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Celotti A, Gargiulo F, Quiros-Roldan E, Properzi M, De Francesco MAD, Coletto D, Caccuri F, Izzo I, Caruso A, Castelli F, Focà E. Presence of V72I, G123S and R127K Integrase Inhibitor polymorphisms could reduce ART effectiveness: a retrospective longitudinal study. HIV Res Clin Pract 2020; 21:24-33. [PMID: 32141388 DOI: 10.1080/25787489.2020.1734753] [Citation(s) in RCA: 1] [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] [Indexed: 01/15/2023]
Abstract
Objectives: Structural aspects of HIV-1 integrase complex and role of integrase minor mutations and polymorphisms in ART effectiveness is still unknown. The objective of this study was to assess the 24 and 48 weeks (W) effectiveness of ART regimens in patients with Integrase Inhibitors (InSTI) minor mutations and polymorphisms receiving InSTI-based regimens.Methods: We enrolled all ART-naïve or InSTI-naïve HIV-infected patients, with a baseline InSTI genotypic resistances test between 2011 and 2016. We analyzed integrase resistance mutations using the Stanford University HIV Drug Resistance Database (HIVdb Program, version 6.3.0). The outcome was virological response at 24 and 48 W of follow up (FU) according to snapshot analysis. We defined virological failure as two consecutive HIV-RNA > 50 copies/ml, or one >1000 copies/ml. Patients were divided in those presenting InSTI minor mutations (Group 1), and those with only polymorphisms or wild type (Group 2).Results: We enrolled 83 patients. 81 patients reached 24 W of FU: 2/20 (10%) and 4/61 (6.5%) showed virological failure in Group 1 and 2 respectively. 66 patients reached 48 W of FU: 0/17 (0%) and 2/49 (4%) showed virological failure in Group 1 and 2 respectively. Interestingly, patients with polymorphisms G123S and R127K had higher risk of failure at 24 W (respectively, relative risk - RR - 36, IQR 2.1-613, p = 0.01; RR 36, IQR 2.1-613, p = 0.01) and patients with V72I had an higher risk of failure both at 24 W (RR 6.52, IQR 1.29-32.9, p = 0.02) and 48 W (RR 21.1, IQR 1.07-414, p = 0.04).Conclusions: Our study showed that the presence of V72I, G123S and R127K polymorphisms could play a role in reducing InSTI effectiveness.
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Affiliation(s)
- Anna Celotti
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Franco Gargiulo
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Eugenia Quiros-Roldan
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Martina Properzi
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Maria Antonia De De Francesco
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Davide Coletto
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Francesca Caccuri
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Ilaria Izzo
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Arnaldo Caruso
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Emanuele Focà
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
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Vena A, Giacobbe DR, Mussini C, Cattelan A, Bassetti M, Bassetti M, Vena A, Castaldo N, Pecori D, Righi E, Carnellutti A, Givone F, Graziano E, Merelli M, Cadeo B, Peghin M, Cattelan A, Cipriani L, Coletto D, Mussini C, Digaetano M, Tascini C, Carrannante N, Menichetti F, Verdenelli S, Fabiani S, Mastroianni CM, Gianluca R, Oliva A, Ciardi MR, Ajassa C, Tieghi T, Tumbarello M, Losito AR, Raffaelli F, Grossi P, Rovelli C, Artioli S, Caruana G, Luzzati R, Bontempo G, Petrosillo N, Capone A, Rizzardini G, Coen M, Passerini M, Mastroianni A, Urso F, Bianco MF, Borgia G, Gentile I, Maraolo AE, Crapis M, Venturini S, Parruti G, Trave F, Angarano G, Carbonara S, Mariani MF, Girardis M, Cascio A, Anselmo M, Malfatto E, Bassetti M, Vena A, Castaldo N, Pecori D, Righi E, Carnellutti A, Givone F, Graziano E, Merelli M, Cadeo B, Peghin M, Cattelan A, Cipriani L, Coletto D, Mussini C, Digaetano M, Tascini C, Carrannante N, Menichetti F, Verdenelli S, Fabiani S, Mastroianni CM, Gianluca R, Oliva A, Ciardi MR, Ajassa C, Tieghi T, Tumbarello M, Losito AR, Raffaelli F, Grossi P, Rovelli C, Artioli S, Caruana G, Luzzati R, Bontempo G, Petrosillo N, Capone A, Rizzardini G, Coen M, Passerini M, Mastroianni A, Urso F, Bianco MF, Borgia G, Gentile I, Maraolo AE, Crapis M, Venturini S, Parruti G, Trave F, Angarano G, Carbonara S, Mariani MF, Girardis M, Cascio A, Anselmo M, Malfatto E. Clinical Efficacy of Ceftolozane-Tazobactam Versus Other Active Agents for the Treatment of Bacteremia and Nosocomial Pneumonia due to Drug-Resistant Pseudomonas aeruginosa. Clin Infect Dis 2020; 71:1799-1801. [DOI: 10.1093/cid/ciaa003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antonio Vena
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Cristina Mussini
- Infectious Diseases Clinics, University of Modena and Reggio Emilia, Modena, Italy
| | - Annamaria Cattelan
- Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - Matteo Bassetti
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
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Bassetti M, Castaldo N, Cattelan A, Mussini C, Righi E, Tascini C, Menichetti F, Mastroianni CM, Tumbarello M, Grossi P, Artioli S, Carannante N, Cipriani L, Coletto D, Russo A, Digaetano M, Losito AR, Peghin M, Capone A, Nicolè S, Vena A. Ceftolozane/tazobactam for the treatment of serious Pseudomonas aeruginosa infections: a multicentre nationwide clinical experience. Int J Antimicrob Agents 2018; 53:408-415. [PMID: 30415002 DOI: 10.1016/j.ijantimicag.2018.11.001] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [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: 06/18/2018] [Revised: 10/04/2018] [Accepted: 11/04/2018] [Indexed: 02/02/2023]
Abstract
This study describes the largest clinical experience using ceftolozane/tazobactam (C/T) for different Pseudomonas aeruginosa infections. A retrospective study was performed at 22 hospitals in Italy (June 2016-March 2018). All adult patients treated with ≥4 days of C/T were enrolled. Successful clinical outcome was defined as complete resolution of clinical signs/symptoms related to P. aeruginosa infection and lack of microbiological evidence of infection. C/T treatment was documented in 101 patients with diverse infections, including nosocomial pneumonia (31.7%), acute bacterial skin and skin-structure infection (20.8%), complicated UTI (13.9%), complicated IAI (12.9%), bone infection (8.9%) and primary bacteraemia (5.9%). Over one-half of P. aeruginosa strains were XDR (50.5%), with 78.2% of isolates resistant to at least one carbapenem. C/T was used as first-line therapy in 39 patients (38.6%). When used as second-line or later, the most common reasons for discontinuation of previous antibiotics were in vitro resistance of P. aeruginosa and clinical failure of previous therapy. Concomitant antibiotics were reported in 35.6% of patients. C/T doses were 1.5 g q8h in 70 patients (69.3%) and 3 g q8h in 31 patients (30.7%); median duration of C/T therapy was 14 days. Overall clinical success was 83.2%. Significant lower success rates were observed in patients with sepsis or receiving continuous renal replacement therapy (CRRT). Mild adverse events were reported in only three patients. C/T demonstrated a favourable safety and tolerability profile regardless of the infection type. Clinicians should be aware of the risk of clinical failure with C/T therapy in septic patients receiving CRRT.
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MESH Headings
- Aged
- Anti-Bacterial Agents/therapeutic use
- Bacteremia/drug therapy
- Bacteremia/microbiology
- Bone Diseases, Infectious/drug therapy
- Bone Diseases, Infectious/microbiology
- Cephalosporins/adverse effects
- Cephalosporins/therapeutic use
- Drug Resistance, Multiple, Bacterial/genetics
- Female
- Humans
- Male
- Middle Aged
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/microbiology
- Pneumonia, Ventilator-Associated/drug therapy
- Pneumonia, Ventilator-Associated/microbiology
- Pseudomonas Infections/drug therapy
- Pseudomonas Infections/microbiology
- Pseudomonas aeruginosa/drug effects
- Pseudomonas aeruginosa/genetics
- Pseudomonas aeruginosa/isolation & purification
- Retrospective Studies
- Skin Diseases, Bacterial/drug therapy
- Skin Diseases, Bacterial/microbiology
- Tazobactam/adverse effects
- Tazobactam/therapeutic use
- Treatment Outcome
- Urinary Tract Infections/drug therapy
- Urinary Tract Infections/microbiology
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy.
| | - Nadia Castaldo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Annamaria Cattelan
- Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - Cristina Mussini
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Elda Righi
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Carlo Tascini
- 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
| | | | - Mario Tumbarello
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS - Istituto Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Grossi
- Department of Infectious and Tropical Diseases, University of Insubria, Ospedale di Circolo-Fondazioni Macchi, Varese, Italy
| | - Stefania Artioli
- Infectious Diseases and Hepatology Unit, Sant'Andrea Hospital La Spezia, La Spezia, Italy
| | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Ludovica Cipriani
- Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - Davide Coletto
- Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Margherita Digaetano
- Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Angela Raffaella Losito
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS - Istituto Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maddalena Peghin
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessandro Capone
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Stefano Nicolè
- Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - Antonio Vena
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
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