1
|
van der Vaart TW, Bossuyt PMM, Durack DT, Baddour LM, Bayer AS, Durante-Mangoni E, Holland TL, Karchmer AW, Miro JM, Moreillon P, Rasmussen M, Selton-Suty C, Fowler VG, van der Meer JTM. External Validation of the 2023 Duke-International Society for Cardiovascular Infectious Diseases Diagnostic Criteria for Infective Endocarditis. Clin Infect Dis 2024; 78:922-929. [PMID: 38330166 PMCID: PMC11006110 DOI: 10.1093/cid/ciae033] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/16/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The 2023 Duke-International Society of Cardiovascular Infectious Diseases (ISCVID) criteria for infective endocarditis (IE) were introduced to improve classification of IE for research and clinical purposes. External validation studies are required. METHODS We studied consecutive patients with suspected IE referred to the IE team of Amsterdam University Medical Center (from October 2016 to March 2021). An international expert panel independently reviewed case summaries and assigned a final diagnosis of "IE" or "not IE," which served as the reference standard, to which the "definite" Duke-ISCVID classifications were compared. We also evaluated accuracy when excluding cardiac surgical and pathologic data ("clinical" criteria). Finally, we compared the 2023 Duke-ISCVID with the 2000 modified Duke criteria and the 2015 and 2023 European Society of Cardiology (ESC) criteria. RESULTS A total of 595 consecutive patients with suspected IE were included: 399 (67%) were adjudicated as having IE; 111 (19%) had prosthetic valve IE, and 48 (8%) had a cardiac implantable electronic device IE. The 2023 Duke-ISCVID criteria were more sensitive than either the modified Duke or 2015 ESC criteria (84.2% vs 74.9% and 80%, respectively; P < .001) without significant loss of specificity. The 2023 Duke-ISCVID criteria were similarly sensitive but more specific than the 2023 ESC criteria (94% vs 82%; P < .001). The same pattern was seen for the clinical criteria (excluding surgical/pathologic results). New modifications in the 2023 Duke-ISCVID criteria related to "major microbiological" and "imaging" criteria had the most impact. CONCLUSIONS The 2023 Duke-ISCVID criteria represent a significant advance in the diagnostic classification of patients with suspected IE.
Collapse
Affiliation(s)
- Thomas W van der Vaart
- Division of Infectious Diseases, Amsterdam University Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Patrick M M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - David T Durack
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine and Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Arnold S Bayer
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA, Torrance, California, USA
- Division of Infectious Diseases, The Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Monaldi Hospital, Naples, Italy
| | - Thomas L Holland
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Adolf W Karchmer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Philippe Moreillon
- Department of Fundamental Microbiology, UNIL—Université de Lausanne, Lausanne, Switzerland
| | - Magnus Rasmussen
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
| | - Christine Selton-Suty
- Centre Hospitalier Régional Universitaire (CHRU) Nancy, Cardiology Department, CIC-EC, Nancy, France
- Association pour l’Étude et la Prévention de l’Endocardite Infectieuse (AEPEI), France
| | - Vance G Fowler
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jan T M van der Meer
- Division of Infectious Diseases, Amsterdam University Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Patauner F, Gallo R, Durante-Mangoni E, Bertolino L. Monkeypox infection, 18 months later: A vanishing epidemic? Eur J Intern Med 2024; 122:35-37. [PMID: 38369446 DOI: 10.1016/j.ejim.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Affiliation(s)
- F Patauner
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio 7, 80138 Napoli Italy; Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli Italy
| | - R Gallo
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio 7, 80138 Napoli Italy; Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli Italy
| | - E Durante-Mangoni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio 7, 80138 Napoli Italy; Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli Italy.
| | - L Bertolino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio 7, 80138 Napoli Italy; Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli Italy
| |
Collapse
|
3
|
Gul S, Durante-Mangoni E. Unraveling the Puzzle: Health Benefits of Probiotics-A Comprehensive Review. J Clin Med 2024; 13:1436. [PMID: 38592298 PMCID: PMC10935031 DOI: 10.3390/jcm13051436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
A growing number of probiotic-containing products are on the market, and their use is increasing. Probiotics are thought to support the health of the gut microbiota, which in turn might prevent or delay the onset of gastrointestinal tract disorders. Obesity, type 2 diabetes, autism, osteoporosis, and some immunological illnesses are among the conditions that have been shown to possibly benefit from probiotics. In addition to their ability to favorably affect diseases, probiotics represent a defense system enhancing intestinal, nutritional, and oral health. Depending on the type of microbial strain utilized, probiotics can have variable beneficial properties. Although many microbial species are available, the most widely employed ones are lactic acid bacteria and bifidobacteria. The usefulness of these bacteria is dependent on both their origin and their capacity to promote health. Probiotics represent a valuable clinical tool supporting gastrointestinal health, immune system function, and metabolic balance. When used appropriately, probiotics may provide benefits such as a reduced risk of gastrointestinal disorders, enhanced immunity, and improved metabolic health. Most popular probiotics, their health advantages, and their mode of action are the topic of this narrative review article, aimed to provide the reader with a comprehensive reappraisal of this topic matter.
Collapse
Affiliation(s)
- Sabiha Gul
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio 7, 80138 Napoli, Italy;
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio 7, 80138 Napoli, Italy;
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli—Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| |
Collapse
|
4
|
Ramadan MS, Bertolino L, Boccia F, Hamieh M, Peluso AM, Gallo R, Patauner F, De Santo LS, Carozza A, Zampino R, Durante-Mangoni E. Features of infective endocarditis in a contemporary cohort of persons who inject drugs: a matched comparison analysis of long-term prognostic factors. Intern Emerg Med 2024; 19:455-464. [PMID: 38129537 DOI: 10.1007/s11739-023-03502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
The objective of the study was to assess the short- and long-term mortality of infective endocarditis (IE) among people who inject drugs (PWID). Using prospectively collected data on hospitalized patients (years 2000 through 2021) with IE, PWID were identified and included in this study. Survival analysis was performed to analyze short- and long-term mortality and study their risk factors among PWID and a matched group of non-intravenous drug users (N-IDU). In a study of 485 patients admitted for IE, 55 (11%) of them were PWID. These PWID patients were 1:1 age- and sex- matched to an N-IDU group (N = 55 per group). Both groups had similar baseline comorbid conditions, including congestive heart failure, type 2 diabetes, and neoplastic diseases. However, PWID were more likely to have HCV co-infection (62% vs 16%, respectively, p < 0.001) and advanced liver disease/cirrhosis (52% vs 7.9%, respectively, p < 0.001). IE in PWID more often affected the tricuspid valve (42% vs 22%, respectively, p = 0.024) and presented with more embolic events (66% vs 35%, respectively, p < 0.01). S. aureus was the primary cause of IE in PWID (44% vs 21%, respectively, p = 0.01). After adjusting for other variables, PWID (HR = 2.99, 95% CI [1.06, 8.43], p = 0.038) and valve bioprosthetic replacement (HR = 5.37, 95% CI [1.3, 22.1], p = 0.02) were independently associated with increased mortality risk, whereas IE caused by tricuspid valve infection was associated with reduced mortality risk (HR = 0.25, 95% CI [0.06, 0.97], p = 0.046). In this cohort, PWID had increased risk of long-term mortality after hospital discharge for IE, when compared to matched N-IDU with similar baseline characteristics. The reasons behind the significant increase in mortality warrant further investigation.
Collapse
Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
- Division of Infectious Diseases, Duke University Medical School, Durham, NC, USA
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Filomena Boccia
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2 80138, Naples, Italy
| | - Mahmoud Hamieh
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Anna Maria Peluso
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy
| | - Luca Salvatore De Santo
- Department of Translational Medical Sciences and Unit of Cardiac Surgery, University of Campania "Luigi Vanvitelli", A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
| | - Antonio Carozza
- Department of Translational Medical Sciences and Unit of Cardiac Surgery, University of Campania "Luigi Vanvitelli", A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
| | - Rosa Zampino
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2 80138, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Naples, Italy.
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy.
| |
Collapse
|
5
|
Patauner F, Durante-Mangoni E. Cefiderocol for resistant Gram negatives: linking in vitro activity with clinical effectiveness. Clin Microbiol Infect 2024; 30:155-158. [PMID: 38036218 DOI: 10.1016/j.cmi.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Fabian Patauner
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Ospedale Monaldi, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Ospedale Monaldi, Naples, Italy.
| |
Collapse
|
6
|
Panagides V, Cuervo G, Llopis J, Abdel-Wahab M, Mangner N, Habib G, Regueiro A, Mestres CA, Tornos P, Durand E, Selton-Suty C, Ihlemann N, Bruun N, Urena M, Cecchi E, Thiele H, Durante-Mangoni E, Pellegrini C, Eltchaninoff H, Athan E, Søndergaard L, Linke A, Tattevin P, Del Val D, Quintana E, Chu V, Rodés-Cabau J, Miro JM. Infective Endocarditis After Transcatheter Versus Surgical Aortic Valve Replacement. Clin Infect Dis 2024; 78:179-187. [PMID: 37552784 DOI: 10.1093/cid/ciad464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Scarce data are available comparing infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study aimed to compare the clinical presentation, microbiological profile, management, and outcomes of IE after SAVR versus TAVR. METHODS Data were collected from the "Infectious Endocarditis after TAVR International" (enrollment from 2005 to 2020) and the "International Collaboration on Endocarditis" (enrollment from 2000 to 2012) registries. Only patients with an IE affecting the aortic valve prosthesis were included. A 1:1 paired matching approach was used to compare patients with TAVR and SAVR. RESULTS A total of 1688 patients were included. Of them, 602 (35.7%) had a surgical bioprosthesis (SB), 666 (39.5%) a mechanical prosthesis, 70 (4.2%) a homograft, and 350 (20.7%) a transcatheter heart valve. In the SAVR versus TAVR matched population, the rate of new moderate or severe aortic regurgitation was higher in the SB group (43.4% vs 13.5%; P < .001), and fewer vegetations were diagnosed in the SB group (62.5% vs 82%; P < .001). Patients with an SB had a higher rate of perivalvular extension (47.9% vs 27%; P < .001) and Staphylococcus aureus was less common in this group (13.4% vs 22%; P = .033). Despite a higher rate of surgery in patients with SB (44.4% vs 27.3%; P < .001), 1-year mortality was similar (SB: 46.5%; TAVR: 44.8%; log-rank P = .697). CONCLUSIONS Clinical presentation, type of causative microorganism, and treatment differed between patients with an IE located on SB compared with TAVR. Despite these differences, both groups exhibited high and similar mortality at 1-year follow-up.
Collapse
Affiliation(s)
- Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Guillermo Cuervo
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Department of Genetics, Microbiology, and Statistics, University of Barcelona, Barcelona, Spain
| | | | - Norman Mangner
- Herzzentrum Dresden, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Gilbert Habib
- Cardiology Department, Assistance Publique des Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Ander Regueiro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Pilar Tornos
- Department of Cardiology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Eric Durand
- Department of Cardiology, Normandie University, CHU Rouen, France
| | | | | | - Niels Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Marina Urena
- Cardiology Department, Bichat Hospital, Paris, France
| | - Enrico Cecchi
- Cardiology Department, Hospital Maria Vittoria, Turin, Italy
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | | | | | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | | | - Axel Linke
- Herzzentrum Dresden, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eduard Quintana
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Vivian Chu
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
7
|
Boccia F, Iossa D, Leonardi S, Peluso AM, Bertolino L, Patauner F, Palmieri E, Boenzi R, Zampino R, Durante-Mangoni E. Clinical correlates of circulating small dense low-density lipoproteins in acute infective endocarditis. Infection 2023:10.1007/s15010-023-02139-z. [PMID: 38114685 DOI: 10.1007/s15010-023-02139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND AIM Infective endocarditis (IE) is a complex thrombo-inflammatory disorder, the pathogenesis of which involves a multifaceted interplay between vascular damage and bacterial virulence factors. This study aimed to assess the prognostic role of small dense low-density lipoprotein (sdLDL) cholesterol in patients with IE and its correlation with various disease-related features. METHODS A cohort of 198 patients with definite IE was included in this study. Clinical, laboratory, and echocardiographic parameters were meticulously analyzed, with a specific focus on comorbidities. sdLDL levels were measured using stored plasma samples obtained upon admission during the acute phase of the disease. RESULTS The median level of sdLDL was 24 mg/dL [with an interquartile range of 17.9-35.2 mg/dL], and this value showed a statistically significant positive correlation with LDL/HDL cholesterol and triglycerides (p < 0.01 for all). Furthermore, a remarkable inverse correlation between C-reactive protein and D-dimer levels was observed (p < 0.0001). Univariate analysis revealed that patients with sdLDL levels ≤ 24 mg/dL had 2.75 times higher odds of in-hospital mortality (95% Confidence Interval:1.08-6.98, p = 0.031). In addition, nonsurvivors had significantly lower median sdLDL levels (19.7 vs. 26.0 mg/dL, p = 0.041). Lower sdLDL levels were also associated with embolic complications, larger vegetation size, and positive blood cultures for Staphylococci (p = 0.019, p = 0.022, and p < 0.001, respectively). CONCLUSIONS Low circulating sdLDL levels in the acute phase of IE were significantly correlated with unfavorable clinical outcomes. These results suggest that the sdLDL level may serve as an important marker of disease severity in IE and may represent a link between vascular damage, embolic complications, and disease progression.
Collapse
Affiliation(s)
- Filomena Boccia
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Domenico Iossa
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
- Unit of Infectious and Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, Naples, Italy
| | - Silvia Leonardi
- Unit of Clinical Biochemistry, A.O.R.N. Ospedali dei Colli, Naples, Italy
| | - Anna Maria Peluso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Emilio Palmieri
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Rita Boenzi
- Unit of Clinical Biochemistry, A.O.R.N. Ospedali dei Colli, Naples, Italy
| | - Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
- Unit of Infectious and Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy.
- Unit of Infectious and Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, Naples, Italy.
- Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy.
| |
Collapse
|
8
|
Karruli A, Migliaccio A, Pournaras S, Durante-Mangoni E, Zarrilli R. Cefiderocol and Sulbactam-Durlobactam against Carbapenem-Resistant Acinetobacter baumannii. Antibiotics (Basel) 2023; 12:1729. [PMID: 38136764 PMCID: PMC10740486 DOI: 10.3390/antibiotics12121729] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) remain a clinical challenge due to limited treatment options. Recently, cefiderocol, a novel siderophore cephalosporin, and sulbactam-durlobactam, a bactericidal β-lactam-β-lactamase inhibitor combination, have been approved by the Food and Drug Administration for the treatment of A. baumannii infections. In this review, we discuss the mechanisms of action of and resistance to cefiderocol and sulbactam-durlobactam, the antimicrobial susceptibility of A. baumannii isolates to these drugs, as well as the clinical effectiveness of cefiderocol and sulbactam/durlobactam-based regimens against CRAB. Overall, cefiderocol and sulbactam-durlobactam show an excellent antimicrobial activity against CRAB. The review of clinical studies evaluating the efficacy of cefiderocol therapy against CRAB indicates it is non-inferior to colistin/other treatments for CRAB infections, with a better safety profile. Combination treatment is not associated with improved outcomes compared to monotherapy. Higher mortality rates are often associated with prior patient comorbidities and the severity of the underlying infection. Regarding sulbactam-durlobactam, current data from the pivotal clinical trial and case reports suggest this antibiotic combination could be a valuable option in critically ill patients affected by CRAB infections, in particular where no other antibiotic appears to be effective.
Collapse
Affiliation(s)
- Arta Karruli
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Antonella Migliaccio
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Spyros Pournaras
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12462 Athens, Greece
| | | | - Raffaele Zarrilli
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| |
Collapse
|
9
|
Bertolino L, Florio LL, Patauner F, Gallo R, Peluso AM, Scafuri A, De Vivo S, Corrado C, Zampino R, Ruocco G, D’Onofrio A, Durante-Mangoni E. Leadless Pacemaker Infection Risk in Patients with Cardiac Implantable Electronic Device Infections: A Case Series and Literature Review. J Clin Med 2023; 12:7573. [PMID: 38137641 PMCID: PMC10743511 DOI: 10.3390/jcm12247573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Leadless pacemakers (LPs) have been proposed as a reimplantation strategy in pacing-dependent patients undergoing cardiac implantable electronic device (CIED) extraction for infection. In this study, we analysed the risk of LP infection when this device is implanted before lead extraction. (2) Methods: This was a retrospective study including patients who underwent LP implantation between 2017 and 2022. Patients were divided in two groups according to whether LP was implanted following CIED extraction for infection (Group 1) or other indications (Group 2). The primary aim was to describe the risk of LP infection. (3) Results: We included in this study 49 patients with a median age of 81 [20-94] years, mostly males (36, 73%). In Group 1 patients, 17 cases (85%) showed systemic CIED infections, and 11 (55%) had positive lead cultures. Most Group 1 cases (n = 14, 70%) underwent one stage of LP implantation and CIED extraction. Mortality rate during follow-up was 20% (nine patients). Patients were followed up for a median of 927 [41-1925], days and no cases of definite or suspected LP infections were identified. (4) Conclusions: The risk of LP infection was extremely low. LP appears as a potential option for reimplantation in this setting and should be considered in pacing-dependent patients at a high risk of CIED infection recurrence.
Collapse
Affiliation(s)
- Lorenzo Bertolino
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Letizia Lucia Florio
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Anna Maria Peluso
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
| | - Antonio Scafuri
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
| | - Stefano De Vivo
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Carmelina Corrado
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Rosa Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (L.L.F.); (A.M.P.); (R.Z.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| | - Giuseppe Ruocco
- Unit of Microbiology and Virology, AORN Ospedali dei Colli, Piazzale Ettore Ruggieri, 80131 Naples, Italy;
| | - Antonio D’Onofrio
- Unit of Cardiac Electrophysiology, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (S.D.V.); (C.C.); (A.D.)
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Via de Crecchio, 7, 80138 Napoli, Italy; (L.B.); (F.P.); (R.G.); (A.S.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| |
Collapse
|
10
|
Ambrosioni J, Hernández-Meneses M, Durante-Mangoni E, Tattevin P, Olaison L, Freiberger T, Hurley J, Hannan MM, Chu V, Hoen B, Moreno A, Cuervo G, Llopis J, Miró JM. Correction: Epidemiological Changes and Improvement in Outcomes of Infective Endocarditis in Europe in the Twenty-First Century: An International Collaboration on Endocarditis (ICE) Prospective Cohort Study (2000-2012). Infect Dis Ther 2023; 12:2819-2821. [PMID: 38100016 PMCID: PMC10746667 DOI: 10.1007/s40121-023-00898-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Affiliation(s)
- Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marta Hernández-Meneses
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Pierre Tattevin
- Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Freiberger
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - John Hurley
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Margaret M Hannan
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Vivian Chu
- Duke University School of Medicine, Durham, NC, USA
| | - Bruno Hoen
- Department of Infectious Diseases and Tropical Medicine and Inserm CIC-1424, University of Lorraine Medical Center at Nancy, EA 4364 APEMAC, University of Lorraine, Nancy, France
| | - Asunción Moreno
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Jaume Llopis
- Biostatistics Department, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
11
|
Bertolino L, Ramadan MS, Zampino R, Durante-Mangoni E. Infective endocarditis involving MitraClip © devices: a systematic literature review. Infection 2023; 51:1241-1248. [PMID: 37386329 PMCID: PMC10545607 DOI: 10.1007/s15010-023-02067-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Progress of interventional cardiology has boosted the use of newer cardiac devices. These devices are perceived to be less prone to infections compared to traditional surgical prostheses, but little data are currently available. In this systematic review (SR), we summarize current literature regarding the clinical characteristics, management, and outcomes of patients with MitraClip-related infective endocarditis (IE). METHODS We conducted a SR of PubMed, Google Scholar, Embase, and Scopus between January 2003 and March 2022. MitraClip-related IE was defined according to 2015 ESC criteria whereas MitraClip involvement as vegetation on the device or on the mitral valve. Risk of bias was assessed through standardized checklist and potential bias of underestimation cannot be excluded. Data regarding clinical presentation, echocardiography, management, and outcome were collected. RESULTS Twenty-six cases of MitraClip-related IE were retrieved. The median age of patients was 76 [61-83] years with a median EuroScore of 41%. Fever was present in 65.8% of patients followed by signs and symptoms of heart failure (42.3%). IE occurred early in 20 (76.9%) cases with a median time between MitraClip implantation and IE symptom onset of 5 [2-16] months. Staphylococcus aureus was the major causative microorganism (46%). Surgical mitral valve replacement was needed in 50% of patients. A conservative medical approach was considered in the remainder. The overall in-hospital mortality rate was 50% (surgical group: 38.4%; medical group: 58.3%; p = 0.433). CONCLUSION Our results suggest that MitraClip-related IE affects elderly, comorbid patients, is mostly due to Staphylococcus aureus, and has a poor prognosis irrespective of the therapeutic approach. Clinicians must be aware of the features of this new entity among cardiovascular infections.
Collapse
Affiliation(s)
- Lorenzo Bertolino
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Mohammad Said Ramadan
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Rosa Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy
| | - Emanuele Durante-Mangoni
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy.
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.
| |
Collapse
|
12
|
Bertolino L, Marrazzo T, Boccia F, Zampino R, Durante-Mangoni E. Inotropes administration in patients with acute infective endocarditis and indication for urgent cardiac surgery. Eur J Intern Med 2023; 116:146-148. [PMID: 37468356 DOI: 10.1016/j.ejim.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Lorenzo Bertolino
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Napoli, Italy
| | - Tommaso Marrazzo
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Napoli, Italy
| | - Filomena Boccia
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Napoli, Italy
| | - Rosa Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Napoli, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| | - Emanuele Durante-Mangoni
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy; Department of Precision Medicine, University of Campania 'L. Vanvitelli' Napoli, Italy.
| |
Collapse
|
13
|
Boccia F, Florio LL, Durante-Mangoni E, Zampino R. Guillain-Barré syndrome as clinical presentation of a recently acquired hepatitis C. J Neurovirol 2023; 29:640-643. [PMID: 37646952 PMCID: PMC10645643 DOI: 10.1007/s13365-023-01167-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/27/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023]
Abstract
About 40% of the Guillain-Barré syndrome (GBS) cases are associated with prodromal infections; occasionally, it has been associated to chronic hepatitis C or its reactivation. A 38-year-old man came to our attention after transaminase elevation occurred during recovery from GBS. All the possible causes of acute hepatitis were excluded except for the positivity of HCVRNA, and a diagnosis of new onset hepatitis C was made. Recalling patient history, we observed that (i) anti-HCV antibodies were negative and liver enzymes were normal 7 weeks before GBS onset; (ii) in the early stages of ICU admission, liver enzymes started to rise, but the elevation remained mild under steroid treatment; (iii) serum aminotransferase peak occurred 11 weeks after GBS onset; and (iv) HCV RNA was already significantly high when anti-HCV antibodies became positive, consistent with an acute hepatitis. Furthermore, anti-HCV seroconversion was likely delayed or blurred by steroids and immunoglobulin infusions. The interval of time between GBS onset and transaminase elevation compared with the patient clinical history allows us to establish a cause-effect relationship between the two diseases. All patients with GBS should be tested for hepatitis C, or its reactivation if already present, and followed up for an early diagnosis and treatment.
Collapse
Affiliation(s)
- Filomena Boccia
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Letizia Lucia Florio
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Emanuele Durante-Mangoni
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy.
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| |
Collapse
|
14
|
Unar A, Bertolino L, Patauner F, Gallo R, Durante-Mangoni E. Decoding Sepsis-Induced Disseminated Intravascular Coagulation: A Comprehensive Review of Existing and Emerging Therapies. J Clin Med 2023; 12:6128. [PMID: 37834771 PMCID: PMC10573475 DOI: 10.3390/jcm12196128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Disseminated intravascular coagulation (DIC) is a recurrent complication of sepsis. Since DIC not only promotes organ dysfunction but also represents a strong prognostic factor, it is important to diagnose DIC as early as possible. When coagulation is activated, fibrinolysis is inhibited, blood thinners are consumed, and a condition is created that promotes blood clotting, making it more difficult for the body to remove fibrin or prevent it from being deposited in the blood vessels. This leads to microvascular thrombosis, which plays a role in organ dysfunction. Despite efforts to understand the underlying mechanisms of sepsis-induced DIC, healthcare providers worldwide still face challenges in effectively treating this condition. In this review, we provide an in-depth analysis of the available strategies for sepsis-induced DIC, considering their effectiveness, limitations, and potential for future advances. Corticosteroids (CS), recombinant thrombomodulin (rTM), vitamin C, fibrinolytic therapy, and platelet transfusion are among the treatments discussed in the review. In addition, we are specifically addressing immunomodulatory therapy (IMT) by investigating treatments such as granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon gamma (IFN-γ), and mesenchymal stem cell therapy (MSC). Finally, we also examined how these therapies might affect COVID-19 cases, which often present with sepsis-induced DIC. The review suggests that targeted experiments with randomization are needed to verify the effectiveness of these treatments and to discover novel approaches to treat sepsis-induced DIC. By increasing our knowledge of sepsis-induced DIC, we can develop targeted treatments that have the potential to save lives and improve outcomes.
Collapse
Affiliation(s)
- Ahsanullah Unar
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy
| |
Collapse
|
15
|
Calò F, Onorato L, De Luca I, Macera M, Monari C, Durante-Mangoni E, Massa A, Gentile I, Di Caprio G, Pagliano P, Numis FG, Iuliano P, Buonomo AR, Leone S, Maggi P, Coppola N. Outcome of patients with carbapenem-resistant Acinetobacter baumannii infections treated with cefiderocol: A multicenter observational study. J Infect Public Health 2023; 16:1485-1491. [PMID: 37349243 DOI: 10.1016/j.jiph.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/28/2023] [Revised: 05/15/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND No clear evidence supports the use of cefiderocol as first line treatment in A. baumannii infections. METHODS We conducted an observational retrospective/prospective multicenter study including all patients> 18 years with carbapenem-resistant A. baumannii (CRAB) infections treated with cefiderocol, from June 12021 to October 30 2022. Primary endpoint was 30-day mortality, secondary end-points the clinical and microbiological response at 7 days and at the end of treatment. Furthermore, we compared the clinical and microbiological outcomes among patients who received cefiderocol in monotherapy or in combination. RESULTS Thirty-eight patients with forty episodes of infection were included [mean age 65 years (SD+16.3), 75% males, 90% with hospital-acquired infections and 70% showing sepsis or septic shock]. The most common infections included unknown source or catheter-related bacteremia (45%) and pneumonia (40%). We observed at 7 days and at the end of therapy a rate of microbiological failure of 20% and 10%, respectively, and of clinical failure of 47.5% and 32.5%, respectively; the 30-day mortality rate was 47.5%. At multivariate analysis clinical failure at 7 days of treatment was the only independent predictor of 30-day mortality. Comparing monotherapy (used in 72.5%) vs. combination therapy (used in 27.5%), no differences were observed in mortality (51.7 vs 45.5%) and clinical (41.4 vs 63.7%) or microbiological failure (24.1 vs 9.1%). CONCLUSIONS The findings of this study reinforce the effectiveness of cefiderocol in CRAB infections, also as monotherapy. However, prospective multicenter studies with larger sample sizes and a control group treated with standard of care are needed to identify the best treatment for CRAB infections.
Collapse
Affiliation(s)
- Federica Calò
- Department of Mental Health and Public Medicine - Infectious Diseases Unit. University of Campania Luigi Vanvitelli, Naples, Italy
| | - Lorenzo Onorato
- Department of Mental Health and Public Medicine - Infectious Diseases Unit. University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ilaria De Luca
- Department of Mental Health and Public Medicine - Infectious Diseases Unit. University of Campania Luigi Vanvitelli, Naples, Italy
| | - Margherita Macera
- Department of Mental Health and Public Medicine - Infectious Diseases Unit. University of Campania Luigi Vanvitelli, Naples, Italy
| | - Caterina Monari
- Department of Mental Health and Public Medicine - Infectious Diseases Unit. University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania Luigi Vanvitelli-Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Alessia Massa
- Department of Precision Medicine, University of Campania Luigi Vanvitelli-Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II", Naples, Italy
| | - Giovanni Di Caprio
- Infectious and Tropical Diseases Clinic, AORN Sant'Anna and San Sebastiano, Caserta, Italy
| | - Pasquale Pagliano
- Infective Disease Unit, Department of Medicine and Surgery, Scuola Medica Salernitana", University of Salerno, Italy
| | - Fabio Giuliano Numis
- Department of Emergency and Urgent Medicine, Emergency Medicine Unit, Santa Maria Delle Grazie Hospital, Naples, Italy
| | - Pasquale Iuliano
- Unit of Infectious Disease, AORN "San Giuseppe Moscati", Avellino, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II", Naples, Italy
| | - Sebastiano Leone
- Unit of Infectious Disease, AORN "San Giuseppe Moscati", Avellino, Italy
| | - Paolo Maggi
- Infectious and Tropical Diseases Clinic, AORN Sant'Anna and San Sebastiano, Caserta, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine - Infectious Diseases Unit. University of Campania Luigi Vanvitelli, Naples, Italy.
| |
Collapse
|
16
|
Durante-Mangoni E, Riccardi A, Guarino M, Cesaro F, Lugarà M, Mascolo S, Morelli L, Natale V, Andreoni M. Emergency department care of ABSSSI with dalbavancin infusion, direct discharge, and outpatient telemedicine follow up: a study protocol. J Chemother 2023; 35:397-403. [PMID: 36264157 DOI: 10.1080/1120009x.2022.2134616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 08/05/2022] [Accepted: 10/06/2022] [Indexed: 10/24/2022]
Abstract
Novel therapeutic strategies such as the long-acting lipoglycopeptide antibiotics allow for the treatment and discharge of selected emergency department (ED) patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSI), who require intravenous antibiotics and would otherwise be hospitalized. The COVID-19 pandemic highlighted the need to develop strategies that may reduce hospitalization. The telehealth approach has shown success in remote management of cellulitis patients and could aid in the remote follow up of overall ABSSSI patients. This article describes a study protocol for the telemedicine follow up of patients diagnosed with ABSSSI in the ED, requiring intravenous treatment, receiving a single dalbavancin dose, and directly discharged. A telehealth system for remote follow up is evaluated as well as the possible inclusion of point-of-care ultrasound for the appropriate diagnosis of ABSSSI. The study will be conducted in compliance with regulatory requirements; and all collected data will be kept strictly confidential and in accordance with all relevant legislation on the control and protection of personal information. Dissemination of the study protocol may help increasing knowledge and awareness on this topic, with the aim of optimizing patient management, reducing hospitalization and lower the impact on healthcare associated costs.
Collapse
Affiliation(s)
- Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli" and Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Napoli, Italy
| | | | - Mario Guarino
- Unit of Emergency Medicine, Ospedale CTO, A.O.R.N. Ospedali dei Colli, Napoli, Italy
| | - Flavio Cesaro
- Unit of Emergency Medicine, Ospedale CTO, A.O.R.N. Ospedali dei Colli, Napoli, Italy
| | - Marina Lugarà
- Unit of General Medicine, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
| | - Silvia Mascolo
- Unit of Immunodeficiency and Gender Infectious Diseases, A.O.R.N. Ospedali dei Colli - Ospedale Cotugno, Napoli, Italy
| | - Lucia Morelli
- Unit of Emergency Medicine, Ospedale San Paolo, ASL Napoli 1 Centro, Napoli, Italy
| | - Vincenzo Natale
- Unit of Emergency Medicine, ASP Vibo Valenzia, and SIMEU Calabria, Vibo Valentia, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Infectious Diseases Unit, University Hospital "Tor Vergata", Roma, Italy
| |
Collapse
|
17
|
Unar A, Bertolino L, Patauner F, Gallo R, Durante-Mangoni E. Pathophysiology of Disseminated Intravascular Coagulation in Sepsis: A Clinically Focused Overview. Cells 2023; 12:2120. [PMID: 37681852 PMCID: PMC10486945 DOI: 10.3390/cells12172120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023] Open
Abstract
Sepsis is a major global health problem that results from a dysregulated and uncontrolled host response to infection, causing organ failure. Despite effective anti-infective therapy and supportive treatments, the mortality rate of sepsis remains high. Approximately 30-80% of patients with sepsis may develop disseminated intravascular coagulation (DIC), which can double the mortality rate. There is currently no definitive treatment approach for sepsis, with etiologic treatment being the cornerstone of therapy for sepsis-associated DIC. Early detection, diagnosis, and treatment are critical factors that impact the prognosis of sepsis-related DIC. Over the past several decades, researchers have made continuous efforts to better understand the mechanisms of DIC in sepsis, as well as improve its quantitative diagnosis and treatment. This article aims to provide a comprehensive overview of the current understanding of sepsis-related DIC, focusing on common causes and diagnoses, with the goal of guiding healthcare providers in the care of patients with sepsis.
Collapse
Affiliation(s)
- Ahsanullah Unar
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy
| |
Collapse
|
18
|
Fowler VG, Durack DT, Selton-Suty C, Athan E, Bayer AS, Chamis AL, Dahl A, DiBernardo L, Durante-Mangoni E, Duval X, Fortes CQ, Fosbøl E, Hannan MM, Hasse B, Hoen B, Karchmer AW, Mestres CA, Petti CA, Pizzi MN, Preston SD, Roque A, Vandenesch F, van der Meer JTM, van der Vaart TW, Miro JM. The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis 2023; 77:518-526. [PMID: 37138445 PMCID: PMC10681650 DOI: 10.1093/cid/ciad271] [Citation(s) in RCA: 80] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/04/2023] [Accepted: 04/29/2023] [Indexed: 05/05/2023] Open
Abstract
The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have changed significantly since the Duke Criteria were published in 1994 and modified in 2000. The International Society for Cardiovascular Infectious Diseases (ISCVID) convened a multidisciplinary Working Group to update the diagnostic criteria for IE. The resulting 2023 Duke-ISCVID IE Criteria propose significant changes, including new microbiology diagnostics (enzyme immunoassay for Bartonella species, polymerase chain reaction, amplicon/metagenomic sequencing, in situ hybridization), imaging (positron emission computed tomography with 18F-fluorodeoxyglucose, cardiac computed tomography), and inclusion of intraoperative inspection as a new Major Clinical Criterion. The list of "typical" microorganisms causing IE was expanded and includes pathogens to be considered as typical only in the presence of intracardiac prostheses. The requirements for timing and separate venipunctures for blood cultures were removed. Last, additional predisposing conditions (transcatheter valve implants, endovascular cardiac implantable electronic devices, prior IE) were clarified. These diagnostic criteria should be updated periodically by making the Duke-ISCVID Criteria available online as a "Living Document."
Collapse
Affiliation(s)
- Vance G Fowler
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - David T Durack
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Eugene Athan
- Department of Infectious Disease, Barwon Health and School of Medicine, Deakin University, Geelong, Australia
| | - Arnold S Bayer
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA, Torrance, California, USA
- Department of Medicine, The Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anna Lisa Chamis
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Anders Dahl
- Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Louis DiBernardo
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Monaldi Hospital, Naples, Italy
| | - Xavier Duval
- AP-HP, Hôpital Bichat, Centre d'Investigation Clinique, INSERM CIC 1425, Université Paris Cité, IAME, INSERM, Paris, France
| | - Claudio Querido Fortes
- Infectious Diseases Department, Hospital Universitário Clementino Fraga Filho—Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Emil Fosbøl
- The Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Margaret M Hannan
- Clinical Microbiology Department, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland
| | - Bruno Hoen
- Department of Infectious Diseases and Tropical Medicine and Inserm CIC-1424, Université de Lorraine, APEMAC, Nancy, France
| | - Adolf W Karchmer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Cathy A Petti
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- HealthSpring Global Inc, Bradenton, Florida, USA
| | | | | | - Albert Roque
- Department of Radiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Francois Vandenesch
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, INSERM, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
- Institut des agents infectieux, Hospices Civils de Lyon, Lyon, France
| | | | | | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
19
|
Kon H, Hameir A, Nutman A, Temkin E, Keren Paz A, Lellouche J, Schwartz D, Weiss DS, Kaye KS, Daikos GL, Skiada A, Durante-Mangoni E, Dishon Benattar Y, Yahav D, Daitch V, Bernardo M, Iossa D, Friberg LE, Theuretzbacher U, Leibovici L, Dickstein Y, Pollak D, Mendelsohn S, Paul M, Carmeli Y. Prevalence and Clinical Consequences of Colistin Heteroresistance and Evolution into Full Resistance in Carbapenem-Resistant Acinetobacter baumannii. Microbiol Spectr 2023; 11:e0509322. [PMID: 37219426 PMCID: PMC10269815 DOI: 10.1128/spectrum.05093-22] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/08/2023] [Indexed: 05/24/2023] Open
Abstract
Colistin heteroresistance (HR) refers to a bacterial population comprised of several subpopulations with different levels of resistance to colistin. In this study, we discuss the classic form of HR, in which a resistant subpopulation exists within a predominantly susceptible population. We investigated the prevalence of colistin HR and its evolution into full resistance among 173 clinical carbapenem-resistant Acinetobacter baumannii isolates and examined the effect of HR on clinical outcomes. To determine HR, we performed population analysis profiling. Our results showed a high prevalence of HR (67.1%). To examine evolution of HR strains into full resistance, the HR strains were grown in colistin-containing broth, transferred onto colistin-containing plates, and colonies on these plates were transferred into colistin-free broth. Many of the HR strains (80.2%) evolved into full resistance, 17.2% reverted to HR, and 2.6% were borderline. We used logistic regression to compare 14-day clinical failure and 14-day mortality between patients infected by HR versus susceptible non-HR carbapenem-resistant A. baumannii. In the subgroup of patients with bacteremia, HR was significantly associated with 14-day mortality. IMPORTANCE To our knowledge, this is the first large-scale study to report on HR in Gram-negative bacteria. We described the prevalence of colistin HR in a large sample of carbapenem-resistant A. baumannii isolates, the evolution of many colistin HR isolates to a resistant phenotype following colistin exposure and withdrawal, and the clinical consequences of colistin HR. We found a high prevalence of HR among clinical carbapenem-resistant A. baumannii isolates; most evolved into a resistant phenotype following colistin exposure and withdrawal. In patients treated with colistin, evolution of HR A. baumannii into full resistance could lead to higher rates of treatment failure and contribute to the reservoir of colistin-resistant pathogens in health care settings.
Collapse
Affiliation(s)
- Hadas Kon
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - Amichay Hameir
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - Amir Nutman
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elizabeth Temkin
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - Alona Keren Paz
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - Jonathan Lellouche
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
- Adelson School of Medicine, Ariel University, Israel
| | - David Schwartz
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - David S. Weiss
- Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Keith S. Kaye
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - George L. Daikos
- First Department of Medicine, Laikon General Hospital, Athens, Greece
- National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Skiada
- First Department of Medicine, Laikon General Hospital, Athens, Greece
- National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
- AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Yael Dishon Benattar
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Dafna Yahav
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Vered Daitch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Mariano Bernardo
- Microbiology and Virology Unit, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Domenico Iossa
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | | | - Leonard Leibovici
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yaakov Dickstein
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Dina Pollak
- Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
| | - Sigal Mendelsohn
- Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
| | - Mical Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
20
|
Zampino R, Gallo R, Salemme A, Marrazzo T, Iossa D, Karruli A, Andini R, Esitini D, Moretto SM, De Gregorio F, Durante-Mangoni E. Clinical results with the use of Ceftaroline and Ceftobiprole: real life experience in a tertiary care Hospital. Int J Antimicrob Agents 2023:106883. [PMID: 37302772 DOI: 10.1016/j.ijantimicag.2023.106883] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/28/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Ceftaroline and Ceftobiprole show activity against resistant Gram-positive cocci and good tolerability, and are increasingly used in diverse infections. No comparative data on efficacy and safety of Ceftaroline and Ceftobiprole in real-life are available. METHODS In this single center, observational, retrospective clinical study, we compared outcomes of patients treated with Ceftaroline or Ceftobiprole in our Hospital, assessing clinical data, use and drug exposure of study antibiotics, and outcomes. RESULTS Included in this study were 138 patients, of whom 75 were treated with Ceftaroline and 63 with Ceftobiprole. Patients treated with Ceftobiprole had more comorbidities (median CCI 5 [4-7] vs 4 [2-6] for Ceftaroline, p=0.003), higher prevalence of multiple site infections (p< 0.001) and were more often treated empirically (p= 0.004), whilst Ceftaroline was more frequently used in patients with health-care related infections. No differences were observed in terms of hospital mortality, length of stay and clinical cure, improvement or failure. The only independent predictor of outcome was S. aureus infection. Both treatments were generally well tolerated. CONCLUSION In our real-life experience, Ceftaroline and Ceftobiprole, applied in different clinical scenarios, were comparable in terms of clinical efficacy and tolerability in a range of severe infections with variable aetiology and different levels of clinical severity. We believe our data may support the clinician choosing the best option for each therapeutic setting.
Collapse
Affiliation(s)
- Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Napoli, (Italy); Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Napoli, (Italy)
| | - Raffaella Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Napoli, (Italy)
| | - Anna Salemme
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Napoli, (Italy)
| | - Tommaso Marrazzo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Napoli, (Italy); Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Napoli, (Italy)
| | - Domenico Iossa
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Napoli, (Italy)
| | - Arta Karruli
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Napoli, (Italy)
| | - Roberto Andini
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Napoli, (Italy)
| | - Daniele Esitini
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Napoli, (Italy)
| | - Simona Maria Moretto
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Napoli, (Italy)
| | - Fabrizio De Gregorio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia, 2, 80138, Napoli, (Italy)
| | - Emanuele Durante-Mangoni
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Napoli, (Italy); Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Via de Crecchio, 7, 80138, Napoli, (Italy).
| |
Collapse
|
21
|
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: 6] [Impact Index Per Article: 6.0] [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.
Collapse
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
| |
Collapse
|
22
|
Ambrosioni J, Hernández-Meneses M, Durante-Mangoni E, Tattevin P, Olaison L, Freiberger T, Hurley J, Hannan MM, Chu V, Hoen B, Moreno A, Cuervo G, Llopis J, Miró JM. Epidemiological Changes and Improvement in Outcomes of Infective Endocarditis in Europe in the Twenty-First Century: An International Collaboration on Endocarditis (ICE) Prospective Cohort Study (2000-2012). Infect Dis Ther 2023; 12:1083-1101. [PMID: 36922460 PMCID: PMC10147876 DOI: 10.1007/s40121-023-00763-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Infective endocarditis (IE) has undergone important changes in its epidemiology worldwide. METHODS The study aimed to compare IE epidemiological features and outcomes according to predefined European regions and between two different time periods in the twenty-first century. RESULTS IE cases from 13 European countries were included. Two periods were considered: 2000-2006 and 2008-2012. Two European regions were considered, according to the United Nations geoscheme for Europe: Southern (SE) and Northern-Central Europe (NCE). Comparisons were performed between regions and periods. A total of 4195 episodes of IE were included, 2113 from SE and 2082 from NCE; 2787 cases were included between 2000 and 2006 and 1408 between 2008 and 2012. Median (IQR) age was 63.7 (49-74) years and 69.4% were males. Native valve IE (NVE), prosthetic valve IE (PVE), and device-related IE were diagnosed in 68.3%, 23.9%, and 7.8% of cases, respectively; 52% underwent surgery and 19.3% died during hospitalization. NVE was more prevalent in NCE, whereas device-related IE was more frequent in SE. Higher age, acute presentation, hemodialysis, cancer, and diabetes mellitus all were more prevalent in the second period. NVE decreased and PVE and device-related IE both increased in the second period. Surgical treatment also increased from 48.7% to 58.4% (p < 0.01). In-hospital and 6-month mortality rates were comparable between regions and significantly decreased in the second period. CONCLUSIONS Despite an increased complexity of IE cases, prognosis improved in recent years with a significant decrease in 6-month mortality. Outcome did not differ according to the European region (SE versus NCE).
Collapse
Affiliation(s)
- Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marta Hernández-Meneses
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Pierre Tattevin
- Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Freiberger
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - John Hurley
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Margaret M Hannan
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Vivian Chu
- Duke University School of Medicine, Durham, NC, USA
| | - Bruno Hoen
- Department of Infectious Diseases and Tropical Medicine and Inserm CIC-1424, University of Lorraine Medical Center at Nancy, EA 4364 APEMAC, University of Lorraine, Nancy, France
| | - Asunción Moreno
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Jaume Llopis
- Biostatistics Department, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
23
|
Pascale R, Toschi A, Aslan AT, Massaro G, Maccaro A, Fabbricatore D, Dell'Aquila A, Ripa M, Işık ME, Kızmaz YU, Iacopino S, Camici M, Perna F, Akinosoglou K, Karruli A, Papadimitriou-Olivgeris M, Kayaaslan B, Bilir YA, Evren Özcan E, Turan OE, Işık MC, Pérez-Rodríguez MT, Yagüe BL, Quirós AM, Yılmaz M, Petersdorf S, De Potter T, Durante-Mangoni E, Akova M, Curnis A, Gibertoni D, Diemberger I, Scudeller L, Viale P, Giannella M. Risk factors for Gram-negative bacterial infection of cardiovascular implantable electronic devices: multicentre observational study (CarDINe Study). Int J Antimicrob Agents 2023; 61:106734. [PMID: 36690123 DOI: 10.1016/j.ijantimicag.2023.106734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Infections of cardiovascular implantable electronic devices (CIED) are mainly due to Gram-positive bacteria (GPB). Data about Gram-negative bacteria CIED (GNB-CIED) infections are limited. This study aimed to investigate risk factors, clinical and diagnostic characteristics, and outcome of patients with GNB-CIED. METHODS A multicentre, international, retrospective, case-control-control study was performed on patients undergoing CIED implantation from 2015 to 2019 in 17 centres across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected. RESULTS A total of 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infection and 118 without infection. No between-group differences were found regarding clinical presentation, diagnostic and therapeutic management. A trend toward a higher rate of fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity was observed among patients with GNB than in those with GPB-CIED infection (85.7% vs. 66.7%; P = 0.208). Risk factors for GNB-CIED infection were Charlson Comorbidity Index Score (relative risk reduction, RRR = 1.211; P = 0.011), obesity (RRR = 5.122; P = 0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker implantation (RRR = 3.027; P = 0.006) and right subclavian vein site of implantation (RRR = 5.014; P = 0.004). At 180-day survival analysis, GNB-CIED infection was associated with increased mortality risk (HR = 1.842; P = 0.067). CONCLUSIONS Obesity, high number of comorbidities and right subclavian vein implantation site were associated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided using FDG PET/CT is suggested in patients with GNB-CIED infection, considering the poorer outcome observed in this group.
Collapse
Affiliation(s)
- Renato Pascale
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Alice Toschi
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Abdullah Tarik Aslan
- Golhisar State Hospital, Department of Internal Medicine, Burdur, Turkey; Hacettepe University School of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Giulia Massaro
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Maccaro
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Fabbricatore
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Andrea Dell'Aquila
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili Hospital of Brescia and University of Brescia, Brescia, Italy
| | - Marco Ripa
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mehmet Emirhan Işık
- University of Health Sciences Kosuyolu Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Yeşim Uygun Kızmaz
- University of Health Sciences Kosuyolu Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | | | - Marta Camici
- Institute of infectious diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; HIV/AIDS Clinical Unit, National Institute for infectious Diseases L. Spallanzani IRCCS, Rome, Italy
| | - Francesco Perna
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Arta Karruli
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | | | - Bircan Kayaaslan
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Yeşim Aybar Bilir
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Emin Evren Özcan
- Dokuz Eylul University, Heart Rhythm Management Center, İzmir, Turkey
| | | | - Muhammed Cihan Işık
- Hacettepe University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - María Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain Instituto de Investigación Biomédica Galicia Sur, Spain
| | - Belén Loeches Yagüe
- Infectious Diseases Unit, Hospital Universitario La Paz - IDIPAZ, Madrid, Spain
| | | | - Mesut Yılmaz
- Istanbul Medipol University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Sabine Petersdorf
- Institute of Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal, Witten/Herdecke University, Witten, Germany
| | - Tom De Potter
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Murat Akova
- Hacettepe University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Antonio Curnis
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili Hospital of Brescia and University of Brescia, Brescia, Italy
| | - Dino Gibertoni
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigia Scudeller
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | |
Collapse
|
24
|
Karruli A, Catalini C, D’Amore C, Foglia F, Mari F, Harxhi A, Galdiero M, Durante-Mangoni E. Evidence-Based Treatment of Pseudomonas aeruginosa Infections: A Critical Reappraisal. Antibiotics (Basel) 2023; 12:antibiotics12020399. [PMID: 36830309 PMCID: PMC9952410 DOI: 10.3390/antibiotics12020399] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 01/22/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Multidrug-resistant (MDR)/extensively drug-resistant (XDR) Pseudomonas aeruginosa is emerging as a major threat related to adverse patient outcomes. The goal of this review is to describe evidence-based empiric and targeted treatment regimens that can be exploited when dealing with suspected or confirmed infections due to MDR/XDR P. aeruginosa. P. aeruginosa has inherent resistance to many drug classes, the capacity to form biofilms, and most importantly, the ability to quickly acquire resistance to ongoing treatments. Based on the presence of risk factors for MDR/XDR infections and local epidemiology, where large proportions of strains are resistant to classic beta-lactams, the recommended empirical treatment for suspected P. aeruginosa infections is based on ceftolozane-tazobactam or ceftazidime-avibactam. Where local epidemiology indicates low rates of MDR/XDR and there are no risk factors, a third or fourth generation cephalosporin can be used in the context of a "carbapenem-sparing" strategy. Whenever feasible, antibiotic de-escalation is recommended after antimicrobial susceptibility tests suggest that it is appropriate, and de-escalation is based on different resistance mechanisms. Cefiderocol and imipenem-cilastatin-relebactam withstand most resistance mechanisms and may remain active in cases with resistance to other new antibiotics. Confronting the growing threat of MDR/XDR P. aeruginosa, treatment choices should be wise, sparing newer antibiotics when dealing with a suspected/confirmed susceptible P. aeruginosa strain and choosing the right option for MDR/XDR P. aeruginosa based on specific types and resistance mechanisms.
Collapse
Affiliation(s)
- Arta Karruli
- Department of Precision Medicine, University of Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy
- Department of Infectious Diseases, University Hospital “Mother Teresa”, 10001 Tirana, Albania
- Correspondence: ; Tel.: +39-324-6222295
| | - Christian Catalini
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy
| | - Chiara D’Amore
- Infectious Diseases Unit, San Giovanni di Dio e Ruggi D’Aragona Hospital, 84131 Salerno, Italy
| | - Francesco Foglia
- Unit of Microbiology and Virology, Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy
| | - Fabio Mari
- Department of Emergency Medicine, University “Federico II”, 80138 Naples, Italy
| | - Arjan Harxhi
- Department of Infectious Diseases, University Hospital “Mother Teresa”, 10001 Tirana, Albania
| | - Massimiliano Galdiero
- Unit of Microbiology and Virology, Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy
| |
Collapse
|
25
|
Karruli A, Massa A, Andini R, Marrazzo T, Ruocco G, Zampino R, Durante-Mangoni E. Clinical efficacy and safety of cefiderocol for resistant Gram-negative infections: a real-life, single-centre experience. Int J Antimicrob Agents 2023; 61:106723. [PMID: 36642233 DOI: 10.1016/j.ijantimicag.2023.106723] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/18/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Cefiderocol is a 'siderophore' cephalosporin active against Gram-negative bacteria, including carbapenem-resistant strains. Data on the use of cefiderocol in real life are limited. We evaluated the efficacy and safety of cefiderocol in the context of our hospital clinical practice. METHODS This was a single-centre, observational, retrospective clinical study. We collected data for all patients who received cefiderocol therapy in our hospital, with a focus on clinical outcomes and adverse events. RESULTS The study cohort included 28 patients, with a median age of 73 years (25-83 years) and a high burden of co-morbidities. Up to 45 Gram-negative isolates were cultured from the study patients, the most common pathogen being Acinetobacter baumannii (31.1%). Cefiderocol was mostly prescribed for pneumonia (37.8% of cases), bloodstream infection (24.4%), urinary tract infection (22.2%) and intra-abdominal infection (20%), and largely as salvage therapy (92.8%). Of the 18 patients for whom follow-up cultures were available, 14 (77.8%) achieved eradication of the causative micro-organism. Therapeutic success (improvement/resolution of infection) occurred in 64.3% of cases at 7 days and 50% at 14 days from treatment start. Treatment failed in 9 cases (32.1%). No effects on kidney, liver or bone marrow function were observed. CONCLUSIONS Cefiderocol showed fair efficacy and excellent tolerability in highly co-morbid patients with a range of multiresistant infections. It may be an option for infections due to colistin-resistant pathogens, when other regimens fail or in cases at risk of kidney dysfunction.
Collapse
Affiliation(s)
- Arta Karruli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessia Massa
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Andini
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy
| | - Tommaso Marrazzo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Ruocco
- Unit of Microbiology and Virology, AORN Ospedali dei Colli, Piazzale Ettore Ruggieri, 80131 Naples, Italy
| | - Rosa Zampino
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy.
| |
Collapse
|
26
|
Kaye KS, Marchaim D, Thamlikitkul V, Carmeli Y, Chiu CH, Daikos G, Dhar S, Durante-Mangoni E, Gikas A, Kotanidou A, Paul M, Roilides E, Rybak M, Samarkos M, Sims M, Tancheva D, Tsiodras S, Kett D, Patel G, Calfee D, Leibovici L, Power L, Munoz-Price S, Stevenson K, Susick L, Latack K, Daniel J, Chiou C, Divine GW, Ghazyaran V, Pogue JM. Colistin Monotherapy versus Combination Therapy for Carbapenem-Resistant Organisms. NEJM Evid 2023; 2:10.1056/evidoa2200131. [PMID: 37538951 PMCID: PMC10398788 DOI: 10.1056/evidoa2200131] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Pneumonia and bloodstream infections (BSI) due to extensively drug-resistant (XDR) Acinetobacter baumannii, XDR Pseudomonas aeruginosa, and carbapenem-resistant Enterobacterales (CRE) are associated with high mortality rates, and therapeutic options remain limited. This trial assessed whether combination therapy with colistin and meropenem was superior to colistin monotherapy for the treatment of these infections. METHODS The OVERCOME (Colistin Monotherapy versus Combination Therapy) trial was an international, randomized, double-blind, placebo-controlled trial. We randomly assigned participants to receive colistin (5 mg/kg once followed by 1.67 mg/kg every 8 hours) in combination with either meropenem (1000 mg every 8 hours) or matching placebo for the treatment of pneumonia and/or BSI caused by XDR A. baumannii, XDR P. aeruginosa, or CRE. The primary outcome was 28-day mortality, and secondary outcomes included clinical failure and microbiologic cure. RESULTS Between 2012 and 2020, a total of 464 participants were randomly assigned to treatment, and 423 eligible patients comprised the modified intention-to-treat population. A. baumannii was the predominant trial pathogen (78%) and pneumonia the most common index infection (70%). Most patients were in the intensive care unit at the time of enrollment (69%). There was no difference in mortality (43 vs. 37%; P=0.17), clinical failure (65 vs. 58%; difference, 6.8 percentage points; 95% confidence interval [CI], -3.1 to 16.6), microbiologic cure (65 vs. 60%; difference, 4.8 percentage points; 95% CI, -5.6 to 15.2), or adverse events (acute kidney injury, 52 vs. 49% [P=0.55]; hypersensitivity reaction, 1 vs. 3% [P=0.22]; and neurotoxicity, 5 vs. 2% [P=0.29]) between patients receiving monotherapy and combination therapy, respectively. CONCLUSIONS Combination therapy with colistin and meropenem was not superior to colistin monotherapy for the treatment of pneumonia or BSI caused by these pathogens. (Funded by the National Institute of Allergy and Infectious Diseases, Division of Microbiology and Infectious Diseases protocol 10-0065; ClinicalTrials.gov number, NCT01597973.).
Collapse
Affiliation(s)
- Keith S Kaye
- Division of Allergy, Immunology, and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Dror Marchaim
- Division of Infectious Diseases, Assaf Harofeh Medical Center, Be'er Ya'akov, Israel
| | - Visanu Thamlikitkul
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yehuda Carmeli
- Laboratory for Microbiology and Infection Control, Tel Aviv University, Tel Aviv, Israel
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - George Daikos
- School of Medicine, National and Kapodistrian University of Athens
| | - Sorabh Dhar
- Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit
| | - Emanuele Durante-Mangoni
- Internal Medicine, University of Campania "Luigi Vanvitelli" and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - Achilles Gikas
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Irákleio, Greece
| | | | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Emmanuelle Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University School of Health Sciences and Hippokration General Hospital, Thessaloniki, Greece
| | - Michael Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit
| | - Michael Samarkos
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens
| | | | - Dora Tancheva
- Centre for Burns and Plastic Surgery, Pirogov Emergency Medicine Hospital, Sofia, Bulgaria
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School
| | - Daniel Kett
- University of Miami Hospital, Jackson Memorial Hospital
| | - Gopi Patel
- Division of Infectious Diseases, Mount Sinai Hospital, New York
| | - David Calfee
- Division of Infectious Disease, Weill Cornell Medicine, New York
| | | | | | | | | | - Laura Susick
- Department of Public Health Sciences, Henry Ford Health, Detroit
| | - Katie Latack
- Department of Public Health Sciences, Henry Ford Health, Detroit
| | - Jolene Daniel
- Division of Allergy, Immunology, and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christine Chiou
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - George W Divine
- Department of Public Health Sciences, Henry Ford Health, Detroit
| | - Varduhi Ghazyaran
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Jason M Pogue
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor
| |
Collapse
|
27
|
Abstract
As of August 5, 2022, >26,000 cases of monkeypox have been diagnosed worldwide and the steep increase of cases has spurred renewed concern about the risk for another viral pandemic. In this narrative review, we address etiology, epidemiology and virology of monkeypox, describing routes of transmission and modes of spread. We also describe the current clinical presentation of monkeypox, focusing on circumstances where the disease should be suspected, and the methods to diagnose it. Finally, we briefly describe available treatments and strategies for active immune prophylaxis.
Collapse
Affiliation(s)
- Fabian Patauner
- Department of Precision Medicine, University fo Campania 'Luigi Vanvitelli' & Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Raffaella Gallo
- Department of Precision Medicine, University fo Campania 'Luigi Vanvitelli' & Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University fo Campania 'Luigi Vanvitelli' & Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
| |
Collapse
|
28
|
Ramadan MS, Boccia F, Moretto SM, De Gregorio F, Gagliardi M, Iossa D, Durante-Mangoni E, Zampino R. Cardiovascular Risk in Patients with Chronic Hepatitis C Treated with Direct Acting Antivirals. J Clin Med 2022; 11:jcm11195781. [PMID: 36233646 PMCID: PMC9572655 DOI: 10.3390/jcm11195781] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic hepatitis C (CHC) is associated with hepatic and extrahepatic complications, including cardiovascular disease (CVD). The effects of sustained virological response (SVR) and liver fibrosis on CVD risk are not well established. Aims: We aim to assess the dynamics of Fibrosis-4 (FIB-4) and Atherosclerotic Cardiovascular Disease 2013 (ASCVD) scores up to three years after direct acting antivirals (DAA) treatment and explore the time-dependent association between the two scores. Methods: We included consecutive CHC patients treated with DAA and followed up with them for three years. Outcomes were changes from baseline (before DAA) in ASCVD and FIB-4 scores, measured at the end of treatment, 12-, 24-, and 36-months follow-up. Results: In total, 91 patients with CHC were finally included (median age: 66 years (IQR = 58−72 years); 43% females). Median follow-up was 2 years (1−3 years) and all patients reached SVR. The ASCVD score did not significantly change from baseline (Mean = 17.2%, 95% CI 14.1, 20.3), but the FIB-4 score significantly decreased at any time-point by an average of 0.8 (95% CI 0.78, 0.82, p < 0.001). Elevated FIB-4 scores at one (β = 1.16, p < 0.001) and three years (β = 2.52, p < 0.001) were associated with an increased ASCVD score. Clinically, two participants- with non-decreasing FIB-4 scores after treatment- had acute coronary syndrome at the end of treatment and one year follow-up, respectively. Conclusions: In our study, we found that FIB-4 and ASCVD scores exhibited a positive correlation irrespective of time-point after treatment. Larger studies are essential to further investigate the utility of FIB-4 scores in cardiovascular risk assessment.
Collapse
Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, 80138 Naples, Italy
| | - Filomena Boccia
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Simona Maria Moretto
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Fabrizio De Gregorio
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Massimo Gagliardi
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
| | - Domenico Iossa
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, 80138 Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-7062475; Fax: +39-081-7702645
| | - Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 81031 Naples, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy
| |
Collapse
|
29
|
Ramadan MS, Gallo R, Patauner F, Bertolino L, Durante-Mangoni E. Emerging Concepts on Infection of Novel Cardiac Implantable Devices. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2308277] [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: 11/06/2022] Open
|
30
|
Patauner F, Stanzione M, Stornaiuolo G, Martone V, Palladino R, Coppola N, Durante-Mangoni E, Zampino R. Safety and Efficacy of Direct Antiviral Agents for Hepatitis C in Patients with Malignancies Other Than Liver Cancer: A Case Series. Pathogens 2022; 11:pathogens11080860. [PMID: 36014981 PMCID: PMC9414735 DOI: 10.3390/pathogens11080860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: direct-acting antivirals (DAA) are the current standard of care for chronic hepatitis C. Oncologic patients remain among the most difficult-to-treat subgroups of hepatitis C virus (HCV)-infected patients due to their clinical frailty and complex therapeutic protocols received. (2) Methods: we retrospectively collected and analysed clinical data of 30 consecutive patients treated with DAA, between 2015 and 2022, for chronic HCV infection in the context of oncologic disease. (3) Results: most patients were females (63.3%), median age was 67 years, HCV genotype 1 was prevalent (60%), and median HCV RNA levels were 2.2 × 106 IU/mL. The most common malignancy was breast cancer (37%), and the chief oncologic drugs co-administered with DAAs were tamoxifen, platinum derivatives, cyclophosphamide, paclitaxel, rituximab and doxorubicin. Overall, 50% of patients had chronic hepatitis. A total of 76.7% underwent a sofosbuvir-based treatment. Sustained virological response 12 weeks after the end of therapy (SVR12) was reached in all patients. After SVR12, two patients died. DAA treatment was well tolerated; no patients had to stop DAA treatment or showed any adverse event or drug-drug interaction specifically attributable to DAAs. (4) Conclusions: DAA treatment should be promptly offered to oncologic patients with chronic hepatitis C in order to achieve aminotransferase normalization and viremia control, making antineoplastic therapy feasible and safe.
Collapse
Affiliation(s)
- Fabian Patauner
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (F.P.); (V.M.); (R.Z.)
| | - Maria Stanzione
- Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (M.S.); (G.S.); (R.P.); (N.C.)
| | - Gianfranca Stornaiuolo
- Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (M.S.); (G.S.); (R.P.); (N.C.)
| | - Veronica Martone
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (F.P.); (V.M.); (R.Z.)
| | - Roberta Palladino
- Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (M.S.); (G.S.); (R.P.); (N.C.)
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (M.S.); (G.S.); (R.P.); (N.C.)
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy
- Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-7062475; Fax: +39-081-7062686
| | - Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy; (F.P.); (V.M.); (R.Z.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, 80131 Naples, Italy
| |
Collapse
|
31
|
Pascale R, Abdullah TA, Fabbricatore D, De Potter T, Ripa M, Durante-Mangoni E, Leventopulos G, Domenichini G, Iacopino S, Akova M, Diemberger I, Viale P, Giannella M. Risk factors for gram-negative infection of cardiovascular implantable electronic devices: retrospective multicenter study - CarDINe study. Europace 2022. [DOI: 10.1093/europace/euac053.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Dr. Fabbricatore is supported by a research grant from the CardioPaTh PhD Program
Background
Gram-negative bacteria (GNB) are unfrequently isolated from patients with cardiac implantable electronic device (CIED) infection. However, data about risk factors for GNB-CIED-infection and associated clinical outcome are missing.
Methods
Multicenter, retrospective case-control-control study. Adult patients undergoing CIED implantation from Jan 2015 to Dec 2019 were included and classified as case (C) if diagnosed of GNB-CIED-infection; control 1 (C1) if diagnosed with Gram positive bacteria (GPB)-CIED infection; and control 2 (C2) if no CIED-infection was diagnosed during the study period. Patients were matched by center and risk period (from CIED implantation to infection diagnosis ±1 month), with a minimum follow-up period after infection diagnosis of 180 days.
Results
Study cohort consisted of 134 patients (33 C, 53 C1 and 42 C2) from 11 centers. Overall, 99 (73.9%) were male, median age 73 (IQR 66-81) years. Cardiac diseases leading to CIED implantation were bradi-arrythmia (48%), hearth failure (23.5), and primary prevention (20.6%). There were not differences for demographic variables and Charlson Index between C, C1 and C2. Time from implantation to infection diagnosis was similar between C and C1 [274 (39-621) vs 220 (58-866) days, p=0.581]. Shariff score was lower in C compared with C1 [1(1-2) vs 2 (1-3); p<0.001]. C reported more frequently than C1 a prior infection (not CIED related) (33% vs 16%, p=0.08). GN and GP causative agents of CIED-infection are depicted in Fig.1. No differences regarding CIED-infection type (pocket site, endocarditis) were observed between C and C1. Interestingly, PET-FDG was more frequently performed in C compared with C1 (41.2% vs 17%, p=0.013), with a trend toward higher yielding (83% vs. 50%, p=0.16). CIED extraction was performed in 79.4% and 92.5% (p=0.07) of C and C1, respectively. Length of stay was similar between groups [17 (7-39) vs23 (12-41) days, p=0.326]. 6-month survival was significantly lower in C compared with C1 and C2 at Kaplan Meier analysis (Fig.2).
Conclusions
GNB-CIED infection is associated with higher 6-month mortality than GPB- or no-CIED infections, prior GNB infection may favor subsequent GNB-CIED infection, the role of PET-FDG in diagnosing GNB-CIED infection seems to be key.
Collapse
Affiliation(s)
- R Pascale
- University of Bologna - Alma Mater Studiorum, Infectious disease, Bologna, Italy
| | - TA Abdullah
- Hacettepe University, Infectious disease, Ankara, Turkey
| | - D Fabbricatore
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - T De Potter
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - M Ripa
- University Vita-Salute San Raffaele, Milan, Italy
| | | | | | - G Domenichini
- University Hospital of Lausanne, Lausanne, Switzerland
| | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - M Akova
- Hacettepe University, Infectious disease, Ankara, Turkey
| | - I Diemberger
- Institute of Cardiology University of Bologna, Bologna, Italy
| | - P Viale
- University of Bologna - Alma Mater Studiorum, Infectious disease, Bologna, Italy
| | - M Giannella
- University of Bologna - Alma Mater Studiorum, Infectious disease, Bologna, Italy
| |
Collapse
|
32
|
Bertolino L, Ursi MP, Iossa D, Karruli A, D’Amico F, Zampino R, Dialetto G, De Feo M, Durante-Mangoni E, Durante-Mangoni E, Iossa D, Bertolino L, Ursi MP, D’Amico F, Karruli A, Ramadan M, Andini R, Zampino R, Bernardo M, Ruocco G, Dialetto G, Covino FE, Manduca S, Della Corte A, De Santo LS, Carozza A, De Feo M, De Vivo MD S, De Rimini ML, Galdieri N. Dissecting the correlates of N-terminal prohormone brain natriuretic peptide in acute infective endocarditis. Infection 2022; 50:1465-1474. [PMID: 35430641 PMCID: PMC9705495 DOI: 10.1007/s15010-022-01813-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/22/2022] [Indexed: 11/05/2022]
Abstract
Abstract
Purpose
To explore the prognostic value and the correlates of NT-proBNP in patients with acute infective endocarditis, a life-threatening disease, with an often unpredictable outcome given by the lack of reliable prognostic parameters.
Methods
We retrospectively studied 337 patients admitted to our centre between January 1, 2006 and September 30, 2020 with available NT-proBNP level at admission. Our analyses were performed considering NT-proBNP as both a categorical variable, using the median value as the cut-off level, and numerical variable. Study end points were in-hospital mortality, cardiac surgery and 1 year survival.
Results
NT-proBNP was an independent predictor of in-hospital mortality (OR 14.9 [95%C.I. 2.46–90.9]; P = .003). Levels below 2926 pg/mL were highly predictive of a favorable in-hospital outcome (negative predictive value 96.6%). Patients with higher NT-proBNP levels showed a significantly lower survival rate at 1 year follow-up (log-rank P = .005). NT-proBNP was strongly associated with chronic kidney disease (P < .001) and significantly higher in patients with prior chronic heart failure (P = .001). NT-proBNP was tightly related to staphylococcal IE (P = .001) as well as with higher CRP and hs-troponin I (P = 0.023, P < .001, respectively).
Conclusion
Our results confirm the remarkable prognostic role of NT-proBNP in patients with IE and provide novel evidences of its multifaceted correlates in this unique clinical setting. Our data strongly support the incorporation of NT-proBNP into the current diagnostic work-up of IE.
Collapse
|
33
|
Zampino R, Patauner F, Karruli A, Iossa D, Ursi MP, Bertolino L, Peluso AM, D’Amico F, Cavezza G, Durante-Mangoni E. Prognostic Value of Decreased High-Density Lipoprotein Cholesterol Levels in Infective Endocarditis. J Clin Med 2022; 11:jcm11040957. [PMID: 35207230 PMCID: PMC8877683 DOI: 10.3390/jcm11040957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Simple parameters to be used as early predictors of prognosis in infective endocarditis (IE) are lacking. The aim of this study was to evaluate the prognostic role of high-density-lipoprotein cholesterol (HDL-C) and also of total-cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), and triglycerides, in relation to clinical features and mortality, in IE. (2) Methods: Retrospective analysis of observational data from 127 consecutive patients with a definite diagnosis of IE between 2016 and 2019. Clinical, laboratory and echocardiography data, mortality, and co-morbidities were analyzed in relation to HDL-C and lipid profile. (3) Results: Lower HDL-C levels (p = 0.035) were independently associated with in-hospital mortality. HDL-C levels were also significantly lower in IE patients with embolic events (p = 0.036). Based on ROC curve analysis, a cut-off value was identified for HDL-C equal to 24.5 mg/dL for in-hospital mortality. HDL-C values below this cut-off were associated with higher triglyceride counts (p = 0.008), higher prevalence of S. aureus etiology (p = 0.046) and a higher in-hospital mortality rate (p = 0.004). Kaplan–Meier survival analysis showed higher 90-day mortality in patients with HDL-C ≤ 24.5 mg/dL (p = 0.001). (4) Conclusions: Low HDL-C levels could be used as an easy and low-cost marker of severity in IE, particularly to predict complications, in-hospital and 90-day mortality.
Collapse
Affiliation(s)
- Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (R.Z.); (F.P.); (M.P.U.); (L.B.); (A.M.P.)
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli—Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (D.I.); (F.D.)
| | - Fabian Patauner
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (R.Z.); (F.P.); (M.P.U.); (L.B.); (A.M.P.)
| | - Arta Karruli
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio, 7, 80138 Napoli, Italy; (A.K.); (G.C.)
| | - Domenico Iossa
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli—Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (D.I.); (F.D.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio, 7, 80138 Napoli, Italy; (A.K.); (G.C.)
| | - Maria Paola Ursi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (R.Z.); (F.P.); (M.P.U.); (L.B.); (A.M.P.)
| | - Lorenzo Bertolino
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (R.Z.); (F.P.); (M.P.U.); (L.B.); (A.M.P.)
| | - Anna Maria Peluso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy; (R.Z.); (F.P.); (M.P.U.); (L.B.); (A.M.P.)
| | - Fabiana D’Amico
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli—Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (D.I.); (F.D.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio, 7, 80138 Napoli, Italy; (A.K.); (G.C.)
| | - Giusi Cavezza
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio, 7, 80138 Napoli, Italy; (A.K.); (G.C.)
| | - Emanuele Durante-Mangoni
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli—Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131 Napoli, Italy; (D.I.); (F.D.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio, 7, 80138 Napoli, Italy; (A.K.); (G.C.)
- Correspondence: ; Tel.: +39-081-7062475; Fax: +39-081-7062686
| |
Collapse
|
34
|
Ramadan MS, Gallo R, Lugarà M, Gambardella M, Oliva G, Bertolino L, Andini R, Coppola N, Zampino R, Durante-Mangoni E. Dalbavancin treatment for spondylodiscitis: multi-center clinical experience and literature review. J Chemother 2021; 34:360-366. [PMID: 34923922 DOI: 10.1080/1120009x.2021.2015649] [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: 10/19/2022]
Abstract
Dalbavancin is a novel lipoglycopeptide antibiotic, characterized by a broad spectrum of activity against Gram-positive cocci. However, its efficacy in spondylodiscitis treatment is not fully established. All adult patients diagnosed with spondylodiscitis and treated with dalbavancin were included across four Italian medical centers from January 2018 to April 2021. We collected clinical and laboratory data, and presented follow-up findings along with a thorough literature review. 13 patients (mean age= 65 years) were included in this study. Dalbavancin was administered as first line treatment in six (46%) of the patients. Reasons for using Dalbavancin included treatment simplification (62%) and clinical failure of previous antibiotics (23%). In general, Dalbavancin was well tolerated with minimal adverse events, and clinical success was achieved in 11/13 (85%) of the patients during hospitalization with additional antibiotics required in the remaining two cases. Five months after discharge, no mortality was observed, however, 42% of patients required additional antibiotics for signs of infection on follow-up imaging. Our study suggests that Dalbavancin could be an effective and safe option in treating spondylodiscitis, however, the scarcity of studies on the topic is concerning. Thus, further studies with large samples and long-term follow-up are warranted to compare the efficacy of Dalbavancin with other available treatment options.
Collapse
Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marina Lugarà
- Unit of Internal Medicine, Ospedale del Mare, Naples, Italy
| | | | | | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto Andini
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Naples, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosa Zampino
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Naples, Italy.,Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.,Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli - Ospedale Monaldi, Naples, Italy
| |
Collapse
|
35
|
Durante-Mangoni E, Giuffrè G, Ursi MP, Iossa D, Bertolino L, Senese A, Pafundi PC, D'Amico F, Albisinni R, Zampino R. Predictors of long-term mortality in left-sided infective endocarditis: an historical cohort study in 414 patients. Eur J Intern Med 2021; 94:27-33. [PMID: 34474958 DOI: 10.1016/j.ejim.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/20/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Very limited data are available on the long-term outcome of infective endocarditis (IE) and its determinants. The aim of this study was to identify the predictors of long-term mortality in patients affected by left sided IE (LSIE). METHODS This was an historical retrospective observational study on prospectively collected data from patients with LSIE hospitalized in our Unit (January 2000-December 2017). Multiple variables relevant to history, physical examination, laboratory tests, echocardiography, comorbidities, complications and outcome were analysed by Cox regression to identify predictors of long-term mortality. RESULTS 414 patients were included, and followed up for a median of 39 months [IQR 11-74]. Median age was 59 years [range 3-89], and most patients were male. Over 50% showed at least one comorbidity. Hyperglycaemia, increased creatinine and an indication for surgery predicted in-hospital mortality, while a prior myocardial infarction, chronic kidney disease (CKD) on hemodialysis and a larger vegetation were independent predictors of 1-year mortality. At multivariate analysis, peripheral arterial disease (p= 0.017), hyperglycemia on admission (p=0.013) and a higher BMI (p=0.009) were independent predictors of long-term mortality in 1-year survivors. At multivariable Cox proportional hazard regression, peripheral arterial disease (p=0.002), hyperglycemia (p=0.041) and CKD on hemodialysis (p=0.025) confirmed to be independently associated with an increased risk of long-term mortality in the overall 414 patient cohort. CONCLUSIONS Cardiovascular and metabolic risk signals, specifically peripheral arterial disease and hyperglicemia, affect long-term mortality of LSIE. An active and long-term follow up seems warranted in IE survivors showing these conditions at outset.
Collapse
Affiliation(s)
- Emanuele Durante-Mangoni
- Departments of Precision Medicine, Univeristy of Perugia; Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy.
| | | | | | - Domenico Iossa
- Departments of Precision Medicine, Univeristy of Perugia
| | | | | | | | | | - Rosina Albisinni
- Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| | - Rosa Zampino
- Advanced Medical and Surgical Sciences, University of Campania 'L. Vanvitelli'; Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| |
Collapse
|
36
|
Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak E, Bakakos A, Bakar NA, Bal A, Balakrishnan M, Balan V, Bani-Sadr F, Barbalho R, Barbosa NY, Barclay WS, Barnett SU, Barnikel M, Barrasa H, Barrelet A, Barrigoto C, Bartoli M, Bartone C, Baruch J, Bashir M, Basmaci R, Basri MFH, Bastos D, Battaglini D, Bauer J, Bautista Rincon DF, Bazan Dow D, Bedossa A, Bee KH, Behilill S, Beishuizen A, Beljantsev A, Bellemare D, Beltrame A, Beltrão BA, Beluze M, Benech N, Benjiman LE, Benkerrou D, Bennett S, Bento L, Berdal JE, Bergeaud D, Bergin H, Bernal Sobrino JL, Bertoli G, Bertolino L, Bessis S, Betz A, Bevilcaqua S, Bezulier K, Bhatt A, Bhavsar K, Bianchi I, Bianco C, Bidin FN, Bikram Singh M, Bin Humaid F, Bin Kamarudin MN, Bissuel F, Biston P, Bitker L, Blanco-Schweizer P, Blier C, Bloos F, Blot M, Blumberg L, Boccia F, Bodenes L, Bogaarts A, Bogaert D, Boivin AH, Bolze PA, Bompart F, Bonfasius A, Borges D, Borie R, Bosse HM, Botelho-Nevers E, Bouadma L, Bouchaud O, Bouchez S, Bouhmani D, Bouhour D, Bouiller K, Bouillet L, Bouisse C, Boureau AS, Bourke J, Bouscambert M, Bousquet A, Bouziotis J, Boxma B, Boyer-Besseyre M, Boylan M, Bozza FA, Brack M, Braconnier A, Braga C, Brandenburger T, Brás Monteiro F, Brazzi L, Breen D, Breen P, Breen P, Brett S, Brickell K, Broadley T, Browne A, Browne S, Brozzi N, Brusse-Keizer M, Buchtele N, Buesaquillo C, Bugaeva P, Buisson M, Burhan E, Burrell A, Bustos IG, Butnaru D, Cabie A, Cabral S, Caceres E, Cadoz C, Callahan M, Calligy K, Calvache JA, Cam J, Campana V, Campbell P, Campisi J, Canepa C, Cantero M, Caraux-Paz P, Cárcel S, Cardellino CS, Cardoso F, Cardoso F, Cardoso N, Cardoso S, Carelli S, Carlier N, Carmoi T, Carney G, Carpenter C, Carqueja I, Carret MC, Carrier FM, Carroll I, Carson G, Carton E, Casanova ML, Cascão M, Casey S, Casimiro J, Cassandra B, Castañeda S, Castanheira N, Castor-Alexandre G, Castrillón H, Castro I, Catarino A, Catherine FX, Cattaneo P, Cavalin R, Cavalli GG, Cavayas A, Ceccato A, Cervantes-Gonzalez M, Chair A, Chakveatze C, Chan A, Chand M, Chantalat Auger C, Chapplain JM, Chas J, Chaudary M, Chávez Iñiguez JS, Chen A, Chen YS, Cheng MP, Cheret A, Chiarabini T, Chica J, Chidambaram SK, Chin-Tho L, Chirouze C, Chiumello D, Cho HJ, Cho SM, Cholley B, Chopin MC, Chow TS, Chow YP, Chua HJ, Chua J, Cidade JP, Cisneros Herreros JM, Citarella BW, Ciullo A, Clarke E, Clarke J, Claure Del Granado R, Clohisey S, Cobb JP, Coca N, Codan C, Cody C, Coelho A, Coles M, Colin G, Collins M, Colombo SM, Combs P, Connolly J, Connor M, Conrad A, Contreras S, Conway E, Cooke GS, Copland M, Cordel H, Corley A, Cormican S, Cornelis S, Cornet AD, Corpuz AJ, Cortegiani A, Corvaisier G, Costigan E, Couffignal C, Couffin-Cadiergues S, Courtois R, Cousse S, Cregan R, Crepy D'Orleans C, Croonen S, Crowl G, Crump J, Cruz C, Cruz Berm JL, Cruz Rojo J, Csete M, Cucino A, Cullen A, Cullen C, Cummings M, Curley G, Curlier E, Curran C, Custodio P, da Silva Filipe A, Da Silveira C, Dabaliz AA, Dagens A, Dahly D, Dalton H, Dalton J, Daly S, D'Amico F, Daneman N, Daniel C, Dankwa EA, Dantas J, D’Aragon F, de Boer M, de Loughry G, de Mendoza D, De Montmollin E, de Oliveira França RF, de Pinho Oliveira AI, De Rosa R, de Silva T, de Vries P, Deacon J, Dean D, Debard A, DeBenedictis B, Debray MP, DeCastro N, Dechert W, Deconninck L, Decours R, Defous E, Delacroix I, Delaveuve E, Delavigne K, Delfos NM, Deligiannis I, Dell'Amore A, Delmas C, Delobel P, Delsing C, Demonchy E, Denis E, Deplanque D, Depuydt P, Desai M, Descamps D, Desvallée M, Dewayanti S, Diallo A, Diamantis S, Dias A, Diaz P, Diaz R, Diaz Diaz JJ, Didier K, Diehl JL, Dieperink W, Dimet J, Dinot V, Diop F, Diouf A, Dishon Y, Dixit D, Djossou F, Docherty AB, Doherty H, Dondorp AM, Dong A, Donnelly CA, Donnelly M, Donohue C, Donohue S, Donohue Y, Doran C, Doran P, Dorival C, D'Ortenzio E, Douglas JJ, Douma R, Dournon N, Downer T, Downey J, Downing M, Drake T, Driscoll A, Dryden M, Duarte Fonseca C, Dubee V, Dubos F, Ducancelle A, Duculan T, Dudman S, Duggal A, Dunand P, Dunning J, Duplaix M, Durante-Mangoni E, Durham III L, Dussol B, Duthoit J, Duval X, Dyrhol-Riise AM, Ean SC, Echeverria-Villalobos M, Egan S, Eira C, El Sanharawi M, Elapavaluru S, Elharrar B, Ellerbroek J, Eloy P, Elshazly T, Elyazar I, Enderle I, Endo T, Eng CC, Engelmann I, Enouf V, Epaulard O, Escher M, Esperatti M, Esperou H, Esposito-Farese M, Estevão J, Etienne M, Ettalhaoui N, Everding AG, Evers M, Fabre I, Fabre M, Faheem A, Fahy A, Fairfield CJ, Fakar Z, Faria P, Farooq A, Farrar JJ, Farshait N, Fateena H, Fatoni AZ, Faure K, Favory R, Fayed M, Feely N, Feeney L, Fernandes J, Fernandes M, Fernandes S, Ferrand FX, Ferrand Devouge E, Ferrão J, Ferraz M, Ferreira B, Ferreira S, Ferrer-Roca R, Ferriere N, Ficko C, Figueiredo-Mello C, Fiorda J, Flament T, Flateau C, Fletcher T, Florio LL, Flynn B, Flynn D, Foley C, Foley J, Fomin V, Fonseca T, Fontela P, Forsyth S, Foster D, Foti G, Fourn E, Fowler RA, Fraher DM, Franch-Llasat D, Fraser C, Fraser JF, Freire MV, Freitas Ribeiro A, Friedrich C, Fritz R, Fry S, Fuentes N, Fukuda M, Gaborieau V, Gaci R, Gagliardi M, Gagnard JC, Gagné N, Gagneux-Brunon A, Gaião S, Gail Skeie L, Gallagher P, Gallego Curto E, Gamble C, Gani Y, Garan A, Garcia R, García Barrio N, Garcia-Diaz J, Garcia-Gallo E, Garimella N, Garot D, Garrait V, Gauli B, Gault N, Gavin A, Gavrylov A, Gaymard A, Gebauer J, Geraud E, Gerbaud Morlaes L, Germano N, ghisulal PK, Ghosn J, Giani M, Giaquinto C, Gibson J, Gigante T, Gilg M, Gilroy E, Giordano G, Girvan M, Gissot V, Gitahi J, Giwangkancana G, Glikman D, Glybochko P, Gnall E, Goco G, Goehringer F, Goepel S, Goffard JC, Goh JY, Golob J, Gomes R, Gomez K, Gómez-Junyent J, Gominet M, Gonzalez A, Gordon P, Gordon A, Gorenne I, Goubert L, Goujard C, Goulenok T, Grable M, Graf J, Grandin EW, Granier P, Grasselli G, Grazioli L, Green CA, Greene C, Greenhalf W, Greffe S, Grieco DL, Griffee M, Griffiths F, Grigoras I, Groenendijk A, Grosse Lordemann A, Gruner H, Gu Y, Guarracino F, Guedj J, Guego M, Guellec D, Guerguerian AM, Guerreiro D, Guery R, Guillaumot A, Guilleminault L, Guimarães de Castro M, Guimard T, Haalboom M, Haber D, Habraken H, Hachemi A, Hadri N, Haidash O, Haider S, Haidri F, Hakak S, Hall A, Hall M, Halpin S, Hamer A, Hamers R, Hamidfar R, Hammond T, Han LY, Haniffa R, Hao KW, Hardwick H, Harrison EM, Harrison J, Harrison SBE, Hartman A, Hashmi J, Hashmi M, Hayat M, Hayes A, Hays L, Heerman J, Heggelund L, Hendry R, Hennessy M, Henriquez A, Hentzien M, Herekar F, Hernandez-Montfort J, Herr D, Hershey A, Hesstvedt L, Hidayah A, Higgins D, Higgins E, HigginsOKeeffe G, Hinchion R, Hinton S, Hiraiwa H, Hitoto H, Ho A, Ho YB, Hoctin A, Hoffmann I, Hoh WH, Hoiting O, Holt R, Holter JC, Horby P, Horcajada JP, Hoshino K, Hoshino K, Houas I, Hough CL, Houltham S, Hsu JMY, Hulot JS, Hussain I, Ijaz S, Illes HG, Imbert P, Imran M, Imran Sikander R, Inácio H, Infante Dominguez C, Ing YS, Iosifidis E, Ippolito M, Isgett S, Ishani PGPI, Isidoro T, Ismail N, Isnard M, Itai J, Ito A, Ivulich D, Jaafar D, Jaafoura S, Jabot J, Jackson C, Jamieson N, Jaquet P, Jassat W, Jaud-Fischer C, Jaureguiberry S, Javidfar J, Jawad I, Jaworsky D, Jayakumar D, Jego F, Jelani AM, Jenum S, Jimbo-Sotomayor R, Job VDP, Joe OY, Jorge García RN, Joseph C, Joseph M, Joshi S, Jourdain M, Jouvet P, June J, Jung A, Jung H, Juzar D, Kafif O, Kaguelidou F, Kaisbain N, Kaleesvran T, Kali S, Kalicinska A, Kalomoiri S, Kamal S, Kamaluddin MAA, Kamaruddin ZAC, Kamarudin N, Kandamby DH, Kandel C, Kang KY, Kant R, Kanwal D, Kanyawati D, Karki B, Karpayah P, Karsies T, Kartsonaki C, Kasugai D, Kataria A, Katz K, Kaur A, Kaur Johal S, Kawasaki T, Kay C, Keane H, Keating S, Kellam P, Kelly A, Kelly A, Kelly C, Kelly N, Kelly S, Kelly Y, Kelsey M, Kennedy R, Kennon K, Kernan M, Kerroumi Y, Keshav S, Kestelyn E, Khalid I, Khalid O, Khalil A, Khan C, Khan I, Khanal S, Kho ME, Khoo D, Khoo R, Khoo S, Khoso N, Kiat KH, Kida Y, Kiiza P, Kildal AB, Kim JB, Kimmoun A, Kindgen-Milles D, King A, Kitamura N, Klenerman P, Klont R, Kloumann Bekken G, Knight S, Kobbe R, Kodippily C, Kohns Vasconcelos M, Koirala S, Komatsu M, Korten V, Kosgei C, Kpangon A, Krawczyk K, Krishnan S, Krishnan V, Kruglova O, Kumar A, Kumar D, Kumar G, Kumar M, Kumar Vecham P, Kuriakose D, Kurtzman E, Kusumastuti NP, Kutsogiannis D, Kutsyna G, Kyriakoulis K, Lachatre M, Lacoste M, Laffey JG, Lagrange M, Laine F, Lairez O, Lakhey S, Lalueza A, Lambert M, Lamontagne F, Langelot-Richard M, Langlois V, Lantang EY, Lanza M, Laouénan C, Laribi S, Lariviere D, Lasry S, Latif N, Launay O, Laureillard D, Lavie-Badie Y, Law A, Lawrence C, Lawrence T, Le M, Le Bihan C, Le Bris C, Le Falher G, Le Fevre L, Le Hingrat Q, Le Maréchal M, Le Mestre S, Le Moal G, Le Moing V, Le Nagard H, Le Turnier P, Leal E, Leal Santos M, Lee BH, Lee HG, Lee J, Lee SH, Lee TC, Lee YL, Leeming G, Lefebvre B, Lefebvre L, Lefevre B, LeGac S, Lelievre JD, Lellouche F, Lemaignen A, Lemee V, Lemeur A, Lemmink G, Lene HS, Lennon J, León R, Leone M, Leone M, Lepiller Q, Lescure FX, Lesens O, Lesouhaitier M, Lester-Grant A, Levy B, Levy Y, Levy-Marchal C, Lewandowska K, L'Her E, Li Bassi G, Liang J, Liaquat A, Liegeon G, Lim KC, Lim WS, Lima C, Lina B, Lina L, Lind A, Lingas G, Lion-Daolio S, Lissauer S, Liu K, Livrozet M, Lizotte P, Loforte A, Lolong N, Loon LC, Lopes D, Lopez-Colon D, Loschner AL, Loubet P, Loufti B, Louis G, Lourenco S, Lovelace-Macon L, Low LL, Lowik M, Loy JS, Lucet JC, Lumbreras Bermejo C, Luna CM, Lungu O, Luong L, Luque N, Luton D, Lwin N, Lyons R, Maasikas O, Mabiala O, MacDonald S, MacDonald S, Machado M, Macheda G, Macias Sanchez J, Madhok J, Maestro de la Calle G, Mahieu R, Mahy S, Maia AR, Maier LS, Maillet M, Maitre T, Malfertheiner M, Malik N, Mallon P, Maltez F, Malvy D, Manda V, Mandei JM, Mandelbrot L, Manetta F, Mangal K, Mankikian J, Manning E, Manuel A, Maria Sant`Ana Malaque C, Marino D, Marino F, Markowicz S, Maroun Eid C, Marques A, Marquis C, Marsh B, Marsh L, Marshal M, Marshall J, Martelli CT, Martin DA, Martin E, Martin-Blondel G, Martinelli A, Martin-Loeches I, Martinot M, Martin-Quiros A, Martins A, Martins J, Martins N, Martins Rego C, Martucci G, Martynenko O, Marwali EM, Marzukie M, Masa Jimenez JF, Maslove D, Maslove D, Mason P, Mason S, Masood S, Masood S, Mat Nor B, Matan M, Mateus Fernandes H, Mathew M, Mathieu D, Mattei M, Matulevics R, Maulin L, Maxwell M, Maynar J, Mazzoni T, Mc Sweeney L, McAndrew L, McArthur C, McCarthy A, McCarthy A, McCloskey C, McConnochie R, McDermott S, McDonald SE, McElroy A, McElwee S, McEneany V, McEvoy N, McGeer A, McKay C, McKeown J, McLean KA, McNally P, McNicholas B, McPartlan E, Meaney E, Mear-Passard C, Mechlin M, Meher M, Mehkri O, Mele F, Melo L, Memon K, Mendes JJ, Menkiti O, Menon K, Mentré F, Mentzer AJ, Mercier E, Mercier N, Merckx A, Mergeay-Fabre M, Mergler B, Merson L, Mesquita A, Metwally O, Meybeck A, Meyer D, Meynert AM, Meysonnier V, Meziane A, Mezidi M, Michelagnoli G, Michelanglei C, Michelet I, Mihelis E, Mihnovit V, Miranda-Maldonado H, Misnan NA, Mohamed NNE, Mohamed TJ, Moin A, Molina D, Molinos E, Molloy B, Mone M, Monteiro A, Montes C, Montrucchio G, Moore S, Moore SC, Morales Cely L, Moro L, Morocho Tutillo DR, Morton B, Motherway C, Motos A, Mouquet H, Mouton Perrot C, Moyet J, Mudara C, Mufti AK, Muh NY, Muhamad D, Mullaert J, Muller F, Müller KE, Munblit D, Muneeb S, Munir N, Munshi L, Murphy A, Murphy A, Murphy L, Murris M, Murthy S, Musaab H, Muyandy G, Myrodia DM, N N, Nagpal D, Nagrebetsky A, Narasimhan M, Narayanan N, Nasim Khan R, Nazerali-Maitland A, Neant N, Neb H, Nekliudov NA, Nelwan E, Neto R, Neumann E, Neves B, Ng PY, Nghi A, Nguyen D, Ni Choileain O, Ni Leathlobhair N, Nichol A, Nitayavardhana P, Nonas S, Noordin NAM, Noret M, Norharizam NFI, Norman L, Notari A, Noursadeghi M, Nowicka K, Nowinski A, Nseir S, Nunez JI, Nurnaningsih N, Nyamankolly E, O Brien F, O'Callaghan A, Occhipinti G, OConnor D, O'Donnell M, Ogston T, Ogura T, Oh TH, O'Halloran S, O'Hearn K, Ohshimo S, Oldakowska A, Oliveira J, Oliveira L, Olliaro PL, O'Neil C, Ong DS, Ong JY, Oosthuyzen W, Opavsky A, Openshaw P, Orakzai S, Orozco-Chamorro CM, Orquera A, Ortoleva J, Osatnik J, O'Shea L, O'Sullivan M, Othman SZ, Ouamara N, Ouissa R, Owyang C, Oziol E, Pabasara HMU, Pagadoy M, Pages J, Palacios A, Palacios M, Palmarini M, Panarello G, Panda PK, Paneru H, Pang LH, Panigada M, Pansu N, Papadopoulos A, Parke R, Parker M, Parra B, Parrini V, Pasha T, Pasquier J, Pastene B, Patauner F, Patel J, Pathmanathan MD, Patrão L, Patricio P, Patrier J, Patterson L, Pattnaik R, Paul C, Paul M, Paulos J, Paxton WA, Payen JF, Peariasamy K, Pedrera Jiménez M, Peek GJ, Peelman F, Peiffer-Smadja N, Peigne V, Pejkovska M, Pelosi P, Peltan ID, Pereira R, Perez D, Periel L, Perpoint T, Pesenti A, Pestre V, Petrou L, Petrov-Sanchez V, Pettersen FO, Peytavin G, Pharand S, Piagnerelli M, Picard W, Picone O, Piero MD, Pierobon C, Piersma D, Pimentel C, Pinto R, Pires C, Pironneau I, Piroth L, Pius R, Piva S, Plantier L, Plotkin D, Png HS, Poissy J, Pokeerbux R, Pokorska-Spiewak M, Poli S, Pollakis G, Ponscarme D, Popielska J, Post AM, Postma DF, Povoa P, Póvoas D, Powis J, Prapa S, Preau S, Prebensen C, Preiser JC, Prinssen A, Pritchard MG, Priyadarshani GDD, Proença L, Pudota S, Puéchal O, Pujo Semedi B, Pulicken M, Puntoni M, Purcell G, Quesada L, Quinones-Cardona V, Quirós González V, Quist-Paulsen E, Quraishi M, Rabaa M, Rabaud C, Rabindrarajan E, Rafael A, Rafiq M, Ragazzo G, Rahman AKHA, Rahman RA, Rahutullah A, Rainieri F, Rajahram GS, Rajapakse N, Ralib A, Ramakrishnan N, Ramanathan K, Ramli AA, Rammaert B, Ramos GV, Rana A, Rangappa R, Ranjan R, Rapp C, Rashan A, Rashan T, Rasheed G, Rasmin M, Rätsep I, Rau C, Ravi T, Raza A, Real A, Rebaudet S, Redl S, Reeve B, Rehan A, Rehman A, Reid L, Reid L, Reikvam DH, Reis R, Rello J, Remppis J, Remy M, Ren H, Renk H, Resende L, Resseguier AS, Revest M, Rewa O, Reyes LF, Reyes T, Ribeiro MI, Richardson D, Richardson D, Richier L, Ridzuan SNAA, Riera J, Rios AL, Rishu A, Rispal P, Risso K, Rivera Nuñez MA, Rizer N, Robb D, Robba C, Roberto A, Roberts S, Robertson DL, Robineau O, Roche-Campo F, Rodari P, Rodeia S, Rodriguez Abreu J, Roessler B, Roger C, Roger PM, Roilides E, Rojek A, Romaru J, Roncon-Albuquerque Jr R, Roriz M, Rosa-Calatrava M, Rose M, Rosenberger D, Rossanese A, Rossetti M, Rossignol B, Rossignol P, Rousset S, Roy C, Roze B, Rusmawatiningtyas D, Russell CD, Ryan M, Ryan M, Ryckaert S, Rygh Holten A, Saba I, Sadaf S, Sadat M, Sahraei V, Saint-Gilles M, Sakiyalak P, Salahuddin N, Salazar L, Saleem J, Saleem J, Sales G, Sallaberry S, Salmon Gandonniere C, Salvator H, Sanchez O, Sánchez Choez X, Sanchez de Oliveira K, Sanchez-Miralles A, Sancho-Shimizu V, Sandhu G, Sandhu Z, Sandrine PF, Sandulescu O, Santos M, Sarfo-Mensah S, Sarmento Banheiro B, Sarmiento ICE, Sarton B, Satyapriya S, Satyawati R, Saviciute E, Savio R, Savvidou P, Saw YT, Schaffer J, Schermer T, Scherpereel A, Schneider M, Schroll S, Schwameis M, Schwartz G, Scott JT, Scott-Brown J, Sedillot N, Seitz T, Selvanayagam J, Selvarajoo M, Semaille C, Semple MG, Senian RB, Senneville E, Sepulveda C, Sequeira F, Sequeira T, Serpa Neto A, Serrano Balazote P, Shadowitz E, Shahidan SA, Shahnaz Hasan M, Shamsah M, Shankar A, Sharjeel S, Sharma P, Shaw CA, Shaw V, Shi H, Shiban N, Shiekh M, Shiga T, Shime N, Shimizu H, Shimizu K, Shimizu N, Shindo N, Shrapnel S, Shum HP, Si Mohammed N, Siang NY, Sibiude J, Siddiqui A, Sigfrid L, Sillaots P, Silva C, Silva MJ, Silva R, Sim Lim Heng B, Sin WC, Singh BC, Singh P, Sitompul PA, Sivam K, Skogen V, Smith S, Smood B, Smyth C, Smyth M, Smyth M, Snacken M, So D, Soh TV, Solis M, Solomon J, Solomon T, Somers E, Sommet A, Song MJ, Song R, Song T, Song Chia J, Sonntagbauer M, Soom AM, Sotto A, Soum E, Sousa AC, Sousa M, Sousa Uva M, Souza-Dantas V, Sperry A, Spinuzza E, Sri Darshana BPSR, Sriskandan S, Stabler S, Staudinger T, Stecher SS, Steinsvik T, Stienstra Y, Stiksrud B, Stolz E, Stone A, Streinu-Cercel A, Streinu-Cercel A, Strudwick S, Stuart A, Stuart D, Subekti D, Suen G, Suen JY, Sukumar P, Sultana A, Summers C, Supic D, Suppiah D, Surovcová M, Suwarti S, Svistunov AA, Syahrin S, Syrigos K, Sztajnbok J, Szuldrzynski K, Tabrizi S, Taccone FS, Tagherset L, Taib SM, Talarek E, Taleb S, Talsma J, Tampubolon ML, Tan KK, Tan LV, Tan YC, Tanaka C, Tanaka H, Tanaka T, Taniguchi H, Tanveer H, Taqdees H, Taqi A, Tardivon C, Tattevin P, Taufik MA, Tawfik H, Tedder RS, Tee TY, Teixeira J, Tejada S, Tellier MC, Teoh SK, Teotonio V, Téoulé F, Terpstra P, Terrier O, Terzi N, Tessier-Grenier H, Tey A, Thabit AAM, Tham ZD, Thangavelu S, Thibault V, Thiberville SD, Thill B, Thirumanickam J, Thompson S, Thomson D, Thomson EC, Thurai SRT, Thuy DB, Thwaites RS, Tierney P, Tieroshyn V, Timashev PS, Timsit JF, Tirupakuzhi Vijayaraghavan BK, Tissot N, Toh JZY, Toki M, Tolppa T, Tonby K, Tonnii SL, Torres A, Torres M, Torres Santos-Olmo RM, Torres-Zevallos H, Towers M, Trapani T, Traynor D, Treoux T, Trieu HT, Tripathy S, Tromeur C, Trontzas I, Trouillon T, Truong J, Tual C, Tubiana S, Tuite H, Turmel JM, Turtle LC, Tveita A, Twardowski P, Uchiyama M, Udayanga PGI, Udy A, Ullrich R, Umer Z, Uribe A, Usman A, Vajdovics C, Val-Flores L, Valle AL, Valran A, Van de Velde S, van den Berge M, van der Feltz M, van der Valk P, Van Der Vekens N, Van der Voort P, Van Der Werf S, van Dyk M, van Gulik L, Van Hattem J, van Lelyveld S, van Netten C, Van Twillert G, van Veen I, Vanel N, Vanoverschelde H, Varghese P, Varrone M, Vasudayan SR, Vauchy C, Vaughan H, Veeran S, Veislinger A, Vencken S, Ventura S, Verbon A, Vidal JE, Vieira C, Vijayan D, Villanueva JA, Villar J, Villeneuve PM, Villoldo A, Vinh Chau NV, Visseaux B, Visser H, Vitiello C, Vonkeman H, Vuotto F, Wahab NH, Wahab SA, Wahid NA, Wainstein M, Wan Muhd Shukeri WF, Wang CH, Webb SA, Wei J, Weil K, Wen TP, Wesselius S, West TE, Wham M, Whelan B, White N, Wicky PH, Wiedemann A, Wijaya SO, Wille K, Willems S, Williams V, Wils EJ, Wing Yiu N, Wong C, Wong TF, Wong XC, Wong YS, Xian GE, Xian LS, Xuan KP, Xynogalas I, Yacoub S, Yakop SRBM, Yamazaki M, Yazdanpanah Y, Yee Liang Hing N, Yelnik C, Yeoh CH, Yerkovich S, Yokoyama T, Yonis H, Yousif O, Yuliarto S, Zaaqoq A, Zabbe M, Zacharowski K, Zahid M, Zahran M, Zaidan NZB, Zambon M, Zambrano M, Zanella A, Zawadka K, Zaynah N, Zayyad H, Zoufaly A, Zucman D. The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
|
37
|
Zampino R, Iossa D, Ursi MP, Bertolino L, Karruli A, Molaro R, Esposito G, Vitrone M, D’Amico F, Albisinni R, Durante-Mangoni E. Clinical Significance and Prognostic Value of Hemostasis Parameters in 337 Patients with Acute Infective Endocarditis. J Clin Med 2021; 10:jcm10225386. [PMID: 34830670 PMCID: PMC8624946 DOI: 10.3390/jcm10225386] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
(1) Background: The aim of this study was to assess the clinical significance and prognostic role of the main hemostasis parameters in infective endocarditis (IE): prothrombin time as international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT), fibrinogen, D-dimers, platelet count, homocysteine. (2) Methods: We studied 337 patients with IE. Clinical, hemato-chemical and echocardiography parameters were analyzed. Coagulation parameters were measured on admission. (3) Results: D-dimers levels (p = 0.012) and a prolonged PT-INR (p = 0.013) were associated with higher in-hospital mortality, while prolonged aPTT (p = 0.021) was associated with increased 1-year mortality. Staphylococcus aureus (S. aureus) infection (p = 0.003), prosthetic valve endocarditis (PVE) (p = 0.001), surgical indication (p = 0.002) and higher D-dimer levels (p = 0.005) were independent predictors of in-hospital mortality. PVE (p = 0.001), a higher Charlson Comorbidity Index (p = 0.049), surgical indication (p = 0.001) and prolonged aPTT (p = 0.012) were independent predictors of 1-year mortality. Higher levels of D-dimers (p < 0.001) and a shorter aPTT (p < 0.001) were associated with embolic complications of IE. S. aureus etiology was bound to higher D-dimers levels (p < 0.001) and a shorter aPTT (p = 0.006). (4) Conclusions: Elevated D-dimers are associated with a higher risk for in-hospital mortality in IE patients. High D-dimers and a short aPTT are associated with a higher risk for embolic events in IE. A longer aPTT is associated with 1-year mortality.
Collapse
Affiliation(s)
- Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.Z.); (M.P.U.); (L.B.); (G.E.); (M.V.)
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, 80131 Naples, Italy; (D.I.); (F.D.); (R.A.)
| | - Domenico Iossa
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, 80131 Naples, Italy; (D.I.); (F.D.); (R.A.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.K.); (R.M.)
| | - Maria Paola Ursi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.Z.); (M.P.U.); (L.B.); (G.E.); (M.V.)
| | - Lorenzo Bertolino
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.Z.); (M.P.U.); (L.B.); (G.E.); (M.V.)
| | - Arta Karruli
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.K.); (R.M.)
| | - Rosa Molaro
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.K.); (R.M.)
| | - Gennaro Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.Z.); (M.P.U.); (L.B.); (G.E.); (M.V.)
| | - Martina Vitrone
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.Z.); (M.P.U.); (L.B.); (G.E.); (M.V.)
| | - Fabiana D’Amico
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, 80131 Naples, Italy; (D.I.); (F.D.); (R.A.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.K.); (R.M.)
| | - Rosina Albisinni
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, 80131 Naples, Italy; (D.I.); (F.D.); (R.A.)
| | - Emanuele Durante-Mangoni
- Unit of Infectious & Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, 80131 Naples, Italy; (D.I.); (F.D.); (R.A.)
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.K.); (R.M.)
- Correspondence: ; Tel.: +39-(0)817062475; Fax: +39-(0)817702645
| | | |
Collapse
|
38
|
Ramadan MS, Bertolino L, Marrazzo T, Florio MT, Durante-Mangoni E. Cardiac complications during the active phase of COVID-19: review of the current evidence. Intern Emerg Med 2021; 16:2051-2061. [PMID: 34046852 PMCID: PMC8158084 DOI: 10.1007/s11739-021-02763-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022]
Abstract
Growing reports since the beginning of the pandemic and till date describe increased rates of cardiac complications (CC) in the active phase of coronavirus disease 2019 (COVID-19). CC commonly observed include myocarditis/myocardial injury, arrhythmias and heart failure, with an incidence reaching about a quarter of hospitalized patients in some reports. The increased incidence of CC raise questions about the possible heightened susceptibility of patients with cardiac disease to develop severe COVID-19, and whether the virus itself is involved in the pathogenesis of CC. The wide array of CC seems to stem from multiple mechanisms, including the ability of the virus to directly enter cardiomyocytes, and to indirectly damage the heart through systemic hyperinflammatory and hypercoagulable states, endothelial injury of the coronary arteries and hypoxemia. The induced CC seem to dramatically impact the prognosis of COVID-19, with some studies suggesting over 50% mortality rates with myocardial damage, up from ~ 5% overall mortality of COVID-19 alone. Thus, it is particularly important to investigate the relation between COVID-19 and heart disease, given the major effect on morbidity and mortality, aiming at early detection and improving patient care and outcomes. In this article, we review the growing body of published data on the topic to provide the reader with a comprehensive and robust description of the available evidence and its implication for clinical practice.
Collapse
Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Tommaso Marrazzo
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Maria Teresa Florio
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli' and Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131, Napoli, Italy.
| |
Collapse
|
39
|
Vitrone M, Mele F, Durante-Mangoni E, Zampino R. Drugs and liver injury: a not to be overlooked binomial in COVID-19. J Chemother 2021; 34:207-220. [PMID: 34644236 DOI: 10.1080/1120009x.2021.1988203] [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: 01/08/2023]
Abstract
SARS-CoV-2 infection (COVID-19) results predominantly in pulmonary involvement but a direct, virus-induced liver damage may also occur, whose mechanisms are being actively investigated. Accordingly, it appears of utmost importance to monitor liver function and carefully evaluate hepatic safety of the various drugs administered during COVID-19. In this respect, many drugs, biological agents and novel molecules, whose efficacy in COVID-19 is under scrutiny, have also been shown to potentially cause or worsen liver damage. In this article, we review safety data of established as well as promising agents for COVID-19.
Collapse
Affiliation(s)
- M Vitrone
- Department of Advanced Medical & Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - F Mele
- Department of Advanced Medical & Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - E Durante-Mangoni
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.,Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - R Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy.,Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| |
Collapse
|
40
|
Durante-Mangoni E, Bertolino L, Mastroianni C, Viale P, Bassetti M, Citton R, Gómez-Ulloa D, Roset M, McCann E. Complicated carbapenem-resistant infections: a treatment pathway analysis in Italian sites. Infez Med 2021; 29:434-449. [PMID: 35146349 PMCID: PMC8805488 DOI: 10.53854/liim-2903-15] [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] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/02/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Efforts to curb a growing prevalence of carbapenem resistance are prominent worldwide and especially in countries where high levels of carbapenem resistance are reported, such as Italy. Complicated infections, including complicated urinary tract infections (cUTI), complicated intra-abdominal infections (cIAI), and hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP), are often caused by carbapenem-resistant Gram-negative (CRGN) bacteria and as such, these infection sites and their causative bacteria are important areas of focus for healthcare practitioners seeking to follow good antimicrobial stewardship practices. The aim of this study was to assess the clinical management and associated clinical and economic outcomes of patients with cUTI, cIAI, and HABP/VABP resulting from CRGN bacteria in Italy. METHODS We first conducted a hospital survey focusing on Gram-negative infections and their antibacterial susceptibility profile in four participating Italian hospitals. The second part of the study involved a non-interventional, retrospective single cohort chart review of 100 patients with cUTI, cIAI, or HABP/VABP caused by CRGN bacteria, in which patient characteristics, index hospitalization characteristics, infection characteristics, patient outcomes, treatment pathways, and healthcare resource use were assessed. RESULTS The hospital survey demonstrated carbapenem resistance in approximately 17% of complicated infections, mostly associated with Acinetobacter baumannii. The non-interventional, retrospective cohort component showed that complicated CRGN infections were hospital- or healthcare-acquired in 99.0% of cases and were most often caused by Klebsiella pneumoniae (66.0%). Despite the carbapenem-resistant nature of the included infections, carbapenems were used in 19.0% of patients as empirical therapy, in 43.0% as late empirical (i.e. immediately before receipt of susceptibility test results), and in 64.0% as targeted therapy (post-susceptibility test result receipt). Colistin was used in 61.0% of patients after susceptibility results were available. High clinical and economic burden was evident, with the average length of hospital stay being greater than 50 days, clinical cure achievement in only 43.0% of patients, and an overall mortality rate of 65.0% by the end of the follow-up period. CONCLUSION Our results reflect the considerable burden associated with complicated CRGN infections in Italy and the limitations in current treatment strategies. Our study pinpoints potential areas for improvement. For example, regular and detailed local surveillance and state of the art microbial diagnostic capabilities might aid and hasten clinical decision-making and facilitate improved antimicrobial stewardship when treating complex CRGN infections. New therapeutic options which more appropriately address CRGN infections may assist in improving outcomes which are important to both patients and healthcare providers.
Collapse
Affiliation(s)
- Emanuele Durante-Mangoni
- Department of Precision Medicine and Unit of Infectious and Transplant Medicine, Università della Campania ‘L. Vanvitelli’, Ospedale Monaldi, AORN Ospedali dei Colli, Naples, Italy
| | - Lorenzo Bertolino
- Department of Precision Medicine and Unit of Infectious and Transplant Medicine, Università della Campania ‘L. Vanvitelli’, Ospedale Monaldi, AORN Ospedali dei Colli, Naples, Italy
| | - Claudio Mastroianni
- Department of Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, AOU Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino IST-IRCCS, Genova, Italy
| | | | | | | | - Eilish McCann
- Outcomes Research, Merck & Co., Inc., Kenilworth NJ, USA
| |
Collapse
|
41
|
Ramadan MS, Bertolino L, Zampino R, Durante-Mangoni E. Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review. Clin Microbiol Infect 2021; 27:1250-1261. [PMID: 34171458 PMCID: PMC8220864 DOI: 10.1016/j.cmi.2021.06.015] [Citation(s) in RCA: 45] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 12/24/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has been implicated in a wide spectrum of cardiac manifestations following the acute phase of the disease. Objectives To assess the range of cardiac sequelae after COVID-19 recovery. Data sources PubMed, Embase, Scopus (inception through 17 February 2021) and Google scholar (2019 through 17 February 2021). Study eligibility criteria Prospective and retrospective studies, case reports and case series. Participants Adult patients assessed for cardiac manifestations after COVID-19 recovery. Exposure Severe acute respiratory syndrome coronavirus 2 infection diagnosed by PCR. Methods Systematic review. Results Thirty-five studies (fifteen prospective cohort, seven case reports, five cross-sectional, four case series, three retrospective cohort and one ambidirectional cohort) evaluating cardiac sequelae in 52 609 patients were included. Twenty-nine studies used objective cardiac assessments, mostly cardiac magnetic resonance imaging (CMR) in 16 studies, echocardiography in 15, electrocardiography (ECG) in 16 and cardiac biomarkers in 18. Most studies had a fair risk of bias. The median time from diagnosis/recovery to cardiac assessment was 48 days (1–180 days). Common short-term cardiac abnormalities (<3 months) included increased T1 (proportion: 30%), T2 (16%), pericardial effusion (15%) and late gadolinium enhancement (11%) on CMR, with symptoms such as chest pain (25%) and dyspnoea (36%). In the medium term (3–6 months), common changes included reduced left ventricular global longitudinal strain (30%) and late gadolinium enhancement (10%) on CMR, diastolic dysfunction (40%) on echocardiography and elevated N-terminal proB-type natriuretic peptide (18%). In addition, COVID-19 survivors had higher risk (risk ratio 3; 95% CI 2.7–3.2) of developing heart failure, arrythmias and myocardial infarction. Conclusions COVID-19 appears to be associated with persistent/de novo cardiac injury after recovery, particularly subclinical myocardial injury in the earlier phase and diastolic dysfunction later. Larger well-designed and controlled studies with baseline assessments are needed to better measure the extent of cardiac injury and its clinical impact.
Collapse
Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Rosa Zampino
- Department of Advanced Medical and Surgical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
| |
Collapse
|
42
|
Giurazza R, Mazza MC, Andini R, Sansone P, Pace MC, Durante-Mangoni E. Emerging Treatment Options for Multi-Drug-Resistant Bacterial Infections. Life (Basel) 2021; 11:life11060519. [PMID: 34204961 PMCID: PMC8229628 DOI: 10.3390/life11060519] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) remains one of the top public health issues of global concern. Among the most important strategies for AMR control there is the correct and appropriate use of antibiotics, including those available for the treatment of AMR pathogens. In this article, after briefly reviewing the most important and clinically relevant multi-drug-resistant bacteria and their main resistance mechanisms, we describe the emerging antimicrobial options for both MDR Gram-positive cocci and Gram-negative bacilli, including recently marketed agents, molecules just approved or under evaluation and rediscovered older antibiotics that have regained importance due to their antimicrobial spectrum. Specifically, emerging options for Gram-positive cocci we reviewed include ceftaroline, ceftobiprole, tedizolid, dalbavancin, and fosfomycin. Emerging treatment options for Gram-negative bacilli we considered comprise ceftolozane-tazobactam, ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, aztreonam-avibactam, minocycline, fosfomycin, eravacycline, plazomicin, and cefiderocol. An exciting scenario is opening today with the long awaited growing availability of novel molecules for the treatment of AMR bacteria. Knowledge of mechanisms of action and resistance patterns allows physicians to increasingly drive antimicrobial treatment towards a precision medicine approach. Strict adherence to antimicrobial stewardship practices will allow us to preserve the emerging antimicrobials for our future.
Collapse
Affiliation(s)
- Roberto Giurazza
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Internal Medicine Section, Piazzale Ettore Ruggieri snc, 80131 Naples, Italy; (R.G.); (M.C.M.)
- Department of Woman, Child and General & Specialized Surgery, University of Campania ‘L. Vanvitelli’, Piazza Miraglia, 80138 Naples, Italy; (P.S.); (M.C.P.)
| | - Maria Civita Mazza
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Internal Medicine Section, Piazzale Ettore Ruggieri snc, 80131 Naples, Italy; (R.G.); (M.C.M.)
- Department of Woman, Child and General & Specialized Surgery, University of Campania ‘L. Vanvitelli’, Piazza Miraglia, 80138 Naples, Italy; (P.S.); (M.C.P.)
| | - Roberto Andini
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131 Naples, Italy;
| | - Pasquale Sansone
- Department of Woman, Child and General & Specialized Surgery, University of Campania ‘L. Vanvitelli’, Piazza Miraglia, 80138 Naples, Italy; (P.S.); (M.C.P.)
| | - Maria Caterina Pace
- Department of Woman, Child and General & Specialized Surgery, University of Campania ‘L. Vanvitelli’, Piazza Miraglia, 80138 Naples, Italy; (P.S.); (M.C.P.)
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Internal Medicine Section, Piazzale Ettore Ruggieri snc, 80131 Naples, Italy; (R.G.); (M.C.M.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-081-7062475; Fax: +39-081-7702645
| |
Collapse
|
43
|
Karruli A, de Cristofaro J, Andini R, Iossa D, Bernardo M, Amarelli C, Mattucci I, Zampino R, Zarrilli R, Durante-Mangoni E. Risk Factors and Outcome of Multidrug-Resistant Infections after Heart Transplant: A Contemporary Single Center Experience. Microorganisms 2021; 9:microorganisms9061210. [PMID: 34205082 PMCID: PMC8230299 DOI: 10.3390/microorganisms9061210] [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: 03/28/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 12/29/2022] Open
Abstract
(1) Background: The aim of this study was to assess risk factors for multidrug-resistant/extensively drug-resistant (MDR/XDR) bacterial infections in heart transplant (HT) patients within three months after surgery and its impact on patient outcome. (2) Methods: Retrospective analysis of clinical, hemato-chemical, imaging, treatment and outcome data from 47 heart transplant recipients from January 2016 to December 2018. MDR/XDR infections were compared to non-MDR/XDR and noninfected patients. (3) Results: Most participants were males, median age 51 years: 35 (74.5%) developed an infection after HT; 14 (29.8%) were MDR/XDR infections. Prolonged hospital stay before HT correlated to MDR/XDR infection (p < 0.001). Sequential organ failure assessment (SOFA) score at sampling day was higher in MDR/XDR (p = 0.027). MDR/XDR were mostly blood-stream (BSI) (p = 0.043) and skin-soft tissue (SSTI) (p = 0.047) infections. Gram-negative infections were the most frequent, specifically carbapenem-resistant Klebsiella pneumoniae. Antibiotic therapy duration for MDR/XDR infections was longer (p = 0.057), eradication rate lower (p = 0.083) and hospital stay longer (p = 0.005) but not associated with a worse outcome. (4) Conclusions: MDR/XDR infections affect compromised HT recipients with a history of prolonged hospitalization, causing a lower rate of eradication and increased hospital stay. These frequently present as BSI and SSTI. We emphasize the need to prevent contamination of central venous catheters and the surgical site.
Collapse
Affiliation(s)
- Arta Karruli
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.K.); (J.d.C.); (D.I.)
| | - Jacopo de Cristofaro
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.K.); (J.d.C.); (D.I.)
| | - Roberto Andini
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.A.); (R.Z.)
| | - Domenico Iossa
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.K.); (J.d.C.); (D.I.)
| | - Mariano Bernardo
- Unit of Microbiology & Virology, AORN Ospedali dei Colli, 80131 Naples, Italy;
| | - Cristiano Amarelli
- Unit of Cardiac Transplant, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (C.A.); (I.M.)
| | - Irene Mattucci
- Unit of Cardiac Transplant, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (C.A.); (I.M.)
| | - Rosa Zampino
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.A.); (R.Z.)
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy
| | - Raffaele Zarrilli
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy;
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.K.); (J.d.C.); (D.I.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.A.); (R.Z.)
- Correspondence: ; Tel.: +39-081-7062475; Fax: +39-081-7702645
| |
Collapse
|
44
|
Nutman A, Temkin E, Lellouche J, Rakovitsky N, Hameir A, Daikos G, Durante-Mangoni E, Pavleas I, Dishon Y, Petersiel N, Yahav D, Eliakim N, Bernardo M, Iossa D, Friberg LE, Theuretzbacher U, Leibovici L, Paul M, Carmeli Y. In vivo fitness of carbapenem-resistant Acinetobacter baumannii strains in murine infection is associated with treatment failure in human infections. Clin Microbiol Infect 2021; 28:73-78. [PMID: 33984488 DOI: 10.1016/j.cmi.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/14/2021] [Accepted: 05/01/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Mortality among patients with carbapenem-resistant Acinetobacter baumannii (CRAB) infections varies between studies. We examined whether in vivo fitness of CRAB strains is associated with clinical outcomes in patients with CRAB infections. METHODS Isolates were collected from patients enrolled in the AIDA trial with hospital-acquired pneumonia, bloodstream infections and/or urinary tract infections caused by CRAB. The primary outcome was 14-day clinical failure, defined as failure to meet all criteria: alive; haemodynamically stable; improved or stable Sequential Organ Failure Assessment (SOFA) score; improved or stable oxygenation; and microbiological cure of bacteraemia. The secondary outcome was 14-day mortality. We tested in vivo growth using a neutropenic murine thigh infection model. Fitness was defined based on the CFU count 24 hours after injection of an inoculum of 105 CFU. We used mixed-effects logistic regression to test the association between fitness and the two outcomes. RESULTS The sample included 266 patients; 215 (80.8%) experienced clinical failure. CRAB fitness ranged from 5.23 to 10.08 log CFU/g. The odds of clinical failure increased by 62% for every 1-log CFU/g increase in fitness (OR 1.62, 95% CI 1.04-2.52). After adjusting for age, Charlson score, SOFA score and acquisition in the intensive care unit, fitness remained significant (adjusted OR 1.63, 95% CI 1.03-2.59). CRAB fitness had a similar effect on 14-day mortailty, although the association was not statistically significant (OR 1.56, 95% CI 0.95-2.57). It became significant after adjusting for age, Charlson score, SOFA score and recent surgery (adjusted OR 1.88, 95% CI 1.09-3.25). CONCLUSIONS In vivo CRAB fitness was associated with clinical failure in patients with CRAB infection.
Collapse
Affiliation(s)
- Amir Nutman
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Elizabeth Temkin
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Lellouche
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - Nadya Rakovitsky
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - Amichay Hameir
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - George Daikos
- First Department of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", AORN Dei Colli-Monaldi Hospital, Napoli, Italy
| | - Ioannis Pavleas
- Intensive Care Unit, Laikon General Hospital, Athens, Greece
| | - Yael Dishon
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel; The Cheryl Spencer Institute for Nursing Research, University of Haifa, Haifa, Israel
| | - Neta Petersiel
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - Noa Eliakim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine E, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - Mariano Bernardo
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", AORN Dei Colli-Monaldi Hospital, Napoli, Italy
| | - Domenico Iossa
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", AORN Dei Colli-Monaldi Hospital, Napoli, Italy
| | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | | | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine E, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - Mical Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Techion - Israel Institute of Technology, Haifa, Israel
| | - Yehuda Carmeli
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
45
|
Dickstein Y, Lellouche J, Schwartz D, Nutman A, Rakovitsky N, Dishon Benattar Y, Altunin S, Bernardo M, Iossa D, Durante-Mangoni E, Antoniadou A, Skiada A, Deliolanis I, Daikos GL, Daitch V, Yahav D, Leibovici L, Rognås V, Friberg LE, Mouton JW, Paul M, Carmeli Y. Colistin Resistance Development Following Colistin-Meropenem Combination Therapy Versus Colistin Monotherapy in Patients With Infections Caused by Carbapenem-Resistant Organisms. Clin Infect Dis 2021; 71:2599-2607. [PMID: 31758195 DOI: 10.1093/cid/ciz1146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We evaluated whether carbapenem-colistin combination therapy reduces the emergence of colistin resistance, compared to colistin monotherapy, when given to patients with infections due to carbapenem-resistant Gram-negative organisms. METHODS This is a pre-planned analysis of a secondary outcome from a randomized, controlled trial comparing colistin monotherapy with colistin-meropenem combination for the treatment of severe infections caused by carbapenem-resistant, colistin-susceptible Gram-negative bacteria. We evaluated rectal swabs taken on Day 7 or later for the presence of new colistin-resistant (ColR) isolates. We evaluated the emergence of any ColR isolate and the emergence of ColR Enterobacteriaceae (ColR-E). RESULTS Data were available for 214 patients for the primary analysis; emergent ColR organisms were detected in 22 (10.3%). No difference was observed between patients randomized to treatment with colistin monotherapy (10/106, 9.4%) versus patients randomized to colistin-meropenem combination therapy (12/108, 11.1%; P = .669). ColR-E organisms were detected in 18/249 (7.2%) patients available for analysis. No difference was observed between the 2 treatment arms (colistin monotherapy 6/128 [4.7%] vs combination therapy 12/121 [9.9%]; P = .111). Enterobacteriaceae, as the index isolate, was found to be associated with development of ColR-E (hazard ratio, 3.875; 95% confidence interval, 1.475-10.184; P = .006). CONCLUSIONS Carbapenem-colistin combination therapy did not reduce the incidence of colistin resistance emergence in patients with infections due to carbapenem-resistant organisms. Further studies are necessary to elucidate the development of colistin resistance and methods for its prevention.
Collapse
Affiliation(s)
- Yaakov Dickstein
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Jonathan Lellouche
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel.,Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - David Schwartz
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel.,Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Amir Nutman
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Nadya Rakovitsky
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel.,Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Sergey Altunin
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Mariano Bernardo
- University of Campania "L. Vanvitelli," Monaldi Hospital, Naples, Italy
| | - Domenico Iossa
- University of Campania "L. Vanvitelli," Monaldi Hospital, Naples, Italy
| | | | - Anastasia Antoniadou
- Fourth Department of Medicine, Attikon University General Hospital, Athens, Greece.,National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Skiada
- National and Kapodistrian University of Athens, Athens, Greece.,First Department of Medicine, Laikon General Hospital, Athens, Greece
| | - Ioannis Deliolanis
- National and Kapodistrian University of Athens, Athens, Greece.,First Department of Medicine, Laikon General Hospital, Athens, Greece
| | - George L Daikos
- National and Kapodistrian University of Athens, Athens, Greece.,First Department of Medicine, Laikon General Hospital, Athens, Greece
| | - Vered Daitch
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.,Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.,Infectious Diseases Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.,Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Viktor Rognås
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Mical Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel.,Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | | |
Collapse
|
46
|
Ramadan MS, Russo V, Nigro G, Durante-Mangoni E, Zampino R. Interplay between Heart Disease and Metabolic Steatosis: A Contemporary Perspective. J Clin Med 2021; 10:jcm10081569. [PMID: 33917867 PMCID: PMC8068259 DOI: 10.3390/jcm10081569] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/26/2021] [Accepted: 04/03/2021] [Indexed: 12/12/2022] Open
Abstract
The liver-heart axis is a growing field of interest owing to rising evidence of complex bidirectional interplay between the two organs. Recent data suggest non-alcoholic fatty liver disease (NAFLD) has a significant, independent association with a wide spectrum of structural and functional cardiac diseases, and seems to worsen cardiovascular disease (CVD) prognosis. Conversely, the effect of cardiac disease on NAFLD is not well studied and data are mostly limited to cardiogenic liver disease. We believe it is important to further investigate the heart-liver relationship because of the tremendous global health and economic burden the two diseases pose, and the impact of such investigations on clinical decision making and management guidelines for both diseases. In this review, we summarize the current knowledge on NAFLD diagnosis, its systemic manifestations, and associations with CVD. More specifically, we review the pathophysiological mechanisms that govern the interplay between NAFLD and CVD and evaluate the relationship between different CVD treatments and NAFLD progression.
Collapse
Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Vincenzo Russo
- Department of Translational Medical Sciences, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (V.R.); (G.N.)
- Cardiology Unit, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Gerardo Nigro
- Department of Translational Medical Sciences, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy; (V.R.); (G.N.)
- Cardiology Unit, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
- Infectious and Transplant Medicine Unit, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy;
- Correspondence:
| | - Rosa Zampino
- Infectious and Transplant Medicine Unit, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy;
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| |
Collapse
|
47
|
Daitch V, Paul M, Daikos GL, Durante-Mangoni E, Yahav D, Carmeli Y, Benattar YD, Skiada A, Andini R, Eliakim-Raz N, Nutman A, Zusman O, Antoniadou A, Cavezza G, Adler A, Dickstein Y, Pavleas I, Zampino R, Bitterman R, Zayyad H, Koppel F, Zak-Doron Y, Levi I, Babich T, Turjeman A, Ben-Zvi H, Friberg LE, Mouton JW, Theuretzbacher U, Leibovici L. Excluded versus included patients in a randomized controlled trial of infections caused by carbapenem-resistant Gram-negative bacteria: relevance to external validity. BMC Infect Dis 2021; 21:309. [PMID: 33789574 PMCID: PMC8010276 DOI: 10.1186/s12879-021-05995-y] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/17/2021] [Indexed: 01/19/2023] Open
Abstract
Background Population external validity is the extent to which an experimental study results can be generalized from a specific sample to a defined population. In order to apply the results of a study, we should be able to assess its population external validity. We performed an investigator-initiated randomized controlled trial (RCT) (AIDA study), which compared colistin-meropenem combination therapy to colistin monotherapy in the treatment of patients infected with carbapenem-resistant Gram-negative bacteria. In order to examine the study’s population external validity and to substantiate the use of AIDA study results in clinical practice, we performed a concomitant observational trial. Methods The study was conducted between October 1st, 2013 and January 31st, 2017 (during the RCTs recruitment period) in Greece, Israel and Italy. Patients included in the observational arm of the study have fulfilled clinical and microbiological inclusion criteria but were excluded from the RCT due to receipt of colistin for > 96 h, refusal to participate, or prior inclusion in the RCT. Non-randomized cases were compared to randomized patients. The primary outcome was clinical failure at 14 days of infection onset. Results Analysis included 701 patients. Patients were infected mainly with Acinetobacter baumannii [78.2% (548/701)]. The most common reason for exclusion was refusal to participate [62% (183/295)]. Non-randomized and randomized patients were similar in most of the demographic and background parameters, though randomized patients showed minor differences towards a more severe infection. Combination therapy was less common in non-randomized patients [31.9% (53/166) vs. 51.2% (208/406), p = 0.000]. Randomized patients received longer treatment of colistin [13 days (IQR 10–16) vs. 8.5 days (IQR 0–15), p = 0.000]. Univariate analysis showed that non-randomized patients were more inclined to clinical failure on day 14 from infection onset [82% (242/295) vs. 75.5% (307/406), p = 0.042]. After adjusting for other variables, non-inclusion was not an independent risk factor for clinical failure at day 14. Conclusion The similarity between the observational arm and RCT patients has strengthened our confidence in the population external validity of the AIDA trial. Adding an observational arm to intervention studies can help increase the population external validity and improve implementation of study results in clinical practice. Trial registration The trial was registered with ClinicalTrials.gov, number NCT01732250 on November 22, 2012.
Collapse
Affiliation(s)
- Vered Daitch
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel. .,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel.
| | - Mical Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - George L Daikos
- First Department of Medicine, Laikon General Hospital, Athens, Greece.,National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Durante-Mangoni
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yehuda Carmeli
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.,National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Yael Dishon Benattar
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Naples, Italy.,Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Anna Skiada
- First Department of Medicine, Laikon General Hospital, Athens, Greece.,National and Kapodistrian University of Athens, Athens, Greece
| | - Roberto Andini
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Noa Eliakim-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel
| | - Amir Nutman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Oren Zusman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel
| | - Anastasia Antoniadou
- National and Kapodistrian University of Athens, Athens, Greece.,Fourth Department of Medicine, Attikon University General Hospital, Athens, Greece
| | - Giusi Cavezza
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Amos Adler
- Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yaakov Dickstein
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Ioannis Pavleas
- Intensive Care Unit, Laikon General Hospital, Athens, Greece
| | - Rosa Zampino
- Internal Medicine, University of Campania 'L Vanvitelli', and AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Roni Bitterman
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Hiba Zayyad
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Fidi Koppel
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Yael Zak-Doron
- Institute of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Inbar Levi
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Tanya Babich
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel
| | - Adi Turjeman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel
| | - Haim Ben-Zvi
- Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | | | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Jebotinski 39, Petah Tikva, Israel
| |
Collapse
|
48
|
Bertolino L, Ursi MP, Zampino R, Durante-Mangoni E. Associating enterococcal endocarditis and colorectal neoplasia: is colonoscopy mandatory? - Authors' reply. Eur J Intern Med 2021; 85:114-115. [PMID: 33390321 DOI: 10.1016/j.ejim.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Lorenzo Bertolino
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli' Via De Crecchio 7, 80138 Napoli, Italy
| | - Maria Paola Ursi
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli' Via De Crecchio 7, 80138 Napoli, Italy
| | - Rosa Zampino
- Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli' Via De Crecchio 7, 80138 Napoli, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital Piazzale Ettore Ruggieri, 80131 Napoli, Italy
| | - Emanuele Durante-Mangoni
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital Piazzale Ettore Ruggieri, 80131 Napoli, Italy; Department of Precision Medicine, University of Campania 'L. Vanvitelli' Via De Crecchio 7, 80138 Napoli, Italy.
| |
Collapse
|
49
|
Karruli A, Spiezia S, Boccia F, Gagliardi M, Patauner F, Salemme A, Maiello C, Zampino R, Durante-Mangoni E. Effect of immunosuppression maintenance in solid organ transplant recipients with COVID-19: Systematic review and meta-analysis. Transpl Infect Dis 2021; 23:e13595. [PMID: 33641202 PMCID: PMC7995235 DOI: 10.1111/tid.13595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/30/2020] [Accepted: 02/14/2021] [Indexed: 12/21/2022]
Abstract
Background The aim of this study was to assess the effect of continuing immune suppressive therapy in solid organ transplant recipients (SOTR) with coronavirus disease 2019 (COVID‐19). Methods Systematic review and meta‐analysis of data on 202 SOTR with COVID‐19, published as case reports or case series. We extracted clinical, hemato‐chemical, imaging, treatment, and outcome data. Results Most patients were kidney recipients (61.9%), males (68.8%), with median age of 57 years. The majority was on tacrolimus (73.5%) and mycophenolate (65.8%). Mortality was 18.8%, but an equal proportion was still hospitalized at last follow up. Immune suppressive therapy was withheld in 77.2% of patients, either partially or completely. Tacrolimus was continued in 50%. One third of survivors that continued immunosuppressants were on dual therapy plus steroids. None of those who continued immunosuppressants developed critical COVID‐19 disease. Age (OR 1.07, 95% CI 1‐1.11, P = .001) and lopinavir/ritonavir use (OR 3.3, 95%CI 1.2‐8.5, P = .013) were independent predictors of mortality while immunosuppression maintenance (OR 0.067, 95% CI 0.008‐0.558, P = .012) and tacrolimus continuation (OR 0.3, 95% CI 0.1‐0.7, P = .013) were independent predictors of survival. Conclusions Our data suggest that maintaining immune suppression might be safe in SOTR with moderate and severe COVID‐19. Specifically, receiving tacrolimus could be beneficial for COVID‐19 SOTR. Because of the quality of the available evidence, no definitive guidance on how to manage SOTR with COVID‐19 can be derived from our data.
Collapse
Affiliation(s)
- Arta Karruli
- Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Serenella Spiezia
- Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Filomena Boccia
- Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Massimo Gagliardi
- Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Fabian Patauner
- Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Anna Salemme
- Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Ciro Maiello
- Unit of Cardiac Surgery and Transplants, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Rosa Zampino
- Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.,Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Emanuele Durante-Mangoni
- Division of Internal Medicine, University of Campania 'L. Vanvitelli', Naples, Italy.,Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| |
Collapse
|
50
|
Karruli A, Boccia F, Gagliardi M, Patauner F, Ursi MP, Sommese P, De Rosa R, Murino P, Ruocco G, Corcione A, Andini R, Zampino R, Durante-Mangoni E. Multidrug-Resistant Infections and Outcome of Critically Ill Patients with Coronavirus Disease 2019: A Single Center Experience. Microb Drug Resist 2021; 27:1167-1175. [PMID: 33600262 DOI: 10.1089/mdr.2020.0489] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 12/11/2022] Open
Abstract
Background: The aim of this study was to assess the drivers of multidrug-resistant (MDR) bacterial infection development in coronavirus disease 2019 (COVID-19) and its impact on patient outcome. Methods: Retrospective analysis on data from 32 consecutive patients with COVID-19, admitted to our intensive care unit (ICU) from March to May 2020. Outcomes considered were MDR infection and ICU mortality. Results: Fifty percent of patients developed an MDR infection during ICU stay after a median time of 8 [4-11] days. Most common MDR pathogens were carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii, causing bloodstream infections and pneumonia. MDR infections were linked to a higher length of ICU stay (p = 0.002), steroid therapy (p = 0.011), and associated with a lower ICU mortality (odds ratio: 0.439, 95% confidence interval: 0.251-0.763; p < 0.001). Low-dose aspirin intake was associated with both MDR infection (p = 0.043) and survival (p = 0.015). Among MDR patients, mortality was related with piperacillin-tazobactam use (p = 0.035) and an earlier onset of MDR infection (p = 0.042). Conclusions: MDR infections were a common complication in critically ill COVID-19 patients at our center. MDR risk was higher among those dwelling longer in the ICU and receiving steroids. However, MDR infections were not associated with a worse outcome.
Collapse
Affiliation(s)
- Arta Karruli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Filomena Boccia
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Massimo Gagliardi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Maria Paola Ursi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Pino Sommese
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Rosanna De Rosa
- Intensive Care Unit, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| | - Patrizia Murino
- Intensive Care Unit, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| | - Giuseppe Ruocco
- Microbiology and Virology Laboratory, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| | - Antonio Corcione
- Intensive Care Unit, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| | - Roberto Andini
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| | - Rosa Zampino
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy.,Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Napoli, Italy.,Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
| |
Collapse
|