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Peghin M, Graziano E, Grossi PA. Skin and soft tissue infections in solid organ transplants. Curr Opin Infect Dis 2024; 37:112-120. [PMID: 38050739 DOI: 10.1097/qco.0000000000000998] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE OF REVIEW Skin and soft tissue infections (SSTI) in solid organ transplant (SOT) recipients may be a great challenge for clinicians caring for SOT due to the involvement of both common and opportunistic pathogens associated with a blunted immune response. The purpose of this review is to outline current literature and describe open issues on the management of SSTI in this special population. RECENT FINDINGS Clinical presentation in SOT recipients can manifest as isolated skin lesions after primary inoculation or be the sign of a disseminated infection. Tissue samples for microscopy and histopathology are crucial to making an accurate diagnosis given the nonspecific and heterogeneous appearance of skin lesions. Multidisciplinary teams are required for a comprehensive diagnosis and management. SUMMARY SSTI are frequent contributors to morbidity and mortality in SOT. Specific research focused on the clinical presentation, risk factors and management in this special population is needed.
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Affiliation(s)
- Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, ASST-Sette Laghi, Varese, Italy
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Mularoni A, Cona A, Campanella M, Barbera F, Medaglia AA, Cervo A, Cuscino N, Di Mento G, Graziano E, El Jalbout JD, Alduino R, Tuzzolino F, Monaco F, Cascio A, Peghin M, Gruttadauria S, Bertani A, Conaldi PG, Mikulska M, Grossi PA. Donor-derived carbapenem-resistant gram-negative bacterial infections in solid organ transplant recipients: Active surveillance enhances recipient safety. Am J Transplant 2024:S1600-6135(24)00131-X. [PMID: 38342183 DOI: 10.1016/j.ajt.2024.02.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/16/2024] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
Donor-derived infections (DDIs) caused by carbapenem-resistant gram-negative bacteria (CR-GNB) in solid organ transplant recipients are potentially life-threatening. In this prospective study, we evaluated the incidence, factors associated with transmission, and the outcome of recipients with unexpected CR-GNB DDIs after the implementation of our local active surveillance system (LASS). LASS provides for early detection of unexpected donor CR-GNB infections, prophylaxis of recipients at high risk, and early diagnosis and treatment of DDIs. Whole genome sequencing confirmed DDI. Among 791 recipients, 38 (4.8%) were at high risk of unexpected CR-GNB DDI: 25 for carbapenem-resistant Enterobacterales (CRE) and 13 for carbapenem-resistant Acinetobacter baumannii (CRAB). Transmission did not occur in 27 (71%) cases, whereas DDIs occurred in 9 of 25 of CRE and 2 of 13 of CRAB cases. Incidence of CR-GNB DDI was 1.4%. Recipients of organs with CR-GNB-positive preservation fluid and liver recipients from a donor with CRE infection were at the highest risk of DDI. There was no difference in length of hospital stay or survival in patients with and without CR-GNB DDI. Our LASS contains transmission and mitigates the negative impacts of CR-GNB DDI. Under well-defined conditions, organs from donors with CR-GNB may be considered after a thorough evaluation of the risk/benefit profile.
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Affiliation(s)
- Alessandra Mularoni
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Andrea Cona
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy.
| | - Maria Campanella
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Floriana Barbera
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Alice Annalisa Medaglia
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy; Infectious and Tropical Disease Unit, AOU Policlinico 'P. Giaccone', Palermo, Italy
| | - Adriana Cervo
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy; University Hospital of Modena, Infectious Diseases Clinic, Modena, Italy
| | - Nicola Cuscino
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Giuseppina Di Mento
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Elena Graziano
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy; Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Jana Dib El Jalbout
- Unit of Infectious Diseases and Infection Control, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Rossella Alduino
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Fabio Tuzzolino
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Francesco Monaco
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Antonio Cascio
- Infectious and Tropical Disease Unit, AOU Policlinico 'P. Giaccone', Palermo, Italy
| | - Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Disease and Abdominal Transplantation, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Chest Center, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Pier Giulio Conaldi
- Department of Research, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Antonio Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
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Abstract
PURPOSE OF REVIEW Recurrent cellulitis is a challenging clinical condition affecting up to 47% of patients after the first episode, especially those with predisposing risk factors. The purpose of this review is to describe the state of the art of literature evidence and to highlight recent developments in its management. RECENT FINDINGS Recurrent cellulitis can occur after successful treatment of cellulitis. Conditions that commonly increase the risk of cellulitis include local and systemic modifiable and nonmodifiable factors. A rigorous approach to the management of risk factors and treatment of acute infection is important as the risk of recurrence rises with repeated episodes. Risk factors, if present, need to be targeted in association with antibiotic prophylaxis. Penicillin V is the preferred antibiotic for prevention but other antibiotics and new drugs can be considered in cases of β-lactam allergy, intolerance, or failure. SUMMARY Recurrent cellulitis is associated with short term and long-term morbidity as well as significant healthcare costs. Management of underlying predisposing conditions is crucial to prevent recurrence in addition with evaluation of pharmacological measures, but specialized and multidisciplinary skills are needed. More efforts are needed to prevent and treat this underestimated problem.
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Affiliation(s)
- Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
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Spennacchio M, Colella M, Andresini M, Dibenedetto RS, Graziano E, Aramini A, Degennaro L, Luisi R. Unlocking geminal fluorohaloalkanes in nucleophilic fluoroalkylation chemistry: generation and trapping of lithiumfluorocarbenoids enabled by flow microreactors. Chem Commun (Camb) 2023; 59:1373-1376. [PMID: 36649092 DOI: 10.1039/d2cc06717j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A direct nucleophilic monofluoroalkylation strategy leveraging on lithium fluorocarbenoids has been developed. Flow microreactor technology allows capitalization of the synthetic potential of these scarcely explored short-lived intermediates - namely 1-fluoro-2-phenylethyllithium, 1-fluoro-3-phenylpropyllithium, and 1-fluorononyllithium - generated through lithium/iodine exchange reaction. This robust protocol was employed to prepare new fluorinated products, adopting various classes of electrophiles. The inherent advantages of microreactor technology contribute to rendering this approach a new valuable tool for direct fluoroalkylation chemistry.
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Affiliation(s)
- Mauro Spennacchio
- Flow Chemistry and Microreactor Technology FLAME-Lab, Department of Pharmacy - Drug Sciences, University of Bari "A. Moro", Bari, 70125, Italy.
| | - Marco Colella
- Flow Chemistry and Microreactor Technology FLAME-Lab, Department of Pharmacy - Drug Sciences, University of Bari "A. Moro", Bari, 70125, Italy.
| | - Michael Andresini
- Flow Chemistry and Microreactor Technology FLAME-Lab, Department of Pharmacy - Drug Sciences, University of Bari "A. Moro", Bari, 70125, Italy.
| | - Roberta Savina Dibenedetto
- Flow Chemistry and Microreactor Technology FLAME-Lab, Department of Pharmacy - Drug Sciences, University of Bari "A. Moro", Bari, 70125, Italy.
| | - Elena Graziano
- Flow Chemistry and Microreactor Technology FLAME-Lab, Department of Pharmacy - Drug Sciences, University of Bari "A. Moro", Bari, 70125, Italy.
| | - Andrea Aramini
- Department of Discovery, Dompé Farmaceutici S.p.A., Via Campo di Pile, L'Aquila, 67100, Italy
| | - Leonardo Degennaro
- Flow Chemistry and Microreactor Technology FLAME-Lab, Department of Pharmacy - Drug Sciences, University of Bari "A. Moro", Bari, 70125, Italy.
| | - Renzo Luisi
- Flow Chemistry and Microreactor Technology FLAME-Lab, Department of Pharmacy - Drug Sciences, University of Bari "A. Moro", Bari, 70125, Italy.
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Peghin M, Bontempo G, De Martino M, Palese A, Gerussi V, Graziano E, Fabris M, D’Aurizio F, Sbrana F, Ripoli A, Curcio F, Isola M, Tascini C. Evaluation of qualitative and semi-quantitative cut offs for rapid diagnostic lateral flow test in relation to serology for the detection of SARS-CoV-2 antibodies: findings of a prospective study. BMC Infect Dis 2022; 22:810. [PMCID: PMC9619007 DOI: 10.1186/s12879-022-07786-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background: There is limited information to compare the qualitative and semi-quantitative performance of rapid diagnostic tests (RDT) and serology for the assessment of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, the objective of the study was (a) to compare the efficacy of SARS-CoV-2 antibody detection between RDT and laboratory serology, trying to identify appropriate semi-quantitative cut-offs for RDT in relation with quantitative serology values and to (b) evaluate diagnostic accuracy of RDT compared to the NAAT gold standard in an unselected adult population. Methods: SARS-CoV-2 antibodies were simultaneously measured with lateral flow immunochromatographic assays (LFA), the Cellex qSARS-CoV-2 IgG/IgM Rapid Test (by capillary blood), the iFlash-SARS-CoV-2 IgG/IgM chemiluminescent immunoassay (CLIA) (by venous blood) and the nucleic acid amplification test (NAAT) in samples from in- and out-patients with confirmed, suspected and negative diagnosis of coronavirus disease 2019 (COVID-19) attending Udine Hospital (Italy) (March-May 2020). Interpretation of RDT was qualitative (positive/negative) and semi-quantitative based on a chromatographic intensity scale (negative, weak positive, positive). Results: Overall, 720 paired antibody measures were performed on 858 patients. The qualitative and semiquantitative agreement analysis performed in the whole sample between LFA and CLIA provided a Kendall’s tau of 0.578 (p < 0.001) and of 0.623 (p < 0.001), respectively, for IgM and IgG. In patients with a diagnosis of COVID-19, accordance between LFA and CLIA was maintained as a function of time from the onset of COVID-19 disease and the severity of disease both for qualitative and semi-quantitative assessments. RDT compared to the NAAT gold standard in 858 patients showed 78.5% sensitivity (95% CI 75.1%-81.7%) and 94.1% specificity (95% CI 90.4%-96.8%), with variable accordance depending on the timing from symptom onset. Conclusion: The RDT used in our study can be a non-invasive and reliable alternative to serological tests and facilitate both qualitative and a semi-quantitative antibody detection in COVID-19.
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Affiliation(s)
- Maddalena Peghin
- grid.5390.f0000 0001 2113 062XInfectious Diseases Division, Department of Medicine, University of Udine and Azienda sanitaria universitaria Friuli Centrale (ASUFC), Udine, Italy ,grid.18147.3b0000000121724807Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy ,Infectious Diseases Division , Azienda sanitaria universitaria Friuli Centrale (ASUFC), Presidio Ospedaliero Universitario Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia 15, 33010 Udine, Italy
| | - Giulia Bontempo
- grid.5390.f0000 0001 2113 062XInfectious Diseases Division, Department of Medicine, University of Udine and Azienda sanitaria universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Maria De Martino
- grid.5390.f0000 0001 2113 062XDivision of Medical Statistics, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Alvisa Palese
- grid.5390.f0000 0001 2113 062XDepartment of Medical Sciences, School of Nursing, University of Udine, Udine, Italy
| | - Valentina Gerussi
- grid.5390.f0000 0001 2113 062XInfectious Diseases Division, Department of Medicine, University of Udine and Azienda sanitaria universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Elena Graziano
- grid.5390.f0000 0001 2113 062XInfectious Diseases Division, Department of Medicine, University of Udine and Azienda sanitaria universitaria Friuli Centrale (ASUFC), Udine, Italy ,grid.18147.3b0000000121724807Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Martina Fabris
- Institute of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Federica D’Aurizio
- Institute of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Francesco Sbrana
- grid.452599.60000 0004 1781 8976U.O. Lipoapheresis and Center for Inherited Dyslipidemias - Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Andrea Ripoli
- grid.452599.60000 0004 1781 8976Bioengineering Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesco Curcio
- Institute of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Miriam Isola
- grid.5390.f0000 0001 2113 062XDivision of Medical Statistics, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Carlo Tascini
- grid.5390.f0000 0001 2113 062XInfectious Diseases Division, Department of Medicine, University of Udine and Azienda sanitaria universitaria Friuli Centrale (ASUFC), Udine, Italy
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Graziano E, Peghin M, Grossi PA. Perioperative antibiotic stewardship in the organ transplant setting. Transpl Infect Dis 2022; 24:e13895. [PMID: 35781915 PMCID: PMC9788034 DOI: 10.1111/tid.13895] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/04/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients can benefit from traditional antimicrobial stewardship (AMS) activities directed to improve judicious perioperative prescribing and management, but evidence is lacking. The aim of this expert opinion review is to provide an update on the current landscape of application of AMS practices for optimization of perioperative prophylaxis (PP). METHODS We reviewed the available literature on early postoperative infectious complications in SOT and PP management, on modified perioperative approaches in case of infection or colonization in recipients and donors and on AMS in transplantation PP. RESULTS SOT recipients are at high risk for early postoperative infectious complications due to the complexity of surgical procedures, severity of end stage organ disease, net state of immunosuppression in the posttransplant period and to the high risk for multidrug resistant organism. Moreover, SOT may be exposed to preservation fluid infections and expected or unexpected donor-derived infections. We summarize main factors to take into account when prescribing transplant PP. CONCLUSION Creating personalized PP to avoid unwanted consequences of antimicrobials while improving outcomes is an emerging and critical aspect in SOT setting. Further studies are needed to offer best PP tailored to SOT type and to evaluate interventions efficacy and safety.
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Affiliation(s)
- Elena Graziano
- Infectious and Tropical Diseases UnitDepartment of Medicine and SurgeryUniversity of Insubria‐ASST‐Sette LaghiVareseItaly
| | - Maddalena Peghin
- Infectious and Tropical Diseases UnitDepartment of Medicine and SurgeryUniversity of Insubria‐ASST‐Sette LaghiVareseItaly
| | - Paolo Antonio Grossi
- Infectious and Tropical Diseases UnitDepartment of Medicine and SurgeryUniversity of Insubria‐ASST‐Sette LaghiVareseItaly
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Da Porto A, Tascini C, Colussi G, Peghin M, Graziano E, De Carlo C, Bulfone L, Antonello M, Sozio E, Fabris M, Curcio F, Pucillo C, Catena C, Sechi LA. Relationship between cytokine release and stress hyperglycemia in patients hospitalized with COVID-19 infection. Front Med (Lausanne) 2022; 9:988686. [PMID: 36059840 PMCID: PMC9437426 DOI: 10.3389/fmed.2022.988686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/04/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Stress hyperglycemia is a frequent finding in patients with COVID-19 infection and could affect the outcome of disease. Cytokines released in response to infection could have adverse effects on insulin sensitivity and pancreatic beta-cell function. The aim of the study was to examine the relationships of stress hyperglycemia with cytokines and clinical outcomes in hospitalized patients with COVID-19. Methods In a cross-sectional analysis of 150 patients hospitalized for COVID-19 infection who were included in the GIRA-COVID database, we identified patients with stress hyperglycemia by calculation of the Stress Hyperglycemia Ratio (SHR) and use of a cut-off of 1.14. Plasma levels of cytokines principally involved in COVID-19 infection-related cytokine storm were measured. Outcome variables were use of mechanical ventilation and death within 60 days from hospital admission. Results Patients with SHR > 1.14 had significantly higher plasma insulin, HOMA-index, and levels of interleukin-10 (IL-10), interleukin-10/tumor necrosis factor-a ratio (IL-10/TNF-α), and CXC motif chemokine ligand 10 (CXCL10) than patients with SHR ≤ 1.14. IL-10, IL-10/TNF-α ratio, CXCL10, and IFN-γ were significantly and directly related with SHR in univariate analysis and multivariate logistic regression models showed that IL-10, IL-10/TNF-α ratio, and CXCL10 were independently associated with SHR>1.14. In a multivariate logistic model, stress hyperglycemia predicted use of mechanical ventilation (OR 2.453; CI 1.078–6.012) and death (OR 2.281; CI 1.049–7.369) independently of diabetes and other major confounders. Conclusions In patients hospitalized for COVID-19 infection, stress hyperglycemia is associated with worse clinical outcomes and is independently related to levels of cytokines that might impair glucose homeostasis.
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Affiliation(s)
- Andrea Da Porto
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
- *Correspondence: Andrea Da Porto
| | - Carlo Tascini
- Division of Infectious Diseases, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Gianluca Colussi
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Maddalena Peghin
- Division of Infectious Diseases, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Elena Graziano
- Division of Infectious Diseases, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Chiara De Carlo
- Division of Infectious Diseases, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Luca Bulfone
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Martina Antonello
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Emanuela Sozio
- Division of Infectious Diseases, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Martina Fabris
- Division of Laboratory Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Francesco Curcio
- Division of Laboratory Medicine, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Carlo Pucillo
- Laboratory of Immunology, Department of Medicine, University of Udine, Udine, Italy
| | - Cristiana Catena
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Leonardo A. Sechi
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
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Graziano E, Peghin M, De Martino M, De Carlo C, Da Porto A, Bulfone L, Casarsa V, Sozio E, Fabris M, Cifù A, Grassi B, Curcio F, Isola M, Sechi LA, Tascini C, Croatto L, Ditaranto P, Ditaranto LM. The impact of body composition on mortality of COVID-19 hospitalized patients: A prospective study on abdominal fat, obesity paradox and sarcopenia. Clin Nutr ESPEN 2022; 51:437-444. [PMID: 36184240 PMCID: PMC9295328 DOI: 10.1016/j.clnesp.2022.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
Background & aims Obesity has been described as a predisposing risk factor to severe forms of COVID-19, but conflicting results are emerging on its real impact on the mortality of COVID-19. We aimed to compare clinical outcomes and mortality among COVID-19 patients according to obesity, metabolic syndrome and adiposity distribution. Methods We conducted a prospective observational study of all consecutive adult patients with a confirmed diagnosis of SARS-CoV-2 infection admitted to the Infectious Diseases Clinic at Udine Hospital, Italy, from January 2021 to February 2021. At admission, the study population was submitted to specific anthropometric, laboratory and bioimpedance analysis (BIA) measurements and divided into five groups according to: 1) BMI < or >30 kg/m2; 2) waist circumference (WC) < or >98 cm for women, < or >102 cm for men; 3) presence or absence of metabolic syndrome (MS); 4) visceral adipose tissue (VAT) distribution; and 5) presence or absence of sarcopenia (SP) both based on BIA. We then compared clinical outcomes (ventilatory support, intensive care unit (ICU) admission, ICU length of stay, total hospital length of stay and mortality), immune and inflammatory makers and infectious and non-infectious acute complications within the five groups. Results A total of 195 patients were enrolled in the study. The mean age of patients was 71 years (IQR 61–80) and 64.6% (126) were male. The most common comorbidities were hypertension (55.9%) and MS (55.4%). Overall mortality was 19.5%. Abdominal adiposity, measured both with WC and with BIA, and SP were significantly associated with need for increased ventilator support (p = 0.013 for WC; p = 0.037, 0.027 and 0.009 for VAT; p = 0.004 and 0.036 for FMI; and p = 0.051 for SP), but not with ICU admission (WC p = 0.627, VAT p = 0.153, FMI p = 0.519 and SP p = 0.938), length of stay (WC p = 0.345, VAT p = 0.650, FMI p = 0.159 and SP p = 0.992) and mortality (WC p = 0.277, VAT p = 0.533, FMI p = 0.957 and SP p = 0.211). Obesity and MS did not discriminate for the intensity of ventilatory outcome (p = 0.142 and p = 0.198, respectively), ICU admission (p = 0.802 and p = 0.947, respectively), length of stay (p = 0.471 and p = 0.768, respectively) and mortality (p = 0.495 and p = 0.268, respectively). We did not find significant differences in inflammatory markers and secondary complications within the five groups. Conclusions In patients admitted with COVID-19, increased WC, visceral abdominal fat and SP are associated with higher need for ventilatory support. However, obesity, MS, SP and abdominal adiposity are not sensitive predictive factors for mortality.
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Mularoni A, Mikulska M, Barbera F, Graziano E, Medaglia AA, Di Carlo D, Monaco F, Bellavia D, Cascio A, Raffa G, Sciacca S, Luca A, Pilato M, Conaldi PG. Molecular Analysis With 16S rRNA PCR/Sanger Sequencing and Molecular Antibiogram Performed on DNA Extracted From Valve Improve Diagnosis and Targeted Therapy of Infective Endocarditis: A Prospective Study. Clin Infect Dis 2022; 76:e1484-e1491. [PMID: 35686318 PMCID: PMC9907470 DOI: 10.1093/cid/ciac452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/29/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Molecular analysis (MA) on heart valve (HV) improves the microbiologic diagnosis of infectious endocarditis (IE). The main drawback of MA is the lack of antimicrobial susceptibility information. METHODS We conducted a prospective cohort observational study of consecutive adult patients from April 2012 to May 2021 who underwent valve surgery at our hospital. The performance of MA, blood cultures (BC) and valve cultures (VC), and the diagnostic and therapeutic impact of MA were evaluated. Molecular antibiogram results were compared to culture-based antimicrobial susceptibility testing (AST). RESULTS A total of 137 patients with definite IE and 52 patients with no IE were enrolled in the study. Among IE cases BC, VC, and MA were positive in 75 (55%), 30 (22%), and 120 (88%) of IE cases, respectively. Among 62 cases of BC-negative IE (BCNE), 57 achieved diagnosis with MA. MA led to a change of antimicrobial therapy in 92% of BCNE. MA was negative in 100% of patients with no IE. Molecular antibiogram performed on 17 valve specimens that resulted positive for pathogens potential carrier of genes encoding for multidrug resistant mechanisms showed 100% concordance with AST. CONCLUSIONS MA showed a high specificity and sensitivity in etiological diagnosis of IE. Molecular antibiogram could overcome the major limitation of MA that is the lack of susceptibility testing. We advocate for the inclusion of MA among diagnostic criteria for IE and for a more extensive use of molecular antibiogram when the culture result is negative, and MA is the only positive test.
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Affiliation(s)
- Alessandra Mularoni
- Correspondence: A. Mularoni, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Ernesto Tricomi 5, 90100, Palermo, Italy ()
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa (DISSAL), Genova, Italy,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Floriana Barbera
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Elena Graziano
- Infectious Diseases Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy,Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, ASST-Sette Laghi, Varese, Italy
| | | | - Daniele Di Carlo
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Francesco Monaco
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Diego Bellavia
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, Palermo, Italy
| | - Giuseppe Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Sergio Sciacca
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Angelo Luca
- Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
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10
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Peghin M, Castaldo N, Tascini C, Bassetti M, Graziano E, Givone F, Savignano C, De Colle MC, Bove T, Pipan C, Loy M, Basso S, Cinque P, Gerevini S, Berastegui C, Hirsch HH, Grossi PA, Comoli P. Successful JC virus-targeted T-cell therapy for progressive multifocal leukoencephalopathy in a lung transplant recipient. J Heart Lung Transplant 2022; 41:991-996. [DOI: 10.1016/j.healun.2022.04.001] [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] [Received: 01/22/2022] [Revised: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
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11
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Mularoni A, Graziano E, Todaro F. Invasive Trichophyton infection in a liver transplant recipient. Transpl Infect Dis 2022; 24:e13794. [PMID: 35041242 DOI: 10.1111/tid.13794] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Alessandra Mularoni
- IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Elena Graziano
- IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.,Unit of Infectious Diseases, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Francesca Todaro
- IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
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12
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Peghin M, Vena A, Graziano E, Giacobbe DR, Tascini C, Bassetti M. Improving management and antimicrobial stewardship for bacterial and fungal infections in hospitalized patients with COVID-19. Ther Adv Infect Dis 2022; 9:20499361221095732. [PMID: 35591884 PMCID: PMC9112312 DOI: 10.1177/20499361221095732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/18/2021] [Accepted: 03/14/2022] [Indexed: 12/27/2022] Open
Abstract
SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection is being
one of the most significant challenges of health care systems worldwide.
Bacterial and fungal infections in hospitalized patients with coronavirus
disease 2019 (COVID-19) are uncommon but consumption of antibiotics and
antifungals has increased dramatically during the ongoing pandemic resulting in
increased selective pressure for global antimicrobial resistance. Nosocomial
bacterial superinfections appear to be more frequent than community-acquired
coinfections, particularly among patients admitted to the intensive care unit
(ICU) and those receiving immunosuppressive treatment. Fungal infections
associated with COVID-19 might be missed or misdiagnosed. Existing and new
antimicrobial stewardship (AMS) programmes can be utilized directly in COVID-19
pandemic and are urgently needed to contain the high rates of misdiagnosis and
antimicrobial prescription. The aim of this review is to describe the role of
bacterial and fungal infections and possible strategies of AMS to use in daily
practice for optimal management of COVID-19.
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Affiliation(s)
- Maddalena Peghin
- Clinica di Malattie Infettive, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Presidio Ospedaliero Universitario Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia 15, 33010 Udine, Italy
| | - Antonio Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Elena Graziano
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | | | - Carlo Tascini
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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13
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Peghin M, Bouza E, Fabris M, De Martino M, Palese A, Bontempo G, Graziano E, Gerussi V, Bressan V, Sartor A, Isola M, Tascini C, Curcio F. Low risk of reinfections and relation with serological response after recovery from the first wave of COVID-19. Eur J Clin Microbiol Infect Dis 2021; 40:2597-2604. [PMID: 34378086 PMCID: PMC8354681 DOI: 10.1007/s10096-021-04335-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/08/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022]
Abstract
The aim of the study was to assess reinfection rates in relation to long-term antibody dynamics against SARS-CoV-2 after the first wave. A prospective longitudinal study with monthly serological follow-up during the first 4 months, and then at 6, 8, and 10 months after the disease onset of all recovered adult in- and outpatients with COVID-19 attending Udine Hospital (Italy) from March to May 2020. During the follow-up, reinfections were collected. A total of 546 unselected individuals with COVID-19 acquired from March to May 2020 were included (292 female, mean age 53 years). After a median follow-up of 10 months (IQR 6.2–10.4), reinfection occurred in 6 (1.1%) patients, median age of 44.5 years (IQR 33‒49). All had a previous history of mild COVID-19 (all were healthcare workers) and reinfection occurred a median of 9 months (IQR 8.2‒10.2) after the onset of the first episode. Patients with reinfection were either seronegative (2/56, n = 3.6%), seroreverted (2/137, 1.5%), or seropositive (2/353, 0.6%) (p = 0.085). All reinfections were mild (n = 5) or asymptomatic (n = 1). After reinfection, none of patients developed IgM response and only two had a transitory boosted IgG immunization response. In an unselected population after the first wave of COVID-19, after a prolonged observation period (mean 10 months), reinfection was very uncommon; occurred in patients with a previous history of mild infection, mostly with weak or absent serological response; and manifested with mild or asymptomatic clinical presentation.
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Affiliation(s)
- Maddalena Peghin
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Presidio Ospedaliero Universitario Santa Maria della Misericordia Piazzale Santa Maria della Misericordia 15 33010, Udine, Italy.
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
| | - Martina Fabris
- Institute of Clinical Pathology, Department of Laboratory Medicine, University of Udine, ASUFC, Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Maria De Martino
- Division of Medical Statistics, Department of Medicine (DAME), University of Udine 33100, Udine, Italy
| | - Alvisa Palese
- Department of Medical Sciences, School of Nursing, University of Udine 33100, Udine, Italy
| | - Giulia Bontempo
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Presidio Ospedaliero Universitario Santa Maria della Misericordia Piazzale Santa Maria della Misericordia 15 33010, Udine, Italy
| | - Elena Graziano
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Presidio Ospedaliero Universitario Santa Maria della Misericordia Piazzale Santa Maria della Misericordia 15 33010, Udine, Italy
| | - Valentina Gerussi
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Presidio Ospedaliero Universitario Santa Maria della Misericordia Piazzale Santa Maria della Misericordia 15 33010, Udine, Italy
| | - Valentina Bressan
- Department of Medical Sciences, School of Nursing, University of Udine 33100, Udine, Italy
| | - Assunta Sartor
- Institute of Clinical Pathology, Department of Laboratory Medicine, University of Udine, ASUFC, Udine, Italy
| | - Miriam Isola
- Division of Medical Statistics, Department of Medicine (DAME), University of Udine 33100, Udine, Italy
| | - Carlo Tascini
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Presidio Ospedaliero Universitario Santa Maria della Misericordia Piazzale Santa Maria della Misericordia 15 33010, Udine, Italy
| | - Francesco Curcio
- Institute of Clinical Pathology, Department of Laboratory Medicine, University of Udine, ASUFC, Udine, Italy
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14
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Migliore A, Graziano E, Martín LSM, Sorbino A, Raichi M, Boni G. Three-year management of hip osteoarthritis with intra-articular polynucleotides: a real-life cohort retrospective study. J BIOL REG HOMEOS AG 2021; 35:1189-1194. [PMID: 34231350 DOI: 10.23812/21-178-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Migliore
- Rheumatology Unit, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - E Graziano
- Department of Orthopaedics and Traumatology, Cardinal Massaia Hospital, Asti, Italy
| | - L S M Martín
- Department of Internal Medicine, Sant'Eugenio Hospital, Rome, Italy
| | - A Sorbino
- Rheumatology Unit, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - M Raichi
- Clinical Pharmacology consultant
| | - G Boni
- Italian Sports Medicine Federation, Umbria Region chapter, Perugia, Italy
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15
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Gerussi V, Peghin M, Palese A, Bressan V, Visintini E, Bontempo G, Graziano E, De Martino M, Isola M, Tascini C. Vaccine Hesitancy among Italian Patients Recovered from COVID-19 Infection towards Influenza and Sars-Cov-2 Vaccination. Vaccines (Basel) 2021; 9:172. [PMID: 33670661 PMCID: PMC7922251 DOI: 10.3390/vaccines9020172] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to assess the attitude towards influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations among coronavirus disease 2019 (COVID-19) recovered patients. We performed a cross-sectional study consisting of a standardized telephone interview carried out between September and November 2020 targeting a cohort of adult in- and out-patients that had recovered from COVID-19 after the first wave (March-May 2020) at Udine Hospital (Italy). Overall, 599 people participated (320 female, median age 53 years) and most had experienced an acute COVID-19 with mild illness (409, 68.3%). The majority were hesitant or undecided towards influenza (327, 54.6%) and SARS-CoV-2 (353, 59.2%) vaccines. Older age, public work exposure, and previous 2019 flu shots were the main factors associated with a positive attitude toward both vaccinations (p < 0.05). Being hospitalized during the acute COVID-19 phase was associated with the willingness to get a flu shot (94/272, 34.5%) but not SARS-CoV-2 vaccine (70/244, 28.7%). Vaccine hesitancy is diffuse and multifactorial also among COVID-19 recovered.
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Affiliation(s)
- Valentina Gerussi
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, 33100 Udine, Italy; (V.G.); (G.B.); (E.G.); (C.T.)
| | - Maddalena Peghin
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, 33100 Udine, Italy; (V.G.); (G.B.); (E.G.); (C.T.)
| | - Alvisa Palese
- Department of Medical Sciences, School of Nursing, University of Udine, 33100 Udine, Italy; (A.P.); (V.B.); (E.V.)
| | - Valentina Bressan
- Department of Medical Sciences, School of Nursing, University of Udine, 33100 Udine, Italy; (A.P.); (V.B.); (E.V.)
| | - Erica Visintini
- Department of Medical Sciences, School of Nursing, University of Udine, 33100 Udine, Italy; (A.P.); (V.B.); (E.V.)
| | - Giulia Bontempo
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, 33100 Udine, Italy; (V.G.); (G.B.); (E.G.); (C.T.)
| | - Elena Graziano
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, 33100 Udine, Italy; (V.G.); (G.B.); (E.G.); (C.T.)
| | - Maria De Martino
- Department of Medicine, University of Udine, 33100 Udine, Italy; (M.D.M.); (M.I.)
| | - Miriam Isola
- Department of Medicine, University of Udine, 33100 Udine, Italy; (M.D.M.); (M.I.)
| | - Carlo Tascini
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, 33100 Udine, Italy; (V.G.); (G.B.); (E.G.); (C.T.)
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16
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Giannella M, Freire M, Rinaldi M, Abdala E, Rubin A, Mularoni A, Gruttadauria S, Grossi P, Shbaklo N, Tandoi F, Ferrarese A, Burra P, Fernandes R, Aranha Camargo LF, Asensio A, Alagna L, Bandera A, Simkins J, Abbo L, Halpern M, Santana Girao E, Valerio M, Muñoz P, Fernandez Yunquera A, Statlender L, Yahav D, Franceschini E, Graziano E, Morelli MC, Cescon M, Viale P, Lewis R. Development of a Risk Prediction Model for Carbapenem-Resistant Enterobacteriaceae Infection after Liver Transplantation: A Multinational Cohort Study. Clin Infect Dis 2021; 73:e955-e966. [PMID: 33564840 DOI: 10.1093/cid/ciab109] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 11/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients colonized with carbapenem resistant Enterobacteriaceae (CRE) are at higher risk of developing CRE infection after liver transplantation (LT) with associated high morbidity and mortality. Prediction model for CRE infection after LT among carriers could be useful to target preventive strategies. METHODS Multinational multicenter cohort study of consecutive adult patients underwent LT and colonized with CRE before or after LT, from January 2010 to December 2017. Risk factors for CRE infection were analyzed by univariate analysis and by Fine-Gray sub-distribution hazard model, with death as competing event. A nomogram to predict 30- and 60-day CRE infection risk was created. RESULTS 840 LT recipients found to be colonized with CRE before (n=203) or after (n=637) LT were enrolled. CRE infection was diagnosed in 250 (29.7%) patients within 19 (IQR 9-42) days after LT. Pre-and post-LT colonization, multisite post-LT colonization, prolonged mechanical ventilation, acute renal injury, and surgical re-intervention were retained in the prediction model. Median 30 and 60-day predicted risk was 15% (IQR 11-24%) and 21% (IQR 15-33%), respectively. Discrimination and prediction accuracy for CRE infection was acceptable on derivation (AUC 74.6, Brier index 16.3) and bootstrapped validation dataset (AUC 73.9, Brier index 16.6). Decision-curve analysis suggested net benefit of model-directed intervention over default strategies (treat all, treat none) when CRE infection probability exceeded 10%. The risk prediction model is freely available as mobile application at https://idbologna.shinyapps.io/CREPostOLTPredictionModel/. CONCLUSIONS Our clinical prediction tool could enable better targeting interventions for CRE infection after transplant.
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Affiliation(s)
- Maddalena Giannella
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maristela Freire
- Working Committee for Hospital Epidemiology and Infection Control, Hospital das Clinicas, Universidade de São Paulo, Brazil
| | - Matteo Rinaldi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Edson Abdala
- Infectious diseases department, Hospital das Clinicas, Universidade de São Paulo, Brazil
| | - Arianna Rubin
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | | | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS, ISMETT-UPMC, Palermo, Italy
| | - Paolo Grossi
- Infectious and Tropical Diseases Department, University of Insubria, Varese, Italy
| | - Nour Shbaklo
- Infectious Disease, Department of Medical Sciences University of Turin AOU Città della salute e della Scienza, Turin, Italy
| | - Francesco Tandoi
- Liver Transplant Center, General Surgery Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Alberto Ferrarese
- Multivisceral Transplant Unit (Gastroenterology), Department of Surgery Oncology and Gastroenterology, Surgical and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit (Gastroenterology), Department of Surgery Oncology and Gastroenterology, Surgical and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
| | - Ruan Fernandes
- Infectious Diseases Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Angel Asensio
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Madrid, Spain
| | - Laura Alagna
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jacques Simkins
- Transplant Infectious Diseases and Immunocompromised Host Service, Division of Infectious Diseases, University of Miami/Miami Transplant Institute, Miami, Florida, USA
| | - Lilian Abbo
- Department of Medicine, Division of Infectious Diseases, University of Miami, Miami, Florida, USA
| | - Marcia Halpern
- Liver Transplant Unit, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Evelyne Santana Girao
- Infectious Diseases Unit and Liver Transplant Unit of Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza- Brazil
| | - Maricela Valerio
- Department of Clinical Microbiology and Infectious Diseases, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ainhoa Fernandez Yunquera
- Department of Gastroenterology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Dafna Yahav
- Infectious Disease Unit, Beilinson Hospital, Petah Tikva, Israel
| | - Erica Franceschini
- Infectious Diseases Unit, Department of Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | | | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Liver and Multiorgan Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Russell Lewis
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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17
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Cattaruzza MS, Gorini G, Bosetti C, Boffi R, Lugo A, Veronese C, Carreras G, Santucci C, Stival C, Pacifici R, Zagà V, Gallus S, Giulietti F, Sarzani R, Spannella F, Del Donno M, Tartaglione S, Marrazzo G, Pelaia G, D'Agosto V, Berti A, Voller F, Cardellicchio S, Cresci C, Foschino Barbaro MP, De Palma R, Negrini S, Sicbaldi V, Serafini A, Bisconti M, Refolo L, Landoni G, Rovere P, Veronesi G, Faverio P, Garavello W, Pesci A, Giacobbe R, Martucci P, Parrella R, Scarano F, Aiello M, Chetta A, Franco C, Mangia A, Carrozzi L, Maggi F, Monzani F, Pistelli F, Russo P, Sanna A, Barreca FM, Conti V, Rossi E, Ruli M, Ruli S, Eslami Varzaneh S, Principe R, Guerrini S, Sebastiani A, Galluccio G, Pezzuto A, Ricci A, Casali E, Mastroianni C, Pirina P, Polo F, Beatrice F, Romagnoli M, Baraldo M, Cojutti PG, Tascini C, Pecori D, Graziano E, Tinghino B. Covid-19 and the role of smoking: the protocol of the multicentric prospective study COSMO-IT (COvid19 and SMOking in ITaly). Acta Biomed 2020; 91:e2020062. [PMID: 32921714 PMCID: PMC7716969 DOI: 10.23750/abm.v91i3.10373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 01/08/2023]
Abstract
The emergency caused by Covid-19 pandemic raised interest in studying lifestyles and comorbidities as important determinants of poor Covid-19 prognosis. Data on tobacco smoking, alcohol consumption and obesity are still limited, while no data are available on the role of e-cigarettes and heated tobacco products (HTP). To clarify the role of tobacco smoking and other lifestyle habits on COVID-19 severity and progression, we designed a longitudinal observational study titled COvid19 and SMOking in ITaly (COSMO-IT). About 30 Italian hospitals in North, Centre and South of Italy joined the study. Its main aims are: 1) to quantify the role of tobacco smoking and smoking cessation on the severity and progression of COVID-19 in hospitalized patients; 2) to compare smoking prevalence and severity of the disease in relation to smoking in hospitalized COVID-19 patients versus patients treated at home; 3) to quantify the association between other lifestyle factors, such as e-cigarette and HTP use, alcohol and obesity and the risk of unfavourable COVID-19 outcomes. Socio-demographic, lifestyle and medical history information will be gathered for around 3000 hospitalized and 700-1000 home-isolated, laboratory-confirmed, COVID-19 patients. Given the current absence of a vaccine against SARS-COV-2 and the lack of a specific treatment for COVID-19, prevention strategies are of extreme importance. This project, designed to highly contribute to the international scientific debate on the role of avoidable lifestyle habits on COVID-19 severity, will provide valuable epidemiological data in order to support important recommendations to prevent COVID-19 incidence, progression and mortality.
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Affiliation(s)
| | - Giuseppe Gorini
- Oncologic network, prevention and research Institute (ISPRO), Florence, Italy .
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Roberto Boffi
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | | | - Giulia Carreras
- Oncologic network, prevention and research Institute (ISPRO), Florence, Italy .
| | - Claudia Santucci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Chiara Stival
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Roberta Pacifici
- National Observatory on Smoking, Alcohol and Drugs, National Institute of Health, Rome, Italy.
| | | | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio Sanna
- Ospedale San Jacopo Azienda USL Toscana Centro, Pistoia.
| | | | | | | | - Mei Ruli
- Ospedale di Stato, Repubblica di San Marino.
| | | | | | | | | | | | | | - Aldo Pezzuto
- Azienda Ospedaliero-Universitaria Sant'Andrea, Roma.
| | - Alberto Ricci
- Azienda Ospedaliero-Universitaria Sant'Andrea, Roma.
| | - Elena Casali
- Azienda Ospedaliero-Universitaria Policlinico Umberto I, Roma.
| | | | - Pietro Pirina
- Azienda Ospedaliero Universitaria di Sassari, Sassari.
| | | | - Fabio Beatrice
- Ospedale San Giovanni Bosco, ASL Città di Torino, Torino.
| | | | | | | | - Carlo Tascini
- Azienza Sanitaria Universitaria Friuli Centrale, Udine.
| | - Davide Pecori
- Azienza Sanitaria Universitaria Friuli Centrale, Udine.
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Vendramin I, Peghin M, Graziano E, Bassetti M, Tioni C, Sut D, De Pellegrin A, Sponga S, Bortolotti U, Livi U. Saprochaete capitata aortitis in an immunocomopetent patient after myocardial revascularization. Cardiovasc Pathol 2020; 48:107223. [PMID: 32470823 DOI: 10.1016/j.carpath.2020.107223] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022] Open
Abstract
Saprochaete species infection is a rare fungal disease reported so far only in immunocompromised patients. We describe the first case of aortitis caused by Saprochaete capitata, presenting as ascending aorta aneurysm, with secondary endophthalmitis in an immunocompetent patient. Infection by Saprochaete capitata is potentially fatal, with a mortality ranging from 50% to 90% of cases. In the present case aortic aneurysm caused by Saprochaete capitata aortitis was successfully treated by the combination of accurate diagnosis with surgical and specific antifungal therapy.
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Affiliation(s)
- Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
| | - Maddalena Peghin
- Infectious Diseases Clinic, Department of Medicine, University Hospital of Udine, Italy
| | - Elena Graziano
- Infectious Diseases Clinic, Department of Medicine, University Hospital of Udine, Italy
| | | | - Chiara Tioni
- Cardiologic Division, Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Dario Sut
- Cardiologic Division, Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | | | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Uberto Bortolotti
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
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Bassetti M, Russo A, Cilloniz C, Giacobbe DR, Vena A, Amaro R, Graziano E, Soriano A, Torres A. Ceftaroline for severe community-acquired pneumonia: A real-world two-centre experience in Italy and Spain. Int J Antimicrob Agents 2020; 55:105921. [PMID: 32061999 DOI: 10.1016/j.ijantimicag.2020.105921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/19/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Ceftaroline is one of latest additions to the armamentarium for treating community-acquired pneumonia (CAP). This study aimed to describe the outcome of severe CAP (SCAP) in a cohort of hospitalised patients treated with ceftaroline. METHODS A retrospective, observational study of patients with SCAP treated with ceftaroline in two hospitals in Spain and Italy. The primary objective was to explore 30-day mortality after diagnosis of SCAP. RESULTS During the study period the following were observed: there were 89 cases of SCAP treated with ceftaroline and 53 cases used in combination with other antibiotics (60%). Overall, 30-day mortality and clinical failure were 20% (18 of 89) and 36% (32 of 89), respectively. Independent predictors of 30-day mortality were: increasing age (OR for 1 year increase 1.0, 95% CI 1.0-1.1, P 0.043), presence of solid neoplasm (OR 4.0, 95% CI 1.0-15.1, P 0.044) and concomitant therapy with oseltamivir (OR 8.5, 95% CI 1.2°57.3, P 0.029). The only independent predictor of clinical failure was the time elapsing from SCAP diagnosis to ceftaroline therapy (OR for each passing day 1.5, 95% CI 1.1-1.9, P 0.003). The clinical success rate was 64% (57 of 89). In the subgroups of patients with proven Streptococcus pneumoniae, methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) infection, clinical success was 83% (10 of 12), 75% (three of four) and 56% (five of nine), respectively. CONCLUSIONS Considering its spectrum of activity, ceftaroline could represent an important therapeutic option for SCAP. Further studies are needed to identify the precise clinical success rate against MRSA in a larger cohort of patients with SCAP.
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Affiliation(s)
- Matteo Bassetti
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Rosanel Amaro
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
| | - Elena Graziano
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
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Falcone M, Bassetti M, Tiseo G, Giordano C, Nencini E, Russo A, Graziano E, Tagliaferri E, Leonildi A, Barnini S, Farcomeni A, Menichetti F. Time to appropriate antibiotic therapy is a predictor of outcome in patients with bloodstream infection caused by KPC-producing Klebsiella pneumoniae. Crit Care 2020; 24:29. [PMID: 32000834 PMCID: PMC6993311 DOI: 10.1186/s13054-020-2742-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [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: 11/01/2019] [Accepted: 01/14/2020] [Indexed: 12/15/2022]
Abstract
Background Bloodstream infections (BSIs) by Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (Kp) are associated with high mortality. The aim of this study is to assess the relationship between time to administration of appropriate antibiotic therapy and the outcome of patients with BSI due to KPC-Kp hospitalized in intensive care unit (ICU). Methods An observational study was conducted in the ICUs of two academic centers in Italy. Patients with KPC-Kp bacteremia hospitalized between January 2015 to December 2018 were included. The primary outcome was the relationship between time from blood cultures (BC) collection to appropriate antibiotic therapy and 30-day mortality. The secondary outcome was to evaluate the association of different treatment regimens with 30-day mortality and a composite endpoint (30-day mortality or nephrotoxicity). A Cox regression analysis to identify factors independently associated with 30-day mortality was performed. Hazard ratio (HR) and 95% confidence interval (CI) were calculated. Results A total of 102 patients with KPC-Kp BSI were included. The most common sources of infection were intra-abdominal (23.5%), urinary tract (20.6%), and skin and skin structure (17.6%). The 30-day mortality was 45%. Median time to appropriate antibiotic therapy was shorter in patients who survived (8.5 h [IQR 1–36]) versus those who died (48 h [IQR 5–108], p = 0.014). A propensity score matching showed that receipt of an in vitro active therapy within 24 h from BC collection was associated with lower 30-day mortality (HR = 0.36, 95% CI: 0.188–0.690, p = 0.0021). At Cox regression analysis, factors associated with 30-day mortality were primary bacteremia (HR 2.662 [95% CI 1.118–6.336], p = 0.027), cardiovascular disease (HR 2.196 [95% CI 1.082–4.457], p = 0.029), time (24-h increments) from BC collection to appropriate therapy (HR 1.382 [95% CI 1.132–1.687], p = 0.001), SOFA score (HR 1.122 [95% CI 1.036–1.216], p = 0.005), and age (HR 1.030 [95% CI 1.006–1.054], p = 0.012). Ceftazidime-avibactam-containing regimens were associated with reduced risk of composite endpoint (30-day mortality OR nephrotoxicity) (HR 0.231 [95% CI 0.071–0.745], p = 0.014) compared to colistin-containing regimens. Conclusions Time to appropriate antibiotic therapy is an independent predictor of 30-day mortality in patients with KPC-Kp BSI. Appropriate antibiotic therapy should begin within 24 h from the collection of BC. Electronic supplementary material The online version of this article (10.1186/s13054-020-2742-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marco Falcone
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa, 2, 56124, Pisa, PI, Italy.
| | - Matteo Bassetti
- Infectious Diseases Clinic Department of Health Science, University of Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy
| | - Giusy Tiseo
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa, 2, 56124, Pisa, PI, Italy
| | - Cesira Giordano
- Microbiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Elia Nencini
- Emergency Medicine Department, University of Pisa, Pisa, Italy
| | - Alessandro Russo
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa, 2, 56124, Pisa, PI, Italy
| | - Elena Graziano
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Enrico Tagliaferri
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa, 2, 56124, Pisa, PI, Italy
| | | | - Simona Barnini
- Microbiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alessio Farcomeni
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Menichetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa, 2, 56124, Pisa, PI, Italy
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Vena A, Giacobbe DR, Mussini C, Cattelan A, Bassetti M, Bassetti M, Vena A, Castaldo N, Pecori D, Righi E, Carnellutti A, Givone F, Graziano E, Merelli M, Cadeo B, Peghin M, Cattelan A, Cipriani L, Coletto D, Mussini C, Digaetano M, Tascini C, Carrannante N, Menichetti F, Verdenelli S, Fabiani S, Mastroianni CM, Gianluca R, Oliva A, Ciardi MR, Ajassa C, Tieghi T, Tumbarello M, Losito AR, Raffaelli F, Grossi P, Rovelli C, Artioli S, Caruana G, Luzzati R, Bontempo G, Petrosillo N, Capone A, Rizzardini G, Coen M, Passerini M, Mastroianni A, Urso F, Bianco MF, Borgia G, Gentile I, Maraolo AE, Crapis M, Venturini S, Parruti G, Trave F, Angarano G, Carbonara S, Mariani MF, Girardis M, Cascio A, Anselmo M, Malfatto E, Bassetti M, Vena A, Castaldo N, Pecori D, Righi E, Carnellutti A, Givone F, Graziano E, Merelli M, Cadeo B, Peghin M, Cattelan A, Cipriani L, Coletto D, Mussini C, Digaetano M, Tascini C, Carrannante N, Menichetti F, Verdenelli S, Fabiani S, Mastroianni CM, Gianluca R, Oliva A, Ciardi MR, Ajassa C, Tieghi T, Tumbarello M, Losito AR, Raffaelli F, Grossi P, Rovelli C, Artioli S, Caruana G, Luzzati R, Bontempo G, Petrosillo N, Capone A, Rizzardini G, Coen M, Passerini M, Mastroianni A, Urso F, Bianco MF, Borgia G, Gentile I, Maraolo AE, Crapis M, Venturini S, Parruti G, Trave F, Angarano G, Carbonara S, Mariani MF, Girardis M, Cascio A, Anselmo M, Malfatto E. Clinical Efficacy of Ceftolozane-Tazobactam Versus Other Active Agents for the Treatment of Bacteremia and Nosocomial Pneumonia due to Drug-Resistant Pseudomonas aeruginosa. Clin Infect Dis 2020; 71:1799-1801. [DOI: 10.1093/cid/ciaa003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antonio Vena
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Cristina Mussini
- Infectious Diseases Clinics, University of Modena and Reggio Emilia, Modena, Italy
| | - Annamaria Cattelan
- Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - Matteo Bassetti
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
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Peghin M, Russo A, Givone F, Ingani M, Graziano E, Bassetti M. Should High-dose Daptomycin be an Alternative Treatment Regimen for Enterococcal Endocarditis? Infect Dis Ther 2019; 8:695-702. [PMID: 31428940 PMCID: PMC6856472 DOI: 10.1007/s40121-019-00261-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/17/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Previous series on the use of daptomycin in enterococcal infective endocarditis (EIE) have shown various outcomes, including higher mortality rates. We analyzed the effectiveness of high-dose daptomycin for the treatment of EIE. METHODS We performed a prospective study from 2010 to 2018 in a referral center in patients with native (NVE) and prosthetic valve endocarditis (PVE) due to Enterococcus spp. The standard high-dose daptomycin at our institution is 10-12 mg/kg/day (CLCr > 30 ml/min). We compared the efficacy of a daptomycin-based regimen (DBR) versus daptomycin-sparing regimen (DSR) and daptomycin monotherapy versus combination therapy. Primary endpoints of the study were evaluation of risk factors associated with 30-day mortality and failure at end of therapy. RESULTS We collected 43 EIE cases; 29 were NVE (67.4%). Overall, 16 (37.2%) were treated with DBR, mainly with combination regimens (11, 68.7%), in the majority of cases in association with ß-lactam (7, 43.7%). The mean administered dose of daptomycin was 10.125 mg/kg/day (range 8-12 mg/kg/day). Overall, patients treated with DBR compared with patients treated with DSR had no higher mortality rates and/or failure at end of therapy (6.2% vs. 22. 2%; P 0.41 and MICs 0.25-2 mg/l, 6.2% vs. 3.7%; P 1.0). In the sub-group of patients with NVE and PVE treated with DBR and DSR, no difference was found regarding the primary endpoints on the single or combined use of daptomycin. CONCLUSION Our findings suggest that high-dose daptomycin might be used as an alternative treatment regimen in EIE.
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Affiliation(s)
- Maddalena Peghin
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - Alessandro Russo
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Filippo Givone
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Martina Ingani
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Elena Graziano
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Russo A, Graziano E, Carnelutti A, Sponza M, Cadeo B, Sartor A, Righi E, Bassetti M. Management of vertebral osteomyelitis over an eight-year period: The UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis). Int J Infect Dis 2019; 89:116-121. [PMID: 31629078 DOI: 10.1016/j.ijid.2019.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 08/13/2019] [Revised: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Vertebral osteomyelitis (VO) is a compelling clinical entity for clinicians because of its insidious and indolent course, which makes diagnosis difficult. METHODS All patients with a suspected diagnosis of VO were analyzed over an 8-year period (January 2009 to January 2017). The UDIPROVE protocol (UDIne PROtocol on VErtebral osteomyelitis) was applied in all cases. The primary endpoint was the performance of the UDIPROVE protocol to obtain the causal bacteria of infection. RESULTS During the study period, 133 episodes of confirmed VO were observed. The etiology of infection was obtained in 73.6% of cases: 70.5% were gram-positive, 16.3% were gram-negative, and 13.2% were mycobacteria. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed that for tubercular VO, the median standard uptake value (SUV) was higher when compared with VO caused by other bacteria. Clinical cure at the end of therapy was reported in 85.7% of patients. Previous antimicrobial therapy and a delay of more than 5 days in performing biopsy were associated with an undiagnosed etiology of VO. Targeted antibacterial therapy and follow-up with FDG-PET/CT were associated with clinical cure at the end of therapy, while the involvement of more than two vertebrae and inadequate drainage were associated with failure. CONCLUSIONS Rigorous application of the UDIPROVE protocol allowed the causative pathogens of VO to be obtained - at about twice the rate reported in the literature. The use of FDG-PET/CT for the follow-up of infection was more reliable when compared to magnetic resonance imaging (MRI).
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Affiliation(s)
- Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Elena Graziano
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Alessia Carnelutti
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Massimo Sponza
- Division of Vascular and Interventional Radiology, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Barbara Cadeo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Assunta Sartor
- Microbiology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Elda Righi
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy.
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Russo A, Peghin M, Givone F, Ingani M, Graziano E, Bassetti M. Daptomycin-containing regimens for treatment of Gram-positive endocarditis. Int J Antimicrob Agents 2019; 54:423-434. [PMID: 31400470 DOI: 10.1016/j.ijantimicag.2019.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/23/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Infective endocarditis (IE) is a severe infection, and a leading cause of mortality and morbidity. Due to its favourable microbiological and pharmacological characteristics, daptomycin is routinely used in clinical practice for treating IE. METHODS A prospective study was conducted at a large tertiary-care hospital in Italy over an 8-year period (January 2010-January 2018) on all patients with native-valve endocarditis (NVE) or prosthetic-valve endocarditis (PVE) caused by Gram-positive bacteria. Patients with NVE and PVE treated with regimens that included daptomycin at different dosages (daptomycin-containing regimens, DCR) were compared with those treated with non-DCR. Primary endpoints of the study were 30-day mortality and clinical treatment failure. RESULTS During the study period, 327 patients with Gram-positive NVE (n = 224, 68.8%) or PVE (n = 103, 31.2%) were analysed. Eighty-four (37.5%) NVE patients were treated with daptomycin, alone (59.9%) or with other antimicrobials. Most PVE patients (n = 61, 58%) were treated with a DCR, which always consisted of daptomycin plus other drugs. Among PVE patients, treatment with a DCR was associated with lower 30-day mortality than treatment with a non-DCR (6.5% vs. 38%, P < 0.001). Among NVE patients treated with DCRs, risk factors for 30-day mortality were streptococcal infections, persistent bacteraemia, and standard-dose (4-6 mg/kg) rather than high-dose daptomycin therapy. Overall, surgical treatment of IE and DCR were associated with clinical success and 30-day survival. CONCLUSIONS Compared with non-DCRs, using single-drug or multiple-drug DCRs is associated with lower 30-day mortality in PVE, but with higher 30-day mortality in NVE at approved doses and in a subgroup of streptococcal IE.
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Affiliation(s)
- Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Maddalena Peghin
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Filippo Givone
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Martina Ingani
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Elena Graziano
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
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Drocco L, Camazzola D, Ferracini R, Lustig S, Ravera L, Graziano E, Massè A, Bistolfi A. Tripled semitendinosus with single harvesting is as effective but less invasive compared to standard gracilis-semitendinosus harvesting. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.04.2017.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L. Drocco
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital “Città della Salute e della Scienza”, Trauma Center, Turin, Italy
| | - D. Camazzola
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital “Città della Salute e della Scienza”, Trauma Center, Turin, Italy
| | - R. Ferracini
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital “Città della Salute e della Scienza”, Trauma Center, Turin, Italy
| | - S. Lustig
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital “Città della Salute e della Scienza”, Trauma Center, Turin, Italy
| | - L. Ravera
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital “Città della Salute e della Scienza”, Trauma Center, Turin, Italy
| | - E. Graziano
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital “Città della Salute e della Scienza”, Trauma Center, Turin, Italy
| | - A. Massè
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital “Città della Salute e della Scienza”, Trauma Center, Turin, Italy
| | - A. Bistolfi
- Department of Orthopaedics, Traumatology and Rehabilitation, Hospital “Città della Salute e della Scienza”, Trauma Center, Turin, Italy
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Bassetti M, Carannante N, Pallotto C, Righi E, Di Caprio G, Bernardo M, Sodano G, Mallardo E, Francisci D, Sartor A, Graziano E, Tascini C. KPC-producing Klebsiella pneumoniae gut decolonisation following ceftazidime/avibactam-based combination therapy: A retrospective observational study. J Glob Antimicrob Resist 2018; 17:109-111. [PMID: 30468915 DOI: 10.1016/j.jgar.2018.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES KPC-producing Klebsiella pneumoniae (KPC-Kp) gut colonisation is a major risk factor for developing systemic infection. Ceftazidime/avibactam (CAZ/AVI) may have a role as decolonisation therapy in special situations. METHODS This was a retrospective, observational, multicentre study. The KPC-Kp gut decolonisation rate of CAZ/AVI-based therapy (Group A) was compared with other antimicrobial regimens (Group B) in patients with KPC-Kp infection. RESULTS Among 12 patients in Group A, 11 (91.7%) achieved gut decolonisation. None of the 24 patients of Group B were decolonised. CONCLUSION CAZ/AVI-based therapy could be useful in KPC-Kp gut decolonisation in high-risk patients.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Department of Medicine, University of Udine and Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, 80131 Naples, Italy
| | - Carlo Pallotto
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, 80131 Naples, Italy; Infectious Diseases Section, Department of Medicine, University of Perugia, Piazzale Gambuli 1, Perugia, Italy.
| | - Elda Righi
- Infectious Diseases Division, Department of Medicine, University of Udine and Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Giovanni Di Caprio
- Infectious Diseases Section, Department of Mental Health and Public Medicine, University of Campania 'Luigi Vanvitelli', largo Madonna delle Grazie, Naples, Italy
| | - Mariano Bernardo
- Microbiology and Virology Unit, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, Naples, Italy
| | - Giuseppe Sodano
- Microbiology and Virology Unit, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, Naples, Italy
| | - Enza Mallardo
- Microbiology and Virology Unit, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, Naples, Italy
| | - Daniela Francisci
- Infectious Diseases Section, Department of Medicine, University of Perugia, Piazzale Gambuli 1, Perugia, Italy
| | - Assunta Sartor
- Infectious Diseases Division, Department of Medicine, University of Udine and Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Elena Graziano
- Infectious Diseases Division, Department of Medicine, University of Udine and Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Via G. Quagliariello 51, 80131 Naples, Italy
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Bassetti M, Righi E, Carnelutti A, Graziano E, Russo A. Multidrug-resistantKlebsiella pneumoniae: challenges for treatment, prevention and infection control. Expert Rev Anti Infect Ther 2018; 16:749-761. [DOI: 10.1080/14787210.2018.1522249] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Matteo Bassetti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elda Righi
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessia Carnelutti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elena Graziano
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessandro Russo
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
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Giamarellos-Bourboulis EJ, Kotsaki A, Routsi C, Graziano E, Righi E, Bassetti M. A prognostic score for the resolution of bacteremia by Gram-negative bacteria resistant to carbapenems. Eur J Clin Microbiol Infect Dis 2018; 37:2083-2089. [PMID: 30083886 DOI: 10.1007/s10096-018-3342-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/30/2018] [Indexed: 11/27/2022]
Abstract
The management of bacteremia by carbapenem-resistant Gram-negative bacteria (CRGNB) necessitates a surrogate marker for response to treatment. We developed a prognostic score of bacteremia resolution using a test and a validation cohort. In the test cohort, five protein biomarkers were measured in serial daily serum samples from 39 patients with ventilator-associated pneumonia (VAP) and CRGNB bacteremia. Receiver operator characteristic curves were designed to identify cut-off of over-time changes that were associated with more than 80% specificity for resolution of bacteremia. The developed score was validated in a cohort of 24 patients mostly with primary bacteremia by carbapenem-resistant enterobacteria (CRE). Among the five tested biomarkers, only procalcitonin (PCT) was associated with resolution of bacteremia. More precisely, resolved bacteremia was considered if at least one of three situations occurred: (a) PCT on day 2 was decreased more than 30% and PCT on day 4 was below 0.5 ng/ml; (b) PCT on day 4 was decreased more than 40% and PCT on day 4 was below 0.5 ng/ml; and (c) PCT on day 2 was decreased more than 30% and PCT on day 4 was decreased more than 40%. Sensitivity, specificity, and positive and negative predictive values of the score were 66.7%, 83.3%, 90.0%, and 52.6% respectively. This score was fully validated (p values of comparison between the cohorts 0.623). The developed score is highly predictive of resolution of bacteremia by CRGNB. A prospective clinical study is mandatory to validate the results.
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Affiliation(s)
| | - Antigone Kotsaki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christina Routsi
- 1st Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Elena Graziano
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Elda Righi
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
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Giannella M, Pascale R, Toschi A, Ferraro G, Graziano E, Furii F, Bartoletti M, Tedeschi S, Ambretti S, Lewis RE, Viale P. Treatment duration for Escherichia coli bloodstream infection and outcomes: retrospective single-centre study. Clin Microbiol Infect 2018; 24:1077-1083. [PMID: 29371138 DOI: 10.1016/j.cmi.2018.01.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 11/03/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To investigate the impact of treatment duration on mortality and on relapse in patients with Escherichia coli bloodstream infection (BSI). METHODS Retrospective single-centre study of patients diagnosed with E. coli BSI at our centre over a 4-year period. EXCLUSION CRITERIA age <18 years, clinical data not available, polymicrobial BSI, failure to receive in vitro active therapy, and death while receiving antibiotic therapy. Exposure variable was treatment duration dichotomized into short (≤10 days) and long (>10 days) therapy. Primary end point was all-cause mortality within 90 days after index BSI. Secondary end point was relapse, defined as repeat isolation of E. coli from blood cultures within 90 days after index BSI, in patients with documented clinical cure and completion of therapy for the initial episode. RESULTS Of the 856 analysed patients: 426 received short and 430 received long therapy. All-cause mortality at day 90 occurred in 47 patients; on multivariate analysis, short therapy was not associated with a higher risk of mortality, also after adjusting the model for the propensity score of receiving short therapy. Relapse occurred in 42 patients. Independent risk factors for relapse using death as competing risk were immunosuppression (subhazard ratio 4.67, p < 0.001), and end-stage liver disease (subhazard ratio 2.58, p 0.013). The propensity-weighted estimation of the average treatment effect for relapse reduction with long therapy (>10 days) was -1.6% (p 0.26) in the total population, and -7.1% (p 0.18) in immunocompromised patients. CONCLUSIONS We could not identify shorter treatment duration as a risk factor for mortality and for relapse in patients with E. coli BSI.
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Affiliation(s)
- M Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
| | - R Pascale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - A Toschi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - G Ferraro
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - E Graziano
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - F Furii
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - M Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - S Tedeschi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - S Ambretti
- Microbiology Department, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - R E Lewis
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - P Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
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Cannavo S, Bogazzi F, Colao A, De Marinis L, Maffei P, Gomez R, Graziano E, Monterubbianesi M, Grottoli S. Does pegvisomant treatment expertise improve control of resistant acromegaly? The Italian ACROSTUDY experience. J Endocrinol Invest 2015; 38:1099-109. [PMID: 25916431 DOI: 10.1007/s40618-015-0289-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 04/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE GH receptor antagonist pegvisomant is indicated for treatment of patients with resistant acromegaly. We compared safety and treatment outcomes of pegvisomant therapy in patients managed by Italian centers enrolling less or more than 15 cases in ACROSTUDY, a safety surveillance study of long-term pegvisomant treatment of patients with acromegaly. A noninterventional safety surveillance study in which safety and treatment outcomes of pegvisomant were evaluated on the basis of data collected during a 7-year period. METHODS A total of 204 acromegaly patients treated by seven centers enrolling 16-49 patients each (group A) and 137 subjects by 18 centers following 3-14 cases ( group B). RESULTS Patients of group A and B were treated for 4.4 ± 2.7 and 4.2 ± 2.2 years, respectively. IGF-1 ULN normalized in 64.4 % (n = 56) and 54.4 % (n = 31) in group A and B, respectively, after 1-year treatment, and in 57.3 % (n = 106) and 72.5 % (n = 87) at last visit. Starting doses were significantly higher in group A. They were progressively increased during treatment in both groups, but were higher in uncontrolled patients than in controlled ones only in group A. Reported adverse events were more frequent, and the prevalence of patients with adverse events was higher in group B. CONCLUSIONS On the basis of this original study approach, we could speculate that in the centers in which more patients are treated with pegvisomant, less adverse events are reported, but the long-term effectiveness is lower than in centers with less cases, perhaps because of an inadequate patient's selection.
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Affiliation(s)
- S Cannavo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - F Bogazzi
- Department of Endocrinology and Metabolic Diseases, Ospedale Cisanello, Pisa, Italy
| | - A Colao
- Endocrinological Clinic, Departmeno of Endocrinology and Molecular and Clinic Oncology, Policlinico Universitario Federico II, Naples, Italy
| | - L De Marinis
- Institute of Endocrinology, Cattolica del Sacro Cuore University, Policlinico A. Gemelli, Rome, Italy
| | - P Maffei
- III Medical Clinic, Department of Medicine, Azienda Ospedaliera di Padova, Padua, Italy
| | - R Gomez
- Pfizer Europe Medical Affairs, Endocrinology, Puurs, Belgium
| | - E Graziano
- Pfizer Italia, Medical Department Endocrinology, Rome, Italy
| | | | - S Grottoli
- Department of Medicine, Division of Endocrinology, Diabetology and Metabolism, Città della, Salute e della Scienza di Torino, University of Torino, Turin, Italy.
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Grottoli S, Maffei P, Bogazzi F, Cannavò S, Colao A, Ghigo E, Gomez R, Graziano E, Monterubbianesi M, Jonsson P, De Marinis L. ACROSTUDY: the Italian experience. Endocrine 2015; 48:334-41. [PMID: 25150035 DOI: 10.1007/s12020-014-0393-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 03/03/2014] [Accepted: 08/11/2014] [Indexed: 11/28/2022]
Abstract
ACROSTUDY is a world-wide non-interventional, post marketing surveillance study performed to monitor the safety and outcomes of pegvisomant (PEG) in clinical practice. We report data from acromegaly patients who have been included in the Italian ACROSTUDY registry. The data of 341 acromegaly patients (171 males) were available for analysis using data freeze (12/9/2012). Patients were enrolled in 25 Italian endocrine centres. Before and during PEG treatment IGF-I, liver enzymes, metabolic parameters, and pituitary MRI were assessed. Before PEG, 54.3% patients had been treated with medical therapy and surgery, 22.9% medical therapy only, and 15.8% medical plus radiation and surgical therapy. 199 adverse events were reported in 98 patients (28.7%). Serious adverse events were documented in 29 patients (8.5%). 71.1% of patients had no significant change in tumor volume. Central MRI reading was performed in 34 patients; in 7 patients, an increase in tumor volume was found. Hormonal efficacy progressively increased since the start of PEG. After 6 years, normal IGF-I levels were found in 70.9% of patients (mean daily dose 18.1 mg). 87.1% of patients were treated with daily PEG although in 8.8% of patients, it was administered 2-6 times per week and in 3.8% with weekly injections. 74.8% received a PEG dose 10-15 mg/daily. PEG is a drug with a favorable safety profile which is efficacious also considering that in Italy it is currently available as third-line therapy.
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Affiliation(s)
- S Grottoli
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Dipartimento di Scienze Mediche, AO Città della Salute e della Scienza di Torino, Università di Torino, C.so AM Dogliotti 14, 10126, Turin, Italy,
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Bastida M, Graziano E, Roca R, López I, Sánchez-Pons N, Puigdoménech P, Vicient CM. A maize defective-kernel mutant (longcell) characterized by tubular cells, severe morphological alterations and induction of cell death. Planta 2006; 223:755-68. [PMID: 16231157 DOI: 10.1007/s00425-005-0136-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Accepted: 08/15/2005] [Indexed: 05/04/2023]
Abstract
Seeds of the longcell mutant in maize (Zea mays L) have a defective-kernel phenotype: the embryo aborts at the early coleoptilar stage and the endosperm is reduced in size. Mutant embryos have severe alterations in morphogenesis. They have a suspensor-, an embryo axis- and a scutellum-like structure, but the shoot apical meristem (SAM) is not formed. Scanning electron microscopy showed that most of the cells in longcell embryos are tubular and abnormally enlarged. The level of expression of several genes involved in basic metabolism is not severely affected during early and mid embryogenesis, but storage molecule accumulation is reduced. Genes which in normal conditions are only expressed after germination, are expressed during kernel development in the longcell seeds. Mutant embryos undergo cell death in late embryogenesis. Nuclei in dying embryos are TUNEL positive, and different genes coding for hydrolytic enzymes are up-regulated. The expression of genes related to oxidative stress is also altered in longcell embryos. These results lead us to suggest that the longcell mutant may be cytokinesis-defective.
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Affiliation(s)
- M Bastida
- Laboratori de Genetica Molecular i Vegetal, CSIC-IRTA, Barcelona, Spain
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Affiliation(s)
- E Graziano
- Institut de Recerca i Tecnologia Agroalimentàries (IRTA), Departament de Genètica Vegetal, Carretera de Cabrils s/n, 08348 Cabrils (Barcelona), Spain
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Abstract
BACKGROUND In Xenopus embryos, fibroblast growth factors (FGFs) and secreted inhibitors of bone morphogenetic protein (BMP)-mediated signalling have been implicated in neural induction. The precise roles, if any, that these factors play in neural induction in amniotes remains to be established. RESULTS To monitor the initial steps of neural induction in the chick embryo, we developed an in vitro assay of neural differentiation in epiblast cells. Using this assay, we found evidence that neural cell fate is specified in utero, before the generation of the primitive streak or Hensen's node. Early epiblast cells expressed both Bmp4 and Bmp7, but the expression of both genes was downregulated as cells acquired neural fate. During prestreak and gastrula stages, exposure of epiblast cells to BMP4 activity in vitro was sufficient to block the acquisition of neural fate and to promote the generation of epidermal cells. Fgf3 was also found to be expressed in the early epiblast, and ongoing FGF signalling in epiblast cells was required for acquisition of neural fate and for the suppression of Bmp4 and Bmp7 expression. CONCLUSIONS The onset of neural differentiation in the chick embryo occurs in utero, before the generation of Hensen's node. Fgf3, Bmp4 and Bmp7 are each expressed in prospective neural cells, and FGF signalling appears to be required for the repression of Bmp expression and for the acquisition of neural fate. Subsequent exposure of epiblast cells to BMPs, however, can prevent the generation of neural tissue and induce cells of epidermal character.
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Affiliation(s)
- S I Wilson
- Department of Microbiology, Umeå University, Umeå, S-901 87, Sweden
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Stiefel V, Becerra EL, Roca R, Bastida M, Jahrmann T, Graziano E, Puigdomènech P. TM20, a gene coding for a new class of transmembrane proteins expressed in the meristematic tissues of maize. J Biol Chem 1999; 274:27734-9. [PMID: 10488116 DOI: 10.1074/jbc.274.39.27734] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In the course of the analysis of lachrima, a recessive, defective kernel, embryo-lethal mutation in Zea mays that alters embryo and endosperm development, a gene coding for a new class of transmembrane proteins was isolated. The mutant was produced by Ac transposon tagging, and a gene located in the insertion region of the transposon was isolated as well as the corresponding cDNA. The predicted protein contains twenty hydrophobic segments that can be grouped in five repeats formed by four segments that fulfill the criteria for membrane spanning domains, and for this reason the gene has been named TM20. The sequences of the domains in each position of each group can be aligned, indicating that TM20 is formed by a four-domain structure duplicated five times. During embryogenesis in wild-type embryos and in the growing plant, TM20 gene expression is associated with meristems.
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Affiliation(s)
- V Stiefel
- Departament de Genètica Molecular, Institut de Biologia Molecular de Barcelona, Centre d'Investigació i Desenvolupament, Consejo Superior de Investigaciones Científicas, Jordi Girona, 18, 08034 Barcelona, Spain
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Muhr J, Graziano E, Wilson S, Jessell TM, Edlund T. Convergent inductive signals specify midbrain, hindbrain, and spinal cord identity in gastrula stage chick embryos. Neuron 1999; 23:689-702. [PMID: 10482236 DOI: 10.1016/s0896-6273(01)80028-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In the chick embryo, neural cells acquire midbrain, hindbrain, and spinal cord character over a approximately 6 hr period during gastrulation. The convergent actions of four signals appear to specify caudal neural character. Fibroblast growth factors (FGFs) and a paraxial mesoderm-caudalizing (PMC) activity are involved, but neither signal is sufficient to induce any single region. FGFs act indirectly by inducing mesoderm that expresses PMC and retinoid activity and also directly on prospective neural cells, in combination with PMC activity and a rostralizing signal, to induce midbrain character. Hindbrain character emerges from cells that possess the potential to acquire midbrain character upon exposure to higher levels of PMC activity. Induction of spinal cord character appears to involve PMC and retinoid activities.
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Affiliation(s)
- J Muhr
- Department of Microbiology, Umeå University, Sweden
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37
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Lampariello C, De Blasio A, Merenda A, Graziano E, Michalopoulou A, Bruno P. [Use of arginine in intruterine growth retardation (IUGR). Authors' experience]. Minerva Ginecol 1997; 49:577-81. [PMID: 9557488] [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: 02/07/2023]
Abstract
BACKGROUND Asymmetrical intrauterine growth retardation (IUGR) represents a foetal mechanism, consequent to placental insufficiency, due to many factors: genetic, vascular, malformative. At present, no therapy is really efficient. The aim of this study was to evaluate the efficacy, in these pathological conditions, of the use of L-arginine. This amino-acid improves GH-RH incretion, with consequent increase of plasmatic GH influencing somatic growth. L-arginine moreover, is the obligatory precursor for nitric oxide (NO) enzymatic synthesis (Endothelial-derived relaxing factor). NO helps the prolapse of smooth musculature and, consequently, the improvement of placental blood circulation. METHODS On the basis of the double activity of NO, vasodilatation and GH-RH induction, 43 pregnant women have been treated suffering from IUGR, diagnosed by ultrasonic examination an by evaluation of Doppler velocimetry values, from 30th week of gestation, administering L-arginine (Bioarginina, 6 g per os/day). Periodically, USG and Doppler velocimetry examinations were performed to evalue foetal growth and possible increase of peripheral vessels resistance. RESULTS 32 patients improved the clinical course of pregnancy: 19 recovered the whole retardation; 9 only one week; 4 had premature delivery after 36 weeks with foetal weight coincident with gestational age. CONCLUSIONS The positive results suggest the prosecution of clinical studies in order to attempt the achievement of an effective pharmacological treatment of IUGR.
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Affiliation(s)
- C Lampariello
- Istituto di Ginecologia ed Ostetricia, Università degli Studi Federico II, Napoli
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Cremonini N, Furno A, Sforza A, Chiarini V, Graziano E, Zampa G, Turba E. 111In-octreotide scintigraphy in endocrine tumors. Preliminary data. Q J Nucl Med 1995; 39:116-20. [PMID: 9002767] [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: 02/03/2023]
Abstract
A large number of endocrine tumors express somatostatin receptors, and the use of radiolabeled somatostatin analogs has been recently introduced for their localization. Using in vivo scintigraphy with 111In-pentetreotide, primary tumor localizations were demonstrated in 3/3 carcinoids (2 intestinal carcinoids and 1 lung ACTH-secreting carcinoid; in 2 patients liver metastases larger than 1 cm were visualized), in 1/1 GH-secreting pituitary macroadenoma, and in 1/1 thyroid localization of MTC. Bone and/or lymph node metastases were imaged in 2/4 patients previously treated for MTC, with persistently high CT and CEA levels; in the other 2 patients the other scintigraphic techniques were also negative. Octreotide scintigraphy was negative in 2/2 insulinomas and in 2/2 ACT-producing pituitary adenomas. In 2 patients with carcinoid syndrome and 1 patient with Cushing syndrome due to ectopic ACTH, octreotide therapy induced a significant decrease in tumoral markers. Our preliminary data are in agreement with the results of larger series reported in literature: octreotide scintigraphy is a useful noninvasive tool to detect endocrine tumors expressing somatostatin receptors, particularly for carcinoids. It is of great use in the differential diagnosis of Cushing syndrome due to ectopic ACTH. Moreover, 111In-pentetreotide scintigraphy may be useful in selecting patients who may benefit from octreotide therapy to control hormonal hypersecretion effects.
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Affiliation(s)
- N Cremonini
- Department of Endocrinology and Metabolic Diseases, Ospedale Maggiore, Bologna, Italy
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Graziano E, Rothe KD. Anyons, spin, and statistics in (2+1)-dimensional U(1)-scalar Chern-Simons gauge field theory. Int J Clin Exp Med 1994; 49:5512-5525. [PMID: 10016870 DOI: 10.1103/physrevd.49.5512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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40
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Cremonini N, Graziano E, Chiarini V, Sforza A, Zampa GA. Atypical McCune-Albright syndrome associated with growth hormone-prolactin pituitary adenoma: natural history, long-term follow-up, and SMS 201-995--bromocriptine combined treatment results. J Clin Endocrinol Metab 1992; 75:1166-9. [PMID: 1400888 DOI: 10.1210/jcem.75.4.1400888] [Citation(s) in RCA: 6] [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] [Indexed: 12/26/2022]
Abstract
A 35-yr-old woman is described as having atypical McCune-Albright syndrome, associated with acromegaly and hyperprolactinemia due to pituitary adenoma. The patient did not present sexual precocity, but primary amenorrhea. After transphenoidal adenomectomy, the GH plasma levels returned to normal, whereas the PRL values decreased; bromocriptine therapy normalized PRL levels and induced ovulatory menses. After 4 uneventful yr the patient developed relapse of active acromegaly that did not recover after a second neurosurgical exploration. Bromocriptine treatment maintained normal PRL levels but did not significantly reduce GH ones; the association with long-acting somatostatin analog SMS 201-995 by continuous sc pump infusion induced definitive control of GH and somatomedin-C secretion. These results suggest an additive inhibitory effect on GH secretion exerted by the two drugs.
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Affiliation(s)
- N Cremonini
- Endocrine and Metabolic Diseases Division, Maggiore Hospital, Bologna, Italy
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Feher J, Librando A, Spizzirri S, De Feo G, Graziano E. Corneal endothelial changes in experimental radial keratotomy and their treatment with bendazac-lysine. Curr Ther Res Clin Exp 1992. [DOI: 10.1016/s0011-393x(05)80436-9] [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: 11/30/2022] Open
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42
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Cremonini N, Chiarini V, Graziano E, Sforza A, Morittu S, Zampa GA. [The hypothalamic-hypophyseal-adrenal axis in obesity]. MINERVA ENDOCRINOL 1990; 15:227-30. [PMID: 1966026] [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: 12/29/2022]
Abstract
The HHA axis was assessed in 26 women with essential obesity using a CRF test, insulin hypoglycemia and oral glucose load. Basal values of ACTH and cortisol were similar in obese subjects and controls, whereas peak ACTH values following CRF administration were significantly lower in obese subjects. The net integrated areas under ACTH and cortisol curves after CRF injection were lower in obese subjects but not statistically significant. Glucose inhibited cortisol levels in controls but not in obese subjects. Insulin hypoglycemia provoked a ACTH and cortisol response in obese women which was significantly higher than that provoked by CRF. The lesser response of ACTH to CRF in obesity might be the result of an altered hypophyseal response to CRF mediated by other factors; in addition, the increased ACTH and cortisol response to the insulin stimulus compared to CRF observed in obese subjects leads to suppose that the metabolic stimulus involves the release of other factors.
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Affiliation(s)
- N Cremonini
- Unità di Endocrinologia, Ospedale Maggiore, Bologna
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43
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Palagi B, Picozzi R, Casazza F, Possa M, Magri G, Zoccarato O, Graziano E, Ferrari F, Morpurgo M. Biventricular function in Friedreich's ataxia: a radionuclide angiographic study. Br Heart J 1988; 59:692-5. [PMID: 3395528 PMCID: PMC1276878 DOI: 10.1136/hrt.59.6.692] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The systolic and diastolic function of both ventricles was assessed by radionuclide angiography in 21 patients with Friedreich's ataxia and hypertrophic cardiomyopathy. The indices of systolic function of the two ventricles and those of diastolic function of the right ventricle were generally normal. But in patients with Friedreich's ataxia the time to peak filling rate divided by the diastolic time of the left ventricle was significantly larger than normal. The increase correlated with the heart rate (r = 0.79) and this suggests an alteration in the timing of ventricle filling that is more evident at high heart rates. Movement of the left ventricle was little impaired; however, in 48% of the patients with Friedreich's ataxia the right ventricle showed evidence of hypokinetic segments. Because there is a tendency for congestive heart failure to develop in patients with Friedreich's ataxia, this hypokinesis of the right ventricle should be monitored at follow up.
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Affiliation(s)
- B Palagi
- Division of Nuclear Medicine, Hospital of Saronno, Varese, Italy
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Quaglia F, Comba D, D'Onofrio M, Borroni L, Graziano E, Portigliatti-Barbos M. The use of scintigraphy with Tc 99 pyrophosphate for the evaluation of meniscal lesions. Ital J Orthop Traumatol 1987; 13:267-72. [PMID: 2837443] [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: 01/02/2023]
Abstract
The preliminary results obtained in a study of the use of scintigraphy with Tc 99 PYP for the evaluation of meniscal lesions of the knee are presented. Three different captation curves are described. Those with an elevated peak and a restricted base are characteristic of meniscal lesions. The use of this method in a series of 50 patients in whom meniscal lesions were suspected demonstrated a high diagnostic sensitivity and specificity with regard to the presence of the lesion, but not to its type.
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Affiliation(s)
- F Quaglia
- 1st Orthopaedic Clinic, University of Turin
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45
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Chiarini V, Graziano E, Cremonini N, Frank G, Zampa GA. Hyperthyroidism and high serum levels of TSH associated with pituitary tumour. Neurochirurgia (Stuttg) 1987; 30:61-3. [PMID: 3106846 DOI: 10.1055/s-2008-1053658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We report a 28-year-old male with persistent clinical and laboratory findings of hyperthyroidism associated with marked elevated serum levels of TSH and no response to TRH despite hemithyroidectomy and subsequent antithyroid drug therapy two years previous to admission to our hospital. Subsequent skull X-rays, CT scans and angiographic findings demonstrated the presence of a pituitary tumour. After operation and radiation therapy T3, T4 and TSH levels returned to normal values. Seven years later the patient is still euthyroid. We conclude that hyperthyroidism in our patient was due to excessive secretion of TSH by the pituitary tumour.
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Carrì MT, Micheli G, Graziano E, Pace T, Buongiorno-Nardelli M. The relationship between chromosomal origins of replication and the nuclear matrix during the cell cycle. Exp Cell Res 1986; 164:426-36. [PMID: 2940105 DOI: 10.1016/0014-4827(86)90041-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A cytological investigation into the dynamic behaviour of the origins of replication with respect to the nuclear matrix has been carried out on Xenopus laevis cultured cells. In order to preferentially label origins or 'non-origin' regions along DNA fibres, 5-fluoro-2'-deoxyuridine (FUdR)-treated cells were pulsed with [3H]deoxyadenosine in early or late S phase. Samples were then allowed to proceed through the cell cycle for increasing times. The DNA loops were induced in situ to completely uncoil around the nuclear matrix. The autoradiographic analysis shows that, under the experimental conditions used, 'non-origin' regions behave as expected from previous studies, i.e., they associate with the nuclear matrix only when they become part of a replication fork, whereas active origins of replication remain associated with the matrix throughout the cell cycle.
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Bruno P, Lampariello C, Graziano E, Volpicelli E, Romei G. [Role of pelvic echotomography in the differential diagnosis of ovarian tumors]. Arch Ostet Ginecol 1982; 87:89-114. [PMID: 7186803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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48
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Levi AC, De Mattei M, Graziano E. Preliminary observations on the neuromelanic pigment in the substantia nigra nucleus of the cat. Boll Soc Ital Biol Sper 1982; 58:165-8. [PMID: 7066112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The AA. study the behaviour of neuromelanic pigment in the substantia nigra of cats' mesencephalon. To this aim they suppress a first group of animals with MgSO4; a second group with a substance whose action is narcotic and curare-like. They carry out the observations on mesencephalon microtomic sections, some stained with hematoxylin, some treated with PAS reaction and some with Sudan Black. The results are: 1)- in the perikaryon of substantia nigra pars compacta neurons of cats suppressed with MgSO4, the pigment, absent in the early age of life, appears in adult age. It is characterized by brownish-yellow granulations, either scattered or clustered together. This finding is substantially similar to that observed in dogs' substantia nigra. 2)- The substantia nigra neurons of the mesencephalon taken from cats suppressed with a curare-like substance, appear instead, almost wholly, without the peculiar neuromelanic granulations. However intracytoplasmic bodies stained with hematoxylin and PAS positive, can be observed. In order to establish the morphological and histochemical events which occur in the substantia nigra neurons in depigmentation induced in this way the AA. consider further investigations absolutely necessary.
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Graziano E, Viti G, Laffi G, Galloni SS, Brillante C. [Pheochromocytoma with hypotension. Study of an unusual clinical case]. Minerva Med 1978; 69:565-71. [PMID: 634506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A case of pheochromocytoma marked by clinostatic hypotensive crises and otherwise normal or low blood pressure is described. The aetiopathogenetic explanations put forward by other workers are cited and a deductive reconstruction is made of the clinical course.
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