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Article ; Online: Colistin versus polymyxin B for the treatment of carbapenem-resistant Klebsiella pneumoniae bloodstream infections.

Vieceli, Tarsila / Henrique, Lilian Rodrigues / Rech, Tatiana Helena / Zavascki, Alexandre Prehn

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy

2024

Abstract: Background: To assess the effectiveness of colistin (administered as colistimethate sodium-CMS) and polymyxin B (PMB) for the treatment of bloodstream infections (BSIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP).: Materials and ... ...

Abstract	Background: To assess the effectiveness of colistin (administered as colistimethate sodium-CMS) and polymyxin B (PMB) for the treatment of bloodstream infections (BSIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). Materials and methods: This retrospective cohort included hospitalized adult patients with CRKP BSIs from a single tertiary-care hospital. A univariate analysis comparing CMS and PMB groups was carried out and an inverse-probability propensity score (IPPS) was created. An IPPS-adjusted Cox regression model for 30-day mortality was performed including covariates potentially associated with mortality. Results: A total of 100 patients with CRKP BSI (87 were KPC-producing isolates) were included. The 30-day mortality was 42.0 %:17/46 (38.8 %) and 25/54 (44.6 %) patients of CMS and PMB groups, respectively, P = 0.54 (incidence rate, 18.9 and 21.7/1000 patients-day in CMS and PMB groups, respectively, P = 0.62). No statistically significant difference in 30-day mortality rate was observed in a model adjusted for Pitt bacteremia score, high-risk primary site and IPPS, which included age, intensive care unit admission, minimal inhibitory concentration, previous colonization by CRKP, diabetes mellitus, malignancy, neutropenia, meropenem use before BSI, adjuvant therapy with meropenem and amikacin, and time to start polymyxin. Acute kidney injury (AKI) occurred in 52.0 % of patients, with no significant differences between groups (47.8 % and 57.4 % for CMS and PMB, respectively, P = 0.83). In-hospital mortality was 47,7 % and 50.0 % in CMS and PMB groups, respectively, P = 0.82. Conclusion: There was no difference in 30-day mortality and AKI rates among patients with CRKP BSI treated with PMB or CMS.
Language	English
Publishing date	2024-01-18
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1355399-9
ISSN	1437-7780 ; 1341-321X
ISSN (online)	1437-7780
ISSN	1341-321X
DOI	10.1016/j.jiac.2024.01.012
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Zs.A 5236: Show issues

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Article: Antimicrobial Stewardship on Patients with Neutropenia: A Narrative Review Commissioned by Microorganisms.

Alves, Joana / Abreu, Betânia / Palma, Pedro / Alp, Emine / Vieceli, Tarsila / Rello, Jordi

Microorganisms

2023 Volume 11, Issue 5

Abstract: The emergence of antibiotic resistance poses a global health threat. High-risk patients such as those with neutropenia are particularly vulnerable to opportunistic infections, sepsis, and multidrug-resistant infections, and clinical outcomes remain the ... ...

Abstract	The emergence of antibiotic resistance poses a global health threat. High-risk patients such as those with neutropenia are particularly vulnerable to opportunistic infections, sepsis, and multidrug-resistant infections, and clinical outcomes remain the primary concern. Antimicrobial stewardship (AMS) programs should mainly focus on optimizing antibiotic use, decreasing adverse effects, and improving patient outcomes. There is a limited number of published studies assessing the impact of AMS programs on patients with neutropenia, where early appropriate antibiotic choice can be the difference between life and death. This narrative review updates the current advances in strategies of AMS for bacterial infections among high-risk patients with neutropenia. Diagnosis, drug, dose, duration, and de-escalation (5D) are the core variables among AMS strategies. Altered volumes of distribution can make standard dose regimens inadequate, and developing skills towards a personalized approach represents a major advance in therapy. Intensivists should partner antibiotic stewardship programs to improve patient care. Assembling multidisciplinary teams with trained and dedicated professionals for AMS is a priority.
Language	English
Publishing date	2023-04-26
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2720891-6
ISSN	2076-2607
ISSN	2076-2607
DOI	10.3390/microorganisms11051127
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Article ; Online: Ventilator-associated events: From surveillance to optimizing management.

Ramirez-Estrada, Sergio / Peña-Lopez, Yolanda / Vieceli, Tarsila / Rello, Jordi

Journal of intensive medicine

2022 Volume 3, Issue 3, Page(s) 204–211

Abstract: Mechanical ventilation (MV) is a life-support therapy that may predispose to morbid and lethal complications, with ventilator-associated pneumonia (VAP) being the most prevalent. In 2013, the Center for Disease Control (CDC) defined criteria for ... ...

Abstract	Mechanical ventilation (MV) is a life-support therapy that may predispose to morbid and lethal complications, with ventilator-associated pneumonia (VAP) being the most prevalent. In 2013, the Center for Disease Control (CDC) defined criteria for ventilator-associated events (VAE). Ten years later, a growing number of studies assessing or validating its clinical applicability and the potential benefits of its inclusion have been published. Surveillance with VAE criteria is retrospective and the focus is often on a subset of patients with higher than lower severity. To date, it is estimated that around 30% of ventilated patients in the intensive care unit (ICU) develop VAE. While surveillance enhances the detection of infectious and non-infectious MV-related complications that are severe enough to impact the patient's outcomes, there are still many gaps in its classification and management. In this review, we provide an update by discussing VAE etiologies, epidemiology, and classification. Preventive strategies on optimizing ventilation, sedative and neuromuscular blockade therapy, and restrictive fluid management are warranted. An ideal VAE bundle is likely to minimize the period of intubation. We believe that it is time to progress from just surveillance to clinical care. Therefore, with this review, we have aimed to provide a roadmap for future research on the subject.
Language	English
Publishing date	2022-11-12
Publishing country	China
Document type	Journal Article ; Review
ISSN	2667-100X
ISSN (online)	2667-100X
DOI	10.1016/j.jointm.2022.09.004
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Article ; Online: Early detection of the SARS-CoV-2 P.1 variant in Rio Grande do Sul, Brazil: a case report.

Volpato, Fabiana Caroline Zempulski / Wink, Priscila Lamb / Monteiro, Francielle Liz / Willig, Julia Biz / Vieceli, Tarsila / Martins, Andreza Francisco / Zavascki, Alexandre Prehn / Barth, Afonso Luís

Infection control and hospital epidemiology

2021 , Page(s) 1–2

Language	English
Publishing date	2021-08-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	639378-0
ISSN	1559-6834 ; 0195-9417 ; 0899-823X
ISSN (online)	1559-6834
ISSN	0195-9417 ; 0899-823X
DOI	10.1017/ice.2021.387
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Zs.A 1714: Show issues

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Article ; Online: Prediction of all-cause and cardiovascular mortality using central hemodynamic indices among elderly people: systematic review and meta-analysis.

Vieceli, Tarsila / Brambilla, Bárbara / Pereira, Raphael Quintana / Dellamea, Bruno Schmidt / Stein, Airton Tetelbom / Grezzana, Guilherme Brasil

Sao Paulo medical journal = Revista paulista de medicina

2021 Volume 139, Issue 2, Page(s) 123–126

Abstract: Background: Despite widespread usage of central blood pressure assessment its predictive value among elderly people remains unclear.: Objective: To ascertain the capacity of central hemodynamic indices for predicting future all-cause and ... ...

Abstract	Background: Despite widespread usage of central blood pressure assessment its predictive value among elderly people remains unclear. Objective: To ascertain the capacity of central hemodynamic indices for predicting future all-cause and cardiovascular hard outcomes among elderly people. Design and setting: Systematic review and meta-analysis developed at the Del Cuore cardiology clinic, in Antonio Prado, Rio Grande do Sul, Brazil. Methods: 312 full-text articles were analyzed, from which 35 studies were included for systematic review. The studies included needed to report at least one central hemodynamic index among patients aged 60 years or over. Results: For all-cause mortality, aortic pulse wave velocity (aPWV) and central systolic blood pressure (SBP) were significant, respectively with standardized mean difference (SMD) 0.85 (95% confidence interval, CI 0.69-1.01; I2 96%; P < 0.001); and SMD 0.27 (95% CI 0.15-0.39; I2 77%; P 0.012). For cardiovascular mortality brachial-ankle PWV (baPWV), central SBP and carotid-femoral PWV (cfPWV) were significant, respectively SMD 0.67 (95% CI 0.40-0.93; I2 0%; P 0.610); SMD 0.65 (95% CI 0.48- 0.82; I2 80%; P 0.023); and SMD 0.51 (95% CI 0.32-0.69; I2 85%; P 0.010). Conclusions: The meta-analysis results showed that aPWV was promising for predicting all-cause mortality, while baPWV and central SBP demonstrated consistent results in evaluating cardiovascular mortality outcomes. Thus, the findings support usage of central blood pressure as a risk predictor for hard outcomes among elderly people. Registration number in prospero: RD42018085264.
MeSH term(s)	Aged ; Blood Pressure ; Brachial Artery ; Brazil/epidemiology ; Cardiovascular Diseases ; Humans ; Middle Aged ; Pulse Wave Analysis
Language	English
Publishing date	2021-03-18
Publishing country	Brazil
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1203171-9
ISSN	1806-9460 ; 1516-3180 ; 0035-0362
ISSN (online)	1806-9460
ISSN	1516-3180 ; 0035-0362
DOI	10.1590/1516-3180.2020.0364.R1.0412020
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Zs.B 184: Show issues

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Article ; Online: Impact of air pollution on respiratory microbiome: A narrative review.

Vieceli, Tarsila / Tejada, Sofia / Martinez-Reviejo, Raquel / Pumarola, Tomas / Schrenzel, Jacques / Waterer, Grant W / Rello, Jordi

Intensive & critical care nursing

2022 Volume 74, Page(s) 103336

Abstract: Background: Respiratory microbiome composition depends on an intricate balance between host characteristics, diet, and environmental factors. Some studies indicate a bidirectional relationship between respiratory microbiota and disease. Air pollution is ...

Abstract	Background: Respiratory microbiome composition depends on an intricate balance between host characteristics, diet, and environmental factors. Some studies indicate a bidirectional relationship between respiratory microbiota and disease. Air pollution is consistently associated with increased respiratory morbidity and mortality in different populations and across different ages. The aim of this review was to report a summary of the evidence regarding the impact of air pollution on the upper and lower respiratory tract microbiome. Methods: A literature search from interaction between air pollution and respiratory microbiome was performed (2010-2022). Results: Sixteen studies demonstrated changes in microbiome with both environmental and household air pollution. Increasing levels of air pollutants are associated with lower relative abundance of Corynebacterium and increasing levels of pathogen colonization, such as Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Pseudomonas aeruginosa and Acinetobacter baumannii, altering the incidence and clinical course of respiratory infections. This ultimately leads to an excess of morbidity and mortality due to antimicrobial resistance. Conclusion: Changes of air pollution on the respiratory microbiome may influence respiratory infections in critical care. Use of probiotics may restore the diversity of baseline microbiome, preventing infections by resistant organisms in the critical care setting. Using protective equipment decreased the effect of air pollutants on increasing potentially pathogenic microorganisms.
MeSH term(s)	Humans ; Air Pollution/adverse effects ; Respiratory Tract Infections/microbiology ; Air Pollutants ; Microbiota
Chemical Substances	Air Pollutants
Language	English
Publishing date	2022-10-28
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	1105892-4
ISSN	1532-4036 ; 0964-3397
ISSN (online)	1532-4036
ISSN	0964-3397
DOI	10.1016/j.iccn.2022.103336
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Zs.B 2818: Show issues

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Article ; Online: Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis.

Martinez-Reviejo, Raquel / Tejada, Sofia / Jansson, Miia / Ruiz-Spinelli, Alfonsina / Ramirez-Estrada, Sergio / Ege, Duygu / Vieceli, Tarsila / Maertens, Bert / Blot, Stijn / Rello, Jordi

Journal of intensive medicine

2023 Volume 3, Issue 4, Page(s) 352–364

Abstract: Background: Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP.: Methods: A systematic review and meta- ...

Abstract	Background: Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP. Methods: A systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780. Results: Thirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation ( Conclusions: The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.
Language	English
Publishing date	2023-06-14
Publishing country	China
Document type	Journal Article
ISSN	2667-100X
ISSN (online)	2667-100X
DOI	10.1016/j.jointm.2023.04.004
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Article: Metastatic adult neuroblastoma with spontaneous tumor lysis syndrome.

Vieceli, Tarsila / Tavares, Ana Laura Jardim / de Moraes, Renata Pibernat / Faulhaber, Gustavo Adolpho Moreira

Autopsy & case reports

2020 Volume 10, Issue 4, Page(s) e2020181

Abstract: Neuroblastoma (NB) is a solid tumor of the sympathetic nervous system, most commonly found in childhood, standing for 7% of all pediatric malignancies. The incidence in adults is markedly smaller: 1 case per 10 million adults per year. We report the case ...

Abstract	Neuroblastoma (NB) is a solid tumor of the sympathetic nervous system, most commonly found in childhood, standing for 7% of all pediatric malignancies. The incidence in adults is markedly smaller: 1 case per 10 million adults per year. We report the case of a previously healthy 27-year-old woman who started with lumbar pain, asthenia, and abdominal distension over the last month. A chest and abdomen tomography scan showed a huge mass in the upper left hemithorax and marked hepatomegaly. The diagnosis was confirmed by hepatic and lung biopsies. On day 4, after admission, the patient started chemotherapy. On the following days, she had severe vaginal bleeding, epistaxis, worsening of the hepatic function markers, refractory shock, and multiple organ dysfunction. She died on the twelfth day of admission. We also present a review of adult cases of NB reported in the past 5 years.
Language	English
Publishing date	2020-09-02
Publishing country	Brazil
Document type	Case Reports
ZDB-ID	2815488-5
ISSN	2236-1960
ISSN	2236-1960
DOI	10.4322/acr.2020.181
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Article ; Online: Evaluation of clinical and microbiological factors related to mortality in patients with Gram-negative bacterial infections treated with ceftazidime-avibactam: A prospective multicentric cohort study.

Arns, Beatriz / Sorio, Guilherme Geraldo Lovato / Vieceli, Tarsila / Pereira, Dariane / Celestino de Souza, Ândrea / Lamb Wink, Priscila / Paes, Julia Hoefel / David, Leonardo / Barboza, Fernanda / Hickmann, Stella / Alves, Gustavo / Santos, Antônio Cândido / da Rosa, Anelise / Duarte Alves, Marcelle / Massotti Magagnin, Cibele / Gomes, Eduardo / Zavascki, Alexandre Prehn / Rigatto, Maria Helena

Journal of global antimicrobial resistance

2024 Volume 36, Page(s) 393–398

Abstract: Objectives: This study aimed to evaluate the clinical and microbiological risk factors associated with mortality in patients treated with ceftazidime-avibactam for carbapenem-resistant Gram-negative bacterial infections.: Methods: This multicentric ... ...

Abstract	Objectives: This study aimed to evaluate the clinical and microbiological risk factors associated with mortality in patients treated with ceftazidime-avibactam for carbapenem-resistant Gram-negative bacterial infections. Methods: This multicentric prospective cohort study included hospitalized adult patients with a microbiologically confirmed infection treated with ceftazidime-avibactam for ≥48 hours. The clinical and microbiological risk factors for 30-day mortality were evaluated using a Cox regression model. Results: Of the 193 patients evaluated from the five tertiary hospitals, 127 were included in the study. Thirty-five patients (27.6%) died within 30 days. Infections with AmpC beta-lactamase-carrying bacteria were independently related to 30-day mortality (adjusted hazard ratio [aHR] 2.49, 95% confidence interval [CI] 1.28-4.84, P < 0.01) after adjusting for time from infection to antimicrobial prescription (P = 0.04). Further, these bacterial infections were also related to higher in-hospital mortality (aHR 2.17, 95% CI 1.24-3.78, P < 0.01). Only one patient developed resistance to ceftazidime-avibactam during treatment. Conclusions: Treatment with ceftazidime-avibactam had worse clinical outcomes in patients with infections with bacteria with chromosomally encoded AmpC beta-lactamase. However, these findings should be confirmed in future studies.
MeSH term(s)	Adult ; Humans ; Anti-Bacterial Agents/adverse effects ; Anti-Bacterial Agents/pharmacology ; Azabicyclo Compounds ; beta-Lactamase Inhibitors/adverse effects ; Ceftazidime/adverse effects ; Drug Combinations ; Drug Resistance, Multiple, Bacterial ; Gram-Negative Bacterial Infections/drug therapy ; Prospective Studies
Chemical Substances	Anti-Bacterial Agents ; avibactam, ceftazidime drug combination ; Azabicyclo Compounds ; beta-Lactamase Inhibitors ; Ceftazidime (9M416Z9QNR) ; Drug Combinations
Language	English
Publishing date	2024-02-09
Publishing country	Netherlands
Document type	Multicenter Study ; Journal Article
ZDB-ID	2710046-7
ISSN	2213-7173 ; 2213-7173
ISSN (online)	2213-7173
ISSN	2213-7173
DOI	10.1016/j.jgar.2024.02.001
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Article ; Online: Organizing pneumonia: A late phase complication of COVID-19 responding dramatically to corticosteroids.

de Oliveira Filho, Cilomar Martins / Vieceli, Tarsila / de Fraga Bassotto, Caroline / da Rosa Barbato, João Pedro / Garcia, Tiago Severo / Scheffel, Rafael Selbach

The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases

2021 Volume 25, Issue 1, Page(s) 101541

Abstract: Organizing pneumonia emerges as a late phase complication of COVID-19. Corticosteroids are standard therapy for organizing pneumonia, but the question of whether an approach with high dose corticosteroids would be beneficial for patients with organizing ... ...

Abstract	Organizing pneumonia emerges as a late phase complication of COVID-19. Corticosteroids are standard therapy for organizing pneumonia, but the question of whether an approach with high dose corticosteroids would be beneficial for patients with organizing pneumonia secondary to COVID-19 remains to be answered. Herein we report a series of three patients, one male and two females, mean age 58.3 years old, admitted for COVID-19 with severe pulmonary disease requiring ventilatory support. The patients underwent chest computed tomography scans due to maintained hypoxemia, which showed a pattern compatible with organizing pneumonia. The patients were treated with a high dose of corticosteroids (prednisone 1 mg/kg PO), showing marked clinical improvement, and decreasing oxygen flow ratio demand. They were discharged after a mean period of 6.3 days of hospitalization. Our report suggests that patients with COVID-19 with organizing pneumonia might benefit from high dose corticosteroids as an adjuvant therapy.
MeSH term(s)	Adrenal Cortex Hormones/adverse effects ; COVID-19 ; Female ; Humans ; Lung ; Male ; Middle Aged ; Pneumonia/drug therapy ; SARS-CoV-2
Chemical Substances	Adrenal Cortex Hormones
Language	English
Publishing date	2021-02-06
Publishing country	Brazil
Document type	Case Reports
ZDB-ID	2041400-6
ISSN	1678-4391 ; 1413-8670
ISSN (online)	1678-4391
ISSN	1413-8670
DOI	10.1016/j.bjid.2021.101541
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