6%), I. Brazilian endemic clone, carrying SCCmec type III, has been the main nosocomial clone in Brazil; however, this study showed that a clone carrying type II predominated.

Cardiovascular …, 2000

Results: The ages of the individuals ranged from 40 to 97 yr (mean 70). Thirty-eight aneurysms we... more Results: The ages of the individuals ranged from 40 to 97 yr (mean 70). Thirty-eight aneurysms were ruptured with diameters ranging from 5.3 to 17.0 cm (mean 7.97), and 40 aneurysms were nonruptured with variations in diameters from 2.8 to 6.1 cm, mean 4.02 cm (P<0.01). ...

Transplant Infectious Disease

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Carbapenem-resistant Enterobacteriaceae are a worldwide health problem and isolates carrying both... more Carbapenem-resistant Enterobacteriaceae are a worldwide health problem and isolates carrying both blaKPC-2 and blaNDM-1 are unusual. Here we describe the microbiological and clinical characteristics of five cases of bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae and Serratia marcescens having both blaKPC-2 and blaNDM-1. Of the five blood samples, three are from hematopoietic stem cell transplantation patients, one from a renal transplant patient, and one from a soft tissue surgical patient. All patients lived in low-income neighbourhoods and had no travel history. Despite antibiotic treatment, four of five patients died. The phenotypic susceptibility assays showed that meropenem added either EDTA, phenylboronic acid (PBA) or both, increased the zone of inhibition in comparison to meropenem alone. Molecular tests showed the presence of blaKPC-2 and blaNDM-1 genes. K. pneumoniae isolates were assigned to ST258 or ST340 by whole genome sequencing. Thi...

Antimicrobial Agents and Chemotherapy

Susceptibility of ceftazidime/avibactam and in vitro synergy with meropenem using disk approximat... more Susceptibility of ceftazidime/avibactam and in vitro synergy with meropenem using disk approximation and time-kill assays were investigated against eleven multiresistant Acinetobacter baumannii harboring oxacillinases and five Serratia marcescens carrying blaKPC-2. Ceftazidime/avibactam was very active and synergistic with meropenem against multiresistant S. marcescens isolates. On the other hand, only A. baumannii isolates co-harboring blaOXA-23 and blaOXA-117 displayed synergy. The disk approximation technique presented good sensitivity for synergism in S. marcescens.

American Journal of Infection Control, 2016

The nontuberculous mycobacteria (NTM) are widely spread. In Brazil, 2,520 cases of rapidly growin... more The nontuberculous mycobacteria (NTM) are widely spread. In Brazil, 2,520 cases of rapidly growing mycobacteria (RGM) infections after medical procedures were reported, with 5.4% of cases related to nonsurgical invasive procedures and with an occurrence of 1 clone (BRA100) of Mycobacterium abscessus subsp bolletii. To describe a pseudooutbreak of M abscessus subsp bolletii in an endoscopy and bronchoscopy unit. The alert for a pseudooutbreak was given when 3 patients, in the same week, had a positive bronchoalveolar lavage culture for M abscessus subsp bolletii. The patients had no symptoms/signs of mycobacterial infection; thus, contamination of bronchoscopes was suspected. Samples for culturing were collected from bronchoscopes, digestive endoscopes, automated disinfection machines, and the water supply. Clinical samples were identified by polymerase chain reaction restriction-enzyme analysis (PRA) of the hsp65 gene and their pulsed-field gel electrophoresis pattern was compared with environmental samples. The investigation demonstrated a contamination of bronchoscopes, digestive endoscopes, and disinfection machines. Molecular typing demonstrated that all strains belonged to the same clone (MAB01), identical to clone BRA100. Cross-transmission due to poor disinfection as well as resistance to glutaraldehyde may play roles in the spread of MAB01 M abscessus subsp bolletii, which may have a unique resistance to the environment and adaption to human hosts. However the water supply may have played a role. Attention is needed to ensure the quality of water used to rinse disinfected equipment.

Diagnostic Microbiology and Infectious Disease, Jan 12, 2009

We compared 41 patients who received colistimethate with 41 who received polymyxin B for the trea... more We compared 41 patients who received colistimethate with 41 who received polymyxin B for the treatment of serious infections caused by carbapenem-resistant Acinetobacter spp. and found both polymyxins have similar efficacy and toxicity.

Revista do Instituto de Medicina Tropical de São Paulo, 2014

Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia ... more Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc) in bone marrow transplant and hematology outpatients. Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW) hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC) care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units. Findings: 14 patients had B. multivorans (one patient had also B. cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, a...

Revista Brasileira de Zootecnia, 2004

The efficiency of absorption of colostral immunoglobulins was evaluated in five Canchim and seven... more The efficiency of absorption of colostral immunoglobulins was evaluated in five Canchim and seven Nelore calves. They received colostrum pools with concentration of 70.20 ± 6.14 mg/mL through esofageal feeder at 2, 12, 24 and 36 hours after birth. The immunoglobulins concentrations of the pools were estimated through specific gravity and measured by radial immunodifusion. In the blood collection at birth and during the first 70 days of life, the total protein was assayed by biuret method and the immunoglobulins were assayed by radial immunodifusion. Data were analysed as a randomized split-plot statistical model. The highest concentrations of serum immunoglobulins and total protein were observed at 24 hours of age. No significant differences (P>0.5484) were observed for immunoglobulins concentration at 24 hours, with concentrations of 28.80 ± 7.24 mg/mL for Canchim and 27.32 ± 9.54 mg/mL for Nelore. The efficiency for immunoglobulins absorption was not significantly different (P&...

Journal of Hospital Infection, 2006

Aims: A better analysis of behavioral, organizational and structural circumstances of exposures. ... more Aims: A better analysis of behavioral, organizational and structural circumstances of exposures. Method: Introduction of a new reporting form for exposures collected at the emergency department, entailing self-reported description of exposures, the involved instruments and body part, followed by additional medical care including Post Exposure Prophylaxis (PEP) for HIV or HBV. Results: 471 exposures were reported 2004/2005 (69% women). 51.2% were nurses, midwives and theatre nurse, 39.3% doctors (surgeons, internists, anaesthiologists). Percutaneous exposures compromised of 86.9% of all reported accidents. 40.5% exposures occurred in the OT, of which half occurred during surgical procedures and 16% in passing instruments. The predominately involved body parts were Dig II (16.9%) and Dig I (12%), left hand. 23.6% of the accidents happened in patients rooms, of which 46% occurred during disposal, 10.8% while recapping, 10.8% during blood drawing. 5.3% of the tested index patients were HIV positive, 1.7% HBsAg positive and 8.7% HCV positive. 26 of the 143 initiated HIV PEP finished the 4 weeks course (18%). 97% of all exposed HCW had Hepatitis B vaccination coverage. Conclusions: Our novel reporting system allows a more precise analysis of the type and location of reported exposures. It allows also to determine the specific department and ward involved (OT, ICU etc.) combined with the type of exposure (needlestick, failure of safety equipment etc.). Subsequently, targeted preventative measures can be taken, involving teaching of staff, feedback of results and preparation of recommendation for organizational and structural changes.

Journal of Antimicrobial Chemotherapy, 2008

Background: There has been an increase in worldwide infections caused by carbapenem-resistant Aci... more Background: There has been an increase in worldwide infections caused by carbapenem-resistant Acinetobacter. This poses a therapeutic challenge as few treatment options are available. Objectives: The aim of this study was to evaluate the efficacy and safety of polymyxins and ampicillin/ sulbactam for treating infections caused by carbapenem-resistant Acinetobacter spp. and to evaluate prognostic factors. Methods: This was a retrospective review of patients from two teaching hospitals who had nosocomial infections caused by carbapenem-resistant Acinetobacter spp. from 1996 to 2004. Diagnosis of infection was based on CDC criteria plus the isolation of Acinetobacter from a usually sterile site or from bronchoalveolar lavage. Urinary tract infections were not included. Data on demographic and clinical features and treatment were collected from medical records. Prognostic factors associated with two outcomes (mortality during treatment and in-hospital mortality) were evaluated. Results: Eighty-two patients received polymyxins and 85 were treated with ampicillin/sulbactam. Multiple logistic regression analysis revealed that independent predictors of mortality during treatment were treatment with polymyxins, higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score, septic shock, delay in starting treatment and renal failure. On multivariate analysis, prognostic factors for in-hospital mortality were older age, septic shock and higher APACHE II score. Conclusions: This is the first study comparing current therapeutic options for infections due to carbapenem-resistant Acinetobacter. The most important finding of the present study is that ampicillin/sulbactam appears to be more efficacious than polymyxins, which was an independent factor associated with mortality during treatment.

Diagnostic Microbiology and Infectious Disease, 2013

Diagnostic Microbiology and Infectious Disease, 2009

Journal of Global Antimicrobial Resistance, 2016

Empirical use of linezolid has been advocated in neutropenic febrile patients colonised by vancom... more Empirical use of linezolid has been advocated in neutropenic febrile patients colonised by vancomycin-resistant enterococci (VRE) because of the risk of bloodstream infection (BSI). This study aimed to genetically describe a vancomycin-resistant Enterococcus faecium (VREfm) BSI isolate resistant to linezolid (VRLRE) in a patient previously colonised by VREfm and to determine the incidence of colonisation and infection by VREfm in a bone marrow transplant unit over a 10-year period. Data for VREfm colonisation and infection were evaluated. PCR for the vanA and vanB genes, pulsed-field gel electrophoresis (PFGE) and microdilution antimicrobial susceptibility testing (vancomycin, teicoplanin, linezolid and aminoglycosides) were performed. Three isolates, including the VRLRE, were selected for whole-genome sequencing by Ion Torrent™, with E. faecium CP006620-Aus0085 used as a reference. Eighty-seven VREfm were analysed; all were linezolid-susceptible and harboured vanA, except for one blood isolate from a febrile neutropenic patient colonised by VREfm who received linezolid for 12 days and developed a BSI by VRLRE (linezolid MIC≥8μg/mL). Linezolid resistance was associated with a G2576T mutation in the 23SrRNA gene. PFGE analysis demonstrated that the 87 isolates belonged to four major clusters; however, the VRLRE presented only 50% similarity. Three sequence types (STs) were identified: ST412 (the predominant clone, which was more virulent compared with the other isolates); ST478 (linezolid-susceptible VREfm); and a novel ST named ST987 (VRLRE). SNP analysis showed a higher similarity between linezolid-susceptible VREfm and the predominant clone compared with VRLRE. VRLRE presented a G2576T mutation and belonged to a novel ST (ST987).

Empirical use of linezolid has been advocated in neutropenic febrile patients colonised by vancom... more Empirical use of linezolid has been advocated in neutropenic febrile patients colonised by vancomycin- resistant enterococci (VRE) because of the risk of bloodstream infection (BSI). This study aimed to genetically describe a vancomycin-resistant Enterococcus faecium (VREfm) BSI isolate resistant to linezolid (VRLRE) in a patient previously colonised by VREfm and to determine the incidence of colonisation and infection by VREfm in a bone marrow transplant unit over a 10-year period. Data for VREfm colonisation and infection were evaluated. PCR for the vanA and vanB genes, pulsed-field gel electrophoresis (PFGE) and microdilution antimicrobial susceptibility testing (vancomycin, teicoplanin, linezolid and aminoglycosides) were performed. Three isolates, including the VRLRE, were selected for whole-genome sequencing by Ion TorrentTM, with E. faecium CP006620-Aus0085 used as a reference. Eighty-seven VREfm were analysed; all were linezolid-susceptible and harboured vanA, except for one blood isolate from a febrile neutropenic patient colonised by VREfm who received linezolid for 12 days and developed a BSI by VRLRE (linezolid MIC 8 mg/mL). Linezolid resistance was associated with a G2576T mutation in the 23SrRNA gene. PFGE analysis demonstrated that the 87 isolates belonged to four major clusters; however, the VRLRE presented only 50% similarity. Three sequence types (STs) were identified: ST412 (the predominant clone, which was more virulent compared with the other isolates); ST478 (linezolid-susceptible VREfm); and a novel ST named ST987 (VRLRE). SNP analysis showed a higher similarity between linezolid-susceptible VREfm and the predominant clone compared with VRLRE. VRLRE presented a G2576T mutation and belonged to a novel ST (ST987).

Cardiovascular …, 2000

Transplant Infectious Disease

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Antimicrobial Agents and Chemotherapy

American Journal of Infection Control, 2016

Diagnostic Microbiology and Infectious Disease, Jan 12, 2009

Revista do Instituto de Medicina Tropical de São Paulo, 2014

Revista Brasileira de Zootecnia, 2004

Journal of Hospital Infection, 2006

Journal of Antimicrobial Chemotherapy, 2008

Diagnostic Microbiology and Infectious Disease, 2013

Diagnostic Microbiology and Infectious Disease, 2009

Journal of Global Antimicrobial Resistance, 2016

Empirical use of linezolid has been advocated in neutropenic febrile patients colonised by vancom... more Empirical use of linezolid has been advocated in neutropenic febrile patients colonised by vancomycin- resistant enterococci (VRE) because of the risk of bloodstream infection (BSI). This study aimed to genetically describe a vancomycin-resistant Enterococcus faecium (VREfm) BSI isolate resistant to linezolid (VRLRE) in a patient previously colonised by VREfm and to determine the incidence of colonisation and infection by VREfm in a bone marrow transplant unit over a 10-year period. Data for VREfm colonisation and infection were evaluated. PCR for the vanA and vanB genes, pulsed-field gel electrophoresis (PFGE) and microdilution antimicrobial susceptibility testing (vancomycin, teicoplanin, linezolid and aminoglycosides) were performed. Three isolates, including the VRLRE, were selected for whole-genome sequencing by Ion TorrentTM, with E. faecium CP006620-Aus0085 used as a reference. Eighty-seven VREfm were analysed; all were linezolid-susceptible and harboured vanA, except for one blood isolate from a febrile neutropenic patient colonised by VREfm who received linezolid for 12 days and developed a BSI by VRLRE (linezolid MIC 8 mg/mL). Linezolid resistance was associated with a G2576T mutation in the 23SrRNA gene. PFGE analysis demonstrated that the 87 isolates belonged to four major clusters; however, the VRLRE presented only 50% similarity. Three sequence types (STs) were identified: ST412 (the predominant clone, which was more virulent compared with the other isolates); ST478 (linezolid-susceptible VREfm); and a novel ST named ST987 (VRLRE). SNP analysis showed a higher similarity between linezolid-susceptible VREfm and the predominant clone compared with VRLRE. VRLRE presented a G2576T mutation and belonged to a novel ST (ST987).