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Increased spread of antimicrobial resistance by Gram-Negative Bacilli (GNB) poses a global challenge, with exacerbated burden post-pandemic. The aim of this study was to investigate the in vitro activity of ceftolozane/tazobactam and its comparators against the frequently identified GNB isolated from patients admitted to Brazilian medical sites between the year 2018‒2019 and 2020‒2021. The impact of pandemic on antimicrobial resistance and presence of β-lactamase genes were also evaluated. Antimicrobial susceptibility testing and molecular characterization of ß-lactamase encoding genes using Polymerase Chain Reaction (PCR) and DNA sequencing were carried out from GNB isolated mostly from intra-abdominal, respiratory, and urinary tract infections and interpreted following BrCAST/EUCAST guidelines. A total of 3994 GNB isolates were evaluated which mostly included E. coli, K. pneumoniae and P. aeruginosa. Ceftolozane/tazobactam remained highly active against E. coli isolates during both 2018‒2019 (96.0 %) and 2020‒2021 (98.5 %). Among K. pneumoniae, ceftolozane/tazobactam (47.6 % and 43.0 % susceptible during 2018‒2019 and 2020‒2021, respectively) showed poor activity due to blaKPC-2. Colistin and ceftolozane/tazobactam were the most active β-lactam agents tested against P. aeruginosa in 2018‒2019 (99.3 % and 88.8 %) and 2020‒2021 (100 % and 92.8 %), including ceftazidime and meropenem resistant isolates. β-lactamase encoding gene characterization was carried out and both carbapenemases and Extended-Spectrum β-Lactamase (ESBL) producers were found in E. coli, K. pneumoniae and P. aeruginosa isolates. Ceftolozane/tazobactam documented remarkable in vitro activity against E. coli and P. aeruginosa isolates in Brazil, both pre- and post-pandemic periods and could constitute an effective therapeutic option for the treatment of urinary tract infections, intra-abdominal infections, and respiratory tract infections.

Objectives: There is a limited number of updated epidemiological Brazilian data on head and neck squamous cell carcinoma (HNSCC). This study aimed to describe demographic and clinical characteristics of HNSCC patients from Brazilian public and private systems. Methods: This is a retrospective observational study that included patients diagnosed with HNSCC from Brazilian public and private settings from 2016 to 2018. As for the public scenario, data were drawn from the public hospital national cancer registry database. As for the private sector, the data were extracted from medical records of patients from Oncoclinicas, a large Brazilian oncology group. Results: A total of 37,121 patients were included in the study, with 36,914 from the public and 207 from the private system. Patients in the public sector were younger than those in the private sector, with medians ages of 61.2 and 66.9 years, respectively. In both cohorts, a predominance of men with a history of tobacco and alcohol consumption and an advanced locoregional stage at diagnosis was observed. The main site of the primary tumor was the oropharynx in the private sector and oral cavity in the public sector. Among patients with oropharyngeal cancer, only those in the private sector were tested for HPV, with the majority being positive. Conclusions: This real-world data study provides epidemiologic characteristics of patients with HNSCC in two different Brazilian healthcare settings, presenting relevant insights into possible opportunities for improvements in the patient's journey with HNSCC.

Abstract In Brazil, data on the management of triple negative breast cancer (TNBC) as well as the burden of the disease in terms of health care resources utilization (HCRU) are scarce. To characterize the treatment patterns and HCRU associated with the management of Brazilian TNBC patients from the perspective of the private healthcare setting. Patients with at least one claim related to ICD-10 C50 from January 2012 until December 2017, and at least one claim for breast cancer treatment were assessed from a private claims database and classified as early and locally advanced, or metastatic. All patients with hormone and/or targeted therapy were excluded. Three thousand and four patients were identified, of which 82.8% were diagnosed in early and locally advanced stages. For early and locally advanced TNBC patients, 75.3% were treated in an adjuvant setting, mainly with anthracycline regimes. For mTNBC patients, bevacizumab regimens were the main treatment prescribed. More than 48% of mTNBC patients were switched to a second line of treatment. HCRU was higher for mTNBC patients when compared to early and locally advanced patients, with higher costs for metastatic disease management. The treatment setting has little influence on the HCRU pattern or the cost of disease management. The highest burden of disease was observed for metastatic management.

The aim of the study is to evaluate the treatment patterns, time to start treatment, and healthcare resources utilization (HCRU) of cervical cancer (CC) patients within the Brazilian public health system (SUS). This is an observational retrospective study using SUS administrative database (DATASUS). Data from January-2014 to December-2020 was gathered from patients with the ICD-10 C53 codes. From 2014 to 2020, 206,861 women were included, among whom 90,073 (43.5%) had stage information. Of staged patients, 60.7% (54,719) had advanced disease (stages III and IV) and the most performed treatments were chemoradiotherapy (CRT) (41.6%), surgery + CRT (19.1%), radiotherapy (RT) only (16.8%) and chemotherapy (CT) only (13.3%). The proportion of patients submitted to CT in advanced stages was higher than in non-advanced stages (I and II), in contrast to RT, which was more frequent in stage I than stage IV. Median time to initiate treatment surpassed two months in approximately 30% of the cases, regardless of stage. Conization was the most performed surgical procedure. The hospitalization rate per patient per month for stage IV was twice as high as stage I (0.05 [95%CI 0.05-0.05] and 0.11 [0.11-0.11], respectively). The same trend was observed for outpatient visits (0.54 [95%CI 0.53-0.55] and 0.96 [0.93-0.98], respectively). This study demonstrated a high proportion of advanced CC at diagnosis in Brazil. The treatment pattern showed that chemoradiotherapy was the most frequent regimen overall and the use of chemotherapy and HCRU increased with staging. These results could provide information to improve public policies towards access to prevention, diagnosis, and treatment of CC in Brazil.

Introdução: Pseudomonas aeruginosa com resistência a carbapenêmicos é um patógeno considerado prioritário (nível crítico) pela Organização Mundial da Saúde para o desenvolvimento de novos antimicrobianos. A resistência a antimicrobianos é um problema de saúde pública crescente no Brasil, principalmente entre pacientes de unidades de terapia intensiva (UTI), se correlacionando a maior risco de mortalidade. Objetivos: Comparar a atividade de ceftolozana/tazobactam (C/T), ceftazidima/avibactam (CAZ/AVI), piperacilina/tazobactam (P/T) e meropeném (MEM) entre isolados de P. aeruginosa coletados no Brasil entre 2018 a 2021, como parte do programa de vigilância global SMART (Study for Monitoring Antimicrobial Resistance Trends). Métodos: Isolados clínicos de P. aeruginosa coletados em 9 centros do Brasil entre 2018 a 2021 foram analisados quanto à suscetibilidade para C/T, CAZ/AVI, P/T e MEM. Foram incluídos apenas isolados de amostras do trato respiratório inferior e provenientes de pacientes em UTI. A suscetibilidade antimicrobiana foi definada através do EUCAST (European Committee on Antimicrobial Susceptibility Testing) 2023. Foram considerados sensíveis os isolados com sensibilidade e sensibilidade com aumento de exposição (S + SIE), conforme padronizado pelo EUCAST. Resultados: O tamanho total da amostra foi de 268 isolados. Destes, oito isolados (3%) apresentavam produção de carbapenemases. C/T e CAZ-AVI mantiveram sensibilidade acima de 90% entre os isolados (92,9% e 91,4%, respectivamente). MEM e P/T apresentaram suscetibilidade menores que 80%: sendo 77,6% e 69%, respectivamente. Quando analisamos as cepas resistentes a P/T (n = 83), C/T foi o antibiótico com maior suscetibilidade, com 78,3% de sensibilidade; CAZ-AVI e MEM apresentaram suscetibilidade de 72,2% e 50,6%, respectivamente. Ao analisar cepas resistentes a MEM (n = 60), C/T, CAZ/AVI e P/T mantiveram suscetibilidade de 75%, 66,6% e 31,6%, respectivamente. Nas amostras resistentes a P/T e MEM concomitantemente (n = 41), C/T manteve suscetibilidade em 63,4% dos isolados, enquanto CAZ/AVI manteve 51% de sensibilidade. Em isolados resistentes a CAZ/AVI (n = 23), C/T manteve-se ativo em 30,4% das amostras. Conclusão: Dentre os antimicrobianos testados, C/T manteve a maior taxa de suscetibilidade em todos os cenários de cross-resistência testados, posicionando-se como um agente relevante entre as opções para o tratamento de pneumonias, especialmente em UTIs.

Introdução: A viremia por citomegalovírus (CMV) após transplante alogênico de células-tronco hematopoiéticas (TCTH) está associada ao risco aumentado de mortalidade geral, aumento do número de infecções, doença do enxerto vs hospedeiro (DECH), e aumento do tempo de hospitalização. O uso de terapia preemptiva diminui a mortalidade mas não impede a viremia por CMV. Este é um estudo descritivo que avalia o impacto da viremia por CMV nos receptores de TCTH. Objetivos: Primário: Descrever a proporção de óbitos relacionados à viremia por CMV em até 6 meses após o TCTH alogênico em adultos soropositivos para CMV. Secundário: Proporção de viremia por CMV associada a outras infecções e DECH. Métodos: Estudo observacional, transversal, centro único (Hospital Amaral Carvalho, em Jaú/SP). A data em que os transplantes foram realizados variou de Jan 2014 a Jul 2021, e os dados foram coletados retrospectivamente de Ago 2021 a Fev 2022. Critérios de inclusão: ≥18 anos, CMV R+ submetidos ao TCTH alogênico. As variáveis foram resumidas por meio de estatística descritiva. Como análise secundária, foram separados os pacientes com CMV-viremia e os sem CMV-viremia, e foi realizada uma análise descritiva. O método utilizado para detecção de CMV-viremia foi o teste de antigenemia pp65. O resultado do teste de antigenemia ≥ 1 célula foi considerado positivo. Resultados: O tamanho total da amostra final foi de 340 pacientes. A viremia por CMV ocorreu em 271 pacientes (79,7%), enquanto em 69 não houve CMV-viremia (20,2%). Um total de 51 pacientes (15%) morreram nos primeiros 6 meses pós TCTH. Nesta série, CMV-viremia não afetou a sobrevida global dos pacientes. Com relação ao tempo de internação, a média foi maior no grupo com CMV-viremia em comparação com o grupo sem CMV-viremia, p = 0,019. Falha/rejeição do enxerto foi observada em 12 pacientes (4,4%) com CMV-viremia e em três pacientes (4,3%) sem CMV-viremia. DECH foi observada em 178 pacientes com CMV-viremia (65,7%) e em 29 (42%) sem CMV-viremia (p < 0,001). Conclusão: Considerando as limitações do desenho do estudo (centro único, tamanho amostral pequeno), não encontramos diferenças na mortalidade entre o grupo que teve viremia por CMV e aqueles que não tiveram. Porém, este estudo evidenciou aumento do tempo de internação e maior incidência de DECH em pacientes com viremia por CMV. Isso pode sugerir um potencial benefício do uso de antivirais para a profilaxia impedindo a viremia ou reativação do CMV.

PURPOSENon–small-cell lung cancer (NSCLC) is the most common type of lung cancer and accounts for 80%-90% of the cases. In Brazil, between 2018 and 2019, lung cancer was ranked as the second most frequent cancer among men and the fourth among women. The primary objectives were to describe the journey and survival rates of patients with advanced NSCLC treated in the Brazilian private health care system (HCS).MATERIALS AND METHODSA retrospective cohort study was based on the search in administrative databases to analyze the Brazilian private HCS. Patients with advanced NSCLC diagnosed between 2011 and 2016 were included. The data on demographics, cancer-related information, treatment-related information, and resources used were collected. Survival analyses were performed using the semiparametric Kaplan-Meier method to assess mortality by NSCLC stage, with NSCLC diagnosis as the index date.RESULTSA total of 5,016 patients were included. Most patients were between 60 and 69 years old (33.6%) and had completed elementary school (52.2%). There was a greater proportion of men (58.1% v 41.9%), and the majority of patients had stage IV NSCLC (67%). It took an average of 31 days, from the first consultation, to have diagnosis. In 44% of the cases, a clinical oncologist was the first specialist in the HCS that the patient was referred to. After the diagnosis, the median time to start of treatment was 35 days. Chemotherapy alone was the most common treatment regimen (32%). The median overall survival was 11.5 months and 6 months for stage II and IV NSCLC, respectively.CONCLUSIONThis study provides contemporary data on stage III and IV NSCLC in private health care in Brazil, which has shown a high rate of metastatic disease diagnoses, high health care–related costs, and low survival rates.

The pneumococcal conjugate vaccination (PCV) was introduced into the Brazilian Childhood National Immunization Program in 2010; however, universal pneumococcal vaccination for older adults has not been implemented yet. Our aim is to evaluate the trends in pneumococcal meningitis incidence and case fatality rate (CFR) across all age groups from 2007 to 2019 using data from the National Surveillance System. The pre-PCV (2007–2009) and post-PCV (2011–2019) periods were compared; changes in incidence and CFR were assessed by joinpoint regression. Additional analyses of bacterial meningitis were performed to compare the patterns and trends. Over the 13-year period, 81,203 and 13,837 cases were classified as bacterial and pneumococcal meningitis, respectively. S. pneumoniae was the main etiological agent of bacterial meningitis in adults aged ≥50 years and the most lethal in all age groups. In the post-PCV period, a 56.5% reduction in the average incidence was seen in pneumococcal meningitis in the pediatric population. In contrast, there was an increasing trend among adults. The CFR for pneumococcal and bacterial meningitis remained stable in most age groups during the study period. These findings highlight the value of expanding pneumococcal vaccination policies, including vaccines that provide better indirect protection from children to adults and broadening vaccination to older adults.

Background: In 2014, a recommended one-dose of inactivated hepatitis A vaccine was included in the Brazilian National Immunization Program targeting children 12–24 months. This decision addressed the low to intermediate endemicity status of hepatitis A across Brazil and the high rate of infection in children and adolescents between 5 and 19 years old. The aim of the study was to conduct a time-series analysis on hepatitis A incidence across age groups and to assess the hepatitis A distribution throughout Brazilian geographic regions. Methods: An interrupted time-series analysis was performed to assess hepatitis A incidence rates before (2010–2013) and after (2015–2018) hepatitis A vaccine program implementation. The time-series analysis was stratified by age groups while a secondary analysis examined geographic distribution of hepatitis A cases. Results: Overall incidence of hepatitis A decreased from 3.19/100.000 in the pre-vaccine period to 0.87/100.000 (p = 0.022) post-vaccine introduction. Incidence rate reduction was higher among children aged 1-4 years old, with an annual reduction of 67.6% in the post-vaccination period against a 7.7% annual reduction in the pre-vaccination period (p < 0.001). Between 2015 and 2018, the vaccination program prevented 14,468 hepatitis A cases. Conclusion: Our study highlighted the positive impact of a recommended one-dose inactivated hepatitis A vaccine for 1–4-years-old in controlling hepatitis A at national level.