IMPACTO-MR: a Brazilian nationwide platform study to assess infections and
            multidrug resistance in intensive care units

Tomazini, Bruno Martins; Júnior, Antonio Paulo Nassar; Lisboa, Thiago; Azevedo, Luciano César Pontes; Veiga, Viviane Cordeiro; Catarino, Daniela Ghidetti Mangas; Fogazzi, Débora Vacaro; Arns, Beatriz; Piastrelli, Filipe; Dietrich, Camila; Negrelli, Karina Leal; Jesuíno, Isabella de Andrade; Reis, Luiz F. L.; Mattos, Renata Rodrigues de; Pinheiro, Carla Cristina Gomes; Luz, Mariane Nascimento; Spadoni, Clayse Carla da Silva; Moro, Elisângela Emilene; Bueno, Flávia Regina; Sampaio, Camila Santana Justo Cintra; Silva, Débora Patrício; Baldassare, Franca Pellison; Silva, Ana Cecilia Alcantara; Veiga, Thabata; Barbante, Leticia; Lambauer, Marianne; Campos, Viviane Bezerra; Santos, Elton J. G.; Santos, Renato Hideo Nakawaga; Laranjeiras, Ligia Nasi; Valeis, Nanci; Santucci, Eliana Vieira; Miranda, Tamiris Abait; Patrocínio, Ana Cristina Lagoeiro do; Carvalho, Andréa de; Sousa, Eduvirgens Maria Couto de; Sousa, Ancelmo Honorato Ferraz de; Malheiro, Daniel Tavares; Bezerra, Isabella Lott; Rodrigues, Mirian Batista; Malicia, Julliana Chicuta; Silva, Sabrina Souza da; Gimenes, Bruna dos Passos; Sesin, Guilhermo Prates; Zavascki, Alexandre Prehn; Sganzerla, Daniel; Medeiros, Gregory Saraiva; Santos, Rosa da Rosa Minho dos; Silva, Fernanda Kelly Romeiro; Cheno, Maysa Yukari; Abrahão, Carolinne Ferreira; Oliveira, Haliton Alves de; Rocha, Leonardo Lima; Neto, Pedro Aniceto Nunes; Pereira, Valéria Chagas; Paciência, Luís Eduardo Miranda; Bueno, Elaine Silva; Caser, Eliana Bernadete; Ribeiro, Larissa Zuqui; Fernandes, Caio César Ferreira; Garcia, Juliana Mazzei; Silva, Vanildes de Fátima Fernandes; Santos, Alexandre Bessa dos; Machado, Flávia Ribeiro; Souza, Maria Aparecida de; Ferronato, Bianca Ramos; Urbano, Hugo Corrêa de Andrade; Moreira, Danielle Conceição Aparecida; Souza-Dantas, Vicente Cés de; Duarte, Diego Meireles; Coelho, Juliana; Figueiredo, Rodrigo Cruvinel; Foreque, Fernanda; Romano, Thiago Gomes; Cubos, Daniel; Spirale, Vladimir Miguel; Nogueira, Roberta Schiavon; Maia, Israel Silva; Zandonai, C.; Lovato, Wilson José; Cerantola, Rodrigo Barbosa; Toledo, Tatiana Gozzi Pancev; Tomba, Pablo Oscar; Almeida, Joyce Ramos de; Sanches, Luciana Coelho; Pierini, Leticia; Cunha, Mariana Sequetin; Sousa, Michelle Tereza; Azevedo, Bruna Marcacini; Dal‐Pizzol, Felipe; Damasio, Danusa de Castro; Bainy, Marina Peres; Beduhn, Dagoberta Alves Vieira; Jatobá, Joana D’Arc Vila Nova; Moura, Maria Tereza Farias de; Rego, Leila Rezegue de Moraes; Silva, Adria Vanessa da; Oliveira, Luana Pontes; Filho, Eliene Sá Sodré; Santos, S.; Neves, Itallo de Lima; Leão, Vanessa Cristina de Aquino; Paes, João Lucidio Lobato; Silva, Marielle Cristina Mendes; Oliveira, Cláudio Dornas de; Santiago, Raquel Caldeira Brant; Paranhos, Jorge; Wiermann, Iany Grinezia da Silva; Pedroso, Durval Ferreira Fonseca; Sawada, Priscilla Yoshiko; Prestes, Rejane Martins; Nascimento, Glícia Cardoso; Grion, Cíntia Magalhães Carvalho; Carrilho, Cláudia Maria Dantas de Maio; Dantas, Roberta Lacerda Almeida de Miranda; Silva, Eliane Pereira; Silva, Antônio Carlos da; Oliveira, Sheila Mara Bezerra de; Golin, Nicole Alberti; Tregnago, Rogerio; Lima, Valéria Paes; Silva, Kamilla Grasielle Nunes da; Boschi, Emerson; Buffon, Viviane Aline; Machado, André Sant’Ana; Capeletti, Leticia; Foernges, Rafael Botelho; Carvalho, Andréia Schubert de; Jr, Lúcio Couto de Oliveira; Oliveira, Daniela; Silva, Everton Macêdo; Ribeiro, Julival; Pereira, Francielle Constantino; Salgado, Fernanda Borges; Deutschendorf, Caroline; Silva, Cristófer Farias da; Gobatto, André Luiz Nunes; Oliveira, Carolaine Bomfim de; Dracoulakis, Marianna Deway Andrade; Alvaia, Natália Oliveira Santos; Souza, Roberta Machado de; Araújo, Larissa Liz Cardoso de; Melo, Rodrigo Morel Vieira de; Passos, Luiz Carlos Santana; Vidal, Cláudia Fernanda de Lacerda; Rodrigues, Fernanda Lopes de Albuquerque; Kurtz, Pedro; Shinotsuka, Cássia Righy; Tavares, Maria Brandão; Santana, Igor das Virgens; Gavinho, Luciana Macedo da Silva; Nascimento, Alaís Brito; Pereira, Adriano José; Cavalcanti, Alexandre Biasi

doi:10.5935/0103-507x.20220209-en

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…This is a national, multicenter, observational, and prospective cohort conducted in 41 hospitals from 16 different Brazilian states. The project is part of a major initiative called IMPACTO MR program, a nationwide registry and platform for observational studies and trials on HAIs, especially those caused by multidrug-resistant Organisms (MDROs) (25). The study was approved by the Hospital Israelita Albert Einstein (HIAE) - São Paulo - Brazil Ethics Committee (approval number 4.122.595), and also by the Hospital do Coração (HCor) - São Paulo - Brazil Ethics committee (approval number 4.040.974).…”

Section: Methodsmentioning

confidence: 99%

A transversal overview of Intensive Care Units environmental microbiome and antimicrobial resistance profile in Brazil

de Bastiani,

Silva,

Christoff

et al. 2024

Preprint

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IntroductionInfections acquired during healthcare setting stay pose significant public health threats. These infections are known as Healthcare-Associated Infections (HAI), mostly caused by pathogenic bacteria, which exhibit a wide range of antimicrobial resistance.ObjectiveCharacterize the microbiome and antimicrobial resistance genes present in high-touch Intensive Care Unit (ICU) surfaces, and to identify the potential contamination of the sanitizers/processes used to clean hospital surfaces.MethodsIn this national, multicenter, observational, and prospective cohort, bacterial profiles and antimicrobial resistance genes from 41 hospitals across 16 Brazilian states were evaluated. Using high-throughput 16S rRNA amplicon sequencing and real-time PCR, the bacterial abundance and resistance genes presence were analyzed in both ICU environments and cleaning products.ResultsWe identified a wide diversity of microbial populations with a recurring presence of HAI-related bacteria among most of the hospitals. The median bacterial positivity rate in surface samples was high (88.24%), varying from 21.62% to 100% in different hospitals. Hospitals with the highest bacterial load in samples were also the ones with highest HAI-related abundances.Streptococcus spp,Corynebacterium spp,Staphylococcus spp,Bacillus spp,Acinetobacter spp,and bacteria from the Flavobacteriaceae family were the microorganisms most found across all hospitals. Despite each hospital particularities in bacterial composition, clustering profiles were found for surfaces and locations in the ICU. Antimicrobial resistance genesmecA,blaKPC-like,blaNDM-like, andblaOXA-23-likewere the most frequently detected in surface samples. A wide variety of sanitizers were collected, with 19 different active principles in-use, and 21% of the solutions collected showed viable bacterial growth with antimicrobial resistance genes detected.ConclusionThis study demonstrated a diverse and spread pattern of bacteria and antimicrobial resistance genes covering a large part of the national territory in ICU surface samples and in sanitizers solutions. This data should contribute to the adoption of surveillance programs to improve HAI control strategies and demonstrate that large-scale epidemiology studies must be performed to further understand the implications of bacterial contamination in hospital surfaces and sanitizer solutions.

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Section: Methodsmentioning

confidence: 99%

A transversal overview of Intensive Care Units environmental microbiome and antimicrobial resistance profile in Brazil

de Bastiani,

Silva,

Christoff

et al. 2024

Preprint

Self Cite

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“…Participants have been recruited at ICUs of Brazilian hospitals participating in the IMPACTO MR platform [ 28 ] since 27 January 2022. In December 2022, additional centers, outside the IMPACTO MR platform, were included as participants sites, affording a total of 36 centers in October 2023, in order to increase recruitment rate.…”

Section: Methodsmentioning

confidence: 99%

A Randomized, Open-Label, Non-inferiority Clinical Trial Assessing 7 Versus 14 Days of Antimicrobial Therapy for Severe Multidrug-Resistant Gram-Negative Bacterial Infections: The OPTIMISE Trial Protocol

Arns,

Horvath,

Rech

et al. 2023

Infect Dis Ther

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Introduction Shorter courses of antimicrobials have been shown to be non-inferior to longer, “traditional” duration of therapies, including for some severe healthcare-associated infections, with a few exceptions. However, evidence is lacking regarding shorter regimes against severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB), which are often caused by distinct strains and commonly treated with second-line antimicrobials. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we aim to assess the non-inferiority of 7-day versus 14-day antimicrobial therapy in critically ill patients with severe infections caused by MDR-GNB. Methods This is a randomized, multicenter, open-label, parallel controlled trial to assess the non-inferiority of 7-day versus 14-day of adequate antimicrobial therapy for intensive care unit (ICU)-acquired severe infections by MDR-GNB. Adult patients with severe infections by MDR-GNB initiated after 48 h of ICU admission are screened for eligibility. Patients are eligible if they proved to be hemodynamically stable and without fever for at least 48 h on the 7th day of adequate antimicrobial therapy. After consenting, patients are 1:1 randomized to discontinue antimicrobial therapy on the 7th (± 1) day or to continue for a total of 14th (± 1) days. Planned Outcomes The primary outcome is treatment failure, defined as death or relapse of infection within 28 days after randomization. Non-inferiority will be achieved if the upper edge of the two-tailed 95% confidence interval of the difference between the clinical failure rate in the 7-day and the 14-day group is not higher than 10%. Conclusion The OPTIMISE trial is the first randomized controlled trial specifically designed to assess the duration of antimicrobial therapy in patients with severe infections by MDR-GNB. Trial Registration ClinicalTrials.gov, NCT05210387. Registered on 27 January 2022. Seven Versus 14 Days of Antibiotic Therapy for Multidrug-resistant Gram-negative Bacilli Infections (OPTIMISE). Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00897-9.

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Patient-level cost analysis of intensive care unit acquired infections: A prospective cohort study

Bezerra,

Nassar Junior,

dos Santos

et al. 2024

Journal of Hospital Infection

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IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units

Cited by 4 publications

References 16 publications

A transversal overview of Intensive Care Units environmental microbiome and antimicrobial resistance profile in Brazil

A transversal overview of Intensive Care Units environmental microbiome and antimicrobial resistance profile in Brazil

A Randomized, Open-Label, Non-inferiority Clinical Trial Assessing 7 Versus 14 Days of Antimicrobial Therapy for Severe Multidrug-Resistant Gram-Negative Bacterial Infections: The OPTIMISE Trial Protocol

Patient-level cost analysis of intensive care unit acquired infections: A prospective cohort study

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