1
|
Mennella S, Alicino C, Anselmo M, Carrega G, Ficarra G, Garra L, Gastaldo A, Gnerre P, Lillo F, Tassara R, Terrile A, Milanese M. COVID-19 after 2 Years from Hospital Discharge: A Pulmonary Function and Chest Computed Tomography Follow-Up Study. Respiration 2024; 103:22-31. [PMID: 38194938 DOI: 10.1159/000535732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Serial follow-up with pulmonary function testing (PFT) and chest computed tomography (CT) after severe COVID-19 are recommended. As a result, many longitudinal studies have been published on COVID-19 of different grade of severity up to 1-year follow-up. Therefore, we aimed at a long-term observational study throughout 2 years after severe COVID-19. METHODS Severe COVID-19 patients were consecutively recruited after hospital discharge between March and June 2020 and prospectively followed up for 24 months, with mMRC dyspnea scale and PFT at 6, 12, and 24 months. Chest CT was performed when clinically indicated. RESULTS One hundred one patients enrolled completed the observational study. At 24 months, those with reduced total lung capacity (TLC) were 16%, associated with fibrotic ground glass opacity (GGO) and mMRC score >1, respectively, in 75% and 69% of them. At 24 months, those with a reduced diffusing capacity of the lung for CO were 41%, associated with fibrotic GGO and mMRC score >1, respectively, in 53% and 22% of them. CONCLUSION Two years after hospitalization for severe COVID-19, a non-negligible number of patients still suffer from "long COVID" due to respiratory damage.
Collapse
Affiliation(s)
| | | | | | - Giuliana Carrega
- S.C. Malattie Infettive Osteoarticolari, ASL2 Savonese, Albenga, Italy
| | | | - Luca Garra
- Direzione Sanitaria, ASL2 Savonese, Savona, Italy
| | | | - Paola Gnerre
- Dipartimento Medico, ASL2 Savonese, Savona, Italy
| | - Flavia Lillo
- S.C. Laboratorio di Patologia Clinica, ASL2 Savonese, Savona, Italy
| | | | - Anna Terrile
- S.C. Laboratorio di Patologia Clinica, ASL2 Savonese, Savona, Italy
| | | |
Collapse
|
2
|
Bassetti M, Vena A, Giacobbe DR, Trucchi C, Ansaldi F, Antonelli M, Adamkova V, Alicino C, Almyroudi MP, Atchade E, Azzini AM, Brugnaro P, Carannante N, Peghin M, Berruti M, Carnelutti A, Castaldo N, Corcione S, Cortegiani A, Dimopoulos G, Dubler S, García-Garmendia JL, Girardis M, Cornely OA, Ianniruberto S, Kullberg BJ, Lagrou K, Lebihan C, Luzzati R, Malbrain M, Merelli M, Marques AJ, Martin-Loeches I, Mesini A, Paiva JA, Raineri SM, Rautemaa-Richardson R, Schouten J, Spapen H, Tasioudis P, Timsit JF, Tisa V, Tumbarello M, Van den Berg CHSB, Veber B, Venditti M, Voiriot G, Wauters J, Zappella N, Montravers P. Risk Factors for Intra-Abdominal Candidiasis in Intensive Care Units: Results from EUCANDICU Study. Infect Dis Ther 2022; 11:827-840. [PMID: 35182353 PMCID: PMC8960530 DOI: 10.1007/s40121-021-00585-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Intra-abdominal infections represent the second most frequently acquired infection in the intensive care unit (ICU), with mortality rates ranging from 20% to 50%. Candida spp. may be responsible for up to 10-30% of cases. This study assesses risk factors for development of intra-abdominal candidiasis (IAC) among patients admitted to ICU. METHODS We performed a case-control study in 26 European ICUs during the period January 2015-December 2016. Patients at least 18 years old who developed an episode of microbiologically documented IAC during their stay in the ICU (at least 48 h after admission) served as the case cohort. The control group consisted of adult patients who did not develop episodes of IAC during ICU admission. Matching was performed at a ratio of 1:1 according to time at risk (i.e. controls had to have at least the same length of ICU stay as their matched cases prior to IAC onset), ICU ward and period of study. RESULTS During the study period, 101 case patients with a diagnosis of IAC were included in the study. On univariate analysis, severe hepatic failure, prior receipt of antibiotics, prior receipt of parenteral nutrition, abdominal drain, prior bacterial infection, anastomotic leakage, recurrent gastrointestinal perforation, prior receipt of antifungal drugs and higher median number of abdominal surgical interventions were associated with IAC development. On multivariate analysis, recurrent gastrointestinal perforation (OR 13.90; 95% CI 2.65-72.82, p = 0.002), anastomotic leakage (OR 6.61; 95% CI 1.98-21.99, p = 0.002), abdominal drain (OR 6.58; 95% CI 1.73-25.06, p = 0.006), prior receipt of antifungal drugs (OR 4.26; 95% CI 1.04-17.46, p = 0.04) or antibiotics (OR 3.78; 95% CI 1.32-10.52, p = 0.01) were independently associated with IAC. CONCLUSIONS Gastrointestinal perforation, anastomotic leakage, abdominal drain and prior receipt of antifungals or antibiotics may help to identify critically ill patients with higher probability of developing IAC. Prospective studies are needed to identify which patients will benefit from early antifungal treatment.
Collapse
Affiliation(s)
- Matteo Bassetti
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Antonio Vena
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132, Genoa, Italy.
- Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Daniele R Giacobbe
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cecilia Trucchi
- A.Li.Sa. Liguria Health Authority, Genoa, Italy
- Healthcare Planning Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Filippo Ansaldi
- A.Li.Sa. Liguria Health Authority, Genoa, Italy
- Healthcare Planning Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Massimo Antonelli
- Department of Intensive Care Anesthesiology and Emercency Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Vaclava Adamkova
- Clinical Microbiology and ATB Centre, Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Prague, Czech Republic
- Department of Medical Microbiology, Medical Faculty of Palackeho University, Olomouc, Czech Republic
| | - Cristiano Alicino
- Medical Direction, Santa Corona Hospital, ASL 2 Regional Health System of Liguria, Pietra Ligure, Italy
| | | | - Enora Atchade
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, Paris, France
| | - Anna M Azzini
- Department of Diagnostics and Public Health, Infectious Disease Unit, University of Verona, Verona, Italy
| | | | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Maddalena Peghin
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
| | - Marco Berruti
- Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alessia Carnelutti
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
| | - Nadia Castaldo
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - George Dimopoulos
- Department of Critical Care, University Hospital Attikon, Attikon Medical School, Νational and Kapodistrian University of Athens, Athens, Greece
| | - Simon Dubler
- Department of Anesthesiology and Intensive Care Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - José L García-Garmendia
- Servicio de Cuidados Críticos y Urgencias, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville, Spain
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Stefano Ianniruberto
- Infectious Diseases Unit, Department of Medical and Surgical Science, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Bart Jan Kullberg
- Radboud Umc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrien Lagrou
- Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals of Leuven, Leuven, Belgium
- Department of Microbiology and Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Clement Lebihan
- APHP; Medical and Infectious Diseases ICU (MI2), Bichat Hospital, 75018, Paris, France
| | - Roberto Luzzati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata Di Trieste, Trieste, Italy
| | - Manu Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), 1090, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Unversiteit Brussel (VUB), 1090, Brussels, Belgium
| | - Maria Merelli
- Infectious Diseases Clinic, Santa Maria della Misericordia University Hospital of Udine, ASUFC, Udine, Italy
| | - Ana J Marques
- C.H. Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer - University of Barcelona, Barcelona, Spain
| | - Alessio Mesini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - José-Artur Paiva
- Department of Emergency and Intensive Care Medicine, Centro Hospitalar Universitário São João, Faculdade de Medicina da Universidade Do Porto E Grupo de Infecção E Sépsis, Porto, Portugal
| | - Santi Maurizio Raineri
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB) - National Research Council (CNR), Palermo, Italy
| | - Riina Rautemaa-Richardson
- Faculty of Biology, Medicine and Health, Division of Evolution, Infection and Genomics, University of Manchester, Manchester, UK
- Department of Infectious Diseases, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Jeroen Schouten
- Radboud Umc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Herbert Spapen
- Universitair Ziekenhuis Brussel, VUB University, Brussels, Belgium
| | | | - Jean-François Timsit
- Université Paris Diderot/Hopital Bichat-Réanimation Medicale et Des Maladies Infectieuses, Paris, France
- UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care, Inserm/Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Valentino Tisa
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Benoit Veber
- Pole Anesthésie-Réanimation-SAMU, Rouen University Hospital, Rouen, France
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guillaume Voiriot
- Service de Réanimation Et USC Médico-Chirurgicale, AP-HP, Hôpitaux Universitaires de L'Est Parisien, Pôle TVAR, Hôpital Tenon, Paris, France
| | - Joost Wauters
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, UK
| | | | | |
Collapse
|
3
|
Maraolo AE, Corcione S, Grossi A, Signori A, Alicino C, Hussein K, Trecarichi EM, Viale P, Timsit JF, Veeraraghavan B, Villegas MV, Rahav G, Daikos GL, Vardakas KZ, Roilides E, Uhlemann AC, Ghafur AK, Mornese Pinna S, Bassetti M, Kohler PP, Giacobbe DR. The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients. Infect Dis Ther 2021; 10:541-558. [PMID: 33586088 PMCID: PMC7954918 DOI: 10.1007/s40121-021-00408-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/23/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. METHODS We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). RESULTS IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56-3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24-2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70-4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36-3.59; I2 = 58%). CONCLUSION Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials.
Collapse
Affiliation(s)
- Alberto E Maraolo
- First Division of Infectious Diseases, Cotugno Hospital, AORN Dei Colli, Naples, Italy.
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Adriano Grossi
- Section of Hygiene, University Department of Life Sciences and Public Health, University Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Cristiano Alicino
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Medical Direction, Santa Corona Hospital, ASL 2 Regional Health System of Liguria, Pietra Ligure, Italy
| | - Khetam Hussein
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Enrico M Trecarichi
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - Jean-François Timsit
- AP-HP, Bichat Claude Bernard Hospital, Medical and Infectious Diseases ICU (MI2), Paris, France
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Maria V Villegas
- Grupo de Resistencia Antimicrobiana Y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - Galia Rahav
- Infectious Diseases Unit, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - George L Daikos
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Z Vardakas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.,Department of Medicine, Henry Dunant Hospital Center, Athens, Greece
| | - Emmanuel Roilides
- Infectious Disease Unit and Third Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece
| | - Anne-Catrin Uhlemann
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, IRCCS Per L'Oncologia, L. go R. Benzi 10, Genoa, Italy
| | - Philipp P Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Daniele R Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, IRCCS Per L'Oncologia, L. go R. Benzi 10, Genoa, Italy
| |
Collapse
|
4
|
Deferrari G, Bonanni A, Bruschi M, Alicino C, Signori A. Remote ischaemic preconditioning for renal and cardiac protection in adult patients undergoing cardiac surgery with cardiopulmonary bypass: systematic review and meta-analysis of randomized controlled trials. Nephrol Dial Transplant 2019; 33:813-824. [PMID: 28992285 DOI: 10.1093/ndt/gfx210] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/28/2017] [Indexed: 12/20/2022] Open
Abstract
Background The main aim of this systematic review was to assess whether remote ischaemic preconditioning (RIPC) protects kidneys and the heart in cardiac surgery with cardiopulmonary bypass (CPB) and to investigate a possible role of anaesthetic agents. Methods Randomized clinical trials (RCTs) on the effects of RIPC through limb ischaemia in adult patients undergoing cardiac surgery with CPB were searched (1965-October 2016) in PubMed, Cochrane Library and article reference lists. A random effects model on standardized mean difference (SMD) for continuous outcomes and the Peto odds ratio (OR) for dichotomous outcomes were used to meta-analyse data. Subgroup analyses to evaluate the effects of different anaesthetic regimens were pre-planned. Results Thirty-three RCTs (5999 participants) were included. In the whole group, RIPC did not significantly reduce the incidence of acute kidney injury (AKI), acute myocardial infarction, atrial fibrillation, mortality or length of intensive care unit (ICU) and hospital stays. On the contrary, RIPC significantly reduced the area under the curve for myocardial injury biomarkers (MIBs) {SMD -0.37 [95% confidence interval (CI) -0.53 to - 0.21]} and the composite endpoint incidence [OR 0.85 (95% CI 0.74-0.97)]. In the volatile anaesthetic group, RIPC significantly reduced AKI incidence [OR 0.57 (95% CI 0.41-0.79)] and marginally reduced ICU stay. Conversely, except for MIBs, RIPC had fewer non-significant effects under propofol with or without volatile anaesthetics. Conclusions RIPC did not consistently reduce morbidity and mortality in adults undergoing cardiac surgery with CPB. In the subgroup on volatile anaesthetics only, RIPC markedly and significantly reduced the incidence of AKI and composite endpoint as well as myocardial injury.
Collapse
Affiliation(s)
- Giacomo Deferrari
- Department of Cardionephrology, Istituto Clinico Di Alta Specialità (ICLAS), Rapallo (GE), Italy.,Department of Internal Medicine (Di.MI), University of Genoa, Genoa, Italy
| | - Alice Bonanni
- Department of Cardionephrology, Istituto Clinico Di Alta Specialità (ICLAS), Rapallo (GE), Italy.,Division of Nephrology, Dialysis and Transplantation and Laboratory on Pathophysiology of Uremia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Bruschi
- Division of Nephrology, Dialysis and Transplantation and Laboratory on Pathophysiology of Uremia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Cristiano Alicino
- Department of Health Science (Di.S.Sal), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Science (Di.S.Sal), University of Genoa, Genoa, Italy
| |
Collapse
|
5
|
Bassetti M, Giacobbe DR, Vena A, Trucchi C, Ansaldi F, Antonelli M, Adamkova V, Alicino C, Almyroudi MP, Atchade E, Azzini AM, Carannante N, Carnelutti A, Corcione S, Cortegiani A, Dimopoulos G, Dubler S, García-Garmendia JL, Girardis M, Cornely OA, Ianniruberto S, Kullberg BJ, Lagrou K, Le Bihan C, Luzzati R, Malbrain MLNG, Merelli M, Marques AJ, Martin-Loeches I, Mesini A, Paiva JA, Peghin M, Raineri SM, Rautemaa-Richardson R, Schouten J, Brugnaro P, Spapen H, Tasioudis P, Timsit JF, Tisa V, Tumbarello M, van den Berg CHSB, Veber B, Venditti M, Voiriot G, Wauters J, Montravers P. Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project. Crit Care 2019; 23:219. [PMID: 31200780 PMCID: PMC6567430 DOI: 10.1186/s13054-019-2497-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/28/2019] [Indexed: 01/26/2023]
Abstract
Background The objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe. Methods A multinational, multicenter, retrospective study was conducted in 23 ICUs in 9 European countries, representing the first phase of the candidemia/intra-abdominal candidiasis in European ICU project (EUCANDICU). Results During the study period, 570 episodes of ICU-acquired IC were observed, with a cumulative incidence of 7.07 episodes per 1000 ICU admissions, with important between-center variability. Separated, non-mutually exclusive cumulative incidences of candidemia and IAC were 5.52 and 1.84 episodes per 1000 ICU admissions, respectively. Crude 30-day mortality was 42%. Age (odds ratio [OR] 1.04 per year, 95% CI 1.02–1.06, p < 0.001), severe hepatic failure (OR 3.25, 95% 1.31–8.08, p 0.011), SOFA score at the onset of IC (OR 1.11 per point, 95% CI 1.04–1.17, p 0.001), and septic shock (OR 2.12, 95% CI 1.24–3.63, p 0.006) were associated with increased 30-day mortality in a secondary, exploratory analysis. Conclusions The cumulative incidence of IC in 23 European ICUs was 7.07 episodes per 1000 ICU admissions. Future in-depth analyses will allow explaining part of the observed between-center variability, with the ultimate aim of helping to improve local infection control and antifungal stewardship projects and interventions.
Collapse
Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy. .,Department of Health Sciences, University of Genoa, Genoa, Italy.
| | | | - Antonio Vena
- Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Cecilia Trucchi
- Health Planning unit, Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.), Liguria Region, Italy.,Health Planning unit, Policlinic San Martino Hospital - IRCCS, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Health Planning unit, Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.), Liguria Region, Italy.,Health Planning unit, Policlinic San Martino Hospital - IRCCS, Genoa, Italy
| | - Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Vaclava Adamkova
- Clinical Microbiology and ATB Centre, Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Prague, Czech Republic.,Department of Medical Microbiology, Medical Faculty of Palackeho University, Olomouc, Czech Republic
| | - Cristiano Alicino
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Medical Direction, Santa Corona Hospital, ASL 2 Regional Health System of Liguria, Pietra Ligure, Italy
| | - Maria-Panagiota Almyroudi
- Department of Critical Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece
| | - Enora Atchade
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, Paris, France
| | - Anna M Azzini
- Department of Diagnostics and Public Health, Infectious Disease Unit, University of Verona, Verona, Italy
| | | | - Alessia Carnelutti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - George Dimopoulos
- Department of Critical Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece
| | - Simon Dubler
- Department of Anesthesiology and Intensive Care Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - José L García-Garmendia
- Servicio de Cuidados Críticos y Urgencias, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, Spain
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Oliver A Cornely
- Department I of Internal Medicine, University Hospital of Cologne and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Stefano Ianniruberto
- Infectious Diseases Unit, Department of Medical and Surgical Science, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Bart Jan Kullberg
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrien Lagrou
- Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals of Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Clement Le Bihan
- Bichat-Réanimation médicale et des maladies infectieuses, Medical ICU, Paris, France
| | - Roberto Luzzati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Jette, Belgium and Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Maria Merelli
- Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Ana J Marques
- C.H. Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland.,Hospital Clinic, IDIBAPS,CIBERes, universidad de Barcelona, Barcelona, Spain
| | - Alessio Mesini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - José-Artur Paiva
- Department of Emergency and Intensive Care Medicine, Centro Hospitalar Universitário São João, Faculdade de Medicina da Universidade do Porto e Grupo de Infecção e Sépsis, Porto, Portugal
| | - Maddalena Peghin
- Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Santi Maurizio Raineri
- Department of Biopathology and Medical Biotechnologies, Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Riina Rautemaa-Richardson
- Department of Infectious Diseases, Manchester University NHS Foundation Trust, Wythenshawe Hospital; and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jeroen Schouten
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pierluigi Brugnaro
- Infectious Diseases Department, Ospedale Civile SS. Giovanni e Paolo, Venice, Italy
| | - Herbert Spapen
- Intensive Care Department, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | | | - Jean-François Timsit
- Université Paris Diderot/Hopital Bichat-Réanimation Medicale et Des Maladies Infectieuses, Paris, France.,UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care, Inserm/Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Valentino Tisa
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Benoit Veber
- Pole Anesthésie-Réanimation-SAMU, Rouen University Hospital, Rouen, France
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guillaume Voiriot
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de réanimation médico-chirurgicale, Hôpital Tenon, 75020, Paris, France
| | - Joost Wauters
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Montravers
- Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, Paris, France.,Université de Paris, INSERM UMR 1152, Paris, France
| |
Collapse
|
6
|
Spila Alegiani S, Alfonsi V, Appelgren EC, Ferrara L, Gallo T, Alicino C, Pascucci MG, Aquilani S, Spadea A, Tafuri S, Rizzo C. Active surveillance for safety monitoring of seasonal influenza vaccines in Italy, 2015/2016 season. BMC Public Health 2018; 18:1401. [PMID: 30577729 PMCID: PMC6303938 DOI: 10.1186/s12889-018-6260-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surveillance for adverse events following immunization is an important component of any national immunization programme because it is critical to assessing the safety of vaccines and to detecting potentially rare and severe adverse events and responding in a timely manner. We conducted an enhanced active surveillance aimed at assessing the safety of flu vaccines in the 2015-2016 season in Italy. The study was targeted to the population groups for which the seasonal vaccine is recommended in Italy. METHODS During the study period, a total of 3213 individuals receiving seasonal influenza vaccination were registered on the web-based platform. Any adverse events experienced after 7 days from vaccination by individuals aged six months or more were collected through a telephone interview or by a web-based self-administered questionnaire. All individuals experiencing at least one event during the 7 days of follow-up were contacted for follow-up to 60 days. RESULTS Overall, 854 events were reported: 845 events (26%) after administration of the first dose and 9 (12%) after the second dose. The majority of adverse events reported after 7 days from the first dose were of little clinical importance, and most involved local symptoms. CONCLUSION Our data, even though the number of vaccinated individuals was smaller than expected, is consistent with the safety of influenza vaccines in Italy during the 2015-2016 season regarding the most common adverse events. Further efforts are needed to obtain sufficient power to study rarer adverse events. Active monitoring and systematic studies to test generated signals and hypotheses are crucial to intensify awareness among the public and professionals with regard to the safety of vaccines.
Collapse
Affiliation(s)
| | - Valeria Alfonsi
- Department of Infectious Disease, Istituto Superiore di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Eva Charlotte Appelgren
- Department of Infectious Disease, Istituto Superiore di Sanità - Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Lorenza Ferrara
- SeREMI, Local Health Unit of Alessandria-Piedmont Region, Alessandria, Italy
| | - Tolinda Gallo
- Department of Prevention, Local Health Unit 4 Medio Friuli, Udine, Italy
| | | | - Maria Grazia Pascucci
- Directorate General for Health and Social Policy - Emilia-Romagna Region, Bologna, Italy
| | | | | | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Caterina Rizzo
- Unit of Innovation and Clinical Pathways, Bambino Gesù Children’s Hospital, Rome, Italy
| |
Collapse
|
7
|
Zoia C, Bongetta D, Guerrini F, Alicino C, Cattalani A, Bianchini S, Galzio RJ, Luzzi S. Outcome of elderly patients undergoing intracranial meningioma resection: a single center experience. J Neurosurg Sci 2018; 65:513-517. [PMID: 29808631 DOI: 10.23736/s0390-5616.18.04333-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Higher life expectancy and higher mean age in general population created growing interest in medical and surgical management of meningiomas in elderly. It is well known that, due to possible complications, pre-operative status and comorbidities, expecially in aged people, should be carefully considerated in the decision-making process. We described our experience with this kind of patients and analized the influence of complications on the outcome. METHODS We conducted a monocentric retrospective study to evaluate outcome and complications in elderly patients that underwent intracranial meningioma surgery in our center in a ten year period. Between January 2005 and December 2014, 107 patients - older than 70 years old - were operated for an intracranial meningioma. We excluded patients operated for a recurrent meningioma. We use the Dindo classification modified by Poon to describe complications and the Karnofsky Performance Status Scale and Glasgow Outcome Scale to evaluate the outcome at discharge and after a 6 months period. RESULTS 84 patients did not have postoperative complications, 10 patients had mild postoperative complications, while 13 patients suffered severe postoperative complications. As a group, patients with mild complications presented, six months after surgery, an average Karnofsky Performance Status better than preoperative one. CONCLUSIONS Even though the fragility is considered an important risk factor, surgery for symptomatic intracranial meningiomas should be considered also in elderly patients. The presence of early postoperative mild complications do not seem to worsen the average 6 months- KSP score.
Collapse
Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesco Guerrini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy -
| | - Cristiano Alicino
- Department of Emergency and Organ Transplantation, University Aldo Moro, Bari, Italy
| | - Andrea Cattalani
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Simonetta Bianchini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Renato J Galzio
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy.,Department of Emergency and Organ Transplantation, University Aldo Moro, Bari, Italy
| |
Collapse
|
8
|
Bassetti M, Righi E, Del Giacomo P, Sartor A, Ansaldi F, Trucchi C, Alicino C, Trecarichi EM, Spanu T, Paganino C, Tumbarello M, Carnelutti A. Predictors of Mortality with Staphylococcus aureus Bacteremia in Elderly Adults. J Am Geriatr Soc 2018; 66:1284-1289. [PMID: 29664994 DOI: 10.1111/jgs.15391] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To analyze risk factors for early and late mortality in individuals aged 75 and older with Staphylococcus aureus bacteremia (SAB) in Italy. DESIGN Four-year retrospective observational study (January 2011-December 2014). SETTING Two tertiary care university hospitals in Italy (Santa Maria Misericordia Hospital in Udine, Policlinico Universitario Agostino Gemelli in Rome). PARTICIPANTS All adults consecutively admitted with SAB. MEASUREMENTS Clinical presentation, infection characteristics, and clinical outcomes of individuals aged 75 and older were compared with those of individuals younger than 75. RESULTS Three hundred thirty-seven cases of SAB were diagnosed during the study period, 118 of which (35%) occurred in those aged 75 and older. Seven- (20.3% vs 9.2%) and 30-day (35.7% vs 20.7%) mortality were significantly higher in elderly than younger adults. Clinical presentation with septic shock, adequacy of empiric antibiotic treatment, and liver cirrhosis were found to be predictors of 7-day mortality in elderly adults with SAB. Risk factors independently associated with 30-day mortality included isolation of methicillin-resistant Staphylococcus aureus (MRSA) and not receiving an infectious disease consultation. CONCLUSION Mortality is significantly higher in elderly than in younger adults with SAB, particularly in those presenting with septic shock, liver cirrhosis, or SAB due to MRSA. Additional risk factors for mortality included inappropriate empiric antibiotic treatment and not receiving an infectious disease consultation.
Collapse
Affiliation(s)
- Matteo Bassetti
- Santa Maria Misericordia Hospital and University of Udine, Udine, Italy
| | - Elda Righi
- Santa Maria Misericordia Hospital and University of Udine, Udine, Italy
| | - Paola Del Giacomo
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Assunta Sartor
- Santa Maria Misericordia Hospital and University of Udine, Udine, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cecilia Trucchi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Enrico Maria Trecarichi
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Teresa Spanu
- Institute of Microbiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Chiara Paganino
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | |
Collapse
|
9
|
Orsi A, Colomba GME, Pojero F, Calamusa G, Alicino C, Trucchi C, Canepa P, Ansaldi F, Vitale F, Tramuto F. Trends of influenza B during the 2010-2016 seasons in 2 regions of north and south Italy: The impact of the vaccine mismatch on influenza immunisation strategy. Hum Vaccin Immunother 2018; 14:523-531. [PMID: 28708953 PMCID: PMC5861802 DOI: 10.1080/21645515.2017.1342907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/22/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022] Open
Abstract
Influenza A and B viruses are responsible for respiratory infections, representing globally seasonal threats to human health. The 2 viral types often co-circulate and influenza B plays an important role in the spread of infection. A 6-year retrospective surveillance study was conducted between 2010 and 2016 in 2 large administrative regions of Italy, located in the north (Liguria) and in the south (Sicily) of the country, to describe the burden and epidemiology of both B/Victoria and B/Yamagata lineages in different healthcare settings. Influenza B viruses were detected in 5 of 6 seasonal outbreaks, exceeding influenza A during the season 2012-2013. Most of influenza B infections were found in children aged ≤ 14 y and significant differences were observed in the age-groups infected by the different lineages. B/Victoria strains prevailed in younger population than B/Yamagata, but also were more frequently found in the community setting. Conversely, B/Yamagata viruses were prevalent among hospitalized cases suggesting their potential role in the development of more severe disease. The relative proportions of viral lineages varied from year to year, resulting in different lineage-level mismatch for the B component of trivalent influenza vaccine. Our findings confirmed the need for continuous virological surveillance of seasonal epidemics and bring attention to the adoption of universal influenza immunization program in the childhood. The use of tetravalent vaccine formulations may be useful to improve the prevention and control of the influenza burden in general population.
Collapse
Affiliation(s)
- Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS University Hospital “San Martino” - IST National Institute for Cancer Research, Genoa, Italy
| | - Giuseppina Maria Elena Colomba
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Fanny Pojero
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Giuseppe Calamusa
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | | | - Cecilia Trucchi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Paola Canepa
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS University Hospital “San Martino” - IST National Institute for Cancer Research, Genoa, Italy
| | - Francesco Vitale
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| | - Fabio Tramuto
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| |
Collapse
|
10
|
Zoia C, Bongetta D, Alicino C, Chimenti M, Pugliese R, Gaetani P. Usefulness of corset adoption after single-level lumbar discectomy: a randomized controlled trial. J Neurosurg Spine 2018; 28:481-485. [PMID: 29424674 DOI: 10.3171/2017.8.spine17370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this paper, the authors sought to verify whether corset adoption could improve the short-term and midterm outcome scores of patients after single-level lumbar discectomy. METHODS A monocentric, randomized controlled trial of 54 consecutive patients who underwent single-level lumbar discectomy at the authors' institution was performed from September 2014 to August 2015. Patients were randomly assigned to use or not use a lumbar corset in the upright position. Patients with previous interventions for disc herniation or with concomitant canal or foraminal stenosis were excluded. The visual analog scale, Oswestry Disability Index, and Roland Morris Disability Questionnaire were used to compare groups at the 1- and 6-month follow-up time points. RESULTS No significant differences between the 2 groups were reported at either time point for any given outcome irrespective of the scale used. CONCLUSIONS Corset adoption does not improve the short-term and midterm outcomes of patients after single-level lumbar discectomy.
Collapse
Affiliation(s)
- Cesare Zoia
- 1Neurosurgery Unit, IRCCS Fondazione Policlinico San Matteo, Pavia
| | - Daniele Bongetta
- 1Neurosurgery Unit, IRCCS Fondazione Policlinico San Matteo, Pavia.,2Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia; and
| | | | - Marcella Chimenti
- 2Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia; and
| | | | - Paolo Gaetani
- 1Neurosurgery Unit, IRCCS Fondazione Policlinico San Matteo, Pavia
| |
Collapse
|
11
|
Dini G, Toletone A, Barberis I, Debarbieri N, Massa E, Paganino C, Bersi F, Montecucco A, Alicino C, Durando P. Persistence of protective anti-HBs antibody levels and anamnestic response to HBV booster vaccination: A cross-sectional study among healthcare students 20 years following the universal immunization campaign in Italy. Hum Vaccin Immunother 2017; 13:440-444. [PMID: 27925503 PMCID: PMC5328216 DOI: 10.1080/21645515.2017.1264788] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Vaccination against Hepatitis B Virus (HBV) became mandatory in Italy for all newborns and 12 years-old individuals in the 1991. The immunogenicity of HBV vaccine and the effectiveness of the universal immunization strategy have been widely demonstrated. However the need to assess the antibody concentrations above the well known serological correlate of protection for HBV infection (≥10 mIU/mL), established in individuals immunized with a 3 doses vaccination course, is still recommended in subjects exposed to occupational risks in different settings, particularly the healthcare services. This practice has to be performed during the preventive medical examination, before the worker's exposure to biological hazards, as a fundamental part of Occupational Health Surveillance Programs in several Countries, including Italy: the goal is to assure individual protection, also providing booster doses when needed, after many years following the primary vaccination. During the 2011–2013 period, an observational study was performed in Healthcare students (HCSs) trained at a regional university acute-care hospital in North-Western Italy, properly immunized against HBV during infancy or adolescence, in order to evaluate the persistence of seroprotection and to assess the anamnestic response to booster vaccination. Data from 717 subjects undergoing HbsAg Ab and HBc Ab testing during the preventive medical examination, and receiving a booster dose of HBV vaccine when resulting with a non-protective titer (<10 mIU/mL), were collected and analyzed. Most of the HCSs (74.6%) included in the survey, mean age 24.8 y ( ± 4.6 SD), had received the primary vaccination course during the first year of life (3–5–11 months). Globally, 507 (70.7%) HCSs showed protective antibody titres, and an anamnestic response was observed in more than 95% subjects receiving the booster dose. Our study demonstrated the long-term persistence of protection of HBV vaccine, more than 20 y following the primary immunization, in HCSs who are exposed to occupational health risk. The anamnestic response observed in non-seroprotected subjects who received the booster further confirms the capability of the HBV vaccine to create a strong immunological memory.
Collapse
Affiliation(s)
- Guglielmo Dini
- a Department of Health Sciences , Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research , Genoa , Italy
| | - Alessandra Toletone
- a Department of Health Sciences , Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research , Genoa , Italy
| | - Ilaria Barberis
- b Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Nicoletta Debarbieri
- a Department of Health Sciences , Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research , Genoa , Italy
| | - Emanuela Massa
- a Department of Health Sciences , Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research , Genoa , Italy
| | - Chiara Paganino
- b Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Francesca Bersi
- a Department of Health Sciences , Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research , Genoa , Italy
| | - Alfredo Montecucco
- a Department of Health Sciences , Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research , Genoa , Italy
| | - Cristiano Alicino
- b Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Paolo Durando
- a Department of Health Sciences , Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, I.R.C.C.S. University Hospital San Martino - IST National Institute for Cancer Research , Genoa , Italy
| |
Collapse
|
12
|
Giacobbe DR, Del Bono V, Mikulska M, Gustinetti G, Marchese A, Mina F, Signori A, Orsi A, Rudello F, Alicino C, Bonalumi B, Morando A, Icardi G, Beltramini S, Viscoli C. Correction to: Impact of a mixed educational and semi-restrictive antimicrobial stewardship project in a large teaching hospital in Northern Italy. Infection 2017; 45:929. [PMID: 28983883 DOI: 10.1007/s15010-017-1068-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A technical error led to incorrect rendering of the author group in this article. The correct authorship is as follows: Daniele Roberto Giacobbe1, Valerio Del Bono1, Malgorzata Mikulska1, Giulia Gustinetti1, Anna Marchese2, Federica Mina3, Alessio Signori4, Andrea Orsi5, Fulvio Rudello6, Cristiano Alicino5, Beatrice Bonalumi3, Alessandra Morando7, Giancarlo Icardi5, Sabrina Beltramini3, Claudio Viscoli1; On behalf of the San Martino Antimicrobial Stewardship Group.
Collapse
Affiliation(s)
- Daniele Roberto Giacobbe
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy.
| | - Valerio Del Bono
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Malgorzata Mikulska
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Giulia Gustinetti
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Anna Marchese
- S.S.D. Microbiologia, University of Genoa (DISC) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, Genoa, Italy
| | - Federica Mina
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | | | - Andrea Orsi
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Fulvio Rudello
- SANTALUCIA PHARMA APPS©, Località Gragnanino, Gragnano Trebbiense, PC, Italy
| | - Cristiano Alicino
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Beatrice Bonalumi
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Alessandra Morando
- U.O. Governo Clinico e Organizzazione Ospedaliera, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Giancarlo Icardi
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Sabrina Beltramini
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Claudio Viscoli
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | | |
Collapse
|
13
|
Alicino C, Paganino C, Orsi A, Astengo M, Trucchi C, Icardi G, Ansaldi F. The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on hospitalization for pneumonia in children: A systematic review and meta-analysis. Vaccine 2017; 35:5776-5785. [DOI: 10.1016/j.vaccine.2017.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/28/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
|
14
|
Bragazzi NL, Alicino C, Trucchi C, Paganino C, Barberis I, Martini M, Sticchi L, Trinka E, Brigo F, Ansaldi F, Icardi G, Orsi A. Global reaction to the recent outbreaks of Zika virus: Insights from a Big Data analysis. PLoS One 2017; 12:e0185263. [PMID: 28934352 PMCID: PMC5608413 DOI: 10.1371/journal.pone.0185263] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 09/08/2017] [Indexed: 01/08/2023] Open
Abstract
Objective The recent spreading of Zika virus represents an emerging global health threat. As such, it is attracting public interest worldwide, generating a great amount of related Internet searches and social media interactions. The aim of this research was to understand Zika-related digital behavior throughout the epidemic spreading and to assess its consistence with real-world epidemiological data, using a behavioral informatics and analytics approach. Methods In this study, the global web-interest and reaction to the recently occurred outbreaks of the Zika Virus were analyzed in terms of tweets and Google Trends (GT), Google News, YouTube, and Wikipedia search queries. These data streams were mined from 1st January 2004 to 31st October 2016, with a focus on the period November 2015—October 2016. This analysis was complemented with the use of epidemiological data. Spearman’s correlation was performed to correlate all Zika-related data. Moreover, a multivariate regression was performed using Zika-related search queries as a dependent variable, and epidemiological data, number of inhabitants in 2015 and Human Development Index as predictor variables. Results Overall 3,864,395 tweets, 284,903 accesses to Wikipedia pages dedicated to the Zika virus were analyzed during the study period. All web-data sources showed that the main spike of researches and interactions occurred in February 2016 with a second peak in August 2016. All novel data streams-related activities increased markedly during the epidemic period with respect to pre-epidemic period when no web activity was detected. Correlations between data from all these web platforms resulted very high and statistically significant. The countries in which web searches were particularly concentrated are mainly from Central and South Americas. The majority of queries concerned the symptoms of the Zika virus, its vector of transmission, and its possible effect to babies, including microcephaly. No statistically significant correlation was found between novel data streams and global real-world epidemiological data. At country level, a correlation between the digital interest towards the Zika virus and Zika incidence rate or microcephaly cases has been detected. Conclusions An increasing public interest and reaction to the current Zika virus outbreak was documented by all web-data sources and a similar pattern of web reactions has been detected. The public opinion seems to be particularly worried by the alert of teratogenicity of the Zika virus. Stakeholders and health authorities could usefully exploited these internet tools for collecting the concerns of public opinion and reply to them, disseminating key information.
Collapse
Affiliation(s)
| | - Cristiano Alicino
- Department of Health Sciences, University of Genoa, Genoa, Italy
- * E-mail:
| | - Cecilia Trucchi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Chiara Paganino
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Ilaria Barberis
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Mariano Martini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Laura Sticchi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit,”Ospedale Policlinico San Martino IRCCS” teaching hospital, Genoa, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Center for Cognitive Neuroscience, Salzburg, Austria
- Department of Public Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, Hall i.T., Innsbruck, Austria
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
- Department of Neurological, Biomedical, and Movement Sciences, University of Verona, Verona, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit,”Ospedale Policlinico San Martino IRCCS” teaching hospital, Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit,”Ospedale Policlinico San Martino IRCCS” teaching hospital, Genoa, Italy
| |
Collapse
|
15
|
Giacobbe DR, Del Bono V, Mikulska M, Gustinetti G, Marchese A, Mina F, Signori A, Orsi A, Rudello F, Alicino C, Bonalumi B, Morando A, Icardi G, Beltramini S, Viscoli C. Impact of a mixed educational and semi-restrictive antimicrobial stewardship project in a large teaching hospital in Northern Italy. Infection 2017; 45:849-856. [PMID: 28856589 DOI: 10.1007/s15010-017-1063-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The overuse of antimicrobials favors the dissemination of antimicrobial resistance, as well as invasive fungal diseases and Clostridium difficile infections (CDI). In this study, we assessed the impact of a mixed educational and semi-restrictive antimicrobial stewardship (AMS) project in a large teaching hospital in Italy. METHODS The AMS project was conducted from May 2014 to April 2016. It consisted of two initiatives in two consecutive periods: (1) educational activities; (2) semi-restrictive control of antimicrobial prescribing through a computerized software. The primary endpoint was consumption of antibacterials and antifungals. Secondary endpoints were incidence of CDI, methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI), carbapenem-resistant Klebsiella pneumoniae (CRKP) BSI, and Candida BSI. RESULTS During the study period, a statistically significant reduction in consumption was observed for antibacterials (-1.45 defined daily doses (DDD)/1000 patient-days monthly, 95% confidence intervals [CI] -2.38 to -0.52, p 0.004), mainly driven by reductions in the use of fluoroquinolones, third/fourth generation cephalosporins, and carbapenems. No decrease in consumption of antifungals was observed (-0.04 DDD/1000 patient-days monthly, 95% CI -0.34 to +0.25, p 0.750). A statistically significant trend towards reduction was observed for incidence of CRKP BSI (incidence rate ratio 0.96, 95% CI 0.92-0.99, p 0.013). No statistically significant variations in trends were observed for CDI, MRSA BSI, and Candida BSI. CONCLUSIONS The mixed AMS project was effective in reducing the use of major antibacterials and the incidence of CRKP BSI. Further research is needed to assess the extent of long-term benefits of semi-restrictive approaches.
Collapse
Affiliation(s)
- Daniele Roberto Giacobbe
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy.
| | - Valerio Del Bono
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Malgorzata Mikulska
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Giulia Gustinetti
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Anna Marchese
- S.S.D. Microbiologia, University of Genoa (DISC) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, Genoa, Italy
| | - Federica Mina
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | | | - Andrea Orsi
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Fulvio Rudello
- SANTALUCIA PHARMA APPS©, Località Gragnanino, Gragnano Trebbiense, PC, Italy
| | - Cristiano Alicino
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Beatrice Bonalumi
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Alessandra Morando
- U.O. Governo Clinico e Organizzazione Ospedaliera, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Giancarlo Icardi
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Sabrina Beltramini
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Claudio Viscoli
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| |
Collapse
|
16
|
Cristina ML, Alicino C, Sartini M, Faccio V, Spagnolo AM, Bono VD, Cassola G, De Mite AM, Crisalli MP, Ottria G, Schinca E, Pinto GL, Bottaro LC, Viscoli C, Orsi A, Giacobbe DR, Icardi G. Epidemiology, management, and outcome of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in hospitals within the same endemic metropolitan area. J Infect Public Health 2017; 11:171-177. [PMID: 28668656 DOI: 10.1016/j.jiph.2017.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/13/2017] [Accepted: 06/09/2017] [Indexed: 01/11/2023] Open
Abstract
In the last decade, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in several countries, including Italy. In the present study, we assessed the differences in epidemiology, management, and mortality of CR-Kp bloodstream infection (BSI) in the three main adult acute-care hospitals of the metropolitan area of Genoa, Italy. From January 2013 to December 2014, all patients with CR-Kp BSI were identified through the computerized microbiology laboratory databases of the three hospitals. The primary endpoints of the study were incidence and characteristics of CR-Kp BSI in hospitals within the same endemic metropolitan area. Secondary endpoints were characteristics of CR-Kp BSI in hospitals with and without internal infectious diseases consultants (IDCs) and 15-day mortality. During the study period, the incidence of healthcare-associated CR-Kp BSI in the entire study population was 1.35 episodes per 10,000 patient-days, with substantial differences between the three hospitals. Patients admitted to the two hospital with internal IDCs were more likely to receive post-susceptibility test combined therapy including carbapenems (77% vs. 26%, p<0.001), adequate post-susceptibility test therapies (86% vs. 52%, p<0.001), and post-susceptibility therapies prescribed by an infectious diseases specialist (84% vs. 14%, p<0.001). Overall, the crude 15-days mortality was 26%. In the final multivariable model, only septic shock at BSI presentation was unfavorably and independently associated with 15-days mortality (odds ratio [OR] 6.7, 95% confidence intervals [CI] 2.6-17.6, p<0.001), while a protective effect was observed for post-susceptibility test combined therapies including a carbapenem (OR 0.11, 95% CI 0.03-0.43, p=0.002). Mortality of CR-Kp remains high. Differences in the incidence of CR-Kp BSI were detected between acute-care centers within the same endemic metropolitan area. Efforts should be made to improve the collaboration and coordination between centers, to prevent further diffusion of CR-Kp.
Collapse
Affiliation(s)
- Maria L Cristina
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy; Hospital Hygiene Unit, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
| | - Cristiano Alicino
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy.
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy; Hospital Hygiene Unit, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
| | - Valeria Faccio
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy.
| | - Anna M Spagnolo
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy.
| | - Valerio D Bono
- Infectious Diseases Unit, IRCCS AOU San Martino-IST Teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy.
| | - Giovanni Cassola
- Infectious Diseases Unit, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
| | - Anna M De Mite
- Medical Directorate, Local Health Unit 3, Via Bertani 4, 16125 Genoa, Italy.
| | - Maria P Crisalli
- Infectious Diseases Unit, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
| | - Gianluca Ottria
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy; Hospital Hygiene Unit, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
| | - Elisa Schinca
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy; Hospital Hygiene Unit, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
| | - Giuliano L Pinto
- Medical Directorate, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
| | - Luigi C Bottaro
- Medical Directorate, Local Health Unit 3, Via Bertani 4, 16125 Genoa, Italy.
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy; Infectious Diseases Unit, IRCCS AOU San Martino-IST Teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy.
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy; Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST Teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy.
| | - Daniele R Giacobbe
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy; Infectious Diseases Unit, IRCCS AOU San Martino-IST Teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy.
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132, Italy; Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST Teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy.
| | | |
Collapse
|
17
|
Tin Tin Htar M, Stuurman AL, Ferreira G, Alicino C, Bollaerts K, Paganino C, Reinert RR, Schmitt HJ, Trucchi C, Vestraeten T, Ansaldi F. Effectiveness of pneumococcal vaccines in preventing pneumonia in adults, a systematic review and meta-analyses of observational studies. PLoS One 2017; 12:e0177985. [PMID: 28542347 PMCID: PMC5441633 DOI: 10.1371/journal.pone.0177985] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/05/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION S. pneumoniae can cause a wide spectrum of diseases, including invasive pneumococcal disease and pneumonia. Two types of pneumococcal vaccines are indicated for use in adults: 23-valent pneumococcal polysaccharide vaccines (PPV23) and a 13-valent pneumococcal conjugate vaccine (PCV13). OBJECTIVE To systematically review the literature assessing pneumococcal vaccine effectiveness (VE) against community-acquired pneumonia (CAP) in adults among the general population, the immunocompromised and subjects with underlying risk factors in real-world settings. METHODS We searched for peer-reviewed observational studies published between 1980 and 2015 in Pubmed, SciELO or LILACS, with pneumococcal VE estimates against CAP, pneumococcal CAP or nonbacteremic pneumococcal CAP. Meta-analyses and meta-regression for VE against CAP requiring hospitalization in the general population was performed. RESULTS 1159 unique articles were retrieved of which 33 were included. No studies evaluating PCV13 effectiveness were found. Wide ranges in PPV23 effectiveness estimates for any-CAP were observed among adults ≥65 years (-143% to 60%). The meta-analyzed VE estimate for any-CAP requiring hospitalization in the general population was 10.2% (95%CI: -12.6; 33.0). The meta-regression indicates that VE against any-CAP requiring hospitalization is significantly lower in studies with a maximum time since vaccination ≥60 months vs. <60 months and in countries with the pediatric PCV vaccine available on the private market. However, these results should be interpreted cautiously due to the high influence of two studies. The VE estimates for pneumococcal CAP hospitalization ranged from 32% (95%CI: -18; 61) to 51% (95%CI: 16; 71) in the general population. CONCLUSIONS Wide ranges in PPV23 effectiveness estimates for any-CAP were observed, likely due to a great diversity of study populations, circulation of S. pneumoniae serotypes, coverage of pediatric pneumococcal vaccination, case definition and time since vaccination. Despite some evidence for short-term protection, effectiveness of PPV23 against CAP was not consistent in the general population, the immunocompromised and subjects with underlying risk factors.
Collapse
Affiliation(s)
| | - Anke L. Stuurman
- P95 Epidemiology and Pharmacovigilance Consulting and Services, P95, Leuven, Belgium
| | - Germano Ferreira
- P95 Epidemiology and Pharmacovigilance Consulting and Services, P95, Leuven, Belgium
| | - Cristiano Alicino
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Kaatje Bollaerts
- P95 Epidemiology and Pharmacovigilance Consulting and Services, P95, Leuven, Belgium
| | - Chiara Paganino
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Ralf René Reinert
- Pfizer: Vaccines Medical Development and Scientific Clinical Affairs, Pfizer Inc, Paris, France
| | - Heinz-Josef Schmitt
- Pfizer: Vaccines Medical Development and Scientific Clinical Affairs, Pfizer Inc, Paris, France
| | - Cecilia Trucchi
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - Thomas Vestraeten
- P95 Epidemiology and Pharmacovigilance Consulting and Services, P95, Leuven, Belgium
| | - Filippo Ansaldi
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| |
Collapse
|
18
|
Bassetti M, Peghin M, Carnelutti A, Righi E, Merelli M, Ansaldi F, Trucchi C, Alicino C, Sartor A, Toniutto P, Wauters J, Laleman W, Tascini C, Menichetti F, Luzzati R, Brugnaro P, Mesini A, Raviolo S, De Rosa FG, Lagunes L, Rello J, Dimopoulos G, Colombo AL, Nucci M, Vena A, Bouza E, Muñoz P, Tumbarello M, Losito R, Martin-Loeches I, Viscoli C. Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: a multicenter study. Intensive Care Med 2017; 43:509-518. [DOI: 10.1007/s00134-017-4717-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/07/2017] [Indexed: 12/23/2022]
|
19
|
Bassetti M, Peghin M, Trecarichi EM, Carnelutti A, Righi E, Del Giacomo P, Ansaldi F, Trucchi C, Alicino C, Cauda R, Sartor A, Spanu T, Scarparo C, Tumbarello M. Characteristics of Staphylococcus aureus Bacteraemia and Predictors of Early and Late Mortality. PLoS One 2017; 12:e0170236. [PMID: 28152067 PMCID: PMC5289427 DOI: 10.1371/journal.pone.0170236] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/01/2017] [Indexed: 12/03/2022] Open
Abstract
We aimed to describe the characteristics of patients with Staphylococcus aureus bacteremia and to evaluate the risk factors associated with early (7-day) and late (30-day) mortality. We performed an observational study including all consecutive episodes of Staphylococcus aureus bacteremia diagnosed at two Italian university hospitals during 2010–2014. A total of 337 patients were included. Mean age was 69 years (range, 57–78) and 65% were males. Methicillin-resistant S. aureus (MRSA) was identified in 132/337 (39%)cases. Overall 7- and 30-day mortality were 13% and 26%, respectively. Early mortality was associated with increased Charlson scores (OR 1.3, 95% CI 1.1–1.5), MRSA bacteremia (OR 3.2, 95% CI 1.4–8.1), presentation with septic shock (OR 13.5, 95% CI 5.4–36.4), and occurrence of endocarditis (OR 4.5, 95%CI 1.4–14.6). Similar risk factors were identified for late mortality, including increased Charlson scores (OR 1.2, 95% CI 1.1–1.4), MRSA bacteremia (OR 2.1, 95% CI 1.2–3.9), presentation with septic shock (OR 4, 95%CI 1.7–9.7), occurrence of endocarditis (OR 3.8, 95% CI 1.4–10.2) as well as Child C cirrhosis (OR 3.9, 95% CI 1.1–14.4) and primary bacteremia (OR 2.5, 95%CI 1.3–5). Infectious disease consultation resulted in better outcomes both at 7 (OR 0.1, 95% CI 0.05–0.4) and at 30 days (OR 0.4, 95% CI 0.2–0.7). In conclusion, our study highlighted high rates of MRSA infection in nosocomial Staphylococcus aureus bacteremia. Multiple comorbidities, disease severity and methicillin-resistance are key factors for early and late mortality in this group. In patients with Staphylococcus aureus bacteremia, infectious disease consultation remains a valuable tool to improve clinical outcome.
Collapse
Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
- * E-mail:
| | - Maddalena Peghin
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | | | - Alessia Carnelutti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Elda Righi
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Paola Del Giacomo
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Ansaldi
- IRCCS AOU San Martino IST, Department of Health Sciences, University of Genoa; Genoa, Italy
| | - Cecilia Trucchi
- IRCCS AOU San Martino IST, Department of Health Sciences, University of Genoa; Genoa, Italy
| | - Cristiano Alicino
- IRCCS AOU San Martino IST, Department of Health Sciences, University of Genoa; Genoa, Italy
| | - Roberto Cauda
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Assunta Sartor
- Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Teresa Spanu
- Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Claudio Scarparo
- Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
20
|
Boccalini S, Alicino C, Martinelli D, Bechini A, Tiscione E, Pellizzari B, Prato R, Icardi G, Iannazzo S, Bonanni P. Clinical and economic impact of herpes zoster vaccination in elderly in Italy. Hum Vaccin Immunother 2016; 13:405-411. [PMID: 27925856 DOI: 10.1080/21645515.2017.1264832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Herpes zoster (HZ) is a very relevant pathology among elderly people (≥ 60 years of age), with a considerable disease burden and loss of quality of life. In the last years a new vaccine against HZ became available in Italy. Therefore, the Italian decision makers are now confronted with the decision whether that vaccination should be implemented. Pharmaco-economic analyses represent useful tools to value the feasibility of new immunization programs and their sustainability. To this aim, an ad hoc population model was developed in order to value the clinical and economic impact of HZ vaccination program for the elderly in Italy. Particularly, different immunization scenarios were modeled: vaccination of 60 years-old subjects (single cohort strategy), simultaneous vaccination of people aged 60 and 65 years (double cohort strategy) and, lastly, immunization of people aged 60, 65 and 70 years (triple cohort strategy), thus leading to the vaccination of 5, 10 and 15 cohorts during the first 5 years of the program. The mathematical model valued the clinical impact of vaccination on the number of HZ, post-herpetic neuralgia (PHN) and ophthalmic HZ. The results of the analysis show that, in Italy, a cohort-based HZ vaccination program in elderly could have a relevant impact on the reduction of clinical cases and a favorable economic profile for the National Health Service (NHS), as already foreseen in other countries. In addition, further benefits could be obtained when extending the study period beyond the 5-year horizon of our analysis.
Collapse
Affiliation(s)
- Sara Boccalini
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Cristiano Alicino
- b Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Domenico Martinelli
- c Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | - Angela Bechini
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Emilia Tiscione
- a Department of Health Sciences , University of Florence , Florence , Italy
| | - Barbara Pellizzari
- d Regional Center for Disease Prevention and Control , Veneto Region , Italy
| | - Rosa Prato
- c Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | - Giancarlo Icardi
- b Department of Health Sciences , University of Genoa , Genoa , Italy
| | | | - Paolo Bonanni
- a Department of Health Sciences , University of Florence , Florence , Italy
| |
Collapse
|
21
|
Trucchi C, Alicino C, Orsi A, Paganino C, Barberis I, Grammatico F, Canepa P, Rappazzo E, Bruzzone B, Sticchi L, Ansaldi F. Fifteen years of epidemiologic, virologic and syndromic influenza surveillance: A focus on type B virus and the effects of vaccine mismatch in Liguria region, Italy. Hum Vaccin Immunother 2016; 13:456-463. [PMID: 27924684 PMCID: PMC5328239 DOI: 10.1080/21645515.2017.1264779] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In order to estimate the burden of influenza and to describe the genetic evolutionary pattern and antigenic variability of type B viral strains, data deriving from 3 surveillance systems active in Liguria region, Northern Italy, were described. Since the re-emergence of the Victoria lineage in 2001, the clinical-epidemiological and syndromic surveillances demonstrated the heavy burden of influenza like illness (ILI) syndrome. Focusing on type B influenza virus, it predominated or played a relevant epidemic role in the 50% of the evaluated influenza seasons. Furthermore, the virologic surveillance demonstrated the frequent co-circulation of both lineages an heterogeneous circulation of different influenza B strains, determining a partial or complete mismatch in at least 6 influenza seasons. The undemonstrated cross-reactivity between lineages and the unpredictability of predominant lineage arose the scientific debate about the opportunity to include the quadrivalent influenza vaccine among the preventive tools to improve the protection against type B viruses. The integration of different surveillance systems highly contribute to estimate the poorly evaluated burden of type B influenza virus and help to find variants to include in the vaccine formulation.
Collapse
Affiliation(s)
- Cecilia Trucchi
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Cristiano Alicino
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Andrea Orsi
- a Department of Health Sciences , University of Genoa , Genoa , Italy.,b O.U. Hygiene, IRCCS AOU San Martino - IST , Genoa , Italy
| | - Chiara Paganino
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Ilaria Barberis
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | | | - Paola Canepa
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Emanuela Rappazzo
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | | | - Laura Sticchi
- a Department of Health Sciences , University of Genoa , Genoa , Italy.,c O.U. Clinical Governance and Hospital Organization, IRCCS AOU San Martino - IST , Genoa , Italy
| | - Filippo Ansaldi
- a Department of Health Sciences , University of Genoa , Genoa , Italy.,c O.U. Clinical Governance and Hospital Organization, IRCCS AOU San Martino - IST , Genoa , Italy
| |
Collapse
|
22
|
Alicino C, Trucchi C, Paganino C, Barberis I, Boccalini S, Martinelli D, Pellizzari B, Bechini A, Orsi A, Bonanni P, Prato R, Iannazzo S, Icardi G. Incidence of herpes zoster and post-herpetic neuralgia in Italy: Results from a 3-years population-based study. Hum Vaccin Immunother 2016; 13:399-404. [PMID: 27925843 PMCID: PMC5328218 DOI: 10.1080/21645515.2017.1264834] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Herpes Zoster (HZ) and its main complication, post-herpetic neuralgia (PHN), represent important public health issues because of their relevant burden among older adults. However, data on the epidemiology of HZ and PHN in Italy are very limited. A population-based study was performed by seeking for cases of HZ and PHN, occurred in the period 2013-2015, in the clinical charts of 56 General Practitioners working in 4 Italian Regions (Liguria, Puglia, Toscana and Veneto). The main objective of the study was to estimate the incidence of HZ and the proportion of PHN (at 1 and 3 mo from the onset of HZ; PHN1 and PHN3) among people aged ≥ 50 y. Overall, 598 cases of HZ were identified over 93,146 person-years of observation, thus corresponding to an overall incidence of 6.42 (IC95%: 5.93 – 6.95) HZ cases per 1,000 person-years. The incidence of HZ increased with age and was higher in female than in male. In total, 22.7%, 12.7%, and 2.4% of HZ cases suffered PHN at 1 and 3 mo and 1 y from the onset of acute episode. The proportions of these complications significantly increased with age, with the peak occurring in people aged ≥ 85 y. Four per cent of patients suffered ophthalmic zoster. The study provided an update of the epidemiological burden of HZ and PHN in Italy, confirming the relevant burden of the disease in the elderly population. The study was funded by the Italian Ministry of Health, Center for Disease Prevention and Control (CCM) in 2013.
Collapse
Affiliation(s)
- Cristiano Alicino
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Cecilia Trucchi
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Chiara Paganino
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Ilaria Barberis
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Sara Boccalini
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Domenico Martinelli
- c Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | - Barbara Pellizzari
- d Regional Center for Disease Prevention and Control , Veneto Region , Italy
| | - Angela Bechini
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Andrea Orsi
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Paolo Bonanni
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Rosa Prato
- c Department of Medical and Surgical Sciences , University of Foggia , Foggia , Italy
| | | | - Giancarlo Icardi
- a Department of Health Sciences , University of Genoa , Genoa , Italy
| |
Collapse
|
23
|
Durando P, Garbarino S, Orsi A, Alicino C, Dini G, Toletone A, Ciprani F, Conte G, Santorsa R, Icardi G. Prevalence and predictors of latent tuberculosis infection among Italian State Policemen engaged in assistance to migrants: a national cross-sectional study. BMJ Open 2016; 6:e012011. [PMID: 27697871 PMCID: PMC5073613 DOI: 10.1136/bmjopen-2016-012011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Better knowledge about tuberculosis (TB) and latent TB infection (LTBI) epidemiology is a crucial step for the development of effective strategies towards the control and elimination of this deadliest and persistent health threat. No study has investigated LTBI epidemiology in policemen who act as an interface with cross-border migrants. METHODS A survey to measure the LTBI prevalence and assess the demographic, professional and clinical features potentially associated with tuberculin skin test (TST) positivity was performed in Italian State Police (ISP) employees engaged, even occasionally, in relief activities, hospitality, photographical identification, escorting and accompanying of migrants, regardless of contact with active TB cases. Variables potentially associated with TST positivity were evaluated with univariate and multivariate analysis. RESULTS From September to December 2014, 4225 ISP workers underwent TST screening and completed the questionnaire for data collection, according to study procedures. The TST was positive in 9.9% of individuals: no active TB cases were registered among the entire study population. Age, previous BCG vaccination and work category resulted independently associated with TST positivity. CONCLUSIONS This is the first study providing updated data about LTBI epidemiology among ISP employees engaged in assistance to migrants and furnish preliminary evidence of possible associations between TST positivity and different conditions that need to be deeply investigated with prospective studies.
Collapse
Affiliation(s)
- Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| | - Sergio Garbarino
- Department of Health Sciences, University of Genoa, Genoa, Italy
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| | | | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Fabrizio Ciprani
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Giuseppe Conte
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Roberto Santorsa
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| |
Collapse
|
24
|
Bassetti M, Righi E, Peghin M, Carnelutti A, Ansaldi F, Trucchi C, Alicino C, Tricarichi EM, Del Giacomo P, Tumbarello M. Is first-line antimicrobial therapy still adequate to treat MRSA in the ICU? A report from a highly endemic country. Crit Care 2016; 20:246. [PMID: 27566537 PMCID: PMC5002169 DOI: 10.1186/s13054-016-1430-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy. .,Clinica Malattie Infettive, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia", Piazzale S. Maria della Misericordia, n. 15, 33100, Udine, Italy.
| | - Elda Righi
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Maddalena Peghin
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Alessia Carnelutti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Filippo Ansaldi
- IRCCS AOU San Martino IST, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cecilia Trucchi
- IRCCS AOU San Martino IST, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cristiano Alicino
- IRCCS AOU San Martino IST, Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Paola Del Giacomo
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
25
|
Durando P, Alicino C, Dini G, Barberis I, Bagnasco AM, Iudici R, Zanini M, Martini M, Toletone A, Paganino C, Massa E, Orsi A, Sasso L. Determinants of adherence to seasonal influenza vaccination among healthcare workers from an Italian region: results from a cross-sectional study. BMJ Open 2016; 6:e010779. [PMID: 27188810 PMCID: PMC4874132 DOI: 10.1136/bmjopen-2015-010779] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Notwithstanding decades of efforts to increase the uptake of seasonal influenza (flu) vaccination among European healthcare workers (HCWs), the immunisation rates are still unsatisfactory. In order to understand the reasons for the low adherence to flu vaccination, a study was carried out among HCWs of two healthcare organisations in Liguria, a region in northwest Italy. METHODS A cross-sectional study based on anonymous self-administered web questionnaires was carried out between October 2013 and February 2014. Through univariate and multivariate regression analysis, the study investigated the association between demographic and professional characteristics, knowledge, beliefs and attitudes of the study participants and (i) the seasonal flu vaccination uptake in the 2013/2014 season and (ii) the self-reported number of flu vaccination uptakes in the six consecutive seasons from 2008/2009 to 2013/2014. RESULTS A total of 830 HCWs completed the survey. Factors statistically associated with flu vaccination uptake in the 2013/2014 season were: being a medical doctor and agreeing with the statements 'flu vaccine is safe', 'HCWs have a higher risk of getting flu' and 'HCWs should receive flu vaccination every year'. A barrier to vaccination was the belief that pharmaceutical companies influence decisions about vaccination strategies. DISCUSSION All the above-mentioned factors, except the last one, were (significantly) associated with the number of flu vaccination uptakes self-reported by the respondents between season 2008/2009 and season 2013/2014. Other significantly associated factors appeared to be level of education, being affected by at least one chronic disease, and agreeing with mandatory flu vaccination in healthcare settings. CONCLUSIONS This survey allows us to better understand the determinants of adherence to vaccination as a fundamental preventive strategy against flu among Italian HCWs. These findings should be used to improve and customise any future promotion campaigns to overcome identified barriers to immunisation.
Collapse
Affiliation(s)
- P Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS University Hospital San Martino–IST National Institute for Cancer Research, Genoa, Italy
| | - C Alicino
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - G Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS University Hospital San Martino–IST National Institute for Cancer Research, Genoa, Italy
| | - I Barberis
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS University Hospital San Martino–IST National Institute for Cancer Research, Genoa, Italy
| | - A M Bagnasco
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - R Iudici
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M Zanini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M Martini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - A Toletone
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS University Hospital San Martino–IST National Institute for Cancer Research, Genoa, Italy
| | - C Paganino
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS University Hospital San Martino–IST National Institute for Cancer Research, Genoa, Italy
| | - E Massa
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS University Hospital San Martino–IST National Institute for Cancer Research, Genoa, Italy
| | - A Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS University Hospital San Martino–IST National Institute for Cancer Research, Genoa, Italy
| | - L Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
| |
Collapse
|
26
|
Tramuto F, Orsi A, Maida CM, Costantino C, Trucchi C, Alicino C, Vitale F, Ansaldi F. The Molecular Epidemiology and Evolutionary Dynamics of Influenza B Virus in Two Italian Regions during 2010-2015: The Experience of Sicily and Liguria. Int J Mol Sci 2016; 17:549. [PMID: 27089319 PMCID: PMC4849005 DOI: 10.3390/ijms17040549] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/31/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
Molecular epidemiology of influenza B virus remained poorly studied in Italy, despite representing a major contributor to seasonal epidemics. This study aimed to reconstruct the phylogenetic relationships and genetic diversity of the hemagglutinin gene sequences of 197 influenza B strains circulating in both Southern (Sicily) and Northern (Liguria) Italy between 2010 and 2015. Upper respiratory tract specimens of patients displaying symptoms of influenza-like illness were screened by real-time RT-PCR assay for the presence of influenza B virus. PCR-positive influenza B samples were further analyzed by sequencing. Neighbor-joining phylogenetic trees were constructed and the amino-acid alignments were analyzed. Phylogenetic analysis showed clusters in B/Victoria clade 1A/1B (n = 29, 14.7%), and B/Yamagata clades 2 (n = 112, 56.8%) and 3 (n = 56, 28.4%). Both influenza B lineages were found to co-circulate during the study period, although a lineage swap from B/Victoria to B/Yamagata occurred in Italy between January 2011 and January 2013. The most represented amino-acid substitutions were N116K in the 120-loop (83.9% of B/Yamagata clade 3 strains) and I146V in the 150-loop (89.6% of B/Victoria clade 1 strains). D197N in 190-helix was found in almost all viruses collected. Our findings provide further evidence to support the adoption of quadrivalent influenza vaccines in our country.
Collapse
Affiliation(s)
- Fabio Tramuto
- Department of Health Promotion Sciences and Mother-Child Care "G. D'Alessandro"-Hygiene Section, University of Palermo, Palermo 90127, Italy.
- Clinical Epidemiology Unit, University Hospital "Paolo Giaccone", Palermo 90127, Italy.
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa 16132, Italy.
- Hygiene Unit, IRCCS University Hospital "San Martino"-IST National Institute for Cancer Research, Genoa 16132, Italy.
| | - Carmelo Massimo Maida
- Department of Health Promotion Sciences and Mother-Child Care "G. D'Alessandro"-Hygiene Section, University of Palermo, Palermo 90127, Italy.
| | - Claudio Costantino
- Department of Health Promotion Sciences and Mother-Child Care "G. D'Alessandro"-Hygiene Section, University of Palermo, Palermo 90127, Italy.
| | - Cecilia Trucchi
- Department of Health Sciences, University of Genoa, Genoa 16132, Italy.
| | - Cristiano Alicino
- Department of Health Sciences, University of Genoa, Genoa 16132, Italy.
| | - Francesco Vitale
- Department of Health Promotion Sciences and Mother-Child Care "G. D'Alessandro"-Hygiene Section, University of Palermo, Palermo 90127, Italy.
- Clinical Epidemiology Unit, University Hospital "Paolo Giaccone", Palermo 90127, Italy.
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa 16132, Italy.
- Hygiene Unit, IRCCS University Hospital "San Martino"-IST National Institute for Cancer Research, Genoa 16132, Italy.
| |
Collapse
|
27
|
Alicino C, Bragazzi NL, Faccio V, Amicizia D, Panatto D, Gasparini R, Icardi G, Orsi A. Assessing Ebola-related web search behaviour: insights and implications from an analytical study of Google Trends-based query volumes. Infect Dis Poverty 2015; 4:54. [PMID: 26654247 PMCID: PMC4674955 DOI: 10.1186/s40249-015-0090-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/02/2015] [Indexed: 12/02/2022] Open
Abstract
Background The 2014 Ebola epidemic in West Africa has attracted public interest worldwide, leading to millions of Ebola-related Internet searches being performed during the period of the epidemic. This study aimed to evaluate and interpret Google search queries for terms related to the Ebola outbreak both at the global level and in all countries where primary cases of Ebola occurred. The study also endeavoured to look at the correlation between the number of overall and weekly web searches and the number of overall and weekly new cases of Ebola. Methods Google Trends (GT) was used to explore Internet activity related to Ebola. The study period was from 29 December 2013 to 14 June 2015. Pearson’s correlation was performed to correlate Ebola-related relative search volumes (RSVs) with the number of weekly and overall Ebola cases. Multivariate regression was performed using Ebola-related RSV as a dependent variable, and the overall number of Ebola cases and the Human Development Index were used as predictor variables. Results The greatest RSV was registered in the three West African countries mainly affected by the Ebola epidemic. The queries varied in the different countries. Both quantitative and qualitative differences between the affected African countries and other Western countries with primary cases were noted, in relation to the different flux volumes and different time courses. In the affected African countries, web query search volumes were mostly concentrated in the capital areas. However, in Western countries, web queries were uniformly distributed over the national territory. In terms of the three countries mainly affected by the Ebola epidemic, the correlation between the number of new weekly cases of Ebola and the weekly GT index varied from weak to moderate. The correlation between the number of Ebola cases registered in all countries during the study period and the GT index was very high. Conclusion Google Trends showed a coarse-grained nature, strongly correlating with global epidemiological data, but was weaker at country level, as it was prone to distortions induced by unbalanced media coverage and the digital divide. Global and local health agencies could usefully exploit GT data to identify disease-related information needs and plan proper communication strategies, particularly in the case of health-threatening events. Electronic supplementary material The online version of this article (doi:10.1186/s40249-015-0090-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Cristiano Alicino
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16132, Italy.
| | | | - Valeria Faccio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16132, Italy.
| | - Daniela Amicizia
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16132, Italy.
| | - Donatella Panatto
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16132, Italy.
| | - Roberto Gasparini
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16132, Italy.
| | - Giancarlo Icardi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16132, Italy. .,Hygiene Unit, IRCCS AOU San Martino - IST of Genoa, Genoa, 16132, Italy.
| | - Andrea Orsi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, 16132, Italy. .,Hygiene Unit, IRCCS AOU San Martino - IST of Genoa, Genoa, 16132, Italy.
| |
Collapse
|
28
|
Orsi A, Alicino C, Faccio V, Zacconi M, Ansaldi F, Durando P, Icardi G. Epidemiology and mortality of Clostridium difficile infection: a 5-year retrospective laboratory-based study in a large teaching hospital in Northern Italy. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474701 DOI: 10.1186/2047-2994-4-s1-p25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
29
|
Prinapori R, Sticchi L, Alicino C, Del Puente F, Mazzarello G, Alessandrini A, Signori A, Icardi G, Bruzzone B, Viscoli C, Di Biagio A. Role of HCV-RNA decay and IP-10 levels after 48 hours of standard HCV therapy as predictors of rapid virological response. Clin Res Hepatol Gastroenterol 2015; 39:705-10. [PMID: 26070571 DOI: 10.1016/j.clinre.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 03/25/2015] [Accepted: 04/15/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Rapid virological response (RVR) is a critical end-point in the era of the new direct-acting antiviral agents (DAA). The aim of this study was to evaluate the predictive value in achieving RVR of HCV-RNA load and IP10 after 48 hours of standard anti HCV therapy. METHODS HCV mono-infected and HIV/HCV co-infected patients naives to interferon were included. Demographic data, immune-virological HIV-related condition and HCV disease status were recorded before starting treatment. HCV-RNA and IP10 concentrations were also measured 48 hours after first interferon dose. Univariate model, logistic regression and ROC curve were performed for statistical analysis. RESULTS Thirty-two patients were enrolled (mean age 49.2 ± 5.6 years): all were treated with pegylated-interferon and ribavirin. Nineteen (59.3%) were HIV/HCV co-infected patients. RVR was reached in 10 patients (31.2%). A decline of more than two log of HCV-RNA after 48 hours of therapy was associated with RVR (P=0.004). A trend was observed between increased IP10 levels at 48 hours and RVR (P=0.08). In a multivariable model only HCV-RNA at 48 hours was associated with RVR (P=0.011). ROC curve analysis for both HCV-RNA at 48 hours and IP-10 at 48 hours showed an area under the curve of 0.87 (95%CI: 0.74-1; P=0.001) with specificity of 72.2% and sensibility of 90%. CONCLUSION In HCV treatment-naïve patients HCV-RNA and IP10 determination after 48 hours of interferon and ribavirin may be a worthwhile endpoint to predict RVR and select patients that may not require DAA addition.
Collapse
Affiliation(s)
- Roberta Prinapori
- Infectious Disease Clinic, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, 16132 Genova, Italy.
| | - Laura Sticchi
- Hygiene Unit, IRCCS AOU San Martino-IST, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Filippo Del Puente
- Infectious Disease Clinic, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, 16132 Genova, Italy
| | - Giovanni Mazzarello
- Infectious Disease Clinic, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, 16132 Genova, Italy
| | - Anna Alessandrini
- Infectious Disease Clinic, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, 16132 Genova, Italy
| | - Alessio Signori
- Biostatistic Unit, Department of Health Sciences, Genoa, Italy
| | - Giancarlo Icardi
- Hygiene Unit, IRCCS AOU San Martino-IST, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Claudio Viscoli
- Infectious Disease Clinic, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, 16132 Genova, Italy
| | - Antonio Di Biagio
- Infectious Disease Clinic, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, 16132 Genova, Italy
| |
Collapse
|
30
|
Alicino C, Giacobbe DR, Orsi A, Tassinari F, Trucchi C, Sarteschi G, Copello F, Del Bono V, Viscoli C, Icardi G. Trends in the annual incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections: a 8-year retrospective study in a large teaching hospital in northern Italy. BMC Infect Dis 2015; 15:415. [PMID: 26464061 PMCID: PMC4605101 DOI: 10.1186/s12879-015-1152-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022] Open
Abstract
Background Bloodstream infections (BSI) due to carbapenem-resistant (C-R) Klebsiella pneumoniae (Kp) are of global concern from both clinical and public health standpoints. This retrospective study aimed to describe C-R Kp BSI epidemiology in a large teaching hospital in northern Italy. Methods Between 1 January 2007 and 31 December 2014, annual incidences both of C-R Kp BSI and of carbapenem-susceptible (C-S) Kp BSI were calculated as the number of events per 10,000 patient-days. A Chi square test for linear trend was used to assess the change in the incidence of C-R Kp BSI and C-S Kp BSI over the study period. Crude 30-day mortality rates were provided both for C-R Kp BSI and for C-S Kp BSI. Results From 2007 to 2014, we observed 511 episodes of Kp BSI, 349 of which were caused by C-R Kp (68.3 %). The incidence of C-R Kp BSI considerably increased from 0.04/10,000 patient-days in 2007 to 1.77/10,000 patient-days in 2014 (Chi square for trend p < 0.001). The highest incidence of C-R Kp BSI was observed in intensive care units (ICUs), with a peak of 22.01 C-R Kp BSI/10,000 patient-days in 2012. A less marked but significant increase of C-S Kp BSI was also observed (Chi square for trend p = 0.004). Crude 30-day mortality was 36.1 % in patients with C-R Kp BSI and 23.5 % in those with C-S Kp BSI. Conclusions During the study period, we observed a dramatic increase in the incidence of C-R Kp BSI in our hospital. More concerted infection-control efforts are needed to contain this alarming C-R Kp diffusion.
Collapse
Affiliation(s)
- Cristiano Alicino
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, L.go R. Benzi, 10-16132, Genoa, Italy.
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| | - Federico Tassinari
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| | - Cecilia Trucchi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| | - Giovanni Sarteschi
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, L.go R. Benzi, 10-16132, Genoa, Italy.
| | - Francesco Copello
- Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| | - Valerio Del Bono
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, L.go R. Benzi, 10-16132, Genoa, Italy.
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, L.go R. Benzi, 10-16132, Genoa, Italy.
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| |
Collapse
|
31
|
Alicino C, Bragazzi NL, Faccio V, Trucchi C, Paganino C, Amicizia D, Panatto D, Gasparini R, Icardi GC. Searching for 2014 Ebola epidemics: a global analytical study of Google Trends-based query volumes. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
32
|
Ansaldi F, Orsi A, Durando P, Alicino C, De Florentiis D, Trucchi C, Paganino C, Zacconi M, Albanese E, Barberis I, Turello V, Schiaffino S, Icardi G. First Italian Experience of Elderly Immunization with Pneumococcal Conjugate Vaccine. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
33
|
Durando P, Alicino C, Orsi A, Barberis I, Paganino C, Dini G, Mazzarello G, Del Bono V, Viscoli C, Copello F, Sossai D, Orengo G, Sticchi L, Ansaldi F, Icardi G. Latent tuberculosis infection among a large cohort of medical students at a teaching hospital in Italy. Biomed Res Int 2015; 2015:746895. [PMID: 25705685 PMCID: PMC4331323 DOI: 10.1155/2015/746895] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/13/2014] [Indexed: 01/08/2023]
Abstract
The surveillance of latent tuberculosis infection (LTBI) in both healthcare workers and healthcare students is considered fundamental for tuberculosis (TB) prevention. The aim of the present study was to estimate LTBI prevalence and evaluate potential risk-factors associated with this condition in a large cohort of medical students in Italy. In a cross-sectional study, performed between March and December 2012, 1511 eligible subjects attending the Medical School of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the tuberculin skin test (TST). All the TST positive cases were confirmed with an interferon-gamma release assay (IGRA). A standardized questionnaire was collected for multivariate risk analysis. A total of 1302 (86.2%) students underwent TST testing and completed the questionnaire. Eleven subjects (0.8%) resulted TST positive and LTBI diagnosis was confirmed in 2 (0.1%) cases. Professional exposure to active TB patients (OR 21.7, 95% CI 2.9-160.2; P value 0.003) and previous BCG immunization (OR 28.3, 95% CI 3.0-265.1; P value 0.003) are independently associated with TST positivity. Despite the low prevalence of LTBI among Italian medical students, an occupational risk of TB infection still exists in countries with low circulation of Mycobacterium tuberculosis.
Collapse
Affiliation(s)
- Paolo Durando
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Cristiano Alicino
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Ilaria Barberis
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Chiara Paganino
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Guglielmo Dini
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giovanni Mazzarello
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Valerio Del Bono
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Francesco Copello
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Dimitri Sossai
- Health Safety and Prevention Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giovanni Orengo
- Quality and Risk Management Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Laura Sticchi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| |
Collapse
|
34
|
Alicino C, Infante MT, Gandoglia I, Miolo N, Mancardi GL, Zappettini S, Capello E, Orsi A, Tamburini T, Grandis M. Acute disseminated encephalomyelitis with severe neurological outcomes following virosomal seasonal influenza vaccine. Hum Vaccin Immunother 2014; 10:1969-73. [PMID: 25424806 PMCID: PMC4186031 DOI: 10.4161/hv.28961] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an inflammatory, usually monophasic, immune mediate, demyelinating disease of the central nervous system which involves the white matter. ADEM is more frequent in children and usually occurs after viral infections, but may follow vaccinations, bacterial infections, or may occur without previous events. Only 5% of cases of ADEM are preceded by vaccination within one month prior to symptoms onset. The diagnosis of ADEM requires both multifocal involvement and encephalopathy and specific demyelinating lesions of white matter. Overall prognosis of ADEM patients is often favorable, with full recovery reported in 23% to 100% of patients from pediatric cohorts, and more severe outcome in adult patients. We describe the first case of ADEM occurred few days after administration of virosomal seasonal influenza vaccine. The patient, a 59-year-old caucasic man with unremarkable past medical history presented at admission decreased alertness, 10 days after flu vaccination. During the 2 days following hospitalization, his clinical conditions deteriorated with drowsiness and fever until coma. The magnetic resonance imaging of the brain showed multiple and symmetrical white matter lesions in both cerebellar and cerebral hemispheres, suggesting demyelinating disease with inflammatory activity, compatible with ADEM. The patient was treated with high dose of steroids and intravenous immunoglobulin with relevant sequelae and severe neurological outcomes.
Collapse
Affiliation(s)
- Cristiano Alicino
- a Department of Health Sciences; Vaccines and Clinical Trials Unit; University of Genoa; Genoa Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Alicino C, Merlano C, Zappettini S, Schiaffino S, Della Luna G, Accardo C, Gasparini R, Durando P, Icardi G. Routine surveillance of adverse events following immunization as an important tool to monitor vaccine safety. Hum Vaccin Immunother 2014; 11:91-4. [PMID: 25483520 DOI: 10.4161/hv.34360] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Post licensure surveillance of adverse events following immunization (AEFI) is a fundamental activity to improve safety and maintain public confidence in vaccines. Since 2011, the Liguria Region has been involved in the inter-regional project of post-marketing surveillance of AEFI, coordinated by the Italian Medicine Agency and the Veneto region. The main objectives of the project are: (1) to coordinate the surveillance activities in the 8 Italian Regions included in the project; (2) to encourage the signal of AEFI by healthcare workers and patients; (3) to organize education activities addressed to health care workers, and, finally; (4) to establish vaccination counseling services in each Region. In particular, the Ligurian multidisciplinary team, composed by physicians expert in the field of vaccination and pharmacists, is involved in the causality assessment between vaccines and all adverse events signaled within the Liguria Region and in the analysis of all adverse events signaled in Italy as possibly related to influenza vaccines. During 2013, the team has organized 4 courses, addressed to healthcare personnel of vaccination outpatient clinics, focused on European and Italian legislation on pharmaco-vigilance and vaccine-vigilance and aimed at promoting signal of AEFI. Since October 2013, the Liguria Region has been participating to the inter-regional project of active surveillance of adverse events aimed at promoting the signal of AEFI by parents of vaccinated infants. After two years of implementation of the project both the number of reported AEFI and the reporting rate per 100 000 administered doses of vaccine increased. The activities need to be consolidated in the next years in order to guarantee high standard of vaccine safety, maintain the confidence in current immunization programs and reach optimal vaccination coverage rate.
Collapse
Affiliation(s)
- Cristiano Alicino
- a Department of Health Sciences, Vaccines and Clinical Trials Unit; University of Genoa; Italy and I.R.C.C.S. University Hospital San Martino; IST National Institute for Cancer Research; Genoa, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Alicino C, Iudici R, Barberis I, Paganino C, Cacciani R, Zacconi M, Battistini A, Bellina D, Di Bella AM, Talamini A, Sticchi L, Morando A, Ansaldi F, Durando P. Influenza vaccination among healthcare workers in Italy. Hum Vaccin Immunother 2014; 11:95-100. [PMID: 25483521 DOI: 10.4161/hv.34362] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Influenza vaccination is a fundamental tool for the prevention of influenza in healthcare settings and its administration to healthcare workers (HCWs) is recommended in more than 40 countries including United States of America and many countries of the European Union. Despite these recommendations, the compliance of HCWs to influenza vaccination is largely inadequate in Italy. Since 2005/06 season, a comprehensive multifaceted intervention project aimed at increasing the seasonal influenza vaccination coverage rates among HCWs was performed at the IRCCS AOU San Martino IST teaching hospital in Genoa, Italy, the regional tertiary adult acute-care reference center with a 1300 bed capacity. Despite almost a decade of efforts, the vaccination coverage rates registered at our hospital steadily remain unsatisfactory and very distant by the minimum objective of 75% defined by the Italian Ministry of Health. During the last influenza season (2013/14), vaccination coverage rates by occupation type resulted 30% among physicians, 11% among nurses and 9% among other clinical personnel. Further efforts are necessary to prevent the transmission of influenza to patient and novel strategies need to be identified and implemented in order to increase the compliance of HCWs, particularly nurses, with the seasonal influenza vaccination.
Collapse
Affiliation(s)
- Cristiano Alicino
- a Department of Health Sciences, Vaccines and Clinical Trials Unit; University of Genoa; Italy and I.R.C.C.S. University Hospital San Martino; IST National Institute for Cancer Research; Genoa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Durando P, Iudici R, Alicino C, Alberti M, de Florentis D, Ansaldi F, Icardi G. Adjuvants and alternative routes of administration towards the development of the ideal influenza vaccine. Human Vaccines 2014; 7 Suppl:29-40. [DOI: 10.4161/hv.7.0.14560] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
38
|
Durando P, Alicino C, Orsi A, Barberis I, Paganino C, Mazzarello G, Del Bono V, Viscoli C, Copello F, Sossai D, Orengo G, Sticchi L, Ansaldi F, Icardi G. Latent tuberculosis infection among a large cohort of medical students at a teaching hospital in Italy. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
39
|
Alicino C, Barberis I, Orsi A, Durando P. Pneumococcal vaccination strategies in adult population: perspectives with the pneumococcal 13 - valent polysaccharide conjugate vaccine. Minerva Med 2014; 105:89-97. [PMID: 24572454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Streptococcus pneumoniae (Sp) is a leading cause of infection in people of all ages worldwide, determining a significant impact because of its relatively high incidence rate, the associated economic costs, and the high case-fatality rates. More attention has to be paid for elderly and people with one or more risk factors, in order to reduce health costs and pneumococcal hospital admissions. Moreover, the increasing incidence of antibiotic-resistant Sp strains is a source of concern for its relevant clinical importance in health-care settings. At present, the 23-valent polysaccharide (PPV23) vaccine has shown some limits in terms of protection in the elderly population and against invasive diseases, among adults affected with chronic diseases, non-bacteriemic pneumonias and with immune suppression, in particular in adults with HIV. In December 2011, FDA licensed the 13-valent pneumococcal conjugate vaccine (PCV13) for prevention of pneumonia and invasive diseases (IPDs) in adults aged ≥50 years. The same decision was concomitantly assumed in Europe by EMA. PCV13 has shown superior results both in terms of immunogenicity and of adequate stimulation of a stable and long-lasting immunological memory. European recommendations for PCV13 vaccination in adults are still heterogeneous between Countries. The availability of PCV13 for adults offer a new and promising tool against Sp IPDs and non-IPDs, especially in elderly and at risk populations.
Collapse
Affiliation(s)
- C Alicino
- Department of Health Sciences University of Genoa, Genoa, Italy -
| | | | | | | |
Collapse
|
40
|
Bedognetti D, Ascierto ML, Sato-Matsushita M, Gugiatti E, Massucco C, Zupo S, Di Meglio A, Dellepiane C, Sertoli MR, Racchi O, Balleari E, De Giorgi V, Sommariva M, Durando P, Ferrarini M, Cacciani R, Provinciali N, Iudici R, Alicino C, Wang E, Ansaldi F, Marincola FM, De Maria A. Intradermal influenza vaccination in complete remission cancer patients: molecular insights. J Immunother Cancer 2013. [PMCID: PMC3990295 DOI: 10.1186/2051-1426-1-s1-p197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
41
|
Sticchi L, Caligiuri P, Cacciani R, Alicino C, Bruzzone B. Epidemiology of HBV S-gene mutants in the Liguria Region, Italy: Implications for surveillance and detection of new escape variants. Hum Vaccin Immunother 2013; 9:568-71. [PMID: 23296324 PMCID: PMC3891713 DOI: 10.4161/hv.23236] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 11/05/2012] [Indexed: 12/27/2022] Open
Abstract
HBV surface antigen (HBsAg) variants may impair diagnosis or allow the virus to escape vaccine-induced immunity and their circulation in the population can represent a Public Health threat. Their prevalence, however, is not yet completely established. Evidence indicates that amino acid substitutions within HBsAg can lead to conformational changes which allow mutated HBV to escape the vaccine-induced antibodies used in the screening tests. In such scenario, the aim of this study was to investigate the prevalence of HBV S-Gene escape mutants by sequencing the gene in a cohort of Ligurian patients monitored for viral load, genotype and drug resistance and to evaluate the risk of false negative HBsAg detection by routine screening tests. From 2007 to 2011, in 256 consecutive samples from Ligurian HBV positive patients sequencing assay for detection of RT/S-Gene mutations using Trugene HBV Genotyping kit (Siemens Healthcare Diagnostics Inc., Tarrytown, NY) was performed. Serological HBV tests and viral load were also performed. Analyzed sequences revealed G145R mutation in 8/256 (3.1%) examined sequences, it was alone in 5 patients and accompanied by other HBsAg mutations in 3 samples. HBsAg resulted undetectable by 3 of the 8 samples, derived from patients with multiple mutations: T126I-T131A-C139Y-E/D144G, T126I-M133L, and P120Q-T126I. The emergence of these mutants, at least the G145R, has already been addressed as a public health concern because of its capability of escaping the immune system. In the present study we point out a second aspect connected with their existence and with similar potential negative impact on public health, that is their capability of escape punctual detection.
Collapse
Affiliation(s)
- Laura Sticchi
- Department of Health Sciences; University of Genoa; Genoa, Italy
- I.R.C.C.S. “A.O.U. San Martino-IST”; Genoa, Italy
| | | | - Roberto Cacciani
- Department of Health Sciences; University of Genoa; Genoa, Italy
| | | | | |
Collapse
|
42
|
Durando P, Bassetti M, Orengo G, Crimi P, Battistini A, Bellina D, Talamini A, Tiberio G, Alicino C, Iudici R, Sticchi C, Ansaldi F, Rossi A, Rosso R, Viscoli C, Icardi G. Adherence to international and national recommendations for the prevention of surgical site infections in Italy: results from an observational prospective study in elective surgery. Am J Infect Control 2012; 40:969-72. [PMID: 22418605 DOI: 10.1016/j.ajic.2011.11.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 11/22/2011] [Accepted: 11/22/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND An observational prospective study of the perioperative procedures for prevention of surgical site infections (SSIs) was carried out in a tertiary referral teaching hospital in Liguria, Italy, to evaluate their adherence to international and national standards. METHODS A 1-month survey was performed in all surgical departments, monitored by turns by trained survey teams. Data regarding presurgical patient preparation and intraoperative infection control practices were collected. RESULTS A total of 717 elective interventions were actively monitored in 703 patients who underwent surgery. Hair-shaving was performed mainly using a razor (92%) by the nurses (72.8%) on the day before the operation (83.5%). All of the patients showered, either with a common detergent (87%) or with an antiseptic solution (13%). Antimicrobial prophylaxis was administered properly in 75.7% of the patients at induction of anaesthesia; however, according to current Italian guidelines, inappropriate prophylaxis was provided in 55.2% patients. Appropriate antisepsis of the incision area was done in 97.4% of the operations, and nearly 90% of the interventions lasted less than the respective 75th percentile. The doors of the operating theatres were mostly open during the duration of the operation in 36.3% of the cases. CONCLUSIONS This review of infection control policies identified significant opportunities for improving the safety and the quality of routine surgical practice.
Collapse
Affiliation(s)
- Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Ansaldi F, De Florentiis D, Parodi V, Rappazzo E, Coppelli M, Martini M, Alicino C, Durando P, Icardi G. Bacterial carriage and respiratory tract infections in subjects > or = 60 years during an influenza season: implications for the epidemiology of community acquired pneumonia and influenza vaccine effectiveness. J Prev Med Hyg 2012; 53:94-97. [PMID: 23240167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION During the 2010/11 influenza season an epidemiological prospective cohort active study was organized, to evaluate etiologic role due to the main bacteria and viruses causing Community Acquired Pneumonia (CAP) and Influenza like-illness (ILl) in elderly and to explore the role of the bacterial nose-pharingeal carriage in subjects with respiratory tract infections. METHODS An integrated active surveillance of a cohort of adults aged > or = 60 y based on a double prospective and retrospective mechanisms of capture of ILl and CAP cases was organized. Samples were collected from all ILI and CAP prospectively identified. The samples were be tested by multiplex PCR for detection of the main respiratory bacteria and viruses. RESULTS AND DISCUSSION The study population amounted to 2,551 adults. During the 2010/11 influenza season, the ILl cumulative incidence was 4.2%, that was twice higher than that calculated by regional sentinel-based Influenza surveillance system during the 2010/11 season in the elderly (2.2%). Among 45 patients with ILI of which had been collected the swab, 17 (37.8%) were positive for influenza viruses and 2 (4.4%) for RSV, 6 (13.3%) patients carried Streptococcus pn and 6 (13.3%) Haemophilus in. In the same period, 7 CAP cases were observed; 3 cases were prospectively identified and samples were collected, while 4 cases were retrospectively detected. The CAP cumulative incidence was 0,3%. The influenza vaccine effectiveness in prevention of laboratory-confirmed influenza emerged by our study was 61%, in condition of good antigenic matching between vaccine and circulating strains observed during the 2010/11. These data contribute to better defining the epidemiological picture of upper and lower respiratory tract infections, fundamental information in light of the recent introduction of new vaccines for prevention of pneumonia in the elderly, including 13-valent conjugate pneumococcal vaccine.
Collapse
Affiliation(s)
- F Ansaldi
- Department of Health Sciences, University of Genoa, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Durando P, Alicino C, De Florentiis D, Martini M, Icardi G. Improving the protection against Streptococcus pneumoniae with the new generation 13-valent pneumococcal conjugate vaccine. J Prev Med Hyg 2012; 53:68-77. [PMID: 23240163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The wide use of the 7-valent Pneumococcal Conjugate Vaccine (PCV7) determined, during the last decade, a dramatic decline in the incidence of Invasive Pneumococcal Diseases (IPD) in infants and children, and also among the non-vaccinated population through the phenomenon known as "herd protection". Furthermore a significant reduction of some non-IPD, such as Community Acquired Pneumonia (CAP) and Acute Otitis Media (AOM) was reported among the pediatric population. At the same time, the high vaccination coverage rates reached with PCV7 contributed to modify the ecology of Streptococcus pneumoniae (Sp), favoring the emergence of some serotypes not included in PCV7 and involved in IPD (replacement phenomenon), thus partially affecting the positive effects of the pediatric immunization programs. To remedy these shortcomings, a new generation of conjugate vaccines, with an enlarged antigenic spectrum of activity than PCV7, has been available since 2010. In particular, the 13-valent Pneumococcal Conjugate Vaccine (PCV13) has been authorized for active prevention of IPD, CAP and AOM in infants and children aged between 6 months and 5 years. More recently, in September 2011, the European Medicine Agency extended the indication for its use to include active immunization of adults aged > or = 50 years for the prevention of IPD, thus opening new interesting opportunities to improve the control of pneumococcal disease among the entire population. The most interesting results from clinical trials using PCV13 in both children and adults are reported and discussed in details.
Collapse
Affiliation(s)
- P Durando
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | | | | | | |
Collapse
|
45
|
Durando P, Alicino C, Alberti M, Sticchi L, Turello V, Marensi L, Caiazzo AL, Panico MG, Giugliano F, Parlato A, Peluso F, Sgricia S, Icardi G. Acceptance and safety of the intradermal influenza vaccine among the elderly in Italy: an on-field national study. Adv Ther 2012; 29:312-26. [PMID: 22529024 DOI: 10.1007/s12325-012-0012-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION An observational multicenter study was carried out in Italy, to evaluate the acceptability and safety of the new intradermal (ID) influenza vaccine (Intanza Sanofi Pasteur SA, Lyon, France) among subjects aged≥60 years, compared with that of other intramuscular (IM) influenza vaccines. Compliance with the use of the ID vaccine by healthcare professionals was also assessed. METHODS A previously validated and self-administered questionnaire, Vaccinees' Perception of Injection (VAPI®), consisting of 21 questions, mainly focused on four dimensions (bother, arm movements, sleep, and acceptability), was administered to >1,600 individuals with spontaneous access to outpatient clinics, located in Northern, Central, and Southern Italy, to evaluate the acceptance of the vaccines. Occurrence of solicited and unsolicited side effects and of serious adverse events was assessed in a subset of subjects (n=500), using a clinical diary filled in by vaccinees following immunization. Compliance with the new ID vaccine by healthcare professionals was investigated using an ad-hoc questionnaire. RESULTS A very favorable opinion concerning the acceptability of both the vaccines under survey, with the most positive answers ranging between 75.5% and 94.9%, was registered within the study population. Also the compliance by healthcare professionals (n=130) with the novel ID vaccine was favorable. No serious adverse event occurred during the 6-month follow-up period. The frequency of solicited systemic reactions was comparable between the two study groups, while solicited local reactions were significantly higher in the ID-vaccine group than in the IM-vaccine group, even if at values lower than those reported in phase 3 clinical trials (ranges=18.5-32.6% vs. 29.5-70.9%). These local events were mild and transient, thus without any clinical relevance. CONCLUSION The novel ID influenza vaccine can be widely recommended in clinical practice, representing a useful tool to improve immunization coverage rates, and thus the control of influenza.
Collapse
|
46
|
Alicino C, Iudici R, Alberti M, Durando P. The dangerous synergism between influenza and Streptococcus pneumoniae and innovative perspectives of vaccine prevention. J Prev Med Hyg 2011; 52:102-106. [PMID: 22010535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Secondary bacterial pneumonia, particularly sustained by Streptococcus pneumoniae (Sp), represents an important cause of excess mortality during both influenza epidemics and pandemics. The lethal synergism between influenza virus and Sp was first suggested by studies performed on samples collected during autopsy from victims of 1918 influenza pandemic, and recently confirmed by data collected during the 2009 A/H1N1v influenza pandemic. Moreover, researches carried out in animal model contributed to partially clarify the pathogenic mechanisms underlying the synergism between these two etiological agents. Since 2000, a seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the US, and in the following year in Europe, determining substantial and almost immediate benefits in terms of reduction of invasive pneumococcal disease (IPD) in both vaccinated children and adults through induction of herd protection. Furthermore, several researches have recently demonstrated the capacity of the PCV7 to prevent community-acquired pneumonia (CAP) and, in particular, influenza-associated pneumonia hospitalisations among children. Taking into account the above-mentioned positive results obtained with PCV7, the availability of a new generation of conjugate pneumococcal vaccine with an enlarged antigenic spectrum (i.e. PCV13) offers promising perspectives, to improve the control of influenza through the protection offered against its major complications, particularly CAP, not only in children, but also among adults.
Collapse
Affiliation(s)
- C Alicino
- Department of Health Sciences, University of Genoa, San Martino University Hospital of Genoa, Italy
| | | | | | | |
Collapse
|
47
|
Crovari P, Alberti M, Alicino C. History and evolution of influenza vaccines. J Prev Med Hyg 2011; 52:91-94. [PMID: 22010533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Since the isolation of influenza virus in 1933, a great deal of work was carried out in order to develop influenza vaccines and improve these fundamental tools of prevention in terms of production, quality control, safety and tolerability, and immunogenicity. The paper summarizes the cornerstones of the continuous evolution of influenza vaccines and the most recent and promising developments in this field.
Collapse
Affiliation(s)
- P Crovari
- Department of Health Sciences, University of Genoa, Italy
| | | | | |
Collapse
|
48
|
Durando P, Bassetti M, Orengo G, Crimi P, Battistini A, Tiberio G, Bellina D, Talamini A, Dodi F, Ansaldi F, Alicino C, Iudici R, Sticchi L, De Florentiis D, Viscoli C, Icardi G. Hospital-acquired infections and leading pathogens detected in a regional university adult acute-care hospital in Genoa, Liguria, Italy: results from a prevalence study. J Prev Med Hyg 2010; 51:80-86. [PMID: 21155410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND A prevalence study aimed to update the epidemiological scenario of Hospital-Acquired Infections (HAI) was performed at the San Martino University Hospital of Genoa, the Regional Reference Adult-care Center in Liguria, Italy, with more than 1300 beds. MATERIALS AND METHODS The investigation was performed in all the wards, except the Psychiatric Units, between 19th March and 6Ih April, 2007, using a one-day monitoring system for each ward. International standardized criteria and definitions for the surveillance of HAI were used for the collection of data, which were recorded in specific software for subsequent consolidation, analysis and quality control. RESULTS The hospital infection control staff actively monitored 912 inpatients: a total of 84 HAI among 72 patients were diagnosed, with an overall prevalence of infections and affected cases of 9.2% (95% CI: 7.3-11.1) and 7.9% (95% CI: 6.1-9.7), respectively. Urinary Tract Infections (UTI) (30.9%), Respiratory Tract Infections (RTI) (28.6%) and Blood Stream Infections (BSI) (21.4%) were found to be the most frequent infections. As expected, both specific prevalence and localization of HAI varied considerably between wards, with the highest values recorded in Intensive Care Units (ICU) and in Functional Rehabilitation wards. RTI (26.3%) and BSI (13.2%) were found primarily represented in ICU, while the highest values of UTI (13.3%) were registered in Functional Rehabilitation Units. Enterococcus spp. (16.8%), Candida spp. (14%), Pseudomonas spp. (12.2), Staphylococcus aureus (10.7%), Escherichia coli (10.3%) and Coagulase-negative staphylococci (CNS) (9.3%) were the most frequent pathogens isolated. The overall rate of administration of antibiotics was 55.3% and penicillin (26.7%), cephalosporins (22.8%) and fluoroquinolones (17.9%) were found to be the leading antibacterial administered. CONCLUSION Results of the present study have been, and are currently, used for orientating surveillance and control hospital policies, planning activities according to a rational and evidence-based approach.
Collapse
Affiliation(s)
- P Durando
- Department of Health Sciences, Section of Hygiene and Preventive Medicine, University of Genoa and San Martino University Hospital of Genoa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Orsi A, Alicino C, Patria AG, Parodi V, Carloni R, Turello V, Comaschi M, Moscatelli P, Orengo G, Martini M, De Florentiis D. Epidemiological and molecular approaches for management of a measles outbreak in Liguria, Italy. J Prev Med Hyg 2010; 51:67-72. [PMID: 21155408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since March 2010 a measles outbreak has been occurred in Genoa, Liguria, an administrative Region in Northern Italy. Epidemiological and molecular data on the outbreak, obtained from the passive mandatory notification system, the laboratory surveillance and an innovative syndrome surveillance system, were investigated. Overall 39 cases were reported in the urban area. Information about demography, vaccination status, hospitalization and geographic distribution of measles cases are available. 19 cases (48.7%) were laboratory-confirmed and were characterized by sequence analysis: 18 strains belonged to genotype D8, so identifying a new measles variant within the Liguria population. Adopted control measures seem to have limited viral circulation. The outbreak allowed to test the efficacy of the 3 surveillance systems active in Liguria, highlighting their advantages and some important limitations. More efforts are needed to collect and integrate any epidemiological and virological available data in order to better describe the local measles transmission dynamics.
Collapse
Affiliation(s)
- A Orsi
- Department of Health Sciences, University of Genoa, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Durando P, Sticchi L, Alberti M, Alicino C, Iudici R, Martini M, Icardi G. [Novel approaches for the prevention of influenza: the intradermal vaccination]. Ig Sanita Pubbl 2010; 66:387-400. [PMID: 20859311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Conventional non-adjuvanted influenza vaccines have shown suboptimal immunogenicity in subjects at high risk for complications, such as the elderly. Between the several strategies proposed to develop more immunogenic vaccines than the conventional ones, a promising option is represented by the administration of non-adjuvanted vaccine through the intradermal (ID) route. This paper summarizes and discusses the main results recently obtained in clinical trials investigating the safety, tolerability and immunogenicity of new ID influenza vaccines, containing standard or reduced antigen dosages, in different age-groups.
Collapse
Affiliation(s)
- Paolo Durando
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Ambulatorio Vaccinazioni e Sperimentazioni Cliniche, Genova
| | | | | | | | | | | | | |
Collapse
|