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Di Bella S, Luzzati R, Mearelli F, Papa G, Spazzapan L, Nunnari A, D’Aleo F, Papola C, Principe L. Anti-infective management of infected skin ulcers. LE INFEZIONI IN MEDICINA 2024; 32:138-147. [PMID: 38827836 PMCID: PMC11142418 DOI: 10.53854/liim-3202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/19/2024] [Indexed: 06/05/2024]
Abstract
Infected skin ulcers represent a frequent and intricate clinical challenge, necessitating prompt and comprehensive multidisciplinary interventions to avert complications. Anti-infective therapy constitutes a cornerstone in the therapeutic paradigm. This manuscript delineates our approach to anti-infective management of infected ulcers, encompassing insights into clinical classifications, diagnostic features, exampless of early clinical decision-making in anti-infective treatment, comprehensive evaluation of infectious diseases encompassing host clinical considerations and potential interventions, determination of antibiotic therapy duration, methodologies for assessing clinical response, identification of potential causes for lack of clinical response, as well as strategies for outpatient parenteral antibiotic therapy and a diagnostic and therapeutic algorithm.
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Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, Trieste,
Italy
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, Trieste,
Italy
| | - Filippo Mearelli
- Internal Medicine Unit, Trieste University Hospital (ASUGI), Trieste,
Italy
| | - Giovanni Papa
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, Trieste,
Italy
| | - Luca Spazzapan
- Plastic Surgery Unit, Trieste University Hospital (ASUGI), Trieste,
Italy
| | - Alessio Nunnari
- Internal Medicine Unit, Trieste University Hospital (ASUGI), Trieste,
Italy
| | - Francesco D’Aleo
- Clinical Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria,
Italy
| | - Carmelo Papola
- Clinical Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria,
Italy
| | - Luigi Principe
- Clinical Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria,
Italy
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Di Bella S. Antibiotics Usage in Special Clinical Situations. Antibiotics (Basel) 2023; 13:34. [PMID: 38247593 PMCID: PMC10812547 DOI: 10.3390/antibiotics13010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Medicine and the treatment of infectious diseases are increasingly focused on patient-tailored diagnostics and therapy [...].
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Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical, and Health Sciences, Trieste University, 34127 Trieste, Italy
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Perdigão Neto LV, Machado AS, da Silva RG, de Souza RBC, Coutinho SM, Comello F, Porto APM, Lima DS, di Gioia TSR, Castro Lima VAC, Farias LABG, Macedo MRF, Noguera SLV, Dos Anjos SN, Tonheiro CMMP, Cocentino BCB, Costa SF, Oliveira MSD. Case Report: Successful Treatment of Recurrent Urinary Tract Infection Due to Extensively Drug-Resistant Klebsiella Pneumoniae in a Kidney Transplant Recipient Using Chloramphenicol. Transplant Proc 2023; 55:654-659. [PMID: 36934054 DOI: 10.1016/j.transproceed.2023.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/19/2023] [Indexed: 03/17/2023]
Abstract
Effective therapies for multidrug-resistant (MDR) microorganisms, especially Gram-negative bacteria, are becoming rare. Also, solid-organ transplant recipients are at high risk of MDR Gram-negative bacilli infection. Urinary tract infections are the most frequent bacterial infections in kidney transplant recipients and are an important cause of mortality after renal transplantation. We describe a case of complicated urinary tract infection in a kidney transplant patient due to extensively drug-resistant (XDR) K. pneumoniae treated successfully with a regimen comprising a combination of chloramphenicol and ertapenem. We do not recommend chloramphenicol as a first-line choice for treating complicated urinary tract infections. Still, we believe it is an alternative for infections caused by MDR and/or XDR pathogens in renal transplant patients, as other options are nephrotoxic.
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Affiliation(s)
- Lauro Vieira Perdigão Neto
- Hospital Paulistano, São Paulo, Brazil; Department of Infectious Diseases of Hospital das Clínicas and Laboratório de Investigação Médica - LIM 49, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | - Luis Arthur Brasil Gadelha Farias
- Department of Infectious Diseases of Hospital das Clínicas and Laboratório de Investigação Médica - LIM 49, University of São Paulo, São Paulo, Brazil.
| | - Mariana Rolim Fernandes Macedo
- Department of Infectious Diseases of Hospital das Clínicas and Laboratório de Investigação Médica - LIM 49, University of São Paulo, São Paulo, Brazil
| | - Saidy Liceth Vasconez Noguera
- Department of Infectious Diseases of Hospital das Clínicas and Laboratório de Investigação Médica - LIM 49, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Silvia Figueiredo Costa
- Department of Infectious Diseases of Hospital das Clínicas and Laboratório de Investigação Médica - LIM 49, University of São Paulo, São Paulo, Brazil
| | - Maura Salaroli de Oliveira
- Hospital Paulistano, São Paulo, Brazil; Department of Infectious Diseases of Hospital das Clínicas and Laboratório de Investigação Médica - LIM 49, University of São Paulo, São Paulo, Brazil
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Lupia T, De Benedetto I, Stroffolini G, Di Bella S, Mornese Pinna S, Zerbato V, Rizzello B, Bosio R, Shbaklo N, Corcione S, De Rosa FG. Temocillin: Applications in Antimicrobial Stewardship as a Potential Carbapenem-Sparing Antibiotic. Antibiotics (Basel) 2022; 11:antibiotics11040493. [PMID: 35453244 PMCID: PMC9032032 DOI: 10.3390/antibiotics11040493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 01/25/2023] Open
Abstract
Temocillin is an old antibiotic, but given its particular characteristics, it may be a suitable alternative to carbapenems for treating infections due to ESBL-producing Enterobacterales and uncomplicated UTI due to KPC-producers. In this narrative review, the main research question was to summarize current evidence on temocillin and its uses in infectious diseases. A search was run on PubMed using the terms (‘Temocillin’ [Mesh]) AND (‘Infection’ [Mesh]). Current knowledge regarding temocillin in urinary tract infection, blood-stream infections, pneumonia, intra-abdominal infections, central nervous system infections, skin and soft tissues infections, surgical sites infections and osteoarticular Infections were summarized. Temocillin retain a favourable profile on microbiota and risk of Clostridioides difficile infections and could be an option for treating outpatients. Temocillin may be a valuable tool to treat susceptible pathogens and for which a carbapenem could be spared. Other advantages in temocillin use are that it is well-tolerated; it is associated with a low rate of C. difficile infections; it is active against ESBL, AmpC, and KPC-producing Enterobacterales; and it can be used in the OPAT clinical setting.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy;
- Correspondence:
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (G.S.); (S.M.P.); (B.R.); (R.B.); (N.S.); (S.C.)
| | - Giacomo Stroffolini
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (G.S.); (S.M.P.); (B.R.); (R.B.); (N.S.); (S.C.)
| | - Stefano Di Bella
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (G.S.); (S.M.P.); (B.R.); (R.B.); (N.S.); (S.C.)
| | - Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), 34125 Trieste, Italy;
| | - Barbara Rizzello
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (G.S.); (S.M.P.); (B.R.); (R.B.); (N.S.); (S.C.)
| | - Roberta Bosio
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (G.S.); (S.M.P.); (B.R.); (R.B.); (N.S.); (S.C.)
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (G.S.); (S.M.P.); (B.R.); (R.B.); (N.S.); (S.C.)
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (G.S.); (S.M.P.); (B.R.); (R.B.); (N.S.); (S.C.)
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy;
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (I.D.B.); (G.S.); (S.M.P.); (B.R.); (R.B.); (N.S.); (S.C.)
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Hagiya H, Tokumasu K, Obika M, Otsuka F. De-escalation concept and MIC literacy among medical students and clinical residents. Postgrad Med J 2021; 98:e183-e184. [PMID: 33452156 DOI: 10.1136/postgradmedj-2020-139562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuki Tokumasu
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mikako Obika
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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