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Melis F, De Vito A, Fiore V, Rostagno R, Ravera L, Babudieri S, Borrè S, Madeddu G. Is oral antibiotic therapy as effective as intravenous treatment in bacterial osteomyelitis? A real-life experience. Eur Rev Med Pharmacol Sci 2022; 26:4069-4073. [PMID: 35731077 DOI: 10.26355/eurrev_202206_28976] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Osteomyelitis is a relatively understudied disease with no standardized and evidence-based approach to treatment. We aimed to evaluate a cohort of patients with osteomyelitis, comparing the outcomes between intravenous (IV) and oral treatment. PATIENTS AND METHODS We performed an observational retrospective study on osteomyelitis cases in adult patients seen for care between 2017 and 2019. We collected information on patient characteristics, microbiological etiology, infection treatment, and outcome. In addition, we divided osteomyelitis cases by antibiotic regimens [oral (OTG) vs. intravenous±oral (ITG)] and therapy durations to evaluate outcomes differences. RESULTS A total of 235 episodes of osteomyelitis were evaluated, with a higher prevalence in male gender. Staphylococci, especially S. aureus, were the most common strains. Out of the 235 evaluated episodes, we selected 142 cases. Of these, 75 were treated with OTG and 67 with ITG. Gram-positive bacteria were the most frequent aetiological agents, with 81 isolates (61.8%). Full recovery was observed in 79 (55.6%) cases; of these, 36 (53.7%) were in the ITG and 43 (57.3%) in the OTG (p = 0.666). At the logistic regression, a polymicrobial infection [OR 4.16 (95%CI 1.28-13.4), p = 0.017] and a less than six weeks treatment duration [OR 4.24 (95%CI 1.38-5.43) p = 0.004] were significantly associated with a higher risk of treatment failure. CONCLUSIONS Our study suggests that oral treatment efficacy is comparable to ITG therapy for osteomyelitis, confirming the most recent evidence suggesting that oral therapy is non-inferior to intravenous therapy to treat osteomyelitis.
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Affiliation(s)
- F Melis
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
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Boglione L, Meli G, Poletti F, Rostagno R, Moglia R, Cantone M, Esposito M, Scianguetta C, Domenicale B, Di Pasquale F, Borrè S. Risk factors and incidence of long-COVID syndrome in hospitalized patients: does remdesivir have a protective effect? QJM 2022; 114:865-871. [PMID: 34850210 PMCID: PMC8690187 DOI: 10.1093/qjmed/hcab297] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/17/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The definition of 'long-COVID syndrome' (LCS) is still debated and describes the persistence of symptoms after viral clearance in hospitalized or non-hospitalized patients affected by coronavirus disease 2019 (COVID-19). AIM In this study, we examined the prevalence and the risk factors of LCS in a cohort of patients with previous COVID-19 and followed for at least 6 months of follow-up. DESIGN We conducted a prospective study including all hospitalized patients affected by COVID-19 at our center of Infectious Diseases (Vercelli, Italy) admitted between 10 March 2020 and 15 January 2021 for at least 6 months after discharge. Two follow-up visits were performed: after 1 and 6 months after hospital discharge. Clinical, laboratory and radiological data were recorded at each visit. RESULTS A total of 449 patients were included in the analysis. The LCS was diagnosed in 322 subjects at Visit 1 (71.7%) and in 206 at Visit 2 (45.9); according to the post-COVID-19 functional status scale we observed 147 patients with values 2-3 and 175 with values >3 at Visit 1; at Visit 2, 133 subjects had the score between 2-3 and 73 > 3. In multivariate analysis, intensive care unit (ICU) admission (OR = 2.551; 95% CI = 1.998-6.819; P = 0.019), time of hospitalization (OR = 2.255; 95% CI = 1.018-6.992; P = 0.016) and treatment with remdesivir (OR = 0.641; 95% CI = 0.413-0.782; P < 0.001) were independent predictors of LCS. CONCLUSIONS Treatment with remdesivir leads to a 35.9% reduction in LCS rate in follow-up. Severity of illness, need of ICU admission and length of hospital stay were factor associated with the persistence of PCS at 6 months of follow-up.
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Affiliation(s)
- L Boglione
- From the Department of Translational Medicine (DiMET), University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
- Address correspondence to Prof. L. Boglione, Department of Translational Medicine (DiMET), University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy.
| | - G Meli
- From the Department of Translational Medicine (DiMET), University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - F Poletti
- Unit of Infectious Diseases, Saint Andrea Hospital, Vercelli, Italy 13100
| | - R Rostagno
- Unit of Infectious Diseases, Saint Andrea Hospital, Vercelli, Italy 13100
| | - R Moglia
- Unit of Infectious Diseases, Saint Andrea Hospital, Vercelli, Italy 13100
| | - M Cantone
- Unit of Infectious Diseases, Saint Andrea Hospital, Vercelli, Italy 13100
| | - M Esposito
- Unit of Infectious Diseases, Saint Andrea Hospital, Vercelli, Italy 13100
| | - C Scianguetta
- Unit of Infectious Diseases, Saint Andrea Hospital, Vercelli, Italy 13100
| | - B Domenicale
- Unit of Infectious Diseases, Saint Andrea Hospital, Vercelli, Italy 13100
| | - F Di Pasquale
- Unit of Infectious Diseases, Saint Andrea Hospital, Vercelli, Italy 13100
| | - S Borrè
- Unit of Infectious Diseases, Saint Andrea Hospital, Vercelli, Italy 13100
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Tatarelli P, Romani T, Santoro V, Spezia M, Gallo A, Ripamonti G, Carducci M, Trotti C, Parisini A, Nicolini LA, Mikulska M, Borrè S, Bassetti M. Debridement, antibiotics and implant retention (DAIR): An effective treatment option for early prosthetic joint infections. J Infect Chemother 2021; 27:1162-1168. [PMID: 33781690 DOI: 10.1016/j.jiac.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/13/2020] [Revised: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Debridement, antibiotics and implant retention (DAIR) is an attractive treatment option for prosthetic joint infections (PJIs). However, reported success rates and predictors of DAIR failure vary widely. The primary aim of this study is to report the outcome of DAIR in patients with hip and knee PJIs receiving short course of antibiotic therapy. The secondary aim is to identify risk factors for DAIR failure. METHODS We performed a retrospective analysis of prospectively collected data of all hip and knee PJIs consecutively diagnosed at Quadrante Orthopedic Center, an Italian orthopedic hospital highly specialized in prosthetic surgery, from January 1, 2013 to January 1, 2019, and we analyzed those treated with DAIR. RESULTS Forty-seven PJIs occurred after 5102 arthroplasty procedures. Twenty-one patients (45%) aged 71 years were treated with DAIR for hip (62%) and knee (38%) PJIs. These were classified as early PJIs in 76% cases, delayed in 19% and late in 5%. Median time from PJI-related symptoms onset to implant revision surgery was 12 days (IQR, 7-20 days). The median duration of antibiotic treatment after surgery was 63 days (IQR, 53-84 days). Sixteen (76%) patients were cured after a median follow-up of 2197 days (IQR, 815-2342 days), while 5 (24%) experienced failure. At multivariate analysis, delayed/late PJIs were significantly associated with failure (OR = 12.51; 95% CI 1.21-129.63, p = 0.03). CONCLUSIONS DAIR represents an effective strategy for the treatment of early PJIs in spite of short course of antibiotic therapy.
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Affiliation(s)
- P Tatarelli
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy.
| | - T Romani
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - V Santoro
- Public Health Department, Santa Maria Delle Croci Hospital, Ravenna, AUSL Romagna, Italy
| | - M Spezia
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - A Gallo
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - G Ripamonti
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - M Carducci
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - C Trotti
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - A Parisini
- Infectious Diseases SOC, A.S.O. SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - L A Nicolini
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy
| | - M Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy
| | - S Borrè
- Infectious Diseases Unit, Sant'Andrea Hospital, Vercelli, Italy
| | - M Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy
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Fantoni M, Borrè S, Rostagno R, Riccio G, Carrega G, Giovannenze F, Taccari F. Epidemiological and clinical features of prosthetic joint infections caused by gram-negative bacteria. Eur Rev Med Pharmacol Sci 2020; 23:187-194. [PMID: 30977885 DOI: 10.26355/eurrev_201904_17490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To review the clinical literature focusing on epidemiology, clinical presentation and outcomes of prosthetic joint infections (PJIs) due to gram-negative bacteria (GNB) and to report the experience of a multicentric cohort. PATIENTS AND METHODS A retrospective, observational, cohort study was performed in three Italian hospitals. All consecutive PJIs caused by GNB over a 12-year period (from May 2007 to March 2018) were enrolled. Epidemiological, clinical, microbiological and therapeutic features were described. Factors related to treatment failure (defined as the occurrence of death, amputation or starting long-term antimicrobial suppression therapy) were analysed with a Cox regression model. RESULTS A total of 82 PJIs due to GNB (42.7% men; median age 73 years) were studied. The implants included 65 (79.3%) hip, 16 (19.5%) knee and one (1.2%) shoulder. An early PJI was diagnosed in 16.2% of patients, a delayed PJI in 29.4% and a late PJI in 54.4%. The most common isolated organisms were Escherichia coli (21.7%) and Pseudomonas spp. (20.9%). 13.4% of the isolates were carbapenem-resistant bacteria (CRB). In 53.8% of cases a two-stage exchange arthroplasty was performed and in 32.5% a Girdlestone excision arthroplasty. The average therapeutic failure occurred in 17.7% of cases. The therapeutic failure rate of the two-stage was 10%. PJI due to CRB was identified as a potential risk factor for failure (aHR 4.90; IC 95%, 0.96-25.08; p=0.05). The therapeutic failure rate in the CRB group was 50%. CONCLUSIONS The treatment with the two-stage procedure for PJIs caused by GNB seems to be associated with a low rate of failure, while PJI due to CRB seems to be related to the worst outcome.
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Affiliation(s)
- M Fantoni
- Fondazione Policlinico A. Gemelli IRCCS - Rome, Italy.
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Vaschetto R, Navalesi P, Clemente N, Boggio E, Valsecchi S, Olivieri C, Soluri MF, Kroumova V, Fonio P, Dinatale C, Borrè S, Fortina G, Umberto D, Della Corte F, Chiocchetti A. Osteopontin induces soluble urokinase-type plasminogen activator receptor production and release. Minerva Anestesiol 2015; 81:157-165. [PMID: 24994498] [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: 06/03/2023]
Abstract
BACKGROUND Osteopontin (OPN) and soluble urokinase plasminogen activator receptor (suPAR) have been proposed as markers of disease severity and risk-stratification in infection and inflammation. In breast cancer, OPN and the membrane bound form of urokinase plasminogen activator receptor (uPAR) are functionally related, as OPN-induced cell migration depends on uPAR triggering by urokinase plasminogen activator (uPA). The aim of this study was to prospectively evaluate the kinetic of OPN and suPAR blood levels in patients developing septic shock (SS) compared to those not developing SS, and to investigate the relationships between these two biomarkers in immune cells in vitro. METHODS We measured the levels of OPN and suPAR for 15 days in forty-three patients, defined a priory as at risk to develop septic shock. Moreover, we investigated in vitro the effect of recombinant OPN on uPAR and suPAR expression in monocytes. RESULTS We found that OPN and suPAR levels were directly correlated to each other both at intensive care unit admission and on the day patients met SIRS/sepsis or septic shock criteria. In patients developing septic shock, OPN increased prior to suPAR and was already detectable up to 4 days before the shock development. In vitro, OPN induced suPAR production in monocytes by increasing both uPAR gene expression, and suPAR release from the cell surface. CONCLUSION These data suggest that OPN is partly responsible for the increased plasma levels of suPAR and might be a valuable tool to predict the occurrence of septic shock.
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Affiliation(s)
- R Vaschetto
- Azienda Ospedaliero-Universitaria "Maggiore della Carità", Dipartimento di Anestesia e Rianimazione, Novara, Italy -
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Esposito S, Leone S, Bassetti M, Borrè S, Leoncini F, Meani E, Venditti M, Mazzotta F. Italian Guidelines for the Diagnosis and Infectious Disease Management of Osteomyelitis and Prosthetic Joint Infections in Adults. Infection 2009; 37:478-96. [DOI: 10.1007/s15010-009-8269-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 03/19/2009] [Indexed: 12/21/2022]
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Borrè S, Kroumova V. IL CONSULTING MICROBIOLOGICO ED INFETTIVOLOGICO STRUMENTO PER IL TRATTAMENTO E LA SORVEGLIANZA DELLE INFEZIONI OSPEDALIERE. Microbiol Med 2005. [DOI: 10.4081/mm.2005.3435] [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: 11/22/2022] Open
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Borrè S, Brondolo R, Brustia D, Rosa F, Rizzo G, Garavelli PL. [Immune restoration syndrome]. Recenti Prog Med 2001; 92:463. [PMID: 11475789] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A new syndrome, "immune restoration syndrome", has been described among patients with CMV retinitis, mycobacterial infections or cryptococcosis when HAART is initiated. The mechanism is most likely an enhanced immunologic reaction at the site of infection due to an improved T-lymphocyte function. The syndrome appears to be a rare event: the authors report a case of immune restoration syndrome in a patient with atypical mycobacteriosis.
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Affiliation(s)
- S Borrè
- Struttura Complessa di Malattie Infettive, Azienda Ospedaliera Maggiore della Carità, Novara
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