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Vetrugno L, Castaldo N, Fantin A, Deana C, Cortegiani A, Longhini F, Forfori F, Cammarota G, Grieco DL, Isola M, Navalesi P, Maggiore SM, Bassetti M, Chetta A, Confalonieri M, De Martino M, Ferrari G, Francisi D, Luzzati R, Meini S, Scozzafava M, Sozio E, Tascini C, Bassi F, Patruno V, De Robertis E, Aldieri C, Ball L, Baratella E, Bartoletti M, Boscolo A, Burgazzi B, Catalanotti V, Confalonieri P, Corcione S, De Rosa FG, De Simoni A, Bono VD, Tria RD, Forlani S, Giacobbe DR, Granozzi B, Labate L, Lococo S, Lupia T, Matellon C, Mehrabi S, Morosi S, Mongodi S, Mura M, Nava S, Pol R, Pettenuzzo T, Quyen NH, Rescigno C, Righi E, Ruaro B, Salton F, Scabini S, Scarda A, Sibani M, Tacconelli E, Tartaglione G, Tazza B, Vania E, Viale P, Vianello A, Visentin A, Zuccon U, Meroi F, Buonsenso D. Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study). Pulmonology 2023; 29:457-468. [PMID: 36669936 PMCID: PMC9684110 DOI: 10.1016/j.pulmoe.2022.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication. METHODS This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death. RESULTS We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001). CONCLUSIONS C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality. TRIAL REGISTRATION this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.
| | - Nadia Castaldo
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Alberto Fantin
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy; Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, AOUP-Pisa, Italy
| | - Gianmaria Cammarota
- Anesthesia and Intensive Care Service 2, University Hospital of Perugia, Perugia, Italy; Department of Medicine and Surgery, Universiy of Perugia, Perugia, Italy
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Department of Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Miriam Isola
- Department of Medicine, University of Udine, Udine, Italy
| | - Paolo Navalesi
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy; Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alfredo Chetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | | | - Giovanni Ferrari
- Pneumologia e Unità di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano, Turin, Italy
| | - Daniela Francisi
- Department of Infectious Disease "S. Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Roberto Luzzati
- Infectious Disease Unit, University of Trieste, Trieste, Italy
| | - Simone Meini
- U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | | | - Emanuela Sozio
- Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy; Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Edoardo De Robertis
- Anesthesia and Intensive Care Service 2, University Hospital of Perugia, Perugia, Italy; Department of Medicine and Surgery, Universiy of Perugia, Perugia, Italy
| | - Chiara Aldieri
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Elisa Baratella
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Annalisa Boscolo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Barbara Burgazzi
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vito Catalanotti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy; Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy
| | - Alessandro De Simoni
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Valerio Del Bono
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Roberta Di Tria
- Pneumologia e Unità di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano, Turin, Italy
| | - Sara Forlani
- Pulmonary Medicine Unit, Lodi General Hospital, Lodi, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Bianca Granozzi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Laura Labate
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Sara Lococo
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Tommaso Lupia
- Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy
| | - Carola Matellon
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Sara Mehrabi
- Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, Verona, Italy
| | - Sabrina Morosi
- Department of Infectious Disease "S. Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Silvia Mongodi
- Anaesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maddalena Mura
- U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy; Respiratory and Critical Care Unit, Sant Orsola University Hospital, Bologna, Italy
| | - Riccardo Pol
- Infectious Disease Unit, University of Trieste, Trieste, Italy
| | - Tommaso Pettenuzzo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Nguyen Hoang Quyen
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Carolina Rescigno
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Elda Righi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Silvia Scabini
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Angelo Scarda
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - Marcella Sibani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Evelina Tacconelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gennaro Tartaglione
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - Beatrice Tazza
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Eleonora Vania
- Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Andrea Vianello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Visentin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Umberto Zuccon
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Giacobbe DR, Marelli C, Cattardico G, Fanelli C, Signori A, Di Meco G, Di Pilato V, Mikulska M, Mazzitelli M, Cattelan AM, Pallotto C, Francisci D, Calabresi A, Lombardi A, Gori A, Del Bono V, Aldieri C, Losito AR, Raffaelli F, Cortegiani A, Milazzo M, Del Puente F, Pontali E, De Rosa FG, Corcione S, Mularoni A, Russelli G, Giacomini M, Badalucco Ciotta F, Oltolini C, Serino FS, Momesso E, Spinicci M, Graziani L, Torti C, Trecarichi EM, Merli M, D'Amico F, Marchese A, Vena A, Bassetti M. Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape. J Antimicrob Chemother 2023; 78:2505-2514. [PMID: 37606528 DOI: 10.1093/jac/dkad262] [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] [Received: 05/16/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES To assess the impact of carbapenem resistance on mortality in Klebsiella pneumoniae bloodstream infection (BSI) in the era of novel β-lactam/β-lactamase inhibitor combinations. MATERIAL AND METHODS Retrospective study of patients with K. pneumoniae BSI between January and August 2020 in 16 centres (CARBANEW study within the MULTI-SITA project). RESULTS Overall, 426 patients were included: 107/426 (25%) had carbapenem-resistant K. pneumoniae (CR-Kp) BSI and 319/426 (75%) had carbapenem-susceptible K. pneumoniae (CS-Kp) BSI. Crude cumulative 30 day mortality was 33.8% and 20.7% in patients with, respectively, CR-Kp BSI and CS-Kp BSI (P = 0.027). Carbapenemase production or carbapenemase-encoding genes were detected in 84/98 tested CR-Kp isolates (85.7%), mainly KPC (78/84; 92.9%). Ceftazidime/avibactam was the most frequently used appropriate therapy for CR-Kp BSI (80/107; 74.7%). In multivariable analyses, variables showing an unfavourable association with mortality after correction for multiple testing were age-adjusted Charlson comorbidity index (HR 1.20; 95% CI 1.10-1.31, P < 0.001) and Pitt score (HR 1.33; 95% CI 1.15-1.55, P < 0.001), but not carbapenem resistance (HR 1.28, 95% CI 0.74-2.22, P = 0.410). In a propensity score-matched analysis, there was no difference in mortality between patients appropriately treated with ceftazidime/avibactam for CR-Kp BSI and patients appropriately treated with other agents (mainly meropenem monotherapy or piperacillin/tazobactam monotherapy) for CS-Kp BSI (HR 1.07; 95% CI 0.50-2.29, P = 0.866). CONCLUSIONS Our results suggest that the increased mortality in CR-Kp BSI compared with CS-Kp BSI is not (or no longer) dependent on the type of therapy in areas where ceftazidime/avibactam-susceptible KPC-producing isolates are the most prevalent type of CR-Kp.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Marelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Greta Cattardico
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Fanelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Gabriele Di Meco
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Carlo Pallotto
- Department of Medicine and Surgery, Clinic of Infectious Diseases, 'Santa Maria della Misericordia' Hospital, University of Perugia, Perugia, Italy
| | - Daniela Francisci
- Department of Medicine and Surgery, Clinic of Infectious Diseases, 'Santa Maria della Misericordia' Hospital, University of Perugia, Perugia, Italy
| | - Alessandra Calabresi
- SOC Malattie Infettive, ASO 'SS Antonio e Biagio e C. Arrigo', Alessandria, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Ospedale Luigi Sacco-Polo Universitario, Milan, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Chiara Aldieri
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Angela Raffaella Losito
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, University of Palermo, Palermo, Italy
- Department of Anesthesia Analgesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Marta Milazzo
- Department of Surgical, Oncological and Oral Science, University of Palermo, Palermo, Italy
| | | | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- Unit of Infectious Diseases, Cardinal Massaia, Asti, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Alessandra Mularoni
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Giovanna Russelli
- Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Flavia Badalucco Ciotta
- Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Saverio Serino
- Azienda ULSS4 Veneto Orientale, UOS Malattie Infettive, UOC Medicina Generale, Ospedale di Portogruaro, Portogruaro, Italy
| | - Elena Momesso
- Azienda ULSS4 Veneto Orientale, UOC Anestesia e Rianimazione, Ospedale di San Donà di Piave, San Donà di Piave, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lucia Graziani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, University 'Magna Graecia', Catanzaro, Italy
- Unit of Infectious and Tropical Diseases, 'Mater Domini' Teaching Hospital, Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, University 'Magna Graecia', Catanzaro, Italy
- Unit of Infectious and Tropical Diseases, 'Mater Domini' Teaching Hospital, Catanzaro, Italy
| | - Marco Merli
- Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Federico D'Amico
- Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Anna Marchese
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- UO Microbiologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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3
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Gentile I, Buonomo AR, Corcione S, Paradiso L, Giacobbe DR, Bavaro DF, Tiseo G, Sordella F, Bartoletti M, Palmiero G, Vozza A, Vena A, Canta F, Moriello NS, Congera P, Karruli A, Tascini C, Viale P, Bono VD, Falcone M, Carbonara S, Mikulska MK, Bassetti M, Durante-Mangoni E, De Rosa FG, Maraolo AE. CEFTO-CURE Study: CEFTObiprole Clinical Use in Real-lifE - a multi-centre experience in Italy. Int J Antimicrob Agents 2023; 62:106817. [PMID: 37061102 DOI: 10.1016/j.ijantimicag.2023.106817] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 10/05/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Ceftobiprole is approved in Europe for community-acquired pneumonia (CAP) and non-ventilator associated hospital-acquired pneumonia (HAP) in adults. Real-life data are limited. METHODS This was a multicentre, observational and ambispective investigator-initiated study run in Italy from January 2018 to December 2019 in order evaluate the use of ceftobiprole in a real-life setting. RESULTS Overall, 195 patients from 10 centres were evaluated (68% retrospectively). Male sex was prevalent (121, 62%). Median age was 67 years (interquartile range - IQR 53-75). Median value of Charlson score was 5 (3-7). The most frequent indication was pneumonia (151/195, 77%), especially HAP. Other uses were skin and soft tissue infections (5%), endocarditis (4%) and bone infections (4%). Ceftobiprole was usually an empiric choice (65%), in combination with other drugs (66%) and as second-line therapy (58%). A causative agent was found in 39% of cases. A diagnosis of sepsis was made in 59 episodes (30%). Success in the clinical evaluable population (excluding 12 cases owing to isolation of pathogens out of ceftobiprole's spectrum of activity) was obtained in 79% of cases, with an all-cause mortality of 20%. At multilevel analysis, 3 predictors were positively associated with clinical success: male gender, pneumonia, detection of causal agent; sepsis was a negative predictor. Nine factors were independently associated, favourably or unfavourably, with fatal outcome. CONCLUSIONS Ceftobiprole is a safe and effective therapeutic choice even in a real-world setting. More data are needed to establish its efficacy in septic patients.
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Affiliation(s)
- Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy.
| | - Antonio Riccardo Buonomo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Torino, Italy
| | - Laurenza Paradiso
- Ninth Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Napoli, Italy; Department of Precision Medicine, University of Campania 'L. Vanvitelli' and AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy; Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Giusy Tiseo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Sordella
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Michele Bartoletti
- Division of Infectious Diseases, University of Bologna Alma Mater Studiorum, Bologna, Italy
| | - Giulia Palmiero
- Fourth Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Italy
| | | | - Antonio Vena
- Department of Health Sciences, University of Genoa, Genoa, Italy; Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Francesca Canta
- Department of Medical Sciences, Infectious Diseases, University of Turin, Torino, Italy
| | - Nicola Schiano Moriello
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Paola Congera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Arta Karruli
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Carlo Tascini
- Division of Infectious Diseases, University Hospital ASUFC, Udine, Italy
| | - Pierluigi Viale
- Division of Infectious Diseases, University of Bologna Alma Mater Studiorum, Bologna, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sergio Carbonara
- Infectious Diseases Unit, V. Emanuele II Hospital, Bisceglie, BT, Italy
| | - Malgorzata Karolina Mikulska
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy; Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | | | - Alberto Enrico Maraolo
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Napoli, Italy
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Manzini PM, Ciccone G, De Rosa FG, Cavallo R, Ghisetti V, D’Antico S, Galassi C, Saccona F, Castiglione A, Birocco N, Francisci T, Hu H, Pecoraro C, Danielle F, Labanca L, Bordiga AM, Lorenzi M, Camisasca G, Giachino O, Pagliarino M, Ottone P, Scuvera ITD, Guaschino R, Freilone R, Berti P, Pittaluga F, Avolio M, Costa C, Raso S, Nucci A, Milan M, Baffa A, Russo A, Tornello A, Maddalena L, Delios G, Marletto FP, De Micheli AG, Mattei A, Baldassano S, Canta F, Russo ML, Bergamo D, Vitale F, Liccardi MM, Chinaglia A, Calcagno A, Converso M, Aldieri C, Libanore V, Blangetti I, Benedetti V, Mitola B, Scozzari G, Valfrè A, Rizzioli G, D’Amato T, Crocillà C, Naselli S, Granero V, Cornagliotto G, Lucania G, Scaglia C, Ferro F, Solimine C, Ricotti M, Gilestro C, Roncato R, Palladino A, Ongaro D, Poggio GA, Chiappero C, Pinna SM, Scabini S, Vischia F, Gregoretti MG, Lupia E, Brazzi L, Albera C, Scaglione L, Gallo V, Norbiato C, Albiani R, Sini BL, Fassiola A, Locatelli A, Di Perri G, Navarra M, Gardini I, Ciardiello A, La Grotta R, De Rosa A, Pasquino P, Fiore G, Franza O, Artoni P, Meinardi S, Calosso L, Molino P, Veglio MG, Beltramo T, Camerini O, Giancaspero K, Napoli F, Perboni A, Messa E, Buffolo F, Pagnozzi F, Bertone S, Lutri L, Gravante U, Sacchetti P, Pavan A, Castenetto E, Novelli M, Tucciarone M, Ocello P, Guido G, Frascaroli C, Vivenza DML, Patti F, Lorenzelli L, Balduzzi G, Ratti D, Mazzucco L, Balbo V, Pollis F, Leoncino S, Lupo C, Romano D, Ziccardi S, Marmifero M, Chichino G, Salio M, Aiosa G, Boverio R, Avonto I, Ghiotto S, Balbo R, Nico V, Aguzzi C, Pellegrino MC, Prucca M, Longa LA, Perotti L, Piovano F, Ambrogio L, Formica M, Monge E, Arena F, Barzaghi N, Tavera S, Canepari M, Strani G, Pomero F, Cianci MG, Gianarda M, Ruscitto L, De Martino D, Macchi S, Montagnana M, Grandinetti V, Magnani S, Radin E, Pellu V, Meucci M, Noè E, Torti P, Montagnani L, Doveri G, Giustetto G, Avdis C, Prina M, Eliantonio F, Lemut F, Semino G, Spidalieri P, Vallino D, Prota R, Buono G, Segala V, Milia MG, Aprà F, Livigni S, Manno E, Caula G, Vitali E, Liuzzi N, Pastorelli M, Caironi P, Gamna F, Scapino B, Gurioli L, Magro E, Roberti G, Santamaria GM, Daffonchio A, Varese P, Ghiazza G, Girino M, Pelazza C, Racca F, Grillo M, Del Bono V, Gianotto G, Aluffi E, Ravera E. Convalescent or standard plasma versus standard of care in the treatment of COVID-19 patients with respiratory impairment: short and long-term effects. A three-arm randomized controlled clinical trial. BMC Infect Dis 2022; 22:879. [PMID: 36418984 PMCID: PMC9682750 DOI: 10.1186/s12879-022-07716-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The efficacy of early treatment with convalescent plasma in patients with COVID-19 is debated. Nothing is known about the potential effect of other plasma components other than anti-SARS-CoV-2 antibodies. METHODS To determine whether convalescent or standard plasma would improve outcomes for adults in early phase of Covid19 respiratory impairment we designed this randomized, three-arms, clinical trial (PLACO COVID) blinded on interventional arms that was conducted from June 2020 to August 2021. It was a multicentric trial at 19 Italian hospitals. We enrolled 180 hospitalized adult patients with COVID-19 pneumonia within 5 days from the onset of respiratory distress. Patients were randomly assigned in a 1:1:1 ratio to standard of care (n = 60) or standard of care + three units of standard plasma (n = 60) or standard of care + three units of high-titre convalescent plasma (n = 60) administered on days 1, 3, 5 after randomization. Primary outcome was 30-days mortality. Secondary outcomes were: incidence of mechanical ventilation or death at day 30, 6-month mortality, proportion of days with mechanical ventilation on total length of hospital stay, IgG anti-SARS-CoV-2 seroconversion, viral clearance from plasma and respiratory tract samples, and variations in Sequential Organ Failure Assessment score. The trial was analysed according to the intention-to-treat principle. RESULTS 180 patients (133/180 [73.9%] males, mean age 66.6 years [IQR 57-73]) were enrolled a median of 8 days from onset of symptoms. At enrollment, 88.9% of patients showed moderate/severe respiratory failure. 30-days mortality was 20% in Control arm, 23% in Convalescent (risk ratio [RR] 1.13; 95% confidence interval [CI], 0.61-2.13, P = 0.694) and 25% in Standard plasma (RR 1.23; 95%CI, 0.63-2.37, P = 0.544). Time to viral clearance from respiratory tract was 21 days for Convalescent, 28 for Standard plasma and 23 in Control arm but differences were not statistically significant. No differences for other secondary endpoints were seen in the three arms. Serious adverse events were reported in 1.7%, 3.3% and 5% of patients in Control, Standard and Convalescent plasma arms respectively. CONCLUSIONS Neither high-titer Convalescent nor Standard plasma improve outcomes of COVID-19 patients with acute respiratory failure. Trial Registration Clinicaltrials.gov Identifier: NCT04428021. First posted: 11/06/2020.
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Affiliation(s)
- Paola Maria Manzini
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Giovannino Ciccone
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Francesco Giuseppe De Rosa
- grid.7605.40000 0001 2336 6580Department of Medical Science, University of Turin Faculty of Medicine and Surgery, Turin, Italy
| | - Rossana Cavallo
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Valeria Ghisetti
- grid.413671.60000 0004 1763 1028Laboratory of Microbiology and Virology, Amedeo di Savoia Hospital, Turin, Italy
| | - Sergio D’Antico
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Claudia Galassi
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Fabio Saccona
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Anna Castiglione
- grid.420240.00000 0004 1756 876XUnit of Clinical Epidemiology, University Hospital City of Science and Health Turin, CPO Piemonte, Turin, Italy
| | - Nadia Birocco
- Oncology Department, University Hospital City of Science and Health Turin, Turin, Italy
| | - Tiziana Francisci
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Huijing Hu
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Clara Pecoraro
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Franca Danielle
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Luciana Labanca
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Anna Maria Bordiga
- Transfusion Medicine and Blood Establishment, University Hospital City of Science and Health Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Marco Lorenzi
- Immunohematology and Transfusion Medicine, S Croce and Carle Cuneo Hospital District, Cuneo, Italy
| | - Giovanni Camisasca
- Transfusion Medicine and Blood Establishment, Holy Trinity Hospital Borgomanero, Borgomanero, Italy
| | - Osvaldo Giachino
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Mauro Pagliarino
- Maternal, Pediatric and Trauma Transfusion Medicine, University Hospital City of Science and Health Turin, Turin, Italy
| | - Piero Ottone
- grid.415081.90000 0004 0493 6869Transfusion Medicine, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | | | - Roberto Guaschino
- Transfusion Medicine, Saints Anthony and Biagio and Cesare Arrigo Alessandria National Hospital, Alessandria, Italy
| | | | - Pierluigi Berti
- Immunohematology and Transfusion Medicine, Umberto Parini Hospital, Aosta, Italy
| | - Fabrizia Pittaluga
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Maria Avolio
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Cristina Costa
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Turin, Turin, Italy
| | - Samuele Raso
- Maternal, Pediatric and Trauma Transfusion Medicine, University Hospital City of Science and Health Turin, Turin, Italy
| | - Aurora Nucci
- Maternal, Pediatric and Trauma Transfusion Medicine, University Hospital City of Science and Health Turin, Turin, Italy
| | - Massimo Milan
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Alessandra Baffa
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Alessandra Russo
- grid.415044.00000 0004 1760 7116Transfusion Medicine, San Giovanni Bosco Hospital, Turin, Italy
| | - Antonella Tornello
- Immunohematology and Transfusion Medicine, S Croce and Carle Cuneo Hospital District, Cuneo, Italy ,Immunohematology and Transfusion Medicine, ASL CN1 Mondovì, Mondovì, Italy
| | - Laura Maddalena
- Immunohematology and Transfusion Medicine, S Croce and Carle Cuneo Hospital District, Cuneo, Italy
| | | | - Fabio Paolo Marletto
- Immunohematology and Transfusion Medicine, Umberto Parini Hospital, Aosta, Italy
| | - Anna Grazia De Micheli
- Medical Emergency Division, University Hospital City of Science and Health Turin, Turin, Italy
| | - Alessio Mattei
- Pulmunology Unit, University Hospital City of Science and Health Turin, Turin, Italy
| | - Stefano Baldassano
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Science, Faculty of Medicine and Surgery, University of Turin, Turin, Italy
| | - Francesca Canta
- Infectious Diseases Unit, University Hospital City of Science and Health Turin, Turin, Italy
| | - Maria Luisa Russo
- Internal Medicine Unit, Santa Croce Hospital of Moncalieri, Moncalieri, Italy
| | - Daniele Bergamo
- Internal Medicine Unit, Santa Croce Hospital of Moncalieri, Moncalieri, Italy
| | - Francesco Vitale
- grid.414700.60000 0004 0484 5983Internal Medicine Unit, Ordine Mauriziano Di Torino Hospital, Turin, Italy
| | | | | | - Andrea Calcagno
- grid.7605.40000 0001 2336 6580Infectious Diseases Unit, Department of Medical Sciences, University of Turin Faculty of Medicine and Surgery, Turin, Italy
| | - Marcella Converso
- grid.415044.00000 0004 1760 7116Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Chiara Aldieri
- Infectious Diseases, S Croce and Carle Cuneo Hospital District, Cuneo, Italy
| | - Valentina Libanore
- grid.492852.0Infectious Diseases Unit, Cardinal Massaia Hospital of Asti, Asti, Italy
| | | | | | - Barbara Mitola
- grid.414700.60000 0004 0484 5983Hospital Medical Direction, Ordine Mauriziano di Torino Hospital, Turin, Italy
| | - Gitana Scozzari
- grid.413005.30000 0004 1760 6850Molinette Hospital Medical Direction, University Hospital City of Science and Health Turin, Turin, Italy
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Gianotti L, D’Agnano S, Pettiti G, Tassone F, Giraudo G, Lauro C, Lauria G, Del Bono V, Borretta G. Persistence of Elevated Procalcitonin in a Patient with Coronavirus Disease 2019 Uncovered a Diagnosis of Medullary Thyroid Carcinoma. AACE Clin Case Rep 2021; 7:288-292. [PMID: 33997278 PMCID: PMC8113110 DOI: 10.1016/j.aace.2021.05.001] [Citation(s) in RCA: 3] [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: 03/01/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 12/17/2022] Open
Abstract
Objective During the ongoing coronavirus disease 2019 pandemic, procalcitonin (PCT) levels have proven useful in assisting clinicians to diagnose bacterial superinfection. However, in the absence of signs of infection or at the resolution thereof, inappropriately and persistently high PCT levels may suggest and reveal the presence of other pathologies. We report a patient with severe acute respiratory syndrome coronavirus 2 pneumonia with initially elevated PCT levels that persisted during recovery, prompting the diagnosis of medullary thyroid carcinoma (MTC). Methods A 43-year-old man presented with a 2-day history of fever, sneezing, sore throat, and dry cough. His PCT was 94 ng/mL (normal value, 0.00-0.10 ng/mL), and he was positive for severe acute respiratory syndrome coronavirus 2 RNA. Results Empirical antibiotic therapy was administered for 7 days, but despite a clinical improvement, serum PCT remained high (84 ng/mL). Serum calcitonin (CTN) was 2120 pg/mL (normal, ≤12 pg/mL). Cytologic examination of thyroid nodules and CTN measurement of the aspiration needle washout confirmed MTC. The patient underwent total thyroidectomy with bilateral cervical lymph node dissection. Lowered CTN (986 pg/mL) and PCT (16 ng/mL) levels were observed 48 hours after surgery. A close follow-up was planned following the results of RET gene analysis. Conclusion PCT can be a useful biochemical marker of MTC suspicion in patients with inflammatory conditions and persistently elevated PCT, even after resolution. In our case, high levels of PCT in a patient with coronavirus disease 2019 pneumonia without signs of bacterial infection led to MTC diagnosis.
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Affiliation(s)
- Laura Gianotti
- Division of Endocrinology and Metabolism, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Salvatore D’Agnano
- Division of Internal Medicine, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Giorgio Pettiti
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Francesco Tassone
- Division of Endocrinology and Metabolism, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Giorgio Giraudo
- Division of General and Oncological Surgery, Department of Surgery. Hospital Santa Croce e Carle, Cuneo, Italy
| | - Corrado Lauro
- Division of General and Oncological Surgery, Department of Surgery. Hospital Santa Croce e Carle, Cuneo, Italy
| | - Giuseppe Lauria
- Division of Emergency Medicine, Department of Emergency, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Valerio Del Bono
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Giorgio Borretta
- Division of Endocrinology and Metabolism, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
- Address correspondence and reprint requests to Dr Giorgio Borretta, Division of Endocrinology and Metabolism, Department of Medicine, Carle Hospital, Via Antonio Carle 5, Confreria, Cuneo 12100, Italy.
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De Rosa FG, Palazzo A, Rosso T, Shbaklo N, Mussa M, Boglione L, Borgogno E, Rossati A, Mornese Pinna S, Scabini S, Chichino G, Borrè S, Del Bono V, Garavelli PL, Barillà D, Cattel F, Di Perri G, Ciccone G, Lupia T, Corcione S. Risk Factors for Mortality in COVID-19 Hospitalized Patients in Piedmont, Italy: Results from the Multicenter, Regional, CORACLE Registry. J Clin Med 2021; 10:jcm10091951. [PMID: 34062864 PMCID: PMC8124506 DOI: 10.3390/jcm10091951] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 02/19/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background: CORACLE is a retrospective and prospective, regional multicenter registry, developed to evaluate risk factors for mortality in a cohort of patients admitted with SARS-CoV-2 infection within non-intensive wards. Methods: The primary objective was to estimate the role of several prognostic factors on hospital mortality in terms of adjusted Odds Ratios (aOR) with multivariable logistic regression models. Results: A total of 1538 patients were enrolled; 42% were female, and 58% were >70 years old. Deceased patients were 422 (27%), with a median age of 83 years (IQR (Inter Quartile Range) 76–87). Older age at admission (aOR 1.07 per year, 95%CI 1.06–1.09), diabetes (1.41, 1.02–1.94), cardiovascular disease (1.79, 1.31–2.44), immunosuppression (1.65, 1.04–2.62), estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 (3.53, 2.26–5.51), higher C-reactive protein values and a decreased PaO2/FiO2 ratio at admission were associated with a higher risk of hospital mortality. Amongst patients still alive on day 7, only hydroxychloroquine (HCQ) treatment was associated with reduced mortality (0.57, 0.36–0.90). Conclusions: Several risk factors were associated with mortality in SARS-CoV-2 positive patients. Although HCQ seems to be the only factor significantly associated with reduced mortality, this result is in contrast with evidence from randomized studies. These results should be interpreted in light of the study limitations.
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Affiliation(s)
- Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.G.D.R.); (A.P.); (N.S.); (S.M.P.); (S.S.); (G.D.P.); (S.C.)
- Infectious Diseases Unit, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Annagloria Palazzo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.G.D.R.); (A.P.); (N.S.); (S.M.P.); (S.S.); (G.D.P.); (S.C.)
| | - Tiziana Rosso
- Unit of Clinical Epidemiology, CPO, AOU “Città della Salute e della Scienza”, 10126 Turin, Italy; (T.R.); (G.C.)
| | - Nour Shbaklo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.G.D.R.); (A.P.); (N.S.); (S.M.P.); (S.S.); (G.D.P.); (S.C.)
| | - Marco Mussa
- Infectious Diseases Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy; (M.M.); (G.C.)
| | - Lucio Boglione
- Department of Translational Medicine, University of Eastern Piedmont, 13100 Novara, Italy;
| | - Enrica Borgogno
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, 12100 Cuneo, Italy; (E.B.); (V.D.B.)
| | - Antonella Rossati
- Infectious Diseases Department, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; (A.R.); (P.L.G.)
| | - Simone Mornese Pinna
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.G.D.R.); (A.P.); (N.S.); (S.M.P.); (S.S.); (G.D.P.); (S.C.)
| | - Silvia Scabini
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.G.D.R.); (A.P.); (N.S.); (S.M.P.); (S.S.); (G.D.P.); (S.C.)
| | - Guido Chichino
- Infectious Diseases Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy; (M.M.); (G.C.)
| | - Silvio Borrè
- Unit of Infectious Diseases, Saint Andrea Hospital, 13100 Vercelli, Italy;
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, 12100 Cuneo, Italy; (E.B.); (V.D.B.)
| | - Pietro Luigi Garavelli
- Infectious Diseases Department, University Hospital “Maggiore della Carità”, 28100 Novara, Italy; (A.R.); (P.L.G.)
| | - Diego Barillà
- Hospital Pharmacy, Città della Salute e della Scienza, 10126 Turin, Italy; (D.B.); (F.C.)
| | - Francesco Cattel
- Hospital Pharmacy, Città della Salute e della Scienza, 10126 Turin, Italy; (D.B.); (F.C.)
| | - Giovanni Di Perri
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.G.D.R.); (A.P.); (N.S.); (S.M.P.); (S.S.); (G.D.P.); (S.C.)
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, CPO, AOU “Città della Salute e della Scienza”, 10126 Turin, Italy; (T.R.); (G.C.)
| | - Tommaso Lupia
- Infectious Diseases Unit, Cardinal Massaia Hospital, 14100 Asti, Italy
- Correspondence: ; Tel.: +39-01-4148-6404 or +39-34-6224-8637
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.G.D.R.); (A.P.); (N.S.); (S.M.P.); (S.S.); (G.D.P.); (S.C.)
- Department of Infectious Diseases, Tufts University School of Medicine, Boston, MA 02109, USA
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7
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Salvarani C, Dolci G, Massari M, Merlo DF, Cavuto S, Savoldi L, Bruzzi P, Boni F, Braglia L, Turrà C, Ballerini PF, Sciascia R, Zammarchi L, Para O, Scotton PG, Inojosa WO, Ravagnani V, Salerno ND, Sainaghi PP, Brignone A, Codeluppi M, Teopompi E, Milesi M, Bertomoro P, Claudio N, Salio M, Falcone M, Cenderello G, Donghi L, Del Bono V, Colombelli PL, Angheben A, Passaro A, Secondo G, Pascale R, Piazza I, Facciolongo N, Costantini M. Effect of Tocilizumab vs Standard Care on Clinical Worsening in Patients Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:24-31. [PMID: 33080005 PMCID: PMC7577199 DOI: 10.1001/jamainternmed.2020.6615] [Citation(s) in RCA: 489] [Impact Index Per Article: 163.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic is threatening billions of people worldwide. Tocilizumab has shown promising results in retrospective studies in patients with COVID-19 pneumonia with a good safety profile. OBJECTIVE To evaluate the effect of early tocilizumab administration vs standard therapy in preventing clinical worsening in patients hospitalized with COVID-19 pneumonia. DESIGN, SETTING, AND PARTICIPANTS Prospective, open-label, randomized clinical trial that randomized patients hospitalized between March 31 and June 11, 2020, with COVID-19 pneumonia to receive tocilizumab or standard of care in 24 hospitals in Italy. Cases of COVID-19 were confirmed by polymerase chain reaction method with nasopharyngeal swab. Eligibility criteria included COVID-19 pneumonia documented by radiologic imaging, partial pressure of arterial oxygen to fraction of inspired oxygen (Pao2/Fio2) ratio between 200 and 300 mm Hg, and an inflammatory phenotype defined by fever and elevated C-reactive protein. INTERVENTIONS Patients in the experimental arm received intravenous tocilizumab within 8 hours from randomization (8 mg/kg up to a maximum of 800 mg), followed by a second dose after 12 hours. Patients in the control arm received supportive care following the protocols of each clinical center until clinical worsening and then could receive tocilizumab as a rescue therapy. MAIN OUTCOME AND MEASURES The primary composite outcome was defined as entry into the intensive care unit with invasive mechanical ventilation, death from all causes, or clinical aggravation documented by the finding of a Pao2/Fio2 ratio less than 150 mm Hg, whichever came first. RESULTS A total of 126 patients were randomized (60 to the tocilizumab group; 66 to the control group). The median (interquartile range) age was 60.0 (53.0-72.0) years, and the majority of patients were male (77 of 126, 61.1%). Three patients withdrew from the study, leaving 123 patients available for the intention-to-treat analyses. Seventeen patients of 60 (28.3%) in the tocilizumab arm and 17 of 63 (27.0%) in the standard care group showed clinical worsening within 14 days since randomization (rate ratio, 1.05; 95% CI, 0.59-1.86). Two patients in the experimental group and 1 in the control group died before 30 days from randomization, and 6 and 5 patients were intubated in the 2 groups, respectively. The trial was prematurely interrupted after an interim analysis for futility. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of hospitalized adult patients with COVID-19 pneumonia and Pao2/Fio2 ratio between 200 and 300 mm Hg who received tocilizumab, no benefit on disease progression was observed compared with standard care. Further blinded, placebo-controlled randomized clinical trials are needed to confirm the results and to evaluate possible applications of tocilizumab in different stages of the disease. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04346355; EudraCT Identifier: 2020-001386-37.
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Affiliation(s)
- Carlo Salvarani
- SOC Reumatologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Unità di Reumatologia, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Dolci
- Unità di Malattie Infettive, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Marco Massari
- SOC Malattie Infettive, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Franco Merlo
- SC Infrastruttura Ricerca e Statistica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- SC Infrastruttura Ricerca e Statistica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luisa Savoldi
- SC Infrastruttura Ricerca e Statistica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Bruzzi
- SC Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabrizio Boni
- SOC Internistica Multidisciplinare, Ospedale Civile Guastalla, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Braglia
- SC Infrastruttura Ricerca e Statistica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Turrà
- SOC Farmacia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Roberto Sciascia
- UOC Medicina Generale Ospedale di Vittorio Veneto, Treviso, Italy
| | - Lorenzo Zammarchi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, SOD Malattie infettive e tropicali, AOU Careggi, Firenze, Italy
| | - Ombretta Para
- Medicina Interna 1, Dipartimento Emergenza ed Accettazione, AOU Careggi, Firenze, Italy
| | - Pier Giorgio Scotton
- UO di Malattie Infettive, Ospedale Regionale Ca' Foncello di Treviso, Treviso, Italy
| | - Walter Omar Inojosa
- UO di Malattie Infettive, Ospedale Regionale Ca' Foncello di Treviso, Treviso, Italy
| | - Viviana Ravagnani
- SSD Centro DH Allergologia e Immunologia Clinica, ASST-Mantova, Mantva, Italy
| | | | - Pier Paolo Sainaghi
- SS Reumatologia, SC Medicina Interna, DIMET, Università del Piemonte Orientale e AOU Maggiore della Carità di Novara
| | | | | | - Elisabetta Teopompi
- SOC Internistica Multidisciplinare, Ospedale Civile Guastalla, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Milesi
- Unità di malattie Infettive, ASST di Cremona, Cremona, Italy
| | - Perla Bertomoro
- UOC Medicina Generale, ULSS6 Euganea Ospedali Riuniti Padova Sud, Padova, Italy
| | | | - Mario Salio
- SC Malattie dell'Apparato Respiratorio, AO SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Marco Falcone
- Unità di Malattie Infettive, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | | | - Lorenzo Donghi
- UO Malattie Infettive ed Epatologia, AOU Parma, Parma, Italy
| | - Valerio Del Bono
- Malattie Infettive e Tropicali, AO S. Croce e Carle, Cuneo, Italy
| | | | - Andrea Angheben
- Dipartimento di Malattie Infettive, Tropicali e Microbiologia, IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar di Valpolicella, Verona, Italy
| | | | | | - Renato Pascale
- UO Malattie Infettive, Dipartimento di scienze mediche e chirurgiche, Università di Bologna, Bologna, Italy
| | - Ilaria Piazza
- UOC Medicina Interna, AUSSS3 Serenissima, Dolo, Venezia, Italy
| | - Nicola Facciolongo
- SOC Pneumologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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8
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Giacobbe DR, Salsano A, Del Puente F, Miette A, Vena A, Corcione S, Bartoletti M, Mularoni A, Maraolo AE, Peghin M, Carnelutti A, Losito AR, Raffaelli F, Gentile I, Maccari B, Frisone S, Pascale R, Mikus E, Medaglia AA, Conoscenti E, Ricci D, Lupia T, Comaschi M, Giannella M, Tumbarello M, De Rosa FG, Del Bono V, Mikulska M, Santini F, Bassetti M. Risk Factors for Candidemia After Open Heart Surgery: Results From a Multicenter Case-Control Study. Open Forum Infect Dis 2020; 7:ofaa233. [PMID: 32766378 PMCID: PMC7397829 DOI: 10.1093/ofid/ofaa233] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/11/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Candida species are among the most frequent causative agents of health care-associated bloodstream infections, with mortality >40% in critically ill patients. Specific populations of critically ill patients may present peculiar risk factors related to their reason for intensive care unit admission. The primary objective of the present study was to assess the predictors of candidemia after open heart surgery. METHODS This retrospective, matched case-control study was conducted in 8 Italian hospitals from 2009 to 2016. The primary study objective was to assess factors associated with the development of candidemia after open heart surgery. RESULTS Overall, 222 patients (74 cases and 148 controls) were included in the study. Candidemia developed at a median time (interquartile range) of 23 (14-36) days after surgery. In multivariable analysis, independent predictors of candidemia were New York Heart Association class III or IV (odds ratio [OR], 23.81; 95% CI, 5.73-98.95; P < .001), previous therapy with carbapenems (OR, 8.87; 95% CI, 2.57-30.67; P = .001), and previous therapy with fluoroquinolones (OR, 5.73; 95% CI, 1.61-20.41; P = .007). Crude 30-day mortality of candidemia was 53% (39/74). Septic shock was independently associated with mortality in the multivariable model (OR, 5.64; 95% CI, 1.91-16.63; P = .002). No association between prolonged cardiopulmonary bypass time and candidemia was observed in this study. CONCLUSIONS Previous broad-spectrum antibiotic therapy and high NYHA class were independent predictors of candidemia in cardiac surgery patients with prolonged postoperative intensive care unit stay.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Antonio Salsano
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Filippo Del Puente
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Ambra Miette
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Michele Bartoletti
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | | | - Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maddalena Peghin
- 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
| | - Angela Raffaella Losito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Raffaelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | | | - Renato Pascale
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Elisa Mikus
- Maria Cecilia Hospital - GVM Care & Research, Cotignola, Italy
| | | | | | - Davide Ricci
- Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | | | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Mario Tumbarello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Francesco Santini
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
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9
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Mesini A, Mikulska M, Giacobbe DR, Del Puente F, Gandolfo N, Codda G, Orsi A, Tassinari F, Beltramini S, Marchese A, Icardi G, Del Bono V, Viscoli C. Changing epidemiology of candidaemia: Increase in fluconazole-resistant Candida parapsilosis. Mycoses 2020; 63:361-368. [PMID: 31954083 DOI: 10.1111/myc.13050] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 09/29/2019] [Revised: 01/06/2020] [Accepted: 01/11/2020] [Indexed: 12/20/2022]
Abstract
AIM During the last decade a continuous increase in non-albicans species isolation has been observed with Candida parapsilosis being one of the leading species. Aim of this study was to describe the epidemiology of candidemia, particularly of C parapsilosis, its predictors and clinical outcome. MATERIALS AND METHODS Incidences of candidemia was evaluated analyzing data from both a prospective collection (2012-2016) and a retrospective one (2008-2011). Predictors and outcome were based only on the prospective phase. C parapsilosis potential clusters were analysed by randomly amplified polymorphic DNA (RAPD) technique. RESULTS 1240 episodes were identified. Incidences of candidemia increased from 1.97 episodes/10 000 patient-days in 2008 to 4.59/10 000 patient-days in 2016 (P < .001), mainly due to an increase of C parapsilosis (incidence rate ratio, IRR: 1.04, P < .001). 33.0% of C parapsilosis strains were resistant to fluconazole; no resistance to echinocandins was found. Independent predictors of C parapsilosis candidemia were time of infection (P = .007), previous use of echinocandins (P < .0001) and year in which the episode was registered (P < .0001). 30 days mortality was 32.4% for C parapsilosis, with a significant difference compared to C non-parapsilosis. Potential clonal C parapsilosis strains were detected by genetic analyses, showing RAPD profile A as the most represented (72.6% of isolates). DISCUSSION C parapsilosis candidemia is an emerging issue in our center, possibly attributed to some extent to horizontal transmission of the pathogen, as confirmed by the analysis of isolates similarities. Further microbiological and epidemiological investigations are needed in order to identify the most effective measures to reduce the rate of this infection.
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Affiliation(s)
- Alessio Mesini
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy
| | - Małgorzata Mikulska
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy.,Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | | | - Filippo Del Puente
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy
| | - Nemo Gandolfo
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy
| | - Giulia Codda
- Department of Surgical and Diagnostic Sciences (DiSC), University of Genova, Genova, Italy.,Microbiology Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Andrea Orsi
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy.,Hygiene Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Federico Tassinari
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy
| | - Sabrina Beltramini
- Pharmacy Complex Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Anna Marchese
- Department of Surgical and Diagnostic Sciences (DiSC), University of Genova, Genova, Italy.,Microbiology Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Giancarlo Icardi
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy.,Hygiene Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Claudio Viscoli
- Department of Health Sciences (DiSSal), University of Genova, Genova, Italy.,Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy
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10
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Mikulska M, Furfaro E, De Carolis E, Drago E, Pulzato I, Borghesi ML, Zappulo E, Raiola AM, Grazia CD, Del Bono V, Cittadini G, Angelucci E, Sanguinetti M, Viscoli C. Use of Aspergillus fumigatus real-time PCR in bronchoalveolar lavage samples (BAL) for diagnosis of invasive aspergillosis, including azole-resistant cases, in high risk haematology patients: the need for a combined use with galactomannan. Med Mycol 2020; 57:987-996. [PMID: 30753590 PMCID: PMC7107636 DOI: 10.1093/mmy/myz002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/04/2018] [Accepted: 01/26/2019] [Indexed: 12/17/2022] Open
Abstract
Diagnosis of invasive aspergillosis (IA) is challenging, particularly in high-risk patients with lung lesions other than typical according to 2008-EORTC/MSG criteria. Even if microbiology is positive, they still remain unclassified according to 2008-EORTC/MSG. Quantitative polymerase chain reaction (qPCR) provides new mycological documentation of IA. This retrospective study assessed Aspergillus fumigatus real time qPCR (MycoGENIE®) in BAL to diagnose IA and identify azole-resistant strains. Clinical, radiological, and microbiological data from 114 hematology patients (69% HSCT recipients; 29% on mould active agents) from years 2012-2017 were collected; and 123 BAL samples were tested with qPCR (cutoff: Ct < 40) and galactomannan (GM, Platelia®, cutoff: 0.5 ODI). Patients were classified as proven/probable, possible, and no-IA. "Atypical-IA" referred to patients with lesions other than typical according to 2008-EORTC/MSG and positive mycology. Proven IA was diagnosed in two cases (1.6%), probable in 28 (22.8%), possible in 27 (22%), atypical in 14 (11.4%). qPCR was positive in 39 samples (31.7%). Sensitivity and specificity of qPCR for proven/probable IA (vs no-IA; atypical-IA excluded) were 40% (95% confidence interval [CI]: 23–59) and 69% (95%CI: 55–81), respectively. Sensitivity of qPCR was higher when combined with GM (83%, 95%CI: 65–94) and in those receiving mould-active agents at BAL (61%, 95%CI: 32–86). One sample had TR34/L98H mutation. In conclusion, in high-risk hematology patients with various lung lesions, A. fumigatus qPCR in BAL contributes to diagnosing IA, particularly if combined with GM and in patients receiving mould-active agents might allow detecting azole-resistant mutations in culture negative samples.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Elisa Furfaro
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Elena De Carolis
- Institute of Microbiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Enrico Drago
- School of Medicine, University of Genoa, Genoa, Italy
| | - Ilaria Pulzato
- Department of Radiology, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Maria Lucia Borghesi
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Emanuela Zappulo
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy.,Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Anna Maria Raiola
- Division of Hematology and Bone Marrow Transplantation, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Carmen Di Grazia
- Division of Hematology and Bone Marrow Transplantation, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Giuseppe Cittadini
- Department of Radiology, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Emanuele Angelucci
- Division of Hematology and Bone Marrow Transplantation, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Maurizio Sanguinetti
- Institute of Microbiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Claudio Viscoli
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
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11
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Giacobbe DR, De Rosa FG, Del Bono V, Grossi PA, Pea F, Petrosillo N, Rossolini GM, Tascini C, Tumbarello M, Viale P, Bassetti M. Ceftobiprole: drug evaluation and place in therapy. Expert Rev Anti Infect Ther 2019; 17:689-698. [PMID: 31553250 DOI: 10.1080/14787210.2019.1667229] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Ceftobiprole is a fifth-generation cephalosporin with a broad spectrum of antimicrobial activity, including also methicillin-resistant Staphylococcus aureus (MRSA). Ceftobiprole is approved for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), excluding ventilator-associated pneumonia, in several European and non-European countries. Areas covered: In this narrative review, we discuss the current place in therapy of ceftobiprole, both within and outside approved indications. An inductive MEDLINE/PubMed search of the available literature was conducted. Expert opinion: There are three main reasons which render ceftobiprole an attractive option for the empirical and targeted treatment of CAP and HAP: (i) its broad spectrum of activity; (ii) its activity against MRSA; (iii) its good safety profile. For these indications, ceftobiprole should be employed thoughtfully, in those scenarios in which its intrinsic advantages could be maximized. The use of ceftobiprole outside approved indications could be justified in specific scenarios, such as when other approved alternatives are ineffective, when the risk of toxicity due to other agents is unacceptable, and for salvage therapy. In the near future, ongoing phase 3 studies and further observational experiences could both enlarge the current panel of approved indications and enrich our knowledge on the use of ceftobiprole for off-label indications.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa , Genoa , Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS , Genoa , Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences , Turin , Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle , Cuneo , Italy
| | | | - Federico Pea
- Department of Medicine, University of Udine and Institute of Clinical Pharmacology, Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia , Udine , Italy
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS , Rome , Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence , Florence , Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital , Florence , Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli , Naples , Italy
| | - Mario Tumbarello
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS , Roma , Italy.,Istituto di Malattie Infettive, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna , Bologna , Italy
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa , Genoa , Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS , Genoa , Italy.,Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine , Udine , Italy
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12
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Giacobbe DR, Saffioti C, Losito AR, Rinaldi M, Aurilio C, Bolla C, Boni S, Borgia G, Carannante N, Cassola G, Ceccarelli G, Corcione S, Dalla Gasperina D, De Rosa FG, Dentone C, Di Bella S, Di Lauria N, Feasi M, Fiore M, Fossati S, Franceschini E, Gori A, Granata G, Grignolo S, Grossi PA, Guadagnino G, Lagi F, Maraolo AE, Marinò V, Mazzitelli M, Mularoni A, Oliva A, Pace MC, Parisini A, Patti F, Petrosillo N, Pota V, Raffaelli F, Rossi M, Santoro A, Tascini C, Torti C, Trecarichi EM, Venditti M, Viale P, Signori A, Bassetti M, Del Bono V, Giannella M, Mikulska M, Tumbarello M, Viscoli C. Use of colistin in adult patients: A cross-sectional study. J Glob Antimicrob Resist 2019; 20:43-49. [PMID: 31207379 DOI: 10.1016/j.jgar.2019.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 04/01/2019] [Revised: 06/03/2019] [Accepted: 06/08/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess colistin use in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). METHODS Colistin prescription patterns were evaluated in 22 Italian centres. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. RESULTS A total of 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52-73 years) and 134 (61%) were male. Colistin was mostly administered intravenously (203/221; 92%) and mainly for targeted therapy (168/221; 76%). The most frequent indications for colistin therapy were bloodstream infection and lower respiratory tract infection. Intravenous colistin was administered in combination with at least another anti-MDR-GNB agent in 80% of cases (163/203). A loading dose of 9 MU of colistimethate was administered in 79% of patients receiving i.v. colistin and adequate maintenance doses in 85%. In multivariable analysis, empirical therapy [odds ratio (OR) = 3.25, 95% confidence interval (CI) 1.24-8.53;P = 0.017] and targeted therapy for carbapenem-resistant Enterobacterales infection (OR = 4.76, 95% CI 1.69-13.43; P = 0.003) were associated with use of colistin in combination with other agents, whilst chronic renal failure (OR = 0.39, 95% CI 0.17-0.88; P = 0.024) was associated with use of colistin monotherapy. CONCLUSION Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimising its use owing to peculiar pharmacokinetic/pharmacodynamic characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.
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Affiliation(s)
| | - Carolina Saffioti
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Angela Raffaella Losito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Rinaldi
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Caterina Aurilio
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
| | - Cesare Bolla
- SC Malattie Infettive, ASO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Silvia Boni
- Divisione di Malattie Infettive, Ospedale Sant'Andrea, La Spezia, Italy
| | - Guglielmo Borgia
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Giovanni Cassola
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Daniela Dalla Gasperina
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Chiara Dentone
- Medical Department, Infectious Diseases Unit, Sanremo Hospital, Imperia, Italy
| | - Stefano Di Bella
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Nicoletta Di Lauria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marcello Feasi
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Marco Fiore
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Sara Fossati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Gori
- University of Milan and Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Guido Granata
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Sara Grignolo
- Divisione di Malattie Infettive, Ospedale Sant'Andrea, La Spezia, Italy
| | - Paolo Antonio Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Filippo Lagi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Maria Mazzitelli
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy
| | | | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy; IRCCS INM Neuromed, Pozzilli, Italy
| | - Maria Caterina Pace
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Andrea Parisini
- SC Malattie Infettive, ASO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesca Patti
- Medical Department, Infectious Diseases Unit, Sanremo Hospital, Imperia, Italy
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Vincenzo Pota
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
| | - Francesca Raffaelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marianna Rossi
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Antonella Santoro
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Mario Tumbarello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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13
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Salsano A, Giacobbe DR, Sportelli E, Olivieri GM, Natali R, Prevosto M, Del Bono V, Viscoli C, Santini F. Aortic cross-clamp time and cardiopulmonary bypass time: prognostic implications in patients operated on for infective endocarditis. Interact Cardiovasc Thorac Surg 2019; 27:328-335. [PMID: 29579243 DOI: 10.1093/icvts/ivy085] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/22/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Prolonged aortic cross-clamp (XCT) and cardiopulmonary bypass time (CPBT) are associated with increased morbidity and mortality following cardiac surgery. The aim of this study was to assess the predictors of mortality and other severe postoperative complications in patients undergoing surgery for infective endocarditis (IE), focusing in particular on the role of prolonged XCT and CPBT. METHODS A retrospective single-centre study was conducted from January 2000 to January 2017, including all patients undergoing valvular surgery for IE. The primary end point was early postoperative mortality. The main secondary end point was a composite end point for severe postoperative complications. RESULTS During the study period, 264 patients were included. Early postoperative mortality was 14%. Prolonged CPBT [odds ratio (OR) 1.008, 95% confidence intervals (CIs) 1.003-1.01; P = 0.009] and increasing age (OR 1.04, 95% CI 1.01-1.07; P = 0.02) independently predicted mortality, while an inverse association was observed for left ventricular ejection fraction (OR 0.93, 95% CI 0.89-0.97; P = 0.0007). The best mortality cut-offs were >72 min for XCT and >166 min for CPBT. Prolonged CPBT also predicted severe complications, along with age, stroke, preoperative mechanical ventilation and reduced left ventricular ejection fraction. When XCT was included in the multivariable models instead of CPBT, it was associated with both mortality and severe complications. CONCLUSIONS Prolonged XCT and CPBT are associated with mortality and development of severe complications after valvular surgery for IE. Further validation of safe limits for XCT and CPBT might provide novel insights on how to improve intraoperative and postoperative outcomes of patients with IE.
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Affiliation(s)
- Antonio Salsano
- Division of Cardiac Surgery, University of Genoa (DISC), Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, University of Genoa (DISSAL), Ospedale Policlinico San Martino, Genoa, Italy
| | - Elena Sportelli
- Division of Cardiac Surgery, University of Genoa (DISC), Ospedale Policlinico San Martino, Genoa, Italy
| | - Guido Maria Olivieri
- Division of Cardiac Surgery, University of Genoa (DISC), Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Natali
- Division of Cardiac Surgery, University of Genoa (DISC), Ospedale Policlinico San Martino, Genoa, Italy
| | - Martina Prevosto
- Division of Cardiac Surgery, University of Genoa (DISC), Ospedale Policlinico San Martino, Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, University of Genoa (DISSAL), Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Viscoli
- Infectious Diseases Unit, University of Genoa (DISSAL), Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Santini
- Division of Cardiac Surgery, University of Genoa (DISC), Ospedale Policlinico San Martino, Genoa, Italy
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14
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Russo A, Bassetti M, Ceccarelli G, Carannante N, Losito AR, Bartoletti M, Corcione S, Granata G, Santoro A, Giacobbe DR, Peghin M, Vena A, Amadori F, Segala FV, Giannella M, Di Caprio G, Menichetti F, Del Bono V, Mussini C, Petrosillo N, De Rosa FG, Viale P, Tumbarello M, Tascini C, Viscoli C, Venditti M. Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: Clinical features, therapy and outcome from a multicenter study. J Infect 2019; 79:130-138. [PMID: 31145911 DOI: 10.1016/j.jinf.2019.05.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES bloodstream infections (BSI) due to multidrug-resistant (MDR) Acinetobacter baumannii (AB) have been increasingly observed among hospitalized patients. METHODS prospective, observational study conducted among 12 large tertiary-care hospitals, across 7 Italian regions. From June 2017 to June 2018 all consecutive hospitalized patients with bacteremia due to MDR-AB were included and analyzed in the study. RESULTS During the study period 281 episodes of BSI due to MDR-AB were observed: 98 (34.8%) episodes were classified as primary bacteremias, and 183 (65.2%) as secondary bacteremias; 177 (62.9%) of them were associated with septic shock. Overall, 14-day mortality was observed in 172 (61.2%) patients, while 30-day mortality in 207 (73.6%) patients. On multivariate analysis, previous surgery, continuous renal replacement therapy, inadequate source control of infection, and pneumonia were independently associated with higher risk of septic shock. Instead, septic shock and Charlson Comorbidity Index >3 were associated with 14-day mortality, while adequate source control of infection and combination therapy with survival. Finally, septic shock, previous surgery, and aminoglycoside-containing regimen were associated with 30-day mortality, while colistin-containing regimen with survival. CONCLUSIONS BSI caused by MDR-AB represents a difficult challenge for physicians, considering the high rates of septic shock and mortality associated with this infection.
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Affiliation(s)
- Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università 37, 00161 Rome, Italy
| | - Novella Carannante
- First division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Angela Raffaella Losito
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Michele Bartoletti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Guido Granata
- Clinical and Research Department for Infectious Diseases, Unit Systemic and Immunedepression-Associated Infections, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | | | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Maddalena Peghin
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | - Antonio Vena
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | - Francesco Amadori
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Francesco Vladimiro Segala
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Di Caprio
- First division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Cristina Mussini
- Clinic of Infectious Disease, University Hospital, Modena, Italy
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, Unit Systemic and Immunedepression-Associated Infections, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Carlo Tascini
- First division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Claudio Viscoli
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università 37, 00161 Rome, Italy.
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15
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Giacobbe DR, Signori A, Tumbarello M, Ungaro R, Sarteschi G, Furfaro E, Mikulska M, Sanguinetti M, Posteraro B, Losito AR, De Pascale G, Del Bono V, Viscoli C. Desirability of outcome ranking (DOOR) for comparing diagnostic tools and early therapeutic choices in patients with suspected candidemia. Eur J Clin Microbiol Infect Dis 2018; 38:413-417. [PMID: 30506332 DOI: 10.1007/s10096-018-3441-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/15/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
Desirability of outcome ranking (DOOR) has been developed for assessing desirability of outcome in interventional studies. However, its possible use in observational studies of the diagnosis and early treatment of infectious diseases has not been explored so far, and it might introduce interesting features in specific scenarios. This was a post hoc analysis of a prospective observational study in intensive care unit patients with sepsis and at risk of candidemia. The probabilities that a randomly selected patient would have a more, less, and equally cost-effective early therapeutic choice following a BDG-based diagnostic strategy rather than the empirical administration of antifungals to all patients were calculated using DOOR methods. The probability of a more cost-effective therapeutic choice following the BDG-based rather than the empirical strategy was 67.81% (95% CI 67.32-68.30), whereas the probabilities of a less and equally cost-effective early therapeutic choice were 19.68% (95% CI 19.27-20.10) and 12.50% (95% CI 12.16-12.85), respectively. The application of DOOR methods to observational studies focused on diagnosis and early treatment is a novel field that could merit further investigation.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Largo R. Benzi, 10, 16132, Genoa, Italy. .,Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy.
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, DISSAL, University of Genoa, Genoa, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Ungaro
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Largo R. Benzi, 10, 16132, Genoa, Italy.,Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy
| | - Giovanni Sarteschi
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Largo R. Benzi, 10, 16132, Genoa, Italy.,Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy
| | - Elisa Furfaro
- Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Largo R. Benzi, 10, 16132, Genoa, Italy.,Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy
| | - Maurizio Sanguinetti
- Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Brunella Posteraro
- Institute of Public Health (Section of Hygiene), Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Raffaella Losito
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione - UOC di Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica - Istituto di Anestesia e Rianimazione. Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Del Bono
- Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy.,Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Claudio Viscoli
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Largo R. Benzi, 10, 16132, Genoa, Italy.,Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy
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16
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Giacobbe DR, di Masi A, Leboffe L, Del Bono V, Rossi M, Cappiello D, Coppo E, Marchese A, Casulli A, Signori A, Novelli A, Perrone K, Principe L, Bandera A, Vender LE, Misin A, Occhilupo P, Melone M, Ascenzi P, Gori A, Luzzati R, Viscoli C, Di Bella S. Hypoalbuminemia as a predictor of acute kidney injury during colistin treatment. Sci Rep 2018; 8:11968. [PMID: 30097635 PMCID: PMC6086859 DOI: 10.1038/s41598-018-30361-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/27/2018] [Indexed: 11/09/2022] Open
Abstract
This study aimed to assess the predictors of acute kidney injury (AKI) during colistin therapy in a cohort of patients with bloodstream infections (BSI) due to colistin-susceptible Gram-negative bacteria, focusing on the role of serum albumin levels. The study consisted of two parts: (1) a multicentre retrospective clinical study to assess the predictors of AKI during colistin therapy, defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria; and (2) bioinformatic and biochemical characterization of the possible interaction between human serum albumin and colistin. Among the 170 patients included in the study, 71 (42%), 35 (21%), and 11 (6%) developed KDIGO stage 1 (K1-AKI), KDIGO stage 2 (K2-AKI), and KDIGO stage 3 (K3-AKI), respectively. In multivariable analyses, serum albumin <2.5 g/dL was independently associated with K1-AKI (subdistribution hazard ratio [sHR] 1.85, 95% confidence interval [CI] 1.17-2.93, p = 0.009) and K2-AKI (sHR 2.37, 95% CI 1.15-4.87, p = 0.019). Bioinformatic and biochemical analyses provided additional information nurturing the discussion on how hypoalbuminemia favors development of AKI during colistin therapy. In conclusion, severe hypoalbuminemia independently predicted AKI during colistin therapy in a large cohort of patients with BSI due to colistin-susceptible Gram-negative bacteria. Further study is needed to clarify the underlying causal pathways.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia and Department of Health Science (DISSAL), University of Genoa, Genoa, Italy.
| | - Alessandra di Masi
- Department of Sciences, Section Biomedical Sciences and Technology, Roma Tre University, Rome, Italy
| | - Loris Leboffe
- Department of Sciences, Section Biomedical Sciences and Technology, Roma Tre University, Rome, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Marianna Rossi
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Dario Cappiello
- Città di Lecce Hospital - GVM Care and Research, Lecce, Italy
| | - Erika Coppo
- Microbiology Unit, University of Genoa (DISC) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy
| | - Anna Marchese
- Microbiology Unit, University of Genoa (DISC) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy
| | - Annarita Casulli
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia and Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Katja Perrone
- Città di Lecce Hospital - GVM Care and Research, Lecce, Italy
| | - Luigi Principe
- Clinical Microbiology and Virology Unit, A. Manzoni Hospital, Lecco, Italy
| | - Alessandra Bandera
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Luca Enrico Vender
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Andrea Misin
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | | | - Marcello Melone
- Città di Lecce Hospital - GVM Care and Research, Lecce, Italy
| | - Paolo Ascenzi
- Department of Sciences, Section Biomedical Sciences and Technology, Roma Tre University, Rome, Italy
| | - Andrea Gori
- University of Milan and Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Luzzati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Claudio Viscoli
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia and Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Stefano Di Bella
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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Furfaro E, Giacobbe DR, Del Bono V, Signori A, Guolo F, Minetto P, Clavio M, Ballerini F, Gobbi M, Viscoli C, Mikulska M. Performance of serum (1,3)-ß-d-glucan screening for the diagnosis of invasive aspergillosis in neutropenic patients with haematological malignancies. Mycoses 2018; 61:650-655. [PMID: 29693758 DOI: 10.1111/myc.12787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/31/2018] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 01/22/2023]
Abstract
We report our experience with the use of (1,3)-ß-d-glucan (BDG) screening for the diagnosis of invasive aspergillosis (IA) in neutropenic patients with haematological malignancies. The performance of BDG screening was assessed retrospectively in per patient and per sample analyses. Overall, 20 among 167 patients developed IA (12%). In the per patient analysis, BDG showed 60% sensitivity and 78% specificity when the criterion for positivity was the presence of at least one BDG value ≥80 pg/mL. For 2 consecutive positive results, sensitivity decreased to 40%, while specificity increased to 93% and was similar to that of a positive galactomannan (GM; 90%). The highest specificity (97%) was observed for combined positivity of at least one BDG and at least one GM. In the per sample analysis, the specificity of BDG was 100% in the best scenario, 96% in the median scenario and 89% in the worst scenario. BDG became positive before GM in 33% of IA patients with both markers positive (n = 12). Despite good specificity for 2 consecutive positive results, the BDG test offered unsatisfactory performance for the diagnosis of IA due to low sensitivity. The combination of BDG and GM showed the potential for increasing specificity.
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Affiliation(s)
- Elisa Furfaro
- Department Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Department Health Sciences (DISSAL), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Department Health Sciences (DISSAL), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Fabio Guolo
- Clinic of Haematology, Department of Internal Medicine (DiMI), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Paola Minetto
- Clinic of Haematology, Department of Internal Medicine (DiMI), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Marino Clavio
- Clinic of Haematology, Department of Internal Medicine (DiMI), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Filippo Ballerini
- Clinic of Haematology, Department of Internal Medicine (DiMI), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Marco Gobbi
- Clinic of Haematology, Department of Internal Medicine (DiMI), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Claudio Viscoli
- Infectious Diseases Unit, Department Health Sciences (DISSAL), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit, Department Health Sciences (DISSAL), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
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18
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Gustinetti G, Raiola AM, Varaldo R, Galaverna F, Gualandi F, Del Bono V, Bacigalupo A, Angelucci E, Viscoli C, Mikulska M. De-Escalation and Discontinuation of Empirical Antibiotic Treatment in a Cohort of Allogeneic Hematopoietic Stem Cell Transplantation Recipients during the Pre-Engraftment Period. Biol Blood Marrow Transplant 2018; 24:1721-1726. [PMID: 29578073 DOI: 10.1016/j.bbmt.2018.03.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/18/2018] [Indexed: 01/19/2023]
Abstract
To investigate rates and outcomes of antibiotic de-escalation during pre-engraftment neutropenia in allogeneic hematopoietic stem cell transplantation (HSCT) recipients. 110 consecutive HSCTs performed between January 2013 and March 2014 were analyzed. De-escalation was defined as narrowing the spectrum of antibiotic treatment either within (early) or after 96 hours (late) from starting antibiotics. Discontinuation, considered a form of de-escalation, was defined as stopping antibiotics before engraftment. De-escalation failure was defined as restarting/escalating antibiotics within 96 hours after de-escalation. Predictors of de-escalation were analyzed. Among 102 patients who started antibiotics and were included, 68 (67%) received monotherapy (mainly piperacillin-tazobactam, n = 58), whereas 34 (33%) received combination therapy (mainly meropenem plus glycopeptide, n = 24). Median duration of neutropenia was 17 days. Bloodstream infections (BSIs) were diagnosed in 28 patients (20%). Early de-escalation rate was 25.5% (n = 26) and mostly consisted of reducing the spectrum of β-lactams (n = 11, 42%). In comparison with theoretical scenario of continuing therapy until engraftment, the median savings in terms of antibiotic days were 10 for meropenem, 8 for piperacillin-tazobactam, and 7 for vancomycin. Failure rate of early de-escalation was 15% (4/26). Late de-escalation rate was 30.4% (n = 31) and failure rate 19% (6/31). The rate of de-escalation any time before engraftment was 55.9% (n = 57), including discontinuation in 33 patients (32%). Death at day 60 after HSCT occurred in 3 patients who never underwent de-escalation. Acute myeloid disease and BSIs were independent predictors of early de-escalation. De-escalation, including discontinuation, is feasible and safe in pre-engraftment neutropenia after allogeneic HSCT.
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Affiliation(s)
- Giulia Gustinetti
- Division of Infectious Diseases, Department of Health Science (DISSAL), Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Anna Maria Raiola
- Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Riccardo Varaldo
- Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Federica Galaverna
- Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Francesca Gualandi
- Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Valerio Del Bono
- Division of Infectious Diseases, Department of Health Science (DISSAL), Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Andrea Bacigalupo
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, Rome, Italy
| | - Emanuele Angelucci
- Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Claudio Viscoli
- Division of Infectious Diseases, Department of Health Science (DISSAL), Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Science (DISSAL), Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa, Genoa, Italy.
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Giacobbe DR, Bassetti M, De Rosa FG, Del Bono V, Grossi PA, Menichetti F, Pea F, Rossolini GM, Tumbarello M, Viale P, Viscoli C. Ceftolozane/tazobactam: place in therapy. Expert Rev Anti Infect Ther 2018; 16:307-320. [DOI: 10.1080/14787210.2018.1447381] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino – IRCCS per l’Oncologia and Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Ospedale Policlinico San Martino – IRCCS per l’Oncologia and Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Paolo Antonio Grossi
- Department of Surgical and Morphological Sciences of Clinical Medicine, University of Insubria, Varese, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Federico Pea
- Institute of Clinical Pharmacology, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Claudio Viscoli
- Infectious Diseases Unit, Ospedale Policlinico San Martino – IRCCS per l’Oncologia and Department of Health Sciences, University of Genoa, Genoa, Italy
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20
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Concia E, Viscoli C, Del Bono V, Giannella M, Bassetti M, De Rosa GF, Durante Mangoni E, Esposito S, Giusti M, Grossi P, Menichetti F, Pea F, Petrosillo N, Tumbarello M, Stefani S, Venditti M, Viale P. The current role of glycopeptides in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in not neutropenic adults: the viewpoint of a group of Italian experts. J Chemother 2018; 30:157-171. [PMID: 29380676 DOI: 10.1080/1120009x.2017.1420610] [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] [Indexed: 10/18/2022]
Abstract
Staphylococcus aureus is still an important problem in clinical and therapeutic area, worldwide. In Italy, in recent years, methicillin resistance remained stable, yet considerably high, the percentage of strains of MRSA being around 40%. It was deemed interesting and timely to carry out a consensus conference using the RAND/UCLA method to collect the opinion of a group of experts in infectious diseases on the role of glycopeptides in the management of MRSA infections within several clinical scenarios and namely in pneumonia, bacteremia and endocarditis, joint replacement infections, skin and soft tissue infections, diabetic foot, abdominal infections and central nervous system infections. The scenarios proposed by the Scientific Committee have been validated by a group of experts in infectious diseases and then voted in three meetings of infectious disease specialists. The results obtained on each individual condition were analyzed and therapeutic recommendations on each of these were released.
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Affiliation(s)
- Ercole Concia
- a Università degli Studi di Verona, Italy - Dipartimento Diagnostica e Sanità Pubblica - Sezione Malattie Infettive
| | - Claudio Viscoli
- b A.O.U. IRCCS San Martino/Università degli Studi, Genova, Italy - Clinica delle Malattie Infettive
| | - Valerio Del Bono
- b A.O.U. IRCCS San Martino/Università degli Studi, Genova, Italy - Clinica delle Malattie Infettive
| | - Maddalena Giannella
- c Università degli Studi di Bologna/Ospedale Sant'Orsola-Malpighi, Bologna, Italy - Dipartimento di Scienze Mediche e Chirurgiche, Settore Malattie Infettive
| | - Matteo Bassetti
- d A.O.U. Santa Maria della Misericordia, Udine, Italy - Clinica di Malattie Infettive (Bassetti), Istituto di Farmacologia Clinica (Pea)
| | | | | | - Silvano Esposito
- g Università degli Studi di Salerno, Italy, Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana"
| | - Massimo Giusti
- h A.O. San Giovanni Bosco, Torino, Italy - Reparto di Medicina Interna A
| | - Paolo Grossi
- i Università degli Studi dell'Insubria, Varese, Italy - Dipartimento di Medicina Interna - Malattie infettive e tropicali
| | - Francesco Menichetti
- j A.O.U. Pisana, Pisa, Italy - Direttore di Unità Operativa - U.O. Malattie Infettive
| | - Federico Pea
- d A.O.U. Santa Maria della Misericordia, Udine, Italy - Clinica di Malattie Infettive (Bassetti), Istituto di Farmacologia Clinica (Pea)
| | - Nicola Petrosillo
- k Istituto Nazionale Malattie Infettive "Lazzaro Spallanzani", Roma, Italy - U.O.C. Infezioni Sistemiche e dell'Immunodepresso
| | - Mario Tumbarello
- l Università Cattolica del Sacro Cuore, Roma, Italy - Facoltà di Medicina e Chirurgia, Clinica delle Malattie Infettive
| | - Stefania Stefani
- m Università degli Studi di Catania, Italy - Dipartimento di Scienze Biomediche e Biotecnologiche
| | - Mario Venditti
- n Università "La Sapienza"/A.O. Policlinico Umberto I, Roma, Italy - Dipartimento di Sanità Pubblica e Malattie Infettive
| | - Pierluigi Viale
- c Università degli Studi di Bologna/Ospedale Sant'Orsola-Malpighi, Bologna, Italy - Dipartimento di Scienze Mediche e Chirurgiche, Settore Malattie Infettive
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21
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Delfino E, Fucile C, Del Bono V, Marchese A, Marini V, Coppo E, Casciaro R, Minicucci L, Giacobbe DR, Martelli A, Viscoli C, Mattioli F. Pharmacokinetics of high-dose extended-infusion meropenem during pulmonary exacerbation in adult cystic fibrosis patients: a case series. New Microbiol 2018; 41:47-51. [PMID: 29313863] [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] [Received: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 06/07/2023]
Abstract
This case series explored the pharmacokinetic/pharmacodynamic (PK/PD) characteristics of meropenem (MEM) in adult cystic fibrosis (CF) patients hospitalized for a pulmonary exacerbation. From January 2015 to June 2016, all adult patients with cystic fibrosis (CF) and chronic pulmonary infection due to meropenem (MEM)-susceptible/intermediate Pseudomonas aeruginosa who received at least 48 h of MEM as an extended 3-hour infusion for treating a pulmonary exacerbation were enrolled. MEM plasma concentrations were determined by high-performance liquid chromatography. Six adult CF patients with a median age of 47 years were included in the study. MEM showed a high Vd (mean 45.98 L, standard deviation [SD] ±34.45). A minimal PK/PD target of 40% T > minimum inhibitory concentration (MIC) with respect to the MEM MIC of P. aeruginosa strains isolated from sputum during exacerbation was achieved in 5/6 patients (83%). MEM failed to achieve this target only in one patient, whose strain showed the highest MEM MIC in our cohort (8 mg/L). In all patients, MEM was well tolerated, and no adverse events were reported. In conclusion, high-dose, extended-infusion MEM during pulmonary exacerbation showed a high Vd in six adult CF patients with high median age, and was well tolerated.
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Affiliation(s)
- Emanuele Delfino
- Infectious Diseases Division, University of Genoa (DISSAL) and San Martino Hospital, Genoa, Italy
| | - Carmen Fucile
- Clinical Pharmacology and Toxicology Unit, University of Genoa (DIMI), Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Division, University of Genoa (DISSAL) and San Martino Hospital, Genoa, Italy
| | - Anna Marchese
- Microbiology Unit, University of Genoa (DISC) and San Martino Hospital, Genoa, Italy
| | - Valeria Marini
- Clinical Pharmacology and Toxicology Unit, University of Genoa (DIMI), Genoa, Italy
| | - Erika Coppo
- Microbiology Unit, University of Genoa (DISC) and San Martino Hospital, Genoa, Italy
| | - Rosaria Casciaro
- Cystic Fibrosis Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Laura Minicucci
- Cystic Fibrosis Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Division, University of Genoa (DISSAL) and San Martino Hospital, Genoa, Italy
| | - Antonietta Martelli
- Clinical Pharmacology and Toxicology Unit, University of Genoa (DIMI), Genoa, Italy
| | - Claudio Viscoli
- Infectious Diseases Division, University of Genoa (DISSAL) and San Martino Hospital, Genoa, Italy
| | - Francesca Mattioli
- Clinical Pharmacology and Toxicology Unit, University of Genoa (DIMI), Genoa, Italy
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Abstract
INTRODUCTION Invasive fungal diseases (IFD) remain a leading cause of morbidity and mortality in hematology patients. Within a diagnostic-driven approach, the use of the serum (1,3)-ß-D-glucan (BDG) test represents a valid tool for the early diagnosis and treatment of IFD. Areas covered: The available literature on the use of BDG in hematology patients was systematically retrieved. Then, it was reviewed and discussed, to identify key issues pertaining to a clinically-oriented narrative presentation of the topic. Expert commentary: The use of BDG in hematology patients at risk for invasive aspergillosis (IA) is secondary to the use of galactomannan. However, since BDG is not specific for IA, it offers an advantage of diagnosing also other IFD, such as candidiasis and pneumocystosis. The limitations of BDG include high costs and lower sensitivity in hematology patients compared to other cohorts. The risk of false positive results is possibly lower in real life than in theory, since glucan-free equipment is available and modern dialysis membranes and blood products usually do not release BDG. Thus, in experienced hands and selected clinical situations, BDG is a useful diagnostic tool, particularly due to short turnover time to results and versatility in diagnosing different IFD.
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Affiliation(s)
- Daniele Roberto Giacobbe
- a Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS per l'Oncologia, University of Genoa, DISSAL , Genoa , Italy
| | - Valerio Del Bono
- a Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS per l'Oncologia, University of Genoa, DISSAL , Genoa , Italy
| | - Claudio Viscoli
- a Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS per l'Oncologia, University of Genoa, DISSAL , Genoa , Italy
| | - Malgorzata Mikulska
- a Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS per l'Oncologia, University of Genoa, DISSAL , Genoa , Italy
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23
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Galli M, Antinori S, Atzeni F, Meroni L, Riva A, Scirè C, Adorni F, Quartuccio L, Sebastiani M, Airò P, Bazzichi L, Cristini F, Del Bono V, Manfredi A, Viapiana O, De Rosa F, Favalli E, Petrelli E, Salvarani C, Govoni M, Corcione S, Scrivo R, Sarmati L, Lazzarin A, Grassi W, Mastroianni C, Gaeta GB, Ferraccioli G, Cutolo M, De Vita S, Lapadula G, Matucci-Cerinic M, Armignacco O, Sarzi-Puttini P. Recommendations for the management of pulmonary fungal infections in patients with rheumatoid arthritis. Clin Exp Rheumatol 2017; 35:1018-1028. [PMID: 29185961] [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] [Received: 12/13/2016] [Accepted: 02/19/2017] [Indexed: 06/07/2023]
Abstract
Often life-threatening pulmonary fungal infections (PFIs) can occur in patients with rheumatoid arthritis (RA) receiving disease-modifying anti-rheumatic drugs (DMARDs). Most of the data concerning PFIs in RA patients come from case reports and retrospective case series. Of the ve most widely described PFIs, Pneumocystis jirovecii pneumonia (PJP) has rarely been seen outside Japan, pulmonary cryptococcosis has been diagnosed in only a small number of patients worldwide, pulmonary coccidioidomycosis has almost only been observed in endemic areas, the limited number of cases of pulmonary histoplasmosis have mainly occurred in the USA, and the rare cases of invasive pulmonary aspergillosis have only been encountered in leukopenic patients. Many aspects of the prophylaxis, diagnosis and treatment of PFIs in RA patients remain to be defined, as does the role of each DMARD in increasing the risk of infection, and the possibility of resuming biological and non-biological DMARD treatment after the infection has been cured. The recommendations for the management of PFIs described in this paper are the product of a consensus procedure promoted by the Italian group for the Study and Management of Infections in Patients with Rheumatic Diseases (the ISMIR group).
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Affiliation(s)
- Massimo Galli
- Clinica delle Malattie Infettive, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Italy.
| | - Spinello Antinori
- Clinica delle Malattie Infettive, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Italy
| | | | - Luca Meroni
- Clinica delle Malattie Infettive, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Italy
| | - Agostino Riva
- Clinica delle Malattie Infettive, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Italy
| | - Carlo Scirè
- Department of Medical Sciences, UOC of Rheumatology, Santa Anna University Hospital, Ferrara, Italy
| | - Fulvio Adorni
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | - Luca Quartuccio
- Department of Medical and Biological Sciences, Rheumatology Clinic, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marco Sebastiani
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Airò
- Rheumatology, Allergology and Clinical Immunology Service, Spedali Civili and University, Brescia, Italy
| | - Laura Bazzichi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesco Cristini
- Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Italy
| | - Valerio Del Bono
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST, Università di Genova, Italy
| | - Andreina Manfredi
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, University of Modena and Reggio Emilia, Modena, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, Department of Medicine, University of Verona, Italy
| | - Francesco De Rosa
- Infectious Disease Unit, Amedeo di Savoia Hospital, University of Turin, Italy
| | | | - Enzo Petrelli
- Infectious Diseases Unit, San Salvatore Hospital, Pesaro, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Marcello Govoni
- Department of Medical Sciences, UOC of Rheumatology, Santa Anna University Hospital, Ferrara, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
| | | | - Loredana Sarmati
- Infectious Disease Unit, University of Rome Tor Vergata, Rome, Italy
| | | | - Walter Grassi
- Rheumatology Unit, Polytechnic University of Marche, C. Urbani Hospital, Jesi, Italy
| | - Claudio Mastroianni
- Infectious Disease Unit, Sapienza University, Polo Pontino, ASL Latina, Italy
| | | | - Gianfranco Ferraccioli
- Division of Rheumatology, Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Cutolo
- Research Laboratory and Division of Clinical Rheumatology, University of Genova, Italy
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Division of Rheumatology, AOUC, University of Florence, Italy
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24
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Giacobbe DR, Del Bono V, Mikulska M, Gustinetti G, Marchese A, Mina F, Signori A, Orsi A, Rudello F, Alicino C, Bonalumi B, Morando A, Icardi G, Beltramini S, Viscoli C. Correction to: Impact of a mixed educational and semi-restrictive antimicrobial stewardship project in a large teaching hospital in Northern Italy. Infection 2017; 45:929. [PMID: 28983883 DOI: 10.1007/s15010-017-1068-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A technical error led to incorrect rendering of the author group in this article. The correct authorship is as follows: Daniele Roberto Giacobbe1, Valerio Del Bono1, Malgorzata Mikulska1, Giulia Gustinetti1, Anna Marchese2, Federica Mina3, Alessio Signori4, Andrea Orsi5, Fulvio Rudello6, Cristiano Alicino5, Beatrice Bonalumi3, Alessandra Morando7, Giancarlo Icardi5, Sabrina Beltramini3, Claudio Viscoli1; On behalf of the San Martino Antimicrobial Stewardship Group.
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Affiliation(s)
- Daniele Roberto Giacobbe
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy.
| | - Valerio Del Bono
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Malgorzata Mikulska
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Giulia Gustinetti
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Anna Marchese
- S.S.D. Microbiologia, University of Genoa (DISC) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, Genoa, Italy
| | - Federica Mina
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | | | - Andrea Orsi
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Fulvio Rudello
- SANTALUCIA PHARMA APPS©, Località Gragnanino, Gragnano Trebbiense, PC, Italy
| | - Cristiano Alicino
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Beatrice Bonalumi
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Alessandra Morando
- U.O. Governo Clinico e Organizzazione Ospedaliera, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Giancarlo Icardi
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Sabrina Beltramini
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Claudio Viscoli
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
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Mikulska M, Raiola AM, Galaverna F, Balletto E, Borghesi ML, Varaldo R, Gualandi F, Giannoni L, Pastori G, Giacobbe DR, Signori A, Del Bono V, Viscoli C, Bacigalupo A, Angelucci E. Pre-Engraftment Bloodstream Infections after Allogeneic Hematopoietic Cell Transplantation: Impact of T Cell-Replete Transplantation from a Haploidentical Donor. Biol Blood Marrow Transplant 2017; 24:109-118. [PMID: 28860000 DOI: 10.1016/j.bbmt.2017.08.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/22/2017] [Indexed: 01/01/2023]
Abstract
Bloodstream infections (BSIs) are frequent and important infectious complications after hematopoietic cell transplantation (HCT). The aim of this study was to analyze the incidence, risk factors, and outcome of pre-engraftment BSIs after allogeneic HCT. We retrospectively analyzed data from 553 consecutive patients who underwent HCT between 2010 and 2016. Sixty percent of the patients received T cell-replete unmanipulated haploidentical bone marrow with high-dose post-transplantation cyclophosphamide. The BSI rate was 30%; among isolated 213 pathogens, 54% were Gram-positive, 43% were Gram-negative, and 3% were fungi. Independent risk factors for pre-engraftment BSI were transplantation from a haploidentical donor or from cord blood (P < .001), active disease (P = .002), age (P = .04), and myeloproliferative disorders or aplastic anemia (P < .001). Transplantation from a haploidentical donor was an independent risk factor for both Gram-positive and Gram-negative BSI. The 7-day mortality after any BSI was 5% (9 of 178), and in multivariate analysis, BSI etiology was the sole risk factor, with increased mortality in carbapenem-resistant Gram-negative BSI (P < .001). Nonrelapse mortality at day +60 after HCT was 3.8% (21 of 553); independent predictors were active disease (P = .045), year of HCT (P = .027), nonengraftment (P = .001), and pre-engraftment BSI (P < .001), with significantly higher risk in BSI due to Gram-negative pathogens compared with Gram-positive pathogens, and BSI due to carbapenem-resistant Gram-negative pathogens compared with susceptible pathogens. Pre-engraftment BSI is a frequent complication after HCT from a haploidentical donor or cord blood. Because the negative impact of pre-engraftment BSI on 60-day nonrelapse mortality was caused mainly by carbapenem-resistant Gram-negative pathogens, particular attention should be given to appropriate empiric therapy and management of patients at high risk for Gram-negative BSI.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa, Genoa, Italy; Division of Infectious Diseases, San Martino Hospital, Genoa, Italy.
| | - Anna Maria Raiola
- Division of Hematology and Bone Marrow Transplantation, San Martino Hospital, Genoa, Italy
| | - Federica Galaverna
- Division of Hematology and Bone Marrow Transplantation, San Martino Hospital, Genoa, Italy
| | - Elisa Balletto
- Division of Infectious Diseases, University of Genoa, Genoa, Italy; Division of Infectious Diseases, San Martino Hospital, Genoa, Italy
| | - Maria Lucia Borghesi
- Division of Infectious Diseases, University of Genoa, Genoa, Italy; Division of Infectious Diseases, San Martino Hospital, Genoa, Italy
| | - Riccardo Varaldo
- Division of Hematology and Bone Marrow Transplantation, San Martino Hospital, Genoa, Italy
| | - Francesca Gualandi
- Division of Hematology and Bone Marrow Transplantation, San Martino Hospital, Genoa, Italy
| | - Livia Giannoni
- Division of Infectious Diseases, San Martino Hospital, Genoa, Italy; Hematology Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Giordana Pastori
- Division of Infectious Diseases, San Martino Hospital, Genoa, Italy; Hematology Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Division of Infectious Diseases, University of Genoa, Genoa, Italy; Division of Infectious Diseases, San Martino Hospital, Genoa, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Valerio Del Bono
- Division of Infectious Diseases, University of Genoa, Genoa, Italy; Division of Infectious Diseases, San Martino Hospital, Genoa, Italy
| | - Claudio Viscoli
- Division of Infectious Diseases, University of Genoa, Genoa, Italy; Division of Infectious Diseases, San Martino Hospital, Genoa, Italy
| | - Andrea Bacigalupo
- Hematology Department, Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic, Rome, Italy
| | - Emanuele Angelucci
- Division of Hematology and Bone Marrow Transplantation, San Martino Hospital, Genoa, Italy
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Giacobbe DR, Del Bono V, Mikulska M, Gustinetti G, Marchese A, Mina F, Signori A, Orsi A, Rudello F, Alicino C, Bonalumi B, Morando A, Icardi G, Beltramini S, Viscoli C. Impact of a mixed educational and semi-restrictive antimicrobial stewardship project in a large teaching hospital in Northern Italy. Infection 2017; 45:849-856. [PMID: 28856589 DOI: 10.1007/s15010-017-1063-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The overuse of antimicrobials favors the dissemination of antimicrobial resistance, as well as invasive fungal diseases and Clostridium difficile infections (CDI). In this study, we assessed the impact of a mixed educational and semi-restrictive antimicrobial stewardship (AMS) project in a large teaching hospital in Italy. METHODS The AMS project was conducted from May 2014 to April 2016. It consisted of two initiatives in two consecutive periods: (1) educational activities; (2) semi-restrictive control of antimicrobial prescribing through a computerized software. The primary endpoint was consumption of antibacterials and antifungals. Secondary endpoints were incidence of CDI, methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI), carbapenem-resistant Klebsiella pneumoniae (CRKP) BSI, and Candida BSI. RESULTS During the study period, a statistically significant reduction in consumption was observed for antibacterials (-1.45 defined daily doses (DDD)/1000 patient-days monthly, 95% confidence intervals [CI] -2.38 to -0.52, p 0.004), mainly driven by reductions in the use of fluoroquinolones, third/fourth generation cephalosporins, and carbapenems. No decrease in consumption of antifungals was observed (-0.04 DDD/1000 patient-days monthly, 95% CI -0.34 to +0.25, p 0.750). A statistically significant trend towards reduction was observed for incidence of CRKP BSI (incidence rate ratio 0.96, 95% CI 0.92-0.99, p 0.013). No statistically significant variations in trends were observed for CDI, MRSA BSI, and Candida BSI. CONCLUSIONS The mixed AMS project was effective in reducing the use of major antibacterials and the incidence of CRKP BSI. Further research is needed to assess the extent of long-term benefits of semi-restrictive approaches.
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Affiliation(s)
- Daniele Roberto Giacobbe
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy.
| | - Valerio Del Bono
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Malgorzata Mikulska
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Giulia Gustinetti
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Anna Marchese
- S.S.D. Microbiologia, University of Genoa (DISC) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, Genoa, Italy
| | - Federica Mina
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | | | - Andrea Orsi
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Fulvio Rudello
- SANTALUCIA PHARMA APPS©, Località Gragnanino, Gragnano Trebbiense, PC, Italy
| | - Cristiano Alicino
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Beatrice Bonalumi
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Alessandra Morando
- U.O. Governo Clinico e Organizzazione Ospedaliera, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Giancarlo Icardi
- U.O. Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Sabrina Beltramini
- U.O. Farmacia, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Claudio Viscoli
- U.O. Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS per L'Oncologia, L.go R. Benzi, 10, 16132, Genoa, Italy
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Giacobbe DR, Mikulska M, Tumbarello M, Furfaro E, Spadaro M, Losito AR, Mesini A, De Pascale G, Marchese A, Bruzzone M, Pelosi P, Mussap M, Molin A, Antonelli M, Posteraro B, Sanguinetti M, Viscoli C, Del Bono V. Combined use of serum (1,3)-β-D-glucan and procalcitonin for the early differential diagnosis between candidaemia and bacteraemia in intensive care units. Crit Care 2017; 21:176. [PMID: 28693606 PMCID: PMC5504626 DOI: 10.1186/s13054-017-1763-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/19/2017] [Indexed: 01/02/2023]
Abstract
Background This study aimed to assess the combined performance of serum (1,3)-β-d-glucan (BDG) and procalcitonin (PCT) for the differential diagnosis between candidaemia and bacteraemia in three intensive care units (ICUs) in two large teaching hospitals in Italy. Methods From June 2014 to December 2015, all adult patients admitted to the ICU who had a culture-proven candidaemia or bacteraemia, as well as BDG and PCT measured closely to the time of the index culture, were included in the study. The diagnostic performance of BDG and PCT, used either separately or in combination, was assessed by calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR+ and LR–). Changes from pre-test probabilities to post-test probabilities of candidaemia and bacteraemia were inferred from Fagan’s nomograms. Results One hundred and sixty-six patients were included, 73 with candidaemia (44%) and 93 with bacteraemia (56%). When both markers indicated candidaemia (BDG ≥80 pg/ml and PCT <2 ng/ml) they showed higher PPV (96%) compared to 79% and 66% for BDG or PCT alone, respectively. When both markers indicated bacteraemia (BDG <80 pg/ml and PCT ≥2 ng/ml), their NPV for candidaemia was similar to that of BDG used alone (95% vs. 93%). Discordant BDG and PCT results (i.e. one indicating candidaemia and the other bacteraemia) only slightly altered the pre-test probabilities of the two diseases. Conclusions The combined use of PCT and BDG could be helpful in the diagnostic workflow for critically ill patients with suspected candidaemia. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1763-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Infectious Diseases Division, University of Genoa (DISSAL) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, L.go R. Benzi, 10 - 16132, Genoa, Italy.
| | - Malgorzata Mikulska
- Infectious Diseases Division, University of Genoa (DISSAL) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, L.go R. Benzi, 10 - 16132, Genoa, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Elisa Furfaro
- Infectious Diseases Division, University of Genoa (DISSAL) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, L.go R. Benzi, 10 - 16132, Genoa, Italy
| | - Marzia Spadaro
- Infectious Diseases Division, University of Genoa (DISSAL) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, L.go R. Benzi, 10 - 16132, Genoa, Italy
| | - Angela Raffaella Losito
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Alessio Mesini
- Infectious Diseases Division, University of Genoa (DISSAL) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, L.go R. Benzi, 10 - 16132, Genoa, Italy
| | - Gennaro De Pascale
- Department of Intensive Care and Anesthesiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Anna Marchese
- Microbiology Unit, University of Genoa (DISC) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy
| | - Marco Bruzzone
- Clinical Epidemiology Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy
| | - Paolo Pelosi
- Anesthesiology and Intensive Care Unit, DIPEA, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy.,Anesthesiology and Intensive Care, University of Genoa (DISC), Genoa, Italy
| | - Michele Mussap
- Department of Bio-medical Laboratory, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy
| | - Alexandre Molin
- Anesthesiology and Intensive Care Unit, DIPEA, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy
| | - Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Brunella Posteraro
- Institute of Public Health (Section of Hygiene), Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Maurizio Sanguinetti
- Institute of Microbiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Claudio Viscoli
- Infectious Diseases Division, University of Genoa (DISSAL) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, L.go R. Benzi, 10 - 16132, Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Division, University of Genoa (DISSAL) and Ospedale Policlinico San Martino - IRCCS per l'Oncologia, L.go R. Benzi, 10 - 16132, Genoa, Italy
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Grignolo S, Tatarelli P, Guolo F, Minetto P, Rivoli G, Guardo D, Del Bono V, Varaldo R, Gualandi F, Ballerini F, Raiola A, Gobbi M, Viscoli C, Mikulska M. Good tolerability of high dose colistin-based therapy in patients with haematological malignancies. Infection 2017; 45:505-511. [PMID: 28353153 DOI: 10.1007/s15010-017-1010-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Colistin is usually the only drug fully active against multi-drug resistant Gram-negative bacteria, but its nephrotoxicity might limit its use. Recent pharmacokinetic/pharmacodynamic data suggest that high dose of colistin, preceded by a loading dose, are needed to maximize its antibacterial effect. The aim of this study was to determine the safety of high doses colistin, in haematology population. METHODS A retrospective review of haematology patients who received high dose colistin-based therapy in years 2011-2016 was performed. Nephrotoxicity was assessed using RIFLE criteria. RESULTS Thirty patients who received 38 courses of colistin were included in the study. Colistin was always administered together with other antibiotics. Colistin was well tolerated, with one case of neurological toxicity and one of cutaneous reaction. There were 22 (58%) treatment cycles without any nephrotoxicity, even though during 16 of these cycles other nephrotoxic drugs were administered. Severe (injury or failure) renal toxicity occurred during 6 (16%) treatment courses, requiring colistin discontinuation in 2 patients and colistin dose reduction in 1. Poorer renal function at baseline and younger age were the only variables associated with increased renal toxicity (p = 0.011 and p = 0.031, respectively). Overall mortality was 18% (7/38) and 29% (11/38) at 7 and 30 days after the treatment onset. CONCLUSIONS In adult haematology population, high dose colistin therapy is safe and efficacious, despite high frequency of concomitant nephrotoxic treatment.
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Affiliation(s)
- Sara Grignolo
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Paola Tatarelli
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
| | - Fabio Guolo
- Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Paola Minetto
- Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Giulia Rivoli
- Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Daniela Guardo
- Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Valerio Del Bono
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Riccardo Varaldo
- Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, IRCCS San Martino-IST, Genoa, Italy
| | - Francesca Gualandi
- Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, IRCCS San Martino-IST, Genoa, Italy
| | - Filippo Ballerini
- Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Annamaria Raiola
- Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, IRCCS San Martino-IST, Genoa, Italy
| | - Marco Gobbi
- Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Claudio Viscoli
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
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Del Bono V, Giacobbe DR, Marchese A, Parisini A, Fucile C, Coppo E, Marini V, Arena A, Molin A, Martelli A, Gratarola A, Viscoli C, Pelosi P, Mattioli F. Meropenem for treating KPC-producing Klebsiella pneumoniae bloodstream infections: Should we get to the PK/PD root of the paradox? Virulence 2017; 8:66-73. [PMID: 27430122 PMCID: PMC5963200 DOI: 10.1080/21505594.2016.1213476] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/14/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022] Open
Abstract
The objective of this study was to assess the achievement of pharmacokinetic/pharmacodynamic (PK/PD) targets of meropenem (MEM) in critically-ill patients with bloodstream infections (BSI) due to Klebsiella pneumoniae-carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) with MEM minimum inhibitory concentrations (MICs) ≥16 mg/L. Nineteen critically-ill patients with KPC-Kp BSI were given combination therapy including MEM, tigecycline, plus colistin or gentamicin (according to susceptibility testing). MEM was administered as an extended 3-hour infusion of 2 g every 8 hours, or adjusted according to renal function. MEM plasma concentrations were determined by high-performance liquid chromatography. PK/PD targets for MEM were defined as T > 40% 1×MIC and T > 40% 4×MIC. Possible synergisms between MEM and coadministered agents were assessed by time-kill assays based on plasma levels for MEM and on fixed plasma concentrations for the other agents. In none of 19 patients MEM reached any PK/PD target. The actual MEM MICs were 256, 512, and 1024 mg/L in 1, 3, and 15 isolates, respectively. However, theoretically, the PK/PD target of T > 40% 1×MIC could have been achieved in 95%, 68%, 32% and 0% of the isolates for MIC equal to 8, 16, 32, and 64 mg/L, respectively. No synergisms were observed between MEM and coadministered agents. In conclusion, high-dose MEM failed to reach PK/PD targets in 19 patients with BSI due to KPC-Kp with very high MEM MICs. On a theoretical basis, our results suggest a possible usefulness of MEM against resistant blood isolates with MICs up to 32 mg/L.
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Affiliation(s)
- Valerio Del Bono
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Anna Marchese
- Unità di Microbiologia, DIPSE, DISC, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Andrea Parisini
- Centro ortopedico di Quadrante, Ospedale Madonna del Popolo, Omegna, Italy
| | - Carmen Fucile
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Erika Coppo
- Unità di Microbiologia, DIPSE, DISC, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Valeria Marini
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Antonio Arena
- U.O. Anestesia e Rianimazione, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Alexandre Molin
- U.O. Anestesia e Terapia Intensiva, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Antonietta Martelli
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Angelo Gratarola
- U.O. Anestesia e Rianimazione, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Claudio Viscoli
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Paolo Pelosi
- U.O. Anestesia e Terapia Intensiva, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
- Anestesia e Terapia Intensiva, DISC, Università di Genova, Genova, Italy
| | - Francesca Mattioli
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
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Scudeller L, Bassetti M, Concia E, Corrao S, Cristini F, De Rosa FG, Del Bono V, Durante-Mangoni E, Falcone M, Menichetti F, Tascini C, Tumbarello M, Venditti M, Viale P, Viscoli C, Mazzone A. MEDical wards Invasive Candidiasis ALgorithms (MEDICAL):Consensus proposal for management. Eur J Intern Med 2016; 34:45-53. [PMID: 27495949 DOI: 10.1016/j.ejim.2016.07.007] [Citation(s) in RCA: 7] [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: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION A majority of invasive Candida infections occur in medical wards; however, evidence for management in this setting is scarce and based primarily on the intensive care or surgical setting. On behalf of the Italian Society for Anti-Infective Therapy (SITA) and the Italian Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), the MEDICAL group produced practical management algorithms for patients in internal medicine wards. METHODS The MEDICAL group panel, composed of 30 members from internal medicine, infectious disease, clinical pharmacology, clinical microbiology and clinical epidemiology, provided expert opinion through the RAND/UCLA method. RESULTS Seven clinical scenarios were constructed based on clinical severity and probability of invasive candidiasis. For each scenario, the appropriateness of 63 different diagnostic, imaging, management, or therapeutic procedures was determined in two Delphi rounds. The necessity for performing each appropriate procedure, was then determined in a third Delphi round. Results were summarized in algorithms. DISCUSSION The proposed algorithms provide internal medicine physicians and managers with an easy to interpret tool that is exhaustive, clear and suitable for adaption to individual local settings. Attention was paid to individual patient management and resource allocation.
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Affiliation(s)
- Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, IRCCS, Policlinico San Matteo Foundation, Pavia, Italy.
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Ercole Concia
- Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico G B Rossi, Verona, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Di.Bi.M.I.S., University of Palermo, Italy
| | - Francesco Cristini
- Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Valerio Del Bono
- Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Emanuele Durante-Mangoni
- Internal Medicine Section, Department of Cardiothoracic Sciences, and Division of Infectious and Transplant Medicine, Second University of Naples at Monaldi Hospital, Napoli, Italy
| | - Marco Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Carlo Tascini
- Infectious Disease Department, Cisanello Hospital, Pisa, Italy
| | - Mario Tumbarello
- Infectious Diseases Institute, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Claudio Viscoli
- Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Antonino Mazzone
- Internal Medicine Department, Hospital of Legnano, Legnano, Italy
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Salsano A, Giacobbe DR, Sportelli E, Olivieri GM, Brega C, Di Biase C, Coppo E, Marchese A, Del Bono V, Viscoli C, Santini F. Risk factors for infections due to carbapenem-resistant
Klebsiella pneumoniae
after open heart surgery. Interact Cardiovasc Thorac Surg 2016; 23:762-768. [DOI: 10.1093/icvts/ivw228] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/17/2016] [Accepted: 06/02/2016] [Indexed: 11/12/2022] Open
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Mattioli F, Fucile C, Del Bono V, Marini V, Parisini A, Molin A, Zuccoli ML, Milano G, Danesi R, Marchese A, Polillo M, Viscoli C, Pelosi P, Martelli A, Di Paolo A. Population pharmacokinetics and probability of target attainment of meropenem in critically ill patients. Eur J Clin Pharmacol 2016; 72:839-48. [PMID: 27048201 DOI: 10.1007/s00228-016-2053-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 01/27/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients admitted to intensive care unit (ICU) with Klebsiella pneumoniae infections are characterized by high mortality. The aims of the present study were to investigate the population pharmacokinetics parameters and to assess the probability of target attainment of meropenem in critically ill patients to provide information for more effective regimens. METHODS Twenty-seven consecutive patients were included in the study. Meropenem was administered as 3-h intravenous (i.v.) infusions at doses of 1-2 g every 8 or 12 h. Meropenem plasma concentrations were measured by a high-performance liquid chromatography (HPLC) method, and a population pharmacokinetics analysis was performed using NONMEM software. Meropenem plasma disposition was simulated for extended (3 h; 5 h) or continuous i.v. infusions, and the following parameters were calculated: time during which free drug concentrations were above minimum inhibitory concentration (MIC) (fT > MIC), free minimum plasma concentrations above 4× MIC (fCmin > 4× MIC), probability of target attainment (PTA), and cumulative fraction of response (CFR). RESULTS Gender and severity of sepsis affected meropenem clearance, whose typical population values ranged from 6.22 up to 12.04 L/h (mean ± standard deviation (SD) value, 9.38 ± 4.47 L/h). Mean C min value was 7.90 ± 7.91 mg/L, suggesting a high interindividual variability. The simulation confirmed that 88 and 97.5 % of patients achieved effective C min > 4× MIC values after 3- and 5-h i.v. infusions of meropenem 2 g × 3/day, respectively. On the contrary, the same total daily doses reached the target C min > 4× MIC values in 100 % of patients when administered as continuous i.v. infusions. CONCLUSIONS Several factors may influence meropenem pharmacokinetics in ICU patients. Continuous i.v. infusions of meropenem seem to be more effective than standard regimens to achieve optimal therapeutic targets.
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Affiliation(s)
- Francesca Mattioli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy.
| | - Carmen Fucile
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Clinics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Valeria Marini
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Andrea Parisini
- Infectious Diseases Clinics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Alexandre Molin
- Anesthesia and Intensive Care, Department Surgical Sciences and Integrated Diagnostics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Maria Laura Zuccoli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Giulia Milano
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Romano Danesi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10, 56126, Pisa, Italy
| | - Anna Marchese
- Section of Microbiology-DISC, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Marialuisa Polillo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10, 56126, Pisa, Italy
| | - Claudio Viscoli
- Infectious Diseases Clinics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, Department Surgical Sciences and Integrated Diagnostics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Antonietta Martelli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10, 56126, Pisa, Italy
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Giacobbe DR, Tumbarello M, Del Bono V, Viscoli C. Comment on: Mortality due toblaKPCKlebsiella pneumoniaebacteraemia. J Antimicrob Chemother 2016; 71:1743-4. [DOI: 10.1093/jac/dkw034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Bloodstream infections (BSI) carry a heavy burden of morbidity and mortality in modern internal medicine wards (IMW). These wards are often filled with elderly subjects with several risk factors for BSI, such as multiple comorbidities, polypharmacy, immunosuppression, and indwelling devices. Diagnosing BSI in such a setting might require a high degree of suspicion, since the clinical presentation could be affected by underlying conditions and concomitant medications, which might delay the administration of an appropriate antimicrobial therapy, an event strongly and unfavorably influencing survival. Furthermore, selecting the appropriate antimicrobial therapy to treat these patients is becoming an increasingly complex task in which all possible benefits and costs should be carefully analyzed from patient and public health perspectives. Only a specialized, continuous, and interdisciplinary approach could really improve the management of IMW patients in an era of increasing antimicrobial resistance and complexity of care.
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Affiliation(s)
- Valerio Del Bono
- a Clinica Malattie Infettive, IRCCS AOU San Martino-IST, Università di Genova , Genova , Italy
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Alicino C, Giacobbe DR, Orsi A, Tassinari F, Trucchi C, Sarteschi G, Copello F, Del Bono V, Viscoli C, Icardi G. Trends in the annual incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections: a 8-year retrospective study in a large teaching hospital in northern Italy. BMC Infect Dis 2015; 15:415. [PMID: 26464061 PMCID: PMC4605101 DOI: 10.1186/s12879-015-1152-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022] Open
Abstract
Background Bloodstream infections (BSI) due to carbapenem-resistant (C-R) Klebsiella pneumoniae (Kp) are of global concern from both clinical and public health standpoints. This retrospective study aimed to describe C-R Kp BSI epidemiology in a large teaching hospital in northern Italy. Methods Between 1 January 2007 and 31 December 2014, annual incidences both of C-R Kp BSI and of carbapenem-susceptible (C-S) Kp BSI were calculated as the number of events per 10,000 patient-days. A Chi square test for linear trend was used to assess the change in the incidence of C-R Kp BSI and C-S Kp BSI over the study period. Crude 30-day mortality rates were provided both for C-R Kp BSI and for C-S Kp BSI. Results From 2007 to 2014, we observed 511 episodes of Kp BSI, 349 of which were caused by C-R Kp (68.3 %). The incidence of C-R Kp BSI considerably increased from 0.04/10,000 patient-days in 2007 to 1.77/10,000 patient-days in 2014 (Chi square for trend p < 0.001). The highest incidence of C-R Kp BSI was observed in intensive care units (ICUs), with a peak of 22.01 C-R Kp BSI/10,000 patient-days in 2012. A less marked but significant increase of C-S Kp BSI was also observed (Chi square for trend p = 0.004). Crude 30-day mortality was 36.1 % in patients with C-R Kp BSI and 23.5 % in those with C-S Kp BSI. Conclusions During the study period, we observed a dramatic increase in the incidence of C-R Kp BSI in our hospital. More concerted infection-control efforts are needed to contain this alarming C-R Kp diffusion.
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Affiliation(s)
- Cristiano Alicino
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, L.go R. Benzi, 10-16132, Genoa, Italy.
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| | - Federico Tassinari
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| | - Cecilia Trucchi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| | - Giovanni Sarteschi
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, L.go R. Benzi, 10-16132, Genoa, Italy.
| | - Francesco Copello
- Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
| | - Valerio Del Bono
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, L.go R. Benzi, 10-16132, Genoa, Italy.
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, L.go R. Benzi, 10-16132, Genoa, Italy.
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Genoa, Italy.
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Tumbarello M, Trecarichi EM, De Rosa FG, Giannella M, Giacobbe DR, Bassetti M, Losito AR, Bartoletti M, Del Bono V, Corcione S, Maiuro G, Tedeschi S, Celani L, Cardellino CS, Spanu T, Marchese A, Ambretti S, Cauda R, Viscoli C, Viale P. Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentre study. J Antimicrob Chemother 2015; 70:2133-43. [PMID: 25900159 DOI: 10.1093/jac/dkv086] [Citation(s) in RCA: 360] [Impact Index Per Article: 40.0] [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: 12/06/2014] [Accepted: 03/14/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Infections caused by Klebsiella pneumoniae (Kp) carbapenemase (KPC)-producing strains of Kp have become a significant threat in recent years. To assess their outcomes and identify risk factors for 14 day mortality, we conducted a 4 year (2010-13) retrospective cohort study in five large Italian teaching hospitals. METHODS The cohort included 661 adults with bloodstream infections (BSIs; n = 447) or non-bacteraemic infections (lower respiratory tract, intra-abdominal structure, urinary tract or other sites) caused by a KPC-Kp isolate. All had received ≥48 h of therapy (empirical and/or non-empirical) with at least one drug to which the isolate was susceptible. RESULTS Most deaths occurred within 2 weeks of infection onset (14 day mortality: 225/661, 34.1%). Logistic regression analysis identified BSI (OR, 2.09; 95% CI, 1.34-3.29), presentation with septic shock (OR, 2.45; 95% CI, 1.47-4.08), inadequate empirical antimicrobial therapy (OR, 1.48; 95% CI, 1.01-2.18), chronic renal failure (OR, 2.27; 95% CI, 1.44-3.58), high APACHE III score (OR, 1.05; 95% CI, 1.04-1.07) and colistin-resistant isolates (OR, 2.18; 95% CI, 1.37-3.46) as independent predictors of 14 day mortality. Combination therapy with at least two drugs displaying in vitro activity against the isolate was associated with lower mortality (OR, 0.52; 95% CI, 0.35-0.77), in particular in patients with BSIs, lung infections or high APACHE III scores and/or septic shock at infection onset. Combinations that included meropenem were associated with significantly higher survival rates when the KPC-Kp isolate had a meropenem MIC of ≤8 mg/L. CONCLUSIONS KPC-Kp infections are associated with high mortality. Treatment with two or more drugs displaying activity against the isolate improves survival, mainly in patients who are critically ill.
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Affiliation(s)
- Mario Tumbarello
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Enrico Maria Trecarichi
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin, Torino, Italy Infectious Diseases at Amedeo di Savoia Hospital, Torino, Italy
| | - Maddalena Giannella
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Angela Raffaella Losito
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Michele Bartoletti
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Valerio Del Bono
- Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin, Torino, Italy Infectious Diseases at Amedeo di Savoia Hospital, Torino, Italy
| | - Giuseppe Maiuro
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Sara Tedeschi
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luigi Celani
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Chiara Simona Cardellino
- Department of Medical Sciences, University of Turin, Torino, Italy Infectious Diseases at Amedeo di Savoia Hospital, Torino, Italy
| | - Teresa Spanu
- Institute of Microbiology, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Anna Marchese
- Microbiology Unit, University of Genoa (DISC) and IRCCS San Martino-IST, Genoa, Italy
| | - Simone Ambretti
- Operative Unit of Clinical Microbiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Roberto Cauda
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy
| | - Claudio Viscoli
- Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy
| | - Pierluigi Viale
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Durando P, Alicino C, Orsi A, Barberis I, Paganino C, Dini G, Mazzarello G, Del Bono V, Viscoli C, Copello F, Sossai D, Orengo G, Sticchi L, Ansaldi F, Icardi G. Latent tuberculosis infection among a large cohort of medical students at a teaching hospital in Italy. Biomed Res Int 2015; 2015:746895. [PMID: 25705685 PMCID: PMC4331323 DOI: 10.1155/2015/746895] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/13/2014] [Indexed: 01/08/2023]
Abstract
The surveillance of latent tuberculosis infection (LTBI) in both healthcare workers and healthcare students is considered fundamental for tuberculosis (TB) prevention. The aim of the present study was to estimate LTBI prevalence and evaluate potential risk-factors associated with this condition in a large cohort of medical students in Italy. In a cross-sectional study, performed between March and December 2012, 1511 eligible subjects attending the Medical School of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the tuberculin skin test (TST). All the TST positive cases were confirmed with an interferon-gamma release assay (IGRA). A standardized questionnaire was collected for multivariate risk analysis. A total of 1302 (86.2%) students underwent TST testing and completed the questionnaire. Eleven subjects (0.8%) resulted TST positive and LTBI diagnosis was confirmed in 2 (0.1%) cases. Professional exposure to active TB patients (OR 21.7, 95% CI 2.9-160.2; P value 0.003) and previous BCG immunization (OR 28.3, 95% CI 3.0-265.1; P value 0.003) are independently associated with TST positivity. Despite the low prevalence of LTBI among Italian medical students, an occupational risk of TB infection still exists in countries with low circulation of Mycobacterium tuberculosis.
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Affiliation(s)
- Paolo Durando
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Cristiano Alicino
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Ilaria Barberis
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Chiara Paganino
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Guglielmo Dini
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giovanni Mazzarello
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Valerio Del Bono
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Francesco Copello
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Dimitri Sossai
- Health Safety and Prevention Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giovanni Orengo
- Quality and Risk Management Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Laura Sticchi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
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Giacobbe DR, Del Bono V, Coppo E, Marchese A, Viscoli C. Emergence of a KPC-3-Producing Escherichia coli ST69 as a Cause of Bloodstream Infections in Italy. Microb Drug Resist 2014; 21:342-4. [PMID: 25514440 DOI: 10.1089/mdr.2014.0230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The spread of carbapenem-resistant gram negatives is a global emergency, and surveillance of new resistant clones is critical from both public health and clinical standpoints. Herein, we describe the emergence of a KPC-3-producing Escherichia coli ST69 as a cause of bloodstream infection in two Italian patients.
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Affiliation(s)
- Daniele Roberto Giacobbe
- 1Infectious Diseases Unit, IRCCS San Martino University Hospital-IST, University of Genoa, Genoa, Italy
| | - Valerio Del Bono
- 1Infectious Diseases Unit, IRCCS San Martino University Hospital-IST, University of Genoa, Genoa, Italy
| | - Erika Coppo
- 2Microbiology Unit DISC, IRCCS San Martino University Hospital-IST, University of Genoa, Genoa, Italy
| | - Anna Marchese
- 2Microbiology Unit DISC, IRCCS San Martino University Hospital-IST, University of Genoa, Genoa, Italy
| | - Claudio Viscoli
- 1Infectious Diseases Unit, IRCCS San Martino University Hospital-IST, University of Genoa, Genoa, Italy
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Artom F, Del Bono V. Recurrent Clostridium difficile colitis in elderly: the role of fidaxomicin. CMI 2014. [DOI: 10.7175/cmi.v8i1s.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Clostridium difficile colitis is a substantial cause of in-hospital morbidity. Since the mortality attributable may be as high as 10%, a prompt and effective treatment is advisable. Fidaxomicin is a well-documented effective drug for the treatment of C. difficile colitis and it is particularly effective in the treatment of recurrences. We report a case of a 92-year-old woman with prolonged hospitalization and recurrent episodes (three in a three-month period) of C. difficile diarrhea. Each episode initially responded to vancomycin. However, after the third episode fidaxomicin was given, with a sustained response (5 months without further episodes). In this patient fidaxomicin was safe and effective in treating recurrence of C. difficile colitis. The use of fidaxomicin as a therapy of first episode of C. difficile colitis should be considered for those patients with a predictable high risk of recurrent C. difficile colitis.
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Coppo E, Del Bono V, Ventura F, Camera M, Orengo G, Viscoli C, Marchese A. Identification of a New Delhi metallo-β-lactamase-4 (NDM-4)-producing Escherichia coli in Italy. BMC Microbiol 2014; 14:148. [PMID: 24906230 PMCID: PMC4060580 DOI: 10.1186/1471-2180-14-148] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During June-July 2012, six imipenem-resistant Escherichia coli isolates were isolated from two patients hospitalized in a ward of one large tertiary-care hospital in Genoa, Italy. Genetic features associated with blaNDM-4 gene were investigated. RESULTS The isolates exhibited the same PFGE profile and a multidrug-resistant (MDR) phenotype to aminoglycosides, fluoroquinolones, and β-lactams. The strains produced the NDM-4 carbapenemase and the blaNDM-4 gene was part of the variable region of a class 1 integron. MLST analysis revealed that all isolates belonged to sequence type 405 (ST405). CONCLUSIONS This is the first report on the emergence of an MDR strain of E.coli producing the NDM-4 MBL in Italy.
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Affiliation(s)
| | | | | | | | | | | | - Anna Marchese
- Microbiology Unit DISC, University of Genoa, IRCCS AOU San Martino-IST, Largo R, Benzi 10, 16132 Genoa, Italy.
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Tumbarello M, Trecarichi EM, Tumietto F, Del Bono V, De Rosa FG, Bassetti M, Losito AR, Tedeschi S, Saffioti C, Corcione S, Giannella M, Raffaelli F, Pagani N, Bartoletti M, Spanu T, Marchese A, Cauda R, Viscoli C, Viale P. Predictive models for identification of hospitalized patients harboring KPC-producing Klebsiella pneumoniae. Antimicrob Agents Chemother 2014; 58:3514-20. [PMID: 24733460 PMCID: PMC4068482 DOI: 10.1128/aac.02373-13] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 04/06/2014] [Indexed: 12/30/2022] Open
Abstract
The production of Klebsiella pneumoniae carbapenemases (KPCs) by Enterobacteriaceae has become a significant problem in recent years. To identify factors that could predict isolation of KPC-producing K. pneumoniae (KPCKP) in clinical samples from hospitalized patients, we conducted a retrospective, matched (1:2) case-control study in five large Italian hospitals. The case cohort consisted of adult inpatients whose hospital stay included at least one documented isolation of a KPCKP strain from a clinical specimen. For each case enrolled, we randomly selected two matched controls with no KPCKP-positive cultures of any type during their hospitalization. Matching involved hospital, ward, and month/year of admission, as well as time at risk for KPCKP isolation. A subgroup analysis was also carried out to identify risk factors specifically associated with true KPCKP infection. During the study period, KPCKP was isolated from clinical samples of 657 patients; 426 of these cases appeared to be true infections. Independent predictors of KPCKP isolation were recent admission to an intensive care unit (ICU), indwelling urinary catheter, central venous catheter (CVC), and/or surgical drain, ≥ 2 recent hospitalizations, hematological cancer, and recent fluoroquinolone and/or carbapenem therapy. A Charlson index of ≥ 3, indwelling CVC, recent surgery, neutropenia, ≥ 2 recent hospitalizations, and recent fluoroquinolone and/or carbapenem therapy were independent risk factors for KPCKP infection. Models developed to predict KPCKP isolation and KPCKP infection displayed good predictive power, with the areas under the receiver-operating characteristic curves of 0.82 (95% confidence interval [CI], 0.80 to 0.84) and 0.82 (95% CI, 0.80 to 0.85), respectively. This study provides novel information which might be useful for the clinical management of patients harboring KPCKP and for controlling the spread of this organism.
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Affiliation(s)
- Mario Tumbarello
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
| | - Enrico Maria Trecarichi
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
| | - Fabio Tumietto
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Valerio Del Bono
- Clinic of Infectious Diseases, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy
| | | | - Matteo Bassetti
- Infectious Disease Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Angela Raffaella Losito
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
| | - Sara Tedeschi
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Carolina Saffioti
- Clinic of Infectious Diseases, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy
| | - Silvia Corcione
- Department of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Maddalena Giannella
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Raffaelli
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
| | - Nicole Pagani
- Department of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Michele Bartoletti
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Teresa Spanu
- Institute of Microbiology, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
| | - Anna Marchese
- Section of Microbiology-DISC, University of Genoa, Genoa, Italy
| | - Roberto Cauda
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
| | - Claudio Viscoli
- Clinic of Infectious Diseases, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy
| | - Pierluigi Viale
- Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Mikulska M, Del Bono V, Gandolfo N, Dini S, Dominietto A, Di Grazia C, Bregante S, Varaldo R, Orsi A, Ansaldi F, Bacigalupo A, Viscoli C. Epidemiology of viral respiratory tract infections in an outpatient haematology facility. Ann Hematol 2013; 93:669-76. [PMID: 24097084 PMCID: PMC7079995 DOI: 10.1007/s00277-013-1912-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 09/22/2013] [Indexed: 01/03/2023]
Abstract
Viral respiratory tract infections (VRTI) are an important cause of morbidity and mortality in haematology patients, particularly after haematopoietic stem cell transplantation (HSCT). The incidence, clinical presentation and outcome of symptomatic and asymptomatic VRTI in HSCT outpatient unit were prospectively evaluated during a single influenza season (January–March 2011). Pharyngeal swabs were performed at the first visit and if new symptoms were present. Molecular multiplex assay for 12 respiratory viruses was performed by the regional reference laboratory. Among 264 swabs from 193 outpatients, 58 (22 %) resulted positive for 61 viruses (influenza, n = 20; respiratory syncytial virus [RSV], n = 21; rhinovirus, n = 12; coronavirus, n = 4; adenovirus, n = 3; parainfluenza, n = 1). VRTI were detected more frequently in the presence of symptoms than in asymptomatic patients: 49 out of 162 (30 %) vs. 9 out of 102 (9 %), p < 0.001. Influenza-like illness syndrome (ILI) was significantly associated with a VRTI if compared to other presentations (42 %), while the European Centre for Disease Prevention and Control definition was not (30 %). Positive predictive value (PPV) of ILI for influenza was 17 %. Influenza and RSV peak periods were contemporary. Influenza prophylaxis was given to 25 patients following exposure. Low rate of progression from upper to lower respiratory tract infection (approximately 5 % for influenza and RSV), no nosocomial epidemics and no VRTI-related deaths were observed. VRTI are very frequent in high-risk haematology outpatients, but symptoms are aspecific and PPV of ILI is low. Symptoms of influenza and RSV overlap. Thus, microbiological diagnosis and contact preventive measures are crucial. Rather than universal influenza prophylaxis, prompt diagnosis and treatment of only documented infections could be pursued.
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Affiliation(s)
- Małgorzata Mikulska
- Division of Infectious Diseases, San Martino Hospital and University of Genoa, Largo R. Benzi, 10-16132, Genoa, Italy,
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Mikulska M, Raiola AM, Signori A, Furfaro E, Del Bono V, Bacigalupo A, Viscoli C. Screening with serum galactomannan might be associated with better outcome than symptom-triggered galactomannan testing in allogeneic HSCT recipients with invasive aspergillosis. Clin Infect Dis 2013; 57:1786-7. [PMID: 24046295 DOI: 10.1093/cid/cit565] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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)
- Malgorzata Mikulska
- Division of Infectious Diseases, San Martino University Hospital and Department of Health Sciences, University of Genoa
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Cenderello G, Pasa A, Dusi A, Dentone C, Toscanini F, Bobbio N, Bondi E, Del Bono V, Izzo M, Riccio G, Anselmo M, Giacchino R, Marazzi MG, Pagano G, Cassola G, Viscoli C, Ferrea G, De Maria A. Varied spectrum of clinical presentation and mortality in a prospective registry of visceral leishmaniasis in a low endemicity area of Northern Italy. BMC Infect Dis 2013; 13:248. [PMID: 23718708 PMCID: PMC3674923 DOI: 10.1186/1471-2334-13-248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 05/22/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Visceral Leishmaniasis (VL) is endemic in 88 countries, in areas of relatively low incidence with a relevant proportion of immune suppressed patients clinical presentation, diagnosis and management may present difficulties and pitfalls. METHODS Demographic data, clinical, laboratory features and therapeutic findings were recorded in patients identified by a regional VL disease registry from January 2007 to December 2010. RESULTS A total of 55 patients (36 adults mean age 48.7 years, 19 children median age 37.5 months) were observed presenting with 65 episodes. All childen were immunocompetent, whereas adults affected by VL included both immunocompetent (n°17) and immunesuppressed (n°19) patients. The clinical presentation was homogeneous in children with predominance of fever and hepato-splenomegaly. A wider spectrum of clinical presentations was observed in immunocompromised adults. Bone marrow detection of intracellular parasites (Giemsa staining) and serology (IFAT) were the most frequently used diagnostic tools. In addition, detection of urinary antigen was used in adult patients with good specificity (90%). Liposomal amphotericin B was the most frequently prescribed first line drug (98.2% of cases) with 100% clinical cure. VL relapses (n°10) represented a crucial finding: they occurred only in adult patients, mainly in immunocompromised patients (40% of HIV, 22% of non-HIV immunocompromised patients, 5,9% of immunocompetent patients). Furthermore, three deaths with VL were reported, all occurring in relapsing immunocompromised patients accounting for a still high overall mortality in this group (15.8%). CONCLUSIONS The wide spectrum of clinical presentation in immunesuppresed patients and high recurrence rates still represent a clinical challenge accounting for high mortality. Early clinical identification and satisfactory treatment performance with liposomal amphotericin B are confirmed in areas with low-level endemicity and good clinical standards. VL needs continuing attention in endemic areas where increasing numbers of immunocompromised patients at risk are dwelling.
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Affiliation(s)
| | - Ambra Pasa
- S.C. Oncologia Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Andrea Dusi
- SSD Microbiologia ASL1 Imperiese-Ospedale Sanremo, Sanremo (IM), Italy
| | - Chiara Dentone
- SC. Malattie Infettive, ASL1 Imperiese-Ospedale Sanremo, Sanremo (IM), Italy
| | | | - Nicoletta Bobbio
- S.C. Malattie Infettive Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Elisabetta Bondi
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
| | - Valerio Del Bono
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST Genova, Genova, Italy
| | - Manuela Izzo
- SC Malattie infettive Ospedale Santa Maria della Misericordia Albenga ASL-2, Albenga (SV), Italy
| | - Giovanni Riccio
- SC Malattie infettive Ospedale Santa Maria della Misericordia Albenga ASL-2, Albenga (SV), Italy
| | - Marco Anselmo
- SC Malattie Infettive Ospedale San Paolo ASL2, Savona, Italy
| | - Raffaella Giacchino
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
| | - Maria Grazia Marazzi
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
| | - Gabriella Pagano
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST Genova, Genova, Italy
| | - Giovanni Cassola
- S.C. Malattie Infettive Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Claudio Viscoli
- Clinica Malattie Infettive, IRCCS AOU San Martino-IST Genova, Genova, Italy
| | - Giuseppe Ferrea
- SC. Malattie Infettive, ASL1 Imperiese-Ospedale Sanremo, Sanremo (IM), Italy
| | - Andrea De Maria
- Dipartimento di Scienze della Salute (DISSAL), University of Genova, Genova, Italy
- Istituto G. Gaslini, Genova, Italy
- S.S.Infettivologia, IRCCS AOU San Martino-IST Genova, Genova, Italy
- A.D.M, University of Genova, Largo R.Benzi 10, Genova, 16132, Italy
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Abstract
Candida is one of the most common causes of nosocomial bloodstream infections. Candidemia is not confined to hematological patients, intensive care units or abdominal surgery wards, but it is remarkably frequent in the internal medicine setting. High mortality associated with candidemia can be reduced by prompt, appropriate antifungal therapy. The epidemiology of species has been shifting toward non-albicans strains. Significant improvements in nonculture-based diagnostic methods, such as serological markers, have been made in recent years, and novel diagnostic techniques should be further studied to enable early pre-emptive therapy. Treatment guidelines indicate that echinocandins are at present the best choice for patients who are severely ill or possibly infected with fluconazole-resistant strains.
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Affiliation(s)
- Małgorzata Mikulska
- Division of Infectious Diseases, Department of Health Science, University of Genoa, Genoa, Italy
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Di Biagio A, Del Bono V, Rosso R, Viscoli C. HIV and accelerated atheroprogression: role of antiretroviral therapy. Curr Pharm Biotechnol 2012; 13:88-96. [PMID: 21470158 DOI: 10.2174/138920112798868520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 08/10/2010] [Indexed: 11/22/2022]
Abstract
The introduction of effective and potent treatments for human immunodeficiency virus (HIV) infection resulted in prolonged survival and better quality of life of HIV-infected patients. However, the longer survival and the anti-HIV medication side effects caused the emergence of new clinical issues, such as the increase in cardiovascular risk, favored by multiple factors, partly related to HIV infection itself, partly to the anti-HIV molecules. HIV infection itself may affect cardiovascular risk through chronic inflammation induced by uncontrolled viral replication, whereas long-term antiretroviral therapy may increase the cardiovascular risk through several mechanisms. Thus, due to the multiple and conflicting causes of cardiovascular disorders in HIV-infected patients, clinicians should take into consideration all modifiable risk factors, in order to implement an effective prevention of this clinical issue.
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Affiliation(s)
- Antonio Di Biagio
- Clinica Malattie Infettive, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
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Bassetti M, Nicolini L, Repetto E, Righi E, Del Bono V, Viscoli C. Tigecycline use in serious nosocomial infections: a drug use evaluation. BMC Infect Dis 2010; 10:287. [PMID: 20920273 PMCID: PMC2956728 DOI: 10.1186/1471-2334-10-287] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [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: 03/16/2010] [Accepted: 09/29/2010] [Indexed: 11/20/2022] Open
Abstract
Background Tigecycline is a novel antibiotic with activity against multidrug resistant bacteria. The aim of this study was to assess the efficacy of tigecycline use in serious hospital-acquired infections (HAI) Case presentation Prospective observational study of tigecycline use was conducted in a 1500 beds university hospital. From January 1, 2007 and January 31, 2010, 207 pts were treated with tigecycline for the following indications: intra-abdominal, pneumonia, bloodstream and complicated skin and soft tissue infections and febrile neutropenia. The therapy was targeted in 130/207 (63%) and empirical in 77/207 (37%) patients. All bacteria treated were susceptible to tigecycline. Median duration of tigecycline therapy was 13 days (range, 6-28). Clinical success was obtained in 151/207 (73%) cases, with the highest success rate recorded in intra-abdominal infections [81/99 (82%)]. Microbiological success was achieved in 100/129 (78%) treated patients. Adverse clinical events were seen in 16/207 patients (7.7%): Conclusions Considering the lack of data on tigecycline for critically ill patients, we think that the reported data of our clinical experience despite some limitations can be useful for clinicians.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, San Martino Hospital and University of Genoa School of Medicine, Genoa, Italy.
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Li Pira G, Ivaldi F, Dentone C, Righi E, Del Bono V, Viscoli C, Koopman G, Manca F. Evaluation of antigen-specific T-cell responses with a miniaturized and automated method. Clin Vaccine Immunol 2008; 15:1811-8. [PMID: 18945878 PMCID: PMC2593160 DOI: 10.1128/cvi.00322-08] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 10/11/2008] [Accepted: 10/15/2008] [Indexed: 11/20/2022]
Abstract
The evaluation of antigen-specific T-cell responses is helpful for both research and clinical settings. Several techniques can enumerate antigen-responsive T cells or measure their products, but they require remarkable amounts of peripheral blood mononuclear cells (PBMCs). Since screening numerous antigens or testing samples from pediatric or lymphopenic patients is hampered in clinical practice, we refined a miniaturized, high-throughput assay for T-cell immunity. Antigens and cells in 10-microl volumes were dispensed into 1,536-well culture plates precoated with anti-gamma interferon (anti-IFN-gamma) antibodies. After being cultured, the wells were developed by enzyme-linked immunosorbent assay for bound cytokine. Miniaturization and automation allowed quantitation of antigen-specific responses on 10(4) PBMCs. This method was applied for epitope mapping of mycobacterial antigens and was used in the clinic to evaluate T-cell immunity to relevant opportunistic pathogens by using small blood samples. A comparison with conventional methods showed similar sensitivity. Therefore, current flow cytometric methods that provide information on frequency and phenotype of specific T cells can be complemented by this assay that provides extensive information on cytokine concentrations and profiles and requires 20- to 50-fold fewer PBMCs than other analytical methods.
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Affiliation(s)
- Giuseppina Li Pira
- Laboratory of Cellular Immunology, Advanced Biotechnology Center, Largo Benzi 10, 16132 Genoa, Italy.
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Mikulska M, Bono VD, Raiola AM, Bruno B, Bacigalupo A, Viscoli C. Blood Stream Infections in Haematopoietic Stem Cell Transplant. Int J Infect Dis 2008. [DOI: 10.1016/s1201-9712(08)60043-0] [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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Bassetti M, Di Biagio A, Del Bono V, Cenderello G, Bassetti D. Successful treatment of methicillin-resistant Staphylococcus aureus endocarditis with linezolid. Int J Antimicrob Agents 2004; 24:83-4. [PMID: 15225867 DOI: 10.1016/j.ijantimicag.2003.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2003] [Accepted: 12/12/2003] [Indexed: 10/26/2022]
Abstract
We report the successful treatment with linezolid of a methicillin-resistant Staphylococcus aureus (MRSA) endocarditis in a patient with a severe allergic reaction to glycopeptides. Linezolid is a drug with well-recognised activity against S. aureus and proved to be efficacious even in the unusual site of heart valves. This drug could be a good therapeutic choice when glycopeptides treatment is not feasible.
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Affiliation(s)
- Matteo Bassetti
- Department of Infectious Diseases, San Martino Hospital, University of Genoa, School of Medicine, Genoa, Italy
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