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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2019.tde-07052019-141350
Document
Author
Full name
Barbara Riquena Pimentel
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2018
Supervisor
Committee
Adde, Fabiola Villac (President)
Bussamra, Maria Helena de Carvalho Ferreira
Athanazio, Rodrigo Abensur
Pastorino, Antonio Carlos
Title in Portuguese
Erradicação da Pseudomonas aeruginosa na colonização inicial em pacientes com fibrose cística: avaliação do protocolo de um centro de referência
Keywords in Portuguese
Ciprofloxacino
Colistina
Erradicação de doenças
Fibrose cística
Protocolos
Pseudomonas aeruginosa
Abstract in Portuguese
Objetivo: Diversas estratégias de erradicação da Pseudomonas aeruginosa (Pa) em pacientes com fibrose cística (FC) têm sido propostas, mas poucas realizaram o tratamento em fases e incluíram crianças na primeira colonização por Pa na vida. O objetivo desse estudo é descrever a efetividade do protocolo de erradicação em fases, em crianças brasileiras com FC no primeiro aparecimento de Pa. Métodos: Estudo de vida real, retrospectivo, que avaliou os prontuários dos pacientes pediátricos submetidos ao protocolo de erradicação em um período de 8,5 anos. O protocolo de 3 fases era guiado pela cultura de via aérea, e utilizou colistimetato nebulizado e ciprofloxacino oral. Foram avaliadas as taxas de sucesso após cada fase e a acumulada. Resultados: 47 episódios de colonização por Pa foram elegíveis à erradicação. A fase 1 do protocolo foi aplicada em 29 pacientes (mediana 2,7 anos, 59% masculino, 65% com no mínimo um alelo F508del), a fase 2 em 12 e a fase 3 em 6 pacientes. A taxa de sucesso foi de 58,6% (IC 95%: 40,7 a 74,5), 50,0% (IC 95%: 25,4 a 74,6) e 66,7% (IC 95%:30,0 a 90,3), após as fases 1, 2 e 3 respectivamente. A taxa de sucesso acumulado foi de 93,1% (IC: 78,0 a 98,1). Apenas 2 pacientes tiveram falha do tratamento de erradicação. Conclusão: O primeiro aparecimento da Pa ocorreu em crianças de baixa idade. O protocolo de erradicação em fases foi efetivo com alta taxa de sucesso
Title in English
Eradication of new onset of Pseudomonas aeruginosa in cystic fibrosis patients: evaluation of a reference center protocol
Keywords in English
Ciprofloxacin
Colistin
Cystic fibrosis
Disease eradication
Protocols
Pseudomonas aeruginosa
Abstract in English
Background: Although several Pseudomonas aeruginosa (Pa) eradication strategies have been proposed for Cystic Fibrosis (CF) patients, only a few have used a stepwise treatment and enrolled children in their first-onset Pa colonization. The purpose of this study is to describe the effectiveness of a multistep eradication protocol in CF Brazilian children in their first-onset Pa. Methods: This was a real life retrospective study that evaluated medical records of pediatric patients who underwent the eradication protocol in a timeframe of 8.5 years. The 3-step protocol was guided by airway culture, using inhaled colistimethate and oral ciprofloxacin. The success rate after each step, and also the cumulative success rate were evaluated. Results: During the study period, 47 Pa colonization episodes were eligible to eradication. All the 29 patients underwent protocol's step 1 (median 2.7 years old, 59% male, 65% with at least one F508del allele), twelve patients step 2, and six patients step 3. Success rate was 58.6% (CI 95%: 40.7 to 74.5), 50.0% (CI 95%: 25.4 to 74.6) and 66.7% (CI 95%:30.0 to 90.3), after step 1, 2 and 3 respectively. Cumulative success rate was 93.1% (CI: 78.0 to 98.1). Failure of the eradication protocol occurred in only 2 patients. Conclusion: First-onset Pa colonization occurred in very young children. The stepwise eradication protocol was effective with a high success rate
 
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Publishing Date
2019-05-08
 
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