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Karaiskos I, Daikos GL, Gkoufa A, Adamis G, Stefos A, Symbardi S, Chrysos G, Filiou E, Basoulis D, Mouloudi E, Galani L, Akinosoglou K, Arvaniti K, Masgala A, Petraki M, Papadimitriou E, Galani I, Poulakou G, Routsi C, Giamarellou H. Ceftazidime/avibactam in the era of carbapenemase-producing Klebsiella pneumoniae: experience from a national registry study. J Antimicrob Chemother 2021; 76:775-783. [PMID: 33249436 DOI: 10.1093/jac/dkaa503] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/06/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Infections caused by KPC-producing Klebsiella pneumoniae (Kp) are associated with high mortality. Therefore, new treatment options are urgently required. OBJECTIVES To assess the outcomes and predictors of mortality in patients with KPC- or OXA-48-Kp infections treated with ceftazidime/avibactam with an emphasis on KPC-Kp bloodstream infections (BSIs). METHODS A multicentre prospective observational study was conducted between January 2018 and March 2019. Patients with KPC- or OXA-48-Kp infections treated with ceftazidime/avibactam were included in the analysis. The subgroup of patients with KPC-Kp BSIs treated with ceftazidime/avibactam was matched by propensity score with a cohort of patients whose KPC-Kp BSIs had been treated with agents other than ceftazidime/avibactam with in vitro activity. RESULTS One hundred and forty-seven patients were identified; 140 were infected with KPC producers and 7 with OXA-48 producers. For targeted therapy, 68 (46.3%) patients received monotherapy with ceftazidime/avibactam and 79 (53.7%) patients received ceftazidime/avibactam in combination with at least another active agent. The 14 and 28 day mortality rates were 9% and 20%, respectively. The 28 day mortality among the 71 patients with KPC-Kp BSIs treated with ceftazidime/avibactam was significantly lower than that observed in the 71 matched patients, whose KPC-Kp BSIs had been treated with agents other than ceftazidime/avibactam (18.3% versus 40.8%; P = 0.005). In the Cox proportional hazards model, ultimately fatal disease, rapidly fatal disease and Charlson comorbidity index ≥2 were independent predictors of death, whereas treatment with ceftazidime/avibactam-containing regimens was the only independent predictor of survival. CONCLUSIONS Ceftazidime/avibactam appears to be an effective treatment against serious infections caused by KPC-Kp.
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Affiliation(s)
- I Karaiskos
- Hygeia General Hospital, 1st Department of Internal Medicine - Infectious Diseases, Athens, Greece
| | - G L Daikos
- Laiko General Hospital, 1st Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Gkoufa
- Laiko General Hospital, 1st Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - G Adamis
- Peripheral General Hospital Athens Giorgos Gennimatas, 1st Department of Internal Medicine and Infectious Diseases Unit, Athens, Greece
| | - A Stefos
- University of Thessaly, Larissa, Department of Medicine and Research Laboratory of Internal Medicine, Larissa, Greece
| | - S Symbardi
- Thriaseio Geniko Nosokomeio Elefsinas, 1st Department of Internal Medicine, Magoula of Elefsina, Athens, Greece
| | - G Chrysos
- Peripheral General Hospital of Peiraias Tzaneio, 2nd Department of Internal Medicine and Infectious Diseases Unit, Athens, Greece
| | - E Filiou
- Sotiria General Hospital of Chest Diseases of Athens, Intensive Care Unit, 1st Department of Respiratory Medicine, Athens, Greece
| | - D Basoulis
- Laiko General Hospital, 1st Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Mouloudi
- Ippokrateio General Hospital of Thessaloniki, Intensive Care Unit, Thessaloniki, Greece
| | - L Galani
- Hygeia General Hospital, 1st Department of Internal Medicine - Infectious Diseases, Athens, Greece
| | - K Akinosoglou
- University of Patras, Department of Medicine, Medical School, Patras, Greece
| | - K Arvaniti
- Geniko Nosokomeio Thessalonikis Papageorgiou, Intensive Care Unit and Antimicrobial Stewardship Unit, Thessaloniki, Greece
| | - A Masgala
- Konstantopouleio General Hospital Neas Ionias Patesion, 1st Department of Internal Medicine, Athens, Greece
| | - M Petraki
- Mediterraneo Hospital, Intensive Care Unit, Athens, Greece
| | - E Papadimitriou
- General Hospital of Lamia, Department of Internal Medicine, Lamia, Greece
| | - I Galani
- National and Kapodistrian University of Athens Faculty of Medicine, Infectious Diseases Laboratory, 4th Department of Internal Medicine, Athens, Greece
| | - G Poulakou
- Sotiria General Hospital of Chest Diseases of Athens, 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - C Routsi
- Evaggelismos Hospital, Intensive Care Unit, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - H Giamarellou
- Hygeia General Hospital, 1st Department of Internal Medicine - Infectious Diseases, Athens, Greece
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Maltezou HC, Dedoukou X, Tsonou P, Tseroni M, Raftopoulos V, Pavli A, Papadima K, Chrysochoou A, Randou E, Adamis G, Kostis E, Pefanis A, Gogos C, Sipsas NV. Hospital factors associated with SARS-CoV-2 infection among healthcare personnel in Greece. J Hosp Infect 2020; 109:40-43. [PMID: 33169676 PMCID: PMC7581318 DOI: 10.1016/j.jhin.2020.10.010] [Citation(s) in RCA: 8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/17/2020] [Accepted: 10/18/2020] [Indexed: 11/24/2022]
Abstract
Healthcare workers (HCWs) have been recognized as a high-risk group for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This study estimated their risk of infection based on hospital characteristics. Factors significantly associated with increased risk for SARS-CoV-2 infection were: working in a non-referral hospital compared with a coronavirus disease 2019 (COVID-19) referral hospital, working in a hospital with a high number of employees, and working in a hospital with an increased number of patients with COVID-19. This study revealed gaps in infection control in the non-referral hospitals. There is an urgent need for continuous training in infection control practices. Compliance of HCWs with the use of personal protective equipment should also be addressed.
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Affiliation(s)
- H C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - X Dedoukou
- National Public Health Organization, Athens, Greece
| | - P Tsonou
- Department of Cardiovascular Diseases, Directorate of Non-Communicable Diseases, National Public Health Organization, Athens, Greece
| | - M Tseroni
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - V Raftopoulos
- Department of HIV Surveillance, National Public Health Organization, Athens, Greece
| | - A Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - K Papadima
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - A Chrysochoou
- Emergency Department, General Hospital of Kastoria, Kastoria, Greece
| | - E Randou
- Department of Internal Medicine, General Hospital of Kozani, Kozani, Greece
| | - G Adamis
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - E Kostis
- Therapeutic Clinic, Alexandra General Hospital, Athens, Greece
| | - A Pefanis
- First Internal Medicine and Infectious Diseases Department, 'Sotiria' General and Chest Diseases Hospital of Athens, Athens, Greece
| | - C Gogos
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - N V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Giamarellos-Bourboulis EJ, Tsaganos T, Tsangaris I, Lada M, Routsi C, Sinapidis D, Koupetori M, Bristianou M, Adamis G, Mandragos K, Dalekos GN, Kritselis I, Giannikopoulos G, Koutelidakis I, Pavlaki M, Antoniadou E, Vlachogiannis G, Koulouras V, Prekates A, Dimopoulos G, Koutsoukou A, Pnevmatikos I, Ioakeimidou A, Kotanidou A, Orfanos SE, Armaganidis A, Gogos C. Validation of the new Sepsis-3 definitions: proposal for improvement in early risk identification. Clin Microbiol Infect 2016; 23:104-109. [PMID: 27856268 DOI: 10.1016/j.cmi.2016.11.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [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: 06/16/2016] [Revised: 10/19/2016] [Accepted: 11/04/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Sepsis-3 definitions generated controversies regarding their general applicability. The Sepsis-3 Task Force outlined the need for validation with emphasis on the quick Sequential Organ Failure Assessment (qSOFA) score. This was done in a prospective cohort from a different healthcare setting. METHODS Patients with infections and at least two signs of systemic inflammatory response syndrome (SIRS) were analysed. Sepsis was defined as total SOFA ≥2 outside the intensive care unit (ICU) or as an increase of ICU admission SOFA ≥2. The primary endpoints were the sensitivity of qSOFA outside the ICU and sepsis definition both outside and within the ICU to predict mortality. RESULTS In all, 3346 infections outside the ICU and 1058 infections in the ICU were analysed. Outside the ICU, respective mortality with ≥2 SIRS and qSOFA ≥2 was 25.3% and 41.2% (p <0.0001); the sensitivities of qSOFA and of sepsis definition to predict death were 60.8% and 87.2%, respectively. This was 95.9% for sepsis definition in the ICU. The sensitivity of qSOFA and of ≥3 SIRS criteria for organ dysfunction outside the ICU was 48.7% and 72.5%, respectively (p <0.0001). Misclassification outside the ICU with the 1991 and Sepsis-3 definitions into stages of lower severity was 21.4% and 3.7%, respectively (p <0.0001) and 14.9% and 3.7%, respectively, in the ICU (p <0.0001). Adding arterial pH ≤7.30 to qSOFA increased sensitivity for prediction of death to 67.5% (p 0.004). CONCLUSIONS Our analysis positively validated the use of SOFA score to predict unfavourable outcome and to limit misclassification into lower severity. However, qSOFA score had inadequate sensitivity for early risk assessment.
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Affiliation(s)
- E J Giamarellos-Bourboulis
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - T Tsaganos
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - I Tsangaris
- 2(nd) Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - M Lada
- 2(nd) Department of Internal Medicine, Sismanogleion General Hospital, Athens, Greece
| | - C Routsi
- 1(st) Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - D Sinapidis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - M Koupetori
- 1(st) Department of Internal Medicine, Thriasion Elefsis General Hospital, Elefsina, Greece
| | - M Bristianou
- Department of Urology, Lamia General Hospital, Lamia, Greece
| | - G Adamis
- 1(st) Department of Internal Medicine, "G.Gennimatas" Athens General Hospital, Athens, Greece
| | - K Mandragos
- Intensive Care Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - G N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, Larissa University Hospital, University of Thessaly, Medical School, Larissa, Greece
| | - I Kritselis
- Department of Surgery, Nafplion General Hospital, Nafplion, Greece
| | - G Giannikopoulos
- Department of Internal Medicine, Chios General Hospital, Chios, Greece
| | - I Koutelidakis
- 2(nd) Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M Pavlaki
- Department of Internal Medicine, Argos General Hospital, Argos, Greece
| | - E Antoniadou
- Intensive Care Unit, "G.Gennimatas" General Hospital, Thessaloniki, Greece
| | - G Vlachogiannis
- Intensive Care Unit, "Aghios Dimitrios" General Hospital, Thessaloniki, Greece
| | - V Koulouras
- Department of Critical Care Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - A Prekates
- Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece
| | - G Dimopoulos
- 2(nd) Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Koutsoukou
- 1(st) Department of Pulmonary Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - I Pnevmatikos
- Department of Critical Care Medicine, Alexandroupolis University Hospital, Alexandroupolis, Greece
| | - A Ioakeimidou
- Intensive Care Unit, Korinthos General Hospital, Korinthos, Greece
| | - A Kotanidou
- 1(st) Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - S E Orfanos
- 2(nd) Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Armaganidis
- 2(nd) Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - C Gogos
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
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Terzi N, Papanagiotou A, Prifti E, Angeletou A, Paftounou A, Koumbi I, Kazani M, Chaidopoulos D, Adamis G, Tzanetou K. Seroprevalence and susceptibility to primary cytomegalovirus infection among childbearing women. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1365] [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: 10/25/2022] Open
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Prifti E, Adamis G, Papanagiotou A, Charalabopoulou A, Dandoulakis D, Psylakou E, Nikolakopoulou A, Tsetsa P, Kostis E, Tzanetou K. Urinary tract infections in pregnant women: Uropathogens and antimicrobial resistance profiles. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Papanagiotou A, Vlachos S, Prifti E, Charalabopoulou A, Pepa A, Tsiachris P, Glinavos F, Adamis G, Kostis E, Tzanetou K. Candida blood steam infections: species distribution and antifungal resistance patterns. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Astriti M, Tzanetou K, Sarri K, Ntinos K, Adamis G, Delis V, moustakas G, Choreftaki M, Gargalianos P. The role of colonoscapy and squash preparations in diagnosis and follow-up of stool negative enteric schistosomiasis: A case report of double infection with S. mansoni and S. intercalatum. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.593] [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: 10/19/2022] Open
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Katsarolis I, Poulakou G, Athanasia S, Kontopidou F, Panagopoulos P, Karaiskos E, Voutsinas D, Zarkotou L, Gavra P, Koratzanis G, Kanellopoulou M, Adamis G, Vagiakou E, Matthaiopoulou I, Vogiatzi E, Perdikaki P, Panou G, Kremastinou E, Giamarellou H. P1130 The panhellenic study on the antimicrobial susceptibility of community-acquired uropathogens: preliminary data report. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70970-6] [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: 11/25/2022]
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Lelekis M, Economou E, Adamis G, Gargalianos P, Kosmidis J. Asymptomatic bacteriuria of pregnancy: do obstetricians bother? J Chemother 1994; 6:58-60. [PMID: 8071681 DOI: 10.1080/1120009x.1994.11741131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In view of the potentially serious consequences of asymptomatic bacteriuria of pregnancy (ASB), we surveyed the attitudes of Greek obstetricians towards this entity. A total of 108 obstetricians practicing in the area of Athens completed a questionnaire concerning ASB. Only 73 of the 108 stated that they screen their clients for ASB (51 of them when pyuria is present and only 22 in all pregnant women). Of special interest is the finding that a larger percentage of younger obstetricians (practicing for up to 9 years) habitually screen their patients, compared to older ones (83% vs 60%). Concerning treatment of ASB, only 45 out of 73 doctors screening for ASB give any treatment when ASB is present. Most obstetricians (87%) prefer a beta-lactam antibiotic. In almost all cases 7-10 days are considered the appropriate duration of treatment. Better education of obstetricians, especially the older ones, concerning detection and management of ASB is needed.
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Affiliation(s)
- M Lelekis
- Dept. of Medicine and Infectious Diseases Outpatient Clinic, General Hospital of Athens, Greece
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Kosmidis J, Gargalianos P, Lelekis M, Adamis G, Petropoulou D, Makris D. Acute, uncomplicated, lower urinary tract infections: the role of single-dose fleroxacin. J Chemother 1989; 1:864-5. [PMID: 16312675] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- J Kosmidis
- First Department of Medicine, The General Hospital, Athens, Greece
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Kosmidis J, Gargalianos P, Adamis G, Petropoulou D, Makris D. Fleroxacin in single dose oral therapy of uncomplicated lower urinary tract infection. J Antimicrob Chemother 1988; 22 Suppl D:219-21. [PMID: 3144541 DOI: 10.1093/jac/22.supplement_d.219] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A randomized comparative study was performed in twenty women with acute uncomplicated lower urinary tract infection (UTI). They received a single oral dose of either fleroxacin 600 mg or amoxycillin 3 g. Pathogens were Escherichia coli (17), Proteus mirabilis (2) and Staphylococcus aureus (1). A complete clinical and microbiological cure was observed in all patients of both groups. One patient in the fleroxacin group had gastric irritation. A single oral dose of fleroxacin may be suitable for the treatment of lower UTI even when it is due to organisms resistant to amoxycillin and other traditional oral antimicrobials.
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Affiliation(s)
- J Kosmidis
- First Department of Medicine, General Hospital, Athens, Greece
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