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Paglicci L, Borgo V, Lanzarone N, Fabbiani M, Cassol C, Cusi MG, Valassina M, Scolletta S, Bargagli E, Marchetti L, Paladini P, Luzzi L, Fossi A, Bennett D, Montagnani F. Incidence and risk factors for respiratory tract bacterial colonization and infection in lung transplant recipients. Eur J Clin Microbiol Infect Dis 2021; 40:1271-1282. [PMID: 33479881 PMCID: PMC8139905 DOI: 10.1007/s10096-021-04153-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/06/2021] [Indexed: 01/06/2023]
Abstract
To evaluate incidence of and risk factors for respiratory bacterial colonization and infections within 30 days from lung transplantation (LT). We retrospectively analyzed microbiological and clinical data from 94 patients transplanted for indications other than cystic fibrosis, focusing on the occurrence of bacterial respiratory colonization or infection during 1 month of follow-up after LT. Thirty-three percent of patients developed lower respiratory bacterial colonization. Bilateral LT and chronic heart diseases were independently associated to a higher risk of overall bacterial colonization. Peptic diseases conferred a higher risk of multi-drug resistant (MDR) colonization, while longer duration of aerosol prophylaxis was associated with a lower risk. Overall, 35% of lung recipients developed bacterial pneumonia. COPD (when compared to idiopathic pulmonary fibrosis, IPF) and higher BMI were associated to a lower risk of bacterial infection. A higher risk of MDR infection was observed in IPF and in patients with pre-transplant colonization and infections. The risk of post-LT respiratory infections could be stratified by considering several factors (indication for LT, type of LT, presence of certain comorbidities, and microbiologic assessment before LT). A wider use of early nebulized therapies could be useful to prevent MDR colonization, thus potentially lowering infectious risk.
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Affiliation(s)
- L Paglicci
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy
| | - V Borgo
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy
| | - N Lanzarone
- Department of Medical and Surgical Sciences & Neurosciences, Respiratory Diseases and Lung Transplantation Unit, Siena University Hospital, Siena, Italy
| | - M Fabbiani
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy
| | - C Cassol
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - M G Cusi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Innovation, Experimentation and Clinical Research, Microbiology and Virology Unit, Siena University Hospital, Siena, Italy
| | - M Valassina
- Department of Innovation, Experimentation and Clinical Research, Microbiology and Virology Unit, Siena University Hospital, Siena, Italy
| | - S Scolletta
- Department of Emergency and Urgency, Medicine, Surgery and Neurosciences, Unit of Intensive Care Medicine, Siena University Hospital, Siena, Italy
| | - E Bargagli
- Department of Medical and Surgical Sciences & Neurosciences, Respiratory Diseases and Lung Transplantation Unit, Siena University Hospital, Siena, Italy
| | - L Marchetti
- Cardio-Thoracic-Vascular Department, Anesthesia and Cardio-Thoracic-Vascular Intensive Care Unit, Siena University Hospital, Siena, Italy
| | - P Paladini
- Cardio-Thoracic-Vascular Department, Thoracic Surgery Unit, Siena University Hospital, Siena, Italy
| | - L Luzzi
- Cardio-Thoracic-Vascular Department, Thoracic Surgery Unit, Siena University Hospital, Siena, Italy
| | - A Fossi
- Department of Medical and Surgical Sciences & Neurosciences, Respiratory Diseases and Lung Transplantation Unit, Siena University Hospital, Siena, Italy
| | - D Bennett
- Department of Medical and Surgical Sciences & Neurosciences, Respiratory Diseases and Lung Transplantation Unit, Siena University Hospital, Siena, Italy
| | - F Montagnani
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Siena University Hospital, Siena, Italy.
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.
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Spertilli Raffaelli C, Rossetti B, Paglicci L, Colafigli M, Punzi G, Borghi V, Pecorari M, Santoro MM, Penco G, Antinori A, Zazzi M, De Luca A, Zanelli G. Impact of transmitted HIV-1 drug resistance on the efficacy of first-line antiretroviral therapy with two nucleos(t)ide reverse transcriptase inhibitors plus an integrase inhibitor or a protease inhibitor. J Antimicrob Chemother 2019; 73:2480-2484. [PMID: 29945251 DOI: 10.1093/jac/dky211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/09/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To examine the impact of transmitted drug resistance (TDR) on response to first-line regimens with integrase strand transfer inhibitors (INSTIs) or boosted protease inhibitors (bPIs). Methods From an Italian observational database (ARCA) we selected HIV-1-infected drug-naive patients starting two NRTIs and either an INSTI or a bPI, with an available pre-ART resistance genotype. The endpoint was virological failure (VF; plasma HIV-1 RNA >200 copies/mL after week 24). WHO surveillance drug resistance mutations and the Stanford algorithm were used to classify patients into three resistance categories: no TDR (A), TDR but fully-active ART prescribed (B), TDR and at least low-level resistance to one or more prescribed drug (C). Results We included 1365 patients with a median follow-up of 96 weeks (IQR 54-110): 1205 (88.3%) starting bPI and 160 (11.7%) INSTI. Prevalence of TDR was 6.1%, 12.5%, 2.6% and 0% for NRTI, NNRTI, bPI and INSTI, respectively. Cumulative Kaplan-Meier estimates for VF at 48 weeks were 11% (95% CI 10.1%-11.9%) for the bPI group and 7.7% (95% CI 5.4%-10%) for the INSTI group. In the INSTI group, cumulative estimates for VF at 48 weeks were 6% (95% CI 4%-8%) in resistance category A, 5% (95% CI 1%-10%) in B and 50% (95% CI 30%-70%) in C (P < 0.001). Resistance category C [versus A, adjusted hazard ratio (aHR) 12.6, 95% CI 3.2-49.8, P < 0.001] and nadir CD4 (+100 cells/mm3, aHR 0.6, 95% CI 0.4-0.9, P = 0.03) predicted VF. In the bPI group, VF rates were not influenced by baseline resistance. Conclusions Our data support the need for NRTI resistance genotyping in patients starting an INSTI-based first-line ART.
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Affiliation(s)
- C Spertilli Raffaelli
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.,University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena University Hospital, Siena, Italy
| | - B Rossetti
- University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena University Hospital, Siena, Italy.,Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - L Paglicci
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.,University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena University Hospital, Siena, Italy
| | - M Colafigli
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - G Punzi
- Virology, Bari Hospital, Bari, Italy
| | - V Borghi
- Infectious Diseases Unit, Modena Hospital, Modena, Italy
| | - M Pecorari
- Microbiology and Virology Unit, University Hospital, Modena, Italy
| | - M M Santoro
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - G Penco
- Infectious Diseases Department, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - A Antinori
- Infectious Diseases Department, INMI 'Lazzaro Spallanzani', Rome, Italy
| | - M Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - A De Luca
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.,University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena University Hospital, Siena, Italy
| | - G Zanelli
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.,University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Siena University Hospital, Siena, Italy
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