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Aliberti S, Cook GS, Babu BL, Reyes LF, H Rodriguez A, Sanz F, Soni NJ, Anzueto A, Faverio P, Sadud RF, Muhammad I, Prat C, Vendrell E, Neves J, Kaimakamis E, Feneley A, Swarnakar R, Franzetti F, Carugati M, Morosi M, Monge E, Restrepo MI. International prevalence and risk factors evaluation for drug-resistant Streptococcus pneumoniae pneumonia. J Infect 2019; 79:300-311. [PMID: 31299410 DOI: 10.1016/j.jinf.2019.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 12/27/2018] [Revised: 07/05/2019] [Accepted: 07/06/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Streptococcus pneumoniae is the most frequent bacterial pathogen isolated in subjects with Community-acquired pneumonia (CAP) worldwide. Limited data are available regarding the current global burden and risk factors associated with drug-resistant Streptococcus pneumoniae (DRSP) in CAP subjects. We assessed the multinational prevalence and risk factors for DRSP-CAP in a multinational point-prevalence study. DESIGN The prevalence of DRSP-CAP was assessed by identification of DRSP in blood or respiratory samples among adults hospitalized with CAP in 54 countries. Prevalence and risk factors were compared among subjects that had microbiological testing and antibiotic susceptibility data. Multivariate logistic regressions were used to identify risk factors independently associated with DRSP-CAP. RESULTS 3,193 subjects were included in the study. The global prevalence of DRSP-CAP was 1.3% and continental prevalence rates were 7.0% in Africa, 1.2% in Asia, and 1.0% in South America, Europe, and North America, respectively. Macrolide resistance was most frequently identified in subjects with DRSP-CAP (0.6%) followed by penicillin resistance (0.5%). Subjects in Africa were more likely to have DRSP-CAP (OR: 7.6; 95%CI: 3.34-15.35, p<0.001) when compared to centres representing other continents. CONCLUSIONS This multinational point-prevalence study found a low global prevalence of DRSP-CAP that may impact guideline development and antimicrobial policies.
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Affiliation(s)
- Stefano Aliberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, and University of Milan, Department of Pathophysiology and Transplantation, Milan Italy
| | - Grayden S Cook
- Division of Pulmonary Diseases & Critical Care Medicine, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, USA
| | - Bettina L Babu
- Division of Pulmonary Diseases & Critical Care Medicine, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, USA; Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA
| | - Luis F Reyes
- Department of microbiology, Universidad de la Sabana, Bogota, Colombia
| | - Alejandro H Rodriguez
- Critical Care Medicine, Hospital Universitari Joan XXIII, Rovira & Virgili University and CIBERes (Biomedical Research Network of Respiratory disease), Tarragona, Spain
| | - Francisco Sanz
- Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - Nilam J Soni
- Division of Pulmonary Diseases & Critical Care Medicine, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, USA; Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA
| | - Antonio Anzueto
- Division of Pulmonary Diseases & Critical Care Medicine, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, USA; Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA
| | - Paola Faverio
- Cardio-Thoracic-Vascular Department, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, Monza, Italy
| | | | - Irfan Muhammad
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi-74800, Pakistan
| | - Cristina Prat
- Microbiology Department, Hospital Universitari Germans Trias i Pujol. Institut d'Investigació Germans Trias i Pujol, Badalona, Spain. Universitat Autònoma de Barcelona. CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Spain
| | | | - Joao Neves
- Serviço de Medicina, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | | | - Andrew Feneley
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Fabio Franzetti
- Department of Biomedical and Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Manuela Carugati
- Department of Biomedical and Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Manuela Morosi
- Department of Biomedical and Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Elisa Monge
- Department of Biomedical and Clinical Sciences, Division of Infectious Diseases, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Marcos I Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, USA; Division of Pulmonary Diseases & Critical Care Medicine, South Texas Veterans Health Care System, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA.
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Abstract
Despite the decline in HIV mortality and morbidity, Pneumocystis jirovecii pneumonia (PJP) is still frequently seen, particularly in patients with a low CD4+ cell count. We present a case series where we analyzed the possible role of lung ultrasound (LUS) in the management of PJP in a real-life clinical setting. We describe the ultrasound findings from a consecutive series of six HIV patients hospitalized for PJP, all with a favorable outcome, and evaluated with LUS at admission in our ward and then repeated this once during the hospitalization. Multiple B lines indicating interstitial syndrome were detected at admission in all cases, with a bilateral asymmetric pattern mostly localized in middle and upper lobes. In the follow-up LUS, we noted a substantially improved pattern in all patients, observing a reduction of B lines which correlated with clinical amelioration. One patient at admission and three patients during the follow-up showed lung consolidations with hyperechoic spots inside, that might be typical of the disease. In conclusion, LUS could be a practical and noninvasive imaging tool for supporting diagnosis and treatment response of PJP.
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Affiliation(s)
- Silvia Limonta
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Elisa Monge
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Michele Montuori
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Manuela Morosi
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Massimo Galli
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Fabio Franzetti
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
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Schiroli C, Carugati M, Zanini F, Bandera A, Di Nardo Stuppino S, Monge E, Morosi M, Gori A, Matteelli A, Codecasa L, Franzetti F. Exogenous reinfection of tuberculosis in a low-burden area. Infection 2015; 43:647-53. [PMID: 25754899 DOI: 10.1007/s15010-015-0759-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 01/13/2015] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Recurrence of tuberculosis (TB) can be the consequence of relapse or exogenous reinfection. The study aimed to assess the factors associated with exogenous TB reinfection. METHODS Prospective cohort study based on the TB database, maintained at the Division of Infectious Diseases, Luigi Sacco Hospital (Milan, Italy). Time period: 1995-2010. INCLUSION CRITERIA (1) ≥2 episodes of culture-confirmed TB; (2) cure of the first episode of TB; (3) availability of one Mycobacterium tuberculosis isolate for each episode. Genotyping of the M. tuberculosis strains to differentiate relapse and exogenous reinfection. Logistic regression analysis was used to assess the influence of risk factors on exogenous reinfections. RESULT Of the 4682 patients with TB, 83 were included. Of these, exogenous reinfection was diagnosed in 19 (23 %). It was independently associated with absence of multidrug resistance at the first episode [0, 10 (0.01-0.95), p = 0.045] and with prolonged interval between the first TB episode and its recurrence [7.38 (1.92-28.32) p = 0.004]. However, TB relapses occurred until 4 years after the first episode. The risk associated with being foreign born, extrapulmonary site of TB, and HIV infection was not statistically significant. In the relapse and re-infection cohort, one-third of the patients showed a worsened drug resistance profile during the recurrent TB episode. CONCLUSIONS Exogenous TB reinfections have been documented in low endemic areas, such as Italy. A causal association with HIV infection could not be confirmed. Relapses and exogenous reinfections shared an augmented risk of multidrug resistance development, frequently requiring the use of second-line anti-TB regimens.
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Affiliation(s)
| | | | - Fabio Zanini
- Department of Infectious Diseases, H. Sacco, Milan, Italy
| | | | | | - Elisa Monge
- Department of Infectious Diseases, H. Sacco, Milan, Italy
| | - Manuela Morosi
- Department of Infectious Diseases, H. Sacco, Milan, Italy
| | | | | | - Luigi Codecasa
- Centre of Tuberculosis Control of Lombardy, Villa Marelli, Milan, Italy
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Rusconi S, Vitiello P, Adorni F, Colella E, Focà E, Capetti A, Meraviglia P, Abeli C, Bonora S, D’Annunzio M, Biagio AD, Di Pietro M, Butini L, Orofino G, Colafigli M, d’Ettorre G, Francisci D, Parruti G, Soria A, Buonomini AR, Tommasi C, Mosti S, Bai F, Di Nardo Stuppino S, Morosi M, Montano M, Tau P, Merlini E, Marchetti G. Maraviroc as intensification strategy in HIV-1 positive patients with deficient immunological response: an Italian randomized clinical trial. PLoS One 2013; 8:e80157. [PMID: 24244635 PMCID: PMC3828227 DOI: 10.1371/journal.pone.0080157] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 05/23/2013] [Accepted: 09/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Immunological non-responders (INRs) lacked CD4 increase despite HIV-viremia suppression on HAART and had an increased risk of disease progression. We assessed immune reconstitution profile upon intensification with maraviroc in INRs. METHODS We designed a multi-centric, randomized, parallel, open label, phase 4 superiority trial. We enrolled 97 patients on HAART with CD4+<200/µL and/or CD4+ recovery ≤ 25% and HIV-RNA<50 cp/mL. Patients were randomized 1:1 to HAART+maraviroc or continued HAART. CD4+ and CD8+ CD45+RA/RO, Ki67 expression and plasma IL-7 were quantified at W0, W12 and W48. RESULTS By W48 both groups displayed a CD4 increase without a significant inter-group difference. A statistically significant change in CD8 favored patients in arm HAART+maraviroc versus HAART at W12 (p=.009) and W48 (p=.025). The CD4>200/µL and CD4>200/µL + CD4 gain ≥ 25% end-points were not satisfied at W12 (p=.24 and p=.619) nor at W48 (p=.076 and p=.236). Patients continuing HAART displayed no major changes in parameters of T-cell homeostasis and activation. Maraviroc-receiving patients experienced a significant rise in circulating IL-7 by W48 (p=.01), and a trend in temporary reduction in activated HLA-DR+CD38+CD4+ by W12 (p=.06) that was not maintained at W48. CONCLUSIONS Maraviroc intensification in INRs did not have a significant advantage in reconstituting CD4 T-cell pool, but did substantially expand CD8. It resulted in a low rate of treatment discontinuations. TRIAL REGISTRATION ClinicalTrials.gov NCT00884858 http://clinicaltrials.gov/show/NCT00884858.
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Affiliation(s)
- Stefano Rusconi
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
| | - Paola Vitiello
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
- Divisione di Malattie Infettive, Ospedale di Circolo, Busto Arsizio (VA), Italy
| | | | - Elisa Colella
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
| | - Emanuele Focà
- Clinica di Malattie Infettive e Tropicali, Università degli Studi, Brescia, Italy
| | - Amedeo Capetti
- I Divisione di Malattie Infettive, Ospedale Luigi Sacco, Milano, Italy
| | - Paola Meraviglia
- II Divisione di Malattie Infettive, Ospedale Luigi Sacco, Milano, Italy
| | - Clara Abeli
- Divisione di Malattie Infettive, Ospedale di Circolo, Busto Arsizio (VA), Italy
| | - Stefano Bonora
- Clinica delle Malattie Infettive, Ospedale Amedeo di Savoia, Università degli Studi, Torino, Italy
| | - Marco D’Annunzio
- Clinica di Malattie Infettive, A.O.-Universitaria Policlinico, Bari, Italy
| | - Antonio Di Biagio
- Clinica delle Malattie Infettive, Ospedale San Martino, Università degli Studi, Genova, Italy
| | - Massimo Di Pietro
- Divisione di Malattie Infettive, Ospedale S. Maria Annunziata, Antella, Firenze, Italy
| | - Luca Butini
- Servizio di Immunologia Clinica e Tipizzazione. Tissutale, A.O.-Universitaria, Torrette di Ancona, Italy
| | - Giancarlo Orofino
- Divisione A di Malattie Infettive, Ospedale Amedeo di Savoia, Torino, Italy
| | - Manuela Colafigli
- Istituto di clinica Delle Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gabriella d’Ettorre
- U.O. Malattie Infettive, Università La Sapienza, Policlinico Umberto I, Roma, Italy
| | - Daniela Francisci
- Clinica delle Malattie Infettive, Policlinico Monteluce, Perugia, Italy
| | - Giustino Parruti
- Divisione Clinicizzata di Malattie Infettive, Ospedale Santo Spirito, Pescara, Italy
| | - Alessandro Soria
- Divisione Clinicizzata di Malattie Infettive, Ospedale san Gerardo, Monza, Italy
| | | | - Chiara Tommasi
- III Divisione di Malattie Infettive I.N.M.I “Lazzaro Spallanzani”, Roma, Italy
| | - Silvia Mosti
- IV Divisione di Malattie Infettive I.N,M.I “Lazzaro Spallanzani”, Roma, Italy
| | - Francesca Bai
- Clinica delle Malattie Infettive, Dipartimento di Scienze della Salute, Polo Universitario San Paolo, Università degli Studi, Milano, Italy
| | - Silvia Di Nardo Stuppino
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
| | - Manuela Morosi
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
| | - Marco Montano
- Clinica delle Malattie Infettive, Policlinico "Tor Vergata", Roma, Italy
| | - Pamela Tau
- Divisione Clinicizzata di Malattie Infettive, DIBIC “Luigi Sacco”, Università degli Studi, Milano, Italy
| | - Esther Merlini
- Clinica delle Malattie Infettive, Dipartimento di Scienze della Salute, Polo Universitario San Paolo, Università degli Studi, Milano, Italy
| | - Giulia Marchetti
- Clinica delle Malattie Infettive, Dipartimento di Scienze della Salute, Polo Universitario San Paolo, Università degli Studi, Milano, Italy
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Caneschi S, Pirelli A, Morosi M. The use of human fibrin glue and of the suture in polyglactin 910 in extraintracranial by-pass. J Neurosurg Sci 1988; 32:65-8. [PMID: 3199214] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
At the Division of Neurosurgery of Fatebenefratelli-Oftalmico Hospital in Milano, 12 of the last 22 temporosylvian anastomosis have been performed employing sutures with separate points in mixed materials, partly nylon and partly Polyglactin 910 (reabsorbable) in order to avoid as much as possible the disadvantages of permanent sutures; in the other 10 consecutive cases reducing about 50% the points of suture and employing human fibrin glue as complement of the suture, in order to respect better the arterial wall and to reduce significantly the critical times of the operation (clampage). The Authors compared the clinical and instrumental results of the patients of this series with the ones of a previous series operated with traditional technique and pointed out a better success in the last operations (mixed materials and fibrin glue).
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Affiliation(s)
- S Caneschi
- Division of Neurosurgery, Hospital Fatebenefratelli, Milan, Italy
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