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Galani I, Souli M, Katsala D, Karaiskos I, Giamarellou H, Antoniadou A. In vitro activity of apramycin (EBL-1003) in combination with colistin, meropenem, minocycline or sulbactam against XDR/PDR Acinetobacter baumannii isolates from Greece. J Antimicrob Chemother 2024; 79:1101-1108. [PMID: 38501368 PMCID: PMC11062935 DOI: 10.1093/jac/dkae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/01/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES To evaluate the in vitro activity of the combination of apramycin with colistin, meropenem, minocycline or sulbactam, against some well-characterized XDR Acinetobacter baumannii clinical isolates from Greece, to understand how apramycin can be best incorporated into clinical practice and optimize effectiveness. METHODS In vitro interactions of apramycin (0.5×, 1× and 2× the MIC value) with colistin (2 mg/L), meropenem (30 mg/L), minocycline (3.5 mg/L) or sulbactam (24 mg/L) were tested using time-kill methodology. Twenty-one clinical A. baumannii isolates were chosen, exhibiting apramycin MICs of 4-16 mg/L, which were at or below the apramycin preliminary epidemiological cut-off value of 16 mg/L. These isolates were selected for a range of colistin (4-32 mg/L), meropenem (16-256 mg/L), minocycline (8-32 mg/L) and sulbactam (8-32 mg/L) MICs across the resistant range. Synergy was defined as a ≥2 log10 cfu/mL reduction compared with the most active agent. RESULTS The combination of apramycin with colistin, meropenem, minocycline or sulbactam was synergistic, at least at one of the concentrations of apramycin (0.5×, 1× or 2× MIC), against 83.3%, 90.5%, 90.9% or 92.3% of the tested isolates, respectively. Apramycin alone was bactericidal at 24 h against 9.5% and 33.3% of the tested isolates at concentrations equal to 1× and 2× MIC, while the combination of apramycin at 2× MIC with colistin, meropenem or sulbactam was bactericidal against all isolates tested (100%). The apramycin 2× MIC/minocycline combination had bactericidal activity against 90.9% of the tested isolates. CONCLUSIONS Apramycin combinations may have potential as a treatment option for XDR/pandrug-resistant (PDR) A. baumannii infections and warrant validation in the clinical setting, when this new aminoglycoside is available for clinical use.
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Affiliation(s)
- I Galani
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ‘ATTIKON’, Rimini 1, 124 62 Chaidari, Athens, Greece
| | - M Souli
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - D Katsala
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ‘ATTIKON’, Rimini 1, 124 62 Chaidari, Athens, Greece
| | - I Karaiskos
- 1st Department of Internal Medicine & Infectious Diseases, Hygeia General Hospital, Athens, Greece
| | - H Giamarellou
- 1st Department of Internal Medicine & Infectious Diseases, Hygeia General Hospital, Athens, Greece
| | - A Antoniadou
- Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ‘ATTIKON’, Rimini 1, 124 62 Chaidari, Athens, Greece
- University of Cyprus, Medical School, Nicosia, Cyprus
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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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Besiris GT, Koutserimpas C, Karamitros A, Karaiskos I, Tsakalou D, Raptis K, Kourelis K, Paxinos O, Kotsirakis A, Vlasis K. Topical use of tranexamic acid in primary total knee arthroplasty: a comparative study. G Chir 2020; 41:126-130. [PMID: 32038024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Perioperative blood management represents a major issue in knee arthroplasty. The aim of the present observational study is to compare two different methods of topical tranexamic acid (TXA) administration (periarticular and intraarticular) in primary knee arthroplasty. PATIENTS AND METHODS The present is an observational comparative study. A total of 66 consecutive patients receiving topical injection of TXA after unilateral primary knee arthroplasty due to osteoarthritis were recorded. Patients were divided into two groups: group 1; periarticular injection of TXA and group 2; intraarticular injection. RESULTS Transfusion rate in group 1 was found to be 15%, compared to 44% in group 2 (p-value= 0.015). In transfused patients the mean received blood units were 1.2 (SD=0.44) in group 1, compared to 1.06 (SD=0.24; p-value=0.34) in group 2. The mean hospital stay of group 1 patients was 7.94 days (SD=2.79), compared to 9.58 days (SD=3.26; p-value=0.03) in group 2. DISCUSSION The main findings of the study are that statically significant higher transfusion rates, as well as longer in-hospital stay were found in the intraarticular group, when compared to the periarticular group. According to these two parameters the present study has shown that the topical periarticular TXA injection is superior to the intraarticular one. Further research is of utmost importance in order to conclude to the optimum combination of knee arthroplasty perioperative blood management.
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Russo A, Falcone M, Gutiérrez-Gutiérrez B, Calbo E, Almirante B, Viale PL, Oliver A, Ruiz-Garbajosa P, Gasch O, Gozalo M, Pitout J, Akova M, Peña C, Cisneros JM, Hernández-Torres A, Farcomeni A, Prim N, Origüen J, Bou G, Tacconelli E, Tumbarello M, Hamprecht A, Karaiskos I, de la Calle C, Pérez F, Schwaber MJ, Bermejo J, Lowman W, Hsueh PR, Mora-Rillo M, Rodriguez-Gomez J, Souli M, Bonomo RA, Paterson DL, Carmeli Y, Pascual A, Rodríguez-Baño J, Venditti M. Predictors of outcome in patients with severe sepsis or septic shock due to extended-spectrum β-lactamase-producing Enterobacteriaceae. Int J Antimicrob Agents 2018; 52:577-585. [PMID: 29969692 DOI: 10.1016/j.ijantimicag.2018.06.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE There are few data in the literature regarding sepsis or septic shock due to extended-spectrum β-lactamases (ESBL)-producing Enterobacteriaceae (E). The aim of this study was to assess predictors of outcome in septic patients with bloodstream infection (BSI) caused by ESBL-E. METHODS Patients with severe sepsis or septic shock and BSI due to ESBL-E were selected from the INCREMENT database. The primary endpoint of the study was the evaluation of predictors of outcome after 30 days from development of severe sepsis or septic shock due to ESBL-E infection. Three cohorts were created for analysis: global, empirical-therapy and targeted-therapy cohorts. RESULTS 367 septic patients were analysed. Overall mortality was 43.9% at 30 days. Escherichia coli (62.4%) and Klebsiella pneumoniae (27.2%) were the most frequent isolates. β-lactam/β-lactamase inhibitor (BLBLI) combinations were the most empirically used drug (43.6%), followed by carbapenems (29.4%). Empirical therapy was active in vitro in 249 (67.8%) patients, and escalation of antibiotic therapy was reported in 287 (78.2%) patients. Cox regression analysis showed that age, Charlson Comorbidity Index, McCabe classification, Pitt bacteremia score, abdominal source of infection and escalation of antibiotic therapy were independently associated with 30-day mortality. No differences in survival were reported in patients treated with BLBLI combinations or carbapenems in empirical or definitive therapy. CONCLUSIONS BSI due to ESBL-E in patients who developed severe sepsis or septic shock was associated with high 30-day mortality. Comorbidities, severity scores, source of infection and antibiotic therapy escalation were important determinants of unfavorable outcome.
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Affiliation(s)
- A Russo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - M Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - B Gutiérrez-Gutiérrez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain
| | - E Calbo
- Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - B Almirante
- Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - P L Viale
- Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy
| | - A Oliver
- Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma de Mallorca, Spain
| | | | - O Gasch
- Corporacio Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - M Gozalo
- Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Spain
| | - J Pitout
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Akova
- Hacettepe University School of Medicine, Ankara, Turkey
| | - C Peña
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J M Cisneros
- Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocio, CSIC, University of Seville, Seville, Spain
| | | | - A Farcomeni
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - N Prim
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Origüen
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Bou
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - E Tacconelli
- Universitätsklinikum Tübingen, Tübingen, Germany
| | - M Tumbarello
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Hamprecht
- Institut für Mikrobiologie, Immunologie und Hygiene Universitätsklinikum Köln, Cologne, Germany
| | | | | | - F Pérez
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - M J Schwaber
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Bermejo
- Hospital Español, Rosario, Argentina
| | - W Lowman
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - P-R Hsueh
- National Taiwan University Hospital, National Taiwan University Hospital College of Medicine, Taipei, Taiwan
| | - M Mora-Rillo
- Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - J Rodriguez-Gomez
- Intensive Care Unit. Biomedical Research Institute of Cordoba (IMIBIC)/ Reina Sofia University Hospital/University of Cordoba, Córdoba, Spain
| | - M Souli
- University General Hospital Attikon, Chaidari, Greece
| | - R A Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA; Departments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland Ohio, USA
| | - D L Paterson
- University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia
| | - Y Carmeli
- Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Pascual
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain
| | - J Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla, Seville, Spain
| | - M Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
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Bassetti M, Giacobbe DR, Giamarellou H, Viscoli C, Daikos GL, Dimopoulos G, De Rosa FG, Giamarellos-Bourboulis EJ, Rossolini GM, Righi E, Karaiskos I, Tumbarello M, Nicolau DP, Viale PL, Poulakou G. Management of KPC-producing Klebsiella pneumoniae infections. Clin Microbiol Infect 2017; 24:133-144. [PMID: 28893689 DOI: 10.1016/j.cmi.2017.08.030] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [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: 05/09/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas. AIMS To provide practical suggestion for physicians dealing with the management of KPC-KP infections in critically ill patients, based on expert opinions. SOURCES PubMed search for relevant publications related to the management of KPC-KP infections. CONTENTS A panel of experts developed a list of 12 questions to be addressed. In view of the current lack of high-level evidence, they were asked to provide answers on the bases of their knowledge and experience in the field. The panel identified several key aspects to be addressed when dealing with KPC-KP in critically ill patients (preventing colonization in the patient, preventing infection in the colonized patient and colonization of his or her contacts, reducing mortality in the infected patient by rapidly diagnosing the causative agent and promptly adopting the best therapeutic strategy) and provided related suggestions that were based on the available observational literature and the experience of panel members. IMPLICATIONS Diagnostic technologies could speed up the diagnosis of KPC-KP infections. Combination treatment should be preferred to monotherapy in cases of severe infections. For non-critically ill patients without severe infections, results from randomized clinical trials are needed for ultimately weighing benefits and costs of using combinations rather than monotherapy. Multifaceted infection control interventions are needed to decrease the rates of colonization and cross-transmission of KPC-KP.
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Affiliation(s)
- M Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy.
| | - D R Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa (DISSAL), Genoa, Italy
| | - H Giamarellou
- 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece
| | - C Viscoli
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa (DISSAL), Genoa, Italy
| | - G L Daikos
- 1st Department of Propaedeutic Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Dimopoulos
- Department of Critical Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece
| | - F G De Rosa
- Department of Medical Science, University of Turin, Infectious Diseases Amedeo di Savoia Hospital, Turin, Italy
| | - E J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - E Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | - I Karaiskos
- 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece
| | - M Tumbarello
- Institute of Infectious Diseases Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - D P Nicolau
- Center for Anti-infective Research and Development, Hartford, CT, USA; Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA
| | - P L Viale
- Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Poulakou
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
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Souli M, Karaiskos I, Masgala A, Galani L, Barmpouti E, Giamarellou H. Double-carbapenem combination as salvage therapy for untreatable infections by KPC-2-producing Klebsiella pneumoniae. Eur J Clin Microbiol Infect Dis 2017; 36:1305-1315. [DOI: 10.1007/s10096-017-2936-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
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Protopas K, Tsiodras S, Chranioti K, Papadopoulos A, Panagopoulos P, Georgoulakis J, Antoniadou A, Sakka V, Galani L, Kavatha D, Poulakou G, Spathis A, Katsarolis I, Karaiskos I, Panagiotidis J, Karakitsos P, Giamarellou HG. HPV infection in HIV-positive subjects and molecular epidemiology. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p294] [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: 11/10/2022] Open
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