Publications by authors named "Carlos Magno Castelo Branco Fortaleza"

67 Publications

Seasonality and weather dependance of Acinetobacter baumannii complex bloodstream infections in different climates in Brazil.

PLoS One 2021 19;16(8):e0255593. Epub 2021 Aug 19.

Department of Infectious Diseases, Botucatu School of Medicine, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil.

Recent studies report seasonality in healthcare-associated infections, especially those caused by Acinetobacter baumannii complex. We conducted an ecologic study aimed at analyzing the impact of seasons, weather parameters and climate control on the incidence and carbapenem-resistance in A. baumannii complex bloodstream infections (ABBSI) in hospitals from regions with different climates in Brazil. We studied monthly incidence rates (years 2006-2015) of ABBSI from hospitals in cities from different macro-regions in Brazil: Fortaleza (Ceará State, Northeast region), Goiânia (Goiás State, Middle-west) and Botucatu (São Paulo State, Southeast). Box-Jenkins models were fitted to assess seasonality, and the impact of weather parameters was analyzed in Poisson Regression models. Separate analyses were performed for carbapenem-resistant versus carbapenem-susceptible isolates, as well as for infections occurring in climate-controlled intensive care units (ICUs) versus non-climate-controlled wards. Seasonality was identified for ABSSI ICUs in the Hospitals from Botucatu and Goiânia. In the Botucatu hospital, where there was overall seasonality for both resistance groups, as well as for wards without climate control. In that hospital, the overall incidence was associated with higher temperature (incidence rate ratio for each Celsius degree, 1.05; 95% Confidence Interval, 1.01-1.09; P = 0.006). Weather parameters were not associated with ABBSI in the hospitals from Goiânia and Fortaleza. In conclusion, seasonality was found in the hospitals with higher ABBSI incidence and located in regions with greater thermal amplitude. Strict temperature control may be a tool for prevention of A. baumanii infections in healthcare settings.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255593PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376013PMC
August 2021

Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas Disease.

PLoS Negl Trop Dis 2021 Aug 13;15(8):e0009680. Epub 2021 Aug 13.

Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (UNESP), City of Botucatu, Brazil.

American trypanosomiasis (Chagas disease, CD) affects circa 7 million persons worldwide. While of those persons present the asymptomatic, indeterminate chronic form (ICF), many will eventually progress to cardiac or digestive disorders. We studied a nonconcurrent (retrospective) cohort of patients attending an outpatient CD clinic in Southeastern Brazil, who were admitted while presenting the ICF in the period from 1998 through 2018 and followed until 2019. The outcomes of interest were the progression to cardiac or digestive CD forms. We were also interested in analyzing the impact of Benznidazole therapy on the progression of the disease. Extensive review of medical charts and laboratory files was conducted, collecting data up to year 2019. Demographics (upon inclusion), body mass index, comorbidities (including the Charlson index) and use of Benznidazole were recorded. The outcomes were defined by abnormalities in those test that could not be attributed to other causes. Statistical analysis included univariate and multivariable Cox regression models. Among 379 subjects included in the study, 87 (22.9%) and 100 (26.4%) progressed to cardiac and digestive forms, respectively. In the final multivariable model, cardiac disorders were positively associated with previous coronary syndrome (Hazzard Ratio [HR], 2.42; 95% Confidence Interval [CI], 1.53-3.81) and negatively associated with Benznidazole therapy (HR, 0.26; 95%CI, 0.11-0.60). On the other hand, female gender was the only independent predictor of progression to digestive forms (HR, 1.56; 95%CI, 1.03-2.38). Our results point to the impact of comorbidities on progression do cardiac CD, with possible benefit of the use of Benznidazole.
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http://dx.doi.org/10.1371/journal.pntd.0009680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8386853PMC
August 2021

Impact of nonpharmaceutical strategies on trends of COVID-19 in São Paulo State.

Rev Saude Publica 2021 6;55:48. Epub 2021 Aug 6.

Universidade Estadual Paulista. Faculdade de Medicina de Botucatu. Departamento de Infectologia. Botucatu, SP, Brasil.

Interrupted time series analyses were conducted to measure the impact of social distancing policies (instituted on March 22, 2020) and of subsequent mandatory masking in the community (instituted on May 4, 2020) on the incidence and effective reproductive number of COVID-19 in São Paulo State, Brazil. Overall, the impact of social distancing both on incidence and Rt was greater than the incremental effect of mandatory masking. Those findings may reflect either a small impact of face masking or the loosening of social distancing after mandatory use of masks.
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http://dx.doi.org/10.11606/s1518-8787.2021055003599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317991PMC
August 2021

Automatic algorithm for quantifying lung involvement in patients with chronic obstructive pulmonary disease, infection with SARS-CoV-2, paracoccidioidomycosis and no lung disease patients.

PLoS One 2021 10;16(6):e0251783. Epub 2021 Jun 10.

Medical School, Sao Paulo State University Julio de Mesquita Filho, Botucatu, SP, Brazil.

In this work, we aimed to develop an automatic algorithm for the quantification of total volume and lung impairments in four different diseases. The quantification was completely automatic based upon high resolution computed tomography exams. The algorithm was capable of measuring volume and differentiating pulmonary involvement including inflammatory process and fibrosis, emphysema, and ground-glass opacities. The algorithm classifies the percentage of each pulmonary involvement when compared to the entire lung volume. Our algorithm was applied to four different patients groups: no lung disease patients, patients diagnosed with SARS-CoV-2, patients with chronic obstructive pulmonary disease, and patients with paracoccidioidomycosis. The quantification results were compared with a semi-automatic algorithm previously validated. Results confirmed that the automatic approach has a good agreement with the semi-automatic. Bland-Altman (B&A) demonstrated a low dispersion when comparing total lung volume, and also when comparing each lung impairment individually. Linear regression adjustment achieved an R value of 0.81 when comparing total lung volume between both methods. Our approach provides a reliable quantification process for physicians, thus impairments measurements contributes to support prognostic decisions in important lung diseases including the infection of SARS-CoV-2.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251783PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191897PMC
June 2021

Molecular characterization of methicillin-resistant Staphylococcus aureus among insulin-dependent diabetic individuals in Brazil.

Ann Clin Microbiol Antimicrob 2021 Feb 10;20(1):12. Epub 2021 Feb 10.

Departamento de Ciências Químicas e Biológicas, Instituto de Biociências de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil.

Background: People with diabetes mellitus, especially insulin-dependent diabetic patients, are a risk group for staphylococcal infections. Asymptomatic infection with Staphylococcus aureus is common and favors dissemination of the microorganism, rendering these individuals a source of infection. This study aimed to characterize the resistance profile, clonal profile and sequence type, as well as to analyze the prevalence and risk factors for nasal and oropharyngeal carriage of methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) isolated from insulin-dependent diabetic individuals in the city of Botucatu, SP, Brazil.

Methods: Staphylococcus aureus was collected from the nasopharynx and oropharynx of 312 community-dwelling insulin-dependent diabetic individuals over a period of 3 years (October 2015 to December 2018). The isolates were characterized by susceptibility profiling, detection of the mecA gene, SCCmec typing, and molecular typing by PFGE and MLST. The risk factors associated with S. aureus and MRSA carriage were determined by logistic regression analysis.

Results: The overall prevalence of colonization with S. aureus and MRSA was 30.4% and 4.8%, respectively. Fifteen of the 112 S. aureus isolates carried the mecA gene; SCCmec type IV was identified in 10 isolates, SCCmec type I in three, and SCCmec type II in two. Among the 15 resistant isolates (MRSA), four were susceptible to oxacillin/cefoxitin by the disc diffusion method and one MSSA isolate was resistant to sulfamethoxazole/trimethoprim. The analysis of risk factors revealed a protective effect of age and lung disease, while lower-extremity ulcers were a risk factor for S. aureus. For MRSA, only male gender was significantly associated as a risk factor in multivariate analysis. Clonal profile analysis demonstrated the formation of clusters among MRSA isolates from different patients, with the identification of ST5-IV, ST5-I, and ST8-IV. Isolates carrying ST398 were identified among MSSA and MRSA (ST398-IV).

Conclusion: Our findings reinforce the importance of epidemiological studies of S. aureus carriage, especially in populations at high risk of infections such as diabetics. The data suggest widespread dissemination of MRSA in the population of insulin-dependent diabetic patients studied, as well as the emergence of important lineages among these individuals.
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http://dx.doi.org/10.1186/s12941-020-00401-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876813PMC
February 2021

The use of health geography modeling to understand early dispersion of COVID-19 in São Paulo, Brazil.

PLoS One 2021 7;16(1):e0245051. Epub 2021 Jan 7.

Department of Geography, Faculty of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, São Paulo State, Brazil.

Public health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In São Paulo, the most populous state in Brazil (45 million inhabitants), most COVID-19 cases up to April 18th were reported in the Capital and metropolitan area. However, the inner municipalities, where 20 million people live, are also at risk. As governmental authorities discuss the loosening of measures for restricting population mobility, it is urgent to analyze the routes of dispersion of COVID-19 in São Paulo territory. We hypothesize that urban hierarchy is the main responsible for the disease spreading, and we identify the hotspots and the main routes of virus movement from the metropolis to the inner state. In this ecological study, we use geographic models of population mobility to check for patterns for the spread of SARS-CoV-2 infection. We identify two patterns based on surveillance data: one by contiguous diffusion from the capital metropolitan area, and the other hierarchical with long-distance spread through major highways that connects São Paulo city with cities of regional relevance. This knowledge can provide real-time responses to support public health strategies, optimizing the use of resources in order to minimize disease impact on population and economy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245051PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790416PMC
January 2021

Illicit drug users, alcoholics, and psychiatric patients: and methicillin-resistant colonization on the border between community and healthcare settings.

Infect Control Hosp Epidemiol 2020 Dec 2:1-3. Epub 2020 Dec 2.

Department of Tropical Diseases, Faculdade de Medicina de Botucatu (Botucatu School of Medicine), Universidade Estadual Paulista (São Paulo State University, UNESP). City of Botucatu, São Paulo State, Brazil.

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http://dx.doi.org/10.1017/ice.2020.1330DOI Listing
December 2020

Two hundred days of COVID-19 in São Paulo State, Brazil.

Epidemiol Infect 2020 12 2;148:e295. Epub 2020 Dec 2.

Clinical Hospital of Botucatu Medical School (HCFMB), Botucatu, Brazil.

Two hundred days after the first confirmed case of COVID-19 in Brazil, the epidemic has rapidly spread in metropolitan areas and advanced throughout the countryside. We followed the temporal epidemic pattern at São Paulo State, the most populous of the country, the first to have a confirmed case of COVID-19, and the one with the most significant number of cases until now. We analysed the number of new cases per day in each regional health department and calculated the effective reproduction number (Rt) over time. Social distance measures, along with improvement in testing and isolating positive cases, general population mask-wearing and standard health security protocols for essential and non-essential activities, were adopted and impacted on slowing down epidemic velocity but were insufficient to stop transmission.
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http://dx.doi.org/10.1017/S0950268820002927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750657PMC
December 2020

COVID-19: What we talk about when we talk about masks.

Rev Soc Bras Med Trop 2020 6;53:e20200527. Epub 2020 Nov 6.

Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Programa de Pós-graduação em doenças infecciosas, Botucatu, SP, Brasil.

Even though most current recommendations include the general use of masks to prevent community transmission of SARS-Cov-2, the effectiveness of this measure is still debated. The studies on this policy include physical filtering tests with inanimate microparticles, randomized clinical trials, observational studies, ecological analyses, and even computational modeling of epidemics. Much of the so-called evidence is inferred from studies on different respiratory viruses and epidemiological settings. Heterogeneity is a major factor limiting the generalization of inferences. In this article, we reviewed the empirical and rational bases of mask use and how to understand these recommendations compared to other policies of social distancing, restrictions on non-essential services, and lockdown. We conclude that recent studies suggest a synergistic effect of the use of masks and social distancing rather than opposing effects of the two recommendations. Developing social communication approaches that clarify the need to combine different strategies is a challenge for public health authorities.
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http://dx.doi.org/10.1590/0037-8682-0527-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670747PMC
November 2020

Evidence, rationality, and ignorance: Agnotological issues in COVID-19 science.

Rev Soc Bras Med Trop 2020 21;53:e20200475. Epub 2020 Sep 21.

Universidade Estadual Paulista, Faculdade de Medicina, Câmpus de Botucatu, Departamento de doenças infecciosas, Botucatu, SP, Brasil.

Two decades ago, Robert Proctor coined the term agnotology to refer to the study of ignorance that stems from scientific research. Amid the coronavirus disease pandemic, the world is witnessing the greatest natural experiment ever, and countries have adopted different response strategies. An evaluation of the effectiveness of different policies will play a valuable role in preparing for future public health emergencies. However, controversial issues such as the timing and pathways of viral emergence, the effectiveness of social distancing and lockdown strategies, and the use of antimalarial drugs as therapy have still not been fully resolved. This serves as a fertile breeding ground for agnotological strategies, whereby scientific studies are deliberately or unintentionally designed to create distractions or draw conclusions that are not supported by research findings. Researchers, public health authorities, and healthcare workers should be equipped to identify such agnotological strategies, distinguish them from scientific fraud, and avoid drawing misleading inferences based on an irrational adherence to hypotheses and a lack of criticism of implausible results.
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http://dx.doi.org/10.1590/0037-8682-0475-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508199PMC
September 2020

Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units.

Braz J Infect Dis 2020 Sep - Oct;24(5):373-379. Epub 2020 Sep 16.

Universidade do Estado de São Paulo(UNESP), Faculdade de Medicina de Botucatu, Department of Infectious Diseases, Botucatu, SP, Brazil.

Background: Infection control interventions can be erroneously interpreted if outcomes are assessed in short periods. Also, statistical methods usually applied to compare outcomes before and after interventions are not appropriate for analyzing time series.

Aims: To analyze the impact of a bundle directed at reducing the incidence of ventilator-associated pneumonia (VAP) and other device-associated infections in two medical-surgical intensive care units (ICU) in Brazil.

Methods: Our study had a quasi-experimental design. Interrupted time series analyses (ITS) was performed assessing monthly rates of overall healthcare-associated infections (HCAI), VAP, laboratory-confirmed central line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI), from January 2007 through June 2019. Moreover, multivariate ITS was adjusted for seasonality in Poisson regression models. An intervention based on a bundle for VAP prevention was introduced in August 2010.

Findings: The intervention was followed by sustained reduction in overall HCAI, VAP and CLABSI in both ICU. Continuous post-intervention trends towards reduction were detected for overall HCAI and VAP.

Conclusion: Interventions aimed at preventing one specific site of infection may have sustained impact on other HCAI, which can be documented using time series analyses.
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http://dx.doi.org/10.1016/j.bjid.2020.08.004DOI Listing
November 2020

Increasing molecular diagnostic capacity and COVID-19 incidence in Brazil.

Epidemiol Infect 2020 08 18;148:e178. Epub 2020 Aug 18.

Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil.

Different countries have adopted strategies for the early detection of SARS-CoV-2 since the declaration of community transmission by the World Health Organization (WHO) and timely diagnosis has been considered one of the major obstacles for surveillance and healthcare. Here, we report the increase of the number of laboratories to COVID-19 diagnosis in Brazil. Our results demonstrate an increase and decentralisation of certified laboratories, which does not match the much higher increase in the number of COVID-19 cases. Also, it becomes clear that laboratories are irregularly distributed over the country, with a concentration in the most developed state, São Paulo.
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http://dx.doi.org/10.1017/S0950268820001818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477464PMC
August 2020

Emergency science: Epistemological insights on the response to COVID-19 pandemics.

Infect Control Hosp Epidemiol 2021 01 11;42(1):120-121. Epub 2020 May 11.

Department of Infectious Diseases, Botucatu School of Medicine, São Paulo State University (UNESP). City of Botucatu, São Paulo Sate, Brazil.

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http://dx.doi.org/10.1017/ice.2020.209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237385PMC
January 2021

Performance of rK39-based immunochromatographic rapid diagnostic test for serodiagnosis of visceral leishmaniasis using whole blood, serum and oral fluid.

PLoS One 2020 2;15(4):e0230610. Epub 2020 Apr 2.

Laboratório de Soroepidemiologia e Imunobiologia, Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.

Background: The development of rK39-based immunochromatographic rapid diagnostic tests represents an important advance for serodiagnosis of visceral leishmaniasis, being cheap and easy to use at the point of care (POC). Although the use of rK39 have considerably improved the sensitivity and specificity of serological tests compared with total antigens, great variability in sensitivity and specificity was reported. This study aimed at the evaluation of "Kalazar Detect™ Rapid Test, Whole Blood" (Kalazar Detect RDT) for Visceral Leishmaniasis (VL) diagnosis using oral fluid, whole blood and serum specimens collected at different endemic areas of VL of Brazil.

Methodology: To evaluate Kalazar Detect RDT, oral fluid, whole blood and serum specimens from 128 VL patients, 85 healthy individuals, 22 patients with possible cross-reactivity diseases and 20 VL/aids coinfected patients were collected and assayed at the POC.

Principal Findings And Conclusions: The performance of Kalazar Detect RDT in whole blood and serum was similar; however, using oral fluid, the sensitivity was low. Particularly in samples from the city of Natal, Rio Grande do Norte state in Northeastern Brazil, we observed low sensitivity, 80.0% (95% CI: 62.7-90.5), using whole blood and serum, and poor sensitivity, 43.3% (95% CI: 27.4-60.8) with oral fluid. Those values were much lower than in the other regions, where sensitivity ranged from 92.7-96.3% in whole blood and serum, and 80.0-88.9% in oral fluid. Besides, in VL/aids coinfected patients, lower sensitivity was achieved compared with VL patients. In samples from Natal, the sensitivity was 0.0% (95% CI: 0.0-49.0) and 25.0% (95% CI: 4.6-69.9), using oral fluid and serum/whole blood, respectively; in samples from the other regions, the sensitivity ranged from 40.0-63.6% and 80.0-81.8%, respectively. As for specificity, high values were observed across the fluids, 100.0% (95% CI: 96.5-100.0) in whole blood, 96.3% (95% CI: 90.8-98.5) in serum, and 95.3% (95% CI: 89.5-98.0) in oral fluid; across localities, specificity ranged from 85.7-100.0%. Serum samples sent by the collaborating centers to Instituto de Medicina Tropical (n = 250) were tested by Kalazar Detect RDT, Direct Agglutination Test, Indirect immunofluorescence assay, Enzyme-linked immunosorbent assay, and IT-Leish® RDT. The regional difference in the performance of rK39-based RDT and lower sensitivity in Leishmania/HIV coinfected patients raise concern on the routine use of these products for the diagnosis of VL.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230610PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7117722PMC
July 2020

Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil.

Int J Infect Dis 2020 Jun 20;95:44-49. Epub 2020 Feb 20.

Postgraduate Program in Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil. Electronic address:

Objectives: Visceral leishmaniasis (VL) is a public health threat for several tropical countries, including Brazil. Therapy failures and relapses aggravate VL morbidity and mortality. Our study aimed at identifying predictors of relapse and thus contributes to directing therapeutic options and patient follow-up.

Methods: A nonconcurrent cohort of 571 subjects who completed successful therapy for VL in the city of Bauru, São Paulo State, Brazil, was followed for 24 months in order to identify the incidence and predictors of relapse. Extensive review of medical charts and laboratory files was conducted. Univariate and multivariable Cox regression models were used to identify predictors for the outcome of interest. A hierarchical strategy was used for variable selection in multivariable models.

Results: Relapses occurred in 6.8% of treated subjects, after a median of 6 months (interquartile range, 4-9). In a comprehensive multivariable model, relapse was associated with: HIV-coinfection (hazard ratio [HR], 7.47; 95% confidence interval [CI], 2.58-21.55); the presence of lower limb edema (HR, 6.06; 95%CI, 1.38-26.77) and low platelet count upon admission (HR for platelet count × 1000, 0.99; 95%CI, 0.98-0.99) ; and secondary pneumonia (HR, 5.49; 95%CI, 1.49-20.18). On the other hand, therapy with Liposomal Amphotericin (as opposed to Antimoniate) was not independently associated with relapse (HR, 5.97; 95%CI, 0.63-56.29).

Conclusion: Besides reinforcing the impact of HIV coinfection on the outcome of VL, our study points to clinical and laboratory findings that characterize patients who were more likely to relapse. Those groups should be more closely followed, and possibly could benefit from novel therapeutic options.
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http://dx.doi.org/10.1016/j.ijid.2020.02.028DOI Listing
June 2020

Drivers of press media response to healthcare-associated infections caused by multidrug-resistant organisms: A report from Brazil.

Infect Control Hosp Epidemiol 2020 03 3;41(3):372-373. Epub 2020 Feb 3.

Department of Tropical Diseases, Botucatu School of Medicine, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil.

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http://dx.doi.org/10.1017/ice.2020.17DOI Listing
March 2020

Temperature, humidity, and climate control in hospital units: A clue for understanding the seasonality of healthcare-associated pathogens.

Infect Control Hosp Epidemiol 2019 07 6;40(7):829-830. Epub 2019 May 6.

Department of Tropical Diseases,São Paulo State University (UNESP),Botucatu Medical School, Botucatu, São Paulo State,Brazil.

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http://dx.doi.org/10.1017/ice.2019.97DOI Listing
July 2019

Environmental conditions and health care-associated infections in wards for noncritical patients.

Am J Infect Control 2019 05 28;47(5):599-600. Epub 2019 Feb 28.

Department of Tropical Diseases São Paulo State University Botucatu Medical School Botucatu, São Paulo State, Brazil.

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http://dx.doi.org/10.1016/j.ajic.2019.01.003DOI Listing
May 2019

Surgical site infections and temperature in the operating theater-Challenges for infection control in developing countries.

Infect Control Hosp Epidemiol 2019 01 5;40(1):120-121. Epub 2018 Nov 5.

São Paulo State University (UNESP),Botucatu Medical School,City of Botucatu,São Paulo State,Brazil.

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http://dx.doi.org/10.1017/ice.2018.283DOI Listing
January 2019

Incidence and predictors of health care-associated infections among patients colonized with carbapenem-resistant Enterobacteriaceae.

Am J Infect Control 2019 02 29;47(2):213-216. Epub 2018 Sep 29.

Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil. Electronic address:

Colonization with carbapenem-resistant Enterobacteriaceae (CRE) precedes invasive infections. Neither the actual risk for the latter nor the route between the 2 stages is completely clear. We studied a retrospective cohort of patients hospitalized between 2013-2016 and colonized with CRE. The incidence of CRE health care-associated infections was 13.2%, and predictors were the presence of a urinary catheter and the use of carbapenems. Infection prevention strategies in CRE-colonized patients should focus on invasive devices and antimicrobial stewardship.
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http://dx.doi.org/10.1016/j.ajic.2018.08.007DOI Listing
February 2019

Impact of weather on the risk of surgical site infections in a tropical area.

Am J Infect Control 2019 01 24;47(1):92-94. Epub 2018 Sep 24.

Faculty of Agronomical Sciences, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil.

We studied the impact of average daily temperature and relative humidity on the risk of surgical site infections in 36,429 surgeries performed in a hospital in inner Brazil. Adjusted Poisson regression models found an association between surgical site infections and temperature (rate ratio [RR], 1.013; 95% confidence interval [CI], 1.001-1.025). The effect was concentrated on clean wound procedures and was greater over the 75th (RR, 1.109; 95% CI, 1.015-1.212) and 90th (RR, 1.196; 95% CI, 1.055-1.355) percentiles of daily temperature.
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http://dx.doi.org/10.1016/j.ajic.2018.07.013DOI Listing
January 2019

Post-discharge impact of healthcare-associated infections in a developing country: A cohort study.

Infect Control Hosp Epidemiol 2018 10 7;39(10):1274-1276. Epub 2018 Sep 7.

Department of Tropical Diseases,Botucatu Medical School,São Paulo State University (UNESP),City of Botucatu,São Paulo State,Brazil.

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http://dx.doi.org/10.1017/ice.2018.201DOI Listing
October 2018

Factors associated with community-onset multidrug-resistant organisms in inner Brazil.

Am J Infect Control 2018 12 23;46(12):1423-1424. Epub 2018 Aug 23.

Department of Tropical Diseases, Botucatu School of Medicine, São Paulo State University, Botucatu, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.ajic.2018.07.001DOI Listing
December 2018

Weather, climate control, and imipenem-resistance in Acinetobacter baumannii: an ecological approach.

Infect Control Hosp Epidemiol 2018 09 1;39(9):1133-1135. Epub 2018 Aug 1.

São Paulo State University (UNESP), Botucatu School of Medicine, City of Botucatu, São Paulo State, Brazil.

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http://dx.doi.org/10.1017/ice.2018.171DOI Listing
September 2018

Nasal colonization with methicillin-resistant Staphylococcus aureus among elderly living in nursing homes in Brazil: risk factors and molecular epidemiology.

Ann Clin Microbiol Antimicrob 2018 May 4;17(1):18. Epub 2018 May 4.

Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.

Background: Methicillin-resistant Staphylococcus aureus poses a threat to elderly living in nursing homes. Studies focusing on the epidemiology of colonization may help in the design of infection control strategies.

Objective: To identify factors associated with MRSA colonization and the dissemination of clones among nursing home residents.

Methods: Nasal swabs were collected from 300 persons from nine nursing homes in the city of Bauru, Brazil. Resistance to methicillin was identified through amplification of the mecA gene. Strain typing (Pulsed-Field Gel Electrophoresis) and characterization of the Staphylococcal Chromosome Cassette (SCC) mec was performed. Univariate and multivariable models were used to identify predictors of overall S. aureus and MRSA carriage.

Results: Rates of S. aureus and MRSA colonization were 17.7 and 3.7%, respectively. Age and recent admission to a hospital were independently associated with colonization with S. aureus. MRSA colonization was associated with living in small (< 15 residents) and medium-sized (15-49 residents) facilities, as well as with recent hospitalization. Most MRSA strains carried SCCmec types II or IV, and there was evidence of clonal spread within and among different facilities.

Conclusions: MRSA may be introduced in nursing homes form hospitals or arise from the community setting. Screening for asymptomatic colonization may identify persons with greater risk for infection, and is advised for residents discharged from acute care hospitals.
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http://dx.doi.org/10.1186/s12941-018-0271-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934845PMC
May 2018

Detection of the mecA gene and identification of Staphylococcus directly from blood culture bottles by multiplex polymerase chain reaction.

Braz J Infect Dis 2018 Mar - Apr;22(2):99-105. Epub 2018 Mar 13.

UNESP - Univ Estadual Paulista, Instituto de Biociências de Botucatu, Departamento de Microbiologia e Imunologia, Botucatu, SP, Brazil.

Introduction: Staphylococcus spp. - both S. aureus, including methicillin-resistant strains (MRSA) and coagulase negative staphylococci (CoNS) - are relevant agents of healthcare-associated infections. Therefore, the rapid recognition of MRSA and methicillin-resistant CoNS from blood stream infections is critically important for patient management. It is worth noting that inappropriate empiric therapy has been associated with higher in-hospital mortality.

Material And Methods: In this study we evaluated a multiplex polymerase chain reaction (multiplex PCR) standardized to detect Staphylococcus spp., S. aureus, and mecA gene-encoded oxacillin resistance directly from blood culture bottles. A total of 371 blood cultures with Gram-positive microorganisms confirmed by Gram-stain were analyzed. Results from multiplex PCR were compared to phenotypic characterization of isolates.

Results: Staphylococcus aureus was detected in 85 (23.0%) blood cultures and CoNS in 286 (77.0%). There was 100% agreement between phenotypic and multiplex PCR identification. Forty-three (50.6%) of the 85 S. aureus carried the mecA gene and among the 286 CoNS, 225 (78.7%) were positive for the mecA gene.

Conclusions: The multiplex PCR assay developed here was found to be sensitive, specific, rapid, and showed good agreement with the phenotypic results besides being less expensive. This PCR method could be used in clinical laboratories for rapid identification and initiation of specific and effective treatment, reducing patient mortality and morbidity. Furthermore, this method may reduce misuse of antimicrobial classes that are more expensive and toxic, thus contributing to the selection of antibiotic-resistant Staphylococcus spp.
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http://dx.doi.org/10.1016/j.bjid.2018.02.006DOI Listing
July 2018

Prevalence of and risk factors associated with the presence of Staphylococcus aureus in the chronic wounds of patients treated in primary health care settings in Brazil.

Rev Soc Bras Med Trop 2017 Nov-Dec;50(6):833-838

Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil.

Introduction: Wounds can be colonized by methicillin-resistant Staphylococcus aureus (MRSA).

Methods: We evaluated the prevalence of S. aureus and MRSA in the wounds of patients treated at Basic Health Units in Brazil and identified risk factors associated with their presence.

Results: The prevalence rates of S. aureus and MRSA were 51.5% and 8.7%, respectively. There was a correlation between the presence of S. aureus in wounds and nostrils (p<0.01). A positive association was detected between S. aureus infection and previous benzylpenicillin use (p=0.02). No associations were observed for MRSA.

Conclusions: Multidrug-resistant pathogens are present in primary healthcare settings in Brazil.
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http://dx.doi.org/10.1590/0037-8682-0205-2017DOI Listing
April 2018
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