Papers by Luis Bavestrello
Revista Chilena De Infectologia, 2003
World Journal of Emergency Surgery
Antibiotics are recognized widely for their benefits when used appropriately. However, they are o... more Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement o...
Revista Chilena De Infectologia, Apr 1, 2011
Journal of Infection Control, Nov 9, 2016
Introdução: O aumento da incidência de infecções por A. baumannii tem sido associado à disseminaç... more Introdução: O aumento da incidência de infecções por A. baumannii tem sido associado à disseminação global de alguns clones bem sucedidos associados à produção de oxacilinases, principalmente blaOXA-23. Para caracterizar e investigar a circulação destes clones de importância clínica se faz necessário o uso de técnicas de tipagem, como o MLST, que permitam comparar os dados provenientes de diferentes instituições. Além disso, MLST é considerado a técnica padrão-ouro para investigação de estruturas populacionais e de epidemiologia global de isolados bacterianos Objetivo: Avaliar a diversidade genética e distribuição clonal de isolados de A. baumannii através do MLST. Métodos: Foram selecionados 14 isolados de A. baumannnii resistentes aos carbapenêmicos obtidos entre 2007-2008 de cinco hospitais de Porto Alegre, previamente caracterizados em diferentes grupos clonais por PFGE. A identificação da espécie foi feita por PCR para o gene gyrB. Para a pesquisa de oxacilinases foi utilizada PCR multiplex (OXA-23, OXA-24, OXA-51, OXA-58 e OXA-143). O perfil de suscetibilidade ao imipenem, meropenem e polimixina B foi determinado por E-test® e microdiluição, respectivamente. A tipagem molecular foi realizada utilizando MLST (Instituto Pasteur) através da amplificação de sete genes housekeeping. Os produtos de amplificação foram sequenciados e analisados com base no banco de dados do próprio instituto. Resultados: Todos isolados foram identificados como A. baumannii e apresentaram os genes blaOXA-23 e blaOXA-51. Além disso, os 14 isolados apresentaram sensibilidade a polimixina (MIC <1µg/ mL) e altos níveis de resistência ao imipenem (MIC50 16µg/mL; MIC90 >32 µg/mL) e meropenem (MIC50 >32µg/mL; MIC90 >32 µg/mL). A técnica de MLST demonstrou a presença de quatro diferentes STs: 79 (n=8), 180 (n=3), 191 (n=2) e 239 (n=1). Conclusão: Estudos demonstraram a capacidade de disseminação da ST-79 e já caracterizaram a mesma como um clone emergente no mundo todo. Neste trabalho os isolados pertencentes a ST-79 foram evidenciados nos cinco hospitais do estudo, fato que confirma a capacidade de disseminação deste clone. A ST-191 já foi descrita no Brasil (São Paulo), entretanto ainda não há relatos das ST-180 e ST-239 no país (estas duas ST foram descritas apenas na Espanha e no Japão, respectivamente). Estes dados ressaltam a importância da avaliação da disseminação de cepas de A. baumannii multirresistentes, permitindo sua contextualização na epidemiologia global.
Revista Chilena De Infectologia, Jun 1, 2016
Los autores declaran no tener conflictos de interés en relación a la confección de este manuscrito.
International Journal of Infectious Diseases, Jul 1, 2010
To elucidate the evolutionary history of Staphylococcus aureus clonal complex (CC) 8, which encom... more To elucidate the evolutionary history of Staphylococcus aureus clonal complex (CC) 8, which encompasses several globally distributed epidemic lineages, including hospital-associated methicillin-resistant S. aureus (MRSA) and the highly prevalent community-associated MRSA clone USA300. Methods: We reconstructed the phylogeny of S. aureus CC8 by mutation discovery at 112 genetic housekeeping loci from each of 174 isolates, sampled on five continents between 1957 and 2008. The distribution of antimicrobial resistance traits and of diverse mobile genetic elements was investigated in relation to the isolates' phylogeny. Results: Our analyses revealed the existence of nine phylogenetic clades within CC8. We identified at least eight independent events of methicillin resistance acquisition in CC8 and dated the origin of a methicillin-resistant progenitor of the notorious USA300 clone to the mid-1970s. Of the S. aureus isolates in our collection, 88% carried plasmidic rep gene sequences, with up to five different rep genes in individual isolates and a total of eight rep families. Mapping the plasmid content onto the isolates' phylogeny illustrated the stable carriage over decades of some plasmids and the more volatile nature of others. Strikingly, we observed trends of increasing antibiotic resistance during the evolution of several lineages, including USA300. Conclusions: We propose a model for the evolution of S. aureus CC8, involving a split into at least nine phylogenetic lineages and a subsequent series of acquisitions and losses of mobile genetic elements that carry diverse virulence and antimicrobial resistance traits. The evolution of MRSA USA300 towards resistance to additional antibiotic classes is of major concern.
Revista Chilena De Infectologia, 2002
Polysaccharide 23 valent pneumococcal vaccine commercially available from 1983 includes 23 seroty... more Polysaccharide 23 valent pneumococcal vaccine commercially available from 1983 includes 23 serotypes of Streptococcus pneumoniae, representing near 90% of strains involved in invasive pneumococcal disease in immune competent adults. Vaccine confers protection against invasive pneumococcal disease. Immunization is recommended in adults over 65 years old, in patients affected by chronic diseases (cardiopathies, COPD, nephropathies, diabetes mellitus, hepatic cirrhosis, chronic breakage in brain-blood barrier, functional or anatomical asplenia, alcoholism), in immunocompromised hosts, including HIV infection, chemotherapy treatment and hematological malignancies. Influenza vaccine is prepared with particulated antigens, including two influenza A strains and one influenza B strain, selected according to influenza epidemiological worldwide surveillance the year before. On account of continuous antigenic changes (drifts), it is necessary to modify the vaccine antigen's composition yearly. Cost/effectiveness evaluation has confirmed the efficacy of influenza vaccine in reducing morbidity and mortality associated to influenza epidemic and health economical resources involved in patient care. Besides, clinical trials have confirmed that immunization reduces the risk of acquiring pneumonia, of hospitalization and death in elderly people during the influenza epidemic, when vaccine antigenic composition is similar to the circulating strains. Vaccination is recommended annually in healthy adults over 65 years old, in patients with chronic diseases (cardiopathies, COPD, nephropathies, diabetes mellitus, hepatic cirrhosis, chronic breakage of blood-brain barrier, functional or anatomical asplenia, alcoholism). It is also recommended in women who will be in the second or third trimester of pregnancy during the influenza season, in immunocompromised hosts, in institutionalized patients (geriatrics), health care workers, and travelers to geographical areas that are affected by the influenza epidemic.
DOAJ (DOAJ: Directory of Open Access Journals), Dec 1, 2010
Archivos de medicina interna, 2003
Journal of Chemotherapy, 2002
Community-acquired pneumonia (CAP) is probably one of the infections affecting ambulatory patient... more Community-acquired pneumonia (CAP) is probably one of the infections affecting ambulatory patients for which the greatest diversity of guidelines has been written worldwide 1-4. Most of the guidelines are in agreement in that antimicrobial therapy should be initially tailored according to either the severity of the infection or the presence of comorbidity and the epidemiology. Nevertheless, great variability may be noted among different countries in
Brazilian Journal of Infectious Diseases, Dec 1, 2010
The global spread of methicillin-resistant Staphylococcus aureus (MRSA) means it is now a pathoge... more The global spread of methicillin-resistant Staphylococcus aureus (MRSA) means it is now a pathogen of worldwide public health concern. Within Latin America, MRSA is highly prevalent, with the proportion of S. aureus isolates that are methicillin-resistant on the rise, yet resources for managing the infection are limited. While several guidelines exist for the treatment of MRSA infections, many are written for the North American or European setting and need adaptation for use in Latin America. In this article, we aim to emphasize the importance of appropriate treatment of MRSA in the healthcare and community settings of Latin America. We present a summary of the available guidelines and antibiotics, and discuss particular considerations for clinicians treating MRSA in Latin America.
Intensive Care Medicine, 1992
Canbirr-d Cateinlaines (at) with different dooarinergic, alpha or beta adrssxrrgic activity are f... more Canbirr-d Cateinlaines (at) with different dooarinergic, alpha or beta adrssxrrgic activity are frecg>entely atinitrister ci septic patients (P) to improve hsexxlynamics, alt aigt in sae cases erratic respxtses are obtair>ed. The aim of this study was to evaluate the variability of these rsrsfcslses. l s prospectively staslied 15 septic (P) tifio rxptirecl a basal Ibperrire infusion and the addition of a 2nd CH. Initial and final values for PAJP, I-AP, CI, SR, D02 amyl 402 trure assessed before and after tta second drug had started. 311 15 P rere on Lbomrdne (Dl mean close 8,3 t / g/ndn) infusion. Dobutanitle (Le) sea a:kieci in 7 P (group I nenn dose 11,3 ug/Kg/min, rortality 14%) atzt epinelisine (03) in 8 (group II
Expert Review of Anti-infective Therapy, 2020
ABSTRACT Introduction Carbapenemases are β-lactamases able to hydrolyze a wide range of β-lactam ... more ABSTRACT Introduction Carbapenemases are β-lactamases able to hydrolyze a wide range of β-lactam antibiotics, including carbapenems. Carbapenemase production in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp., with and without the co-expression of other β-lactamases is a serious public health threat. Carbapenemases belong to three main classes according to the Ambler classification: class A, class B, and class D. Areas covered Carbapenemase-bearing pathogens are endemic in Latin America. In this review, we update the status of carbapenemases in Latin America and the Caribbean. Expert opinion Understanding the current epidemiology of carbapenemases in Latin America and the Caribbean is of critical importance to improve infection control policies limiting the dissemination of multi-drug-resistant pathogens and in implementing appropriate antimicrobial therapy.
Anais do XV Congresso Brasileiro de Controle de Infeccao e Epidemiologia Hospitalar e 1o Simposio... more Anais do XV Congresso Brasileiro de Controle de Infeccao e Epidemiologia Hospitalar e 1o Simposio Internacional da Associacao Panamericana de Infectologia em Infeccoes Associadas a Atencao a Saude
Critical care research and practice, 2014
This review summarizes recent epidemiology of Gram-negative infections in selected countries from... more This review summarizes recent epidemiology of Gram-negative infections in selected countries from Latin American and Caribbean adult intensive care units (ICUs). A systematic search of the biomedical literature (PubMed) was performed to identify articles published over the last decade. Where appropriate, data also were collected from the reference list of published articles, health departments of specific countries, and registries. Independent cohort data from all countries (Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Trinidad and Tobago, and Venezuela) signified a high rate of ICU infections (prevalence: Argentina, 24%; Brazil, 57%). Gram-negative pathogens, predominantly Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, accounted for >50% of ICU infections, which were often complicated by the presence of multidrug-resistant strains and clonal outbreaks. Empirical use of antimicrobial agents was identified as a strong risk factor...
International Journal of Antimicrobial Agents, 2009
Meticillin-resistant Staphylococcus aureus (MRSA) has become a serious threat to public health wo... more Meticillin-resistant Staphylococcus aureus (MRSA) has become a serious threat to public health worldwide. Ongoing surveillance is essential to support infection control committees and clinicians in the prevention and treatment of infection. However, in Latin America, resources for monitoring the changing epidemiology of MRSA remain limited. In this article, we review the current situation of MRSA in Latin America in order to highlight the need for a more harmonised effort to improve its management. Literature in the PubMed and SciELO databases as well as the website of the Pan American Health Organization were searched for articles and information about the epidemiology of MRSA in Latin America. MRSA is already the leading cause of nosocomial infection in the Latin American region, and the number of reports of community-acquired MRSA infections is also rising. However, the extent of the problem is not fully understood, especially since data tend to come from large hospitals whereas much of the population is served by small community healthcare centres that do not have extensive facilities for performing microbiological surveillance. In conclusion, wider-reaching and coordinated programmes to provide regular MRSA surveillance reports are required across the Latin American region.
International Journal of Infectious Diseases, 2010
Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a prominent nosocomial bacteria... more Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a prominent nosocomial bacterial pathogen, associated with significant morbidity and mortality. The global incidence is increasing, and Latin America is no exception. This article reviews MRSA clonal distribution in Latin America and implications for clinical practice. Design: A PubMed literature search (1966-2008) identified 32 articles that characterized MRSA clones in Latin America. Results: Data from these articles show that since 1990, several epidemic MRSA clones have spread in Latin America. The multidrug-resistant Brazilian clone is widespread, especially in Brazil and Argentina, but more recently clones with susceptibility to a range of antibiotics have been detected in Brazil, whereas in Argentina, as in Chile, Colombia and Paraguay, the multidrug-resistant Cordobes/Chilean clone prevails. In Mexico, the New York/Japan clone is most frequent. Data were not available from every country and, despite the increasing prevalence of community MRSA infections, most were collected from tertiary care centers. Conclusions: A variety of epidemic MRSA clones are circulating in Latin America, some of which harbor genes that encode multidrug resistance or enhanced pathogenicity. Continued collection and reporting of epidemiological data is crucial for effective prevention and treatment.
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Papers by Luis Bavestrello