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Cennamo V, Landi S, Aragona G, Colecchia A, Conigliaro R, Di Lorenzo D, Di Marco M, Fabbri C, Falcone P, Gaiani F, Manno M, Merighi A, Mussetto A, Peghetti A, Sassateli R, Solfrini V, Zagari RM, Arena R, Bertani H, Binda C, Boarino V, De Padova A, Feletti V, Fuccio L, Iori V, Nervi G, Prati GM, Soriani P, De Palma R. The management of endoscopic retrograde cholangio- pancreatography-related infections risk: results of an italian survey at regional level. Ann Ig 2023; 35:84-91. [PMID: 35442386 DOI: 10.7416/ai.2022.2518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIM Among the Endoscopic retrograde cholangiopancreatography (ERCP) adverse events, an increasingly arising problem is the transmission of Multi Drug Resistant (MDR) Bacteria through duodenoscopes. The aim of this survey was to evaluate the current clinical practice of management of ERCP associated infections in Emilia-Romagna, Italy. METHODS An online survey was developed including 12 questions on management of ERCP associated infections risk. The survey was proposed to all 12 endoscopy centers in Emilia Romagna that perform at least > 200 ERCPs per year. RESULTS 11 centers completed the survey (92%). Among all risk factors of ERCP infections, hospitalization in intensive care units, immunosuppressant therapies, and previous MDR infections have achieved a 80 % minimum of concurrence by our respondents. The majority of them did not have a formalized document in their hospital describing categories and risk factors helpful in the detection of patients undergoing ERCP with an high-level infective risk (9/11, 82%). Most centers (8/11, 72%) do not perform screening in patients at risk of ERCP infections. Post procedural monitoring is performed by 6 of 11 centers (55%). CONCLUSION Our survey showed that, at least at regional level, there is a lack of procedures and protocols related to the management of patients at risk of ERCP infections.
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Affiliation(s)
- V Cennamo
- Gastroenterology and Interventional Endoscopy Unit, Bellaria-Maggiore Hospital, AUSL of Bologna, Italy
| | - S Landi
- Gastroenterology and Interventional Endoscopy Unit, Bellaria-Maggiore Hospital, AUSL of Bologna, Italy
| | - G Aragona
- Department of Internal Medicine, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - A Colecchia
- Gastroenterology Unit, Department of Medical Specialties, Azienda Ospedaliero-Universitaria and University of Modena and Reggio Emilia, Modena, Italy
| | - R Conigliaro
- Digestive Endoscopy Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - D Di Lorenzo
- Territorial Assistance Service - Pharmacy and Medical Devices Area, AUSL of Bologna, Italy
| | - M Di Marco
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Infermi Rimini, AUSL della Romagna, Italy
| | - C Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Italy
| | - P Falcone
- Territorial Assistance Service - Pharmacy and Medical Devices Area, AUSL of Bologna, Italy
| | - F Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Italy
| | - M Manno
- Gastroenterology and Digestive Endoscopy Unit, AUSL Modena, Carpi Hospital and Modena District Network of Gastro-enterology, Italy
| | - A Merighi
- Gastroenterology and Digestive Endoscopy Unit, University Hospital Sant'Anna, Ferrara, Italy
| | - A Mussetto
- Gastroenterology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - A Peghetti
- Territorial Assistance Service - Pharmacy and Medical Devices Area, AUSL of Bologna, Italy
| | - R Sassateli
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Italy
| | - V Solfrini
- Territorial Assistance Service - Pharmacy and Medical Devices Area, AUSL of Bologna, Italy
| | - R M Zagari
- Gastroenterology Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria and University of Bologna, Italy
| | - R Arena
- Gastroenterology and Digestive Endoscopy Unit, University Hospital Sant'Anna, Ferrara, Italy
| | - H Bertani
- Digestive Endoscopy Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - C Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Italy
| | - V Boarino
- Gastroenterology Unit, Department of Medical Specialties, Azienda Ospedaliero-Universitaria and University of Modena and Reggio Emilia, Modena, Italy
| | - A De Padova
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Infermi Rimini, AUSL della Romagna, Italy
| | - V Feletti
- Gastroenterology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - L Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria and University of Bologna, Italy
| | - V Iori
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - IRCCS di Reggio Emilia, Italy
| | - G Nervi
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Italy
| | - G M Prati
- Department of Internal Medicine, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - P Soriani
- Gastroenterology and Digestive Endoscopy Unit, AUSL Modena, Carpi Hospital and Modena District Network of Gastro-enterology, Italy
| | - R De Palma
- Hospital Care Service, AUSL Bologna, Italy
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Conti F, Brillanti S, Buonfiglioli F, Vukotic R, Morelli MC, Lalanne C, Massari M, Foschi FG, Bernabucci V, Serio I, Prati GM, Negri E, Badia L, Caraceni P, Muratori P, Vitale G, Porro A, Morotti M, Mazzella G, Andreone P. Safety and efficacy of direct-acting antivirals for the treatment of chronic hepatitis C in a real-world population aged 65 years and older. J Viral Hepat 2017; 24:454-463. [PMID: 27976461 DOI: 10.1111/jvh.12663] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 11/11/2016] [Accepted: 12/03/2016] [Indexed: 12/27/2022]
Abstract
The availability of direct-acting antiviral agents (DAA) regimens has expanded the pool of patients eligible for treatment. However, data on the virologic response and tolerability of DAAs in elderly patients are lacking. We evaluated the efficacy and safety of DAAs in patients with advanced fibrosis/cirrhosis in real-life practice with the focus on those aged ≥65 years. Between January and December 2015, all consecutive patients with HCV-related advanced fibrosis/cirrhosis treated with DAA at eleven tertiary referral centres in Emilia Romagna (Italy) were enrolled. Regimen choice was based on viral genotype and stage of disease, according to guidelines. The primary end point was sustained virologic response 12 weeks after the end of treatment (SVR12). Overall, 282 of 556 (50.7%) patients evaluated were elderly, most of them with cirrhosis. Antiviral therapy was stopped prematurely in four (1.4%) patients. Two patients, both with cirrhosis, died during treatment due to worsening of liver/renal function. SVR12 was achieved by 94.7% and was comparable to that obtained in patients aged <65 (P=.074). Similar data were also reported in subgroup of patients aged ≥75 years. All patients with advanced fibrosis achieved virologic response. SVR12 was 80.8% in Child-Pugh-Turcotte (CTP)-B cirrhosis and 95.4% in CTP-A (P=.013). According to genotype, the SVR12 was achieved in 172 of 181 (95%) with genotype 1b cirrhosis and in 44 of 48 (91.7%) with genotype 2 cirrhosis. In conclusions, in a real-world setting, DAAs are safe and effective in elderly patients with HCV-related advanced fibrosis/cirrhosis, but SVR12 is lower with worsening CTP class.
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Affiliation(s)
- F Conti
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - S Brillanti
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - F Buonfiglioli
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - R Vukotic
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - M C Morelli
- U.O. di Medicina Interna per il trattamento delle gravi insufficienze d'organo, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - C Lalanne
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - M Massari
- U.O. di Malattie Infettive, Azienda Ospedaliera S. Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - F G Foschi
- U.O. di Medicina Interna, Ospedale di Faenza, Faenza, Italy
| | - V Bernabucci
- U.O. di Gastroenterologia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - I Serio
- U.O. di Medicina Interna, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - G M Prati
- U.O. di Gastroenterologia ed Epatologia, Ospedale "G da Saliceto", Piacenza, Italy
| | - E Negri
- U.O. di Malattie Infettive ed Epatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - L Badia
- U.O. di Malattie Infettive, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - P Caraceni
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - P Muratori
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - G Vitale
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - A Porro
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - M Morotti
- U.O. di Farmacia Clinica, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - G Mazzella
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - P Andreone
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
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Azzaroli F, Colecchia A, Colecchi A, Lodato F, Trerè D, Bacchi Reggiani ML, Festi D, Prati GM, Accogli E, Casanova S, Derenzini M, Roda E, Mazzella G. A statistical model predicting high hepatocyte proliferation index and the risk of developing hepatocellular carcinoma in patients with hepatitis C virus-related cirrhosis. Aliment Pharmacol Ther 2006; 24:129-36. [PMID: 16803611 DOI: 10.1111/j.1365-2036.2006.02955.x] [Citation(s) in RCA: 4] [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: 12/27/2022]
Abstract
BACKGROUND Incidence of hepatocellular carcinoma in hepatitis C virus-related cirrhosis is 4% per year. Although cost-effective, current screening could be improved. AIM To develop a statistical model including non-invasive parameters able to identify patients at high risk of developing hepatocellular carcinoma. METHODS One hundred and fifty-eight patients (73F:85M) with compensated chronic hepatitis C virus liver disease underwent evaluation, including argyrophilic nucleolar organizer regions proliferation index, and were followed up for 56.18 +/- 1.44 months. RESULTS Fifty-six patients had chronic hepatitis without cirrhosis and low argyrophilic nucleolar organizer regions proliferation index (< or =25%), 65 had hepatitis C virus-related cirrhosis and low argyrophilic nucleolar organizer regions proliferation index and 37 had hepatitis C virus-related cirrhosis and high argyrophilic nucleolar organizer regions proliferation index (>25%). Groups were similar for gender and viral genotype distribution. None of the patients with chronic hepatitis without cirrhosis developed hepatocellular carcinoma, compared with 6.1% of low argyrophilic nucleolar organizer regions proliferation index and 30.6% of high argyrophilic nucleolar organizer regions proliferation index (P = 0.002). By multivariable logistic regression analysis, the following parameters were independently associated with hepatocellular carcinoma development and used for the development of the statistical model: platelets (OR 0.98), gamma-globulins (OR 0.111), alanine aminotransferase/aspartate aminotransferase ratio (OR 0.07), serum ferritin (OR 1.0) and ultrasonographic pattern (coarse OR 2.9, coarse nodular OR 10.12). The statistical model properly allocated 95.9% of patients with low argyrophilic nucleolar organizer regions proliferation index and 72.2% of patients with high argyrophilic nucleolar organizer regions proliferation index. CONCLUSIONS The model, to be validated in large prospective studies, may help tailoring screening according to the risk of hepatocellular carcinoma development.
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Affiliation(s)
- F Azzaroli
- Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy.
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