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Risk factors for gram-negative bacterial hospital infection in liver transplantation

Grant number: 10/02267-6
Support type:Regular Research Grants
Duration: May 01, 2010 - October 31, 2012
Field of knowledge:Health Sciences - Medicine
Principal Investigator:Edson Abdala
Grantee:Edson Abdala
Home Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

The infections in patients submitted to solid organ transplant are an important cause of morbidly and have a huge impact in survival. These infections can didactically been divided in three periods, in which the incidences of the different microorganism vary, as well as ambient, state of immunosuppression and expositions: first, second and third period. The majority of infections that occur in the first period are related to health care assistance (IRHA). The liver transplantation patients are particularly susceptible to these infections when compared with others organ transplant, and they have higher frequency of multi-drug resistance bacteria (MDR), in HCFMUSP particularly there is a high prevalence of Gram-negative bacteria MDR. The goal of this study is to identify risk factors for IRHA for Gram-negative bacteria in liver transplant patients in the first two months. The secondary goals are: identify risk factors for MDR Gram-negative bacteria in liver transplant patients; identify risk factor for colonization by Gram-negative bacteria in this population and analyze the impact on survival related to these infections. The consecutive liver transplantation performed in adult patients on HC/FMUSP in the period of April 2010 to April 2012 will be evaluated. Exclusion criteria will be: deaths with less than 48 hours and, patients who need a second transplant with less than 48 hours, the first transplant will be excluded. Weekly microbiological monitoring will be performed. The microbiological surveillance will start on first day after liver transplantation and will continue during the hospital stay or 30 days after transplant. Cultures will be collected from oropharynx (or tracheal aspirate), rectal and axillary sites through swab. The surveillance culture samples will be directed conduct to laboratory research LIM 54, where will be cultivated in selective media for following bacteria: A. Baumannii carbapenemic resistant, P. aeruginosa carbapenemic resistant, extended-spectrum betalactamase-producing K. pneumoniae and E. coli, E. aerogenes third generation cephalosporin resistant. The clinical samples will be processed in routine laboratory; cultures from blood, pulmonary samples, surgical site secretion and ascitic fluid which isolated A. baumanni, P. aeruginosa, E. coli, K. pneumoniae and E. aerogenes will be identified by researcher and conduct to LIM 54 for storage and later comparison with strains isolated in surveillance cultures through pulsed field eletrophoresis.The variables related to donor, recipient and transplant surgical procedure will be prospective collected by the researcher. The statistics analysis will be performed for dichotomy variable qui-square test or Fisher test; for continuos variables Man-Whitney test. Multivaried analysis will be carried through by stepwise logistic regression. Survival analysis will be made by Kaplan-Meyer and multivaried analysis by Cox regression. The significance level considered will be p= 0.05. (AU)

Articles published in Agência FAPESP Newsletter about the research grant
Brazilian doctors request revision of criteria for liver transplant 

Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
FREIRE, MARISTELA PINHEIRO; OSHIRO, ISABEL C. V. S.; PIERROTTI, LIGIA C.; BONAZZI, PATRICIA R.; DE OLIVEIRA, LARISSA M.; SONG, ALICE T. W.; CAMARGO, CARLOS H.; VAN DER HEIJDEN, INNEKE M.; ROSSI, FLAVIA; COSTA, SILVIA F.; D'ALBUQUERQUE, LUIZ A. C.; ABDALA, EDSON. Carbapenem-Resistant Enterobacteriaceae Acquired Before Liver Transplantation: Impact on Recipient Outcomes. TRANSPLANTATION, v. 101, n. 4, p. 811-820, APR 2017. Web of Science Citations: 13.
FREIRE, MARISTELA PINHEIRO; VILLELA SOARES OSHIRO, ISABEL CRISTINA; BONAZZI, PATRICIA RODRIGUES; PIERROTTI, LIGIA CAMERA; DE OLIVEIRA, LARISSA MARQUES; MACHADO, ANNA SILVA; VAN DER HEIJDENN, INNEKE MARIE; ROSSI, FLAVIA; COSTA, SILVIA FIGUEIREDO; CARNEIRO D'ALBUQUERQUE, LUIZ AUGUSTO; ABDALA, EDSON. Surveillance culture for multidrug-resistant gram-negative bacteria: Performance in liver transplant recipients. AMERICAN JOURNAL OF INFECTION CONTROL, v. 45, n. 3, p. E40-E44, MAR 1 2017. Web of Science Citations: 5.
FREIRE, MARISTELA PINHEIRO; PIERROTTI, LIGIA CAMERA; VILLELA SOARES OSHIRO, ISABEL CRISTINA; BONAZZI, PATRICIA RODRIGUES; DE OLIVEIRA, LARISSA MARQUES; MACHADO, ANNA SILVA; VAN DER HEIJDEN, INNEKE MARIE; ROSSI, FLAVIA; COSTA, SILVIA FIGUEIREDO; CARNEIRO D'ALBUQUERQUE, LUIZ AUGUSTO; ABDALA, EDSON. Carbapenem-Resistant Acinetobacter baumannii Acquired Before Liver Transplantation: Impact on Recipient Outcomes. LIVER TRANSPLANTATION, v. 22, n. 5, p. 615-626, MAY 2016. Web of Science Citations: 7.

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