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Amabile E, Totaro M, Cappelli LV, Minotti C, Micozzi A. A Case of Central Venous Catheter-Related Candida parapsilosis Fungemia Evolved to Disseminated Infection in a Neutropenic Patient with Blast Crisis of Chronic Myeloid Leukemia. Mediterr J Hematol Infect Dis 2024; 16:e2024013. [PMID: 38223476 PMCID: PMC10786146 DOI: 10.4084/mjhid.2024.013] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/16/2024] Open
Abstract
Central venous catheter-related infections are of particular importance in onco-hematological patients. Candida parapsilosis is generally reported as a mild pathogen, however it is able to effectively colonize intravascular devices and potentially give rise to sustained fungemias. Here we report a case of invasive, potentially lethal C. parapsilosis disseminated infection in a neutropenic patient affected by chronic myeloid leukemia with blast crisis. We underline the importance of removing the central venous catheter as potential source of infection as soon as possible during the course of candidemia, and not replacing it with other polyurethan intravascular devices, which pose a risk for the maintenance of the fungemia despite the administration of the best antifungal therapy available.
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Affiliation(s)
- Elena Amabile
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome. Via Benevento 6, 00161, Rome Italy
| | - Matteo Totaro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome. Via Benevento 6, 00161, Rome Italy
| | - Luca Vincenzo Cappelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome. Via Benevento 6, 00161, Rome Italy
| | - Clara Minotti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome. Via Benevento 6, 00161, Rome Italy
| | - Alessandra Micozzi
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome. Via Benevento 6, 00161, Rome Italy
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Assanto GM, Totaro M, Poggiali R, Delli Paoli A, Annechini G, D'Elia GM, Aji F, Petrucci L, Fazio F, Del Giudice I, Martelli M, Micozzi A, Gentile G. Impact of Sars-CoV-2 Prophylaxis with Tixagevimab-Cilgavimab in High-Risk Patients with B-Cell Malignancies: A Single-Center Retrospective Study. Mediterr J Hematol Infect Dis 2023; 15:e2023061. [PMID: 38028390 PMCID: PMC10631717 DOI: 10.4084/mjhid.2023.061] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Severe Acute Respiratory Syndrome CoronaVirus‐2 (SARS‐CoV‐2) infection can result in different clinical manifestations (COVID-19), starting from asymptomatic disease to life threatening respiratory insufficiency. Onco-haematologic patients are at higher risk to develop severe COVID-19. In particular, patients affected by lymphoproliferative diseases, given the impaired cell-mediated and antibody-mediated immunity and treatment toxicity, develop more often a symptomatic and a more serious disease of Covid-19. Various therapeutic and prophylactic agents are being used against COVID‐19 such as antiviral drugs, vaccines and antiviral S‐protein monoclonal antibodies. Pre-exposure prophylaxis with AZD442/Evusheld (tixagevimab-cilgavimab) may be a complementary strategy to decrease the incidence or severity of COVID-19 for patients with B-cell malignancies. Tixagevimab-cilgavimab is a combination of two monoclonal antibodies that bind SARS-CoV-2 spike protein and inhibits the attachment to the surface of cells, preventing viral entry in the cell and COVID-19 development. In the setting of hematology real-life, few data are available on the impact of pre-exposure prophylaxis, given the multiple factors involved in the clinical behavior of SARS-CoV-2 . Our aim was to evaluate the clinical benefit and the safety of this strategy at our center.
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Affiliation(s)
| | - Matteo Totaro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Rebecca Poggiali
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Adele Delli Paoli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giorgia Annechini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Gianna Maria D'Elia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesco Aji
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luigi Petrucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesca Fazio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alessandra Micozzi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giuseppe Gentile
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Assanto GM, Di Rocco A, Malfona F, Capriata M, Del Giudice I, Petrucci L, Girardi P, D’Elia GM, Martelli M, Gentile G, Micozzi A, Pulsoni A. Impact of anti-SARS-CoV-2 monoclonal antibodies in the management of patients with lymphoma and COVID19: A retrospective study. Hematol Oncol 2023; 41:343-353. [PMID: 36521843 PMCID: PMC9877821 DOI: 10.1002/hon.3113] [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: 08/04/2022] [Revised: 11/16/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
COVID19 in patients affected by lymphoma represents an important challenge because of the higher mortality rate. Anti-SARS-CoV-2 monoclonal antibodies (anti-S MoAbs) appear promising in this setting. We report a monocentric retrospective study including 176 patients affected by lymphoma which developed SARS-CoV-2 infection since the start of COVID19 pandemic. Overall, mortality was 13.1%, with a decreasing trend between first waves to the last wave of pandemic (18.5% vs. 9.4%, p 0.076). Patients receiving anti-S MoAbs (41.3%) showed inferior mortality rate (overall survival, OS 93.2% vs. 82.7%, p 0.025) with no serious toxicity, reduced documented pneumonia (26% vs. 33%, p 0.005), and reduced need of oxygen support (14.5% vs. 35.7%, p 0.003). Among patients who received 3 doses of vaccine, the employment of anti-COVID MoAbs showed a trend of superior survival versus those who did not receive Anti-S MoAbs (OS rates 97.3% vs. 84.2%, p 0.064). On multivariate analysis, active haematological disease (OS 72% (HR 2.49 CI 1.00-6.41), bendamustine exposure (OS 60% HR 4.2 CI 1.69-10.45) and at least one comorbidity (HR 6.53 CI 1.88-22.60) were independent prognostic factors for death. Our study confirms the adverse prognostic role of COVID-19 in lymphoma patients in presence of active disease, comorbidities and previous exposure to bendamustine. In our experience, anti-S MoAbs represented a therapeutic option in vaccinated patients.
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Affiliation(s)
| | - Alice Di Rocco
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Francesco Malfona
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Marcello Capriata
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Ilaria Del Giudice
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Luigi Petrucci
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Paola Girardi
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Gianna Maria D’Elia
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Maurizio Martelli
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Giuseppe Gentile
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Alessandra Micozzi
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Alessandro Pulsoni
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
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Ligia S, Morano SG, Kaiser F, Micozzi A, Chistolini A, Barberi W, Arena V, Piciocchi A, Forgione M, Gasperini G, Berneschi P, Testi AM. Peripherally inserted central venous catheter for pediatric acute leukemia: A retrospective 11-year single-center experience. J Vasc Access 2023:11297298231185222. [PMID: 37408515 DOI: 10.1177/11297298231185222] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are successfully increasingly used in children in onco-hematologic setting. PICC insertion, especially in oncologic patients, can be associated with adverse events (thrombosis, mechanical complications, and infections). Data regarding the use of PICC, as long-term access in pediatric patients with severe hematologic diseases, are still limited. METHODS We retrospectively evaluated the safety and efficacy of 196 PICC, inserted in 129 pediatric patients with acute leukemia diagnosed and treated at Pediatric Hematology Unit, Sapienza University of Rome. RESULTS The 196 PICC analyzed were in situ for a median dwell time of 190 days (range 12-898). In 42 children, PICC was inserted twice and in 10, three times or more due to hematopoietic stem cell transplant, disease recurrence, or PICC-related complications. The overall complication rate was 34%: catheter-related bloodstream infections (CRBSI) occurred in 22% of cases after a median time of 97 days; a catheter-related thrombosis (CRT) in 3.5% and mechanical complications in 9% of cases. Premature removal for complications occurred in 30% of PICC. One death from CRBSI was observed. CONCLUSIONS To our knowledge, this study represents the largest cohort of pediatric patients who have inserted the PICC for acute leukemia. In our experience, PICC was a cheap, safe, and reliable device for long-term intravenous access in children with acute leukemia. This has been possible with the help of dedicated PICC team.
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Affiliation(s)
- Silvio Ligia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Francesca Kaiser
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandra Micozzi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Chistolini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Walter Barberi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Valentina Arena
- Gimema Data Center, Fondazione GIMEMA Franco Mandelli Onlus, Rome, Italy
| | - Alfonso Piciocchi
- Gimema Data Center, Fondazione GIMEMA Franco Mandelli Onlus, Rome, Italy
| | - Maurizio Forgione
- Umberto 1, Polyclinic Hospital, Sapienza University of Rome, Rome, Italy
| | - Giulia Gasperini
- Umberto 1, Polyclinic Hospital, Sapienza University of Rome, Rome, Italy
| | - Paola Berneschi
- Umberto 1, Polyclinic Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Testi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Lepore D, Vecciolini C, Micozzi A, Spigarelli F. Developing technological capabilities for Industry 4.0 adoption: An analysis of the role of inbound open innovation in small and medium‐sized enterprises. Creat Innov Manage 2023. [DOI: 10.1111/caim.12551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Micozzi A, Minotti C, Capria S, Cartoni C, Trisolini SM, Assanto GM, Barberi W, Moleti ML, Santilli S, Martelli M, Gentile G. Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC- K. pneumoniae in Febrile Neutropenic Patients with Acute Leukemia Who are Colonized with KPC- K. pneumoniae. A 7-Years Retrospective Observational Cohort Study. Infect Drug Resist 2023; 16:695-704. [PMID: 36747900 PMCID: PMC9899007 DOI: 10.2147/idr.s393802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/18/2022] [Accepted: 12/23/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose To evaluate the benefits and safety of the empiric antibiotic treatment (EAT) active against KPC-K. pneumoniae in febrile neutropenic patients with acute leukaemia (AL) who are colonised by KPC-K. pneumoniae. Patients and Methods A 7-year (2013-2019) retrospective observational cohort study was conducted at the Haematology, Sapienza Rome University (Italy) on 94 febrile neutropenia episodes (FNE) in AL patients KPC-K. pneumoniae carriers treated with active EAT. Results Eighty-two (87%) FNE were empirically treated with antibiotic combinations [38 colistin-based and 44 ceftazidime-avibactam (CAZAVI)-based], 12 with CAZAVI monotherapy. Successful outcomes were observed in 88/94 (94%) FNE, 46/49 (94%) microbiologically documented infections, and 24/27 (89%) gram-negative bloodstream infections (GNB-BSI). Mortality due to infective causes was 4.2% (2.1% within 1 week). KPC-K. pneumoniae infections caused 28/94 FNE (30%) and KPC-K. pneumoniae-BSI was documented in 22 FNE (23.4%) (85% of GNB-BSI), in all cases patients received active EAT, and 21 survived. KPC-K.pneumoniae-BSI mortality rate was 4.5%. CAZAVI-based EAT showed better results than colistin-based EAT (55/56 vs 33/38, p = 0.037), overall and without EAT modification (41/56 vs 20/38, p = 0.02). Empirical combinations including CAZAVI were successful in 98% of cases (43/44 vs 33/38 for colistin-based EAT, p = 0.01), without modifications in 82% (36/44 vs 20/28, p = 0.02). All deaths occurred in patients treated with colistin-based EAT (4/38 vs 0/56, p = 0.02). CAZAVI-containing EAT was the only independent factor for an overall successful response (HR 0.058, CI 0.013-1.072, p = 0.058). Nephrotoxicity occurred in 3(8%) patients undergoing colistin-based EAT (none in those undergoing CAZAVI-based EAT, p = 0.02). Conclusion KPC-K. pneumoniae infections are frequent in colonised AL patients with FNE. EAT with active antibiotics, mainly CAZAVI-based combinations, was effective, safe, and associated with low overall and KPC-K. pneumoniae-BSI-related mortality.
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Affiliation(s)
- Alessandra Micozzi
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy,Correspondence: Alessandra Micozzi, Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy, Tel +39 6 857951, Fax +39 6 44241984, Email
| | - Clara Minotti
- Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Saveria Capria
- Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Claudio Cartoni
- Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Silvia Maria Trisolini
- Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Giovanni Manfredi Assanto
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Walter Barberi
- Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Maria Luisa Moleti
- Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Stefania Santilli
- Department of Diagnostics, Azienda Policlinico Umberto I, Rome, Italy
| | - Maurizio Martelli
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Gentile
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Lepore D, Frontoni E, Micozzi A, Moccia S, Romeo L, Spigarelli F. Uncovering the potential of innovation ecosystems in the healthcare sector after the COVID-19 crisis. Health Policy 2023; 127:80-86. [PMID: 36509555 PMCID: PMC9722232 DOI: 10.1016/j.healthpol.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/27/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
Industry 4.0 technologies are expected to enhance healthcare quality at the minimum cost feasible by using innovative solutions based on a fruitful exchange of knowledge and resources among institutions, firms and academia. These collaborative mechanisms are likely to occur in an innovation ecosystem where different stakeholders and resources interact to provide ground-breaking solutions to the market. The paper proposes a framework for studying the creation and development of innovation ecosystems in the healthcare sector by using a set of interrelated dimensions including, technology, value, and capabilities within a Triple-Helix model guided by focal actors. The model is applied to an exemplary Italian innovation ecosystem providing cloud and artificial intelligence-based solutions to general practitioners (GPs) under the focal role of the Italian association of GPs. Primary and secondary data are examined starting from the innovation ecosystem's origins and continuing until the COVID-19 crisis. The findings show that the pandemic represented the turning point that altered the ecosystem's dimensions in order to find immediate solutions for monitoring health conditions and organizing the booking of swabs and vaccines. The data triangulation points out the technical, organizational, and administrative barriers hindering the widespread adoption of these solutions at the national and regional levels, revealing several implications for health policy.
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Affiliation(s)
- Dominique Lepore
- Department of Law, University of Macerata, Piaggia dell'Università 2, 62100, Macerata MC, Italy.
| | - Emanuele Frontoni
- Department of Political Sciences, Communication and International Relations, University of Macerata, Via Don Giovanni Minzoni, 22/A, 62100 Macerata MC, Italy
| | - Alessandra Micozzi
- Faculty of Economics, Universitas Mercatorum, University of the System of the Italian Chambers of Commerce, Rome, Italy
| | - Sara Moccia
- The BioRobotics Institute and at the Department of Excellence in Robotics & AI, Sant'Anna School of Advanced Studies, Viale Rinaldo Piaggio, 34 56025, Pontedera, Italy
| | - Luca Romeo
- Department of Economics and Law, University of Macerata, Piazza S. Vincenzo Maria Strambi, 1, 62100 Macerata MC, Italy
| | - Francesca Spigarelli
- Department of Law, University of Macerata, Piaggia dell'Università 2, 62100, Macerata, MC, Italy
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Micozzi A, Assanto GM, Cesini L, Minotti C, Cartoni C, Capria S, Ciotti G, Alunni Fegatelli D, Donzelli L, Martelli M, Gentile G. Reduced transmission of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) in patients with haematological malignancies hospitalized in an Italian hospital during the COVID-19 pandemic. JAC Antimicrob Resist 2021; 3:dlab167. [PMID: 34806006 PMCID: PMC8599827 DOI: 10.1093/jacamr/dlab167] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/06/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives During the lockdown that started in Italy on 10 March 2020 to address the COVID-19 pandemic, aggressive procedures were implemented to prevent SARS-CoV-2 transmission in SARS-CoV-2-negative patients with haematological malignancies. These efforts progressively reduced Klebsiella pneumonia carbapenemase-producing K. pneumoniae (KPC-KP) spread among these patients. Here we evaluated the potential effects of measures against COVID-19 that reduced KPC-KP transmission. Patients and methods We analysed KPC-KP spread among 123 patients with haematological malignancies, hospitalized between March and August 2020, who were managed using measures against COVID-19. Their outcomes were compared with those of 80 patients hospitalized during the preceding 4 months (November 2019–February 2020). Results During March–August 2020, 15.5% of hospitalized patients were KPC-KP positive, compared with 52.5% in November 2019–February 2020 (P < 0.0001); 8% and 27.5% of patients in these two groups were newly KPC-KP positive, respectively (P = 0.0003). There were eight new KPC-KP-positive patients during January 2020 and none during June 2020. The weekly rate of hospitalized KPC-KP-positive patients decreased from 50% during March 2020 to 17% during August 2020. Four KPC-KP bloodstream infections (BSIs) were experienced by 123 patients (3%) in March–August 2020, and seven BSIs (one fatal) by 80 patients (8%) in November 2019–February 2020 (P = 0.02). Consumption and expense of ceftazidime/avibactam administered to KPC-KP-positive patients significantly decreased in March–August 2020. Conclusions Aggressive strategies to prevent SARS-CoV-2 transmission were applied to all hospitalized patients, characterized by high levels of KPC-KP endemicity and nosocomial transmission. Such measures prevented SARS-CoV-2 infection acquisition and KPC-KP horizontal transmission. Reduced KPC-KP spread, fewer associated clinical complications and decreased ceftazidime/avibactam consumption represented unexpected ‘collateral benefits’ of strategies to prevent COVID-19.
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Affiliation(s)
- Alessandra Micozzi
- Department of Translational and Precision Medicine, Haematology, Sapienza University of Rome, Rome, Italy
- Corresponding author. E-mail:
| | - Giovanni Manfredi Assanto
- Department of Translational and Precision Medicine, Haematology, Sapienza University of Rome, Rome, Italy
| | - Laura Cesini
- Department of Translational and Precision Medicine, Haematology, Sapienza University of Rome, Rome, Italy
| | - Clara Minotti
- Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Claudio Cartoni
- Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Saveria Capria
- Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Giulia Ciotti
- Department of Translational and Precision Medicine, Haematology, Sapienza University of Rome, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Livia Donzelli
- Department of Translational and Precision Medicine, Haematology, Sapienza University of Rome, Rome, Italy
| | - Maurizio Martelli
- Department of Translational and Precision Medicine, Haematology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Gentile
- Department of Translational and Precision Medicine, Haematology, Sapienza University of Rome, Rome, Italy
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Micozzi A, Gentile G, Santilli S, Minotti C, Capria S, Moleti ML, Barberi W, Cartoni C, Trisolini SM, Testi AM, Iori AP, Bucaneve G, Foà R. Reduced mortality from KPC-K.pneumoniae bloodstream infection in high-risk patients with hematological malignancies colonized by KPC-K.pneumoniae. BMC Infect Dis 2021; 21:1079. [PMID: 34666695 PMCID: PMC8524821 DOI: 10.1186/s12879-021-06747-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND KPC-K.pneumoniae bloodstream infection (KPC-KpBSI) mortality rate in patients with hematological malignancies is reported about 60%. The initial treatment active against KPC-K.pneumoniae is crucial for survival and KPC-K.pneumoniae rectal colonization usually precedes KPC-KpBSI. We evaluated the impact on KPC-KpBSI mortality of the preemptive use of antibiotics active against KPC-K.pneumoniae, as opposed to inactive or standard empiric antibiotics, for the empiric treatment of febrile neutropenia episodes in patients with hematological malignancy identified as KPC-K.pneumoniae intestinal carriers. METHODS We compared the outcomes of KPC-KpBSIs occurring in high-risk hematological patients known to be colonized with KPC-K.pneumoniae, during two time periods: March2012-December2013 (Period 1, initial approach to KPC-K.pneumoniae spread) and January2017-October2018 (Period 2, full application of the preemptive strategy). The relative importance of the various prognostic factors that could influence death rates were assessed by forward stepwise logistic regression models. RESULTS KPC-KpBSI-related mortality in hematological patients identified as KPC-K.pneumoniae carriers dropped from 50% in Period 1 to 6% in Period 2 (p < 0.01), from 58 to 9% in acute myeloid leukemia carriers(p < 0.01). KPC-KpBSIs developed in patients identified as KPC-K.pneumoniae carriers were initially treated with active therapy in 56% and 100% of cases in Period 1 and Period 2, respectively (p < 0.01), in particular with an active antibiotic combination in 39 and 94% of cases, respectively(p < 0.01). The 61% of KPC-KpBSI observed in Period 1 developed during inactive systemic antibiotic treatment (none in Period 2, p < 0.01), fatal in the 73% of cases. Overall, KPC-KpBSI-related mortality was 88% with no initial active treatment, 11.5% with at least one initial active antibiotic (p < 0.01), 9% with initial active combination. Only the initial active treatment resulted independently associated with survival. CONCLUSIONS In high-risk hematological patients colonized by KPC-K.pneumoniae, the empiric treatment of febrile neutropenia active against KPC-K.pneumoniae reduced KPC-KpBSI-related mortality to 6% and prevented fatal KPC-KpBSI occurrence during inactive systemic antibiotic treatment.
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Affiliation(s)
- Alessandra Micozzi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy.
| | - Giuseppe Gentile
- Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Stefania Santilli
- Department of Diagnostics, Azienda Policlinico Umberto I, Rome, Italy
| | - Clara Minotti
- Department of Hematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Saveria Capria
- Department of Hematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Maria Luisa Moleti
- Department of Hematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Walter Barberi
- Department of Hematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Claudio Cartoni
- Department of Hematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Silvia Maria Trisolini
- Department of Hematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | - Anna Maria Testi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Anna Paola Iori
- Department of Hematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy
| | | | - Robin Foà
- Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
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Marziali M, Ribersani M, Losardo AA, Taglietti F, Pugliese P, Micozzi A, Gentile G, Angeloni A. COVID-19 pneumonia and pulmonary microembolism in a patient with B-thalassemia major. Clin Case Rep 2020; 8:3139-3142. [PMID: 33173583 PMCID: PMC7646639 DOI: 10.1002/ccr3.3275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/02/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022] Open
Abstract
We think that thalassemia is not necessarily a cause of aggravation of the clinical course in COVID‐19; however, certain key factors must be considered, such as the anemic condition, the likely pathogenic role of the virus on hemoglobin, and the hypercoagulable state to prevent any complications.
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Affiliation(s)
- Marco Marziali
- Hematology Policlinico Umberto 1 Sapienza Università di Roma Roma Italy
| | - Michela Ribersani
- Hematology Policlinico Umberto 1 Sapienza Università di Roma Roma Italy
| | - Anna Annunziata Losardo
- Immunohematology and Transfusion Medicine Unit Policlinico Umberto 1 Sapienza Università di Roma Roma Italy
| | - Fabrizio Taglietti
- Systemic and Immunocompromised Host Infection Unit National Institute for Infectious Diseases "L. Spallanzani" IRCCS Rome Italy
| | - Pellegrina Pugliese
- Immunohematology and Transfusion Medicine Unit Policlinico Umberto 1 Sapienza Università di Roma Roma Italy
| | - Alessandra Micozzi
- Department of Translational and Precision Medicine Sapienza Università di Roma Roma Italy
| | - Giuseppe Gentile
- Department of Translational and Precision Medicine Sapienza Università di Roma Roma Italy
| | - Antonio Angeloni
- Department of Experimental Medicine Sapienza Università di Roma Roma Italy
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11
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Mauro FR, Giannarelli D, Galluzzo CM, Vitale C, Visentin A, Riemma C, Rosati S, Porrazzo M, Pepe S, Coscia M, Trentin L, Gentile M, Raponi S, Micozzi A, Gentile G, Baroncelli S. Response to the conjugate pneumococcal vaccine (PCV13) in patients with chronic lymphocytic leukemia (CLL). Leukemia 2020; 35:737-746. [PMID: 32555297 DOI: 10.1038/s41375-020-0884-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022]
Abstract
Pneumococcal (PC) vaccination is recommended for patients with chronic lymphocytic leukemia (CLL). However, response to vaccines has been investigated in a small series of CLL patients. We analyzed the antibody response and outcomes of 112 CLL patients who received the 13-valent pneumococcal conjugate vaccine (PCV13). An immune response was defined by a twofold increase in the PC-IgG levels assessed by ELISA. The median age of patients was 68 years, 23.2% showed IgG levels ≤ 400 mg/L, 6.3% progressive disease, 52% unmutated IGHV. Twenty-two (19.6%) patients were treatment-naïve and 90 (80.4%) previously treated (40.2% front-line chemoimmunotherapy; ibrutinib first/advanced-line, 9.8%/21.4%; idelalisib advanced-line, 8.9%). Nine (8%) patients developed an immune response, eight treatment-naive, and one on front-line ibrutinib. No responses were observed in patients previously treated with chemoimmunotherapy. Age ≥ 60 years (p = 0.007), IgG levels < 400 mg/L (p < 0.0001), prior treatment (p < 0.0001), and signs of disease progression (p = 0.04) were associated with a lower response rate. Pneumonia-free survival was significantly shorter in patients with clinical signs of progressive disease (HR, 8.39), prior pneumonia (HR, 7.03), and TP53 disruption (HR, 2.91). In conclusion, our results suggest that vaccination should be offered at diagnosis to CLL patients with early stage and stable disease who have better resources for an effective immune response.
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Affiliation(s)
- Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy.
| | - Diana Giannarelli
- Biostatistic Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | | | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Costantino Riemma
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Serena Rosati
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Marika Porrazzo
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Sara Pepe
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Massimo Gentile
- Hematology and Oncology Department, Biotechnology Research Unit, Cosenza, Italy
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Alessandra Micozzi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Giuseppe Gentile
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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12
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Bruzzese A, Chistolini A, Morano SG, Fegatelli DA, Micozzi A. Peripherally inserted central catheter in patients with acute myeloid leukemia: incidence and risk factors for premature removal. Leuk Lymphoma 2020; 61:2265-2267. [PMID: 32436407 DOI: 10.1080/10428194.2020.1762880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Antonella Bruzzese
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Antonio Chistolini
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | | | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Micozzi
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
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13
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Prigitano A, Esposto MC, Grancini A, Passera M, Paolucci M, Stanzani M, Sartor A, Candoni A, Pitzurra L, Innocenti P, Micozzi A, Cascio GL, Delia M, Mosca A, Mikulska M, Ossi C, Fontana C, Pizzolante M, Gelmi M, Cavanna C, Lallitto F, Amato G, Vella A, Pagano L, Bandettini R, De Lorenzis G, Cogliati M, Romanò L, Tortorano A. Prospective multicentre study on azole resistance in Aspergillus isolates from surveillance cultures in haematological patients in Italy. J Glob Antimicrob Resist 2020; 22:231-237. [PMID: 32061880 DOI: 10.1016/j.jgar.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/11/2019] [Revised: 01/16/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study was conducted to assess the prevalence of azole resistance in Aspergillus isolates from patients with haematological malignancies or who were undergoing haematopoietic stem cell transplantation and to identify the molecular mechanism of resistance. METHODS In this 28-month prospective study involving 18 Italian centres, Aspergillus isolates from surveillance cultures were collected and screened for azole resistance, and mutations in the cyp51A gene were identified. Resistant isolates were genotyped by microsatellite analysis, and the allelic profiles were compared with those of resistant environmental and clinical isolates from the same geographical area that had been previously genotyped. RESULTS There were 292 Aspergillus isolates collected from 228 patients. The isolates belonged mainly to the section Fumigati (45.9%), Nigri (20.9%), Flavi (16.8%) and Terrei (4.8%). Three isolates showed itraconazole resistance: Aspergillus fumigatus sensu stricto, Aspergillus lentulus (section Fumigati) and Aspergillus awamori (section Nigri). The itraconazole resistance rates were 1% and 1.48% considering all Aspergillus spp. isolates and the Aspergillus section Fumigati, respectively. The prevalence of azole resistance among all the patients was 1.3%. Among patients harbouring A. fumigatus sensu stricto isolates, the resistance rate was 0.79%. The A. fumigatus isolate, with the TR34/L98H mutation, was genotypically distant from the environmental and clinical strains previously genotyped. CONCLUSIONS In this study, the Aspergillus azole resistance rate was 1% (3/292). In addition to A. fumigatus sensu stricto, A. lentulus and A. awamori azole-resistant isolates were identified. Therefore, it is important have a correct identification at the species level to address a rapid therapy better, quickly understand the shift towards cryptic species and have an updated knowledge of the local epidemiology.
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Affiliation(s)
- A Prigitano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - M C Esposto
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Grancini
- I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Passera
- Microbiology and Virology Unit, Asst. Papa Giovanni XXIII, Bergamo, Italy
| | - M Paolucci
- Institute of Hematology, Lorenzo e Ariosto Seràgnoli, Sant'Orsola-Malpighi Hospital Policlinico, University of Bologna, Bologna, Italy
| | - M Stanzani
- Institute of Hematology, Lorenzo e Ariosto Seràgnoli, Sant'Orsola-Malpighi Hospital Policlinico, University of Bologna, Bologna, Italy
| | - A Sartor
- Division of Hematology, ASUIUD, University of Udine, Udine, Italy
| | - A Candoni
- Division of Hematology, ASUIUD, University of Udine, Udine, Italy
| | - L Pitzurra
- Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italy
| | - P Innocenti
- Laboratory of Microbiology and Virology, Comprensorio Sanitario di Bolzano-AS Alto Adige, Bolzano, Italy
| | - A Micozzi
- Department of Translational and Precision Medicine, Sapienza Università di Roma, Rome, Italy
| | - G Lo Cascio
- Microbiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Delia
- Department of Emergency and Organ Transplantation-UO Haematology with transplantation, AO Universitaria Policlinico di Bari, Bari, Italy
| | - A Mosca
- Interdisciplinary Department of Medicine, AO Universitaria Policlinico di Bari, Bari, Italy
| | - M Mikulska
- Università degli Studi di Genova (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy
| | - C Ossi
- Laboratory of Microbiology and Virology, San Raffaele Scientific Institute, Milan, Italy
| | - C Fontana
- Department of Experimental Medicine, University of Tor Vergata Polyclinic of Tor Vergata, Rome, Italy
| | - M Pizzolante
- Laboratory of Microbiology, Vito Fazzi Regional Hospital Lecce, Lecce, Italy
| | - M Gelmi
- ASST Spedali Civili di Brescia, Brescia, Italy
| | - C Cavanna
- Microbiology and Virology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Lallitto
- Microbiology and Virology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Amato
- UOC. Patologia Clinica, AO A. Cardarelli, Naples, Italy
| | - A Vella
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Pagano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Bandettini
- Clinical Pathology and Microbiology Laboratory Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - G De Lorenzis
- Department of Agricultural and Environmental Sciences-Production, Landscape, Agroenergy, Università degli Studi di Milano, Milan, Italy
| | - M Cogliati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - L Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Tortorano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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15
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16
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Micozzi A, Gentile G, Minotti C, Cartoni C, Capria S, Ballarò D, Santilli S, Pacetti E, Grammatico S, Bucaneve G, Foà R. Carbapenem-resistant Klebsiella pneumoniae in high-risk haematological patients: factors favouring spread, risk factors and outcome of carbapenem-resistant Klebsiella pneumoniae bacteremias. BMC Infect Dis 2017; 17:203. [PMID: 28283020 PMCID: PMC5345173 DOI: 10.1186/s12879-017-2297-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [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: 07/08/2016] [Accepted: 02/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Klebsiella pneumoniae (CRKP) spread and infections in patients with haematological malignancies are a serious concern especially in endemic areas. Treatment failures and delay in appropriate therapy for CRKP infections are frequent and the mortality rate associated with CRKP bacteremia in neutropenic haematological patients is reported about 60%. METHODS Haematological patients harboring CRKP hospitalized between February 2012 and May 2013 in an Italian Teaching hospital were examined. Conditions favouring CRKP spread in a haematological unit, risk factors for bacteremia in CRKP-carriers and for CRKP bacteremia-related death were evaluated in this observational retrospective study. RESULTS CRKP was isolated in 22 patients, 14 (64%) had bacteremia. Control measures implementation, particularly the weekly rectal screening for CRKP performed in all hospitalized patients and contact precautions for CRKP-carriers and newly admitted patients until proved CRKP-negative, reduced significantly the CRKP spread (14 new carriers identified of 131 screened patients vs 5 of 242 after the intervention, p = 0.001). Fifty-eight percent of carriers developed CRKP bacteremia, and acute myeloid leukemia (AML) resulted independently associated with the bacteremia occurrence (p = 0.02). CRKP bacteremias developed mainly during neutropenia (86%) and in CRKP-carriers (79%). CRKP bacteremias were breakthrough in 10 cases (71%). Ten of 14 patient with CRKP bacteremias died (71%) and all had AML. The 70% of fatal bacteremias occurred in patients not yet recognized as CRKP-carriers and 80% were breakthrough. Initial adequate antibiotic therapy resulted the only independent factor able to protect against death (p = 0.02). CONCLUSIONS The identification of CRKP-carriers is confirmed critical to prevent CRKP spread. AML patients colonized by CRKP resulted at high risk of CRKP-bacteremia and poor outcome and the adequacy of the initial antibiotic therapy may be effective to improve survival. To limit the increase of resistance, the extensive use of antibiotics active against CRKP should be avoided, but in the setting of high CRKP pressure and high-risk CRKP-colonized haematological patients, timely empiric antibiotic combinations active against CRKP could be suggested as treatment of febrile neutropenia.
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Affiliation(s)
- Alessandra Micozzi
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161, Rome, Italy.
| | - Giuseppe Gentile
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161, Rome, Italy
| | | | | | | | - Daniele Ballarò
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161, Rome, Italy
| | | | - Emanuele Pacetti
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161, Rome, Italy
| | - Sara Grammatico
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161, Rome, Italy
| | | | - Robin Foà
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università di Roma, Via Benevento 6, 00161, Rome, Italy
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17
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Gentile G, Micozzi A. Speculations on the clinical significance of asymptomatic viral infections. Clin Microbiol Infect 2016; 22:585-8. [PMID: 27450587 DOI: 10.1016/j.cmi.2016.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 03/14/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 12/12/2022]
Abstract
A detailed understanding of asymptomatic chronic viral infections is critical to analyse their pathogenesis, assess the severity and burden of disease and, where required, optimize public health control measures. Recent studies on herpesviruses showed that the host-virus interactions are modulated by co-infections, emphasizing the relevance of co-infections in determining the clinical expression (from asymptomatic to symptomatic infections) and the severity of herpesvirus-associated diseases (either neoplastic or infectious diseases). To demonstrate causality between viruses (virome) and diseases, Koch's postulates should be adapted adding new knowledge on host-microbe relationship and microbial interactions. In the present review we aim to provide an update on asymptomatic chronic infections and criteria for causality and on the virological, immunological and host-virus interactions in asymptomatic chronic infections in human hosts, focusing on herpetic infections.
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Affiliation(s)
- G Gentile
- Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy.
| | - A Micozzi
- Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
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18
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Maccioni F, Vetere S, De Felice C, Al Ansari N, Micozzi A, Gentile G, Foà R, Girmenia C. Pulmonary fungal infections in patients with acute myeloid leukaemia: is it the time to revise the radiological diagnostic criteria? Mycoses 2016; 59:357-64. [PMID: 26865204 DOI: 10.1111/myc.12480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 09/07/2015] [Revised: 12/19/2015] [Accepted: 01/17/2016] [Indexed: 11/27/2022]
Abstract
The definition of pulmonary fungal infections (PFI) according to the EORTC-MSG criteria may lack diagnostic sensitivity due to the possible presentation of PFI with different radiological pictures. We evaluated the hypothesis to apply less restrictive radiological criteria to define PFI in patients with acute myeloid leukaemia (AML) submitted to chemotherapy. Overall, 73 consecutive episodes of pulmonary infiltrates associated to positive serum galactomannan test or fungal isolation or galactomannan detection from respiratory specimens were considered. CT scans acquired at the onset of symptoms (time-0) and within 4 weeks (time-1) were analysed to identify specific (group A) or aspecific radiological signs (group B). Pulmonary infiltrates fulfilled the EORTC-MSG criteria in 49 patients (group A), whereas in 24 patients (group B) they did not reach the criteria due to aspecific CT findings at time-0. Eleven of 21 (52.4%) patients of the group B evaluable for the evolution of the radiological findings fulfilled EORTC-MSG criteria at time-1. All the analysed clinical and mycological characteristics, response to antifungal therapy and survival were comparable in the two groups. Our study seems to confirm the possibility to extend the radiological suspicion of PFI to less restrictive chest CT findings when supported by microbiological criteria in high-risk haematological patients.
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Affiliation(s)
- Francesca Maccioni
- Dipartimento di Scienze Radiologiche, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Simone Vetere
- Dipartimento di Scienze Radiologiche, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Carlo De Felice
- Dipartimento di Scienze Radiologiche, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Najwa Al Ansari
- Dipartimento di Scienze Radiologiche, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Alessandra Micozzi
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Giuseppe Gentile
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Robin Foà
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Corrado Girmenia
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
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19
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Morano SG, Latagliata R, Girmenia C, Massaro F, Berneschi P, Guerriero A, Giampaoletti M, Sammarco A, Annechini G, Fama A, Di Rocco A, Chistolini A, Micozzi A, Molica M, Barberi W, Minotti C, Brunetti GA, Breccia M, Cartoni C, Capria S, Rosa G, Alimena G, Foà R. Catheter-associated bloodstream infections and thrombotic risk in hematologic patients with peripherally inserted central catheters (PICC). Support Care Cancer 2015; 23:3289-95. [PMID: 25910751 DOI: 10.1007/s00520-015-2740-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 12/27/2014] [Accepted: 04/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The use of peripherally inserted central catheters (PICC) as an alternative to other central venous access devices (CVAD) is becoming very frequent in cancer patients. To evaluate the impact of complications associated to these devices in patients with hematologic malignancies, we revised the catheter-related bloodstream infections (CRBSI) and the catheter-related thrombotic complications (CRTC) observed at our institute between January 2009 and December 2012. METHODS A total of 612 PICCs were inserted into 483 patients at diagnosis or in subsequent phases of their hematologic disease. PICCs were successfully inserted in all cases. The median duration of in situ PICC placement was 101 days (interquartile range, 48-184 days). RESULTS A CRBSI occurred in 47 cases (7.7 %), with a rate of 0.59 per 1000 PICC days. A CRTC was recorded in 16 cases (2.6 %), with a rate of 0.20 per 1000 PICC days. No serious complication was associated to these events. Cox regression analyses of variables associated to CRBSIs and to CRTCs showed that only the type of disease (acute leukemia compared to other diseases) was significantly associated to a higher incidence of CRBSIs, while no feature was predictive for a higher risk of CRTCs. CONCLUSIONS PICCs represent a useful and safe alternative to conventional CVAD for the management of patients with hematologic malignancies.
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Affiliation(s)
- Salvatore Giacomo Morano
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy.
| | - Roberto Latagliata
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Corrado Girmenia
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Fulvio Massaro
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Paola Berneschi
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Alfonso Guerriero
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Massimo Giampaoletti
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Arianna Sammarco
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Giorgia Annechini
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Angelo Fama
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Alice Di Rocco
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Antonio Chistolini
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Alessandra Micozzi
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Matteo Molica
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Walter Barberi
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Clara Minotti
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Gregorio Antonio Brunetti
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Massimo Breccia
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Claudio Cartoni
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Saveria Capria
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Giovanni Rosa
- Dipartimento di Anestesiologia e Terapia Intensiva, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giuliana Alimena
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - Robin Foà
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, "Sapienza" University of Rome, Via Benevento 6, 00161, Rome, Italy
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Paolino G, Santopietro M, Palumbo G, Onesti MG, Micozzi A, Venosi S, Laurino M, Ferrazza G, Fino P, Foà R, Giona F. Successful Management of a Chronic Refractory Leg Ulcer in an Adolescent with Sickle Cell Anemia. Acta Dermatovenerol Croat 2015; 23:213-217. [PMID: 26476907] [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: 06/05/2023]
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy characterized by a wide range of clinical manifestations. Chronic leg ulcers are a disabling complication with repercussions on the quality of life. We report the case of a 14-year-old girl with a diagnosis of SCD who developed a chronic leg ulcer that was successfully treated with a multi-disciplinary approach, including local and systemic therapies. The role of different treatments, in particular low molecular weight heparin, in the refractory chronic leg ulcer healing process will be discussed.
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Affiliation(s)
- Giovanni Paolino
- Giovanni Paolino, MD, Clinica Dermatologica, La Sapienza University of Rome, Viale del Policlinico 15, 00186 Rome, Italy;
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Micozzi A, Bucaneve G, Gentile G. Reply to J.H. Joshi. J Clin Oncol 2014; 32:3899-900. [DOI: 10.1200/jco.2014.57.9243] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bucaneve G, Micozzi A, Picardi M, Ballanti S, Cascavilla N, Salutari P, Specchia G, Fanci R, Luppi M, Cudillo L, Cantaffa R, Milone G, Bocchia M, Martinelli G, Offidani M, Chierichini A, Fabbiano F, Quarta G, Primon V, Martino B, Manna A, Zuffa E, Ferrari A, Gentile G, Foà R, Del Favero A. Results of a Multicenter, Controlled, Randomized Clinical Trial Evaluating the Combination of Piperacillin/Tazobactam and Tigecycline in High-Risk Hematologic Patients With Cancer With Febrile Neutropenia. J Clin Oncol 2014; 32:1463-71. [DOI: 10.1200/jco.2013.51.6963] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose Empiric antibiotic monotherapy is considered the standard of treatment for febrile neutropenic patients with cancer, but this approach may be inadequate because of the increasing prevalence of infections caused by multidrug resistant (MDR) bacteria. Patients and Methods In this multicenter, open-label, randomized, superiority trial, adult, febrile, high-risk neutropenic patients (FhrNPs) with hematologic malignancies were randomly assigned to receive piperacillin/tazobactam (4.5 g intravenously every 8 hours) with or without tigecycline (50 mg intravenously every 12 hours; loading dose 100 mg). The primary end point was resolution of febrile episode without modifications of the initial allocated treatment. Results Three hundred ninety FhrNPs were enrolled (combination/monotherapy, 187/203) and were included in the intention-to-treat analysis (ITTA). The ITTA revealed a successful outcome in 67.9% v 44.3% of patients who had received combination therapy and monotherapy, respectively (127/187 v 90/203; absolute difference in risk (adr), 23.6%; 95% CI, 14% to 33%; P < .001). The combination regimen proved better than monotherapy in bacteremias (adr, 32.8%; 95% CI, 19% to 46%; P < .001) and in clinically documented infections (adr, 36%; 95% CI, 9% to 64%; P < .01). Mortality and number of adverse effects were limited and similar in the two groups. Conclusion The combination of piperacillin/tazobactam and tigecycline is safe, well tolerated, and more effective than piperacillin/tazobactam alone in febrile, high-risk, neutropenic hematologic patients with cancer. In epidemiologic settings characterized by a high prevalence of infections because of MDR microorganisms, this combination could be considered as one of the first-line empiric antibiotic therapies.
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Affiliation(s)
- Giampaolo Bucaneve
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Alessandra Micozzi
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Marco Picardi
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Stelvio Ballanti
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Nicola Cascavilla
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Prassede Salutari
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Giorgina Specchia
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Rosa Fanci
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Mario Luppi
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Laura Cudillo
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Renato Cantaffa
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Giuseppe Milone
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Monica Bocchia
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Giovanni Martinelli
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Massimo Offidani
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Anna Chierichini
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Francesco Fabbiano
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Giovanni Quarta
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Valeria Primon
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Bruno Martino
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Annunziata Manna
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Eliana Zuffa
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Antonella Ferrari
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Giuseppe Gentile
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Robin Foà
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
| | - Albano Del Favero
- Giampaolo Bucaneve, Stelvio Ballanti, and Albano Del Favero, Ospedale S. Maria della Misericordia, Perugia, Italy; Alessandra Micozzi, Giuseppe Gentile, and Robin Foà, “Sapienza” Università di Roma, Roma; Marco Picardi, A. O. Universitaria “Federico II,” Napoli; Nicola Cascavilla, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo; Prassede Salutari, Ospedale Civile “Spirito Santo,” Pescara; Giorgina Specchia, Università di Bari, Bari; Rosa Fanci, A. O. Universitaria “Careggi,” Firenze
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Girmenia C, Micozzi A, Piciocchi A, Gentile G, Di Caprio L, Nasso D, Minotti C, Capria S, Cartoni C, Alimena G, Meloni G, Amadori S, Foà R, Venditti A. Invasive fungal diseases during first induction chemotherapy affect complete remission achievement and long-term survival of patients with acute myeloid leukemia. Leuk Res 2014; 38:469-74. [DOI: 10.1016/j.leukres.2014.01.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
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Raponi G, Ghezzi MC, Gherardi G, Dicuonzo G, Caputo D, Venditti M, Rocco M, Micozzi A, Mancini C. Antimicrobial Susceptibility, Biochemical and Genetic Profiles ofStaphylococcus haemolyticusStrains Isolated from the Bloodstream of Patients Hospitalized in Critical Care Units. J Chemother 2013; 17:264-9. [PMID: 16038519 DOI: 10.1179/joc.2005.17.3.264] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 10/31/2022]
Abstract
Staphylococcus haemolyticus strains (n=20), responsible of blood stream infections, were consecutively isolated from patients hospitalized in two different wards at high risk of infection. Strains displayed high rate of resistance to oxacillin (90%). All strains but two with decreased susceptibility (MIC = 4 microg/mL), were sensitive to vancomycin. Ten strains were resistant to teicoplanin. Among the strains susceptible to glycopeptides, three displayed heteroresistance to vancomycin and seven to teicoplanin, when tested by Etest technique with 2 x McFarland inoculum. Biochemical reactions allowed to assign strains to eight biotypes, with 11 strains clustering under two main biotype A and biotype B. Pulsed-field-gel-electrophoresis (PFGE) identified 11 different PFGE-types. Seven strains grouping under the major PFGE-type 1 and three strains clustering in PFGE-type 2, closely correlated to biotype A and biotype B respectively. Seven teicoplanin-resistant isolates clustered in the PFGE-type 1, two in the PFGE-type 2 and one in PFGE-type 5. Therefore, teicoplanin-resistant strains were biochemically and genetically related and clonally distributed, despite different clones of S. haemolyticus circulated in the units during the study period.
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Affiliation(s)
- G Raponi
- Dipartimento di Scienze di Sanità Pubblica G. Sanarelli, Università La Sapienza.
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Mikulska M, Novelli A, Aversa F, Cesaro S, de Rosa FG, Girmenia C, Micozzi A, Sanguinetti M, Viscoli C. Voriconazole in clinical practice. J Chemother 2013; 24:311-27. [DOI: 10.1179/1973947812y.0000000051] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Falcone M, Micozzi A, Pompeo ME, Baiocchi P, Fabi F, Penni A, Martino P, Venditti M. Methicillin-Resistant Staphylococcal Bacteremia in Patients with Hematologic Malignancies: Clinical and Microbiological Retrospective Comparative Analysis ofS. haemolyticus, S. epidermidisandS. aureus. J Chemother 2013; 16:540-8. [PMID: 15700845 DOI: 10.1179/joc.2004.16.6.540] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 10/31/2022]
Abstract
Although Staphylococcus haemolyticus (SH) represents an emerging etiology of methicillin-resistant (MR) coagulase-negative staphylococcal nosocomial bacteremia, little is known of clinical significance of this infection. Thus, we performed case-control retrospective comparative analysis of MRSH bacteremias (MRSHB), methicillin-resistant S. epidermidis bacteremias (MRSEB), and methicillin-resistant S. aureus bacteremias (MRSAB) in patients with hematologic malignancies. Most patients in the three groups were neutropenic and had a central venous catheter (CVC) in place at the onset of bacteremia. However, MRSHB patients had a CVC in place prior to bacteremia for a time significantly more prolonged than MRSEB and MRSAB ones (p<0.05). Severe sepsis or septic shock were more common in patients with MRSAB as compared with MRSHB (p=0.02). Nosocomial attributable mortality rate was very low in the 3 study groups (0 to 5.4%) and only two patients developed metastatic infections. Overall, reduced susceptibility to teicoplanin was observed in 19 (47.5%) MRSH and in 4 (10%) MRSE isolates. Resistance to teicoplanin was observed in 6 isolates, all MRSH. Reduced susceptibility or resistance to vancomycin was observed in 2 isolates, both MRSH. All MRSA isolates were susceptible to the glycopeptides. Comparison between cases of bacteremia in patients with MRSH isolates with reduced susceptibility to teicoplanin and those with susceptible MRSH did not reveal significant differences in the clinical-microbiological response to teicoplanin therapy and outcome. Our results seem to suggest that MRSHB in hematologic patients is associated with low morbidity and mortality rates. MRSH frequently shows a reduced susceptibility to teicoplanin; however these in vitro data do not seem associated with an unfavorable clinical response to teicoplanin therapy for MRSHB in patients with hematologic malignancies.
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Affiliation(s)
- M Falcone
- Dipartimento di Medicina Clinica, Policlinico Umberto I, Università La Sapienza, Roma, Italy
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Capria S, De Angelis F, Gentile G, Trisolini S, Brocchieri S, Canichella M, Chiusolo P, Micozzi A, Foà R, Meloni G. Complete remission obtained with azacitidine in a patient with concomitant therapy related myeloid neoplasm and pulmonary mucormycosis. Mediterr J Hematol Infect Dis 2013; 5:e2013048. [PMID: 23936619 PMCID: PMC3736875 DOI: 10.4084/mjhid.2013.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/11/2013] [Indexed: 12/03/2022] Open
Abstract
Mucormycosis is the third cause of invasive mycosis after candidiasis and aspergillosis in AML patients, representing a poor prognostic factor associated with a high rate of fatal outcome. We report a case of a patient with AML and a concomitant pulmonary mucormycosis at diagnosis, who obtained a complete remission both of her AML and of the fungal infection. The incidence of the infection at the onset of leukemia is extremely unusual, and, to our knowledge, the sporadic cases reported in the literature are included in heterogeneous series retrospectively examined. In our case, Liposomal Amphotericin B as single agent appeared incapable of controlling the infection, so anti-infective therapy was intensified with posaconazole and simultaneously antileukemic treatment with 5-azacitidine was started, with the understanding that the only antifungal treatment would not have been able to keep the infection under control for a long time if not associated with a reversal of neutropenia related to the disease. We observed a progressive improvement of the general conditions, a healing of pneumonia and a complete remission of the leukemic disease, suggesting that a careful utilization of the new compounds available today, in terms of both antifungal and antileukemic treatment, may offer a curative chance a patient who would have otherwise been considered unfit for a potentially curative therapeutic strategy.
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Affiliation(s)
- S. Capria
- Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Rome, Italy
| | - F. De Angelis
- Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Rome, Italy
| | - G. Gentile
- Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Rome, Italy
| | - S.M. Trisolini
- Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Rome, Italy
| | - S. Brocchieri
- Department of Radiologic Sciences, Azienda Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - M. Canichella
- Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Rome, Italy
| | - P. Chiusolo
- Department of Hematology, Catholic University of the Sacred Heart, Rome, Italy
| | - A. Micozzi
- Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Rome, Italy
| | - R. Foà
- Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Rome, Italy
| | - G. Meloni
- Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Rome, Italy
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Girmenia C, Frustaci AM, Gentile G, Minotti C, Cartoni C, Capria S, Trisolini SM, Matturro A, Loglisci G, Latagliata R, Breccia M, Meloni G, Alimena G, Foà R, Micozzi A. Posaconazole prophylaxis during front-line chemotherapy of acute myeloid leukemia: a single-center, real-life experience. Haematologica 2011; 97:560-7. [PMID: 22102706 DOI: 10.3324/haematol.2011.053058] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Posaconazole is effective as primary antifungal prophylaxis of invasive fungal diseases in patients with acute myeloid leukemia. DESIGN AND METHODS The impact of primary antifungal prophylaxis administered during front-line chemotherapy for acute myeloid leukemia was evaluated by comparing 58 patients who received oral amphotericin B (control group) to 99 patients who received oral posaconazole (posaconazole group). The primary endpoint was the incidence of proven/probable invasive fungal diseases. Secondary endpoints included incidence of invasive aspergillosis, survival at 4 and 12 months after the diagnosis of acute myeloid leukemia and costs. RESULTS Proven/probable invasive fungal diseases were documented in 51.7% of patients in the control group and in 23.2% in the posaconazole group (P=0.0002). Invasive aspergillosis was documented in 43% of patients in the control group and in 15% in the posaconazole group (P=0.002). No survival difference was observed in patients aged over 60 years. In patients aged 60 years or less, a statistically significant survival advantage was observed at 4 months, but no longer at 12 months, in the posaconazole group (P=0.03). It was calculated that in the posaconazole group there was a mean 50% cost reduction for the antifungal drugs. CONCLUSIONS Primary antifungal prophylaxis with posaconazole during front-line chemotherapy was effective in preventing invasive fungal diseases in a "real-life" scenario of patients with acute myeloid leukemia, resulted in an early but transitory survival advantage in younger patients and was economically advantageous.
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Affiliation(s)
- Corrado Girmenia
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerative, Azienda Policlinico Umberto I, Sapienza University of Rome Via Benevento 6, 00161 Rome, Italy.
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Girmenia C, Mercanti C, Federico V, Rea M, De Vellis A, Valle V, Micozzi A, Latagliata R, Breccia M, Morano SG, Brunetti GA, Sali M, Delogu G, Foà R, Alimena G, Gentile G. Management of the 2009 A/H1N1 influenza pandemic in patients with hematologic diseases: a prospective experience at an Italian center. Acta Haematol 2011; 126:1-7. [PMID: 21411983 DOI: 10.1159/000323713] [Citation(s) in RCA: 6] [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] [Received: 11/22/2010] [Accepted: 12/21/2010] [Indexed: 11/19/2022]
Abstract
Data derived from epidemiologic surveillance adopted at our center in hematologic and stem cell transplant patients during the 2009 influenza A (H1N1)v pandemic are reported. Of the 52 patients with influenza-like disease we observed, 37 underwent a real-time PCR evaluation and 21 had a confirmed diagnosis. Of the RT-PCR-confirmed cases, 23.8% were children (age <18 years) and 9.5% were >65 years; 47.6% presented with a pulmonary infiltrate and 33.3% with respiratory failure. Pulmonary involvement was observed more frequently in patients with comorbidities. All patients received a course of oseltamivir therapy starting an average of 1 day (range <1-2) after the onset of symptoms. No patient was transferred to the intensive care unit. The viral disease had a generally favorable outcome despite the high frequency of pulmonary involvement. A prompt clinical evaluation with an early antiviral and supportive therapy may have played a beneficial role in the outcome.
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Affiliation(s)
- Corrado Girmenia
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerative, Azienda Policlinico Umberto I, Sapienza Università di Roma, Roma, Italia.
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31
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Girmenia C, Micozzi A, Gentile G, Santilli S, Arleo E, Cardarelli L, Capria S, Minotti C, Cartoni C, Brocchieri S, Guerrisi V, Meloni G, Foà R, Martino P. Clinically Driven Diagnostic Antifungal Approach in Neutropenic Patients: A Prospective Feasibility Study. J Clin Oncol 2010; 28:667-674. [DOI: 10.1200/jco.2009.21.8032] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose Preemptive strategies in neutropenic patients based on serum galactomannan (GM) –guided triggering of diagnostic work-up may be time-consuming and expensive when applied to the entire population. We have assessed the feasibility of a clinically driven diagnostic strategy without GM screening. Patients and Methods Patients with neutropenic fever underwent a baseline diagnostic work-up (BDWU; three blood cultures and other examinations as indicated). An intensive diagnostic work-up (IDWU; GM for 3 days, chest computed tomography and other examinations as indicated) was reserved for patients with 4 days of persisting or relapsing fever or with other clinical findings possibly related to an invasive fungal diseaser (IFD). Antifungal therapy was administered to patients diagnosed with IFD and empirically (negative IDWU) only to those with persisting neutropenic fever and worsening clinical conditions. Results Of 220 neutropenia episodes, fever occurred in 159 cases and recurred in 28 cases. Overall, 49 IFDs were diagnosed (two by BDWU and 47 by IDWU) during 48 episodes (21.8%). Diagnostic-driven therapy was administered to 48 patients with IFDs; one patient with zygomycosis died without treatment. Only one patient received empirical therapy. IDWU was required in 40% of neutropenia episodes, and only 1.4 mean blood samples per neutropenia episode were tested for GM. Our strategy allowed a 43% reduction in antifungal treatments compared with a standard empirical approach. At 3-month follow-up, 63% of patients with IFD survived, and no undetected IFDs were found. Conclusion A clinically driven diagnostic approach in selected neutropenia episodes offered effective antifungal control and reduced the exposure to unnecessary antifungal treatment.
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Affiliation(s)
- Corrado Girmenia
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Alessandra Micozzi
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Giuseppe Gentile
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Stefania Santilli
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Eva Arleo
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Luisa Cardarelli
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Saveria Capria
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Clara Minotti
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Claudio Cartoni
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Simonetta Brocchieri
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Vito Guerrisi
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Giovanna Meloni
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Robin Foà
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Pietro Martino
- From the Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, “Sapienza” University, Rome, Italy
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Bonini A, Capatti C, Parmeggiani M, Gugliotta L, Micozzi A, Gentile G, Capria S, Girmenia C. Galactomannan detection in Geotrichum capitatum invasive infections: report of 2 new cases and review of diagnostic options. Diagn Microbiol Infect Dis 2008; 62:450-2. [PMID: 18945571 DOI: 10.1016/j.diagmicrobio.2008.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 08/07/2008] [Accepted: 08/12/2008] [Indexed: 10/21/2022]
Abstract
We report 2 cases of Geotrichum capitatum infection in leukemia patients for which Aspergillus galactomannan (GM) assay was positive. The diagnostic options of G. capitatum infections in hematologic patients were reviewed. Although the pathogen was isolated from blood in 77% of cases, diagnostic difficulties remain and GM assay may have a role.
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Affiliation(s)
- Alessandro Bonini
- Division of Hematology AO S.Maria Nuova, 42100 Reggio Emilia, University "La Sapienza", 00161 Rome, Italy
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Pizzoferrato R, Ziller T, Paolesse R, Mandoj F, Micozzi A, Ricci A, Lo Sterzo C. Optical properties of novel Er-containing co-polymers with emission at 1530nm. Chem Phys Lett 2006. [DOI: 10.1016/j.cplett.2006.05.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Micozzi A, Bucaneve G. Prophylaxis and treatment of bacterial infections: do we need new strategies? Rev Clin Exp Hematol 2005; 9:E4. [PMID: 16864118] [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: 05/11/2023]
Abstract
Bacterial infections in patients with hematologic malignancies still represent a severe and life-treating problem. Several observational studies during the last decade have revealed that neutropenic patients with fever are a heterogeneous population with various differences regarding response to initial therapy, development of serious complications and mortality. The role of neutropenia as main risk factor for infections in hematologic patients and the definition of different level of risk related to neutrophils count and duration of neutropenia have been extensively studied and different categories of patients based on the risk of infection, mostly the condition of neutropenia, have been clearly defined. The strategies on antimicrobial therapy and supportive care in hematologic patients need to be continuously assessed, in fact new conditions favouring the occurrence of infectious complications in patients with hematologic malignancies have progressively emerged. The use of oral prophylactic antibiotics in neutropenic cancer patients is still a matter of debate. Before 2005, several trials showed how the prevention of infection can be extremely important in this setting of patients but none was conclusive. In 2005 two meta-analysis and two large randomized clinical trials gave new evidence that antibacterial prophylaxis can reduce in neutropenic patients several important outcomes including mortality. The use of the empiric antibacterial therapy represents the cornerstone of the antimicrobial strategies in the febrile neutropenic patients leading, over the span of 20 years, to a dramatic decrease of deaths: Actually beta-lactam monotherapy is commonly used for the empiric treatment of febrile neutropenia. Recently, large randomized clinical trials and meta-analysis showed that the addition of an aminoglycoside and/or a glycopeptides results in a more favourable outcome only in selected severe infections. The use of antibiotics should be prudent and safe also in neutropenic hematologic patients to prevent emergence of microbial resistance, to save costs, to reduce toxicity. For this reasons, according to the evidence, antibacterial prophylaxis should be restricted to high risk hematologic patients and empiric parenteral antibiotic monotherapy should be recommended in case of febrile neutropenia limiting the use of amynoglicosides and glycopeptides. In the next future, a major effort should be made to state in hematologic patients new risk factors which could more accurately define subgroups for targeted anti-infective strategies.
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Affiliation(s)
- Alessandra Micozzi
- Dipartimento di Biotecnologie ed Ematologia Ematologia, Università La Sapienza, Roma
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Girmenia C, Moleti ML, Micozzi A, Iori AP, Barberi W, Foà R, Martino P. Breakthrough Candida krusei fungemia during fluconazole prophylaxis followed by breakthrough zygomycosis during caspofungin therapy in a patient with severe aplastic anemia who underwent stem cell transplantation. J Clin Microbiol 2005; 43:5395-6. [PMID: 16208029 PMCID: PMC1248476 DOI: 10.1128/jcm.43.10.5395-5396.2005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 11/20/2022] Open
Abstract
We report a case of breakthrough invasive zygomycosis in a stem cell transplant recipient who was receiving caspofungin for treatment of a breakthrough Candida krusei fungemia that occurred during fluconazole prophylaxis. Also, patients receiving the echinocandin caspofungin remain at risk for pathogens, such as zygomycetes, that are intrinsically resistant to this agent.
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Affiliation(s)
- Corrado Girmenia
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University "La Sapienza," Rome 00161, Italy.
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Pizzoferrato R, Ziller T, Micozzi A, Ricci A, Sterzo CL, Ustione A, Oliva C, Cricenti A. Suppression of the excimer photoluminescence in a poly(arylene–ethynylene) co-polymer. Chem Phys Lett 2005. [DOI: 10.1016/j.cplett.2005.08.074] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bucaneve G, Micozzi A, Menichetti F, Martino P, Dionisi MS, Martinelli G, Allione B, D'Antonio D, Buelli M, Nosari AM, Cilloni D, Zuffa E, Cantaffa R, Specchia G, Amadori S, Fabbiano F, Deliliers GL, Lauria F, Foà R, Del Favero A. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 2005; 353:977-87. [PMID: 16148283 DOI: 10.1056/nejmoa044097] [Citation(s) in RCA: 428] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prophylactic use of fluoroquinolones in patients with cancer and neutropenia is controversial and is not a recommended intervention. METHODS We randomly assigned 760 consecutive adult patients with cancer in whom chemotherapy-induced neutropenia (<1000 neutrophils per cubic millimeter) was expected to occur for more than seven days to receive either oral levofloxacin (500 mg daily) or placebo from the start of chemotherapy until the resolution of neutropenia. Patients were stratified according to their underlying disease (acute leukemia vs. solid tumor or lymphoma). RESULTS An intention-to-treat analysis showed that fever was present for the duration of neutropenia in 65 percent of patients who received levofloxacin prophylaxis, as compared with 85 percent of those receiving placebo (243 of 375 vs. 308 of 363; relative risk, 0.76; absolute difference in risk, -20 percent; 95 percent confidence interval, -26 to -14 percent; P=0.001). The levofloxacin group had a lower rate of microbiologically documented infections (absolute difference in risk, -17 percent; 95 percent confidence interval, -24 to -10 percent; P<0.001), bacteremias (difference in risk, -16 percent; 95 percent confidence interval, -22 to -9 percent; P<0.001), and single-agent gram-negative bacteremias (difference in risk, -7 percent; 95 percent confidence interval, -10 to -2 percent; P<0.01) than did the placebo group. Mortality and tolerability were similar in the two groups. The effects of prophylaxis were also similar between patients with acute leukemia and those with solid tumors or lymphoma. CONCLUSIONS Prophylactic treatment with levofloxacin is an effective and well-tolerated way of preventing febrile episodes and other relevant infection-related outcomes in patients with cancer and profound and protracted neutropenia. The long-term effect of this intervention on microbial resistance in the community is not known.
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Castagnola E, Haupt R, Micozzi A, Caviglia I, Testi AM, Giona F, Parodi S, Girmenia C. Differences in the proportions of fluoroquinolone-resistant Gram-negative bacteria isolated from bacteraemic children with cancer in two Italian centres. Clin Microbiol Infect 2005; 11:505-7. [PMID: 15882204 DOI: 10.1111/j.1469-0691.2005.01114.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [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: 11/27/2022]
Abstract
The proportion of ciprofloxacin-resistant Gram-negative bacteria isolated from the blood of children with cancer (not receiving prophylaxis) was 10% in a paediatric hospital (Genoa) where the use of quinolones was highly restricted, compared with 41% in a department of haematology (Rome) where leukaemic adults, who received fluoroquinolone prophylaxis, were also treated (p < 0.0001). Moreover, simultaneous resistance to ciprofloxacin and ceftazidime, amikacin or imipenem-cilastatin was 11% in Genoa compared with 37% in Rome (p < 0.001). Ciprofloxacin resistance was more frequent in children who shared an environment with adults who were receiving ciprofloxacin prophylaxis.
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Affiliation(s)
- E Castagnola
- Infectious Diseases Unit, Department of Hematology and Oncology, G. Gaslini Teaching Hospital, Genoa, Italy.
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Girmenia C, Cimino G, Di Cristofano F, Micozzi A, Gentile G, Martino P. Effects of hydration with salt repletion on renal toxicity of conventional amphotericin B empirical therapy: a prospective study in patients with hematological malignancies. Support Care Cancer 2005; 13:987-92. [PMID: 15756584 DOI: 10.1007/s00520-005-0783-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [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: 09/30/2004] [Accepted: 01/18/2005] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Several studies have suggested that hydration and sodium load might reduce nephrotoxicity related to amphotericin B-deoxycholate (AmB-d). However, a schedule of these nephroprotective measures has not been standardized until now. A protocol of hydration and electrolyte supplementation was used prospectively in patients with hematological malignancies receiving empirical AmB-d treatment to evaluate its effect on AmB-d-related renal toxicity. PATIENTS AND METHODS A total of 77 consecutive patients received AmB-d (1 mg/kg per day) in association with an initial intravenous hydration of at least 1 l/m2 body surface, containing at least 1 l of 0.9% saline daily. Hydration was increased when serum creatinine levels showed a 20% increase from baseline. Serum electrolytes were replaced when indicated. RESULTS The median duration of AmB-d therapy was 14 days. The mean intravenous hydration and the mean diuresis were 1530 and 1970 ml/m2 of body surface per day, respectively. Overall, 55 patients (71.4%) received a mean of 18.5 days of therapy without dose-limiting adverse events. Despite significant increases in mean creatinine serum levels and decreases in mean creatinine clearance observed early in the whole population, in only six patients (7.8%) was therapy discontinued due to renal failure, which always recovered after treatment discontinuation. In eight patients (10.4%) therapy was stopped due to infusion-related side effects. Seven patients died while under antifungal therapy without relevant signs of AmB-d-associated toxicity. CONCLUSIONS Our prospective experience confirms that adequate hydration (about 1500 ml/m2 of body surface) and careful electrolyte supplementation are simple measures able to contain nephrotoxicity and to permit adequate antifungal therapy at least in the empirical setting.
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Affiliation(s)
- Corrado Girmenia
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Via Benevento 6, 00161, Rome, Italy.
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Micozzi A, Ottaviani M, Giardina G, Ricci A, Pizzoferrato R, Ziller T, Compagnone D, Lo?Sterzo C. Use of the Pd-PromotedExtended One-Pot (EOP) Synthetic Protocol for the Modular Construction of Poly-(arylene ethynylene)co-Polymers [?Ar?C?C?Ar??C?C?]n, Opto- and Electro-Responsive Materials for Advanced Technology. Adv Synth Catal 2005. [DOI: 10.1002/adsc.200404233] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Capria S, Vitolo D, Cartoni C, Dessanti L, Micozzi A, Mandelli F, Meloni G. Neutropenic enterocolitis in acute leukemia: diagnostic and therapeutic dilemma. Ann Hematol 2003; 83:195-7. [PMID: 15064870 DOI: 10.1007/s00277-003-0755-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 05/06/2003] [Accepted: 08/01/2003] [Indexed: 12/15/2022]
Abstract
The main purpose of this report is to focus on the importance of an accurate etiologic diagnosis of gastrointestinal complications during chemotherapy for acute myeloid leukemia, taking into account that a syndrome characterized by bowel wall thickening associated with diarrhea and abdominal pain may have etiologies different from neutropenic enterocolitis (NE) and in such a case necessitate a different treatment approach. We describe a case of a 46-year-old woman affected by acute myeloid leukemia presenting the onset of a syndrome with clinical features of NE. Supportive therapy for NE was instituted, but during treatment the patient presented a life-threatening gastrointestinal bleeding and was submitted in emergency to hemicolectomy. Following surgery, the patient recovered completely and she is currently alive in complete remission after receiving allogeneic bone marrow transplantation. Histological examination of the surgical specimens showed that the acute abdominal syndrome was related to massive infiltration of the bowel by leukemia cells. A correct baseline evaluation and a prompt diagnosis of the complication may help in making the therapeutic decision, which in our case led necessarily to a surgical procedure, because the bleeding was due to post-chemotherapy necrosis of the leukemic infiltrating tissue. A close collaboration between the hematologist and the surgeon may provide guidelines for behavior in such cases, giving these patients the possibility of survival and the opportunity to carry on the treatment planned for the primary disease.
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Affiliation(s)
- S Capria
- Department of biotecnologie cellulari ed ematologia, University "La Sapienza", via Benevento 6, 00161, Rome, Italy
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Venditti M, Falcone M, Micozzi A, Carfagna P, Taglietti F, Serra PF, Martino P. Staphylococcus aureus bacteremia in patients with hematologic malignancies: a retrospective case-control study. Haematologica 2003; 88:923-30. [PMID: 12935981] [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: 03/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Staphylococcus aureus bacteremia (SAB) continues to be a major problem related to both community and nosocomially acquired infection. Nevertheless few data are presently available in literature about this infection in patients with hematologic malignancies. DESIGN AND METHODS The purpose of this retrospective study was to report further data on the clinical characteristics and outcome of patients with SAB. All episodes of SAB occurring between January 1997 and June 2001 were identified and defined by analysis of the patients' clinical records. RESULTS The nosocomial mortality rate was only 3.5% and no patient developed secondary complications. Comparison between neutropenic hematologic patients with SAB and neutropenic hematologic patients with Gram-negative bacteremia (GNB) revealed an higher mortality in the latter group (p=0.03); furthermore, severe sepsis and septic shock were more frequent in patients with GNB (p<0.001). Comparison between neutropenic patients with hematologic malignancies and non-neutropenic ones with other underlying diseases revealed significantly higher morbidity and mortality rates in the latter group. Non neutropenic patients seemed to be more susceptible to both early complications, such as severe sepsis or septic shock (p=0.002) and to later ones, such as endocarditis and metastatic abscesses (p=0.02). INTERPRETATION AND CONCLUSIONS Our results seem to suggest that SAB in patients with hematologic malignancies is often a low inoculum infection associated with negligible morbidity and mortality rates, especially when adequate antistaphylococcal therapy is administered promptly.
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Affiliation(s)
- Mario Venditti
- Department of Clinical Medicine, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
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Girmenia C, Lo Coco F, Breccia M, Latagliata R, Spadea A, D'Andrea M, Gentile G, Micozzi A, Alimena G, Martino P, Mandelli F. Infectious complications in patients with acute promyelocytic leukaemia treated with the AIDA regimen. Leukemia 2003; 17:925-30. [PMID: 12750707 DOI: 10.1038/sj.leu.2402899] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [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: 11/08/2022]
Abstract
Infections represent a frequent complication of chemotherapy used for acute myeloid leukaemia (AML) and are associated with important toxicity frequently leading to treatment discontinuation. Acute promyelocytic leukaemia (APL) is a unique AML subset requiring tailored therapy including all-trans retinoic acid and anthracycline-based chemotherapy. We analysed in this study the incidence and type of infections complicating the clinical course of 89 consecutive APL patients receiving the AIDA protocol at a single institution. A total of 179 febrile episodes were registered during induction and consolidation, 52% of which were of unknown origin. Infections were clinically and microbiologically documented in 10.6 and 37.4% of cases, respectively. Coagulase-negative staphylococci represented the major cause of septicaemia (28%) and were more frequently isolated during induction, whereas viridans group streptococci, the second pathogen most frequently isolated from blood (27%), represented the principal pathogen detected during consolidation and were significantly associated with mucositis. Gram-negative bacteria accounted for 33.3% of all blood isolates. Fungal infections were only occasionally observed. Bloodstream infections in APL patients were compared with those documented in 271 consecutive patients affected by other subtypes of AML. The incidence of total septicaemia episodes, of staphylococcal bacteraemias and of fungaemias was significantly higher in patients with other AMLs. Empirical antibiotic therapy with ceftriaxone plus amikacin was effective in 73% of APL cases, most of the remaining cases being successfully managed by the addition of teicoplanin. One single death apparently related to infectious complication was recorded. Overall, infections led to antileukaemic treatment withdrawal in six patients, five of whom currently remain in haematologic remission for 13-106 months. These results indicate that a particular pattern of infections is observed in APL patients receiving ATRA plus anthracycline-based chemotherapy and that these appear to be effectively counteracted by standard management.
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Affiliation(s)
- C Girmenia
- Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Rome, Italy
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Pizzoferrato R, Berliocchi M, Di Carlo A, Lugli P, Venanzi M, Micozzi A, Ricci A, Lo Sterzo C. Improvement of the Extended One-Pot (EOP) Procedure To Form Poly(aryleneethynylene)s and Investigation of Their Electrical and Optical Properties. Macromolecules 2003. [DOI: 10.1021/ma0216829] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R. Pizzoferrato
- INFM-Dipartimento di Ingegneria Meccanica and INFM-Dipartimento di Ingegneria Elettronica, Facoltà di Ingegneria, Università di Tor Vergata, Via di Tor Vergata 110, 00133 Roma, Italy, Dipartimento di Scienze e Tecnologie Chimiche, Università di Tor Vergata, Via della Ricerca Scientifica, 00133 Roma, Italy, Istituto C.N.R. di Chimica dei Composti Organometallici (ICCOM-CNR)-Sezione di Roma, Dipartimento di Chimica, Box 34-Roma 62, Universita' “La Sapienza”, Piazzale Aldo Moro 5, 00185 Roma, Italy, and
| | - M. Berliocchi
- INFM-Dipartimento di Ingegneria Meccanica and INFM-Dipartimento di Ingegneria Elettronica, Facoltà di Ingegneria, Università di Tor Vergata, Via di Tor Vergata 110, 00133 Roma, Italy, Dipartimento di Scienze e Tecnologie Chimiche, Università di Tor Vergata, Via della Ricerca Scientifica, 00133 Roma, Italy, Istituto C.N.R. di Chimica dei Composti Organometallici (ICCOM-CNR)-Sezione di Roma, Dipartimento di Chimica, Box 34-Roma 62, Universita' “La Sapienza”, Piazzale Aldo Moro 5, 00185 Roma, Italy, and
| | - A. Di Carlo
- INFM-Dipartimento di Ingegneria Meccanica and INFM-Dipartimento di Ingegneria Elettronica, Facoltà di Ingegneria, Università di Tor Vergata, Via di Tor Vergata 110, 00133 Roma, Italy, Dipartimento di Scienze e Tecnologie Chimiche, Università di Tor Vergata, Via della Ricerca Scientifica, 00133 Roma, Italy, Istituto C.N.R. di Chimica dei Composti Organometallici (ICCOM-CNR)-Sezione di Roma, Dipartimento di Chimica, Box 34-Roma 62, Universita' “La Sapienza”, Piazzale Aldo Moro 5, 00185 Roma, Italy, and
| | - P. Lugli
- INFM-Dipartimento di Ingegneria Meccanica and INFM-Dipartimento di Ingegneria Elettronica, Facoltà di Ingegneria, Università di Tor Vergata, Via di Tor Vergata 110, 00133 Roma, Italy, Dipartimento di Scienze e Tecnologie Chimiche, Università di Tor Vergata, Via della Ricerca Scientifica, 00133 Roma, Italy, Istituto C.N.R. di Chimica dei Composti Organometallici (ICCOM-CNR)-Sezione di Roma, Dipartimento di Chimica, Box 34-Roma 62, Universita' “La Sapienza”, Piazzale Aldo Moro 5, 00185 Roma, Italy, and
| | - M. Venanzi
- INFM-Dipartimento di Ingegneria Meccanica and INFM-Dipartimento di Ingegneria Elettronica, Facoltà di Ingegneria, Università di Tor Vergata, Via di Tor Vergata 110, 00133 Roma, Italy, Dipartimento di Scienze e Tecnologie Chimiche, Università di Tor Vergata, Via della Ricerca Scientifica, 00133 Roma, Italy, Istituto C.N.R. di Chimica dei Composti Organometallici (ICCOM-CNR)-Sezione di Roma, Dipartimento di Chimica, Box 34-Roma 62, Universita' “La Sapienza”, Piazzale Aldo Moro 5, 00185 Roma, Italy, and
| | - A. Micozzi
- INFM-Dipartimento di Ingegneria Meccanica and INFM-Dipartimento di Ingegneria Elettronica, Facoltà di Ingegneria, Università di Tor Vergata, Via di Tor Vergata 110, 00133 Roma, Italy, Dipartimento di Scienze e Tecnologie Chimiche, Università di Tor Vergata, Via della Ricerca Scientifica, 00133 Roma, Italy, Istituto C.N.R. di Chimica dei Composti Organometallici (ICCOM-CNR)-Sezione di Roma, Dipartimento di Chimica, Box 34-Roma 62, Universita' “La Sapienza”, Piazzale Aldo Moro 5, 00185 Roma, Italy, and
| | - A. Ricci
- INFM-Dipartimento di Ingegneria Meccanica and INFM-Dipartimento di Ingegneria Elettronica, Facoltà di Ingegneria, Università di Tor Vergata, Via di Tor Vergata 110, 00133 Roma, Italy, Dipartimento di Scienze e Tecnologie Chimiche, Università di Tor Vergata, Via della Ricerca Scientifica, 00133 Roma, Italy, Istituto C.N.R. di Chimica dei Composti Organometallici (ICCOM-CNR)-Sezione di Roma, Dipartimento di Chimica, Box 34-Roma 62, Universita' “La Sapienza”, Piazzale Aldo Moro 5, 00185 Roma, Italy, and
| | - C. Lo Sterzo
- INFM-Dipartimento di Ingegneria Meccanica and INFM-Dipartimento di Ingegneria Elettronica, Facoltà di Ingegneria, Università di Tor Vergata, Via di Tor Vergata 110, 00133 Roma, Italy, Dipartimento di Scienze e Tecnologie Chimiche, Università di Tor Vergata, Via della Ricerca Scientifica, 00133 Roma, Italy, Istituto C.N.R. di Chimica dei Composti Organometallici (ICCOM-CNR)-Sezione di Roma, Dipartimento di Chimica, Box 34-Roma 62, Universita' “La Sapienza”, Piazzale Aldo Moro 5, 00185 Roma, Italy, and
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Testi AM, Del Giudice I, Arcese W, Moleti ML, Giona F, Basso G, Biondi A, Conter V, Messina C, Rondelli R, Micozzi A, Micalizzi C, Barisone E, Locatelli F, Dini G, Aricò M, Casale F, Comis M, Ladogana S, Lippi A, Mura R, Pinta MF, Santoro N, Valsecchi MG, Masera G, Mandelli F. A single high dose of idarubicin combined with high-dose ARA-C for treatment of first relapse in childhood 'high-risk' acute lymphoblastic leukaemia: a study of the AIEOP group. Br J Haematol 2002; 118:741-7. [PMID: 12181040 DOI: 10.1046/j.1365-2141.2002.03706.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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: 11/20/2022]
Abstract
The outcome of children with acute lymphoblastic leukaemia (ALL) and early relapse remains unsatisfactory. In January 1995, the AIEOP (Associazione Italiana di Oncologia ed Ematologia Pediatrica) group opened a trial for children with ALL in first isolated or combined bone marrow relapse defined at high risk according to the length of first remission and the immunophenotype. The treatment plan included the combination of a single high-dose idarubicin and high-dose cytarabine as induction therapy followed by an intensive consolidation and stem cell transplant (SCT). In total, 100 children from 16 Italian centres were enrolled; 80 out of the 99 evaluable patients (81%) achieved second complete remission; eight (8%) died during induction and 11 (11%) failed to respond. A total of 42 out of the 80 responders (52.5%) received a SCT: 19 from an identical sibling, 11 from a matched unrelated donor and 12 from umbilical cord blood cells. The estimated 4-year overall survival and event-free survival were 25% and 21% respectively. Disease-free survival at 4 years was 25.8% for the 80 responders. At 4 years, 39 out of 100 children remain alive, with 27 of them free of leukaemia. This induction therapy has shown antileukaemic efficacy with acceptable toxicity; moreover, all responders proved eligible for intensive consolidation.
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Affiliation(s)
- Anna Maria Testi
- Dipartimento Biotecnologie Cellulari ed Ematologia, Università La Sapienza Roma, Italy.
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Mengarelli A, Iori A, Guglielmi C, Romano A, Cerretti R, Torromeo C, Micozzi A, Fenu S, Laurenti L, Donato V, De Felice L, Arcese W. Standard versus alternative myeloablative conditioning regimens in allogeneic hematopoietic stem cell transplantation for high-risk acute leukemia. Haematologica 2002; 87:52-8. [PMID: 11801465] [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: 02/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To analyze the results of standard versus alternative myeloablative conditioning regimens in allogeneic hematopoietic stem cell transplantation for high-risk acute leukemia. DESIGN AND METHODS From October 1986 to February 2000, 104 consecutive patients (male: n = 63; median age: 21, range 1.3-44.2 years) with high-risk acute leukemia underwent a non-T-cell depleted graft from an HLA-identical sibling following a standard or alternative myeloablative conditioning regimen. Sixty patients were affected by acute lymphoblastic leukemia (ALL) and 44 by acute myeloid leukemia (AML); the phase at transplant was >= 2nd complete remission (CR) in 76, untreated 1st relapse with < 20% blasts in 11, refractory leukemia or overt resistant relapse in 17. Pre-transplant regimens consisting of either 12 Gy fractionated total body irradiation (TBI) or 16 mg/kg busulphan (BU) combined with cyclophosphamide (CY) were defined standard (n = 38), whereas all other myeloablative regimens (TBI plus 60 mg/kg etoposide and three-drug combinations) were considered alternative (n = 66). RESULTS No significant differences in terms of baseline characteristics, incidence and severity of either acute or chronic graft-versus-host disease (GVHD) were observed between the two groups, but a significantly higher proportion of patients prepared with an alternative regimen were not evaluable for chronic GVHD (36% vs 16%) (p = 0.026). Sixty-six patients died, 38 of relapse, 26 of transplant-related mortality (TRM) and 2 of other causes. Thirty-eight patients are still alive with a follow-up ranging from 0.7 to 13.8 years (median, 7.1 years); only 1 of 39 patients who relapsed after transplant is alive in CR at 5.7 years from relapse. At the median follow-up, the actuarial probabilities of overall survival, relapse and TRM for patients conditioned with standard and alternative regimens are respectively 52% vs 25% (95% CI, 36-68% vs 13-37%; p = 0.0163), 34% vs 58% (95% CI, 18-51% vs 43-73%; p = 0.0377) and 25% vs 32% (95% CI, 9-40% vs 19-44%; p = ns). After adjustment for diagnosis, age, period, leukemia phase, duration of 1st CR, GVHD prophylaxis and donor-recipient sex combination, the multivariate analysis showed that alternative regimens are associated with a significantly worse survival (hazard ratio 2.31; p = 0.0071) and relapse rate (hazard ratio 2.75; p = 0.0187). INTERPRETATION AND CONCLUSIONS From this retrospective analysis we can conclude that the alternative myeloablative conditioning regimens we used did not improve the outcome of patients transplanted for high-risk acute leukemia.
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Affiliation(s)
- Andrea Mengarelli
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università La Sapienza, Rome, Italy
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Del Favero A, Menichetti F, Martino P, Bucaneve G, Micozzi A, Gentile G, Furno P, Russo D, D'Antonio D, Ricci P, Martino B, Mandelli F. A multicenter, double-blind, placebo-controlled trial comparing piperacillin-tazobactam with and without amikacin as empiric therapy for febrile neutropenia. Clin Infect Dis 2001; 33:1295-301. [PMID: 11565068 DOI: 10.1086/322646] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [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: 11/20/2000] [Revised: 03/30/2001] [Indexed: 11/04/2022] Open
Abstract
In a prospective, multicenter, double-blind, randomized clinical trial, we compared the efficacy of piperacillin-tazobactam (4.5 g 3 times daily intravenously) plus placebo versus piperacillin-tazobactam plus amikacin (7.5 mg/kg twice daily intravenously) for the treatment of 760 febrile, adult patients with cancer with chemotherapy-induced profound (<500 neutrophils/mm3) and prolonged (>10 days) neutropenia. A total of 733 patients were assessable for efficacy of the drug regimens, and an overall successful outcome was reported in 49% (179 of 364) of the patients who received monotherapy, compared with 53% (196 of 369) of patients who received combination therapy (P=.2). Response rates were similar with both regimens, as were incidences of bacteremia and clinically documented and possible infections. In our epidemiological setting, the initial empiric combination therapy was not associated with improved outcomes when compared with initial monotherapy.
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Affiliation(s)
- A Del Favero
- Istituto Medicina Interna e Scienze Oncologiche, Università di Perugia, Perugia, Italy.
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Cartoni C, Dragoni F, Micozzi A, Pescarmona E, Mecarocci S, Chirletti P, Petti MC, Meloni G, Mandelli F. Neutropenic enterocolitis in patients with acute leukemia: prognostic significance of bowel wall thickening detected by ultrasonography. J Clin Oncol 2001; 19:756-61. [PMID: 11157028 DOI: 10.1200/jco.2001.19.3.756] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.4] [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: 11/20/2022] Open
Abstract
PURPOSE Neutropenic enterocolitis (NE) is a severe complication of intensive chemotherapy and is barely identifiable by clinical signs alone. Ultrasonography (US) supports the diagnosis of NE by showing pathologic thickening of the bowel wall. The aim of this study was to evaluate the prognostic value of the degree of mural thickening evaluated by US in patients with clinically suspected NE. PATIENTS AND METHODS Neutropenic patients with fever, diarrhea, and abdominal pain after intensive chemotherapy for hematologic malignancies were studied with abdominal US. We evaluated the degree of bowel wall thickening detected by US and its correlation with the duration of the clinical syndrome as well as NE-related mortality. RESULTS Eighty-eight (6%) of 1,450 consecutive patients treated for leukemia had clinical signs of NE. In 44 (50%) of 88 patients, US revealed pathologic wall thickening (mean +/- SD, 10.2 +/- 2.9 mm; range, 6 to 18). The mean duration of symptoms was significantly longer in this group (7.9 days) than among patients without mural thickening (3.8 days, P <.0001), and the NE-related mortality rate was higher (29.5% v 0%, P <.001). Patients with bowel wall thickness of more than 10 mm had a significantly higher mortality rate (60%) than did those with bowel wall thickness < or = 10 mm (4.2%, P <.001). CONCLUSION Symptomatic patients with sonographically detected bowel wall thickening have a poor prognosis compared with patients without this finding. In addition, mural thickness of more than 10 mm is associated with poorer outcome among patients with NE.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Blast Crisis/complications
- Blast Crisis/drug therapy
- Child
- Enterocolitis/chemically induced
- Enterocolitis/diagnostic imaging
- Enterocolitis/mortality
- Enterocolitis/pathology
- Humans
- Intestines/diagnostic imaging
- Intestines/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myeloid/complications
- Leukemia, Myeloid/drug therapy
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Middle Aged
- Neutropenia/chemically induced
- Neutropenia/diagnostic imaging
- Neutropenia/mortality
- Neutropenia/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Prognosis
- Ultrasonography
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Affiliation(s)
- C Cartoni
- Department of Biotecnologie Cellulari ed Ematologia, Policlinico Umberto I, University La Sapienza, Rome, Italy.
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