Papers by Eduardo Medeiros
Revista Do Instituto De Medicina Tropical De Sao Paulo, Aug 1, 2008
E. faecium was the first reported VRE species, carrying the vanA gene in Brazil. In spite of this... more E. faecium was the first reported VRE species, carrying the vanA gene in Brazil. In spite of this, vancomycin-resistant E. faecalis has become the predominant species in Brazilian hospitals. The aim of this study was to evaluate the genetic relatedness of VREs isolated in a Brazilian teaching hospital eight years apart from its first isolation. We analyzed 38 VRE strains obtained from 81 surveillance cultures of patients admitted to the four largest intensive care units in Hospital São Paulo in February, 2006. Presence of the vanA gene was assayed by PCR and PFGE analysis was used for molecular characterization. All VRE strains carried the vanA gene. Two distinct clonal groups were observed among vancomycin-resistant E. faecalis. Vancomycin-resistant E. faecium belonged to five distinct clones were demonstrated by molecular typing. All of these clones were different from the first vancomycin-resistant enterococci clone isolated eight years ago in our hospital.
Acta Paulista De Enfermagem, 2020
Entendendo o ressurgimento e o controle do sarampo no Brasil O sarampo é uma doença de alta trans... more Entendendo o ressurgimento e o controle do sarampo no Brasil O sarampo é uma doença de alta transmissibilidade causada por um vírus RNA, gênero Morbillivirus, família Paramyxoviridae. Um doente é capaz de transmitir para outras 12 a 18 pessoas. Outra característica do sarampo é o período longo de transmissibilidade do vírus: seis dias antes do exantema a quatro dias depois do seu aparecimento. O sarampo estava controlado nas Américas e o Brasil recebeu o certi cado de erradicação em 2016 e perdemos no nal de 2018, pelo avanço dos surtos que estão ocorrendo até os dias atuais. O sarampo é uma doença potencialmente grave que cursa com febre, coriza, conjuntivite e manchas vermelhas pelo corpo, que tem início na região retroauricular e dissemina-se para rosto, tronco e membros: chamada de distribuição craniocaudal. As clássicas lesões de Koplik, que são lesões de 2 a 3mm de diâmetro, discretamente elevadas, de cor branca com base eritematosa, localizadas na região interna da mucosa oral, na altura do segundo molar superior, estão presentes em alguns casos, antes do exantema e desaparecem em 48 horas. O sarampo tem a capacidade de deprimir a resposta imune para outros patógenos. Assim, a doença pode evoluir com complicações infecciosas bacterianas como a otite média e a pneumonia, especialmente em crianças menores de cinco anos, desnutridos e imunodeprimidos. O sarampo em crianças com de ciência de vitamina A associada a desnutrição tem evolução mais grave e pode causar cegueira. Uma outra complicação crônica rara (incidência de 4 a 11 casos por 100.000 pessoas) é a panencefalite esclerosante subaguda, doença d egenerativa que afeta crianças e adultos jovens causada pela infecção persistente do vírus no encéfalo com consequente resposta imunológica crônica. A infecção por sarampo durante a gravidez está associada ao aumento do risco de complicações, incluindo aborto, parto prematuro, doença neonatal, baixo peso ao nascer e morte materna. Embora, os estudos não são conclusivos quanto ao efeito teratogênico do vírus do sarampo. Importante, a gestante não pode ser vacinada, pois a vacina é feita de vírus vivo atenuado. Assim como os imunodeprimidos, a prevenção da infecção na grávida deve ser realizada a pro laxia pós-exposição com imunoglobulina endovenosa. Por que o sarampo ressurgiu no Brasil? Casos noti cados de sarampo no mundo cresceram 300% nos primeiros três meses de 2019, em comparação com o mesmo período de 2018. A Organização Mundial de Saúde alertou que até o nal de março de 2019, 170 países haviam noti cado 112.163 casos de sarampo. O genótipo que está envolvido no surto no Brasil é o D8,
Acta Paulista De Enfermagem, 2020
A luta dos pro ssionais de saúde no enfrentamento da COVID-19 O Brasil está passando pela mais gr... more A luta dos pro ssionais de saúde no enfrentamento da COVID-19 O Brasil está passando pela mais grave pandemia de uma doença infecciosa causada por um novo coronavírus (SARS-CoV-2). A doença chamada COVID-19 é potencialmente fatal e representa o mais importante problema mundial de saúde pública dos últimos 100 anos, comparado apenas com a gripe espanhola que matou cerca de 25 milhões de pessoas entre 1918 e 1920. A pandemia pelo SARS-CoV-2 teve início na cidade de Wuhan, região central da China, relacionada a transmissão em um mercado de frutos do mar e de animais vivos. (1) Rapidamente se disseminou para toda China, a Ásia e, em dois meses, atingiu todos os continentes. SARS-CoV-2 é altamente transmissível por gotículas e contato, principalmente em locais fechados e ambientes hospitalares. Um indivíduo com infecção pelo novo coronavírus transmite para outras duas ou três pessoas, dependendo das condições ambientais. Locais fechados com pouca ventilação e baixa luminosidade facilitam a transmissão do vírus. Esta taxa de transmissão é chamada número reprodutivo, que na COVID-19 varia entre 2,0 e 3,5. O controle da epidemia acontece quando o número reprodutivo da COVID-19 é reduzido a menos de um, fazendo com que a quantidade de casos diminua lentamente. Acredita-se poderíamos suprimir a circulação de vírus em um grau considerável quando atingíssemos o número reprodutivo para menos de 0,2. O vírus pode permanecer no ambiente por horas a dias dependendo da superfície e das condições ambientais. O novo coronavírus é inativado com facilidade com germicidas utilizados no ambiente hospitalar, incluindo o álcool à 70% e o hipoclorito de sódio. A higiene ambiental é fundamental especialmente no ambiente hospitalar. Um fator importante na transmissibilidade do COVID-19 é a alta carga viral no trato respiratório superior, mesmo entre pacientes pré-sintomáticos, que o distingue de outras doenças respiratórias. Em muitos indivíduos, particularmente idosos, o diagnóstico da infecção baseada em sintomas é mais difícil: muitos não apresentam febre, têm tosse crônica por outras patologias ou apresentam dispneia aos esforços por insu ciência cardíaca prévia. Em um surto em casa de repouso nos Estados Unidos da América, a triagem isoladamente baseada em sintomas clínicos não conseguiu diagnosticar muitos idosos com infecção e não foi su ciente para controlar a transmissão da COVID-19. Os pro ssionais de saúde são particularmente susceptíveis a infecção. No Brasil, bem como em outros países, milhares de pro ssionais de saúde foram afastados das atividades pro ssionais por terem adquirido a infecção
Introduction: Sepsis is one of the leading causes of mortality in patients with hematologic malig... more Introduction: Sepsis is one of the leading causes of mortality in patients with hematologic malignancies. Our aim is evaluate the impact of multimodal strategy on sepsis bundle compliance and in-hospital mortality in patients with hematologic malignancies. Methods:We conducted a quasi-experimental study that included patients with hematologic malignancies and sepsis or septic shock, between January 1, 2017 and August 31, 2020. The study comprised two phases: phase 1, survey of sepsis and sepsis shock cases and reformulation of the sepsis team and sepsis bundle; phase 2, staff training, monthly meetings of the sepsis team and feedback for care teams. The followup of patients was for 30 days, during hospitalization, or until death. Data were analyzed with descriptive and inferential statistics, with a 95% significance interval. And the tests considered a 5% significance level. Results: A total of 329 (42.5%) patients were included. The proportion of sepsis was 241 (73.3%) and septic s...
Brazilian Journal of Infectious Diseases, Jun 1, 2007
Pneumonia is the most frequent hospital infection in patients admitted to intensive care units (I... more Pneumonia is the most frequent hospital infection in patients admitted to intensive care units (ICU) and is also responsible for the highest lethality rates, as well as an increase in both the duration and costs of hospitalization. The objective of this study was to identify predisposing factors for pneumonia. A prospective cohort study was carried out between June 1996 and June 1997, and included 540 patients admitted consecutively for periods greater than 24 hours to the adult ICU of the Londrina State University's Teaching Hospital. Of these, 83 (15.4%) developed pneumonia. All patients were analyzed with respect to various risk factors for hospital-acquired pneumonia. Univariate analysis identified the following factors: decreased level of consciousness, craniotomy, prior use of antibiotics, mechanical ventilation, nasogastric tube feeding, enteral feeding, aspiration of gastric contents, central venous catheter and the time spent in the ICU. Multivariate analysis identified four risk factors for pneumonia in the ICU: tracheotomy (RR = 1.09; 95%CI = 1.04-1.17), nasogastric tube feeding (RR = 1.11; 95%CI = 1.05-1.18), H2-blocker use (RR = 1.09; 95%CI = 1.05-1.14) and decreased level of consciousness (RR = 2.67; 95%CI = 1.43-5.04). In 56.6% of patients, pneumonia occurred within the first four days following ICU admission. The risk factors identified were all necessary for the treatment of the patient except for decreased level of consciousness, either present at admission or occurring during hospitalization due to deterioration in the clinical condition of the patient or to the use of sedatives.
Infection Control and Hospital Epidemiology, Jul 22, 2020
To the Editor-With the progression of the coronavirus disease 2019 (COVID-19) pandemic, the perso... more To the Editor-With the progression of the coronavirus disease 2019 (COVID-19) pandemic, the personal protective equipment (PPE) shortage has been highlighted. 1 The sudden increase in demand for PPE due to the number of COVID-19 cases, misinformation, panic buying, and stockpiling resulted in global shortages. The World Health Organization (WHO) published a guideline for the rational use of PPE for coronavirus disease in healthcare and home-care settings during severe shortages. 2 Despite the importance of this topic, observational studies that evaluate the use of PPE during the pandemic by healthcare workers (HCWs) are scarce. A Chinese cross-sectional survey using a self-administered questionnaire included 1,357 HCWs and showed that 89% had sufficient knowledge and 89.7% followed correct practices concerning severe acute respiratory coronavirus virus 2 (SARS-CoV-2). 3 Researchers in the division of infection control and hospital epidemiology of a teaching hospital in Brazil observed compliance regarding additional transmission-based precautions in exclusive care units for patients suspect or confirmed to COVID-19 from April 1 to May 15, 2020. The institutional protocol to control the coronavirus disease was developed based on guidelines of the World Health Organization (WHO) and the National Health Surveillance Agency (ANVISA), a regulatory body of the Brazilian government. 5 Prior to the onset of observations, healthcare professionals (HCPs) received face-to-face or video training on SARS-CoV-2 precautions. In assistance activities, HCPs and support teams should follow contact and droplet precautions or contact and airborne precautions for aerosol-generating procedures. Compliance was considered as satisfactory when the HCPs wore all 5 proper PPE (ie, gown, eye protection, head cap, mask, and gloves) recommended for each specific procedure. During the study, 260 observations were performed and the compliance rate was 31.5% (n = 82). The compliance rate was 22% (2 of 9) among physiotherapists, 29% (15 of 52) among physicians, 31% (56 of 182) in the nursing team, and 53% (9 of 17) among all others (ie, nutrition team, occupational therapists, X-ray technicians, and cleaning staff). More than 1 improper PPE use was identified in each observation, totaling 322 failures, of which 40% (n=129) were practices that could have resulted in self-and/or environmental contamination. Furthermore, 60% of these failures (n=193) were practices that resulted in waste of PPE (Table ). These preliminary results suggest unnecessary consumption of PPE by HCPs, contributing the shortage of these products, which may put the safety of professionals and patients at risk. Therefore, determining the cause of this behavior is crucial to developing targeted interventions to increase precaution compliance to control the spread of SARS-CoV-2. Acknowledgments. None. Financial support. No financial support was provided relevant to this article.
PLOS ONE, Nov 18, 2020
To identify factors associated with hospital admission and mortality within the first 30 days aft... more To identify factors associated with hospital admission and mortality within the first 30 days after enrolment in an outpatient parenteral antimicrobial therapy (OPAT) program, also analysing adequacy of the treatment regimen and clinical outcomes. This was a retrospective cohort study conducted between October 2016 and June 2017 in the state of São Paulo, Brazil. Variables related to hospital admission and mortality were subjected to bivariate analysis, and those with a P<0.05 were subjected to multivariate analysis as risk factors. We evaluated 276 patients, of whom 80.5% were �60 years of age and 69.9% had more than one comorbidity. Of the patients evaluated, 41.3% had pneumonia and 35.1% had a urinary tract infection. The most common etiological agent, isolated in 18 (31.6%) cases, was Klebsiella pneumoniae, and 13 (72,2%) strains were carbapenem resistant. The OPAT was in accordance with the culture results in 76.6% of the cases and with the institutional protocols in 76.4%. The majority (64.5%) of the patients were not admitted, and a cure or clinical improvement was achieved in 78.6%. Multivariate analysis showed that, within the first 30 days after enrolment, the absence of a physician office visit was a predictor of hospital admission (P<0.001) and mortality (P = 0.006).
Regional Studies, 2021
Despite the positive contributions of several European Union (EU) policies to reduce border barri... more Despite the positive contributions of several European Union (EU) policies to reduce border barriers, the EU Cross-Border Review (CBR) initiative reaffirmed their relevance and persistence. Since 2018, the EU has supported the b-solutions initiative, specifically focused on tackling legal and administrative border obstacles, aiming to highlight replicable solutions which can contribute to reducing these obstacles. This article critically assesses the b-solutions and its contribution to reducing administrative and legal border obstacles, with an eye to promoting a more integrated European territory. It concluded that the b-solutions is a valid, yet insufficient initiative to provide replicable solutions to mitigate cross-border barriers.
PLOS ONE, Jul 4, 2013
Background: Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mor... more Background: Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (#16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project). Results: In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (#16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem. In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.
Revista Paulista De Pediatria, 2020
Revista Brasileira de Medicina do Trabalho, 2023
The decline in serum antibodies against SARS-CoV-2 observed in several studies raises questions a... more The decline in serum antibodies against SARS-CoV-2 observed in several studies raises questions about long-term immunity. Lower antibody levels are associated with new cases of COVID-19 even after vaccination, leading to the administration of booster doses. Objective: To evaluate the post vaccination immune humoral response and the relationship between post-vaccination seropositivity rates and demographic data among Healthcare Workers over 6 months after CoronaVac immunization. Methods: A cross section study including Healthcare professionals vaccinated with two doses of CoronaVac after six months or more. The study was carried with the analysis of post-vaccination serological test to assess the levels of humoral response (anti-RBD IgG) after vaccination. Results: In this study, 325 participants were included, 76% were female and the median age was 42 years (20-85; IQR 31-53). Overall, 18.8% (61) of the participants results were seropositive for anti -RDB IgG; 81.2% did not present sufficient quantitative titles. The IgG titers obtained for female HCWs were not different from those obtained for the male participants with a seropositivity, regardless of age. Conclusions: It was possible to identify a group with positive quantitative titles in serological test for IgG antibody against the SARS-CoV-2. Further investigation is required to determine the durability of post-vaccination antibodies and how serological tests can be determine the ideal timing of vaccine booster doses.
PLOS ONE, May 25, 2021
Background COVID-19 is a multisystemic disorder that frequently causes acute kidney injury (AKI).... more Background COVID-19 is a multisystemic disorder that frequently causes acute kidney injury (AKI). However, the precise clinical and biochemical variables associated with AKI progression in patients with severe COVID-19 remain unclear. Methods We performed a retrospective study on 278 hospitalized patients who were admitted to the ward and intensive care unit (ICU) with COVID-19 between March 2020
Antimicrobial Stewardship & Healthcare Epidemiology
Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LM... more Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Design: Prospective cohort study. Setting: This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. Participants: The study included patients admitted to ICUs across 24 years. Results: In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.16–1.28; P < .0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07–1.08; P < .0001); mechanical ventilation (MV) utilization ratio (a...
Clinical Infectious Diseases, 2019
Background Carbapenemase-producing Klebsiella pneumoniae has become a global priority, not least ... more Background Carbapenemase-producing Klebsiella pneumoniae has become a global priority, not least in low- and middle-income countries. Here, we report the emergence and clinical impact of a novel Klebsiella pneumoniae carbapenemase–producing K. pneumoniae (KPC-KP) sequence type (ST) 16 clone in a clonal complex (CC) 258–endemic setting. Methods In a teaching Brazilian hospital, a retrospective cohort of adult KPC-KP bloodstream infection (BSI) cases (January 2014 to December 2016) was established to study the molecular epidemiology and its impact on outcome (30-day all-cause mortality). KPC-KP isolates underwent multilocus sequence typing. Survival analysis between ST/CC groups and risk factors for fatal outcome (logistic regression) were evaluated. Representative isolates underwent whole-genome sequencing and had their virulence tested in a Galleria larvae model. Results One hundred sixty-five unique KPC-KP BSI cases were identified. CC258 was predominant (66%), followed by ST16 (12...
mSphere, 2020
In many parts of the world, carbapenem resistance is a serious public health concern. In Brazil, ... more In many parts of the world, carbapenem resistance is a serious public health concern. In Brazil, carbapenem resistance in Enterobacterales is mostly driven by the dissemination of KPC-2-producing K. pneumoniae clones. Despite being endemic in this country, only a few reports providing both clinical and genomic data are available in Brazil, which limit the understanding of the real clinical impact caused by the dissemination of different clones carrying bla KPC-2 in Brazilian hospitals. Although several of these KPC-2-producer K. pneumoniae isolates belong to the clonal complex 258 and carry Tn 4401 transposons located on large plasmids, a concomitant emergence and silent dissemination of small high-copy-number bla KPC-2 plasmids are of importance, as described in this study. Our data identify a small high-copy-number IncQ1 KPC plasmid, its clinical relevance, and the potential for conjugative transfer into several K. pneumoniae isolates, belonging to different international lineages...
Journal of Epidemiology and Global Health
Background The International Nosocomial Infection Control Consortium (INICC) has found a high ICU... more Background The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. Methods A prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression. Results Between 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06–1.30; p < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15–1.56; p < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01–1.02; p < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03;...
Infection Control & Hospital Epidemiology, 2021
may have occurred if they sought testing outside our healthcare system. Healthcare facilities con... more may have occurred if they sought testing outside our healthcare system. Healthcare facilities continue to experience challenges with medical supply chains. N95 respirators should be prioritized for HCWs involved in AGPs on patients with proven or suspected COVID-19. Shifting ambulatory testing to outdoor areas and parking garages allows for natural airflow and ventilation, decreases indoor crowding, and thus can decrease the risk of viral transmission to individuals, including HCWs. 4 To preserve PPE supplies while balancing HCW safety, regulatory bodies should allow healthcare facilities to determine the appropriate PPE for their employees, based on HCW-focused risk assessments, overall community disease prevalence, patient testing location (indoors versus outdoors), and length of anticipated close contact. Our experience demonstrates that NP and OP specimen collection can be safely performed without use of N95 respirators as part of HCW PPE. Acknowledgments. The authors would like to thank Debbie Lamberger, Melissa Preciso-Temple, and Andrew Christenson for their assistance with the preparation of this manuscript. Financial support. No financial support was provided relevant to this article.
ABSTRACTBackgroundHealth Care workers (HCW) are an important group affected by this pandemic and ... more ABSTRACTBackgroundHealth Care workers (HCW) are an important group affected by this pandemic and COVID-19 has presented substantial challenges for health professionals and health systems in many countries. The Brazilian vaccination plan implemented in October, so that third dose for HCW. However, the persistence of CoronaVac vaccine-induced immunity is unknown, and immunogenicity according to age cohorts may differ among individuals.ObjectiveEvaluate the post vaccination immune humoral response and the relationship between post-vaccination seropositivity rates and demographic data among Healthcare Workers over 6 months after CoronaVac immunization.MethodsA cross section study including Healthcare professionals vaccinated with CoronaVac for 6 months or more. The study was carried with the analysis of post-vaccination serological test to assess the levels of humoral response after vaccination.Results329 participants were included. Among them, 76% were female. Overall, 18.5% were posit...
Revista de Saúde Pública, 2021
This study aimed to verify socio-demographic and baseline clinical factors associated with death ... more This study aimed to verify socio-demographic and baseline clinical factors associated with death in a hospital cohort of patients with COVID-19. A retrospective cohort study was conducted between February and December 2020 in a university hospital in the city of São Paulo, using Hospital Epidemiology Center data. RT-PCR-positive patients were selected to compose the sample (n = 1,034). At the end of the study, 362 (32%) patients died. In this cohort, age equal to or greater than sixty years (HR = 1.49) and liver disease (HR = 1.81) were independent risk factors for death from COVID-19 associated with higher in-hospital mortality.
Brazilian Journal of Cardiovascular Surgery, 2021
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Papers by Eduardo Medeiros