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Akinosoglou K, Kotsaki A, Gounaridi IM, Christaki E, Metallidis S, Adamis G, Fragkou A, Fantoni M, Rapti A, Kalomenidis I, Chrysos G, Boni G, Kainis I, Alexiou Z, Castelli F, Serino FS, Bakakos P, Nicastri E, Tzavara V, Safarika A, Ioannou S, Dagna L, Dimakou K, Tzatzagou G, Chini M, Bassetti M, Kotsis V, Angheben A, Tsoukalas G, Selmi C, Spiropoulou OM, Samarkos M, Doumas M, Damoraki G, Masgala A, Papanikolaou I, Argyraki A, Negri M, Leventogiannis K, Sympardi S, Gatselis NK, Petrakis V, Netea MG, Panagopoulos P, Sakka V, Milionis H, Dalekos GN, Giamarellos-Bourboulis EJ. Efficacy and safety of early soluble urokinase plasminogen receptor plasma-guided anakinra treatment of COVID-19 pneumonia: A subgroup analysis of the SAVE-MORE randomised trial. EClinicalMedicine 2023; 56:101785. [PMID: 36590789 PMCID: PMC9791950 DOI: 10.1016/j.eclinm.2022.101785] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The SAVE-MORE trial demonstrated that anakinra treatment in COVID-19 pneumonia with plasma soluble urokinase plasminogen activator (suPAR) levels of 6 ng/mL or more was associated with 0.36 odds for a worse outcome compared to placebo when expressed by the WHO-Clinical Progression Scale (CPS) at day 28. Herein, we report the results of subgroup analyses and long-term outcomes. METHODS This prospective, double-blind, randomised clinical trial, recruited patients with a confirmed SARS-CoV-2 infection, in need of hospitalisation, lower respiratory tract infection and plasma suPAR ≥6 ng/mL from 37 academic and community hospitals in Greece and Italy. Patients were 1:2 randomised to subcutaneous treatment with placebo or anakinra (100 mg) once daily for 10 days. Pre-defined subgroups of Charlson's comorbidity index (CCI), sex, age, level of suPAR, and time from symptom onset were analysed for the primary endpoint (overall comparison of distribution of frequencies of the scores from the WHO-CPS between treatments on day 28), by multivariable ordinal regression analysis in the intention to treat (ITT) population. This trial is registered with the EU Clinical Trials Register (2020-005828-11) and ClinicalTrials.gov (NCT04680949). FINDINGS Patients were enrolled between 23 December 2020 and 31 March 2021; 189 patients in the placebo arm and 405 patients in the anakinra arm were the ITT population. Multivariable analysis showed that anakinra treatment was accompanied by significantly lower odds for worse outcome compared to placebo at day 28 for all studied subgroups (CCI ≥ 2, OR: 0.34, 95% confidence intervals [CI] 0.22-0.50; CCI < 2, OR: 0.38, 95% CI 0.21-0.68; suPAR > 9 ng/mL, OR: 0.35, 95% CI 0.19-0.66; suPAR 6-9 ng/mL, OR: 0.35, 95% CI 0.24-0.52; patients ≥65 years, OR: 0.41, 95% CI 0.25-0.66; and patients <65 years, OR: 0.29, 95% CI 0.19-0.45). The benefit was uniform, irrespective of the time from start of symptoms until the start of the study drug. At days 60 and 90, anakinra treatment had odds of 0.40 (95% CI 0.28-0.57) and 0.46 (95% CI 0.32-0.67) respectively, for a worse outcome compared to placebo. The costs of general ward stay, ICU stay, and drugs were lower with anakinra treatment. INTERPRETATION Anakinra represents an important therapeutic tool in the management of COVID-19 that may be administered in all subgroups of patients; benefits are maintained until day 90. FUNDING Hellenic Institute for the Study of Sepsis; Swedish Orphan Biovitrum AB.
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Affiliation(s)
| | - Antigone Kotsaki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Ioanna-Maria Gounaridi
- Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini Christaki
- First Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Simeon Metallidis
- First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Adamis
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | | | - Massimo Fantoni
- Dipartimento Scienze di Laboratorio e Infettivologiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Aggeliki Rapti
- Second Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Ioannis Kalomenidis
- First Department of Critical Care and Pulmonary Medicine, Medical School, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Chrysos
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Gloria Boni
- Hospital Pharmacy, IRCCS Hospital Sacro Cuore, Negrar di Valpolicella, Verona, Italy
- IRCSS Sacro Cuore Hospital, Negrar di Valpolicella, Verona, Italy
| | - Ilias Kainis
- Tenth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases of Athens, Athens, Greece
| | - Zoi Alexiou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Francesco Castelli
- Spedali Civili, Brescia ASST Spedali Civili Hospital, University of Brescia, Italy
| | | | - Petros Bakakos
- First Department of Chest Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Nicastri
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Vassiliki Tzavara
- First Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Asimina Safarika
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Sofia Ioannou
- Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Katerina Dimakou
- Fifth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Glykeria Tzatzagou
- First Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Chini
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genoa, Italy
| | - Vasileios Kotsis
- Third Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andrea Angheben
- Department of Infectious – Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar di Valpolicella, Verona, Italy
| | - George Tsoukalas
- Fourth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20072, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - Olga-Maria Spiropoulou
- First Department of Internal Medicine, Asklipieio General Hospital of Voula, Athens, Greece
| | - Michael Samarkos
- First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Doumas
- Second Department of Propedeutic Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Damoraki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Masgala
- Second Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, General Hospital of Kerkyra, Kerkyra, Greece
| | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Marcantonio Negri
- Dipartimento Scienze Mediche e Chirurgiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Konstantinos Leventogiannis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Styliani Sympardi
- First Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Nikolaos K. Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa 41110, Greece
| | - Vasileios Petrakis
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Mihai G. Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen 6500, Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Periklis Panagopoulos
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Vissaria Sakka
- Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- First Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa 41110, Greece
| | - Evangelos J. Giamarellos-Bourboulis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
- Corresponding author. 4th Department of Internal Medicine, ATTIKON University Hospital, 1 Rimini Street, Athens 12462, Greece.
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Pantazis N, Paparizos V, Papastamopoulos V, Metallidis S, Antoniadou A, Adamis G, Psichgiou M, Chini M, Sambatakou H, Chrysos G, Sipsas NV, Gogos C, Barbunakis E, Panagopoulos P, Katsarou O, Touloumi G. Low pre-ART CD4 count is associated with increased risk of clinical progression or death even after reaching 500 CD4 cells/μL on ART. PLoS One 2023; 18:e0283648. [PMID: 36996018 PMCID: PMC10062628 DOI: 10.1371/journal.pone.0283648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/05/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Clinical disadvantages of initiating ART at low CD4 counts have been clearly demonstrated but whether any excess risk remains even after reaching relatively high/safe CD4 levels remains unclear. We explore whether individuals starting ART with <500 CD4 cells/μL who increased their CD4 count above this level, have, from this point onwards, similar risk of clinical progression to serious AIDS/non-AIDS events or death with individuals starting ART with ≥500 CD4 cells/μL. METHODS Data were derived from a multicenter cohort (AMACS). Adults, starting PI, NNRTI or INSTI based ART, in or after 2000 were eligible, provided they started ART with ≥500 ("High CD4") or started with CD4 <500 cells/μL but surpassed this threshold while on ART ("Low CD4"). Baseline was the date of ART initiation ("High CD4") or of first reaching 500 CD4 cells/μL ("Low CD4"). Survival analysis, allowing for competing risks, was used to explore the risk of progression to study's endpoints. RESULTS The study included 694 persons in the "High CD4" and 3,306 in the "Low CD4" group. Median (IQR) follow-up was 66 (36, 106) months. In total, 257 events (40 AIDS related, 217 SNAEs) were observed. Rates of progression did not differ significantly between the two groups but the subgroup of those initiating ART with <200 CD4 cells/μL had significantly higher risk of progression after baseline, compared to those in the "High CD4" group. CONCLUSIONS Individuals starting ART with <200 cells/μL remain on increased risk even after reaching 500 CD4 cells/μL. These patients should be closely followed.
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Affiliation(s)
- Nikos Pantazis
- Dept. of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Paparizos
- AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, Medical School, Syngros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Papastamopoulos
- Division of Infectious Diseases, 5th Department of Internal Medicine, Evangelismos General Hospital of Athens, Athens, Greece
| | - Simeon Metallidis
- 1st Internal Medicine Department, Infectious Diseases Unit, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Antoniadou
- 4th Dept. of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Georgios Adamis
- 1st Dept. of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens G. Gennimatas, Athens, Greece
| | - Mina Psichgiou
- 1st Dept. of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Chini
- 3rd Dept. of Internal Medicine Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Helen Sambatakou
- 2nd Dept. of Internal Medicine, HIV Unit, National and Kapodistrian University of Athens, Medical School, Hippokration University General Hospital, Athens, Greece
| | - Georgios Chrysos
- Infectious Diseases Unit, Tzaneion General Hospital of Piraeus, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Infectious Diseases Unit, Medical School, Laikon Athens General Hospital and National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Gogos
- Dept. of Internal Medicine & Infectious Diseases, Patras University General Hospital, Patras, Greece
| | - Emmanouil Barbunakis
- Dept. of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Periklis Panagopoulos
- 2nd University Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Olga Katsarou
- Blood Centre, National Reference Centre for Congenital Bleeding Disorders, Laikon Athens General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Giota Touloumi
- Dept. of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Kostaki EG, Limnaios S, Adamis G, Xylomenos G, Chini M, Mangafas N, Lazanas M, Patrinos S, Metallidis S, Tsachouridou O, Papastamopoulos V, Chatzidimitriou D, Antoniadou A, Papadopoulos A, Protopapas K, Tsiara C, Psichogiou M, Basoulis D, Pilalas D, Paraskeva D, Chrysos G, Paparizos V, Kourkounti S, Sambatakou H, Bolanos V, Sipsas NV, Lada M, Barbounakis E, Kantzilaki E, Panagopoulos P, Petrakis V, Drimis S, Katsarolis I, Lagiou P, Hatzakis A, Magiorkinis G, Skoura L, Paraskevis D. Estimation of the determinants for HIV late presentation using the traditional definition and molecular clock-inferred dates: Evidence that older age, heterosexual risk group and more recent diagnosis are prognostic factors. HIV Med 2022; 23:1143-1152. [PMID: 36258653 PMCID: PMC10092532 DOI: 10.1111/hiv.13415] [Citation(s) in RCA: 4] [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: 07/26/2022] [Accepted: 09/15/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES HIV late presentation (LP) has been increasing in recent years in Europe. Our aim was to investigate the characteristics of LP in Greece using in addition to the traditional definition for LP, the time interval between HIV infection and diagnosis. METHODS Our nationwide sample included HIV-1 sequences generated from 6166 people living with HIV (PLWH) in Greece during the period 1999-2015. Our analysis was based on the molecularly inferred HIV-1 infection dates for PLWH infected within local molecular transmission clusters of subtypes A1 and B. RESULTS Analysis of the determinants of LP was conducted using either CD4 counts or AIDS-defining condition at diagnosis or the time from infection to diagnosis. Older age, heterosexual transmission risk group and more recent diagnosis were associated with increased risk for LP. In contrast to previous studies, people who inject drugs (PWID) had a shorter median time to diagnosis (0.63 years) compared to men who have sex with men (MSM) (1.72 years) and heterosexuals (2.43 years). Using HIV infection dates that provide an unbiased marker for LP compared to CD4 counts at diagnosis, which are age-dependent, we estimated that the time to diagnosis increased gradually with age. Migrants infected regionally do not differ with respect to LP status compared to native Greeks. CONCLUSIONS We demonstrate that older people and heterosexuals are among those at higher risk for LP; and given the growing number of older people among newly diagnosed cases, tailored interventions are needed in these populations.
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Affiliation(s)
- Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Limnaios
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Adamis
- 1st Department of Internal Medicine, G. Gennimatas General Hospital, Athens, Greece
| | - Georgios Xylomenos
- 1st Department of Internal Medicine, G. Gennimatas General Hospital, Athens, Greece
| | - Maria Chini
- 3rd Department of Internal Medicine-Infectious Diseases Unit, "Korgialeneio-Benakeio" Red Cross General Hospital, Athens, Greece
| | - Nikos Mangafas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, "Korgialeneio-Benakeio" Red Cross General Hospital, Athens, Greece
| | - Marios Lazanas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, "Korgialeneio-Benakeio" Red Cross General Hospital, Athens, Greece
| | | | - Simeon Metallidis
- 1st Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Olga Tsachouridou
- 1st Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, Athens, Greece
| | - Dimitrios Chatzidimitriou
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Papadopoulos
- 4th Department of Medicine, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Protopapas
- 4th Department of Medicine, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mina Psichogiou
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Basoulis
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Pilalas
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Paraskeva
- Department of Internal Medicine, Tzaneio General Hospital, Piraeus, Greece
| | - Georgios Chrysos
- Department of Internal Medicine, Tzaneio General Hospital, Piraeus, Greece
| | - Vasileios Paparizos
- HIV/AIDS Unit, A. Syngros Hospital of Dermatology and Venereology, Athens, Greece
| | - Sofia Kourkounti
- HIV/AIDS Unit, A. Syngros Hospital of Dermatology and Venereology, Athens, Greece
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Bolanos
- HIV Unit, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Malvina Lada
- 2nd Department of Internal Medicine, Sismanogleion General Hospital, Athens, Greece
| | - Emmanouil Barbounakis
- Department of Internal Medicine, University Hospital of Heraklion "PAGNI", Medical School, University of Crete, Heraklion, Greece
| | - Evrikleia Kantzilaki
- Department of Internal Medicine, University Hospital of Heraklion "PAGNI", Medical School, University of Crete, Heraklion, Greece
| | - Periklis Panagopoulos
- Department of Internal Medicine, University General Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Vasilis Petrakis
- Department of Internal Medicine, University General Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stelios Drimis
- Department of Internal Medicine, Tzaneio General Hospital, Piraeus, Greece
| | | | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lemonia Skoura
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Tsilika M, Taks E, Dolianitis K, Kotsaki A, Leventogiannis K, Damoulari C, Kostoula M, Paneta M, Adamis G, Papanikolaou I, Stamatelopoulos K, Bolanou A, Katsaros K, Delavinia C, Perdios I, Pandi A, Tsiakos K, Proios N, Kalogianni E, Delis I, Skliros E, Akinosoglou K, Perdikouli A, Poulakou G, Milionis H, Athanassopoulou E, Kalpaki E, Efstratiou L, Perraki V, Papadopoulos A, Netea MG, Giamarellos-Bourboulis EJ. Corrigendum: ACTIVATE-2: A double-blind randomized trial of BCG vaccination against COVID-19 in individuals at risk. Front Immunol 2022; 13:1018384. [PMID: 36119100 PMCID: PMC9472241 DOI: 10.3389/fimmu.2022.1018384] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maria Tsilika
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Esther Taks
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
| | - Konstantinos Dolianitis
- Department of Internal Medicine, “Bodosakeio” General Hospital of Ptolemaida, Ptolemaida, Greece
| | - Antigone Kotsaki
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Konstantinos Leventogiannis
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christina Damoulari
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Kostoula
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Paneta
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Adamis
- 1Department of Internal Medicine, “G.Gennimatas” Athens General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, Aghia Eirini General Hospital of Kerkyra, Kontokali, Greece
| | - Kimon Stamatelopoulos
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Amalia Bolanou
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Christina Delavinia
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Perdios
- 1Department of Internal Medicine, “G.Gennimatas” Athens General Hospital, Athens, Greece
| | - Aggeliki Pandi
- Department of Pulmonary Medicine, Aghia Eirini General Hospital of Kerkyra, Kontokali, Greece
| | - Konstantinos Tsiakos
- 3Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nektarios Proios
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmanouela Kalogianni
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Delis
- Department of Internal Medicine, General Hospital of Karditsa, Karditsa, Greece
| | | | | | - Aggeliki Perdikouli
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Garyfallia Poulakou
- 3Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- 1Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Eva Athanassopoulou
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Eleftheria Kalpaki
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | - Antonios Papadopoulos
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Mihai G. Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Evangelos J. Giamarellos-Bourboulis
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
- *Correspondence: Evangelos J. Giamarellos-Bourboulis,
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Cozzi-Lepri A, Peters L, Pelchen-Matthews A, Neesgaard B, De Wit S, Johansen IS, Edwards S, Stephan C, Adamis G, Staub T, Zagalo A, Domingo P, Elbirt D, Kusejko K, Brännström J, Paduta D, Trofimova T, Szlavik J, Zilmer K, Losso M, Van Eygen V, Pai H, Lundgren J, Mocroft A. Observational cohort study of rilpivirine (RPV) utilization in Europe. AIDS Res Ther 2022; 19:38. [PMID: 35933352 PMCID: PMC9357334 DOI: 10.1186/s12981-022-00457-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/10/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Data on safety and effectiveness of RPV from the real-world setting as well as comparisons with other NNRTIs such as efavirenz (EFV) remain scarce. METHODS Participants of EuroSIDA were included if they had started a RPV- or an EFV-containing regimen over November 2011-December 2017. Statistical testing was conducted using non-parametric Mann-Whitney U test and Chi-square test. A logistic regression model was used to compare participants' characteristics by treatment group. Kaplan-Meier analysis was used to estimate the cumulative risk of virological failure (VF, two consecutive values > 50 copies/mL). RESULTS 1,355 PLWH who started a RPV-based regimen (11% ART-naïve), as well as 333 initiating an EFV-containing regimen were included. Participants who started RPV differed from those starting EFV for demographics (age, geographical region) and immune-virological profiles (CD4 count, HIV RNA). The cumulative risk of VF for the RPV-based group was 4.5% (95% CI 3.3-5.7%) by 2 years from starting treatment (71 total VF events). Five out of 15 (33%) with resistance data available in the RPV group showed resistance-associated mutations vs. 3/13 (23%) among those in the EFV group. Discontinuations due to intolerance/toxicity were reported for 73 (15%) of RPV- vs. 45 (30%) of EFV-treated participants (p = 0.0001). The main difference was for toxicity of central nervous system (CNS, 3% vs. 22%, p < 0.001). CONCLUSION Our estimates of VF > 50 copies/mL and resistance in participants treated with RPV were similar to those reported by other studies. RPV safety profile was favourable with less frequent discontinuation due to toxicity than EFV (especially for CNS).
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Affiliation(s)
- Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, Rowland Hill St, London, NW3 2PF, UK.
| | - Lars Peters
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, Rowland Hill St, London, NW3 2PF, UK
| | | | - Stephane De Wit
- Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Simon Edwards
- Mortimer Market Centre, Department of HIV, London, UK
| | - Christoph Stephan
- Infectious Diseases Unit, Goethe-University Hospital, Frankfurt, Germany
| | - Georgios Adamis
- 1St Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens G. Gennimatas, Athens, Greece
| | - Therese Staub
- Centre Hospitalier de Luxembourg, Service des Maladies Infectieuses, Luxembourg City, Luxembourg
| | - Alexandra Zagalo
- Department of Infectious Diseases, Santa Maria University Hospital, Lisbon, Portugal
| | - Pere Domingo
- Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Daniel Elbirt
- Allergy, Immunology and HIV Unit
- Kaplan, Medical Center, Rehovot, Israel
| | - Katharina Kusejko
- Division of Infectious Diseases, University Hospital Zürich, Zurich, Switzerland
| | - Johanna Brännström
- Department of Infectious Diseases, Venhälsan Södersjukhuset, Stockholm, Sweden
| | | | - Tatyana Trofimova
- Novgorod Centre for AIDS Prevention and Control, Novgorod the Great, Russia
| | - Janos Szlavik
- South-Pest Hospital Centre-National Institute for Infectiology and Haematology, Budapest, Hungary
| | - Kai Zilmer
- West-Tallinn Central Hospital, Infectious Diseases Clinic, Talinn, Estonia
| | | | | | - Helen Pai
- Janssen Research & Development, Raritan, NJ, USA
| | - Jens Lundgren
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, Rowland Hill St, London, NW3 2PF, UK.,CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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6
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Pantazis N, Papastamopoulos V, Antoniadou A, Adamis G, Paparizos V, Metallidis S, Sambatakou H, Psichogiou M, Chini M, Chrysos G, Panagopoulos P, Sipsas NV, Barbunakis E, Gogos C, Touloumi G. Changes in Body Mass Index after Initiation of Antiretroviral Treatment: Differences by Class of Core Drug. Viruses 2022; 14:v14081677. [PMID: 36016299 PMCID: PMC9415309 DOI: 10.3390/v14081677] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Recent research on antiretroviral treatment (ART) for HIV suggests that integrase strand transfer inhibitors (INSTIs) cause faster weight gain compared to other drug classes. Here, we investigated changes in body mass index (BMI) and obesity prevalence after treatment initiation and corresponding differences between drug classes. Data were derived from a large collaborative cohort in Greece. Included individuals were adults who started ART, in or after 2010, while previously ART naïve and achieved virologic response within the first year of ART. Data were analysed using mixed fractional polynomial models. INSTI regimens led to the more pronounced BMI increases, followed by boosted PI and NNRTI based regimens. Individuals with normal initial BMI are expected to gain 6 kg with an INSTI regimen compared to 4 kg with a boosted PI and less than 3 kg with a NNRTI regimen after four years of treatment. Prevalence of obesity was 5.7% at ART initiation and 12.2%, 14.2% and 18.1% after four years of treatment with NNRTIs, PIs, and INSTIs, respectively. Dolutegravir or Raltegravir were associated with marginally faster BMI increase compared to Elvitegravir. INSTIs are associated with faster weight gain. INSTIs' increased risk of treatment emergent obesity and, possibly, weight-related co-morbidities should be judged against their improved efficacy and tolerability but increased clinical attention is required.
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Affiliation(s)
- Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
- Correspondence:
| | - Vasilios Papastamopoulos
- 5th Department of Internal Medicine—Division of Infectious Diseases, Evangelismos General Hospital of Athens, 10676 Athens, Greece;
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Georgios Adamis
- 1st Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens G. Gennimatas, 11527 Athens, Greece;
| | - Vasilios Paparizos
- AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece;
| | - Simeon Metallidis
- 1st Internal Medicine Department, Medical School, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece;
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, Medical School, Hippokration University General Hospital, 11527 Athens, Greece;
| | - Mina Psichogiou
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Maria Chini
- 3rd Department of Internal Medicine—Infectious Diseases Unit, Red Cross General Hospital, 11526 Athens, Greece;
| | - Georgios Chrysos
- Infectious Diseases Unit, Tzaneion General Hospital of Piraeus, 18536 Athens, Greece;
| | - Periklis Panagopoulos
- Department of Internal Medicine, University Hospital of Alexandroupoli, 68100 Alexandroupolis, Greece;
| | - Nikolaos V. Sipsas
- Infectious Diseases Unit, Department of Pathophysiology, Medical School, Laikon Athens General Hospital and National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Emmanouil Barbunakis
- Department of Internal Medicine, University Hospital of Heraklion, 71500 Heraklion, Crete, Greece;
| | - Charalambos Gogos
- Department of Internal Medicine & Infectious Diseases, Patras University General Hospital, 26504 Patras, Greece;
| | - Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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7
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Tsilika M, Taks E, Dolianitis K, Kotsaki A, Leventogiannis K, Damoulari C, Kostoula M, Paneta M, Adamis G, Papanikolaou I, Stamatelopoulos K, Bolanou A, Katsaros K, Delavinia C, Perdios I, Pandi A, Tsiakos K, Proios N, Kalogianni E, Delis I, Skliros E, Akinosoglou K, Perdikouli A, Poulakou G, Milionis H, Athanassopoulou E, Kalpaki E, Efstratiou L, Perraki V, Papadopoulos A, Netea MG, Giamarellos-Bourboulis EJ. ACTIVATE-2: A Double-Blind Randomized Trial of BCG Vaccination Against COVID-19 in Individuals at Risk. Front Immunol 2022; 13:873067. [PMID: 35865520 PMCID: PMC9294453 DOI: 10.3389/fimmu.2022.873067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022] Open
Abstract
In a recent study of our group with the acronym ACTIVATE, Bacillus Calmete-Guérin (BCG) vaccination reduced the occurrence of new infections compared to placebo vaccination in the elderly. Most benefit was found for respiratory infections. The ACTIVATE-2 study was launched to assess the efficacy of BCG vaccination against coronavirus disease 2019 (COVID-19). In this multicenter, double-blind trial, 301 volunteers aged 50 years or older were randomized (1:1) to be vaccinated with BCG or placebo. The trial end points were the incidence of COVID-19 and the presence of anti–severe acute respiratory syndrome coronavirus 2 (anti–SARS-CoV-2) antibodies, which were both evaluated through 6 months after study intervention. Results revealed 68% relative reduction of the risk to develop COVID-19, using clinical criteria or/and laboratory diagnosis, in the group of BCG vaccine recipients compared with placebo-vaccinated controls, during a 6-month follow-up (OR 0.32, 95% CI 0.13-0.79). In total, eight patients were in need of hospitalization for COVID-19: six in the placebo group and two in the BCG group. Three months after study intervention, positive anti–SARS-CoV-2 antibodies were noted in 1.3% of volunteers in the placebo group and in 4.7% of participants in BCG-vaccinated group. The ACTIVATE II trial did not meet the primary endpoint of the reduction of the risk for COVID-19 3 months after BCG vaccination; however, the secondary endpoint of the reduction of the risk for COVID-19 6 months after BCG vaccination was met. BCG vaccination may be a promising approach against the COVID-19 pandemic.
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Affiliation(s)
- Maria Tsilika
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Esther Taks
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
| | - Konstantinos Dolianitis
- Department of Internal Medicine, “Bodosakeio” General Hospital of Ptolemaida, Ptolemaida, Greece
| | - Antigone Kotsaki
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Konstantinos Leventogiannis
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christina Damoulari
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Kostoula
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Paneta
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Adamis
- 1Department of Internal Medicine, “G.Gennimatas” Athens General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, Aghia Eirini General Hospital of Kerkyra, Kontokali, Greece
| | - Kimon Stamatelopoulos
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Amalia Bolanou
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Christina Delavinia
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Perdios
- 1Department of Internal Medicine, “G.Gennimatas” Athens General Hospital, Athens, Greece
| | - Aggeliki Pandi
- Department of Pulmonary Medicine, Aghia Eirini General Hospital of Kerkyra, Kontokali, Greece
| | - Konstantinos Tsiakos
- 3Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nektarios Proios
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmanouela Kalogianni
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Delis
- Department of Internal Medicine, General Hospital of Karditsa, Karditsa, Greece
| | | | | | - Aggeliki Perdikouli
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Garyfallia Poulakou
- 3Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- 1Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Eva Athanassopoulou
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Eleftheria Kalpaki
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | - Antonios Papadopoulos
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Mihai G. Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Evangelos J. Giamarellos-Bourboulis
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
- *Correspondence: Evangelos J. Giamarellos-Bourboulis,
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8
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Maltezou HC, Tseroni M, Drositis I, Gamaletsou MN, Koukou DM, Bolikas E, Peskelidou E, Daflos C, Panagiotaki E, Ledda C, Pavli A, Moussas N, Kontogianni S, Svarna E, Ploumidis M, Spyrou A, Chini M, Adamis G, Lourida A, Hatzigeorgiou D, Gargalianos P, Syrogiannopoulos G, Sipsas NV. Vaccination coverage rates and attitudes towards mandatory vaccinations among healthcare personnel in tertiary-care hospitals in Greece. Expert Rev Vaccines 2022; 21:853-859. [PMID: 35382665 DOI: 10.1080/14760584.2022.2063118] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES : Our aim was to estimate vaccination and susceptibility rates against vaccine-preventable diseases among healthcare personnel (HCP) in eight hospitals. METHODS This study was a cross-sectional survey. RESULTS A total of 1284 HCP participated (physicians: 31.3%, nursing personnel: 36.6%, paramedical personnel: 11.1%, administrative personnel: 13.2%, supportive personnel: 7.3%). Vaccination rates were 32.9% against measles and mumps, 38.1% against rubella, 5.7% against varicella, 9.2% against hepatitis A, 65.8% against hepatitis B, 31.8% against tetanus-diphtheria, 7.1% against pertussis, 60.2% against influenza, and 80.1% against COVID-19. Susceptibility rates were: 27.8% for measles, 39.6% for mumps, 33.4% for rubella, 22.2% for varicella, 86.3% for hepatitis A, 34.2% for hepatitis B, 68.2% for tetanus-diphtheria, and 92.9% for pertussis. Older HCP had higher susceptibility rates against mumps, rubella, varicella, hepatitis A, hepatitis B, tetanus-diphtheria, and pertussis (p-values <0.001 for all). Mandatory vaccinations were supported by 81.85% of HCP. CONCLUSIONS Although most HCP supported mandatory vaccinations, significant vaccination gaps and susceptibility rates were recorded. The proportion of susceptible HCP to measles, mumps, rubella, and varicella increased the past decade, mostly because of reduction of acquired cases of natural illness. Vaccination programs for HCP should be developed. A national registry to follow HCP' vaccination rates is urgently needed.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
| | - Maria Tseroni
- Directorate of Epidemiological Surveillance of Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Ioannis Drositis
- Medical Oncology Department, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | - Maria N Gamaletsou
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
| | - Dimitra Maria Koukou
- First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Emmanouil Bolikas
- Infection Control Committee, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | - Emmanuela Peskelidou
- COVID-19 Intensive Care Unit, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
| | - Charalambos Daflos
- Infection Control Committee, Korgialeneio-Benakeio Red Cross General Hospital, Athens, Greece
| | | | - Caterina Ledda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Androula Pavli
- Department for Travel Medicine, National Public Health Organization, Athens, Greece
| | - Nikolaos Moussas
- Internal Medicine and Infectious Diseases Clinic, Iatriko Athinon General Hospital, Athens, Greece
| | | | - Eftychia Svarna
- Department of Pediatrics, University of Thessaly, Larissa, Greece
| | - Michalis Ploumidis
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - Andronikos Spyrou
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - Maria Chini
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneio-Benakeio Red Cross Hospital, Athens, Greece
| | - Georgios Adamis
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - Athanasia Lourida
- Infection Prevention and Control Committee, Aghia Sofia Children's Hospital, Athens, Greece
| | | | - Panagiotis Gargalianos
- Internal Medicine and Infectious Diseases Clinic, Iatriko Athinon General Hospital, Athens, Greece
| | | | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
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9
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Touloumi G, Thomadakis C, Pantazis N, Papastamopoulos V, Paparizos V, Metallidis S, Adamis G, Chini M, Psichogiou M, Chrysos G, Sambatakou H, Barbunakis E, Vourli G, Antoniadou A. HIV continuum of care: bridging cross-sectional and longitudinal analyses. AIDS 2022; 36:583-591. [PMID: 34772850 DOI: 10.1097/qad.0000000000003131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to propose a unified continuum-of-care (CoC) analysis combining cross-sectional and longitudinal elements, incorporating time spent between stages. DESIGN The established 90-90-90 target follows a cross-sectional four-stage CoC analysis, lacking information on timing of diagnosis, antiretroviral therapy (ART) initiation, and viral suppression durability. METHODS Data were derived from the Athens Multicenter AIDS Cohort Study (AMACS). In the cross-sectional CoC, we added stratification of diagnosed people with HIV (PWH) by estimated time from infection to diagnosis; of those who ever initiated ART or achieved viral suppression by corresponding current status (in 2018); and cumulative incidence function (CIF) of ART initiation and viral suppression, treating loss-to-follow-up (LTFU) as competing event. Viral suppression was defined as viral load less than 500 copies/ml. Viral suppression durability was assessed by the CIF of viral load rebound. FINDINGS About 89.1% of PWH in 2018 were diagnosed (range of diagnoses: 1980-2018). Median time to diagnosis was 3.5 years (IQR: 1.1-7.0). Among diagnosed, 89.1% were ever treated, of whom 86.7% remained on ART. CIF of ART initiation and LTFU before ART initiation were 80.9 and 6.0% at 5 years since diagnosis, respectively. Among treated, 89.4% achieved viral suppression, of whom 87.4% were currently virally suppressed. The CIF of viral load rebound was 24.2% at 5 years since first viral suppression but substantially reduced in more recent years. INTERPRETATION The proposed analysis highlights time gaps in CoC not evident by the standard cross-sectional approach. Our analysis highlights the need for early diagnosis and identifies late presenters as a key population for interventions that could decrease gaps in the CoC.
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Affiliation(s)
- Giota Touloumi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Christos Thomadakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine - Division of Infectious Diseases, Evangelismos General Hospital of Athens
| | - Vasilios Paparizos
- AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, Medical School, National and Kapodistrian University of Athens, Syngros Hospital, Athens
| | - Simeon Metallidis
- 1 Internal Medicine Department, Infectious Diseases Unit, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | - Georgios Adamis
- 1st Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens G. Gennimatas
| | - Maria Chini
- 3rd Department of Internal Medicine - Infectious Diseases Unit, Red Cross General Hospital
| | - Mina Psichogiou
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens
| | | | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Hippokration University General Hospital, Athens
| | - Emmanouil Barbunakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete
| | - Georgia Vourli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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10
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Limnaios S, Kostaki EG, Adamis G, Astriti M, Chini M, Mangafas N, Lazanas M, Patrinos S, Metallidis S, Tsachouridou O, Papastamopoulos V, Kakalou E, Chatzidimitriou D, Antoniadou A, Papadopoulos A, Psichogiou M, Basoulis D, Gova M, Pilalas D, Paraskeva D, Chrysos G, Paparizos V, Kourkounti S, Sambatakou H, Bolanos V, Sipsas NV, Lada M, Barbounakis E, Kantzilaki E, Panagopoulos P, Maltezos E, Drimis S, Sypsa V, Lagiou P, Magiorkinis G, Hatzakis A, Skoura L, Paraskevis D. Dating the Origin and Estimating the Transmission Rates of the Major HIV-1 Clusters in Greece: Evidence about the Earliest Subtype A1 Epidemic in Europe. Viruses 2022; 14:v14010101. [PMID: 35062305 PMCID: PMC8782043 DOI: 10.3390/v14010101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 12/16/2022] Open
Abstract
Our aim was to estimate the date of the origin and the transmission rates of the major local clusters of subtypes A1 and B in Greece. Phylodynamic analyses were conducted in 14 subtype A1 and 31 subtype B clusters. The earliest dates of origin for subtypes A1 and B were in 1982.6 and in 1985.5, respectively. The transmission rate for the subtype A1 clusters ranged between 7.54 and 39.61 infections/100 person years (IQR: 9.39, 15.88), and for subtype B clusters between 4.42 and 36.44 infections/100 person years (IQR: 7.38, 15.04). Statistical analysis revealed that the average difference in the transmission rate between the PWID and the MSM clusters was 6.73 (95% CI: 0.86 to 12.60; p = 0.026). Our study provides evidence that the date of introduction of subtype A1 in Greece was the earliest in Europe. Transmission rates were significantly higher for PWID than MSM clusters due to the conditions that gave rise to an extensive PWID HIV-1 outbreak ten years ago in Athens, Greece. Transmission rate can be considered as a valuable measure for public health since it provides a proxy of the rate of epidemic growth within a cluster and, therefore, it can be useful for targeted HIV prevention programs.
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Affiliation(s)
- Stefanos Limnaios
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Georgios Adamis
- 1st Department of Internal Medicine, G. Gennimatas General Hospital, 11527 Athens, Greece; (G.A.); (M.A.)
| | - Myrto Astriti
- 1st Department of Internal Medicine, G. Gennimatas General Hospital, 11527 Athens, Greece; (G.A.); (M.A.)
| | - Maria Chini
- 3rd Department of Internal Medicine-Infectious Diseases Unit, “Korgialeneio-Benakeio” Red Cross General Hospital, 11526 Athens, Greece; (M.C.); (N.M.); (M.L.)
| | - Nikos Mangafas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, “Korgialeneio-Benakeio” Red Cross General Hospital, 11526 Athens, Greece; (M.C.); (N.M.); (M.L.)
| | - Marios Lazanas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, “Korgialeneio-Benakeio” Red Cross General Hospital, 11526 Athens, Greece; (M.C.); (N.M.); (M.L.)
| | | | - Simeon Metallidis
- 1st Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (S.M.); (O.T.)
| | - Olga Tsachouridou
- 1st Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (S.M.); (O.T.)
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, 10676 Athens, Greece; (V.P.); (E.K.)
| | - Eleni Kakalou
- 5th Department of Internal Medicine and Infectious Diseases, Evaggelismos General Hospital, 10676 Athens, Greece; (V.P.); (E.K.)
| | - Dimitrios Chatzidimitriou
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.C.); (L.S.)
| | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.A.); (A.P.)
| | - Antonios Papadopoulos
- 4th Department of Medicine, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.A.); (A.P.)
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.P.); (D.B.)
| | - Dimitrios Basoulis
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.P.); (D.B.)
| | - Maria Gova
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Dimitrios Pilalas
- Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Dimitra Paraskeva
- Department of Internal Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece; (D.P.); (G.C.); (S.D.)
| | - Georgios Chrysos
- Department of Internal Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece; (D.P.); (G.C.); (S.D.)
| | - Vasileios Paparizos
- HIV/AIDS Unit, A. Syngros Hospital of Dermatology and Venereology, 16121 Athens, Greece; (V.P.); (S.K.)
| | - Sofia Kourkounti
- HIV/AIDS Unit, A. Syngros Hospital of Dermatology and Venereology, 16121 Athens, Greece; (V.P.); (S.K.)
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (H.S.); (V.B.)
| | - Vasileios Bolanos
- HIV Unit, 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (H.S.); (V.B.)
| | - Nikolaos V. Sipsas
- Department of Pathophysiology, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Malvina Lada
- 2nd Department of Internal Medicine, Sismanogleion General Hospital, 15126 Marousi, Greece;
| | - Emmanouil Barbounakis
- Department of Internal Medicine, University Hospital of Heraklion “PAGNI”, Medical School, University of Crete, 71110 Heraklion, Greece; (E.B.); (E.K.)
| | - Evrikleia Kantzilaki
- Department of Internal Medicine, University Hospital of Heraklion “PAGNI”, Medical School, University of Crete, 71110 Heraklion, Greece; (E.B.); (E.K.)
| | - Periklis Panagopoulos
- Department of Internal Medicine, University General Hospital, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (P.P.); (E.M.)
| | - Efstratios Maltezos
- Department of Internal Medicine, University General Hospital, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (P.P.); (E.M.)
| | - Stelios Drimis
- Department of Internal Medicine, Tzaneio General Hospital, 18536 Piraeus, Greece; (D.P.); (G.C.); (S.D.)
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
| | - Lemonia Skoura
- National AIDS Reference Centre of Northern Greece, Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.C.); (L.S.)
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.L.); (E.G.K.); (M.G.); (V.S.); (P.L.); (G.M.); (A.H.)
- Correspondence:
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11
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Kyriazopoulou E, Poulakou G, Milionis H, Metallidis S, Adamis G, Tsiakos K, Fragkou A, Rapti A, Damoulari C, Fantoni M, Kalomenidis I, Chrysos G, Angheben A, Kainis I, Alexiou Z, Castelli F, Serino FS, Tsilika M, Bakakos P, Nicastri E, Tzavara V, Kostis E, Dagna L, Koufargyris P, Dimakou K, Savvanis S, Tzatzagou G, Chini M, Cavalli G, Bassetti M, Katrini K, Kotsis V, Tsoukalas G, Selmi C, Bliziotis I, Samarkos M, Doumas M, Ktena S, Masgala A, Papanikolaou I, Kosmidou M, Myrodia DM, Argyraki A, Cardellino CS, Koliakou K, Katsigianni EI, Rapti V, Giannitsioti E, Cingolani A, Micha S, Akinosoglou K, Liatsis-Douvitsas O, Symbardi S, Gatselis N, Mouktaroudi M, Ippolito G, Florou E, Kotsaki A, Netea MG, Eugen-Olsen J, Kyprianou M, Panagopoulos P, Dalekos GN, Giamarellos-Bourboulis EJ. Early treatment of COVID-19 with anakinra guided by soluble urokinase plasminogen receptor plasma levels: a double-blind, randomized controlled phase 3 trial. Nat Med 2021; 27:1752-1760. [PMID: 34480127 PMCID: PMC8516650 DOI: 10.1038/s41591-021-01499-z] [Citation(s) in RCA: 297] [Impact Index Per Article: 99.0] [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] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/10/2021] [Indexed: 12/20/2022]
Abstract
Early increase of soluble urokinase plasminogen activator receptor (suPAR) serum levels is indicative of increased risk of progression of coronavirus disease 2019 (COVID-19) to respiratory failure. The SAVE-MORE double-blind, randomized controlled trial evaluated the efficacy and safety of anakinra, an IL-1α/β inhibitor, in 594 patients with COVID-19 at risk of progressing to respiratory failure as identified by plasma suPAR ≥6 ng ml-1, 85.9% (n = 510) of whom were receiving dexamethasone. At day 28, the adjusted proportional odds of having a worse clinical status (assessed by the 11-point World Health Organization Clinical Progression Scale (WHO-CPS)) with anakinra, as compared to placebo, was 0.36 (95% confidence interval 0.26-0.50). The median WHO-CPS decrease on day 28 from baseline in the placebo and anakinra groups was 3 and 4 points, respectively (odds ratio (OR) = 0.40, P < 0.0001); the respective median decrease of Sequential Organ Failure Assessment (SOFA) score on day 7 from baseline was 0 and 1 points (OR = 0.63, P = 0.004). Twenty-eight-day mortality decreased (hazard ratio = 0.45, P = 0.045), and hospital stay was shorter.
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Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Haralampos Milionis
- 1st Department of Internal Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - Simeon Metallidis
- 1st Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Georgios Adamis
- 1st Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Konstantinos Tsiakos
- 2nd Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | | | - Aggeliki Rapti
- 2nd Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Christina Damoulari
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Massimo Fantoni
- Dipartimento Scienze di Laboratorio e Infettivologiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Ioannis Kalomenidis
- 1st Department of Critical Care and Pulmonary Medicine, Medical School, National and Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece
| | - Georgios Chrysos
- 2nd Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Andrea Angheben
- Department of Infectious Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Ilias Kainis
- 10th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases of Athens, Athens, Greece
| | - Zoi Alexiou
- 2nd Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Francesco Castelli
- Spedali Civili, Brescia ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Maria Tsilika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Petros Bakakos
- 1st Department of Chest Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emanuele Nicastri
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Vassiliki Tzavara
- 1st Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Evangelos Kostis
- Department of Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Panagiotis Koufargyris
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Katerina Dimakou
- 5th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Spyridon Savvanis
- Department of Internal Medicine, Elpis General Hospital, Athens, Greece
| | - Glykeria Tzatzagou
- 1st Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Chini
- 3rd Department of Internal Medicine and Infectious Diseases Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genova, Italy
| | - Konstantina Katrini
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Vasileios Kotsis
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - George Tsoukalas
- 4th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy & IRCCS Humanitas Research Hospital, Milan, Italy
| | - Ioannis Bliziotis
- 1st Department of Internal Medicine, Asklepieio General Hospital of Voula, Athens, Greece
| | - Michael Samarkos
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Michael Doumas
- 2nd Department of Propedeutic Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Sofia Ktena
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Aikaterini Masgala
- 2nd Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, General Hospital of Kerkyra, Corfu, Greece
| | - Maria Kosmidou
- 1st Department of Internal Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - Dimitra-Melia Myrodia
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Chiara Simona Cardellino
- Department of Infectious Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar, Verona, Italy
| | | | | | - Vassiliki Rapti
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Efthymia Giannitsioti
- 2nd Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Antonella Cingolani
- Dipartimento Scienze di Laboratorio e Infettivologiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Styliani Micha
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | | | | | - Styliani Symbardi
- 1st Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Nikolaos Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Maria Mouktaroudi
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Giuseppe Ippolito
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Eleni Florou
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Antigone Kotsaki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Mihai G Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, The Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | | | - Periklis Panagopoulos
- 2nd Department of Internal Medicine, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
- Hellenic Institute for the Study of Sepsis, Athens, Greece.
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12
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Maltezou HC, Pavli A, Dedoukou X, Georgakopoulou T, Raftopoulos V, Drositis I, Bolikas E, Ledda C, Adamis G, Spyrou A, Karantoni E, Gamaletsou MN, Koukou DM, Lourida A, Moussas N, Petrakis V, Panagopoulos P, Hatzigeorgiou D, Theodoridou M, Lazanas M, Gargalianos P, Sipsas NV. Determinants of intention to get vaccinated against COVID-19 among healthcare personnel in hospitals in Greece. Infect Dis Health 2021; 26:189-197. [PMID: 33906828 PMCID: PMC8011642 DOI: 10.1016/j.idh.2021.03.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 01/11/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND To investigate intention rates to get vaccinated against COVID-19 among healthcare personnel (HCP) in Greece. METHODS Cross-sectional survey. RESULTS The response rate was 14.5%. Of 1521 HCP with a known profession, 607 (39.9%) were nursing personnel, 480 (31.6%) physicians, 171 (11.2%) paramedical personnel, 72 (4.7%) supportive personnel, and 191 (12.6%) administrative personnel. Overall, 803 of 1571 HCP (51.1%) stated their intention to get vaccinated while 768 (48.9%) stated their intention to decline vaccination. Most HCP (71.3%) who reported intent to get vaccinated noted contributing to the control of the pandemic and protecting their families and themselves as their reasons, while the most common reason for reporting intent to decline vaccination was inadequate information about the vaccines (74.9%), followed by concerns about vaccine safety (36.2%). Logistic regression analysis revealed that the probability of intending to get vaccinated increased with male gender, being a physician, history of complete vaccination against hepatitis B, history of vaccination against pandemic A (H1N1) in 2009-2010, belief that COVID-19 vaccination should be mandatory for HCP, and increased confidence in vaccines in general during the COVID-19 pandemic. The following factors were associated with a lower intention to get vaccinated: no vaccination against influenza the past season, no intention to get vaccinated against influenza in 2020-2021, and no intention to recommend COVID-19 vaccination to high-risk patients. CONCLUSION There is an urgent need to built safety perception towards COVID-19 vaccines and raise vaccine uptake rates by HCP, and thus to protect the healthcare workforce and the healthcare services.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, 11523, Greece.
| | - Androula Pavli
- Department for Travel Medicine, National Public Health Organization, Athens, 11523, Greece
| | | | - Theano Georgakopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, 11523, Greece
| | - Vasilios Raftopoulos
- HIV Surveillance Department, National Public Health Organization, Athens, 11523, Greece
| | - Ioannis Drositis
- Medical Oncology Department, Venizeleio-Pananeio General Hospital, Heraklion, 71409, Greece
| | - Emmanouil Bolikas
- Infection Control Committee, Venizeleio-Pananeio General Hospital, Heraklion, 71409, Greece
| | - Caterina Ledda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, 95124, Italy
| | - Georgios Adamis
- First Department of Internal Medicine, Infectious Diseases Unit, Gennimatas General Hospital, Athens, 11527, Greece
| | - Andronikos Spyrou
- First Department of Internal Medicine, Infectious Diseases Unit, Gennimatas General Hospital, Athens, 11527, Greece
| | - Eleni Karantoni
- Medical Directorate, Hellenic Air Force General Staff, Athens, 11525, Greece
| | - Maria N Gamaletsou
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, 11527, Greece
| | - Dimitra Maria Koukou
- First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, 11527, Greece
| | - Athanasia Lourida
- Infection Prevention and Control Committee, Aghia Sofia Children's Hospital, Athens, 11527, Greece
| | - Nikolaos Moussas
- Internal Medicine and Infectious Diseases Clinic, Iatriko Athinon General Hospital, Athens, 11523, Greece
| | - Vasilios Petrakis
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece
| | - Periklis Panagopoulos
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece
| | | | - Maria Theodoridou
- First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, 11527, Greece
| | - Marios Lazanas
- Internal Medicine and Infectious Diseases Department, Iaso Maternity Hospital, Athens, 11523, Greece
| | - Panagiotis Gargalianos
- Internal Medicine and Infectious Diseases Clinic, Iatriko Athinon General Hospital, Athens, 11523, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, 11527, Greece
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13
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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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14
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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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15
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Kostaki EG, Hodges-Mameletzis I, Magiorkinis G, Adamis G, Xylomenos G, Nikolopoulos G, Lazanas M, Chini M, Mangafas N, Skoutelis A, Papastamopoulos V, Antoniadou A, Papadopoulos A, Protopapas K, Psichogiou M, Basoulis D, Chrysos G, Paraskeva D, Paparizos V, Kourkounti S, Sambatakou H, Sipsas NV, Lada M, Panagopoulos P, Maltezos E, Hatzakis A, Paraskevis D. Earlier treatment initiation is associated with a decreased number of HIV-1 subtype A1 transmissions in Greece. Sex Transm Infect 2020; 97:232-237. [PMID: 32561553 DOI: 10.1136/sextrans-2020-054509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/18/2020] [Revised: 04/30/2020] [Accepted: 05/24/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Subtypes A1 and B are the most prevalent HIV-1 clades in Greece. Subtype A1 epidemic is highly monophyletic and corresponds to transmissions that occurred locally. Our aim in this molecular epidemiology analysis was to investigate the role of early treatment in preventing new HIV-1 transmissions. METHODS Our analysis focused on 791 subtype A1 sequences from treatment-naïve individuals in Greece. Estimation of infection dates was performed by molecular clock calculations using Bayesian methods. We estimated the time interval between (1) the infection and sampling dates (linkage to care window), (2) the sampling dates and antiretroviral therapy (ART) initiation (treatment window), and (3) the infection dates and ART initiation (transmissibility window) for the study population. We also inferred the putative source of HIV infections between individuals of different groups divided according to the length of treatment, linkage to care or transmissibility window. RESULTS A significant decline was detected for the treatment window during 2014-2015 versus the 2 previous years (p=0.0273), while the linkage to care interval remained unchanged during the study period. Inference of the putative source of HIV infections suggested that individuals with a recent diagnosis or narrow transmissibility window (time period between HIV infection and ART initiation) were not sources of HIV infections to other groups. Contrarily, a significant number of HIV infections originated from individuals with longer transmissibility window interval. CONCLUSIONS Our findings showed that the treatment window is decreasing over time, presumably due to the updated treatment guidelines. Our study also demonstrates that people treated earlier after infection do not transmit at high rates, thus documenting the benefits of early ART initiation in preventing ongoing HIV-1 transmission.
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Affiliation(s)
- Evangelia Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Adamis
- 1st Department of Internal Medicine, G Gennimatas GH, Athens, Greece
| | | | | | - Marios Lazanas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Maria Chini
- 3rd Department of Internal Medicine-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Nikos Mangafas
- 3rd Department of Internal Medicine-Infectious Diseases Unit, Red Cross General Hospital, Athens, Greece
| | - Athanasios Skoutelis
- 5th Department of Medicine and Infectious Diseases, Evaggelismos GH, Athens, Greece
| | | | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Papadopoulos
- 4th Department of Medicine, Attikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Protopapas
- 4th Department of Medicine, Attikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Basoulis
- 1st Department of Medicine, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Vasileios Paparizos
- HIV/AIDS Unit, A Syngros Hospital of Dermatology and Venereology, Athens, Greece
| | - Sofia Kourkounti
- HIV/AIDS Unit, A Syngros Hospital of Dermatology and Venereology, Athens, Greece
| | - Helen Sambatakou
- HIV Unit, 2nd Department of Internal Medicine, Hippokration GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Malvina Lada
- 2nd Department of Internal Medicine, Sismanogleion GH, Athens, Greece
| | - Periklis Panagopoulos
- Department of Internal Medicine, University GH, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efstratios Maltezos
- Department of Internal Medicine, University GH, Democritus University of Thrace, Alexandroupolis, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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16
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Touloumi G, Kalpourtzi N, Papastamopoulos V, Paparizos V, Adamis G, Antoniadou A, Chini M, Karakosta A, Makrilakis K, Gavana M, Vantarakis A, Psichogiou M, Metallidis S, Sipsas NV, Sambatakou H, Hadjichristodoulou C, Voulgari PV, Chrysos G, Gogos C, Chlouverakis G, Tripsianis G, Alamanos Y, Stergiou G. Cardiovascular risk factors in HIV infected individuals: Comparison with general adult control population in Greece. PLoS One 2020; 15:e0230730. [PMID: 32226048 PMCID: PMC7105103 DOI: 10.1371/journal.pone.0230730] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/06/2020] [Indexed: 12/24/2022] Open
Abstract
Background Although combined antiretroviral therapy has substantially improved the prognosis of people living with HIV (PLHIV), mortality remains higher compared to the general population, mainly due to higher prevalence of non-HIV-related comorbidities, including cardiovascular diseases (CVD). We assessed the prevalence of CVD risk and its contributing factors in adult PLHIV versus general population controls in Greece. Settings Cross-sectional comparison of PLHIV (Athens-Multicenter-AIDS-Cohort-Study; AMACS) versus general population controls (National health examination survey; EMENO). Methods All HIV-infected adults with ≥1 measurement of interest (blood pressure, lipids, glucose, weight, height) between 2012–2014 and all EMENO participants (2014–2016) were included. Ten-year total CVD risk was estimated using the Framingham (FRS) or the Systematic Coronary Risk Evaluation (SCORE) equations. Results 5839 PLHIV (median age:41.6 years, 85.4% males) and 4820 controls (median age:48 years, 48.4% males) were included. Adjusting for age, sex and origin, PLHIV were more likely to be current smokers (adjusted OR:1.53 [95% CI:1.35–1.74]) and dyslipidemic (aOR:1.18; [1.04–1.34]), less likely to be obese (aOR:0.44 [0.38–0.52], with no differences in hypertension, diabetes or high (≥20%) FRS but with greater odds of high (≥5%) SCORE (aOR:1.55 [1.05–2.30]). Further adjustment for educational level, anti-HCV positivity and BMI showed higher prevalence of hypertension in PLHIV. Conclusions Despite the relative absence of obesity, PLHIV have higher prevalence of traditional CVD risk factors and higher risk of fatal CVD compared to general population. Regular screening and early management of CVD risk factors in PLHIV should be of high priority for CVD prevention.
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Affiliation(s)
- Giota Touloumi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
- * E-mail:
| | - Natasa Kalpourtzi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Papastamopoulos
- 5th Department of Internal Medicine & Infectious Diseases Unit, Evaggelismos General Hospital, Athens, Greece
| | - Vasilios Paparizos
- AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, Syngros Hospital, Athens, Greece
| | - Georgios Adamis
- 1st Dept of Internal Medicine and Infectious Diseases, Gennimatas General Hospital, Athens, Greece
| | - Anastasia Antoniadou
- 4th Dept Of Internal Medicine, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Chini
- 3rd Dept Of Internal Medicine—Infectious Disease Unit, Red Cross General Hospital, Athens, Greece
| | - Argiro Karakosta
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Makrilakis
- Hellenic Diabetes Association, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Magda Gavana
- Lab of Primary Health Care, General Medicine & Health Services Research, Medical Department, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Mina Psichogiou
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Simeon Metallidis
- 1st Internal Medicine Department, Infectious Diseases Unit, Ahepa University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Infectious Diseases Unit, Department of Pathophysiology Laikon Athens General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Sambatakou
- 2nd Dept of Internal Medicine, HIV Unit, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Paraskevi V. Voulgari
- Department of Internal Medicine, Rheumatology Clinic, University of Ioannina, Ioannina, Greece
| | - George Chrysos
- Infectious Diseases Unit, Tzaneion General Hospital of Piraeus, Athens, Greece
| | - Charalambos Gogos
- Dept of Internal Medicine & Infectious Diseases, Patras University General Hospital, Patras, Greece
| | - Grigoris Chlouverakis
- Division of Biostatistics, School of Medicine, University of Crete, Heraklion, Greece
| | - Grigoris Tripsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis, Greece
| | - Yannis Alamanos
- Institute of Epidemiology, Preventive Medicine and Public Health, Corfu, Greece
| | - George Stergiou
- Hypertension Center, STRIDE-7, Third department of Medicine, School of Medicine, National & Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
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17
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Maltezou HC, Adamis G, Tsonou P, Moustaka E, Katerelos P, Gargalianos P. Consumption of antibiotics for community-acquired infections by adults in Greece: A cross-sectional study. Am J Infect Control 2016; 44:1741-1743. [PMID: 27424304 DOI: 10.1016/j.ajic.2016.04.242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Abstract
We studied the rates and characteristics of antibiotics consumption for community-acquired infections in 309 adult patients. Of them, 293 (94.8%) had received at least 1 course of antibiotics during the past year. In total, 419 courses of antibiotics were consumed during the past year, including 285 (68%) following medical examination, 72 (17.2%) following telephone consultation, 30 (7.2%) following suggestion by a pharmacist, and in 16 (3.8%) the antibiotic was available at home. Older age and asthma were significantly associated with a higher risk for antibiotics consumption.
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Affiliation(s)
- Helena C Maltezou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
| | - Georgios Adamis
- First Department of Medicine and Infectious Diseases Unit, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Paraskeui Tsonou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Eleni Moustaka
- Seventh Department of Pulmonary Medicine, Athens Chest General Hospital "Sotiria", Athens, Greece
| | - Panos Katerelos
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Panagiotis Gargalianos
- First Department of Medicine and Infectious Diseases Unit, Athens General Hospital "G. Gennimatas", Athens, Greece
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18
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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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20
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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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21
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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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22
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Maltezou HC, Maltezos E, Antoniadou A, Gourgoulis GM, Katerelos P, Adamis G, Petrikkos G, Gargalianos P. Prescription of antibiotics and knowledge about antibiotic costs among physicians working in tertiary-care hospitals. J Chemother 2014; 26:375-8. [DOI: 10.1179/1973947813y.0000000160] [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: 10/31/2022]
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23
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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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24
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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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25
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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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26
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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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