Publications by authors named "Kiffer C"

Objective: The aim of this study was to analyze if the healthcare organization of perinatal care and availability of referral neonatal intensive care units (NICU) impacted congenital diaphragmatic hernia (CDH) neonatal mortality in the period 2004-2020. This study analyzed the spatial distribution of neonatal deaths of live births with CDH in São Paulo State, Brazil, and its association with NICU beds' availability.

Methods: Population-based study of all live births in São Paulo State from mothers residing in the same State, from 2004 to 2020.

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Our study aim was to identify high-risk areas of neonatal mortality associated with bacterial sepsis in the state of São Paulo, Southeast Brazil. We used a population-based study applying retrospective spatial scan statistics with data extracted from birth certificates linked to death certificates. All live births from mothers residing in São Paulo State from 2004 to 2020 were included.

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Objectives: This study aimed to analyze, in the São Paulo state of Brazil, time trends in prevalence, neonatal mortality, and neonatal lethality of central nervous system congenital malformations (CNS-CM) between 2004 and 2015.

Methods: Population-based study of all live births with gestational age ≥22 weeks and/or birthweight ≥400 g from mothers living in São Paulo State, during 2004-2015. CNS-CM was defined by the presence of International Classification Disease 10th edition codes Q00-Q07 in the death and/or live birth certificates.

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Article Synopsis
  • The study aimed to analyze the underreporting of congenital syphilis outcomes, particularly deaths, in São Paulo, Brazil from 2007 to 2018.
  • Researchers used two health information systems to compare reported cases of congenital syphilis with mortality data, revealing significant discrepancies.
  • They found that a considerable number of deaths related to congenital syphilis were not reported, highlighting an increase in unfavorable outcomes that emphasizes the need for better reporting systems.
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  • Carbapenemase production is a significant global health concern, and analyzing antimicrobial resistance (AMR) data is essential for effective public health policies, as showcased in this study focused on Brazil's AMR Surveillance Network.
  • The study evaluated carbapenemase detection rates in Brazilian hospitals from 2015 to 2022, finding trends such as a notable increase in blaNDM detection and a decrease in blaKPC for Enterobacterales, particularly after the onset of the COVID-19 pandemic.
  • Overall, the findings highlight the resilience of the AMR Surveillance Network and indicate a concerning shift in carbapenemase profiles, with blaNDM becoming increasingly prevalent.
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Introduction: Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births.

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  • * Of the 545,606 moderate to late preterm infants identified, 5,782 died within 27 days, with a significant decrease in neonatal mortality rates from 16.4 to 7.6 per thousand live births over the study period.
  • * Major causes of death included infections (44%), respiratory disorders (27%), and perinatal asphyxia (14%), highlighting the need for improved healthcare policies to reduce preventable deaths in this vulnerable population.
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  • Carbapenem-resistant Enterobacterales pose a significant health threat due to their rapid spread and high mortality rates, particularly worsened by increased antibiotic use during the COVID-19 pandemic.
  • A study conducted in a Brazilian hospital from 2017 to 2021 found a notable rise in New Delhi Metallo β-Lactamase (NDM)-producing Enterobacterales, especially in COVID-19 wards, indicating a troubling trend in antibiotic resistance.
  • Molecular analysis showed diverse clones of NDM-producing Klebsiella pneumoniae emerging in COVID units, suggesting not only horizontal transmission among patients but also links to heightened antibiotic consumption during the pandemic.
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  • The report highlights a multicentric study conducted in Brazil to assess bacterial communities and antimicrobial resistance genes (ARGs) in food-producing animals and healthy humans, using rectal swabs from various regions.
  • The findings revealed a high level of microbial diversity with over 21,000 unique species identified, alongside 405 ARGs linked to multiple antibiotic classes, including previously unreported carbapenemase-encoding genes.
  • The study emphasizes the interconnectedness of humans and animals in the spread of antimicrobial resistance, particularly in low- and middle-income countries, and advocates for enhanced surveillance through One Health approaches.
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Objective: This article aimed to report a temporal series of respiratory distress syndrome (RDS)-associated neonatal mortality rates in preterm live births in São Paulo state, Brazil, and to identify social, maternal, and neonatal characteristics associated with these deaths.

Study Design: This is a population-based study of all live births with gestational age (GA) between 22 and 36 weeks, birth weight ≥400 g, without congenital anomalies from mothers living in São Paulo state during 2004 to 2015. RDS-associated neonatal mortality was defined as death up to 27 days after birth with ICD-10 codes P22.

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Article Synopsis
  • - The One Health concept explores the links between human and animal health, focusing on how various microorganisms transfer between humans and animals, but lacks publicly available genomic data.
  • - This study collects a dataset of 2,915 metagenome-assembled genomes (MAGs) from 107 samples, including human and livestock gut microbiomes from various regions in Brazil, with a breakdown of high and medium-quality drafts.
  • - The findings provide insights into the diversity of gut microbiomes, indicating potential pathogens and new species, and offer a chance to improve our understanding of microbial ecology and discover beneficial biotechnological applications.
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Background: Prematurity and respiratory distress syndrome (RDS) are strongly associated. RDS continues to be an important contributor to neonatal mortality in low- and middle-income countries. This study aimed to identify clusters of preterm live births and RDS-associated neonatal deaths, and their cooccurrence pattern in São Paulo State, Brazil, between 2004 and 2015.

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Background: Carbapenemase-producing, carbapenem-resistant (CP-CRPA) is a global challenge. However, detection efforts can be laborious because numerous mechanisms produce carbapenem resistance. A minimum inhibitory concentration-based algorithm (imipenem- or meropenem-resistant plus ceftazidime-nonsusceptible plus cefepime-nonsusceptible) was proposed to identify the isolates most likely to harbor a carbapenemase; however, prospective validation in geographies displaying genotypic diversity and varied carbapenemase prevalence is warranted.

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Article Synopsis
  • The modified carbapenemase inactivation method (mCIM) and EDTA-modified versions (eCIM) are effective and low-cost ways to detect certain carbapenemases in bacteria, but have shown poor results specifically for IMP- and SPM-producing P. aeruginosa.
  • Recent findings indicate that increasing EDTA concentration to 40 µM significantly improved the sensitivity of eCIM tests for identifying IMP-producing P. aeruginosa.
  • In a study involving SPM-producing P. aeruginosa, using 40 µM EDTA resulted in a jump in test sensitivity from 12% to 100%, recommending further validation for broader application across different healthcare settings.
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  • The study examined the usage trends of four broad-spectrum antibiotics in ICUs from 2013 to 2017 and their relationship with antibiotic resistance in Gram-negative bacilli.
  • Researchers found a significant decrease in consumption of meropenem and polymyxin B, while noting changes in resistance patterns among specific bacteria, such as Acinetobacter and Escherichia coli.
  • The findings suggest that reducing the use of these antimicrobials could significantly impact the types of infections seen and their resistance levels.
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Background: Infant mortality rate is a measure of population health and neonatal mortality account for great proportion of these deaths. Underdevelopment might be associated to higher neonatal mortality risk due to assistant related factors. Spatial and temporal distribution of mortality help identifying and developing strategies for interventions.

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The present study evaluated the potency of ceftazidime and cefepime among carbapenem-resistant Pseudomonas aeruginosa isolates collected as part of a global surveillance program and assessed the pharmacodynamic implications using previously published population pharmacokinetics. When susceptible, MICs resulted at the high end of distribution for both ceftazidime and cefepime, thus 6 g/day was required to achieve optimal pharmacodynamic profiles. These findings should be considered in the clinic and for the application of CLSI susceptibility breakpoints.

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The cephalosporin-β-lactamase-inhibitor-combinations, ceftolozane/tazobactam and ceftazidime/avibactam, have revolutionized treatment of carbapenem-resistant Pseudomonas aeruginosa (CR-PA). A contemporary assessment of their in vitro potency against a global CR-PA collection and an assessment of carbapenemase diversity are warranted. Isolates determined as CR-PA by the submitting site were collected from 2019-2021 (17 centers in 12 countries) during the ERACE-PA Global Surveillance Program.

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In Brazil, secondary data for epidemiology are largely available. However, they are insufficiently prepared for use in research, even when it comes to structured data since they were often designed for other purposes. To date, few publications focus on the process of preparing secondary data.

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Article Synopsis
  • MICs (minimum inhibitory concentrations) for ticarcillin/clavulanic acid (TLc), ceftolozane/tazobactam (C/T), and aztreonam (AT) were tested on SPM-1-producing Pseudomonas aeruginosa using Etest® strips.
  • The study found that the combination of TLc and AT showed synergistic and additive effects against the bacteria, while TLc and C/T had no significant interaction.
  • The GDSC test revealed that TLc and AT reduced the MICs by 3-fold and 2-fold, respectively, suggesting that TLc combined with AT could be a promising treatment for infections caused by SPM-1-producing P
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  • This study investigates neonatal mortality trends in São Paulo, Brazil, from 2004 to 2013, aiming to inform interventions to meet global health goals.
  • Out of over 6 million live births, the neonatal mortality rate was identified as 8.0 per 1,000 live births, with significant reductions across various gestational ages.
  • Key factors linked to higher neonatal death rates were maternal education, prenatal care quality, and certain neonatal characteristics, while cesarean delivery had mixed effects depending on gestational age.
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  • - A child with influenza-like symptoms developed septic shock due to methicillin-resistant Staphylococcus aureus (MRSA) within 48 hours of hospitalization and sadly died shortly after the onset of sepsis.
  • - The isolated MRSA strain was identified as community-associated (CA-MRSA) and carried a specific genetic element known as the staphylococcal cassette chromosome mec (SCCmec) type IV.
  • - The study highlights the need to understand the link between CA-MRSA infections and influenza to improve early diagnosis and treatment for better outcomes in similar cases.
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  • This study investigates the effectiveness of combining ceftolozane/tazobactam with aztreonam and fosfomycin against carbapenem-resistant Pseudomonas aeruginosa (CR-PSA).
  • Results showed that while ceftolozane/tazobactam was often ineffective against CR-PSA carrying certain resistance genes, combining it with fosfomycin proved synergistic for a majority of the isolates.
  • The findings suggest the need for exploring new treatment combinations and strategies to combat the rising challenge of CR-PSA infections.
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