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Cavazza G, Motto C, Regna-Gladin C, Travi G, Di Gennaro E, Peracchi F, Monti B, Corti N, Greco R, Minga P, Riva M, Rimoldi S, Vecchi M, Rogati C, Motta D, Pazzi A, Vismara C, Bandiera L, Crippa F, Mancini V, Sessa M, Oltolini C, Cairoli R, Puoti M. Cerebral Infectious Opportunistic Lesions in a Patient with Acute Myeloid Leukaemia: The Challenge of Diagnosis and Clinical Management. Antibiotics (Basel) 2024; 13:387. [PMID: 38786116 DOI: 10.3390/antibiotics13050387] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Central nervous system (CNS) lesions, especially invasive fungal diseases (IFDs), in immunocompromised patients pose a great challenge in diagnosis and treatment. We report the case of a 48-year-old man with acute myeloid leukaemia and probable pulmonary aspergillosis, who developed hyposthenia of the left upper limb, after achieving leukaemia remission and while on voriconazole. Magnetic resonance imaging (MRI) showed oedematous CNS lesions with a haemorrhagic component in the right hemisphere with lepto-meningitis. After 2 weeks of antibiotics and amphotericin-B, brain biopsy revealed chronic inflammation with abscess and necrosis, while cultures were negative. Clinical recovery was attained, he was discharged on isavuconazole and allogeneic transplant was postponed, introducing azacitidine as a maintenance therapy. After initial improvement, MRI worsened; brain biopsy was repeated, showing similar histology; and 16S metagenomics sequencing analysis was positive (Veilonella, Pseudomonas). Despite 1 month of meropenem, MRI did not improve. The computer tomography and PET scan excluded extra-cranial infectious-inflammatory sites, and auto-immune genesis (sarcoidosis, histiocytosis, CNS vasculitis) was deemed unlikely due to the histological findings and unilateral lesions. We hypothesised possible IFD with peri-lesion inflammation and methyl-prednisolone was successfully introduced. Steroid tapering is ongoing and isavuconazole discontinuation is planned with close follow-up. In conclusion, the management of CNS complications in immunocompromised patients needs an interdisciplinary approach.
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Affiliation(s)
- Gabriele Cavazza
- Department of Health Sciences, University of Milan Bicocca, 20126 Milan, Italy
| | - Cristina Motto
- Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Caroline Regna-Gladin
- Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Giovanna Travi
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Elisa Di Gennaro
- Department of Health Sciences, University of Milan Bicocca, 20126 Milan, Italy
| | - Francesco Peracchi
- Department of Health Sciences, University of Milan Bicocca, 20126 Milan, Italy
| | - Bianca Monti
- Department of Health Sciences, University of Milan Bicocca, 20126 Milan, Italy
| | - Nicolò Corti
- Department of Health Sciences, University of Milan Bicocca, 20126 Milan, Italy
| | - Rosa Greco
- Department of Haematology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Periana Minga
- Department of Haematology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Marta Riva
- Department of Haematology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Sara Rimoldi
- Microbiology Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Marta Vecchi
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Carlotta Rogati
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Davide Motta
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Annamaria Pazzi
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Chiara Vismara
- Clinical Microbiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Laura Bandiera
- Pathology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Fulvio Crippa
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Valentina Mancini
- Department of Haematology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Maria Sessa
- Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Chiara Oltolini
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Roberto Cairoli
- Department of Health Sciences, University of Milan Bicocca, 20126 Milan, Italy
- Department of Haematology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Massimo Puoti
- Department of Health Sciences, University of Milan Bicocca, 20126 Milan, Italy
- Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
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Peracchi F, Merli M, Rogati C, Ravano E, Puoti M, Cairoli R, Travi G. Dual antiviral therapy in haematological patients with protracted SARS-CoV-2 infection. Br J Haematol 2023. [PMID: 37085972 DOI: 10.1111/bjh.18827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Affiliation(s)
- F Peracchi
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - M Merli
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Rogati
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E Ravano
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Puoti
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - R Cairoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - G Travi
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Meschiari M, Cozzi-Lepri A, Cervo A, Granata G, Rogati C, Franceschini E, Casolari S, Tatarelli P, Giacobbe DR, Bassetti M, Pinna SM, De Rosa FG, Barchiesi F, Canovari B, Lorusso C, Russo G, Cenderello G, Cascio A, Petrosillo N, Mussini C. Efficacy of bezlotoxumab in preventing recurrence of Clostridioides difficile infection: an Italian multicenter cohort study. Int J Infect Dis 2023; 131:147-154. [PMID: 37030653 DOI: 10.1016/j.ijid.2023.04.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 04/10/2023] Open
Abstract
OBJECTIVES Bezlotoxumab (BEZ) is a promising tool for preventing recurrence of Clostridioides difficile infection (rCDI). The aim of the study was to emulate, in a real-world setting, the MODIFY trials in a cohort of participants with multiple risk factors for rCDI treated with BEZ in addition to standard of care (SoC) vs. SoC alone. METHODS A multicenter cohort study was conducted including 442 patients with CDI from 2018 to 2022 collected from 18 Italian centers. The main outcome was the 30-days occurrence of rCDI. Secondary outcomes were: (i) all-cause mortality at 30 days (ii) composite outcome (30-day recurrence and/or all-cause death). RESULTS rCDI at day 30 occurred in 54 (12%): 11 in the BEZ+SoC group and 43 treated with SoC alone (8% vs. 14%, OR=0.58, 95%CI:0.31-1.09, p=0.09). The difference between BEZ+SoC vs. SoC was statistically significant after controlling for confounding factors (aOR=0.40, 95%CI:018-0.88, p=0.02) and even more using the composite outcome (aOR=0.35, 95%CI:0.17-0.73, p=0.005). CONCLUSION Our study confirms the efficacy of BEZ+SoC for the prevention of rCDI and death in a real-world setting. BEZ should be routinely considered among participants at high risk of rCDI regardless of age, type of CDI therapy (vancomycin vs. fidaxomicin) and number of risk factors.
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Affiliation(s)
- Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, Policlinico di Modena, University of Modena and Reggio Emilia - Modena (Italy) +39 059 4225830.
| | | | - Adriana Cervo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, Policlinico di Modena, University of Modena and Reggio Emilia - Modena (Italy) +39 059 4225830.
| | - Guido Granata
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani IRCCS, Roma (Italy).
| | - Carlotta Rogati
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, Policlinico di Modena, University of Modena and Reggio Emilia - Modena (Italy) +39 059 4225830
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, Policlinico di Modena, University of Modena and Reggio Emilia - Modena (Italy) +39 059 4225830.
| | | | - Paola Tatarelli
- Infectious Diseases clinic, Hospital of Ravenna - Ravenna (Italy).
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, Genoa (Italy); IRCCS Ospedale Policlinico San Martino, Genoa (Italy).
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa (Italy); IRCCS Ospedale Policlinico San Martino, Genoa (Italy).
| | - Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino - Torino (Italy).
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino - Torino (Italy).
| | - Francesco Barchiesi
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona; Malattie Infettive, Azienda Ospedaliera - Ospedali Riuniti Marche Nord, Pesaro (Italy).
| | - Benedetta Canovari
- Malattie Infettive, Azienda Ospedaliera - Ospedali Riuniti Marche Nord, Pesaro (Italy).
| | - Carolina Lorusso
- Department of Mental Health and Addiction -Local Health Unit 4-LIGURIA, Genoa (Italy).
| | - Giuseppe Russo
- Department of Mental Health and Addiction -Local Health Unit 4-LIGURIA, Genoa (Italy).
| | | | - Antonio Cascio
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy.
| | - Nicola Petrosillo
- Fondazione Policlinico Universitario Campus Biomedico, Roma (Italy).
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Modena, Policlinico di Modena, University of Modena and Reggio Emilia - Modena (Italy) +39 059 4225830.
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Milic J, Banchelli F, Meschiari M, Franceschini E, Ciusa G, Gozzi L, Volpi S, Faltoni M, Franceschi G, Iadisernia V, Yaacoub D, Dolci G, Bacca E, Rogati C, Tutone M, Burastero G, Raimondi A, Menozzi M, Cuomo G, Corradi L, Orlando G, Santoro A, Digaetano M, Puzzolante C, Carli F, Bedini A, Busani S, Girardis M, Cossarizza A, Miglio R, Mussini C, Guaraldi G, D’Amico R. The impact of tocilizumab on respiratory support states transition and clinical outcomes in COVID-19 patients. A Markov model multi-state study. PLoS One 2021; 16:e0251378. [PMID: 34383784 PMCID: PMC8360516 DOI: 10.1371/journal.pone.0251378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/26/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The benefit of tocilizumab on mortality and time to recovery in people with severe COVID pneumonia may depend on appropriate timing. The objective was to estimate the impact of tocilizumab administration on switching respiratory support states, mortality and time to recovery. METHODS In an observational study, a continuous-time Markov multi-state model was used to describe the sequence of respiratory support states including: no respiratory support (NRS), oxygen therapy (OT), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV), OT in recovery, NRS in recovery. RESULTS Two hundred seventy-one consecutive adult patients were included in the analyses contributing to 695 transitions across states. The prevalence of patients in each respiratory support state was estimated with stack probability plots, comparing people treated with and without tocilizumab since the beginning of the OT state. A positive effect of tocilizumab on the probability of moving from the invasive and non-invasive mechanical NIV/IMV state to the OT in recovery state (HR = 2.6, 95% CI = 1.2-5.2) was observed. Furthermore, a reduced risk of death was observed in patients in NIV/IMV (HR = 0.3, 95% CI = 0.1-0.7) or in OT (HR = 0.1, 95% CI = 0.0-0.8) treated with tocilizumab. CONCLUSION To conclude, we were able to show the positive impact of tocilizumab used in different disease stages depicted by respiratory support states. The use of the multi-state Markov model allowed to harmonize the heterogeneous mortality and recovery endpoints and summarize results with stack probability plots. This approach could inform randomized clinical trials regarding tocilizumab, support disease management and hospital decision making.
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Affiliation(s)
- Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Banchelli
- Unit of Statistical and Methodological Support to Clinical Research, Azienda Ospedaliero-Universitaria, Modena, Italy
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Marianna Meschiari
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Erica Franceschini
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giacomo Ciusa
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Licia Gozzi
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Sara Volpi
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Matteo Faltoni
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giacomo Franceschi
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Vittorio Iadisernia
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Dina Yaacoub
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giovanni Dolci
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Erica Bacca
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Carlotta Rogati
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Marco Tutone
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giulia Burastero
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Alessandro Raimondi
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Marianna Menozzi
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Gianluca Cuomo
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Luca Corradi
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Gabriella Orlando
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Antonella Santoro
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Margherita Digaetano
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Cinzia Puzzolante
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Federica Carli
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Andrea Bedini
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Stefano Busani
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Rossella Miglio
- Unit of Statistical and Methodological Support to Clinical Research, Azienda Ospedaliero-Universitaria, Modena, Italy
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Roberto D’Amico
- Unit of Statistical and Methodological Support to Clinical Research, Azienda Ospedaliero-Universitaria, Modena, Italy
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Mussini C, Cozzi-Lepri A, Menozzi M, Meschiari M, Franceschini E, Rogati C, Cuomo G, Bedini A, Iadisernia V, Volpi S, Milic J, Tonelli R, Brugioni L, Pietrangelo A, Girardis M, Cossarizza A, Clini E, Guaraldi G. Better prognosis in females with severe COVID-19 pneumonia: possible role of inflammation as potential mediator. Clin Microbiol Infect 2021; 27:1137-1144. [PMID: 33359539 PMCID: PMC7816626 DOI: 10.1016/j.cmi.2020.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 08/08/2020] [Revised: 10/07/2020] [Accepted: 12/08/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Sex differences in COVID-19 severity and mortality have been described. Key aims of this analysis were to compare the risk of invasive mechanical ventilation (IMV) and mortality by sex and to explore whether variation in specific biomarkers could mediate this difference. METHODS This was a retrospective, observational cohort study among patients with severe COVID-19 pneumonia. A survival analysis was conducted to compare time to the composite endpoint of IMV or death according to sex. Interaction was formally tested to compare the risk difference by sex in sub-populations. Mediation analysis with a binary endpoint IMV or death (yes/no) by day 28 of follow-up for a number of inflammation/coagulation biomarkers in the context of counterfactual prediction was also conducted. RESULTS Among 415 patients, 134 were females (32%) and 281 males (67%), median age 66 years (IQR 54-77). At admission, females showed a significantly less severe clinical and respiratory profiles with a higher PaO2/FiO2 (254 mmHg vs. 191 mmHg; p 0.023). By 28 days from admission, 49.2% (95% CI 39.6-58.9%) of males vs. 31.7% (17.9-45.4%) of females underwent IMV or death (log-rank p < 0.0001) and this amounted to a difference in terms of HR of 0.40 (0.26-0.63, p 0.0001). The area under the curve in C-reactive protein (CRP) over the study period appeared to explain 85% of this difference in risk by sex. DISCUSSION Our analysis confirms a difference in the risk of COVID-19 clinical progression by sex and provides a hypothesis for potential mechanisms leading to this. Specifically, CRP showed a predominant role to mediate the difference in risk by sex.
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Affiliation(s)
- Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy; Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy.
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Carlotta Rogati
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy
| | - Gianluca Cuomo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Andrea Bedini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Vittorio Iadisernia
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy
| | - Sara Volpi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Tonelli
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy; Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinic o of Modena, Modena, Italy
| | - Lucio Brugioni
- Internal Medicine Department, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Antonello Pietrangelo
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Italy
| | - Massimo Girardis
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Anaesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinic o of Modena, Modena, Italy; Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Italy
| | - Giovanni Guaraldi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy; Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy
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6
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Milic J, Novella A, Meschiari M, Menozzi M, Santoro A, Bedini A, Cuomo G, Franceschini E, Digaetano M, Carli F, Ciusa G, Volpi S, Bacca E, Franceschi G, Yaacoub D, Rogati C, Tutone M, Burastero G, Faltoni M, Iadisernia V, Dolci G, Cossarizza A, Mussini C, Pasina L, Guaraldi G. Darunavir/Cobicistat Is Associated with Negative Outcomes in HIV-Negative Patients with Severe COVID-19 Pneumonia. AIDS Res Hum Retroviruses 2021; 37:283-291. [PMID: 33619997 DOI: 10.1089/aid.2020.0305] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to evaluate both positive outcomes, including reduction of respiratory support aid and duration of hospital stay, and negative ones, including mortality and a composite of invasive mechanical ventilation or death, in patients with coronavirus disease 2019 (COVID-19) pneumonia treated with or without oral darunavir/cobicistat (DRV/c, 800/150 mg/day) used in different treatment durations. The secondary objective was to evaluate the percentage of patients treated with DRV/c who were exposed to potentially severe drug-drug interactions (DDIs) and died during hospitalization. This observational retrospective study was conducted in consecutive patients with COVID-19 pneumonia admitted to a tertiary care hospital in Modena, Italy. Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare patients receiving standard of care with or without DRV/c. Adjustment for key confounders was applied. Two hundred seventy-three patients (115 on DRV/c) were included, 75.8% males, mean age was 64.6 (±13.2) years. Clinical improvement was similar between the groups, depicted by respiratory aid switch (p > .05). The same was observed for duration of hospital stay [13.2 (±8.9) for DRV/c vs. 13.4 (±7.2) days for no-DRV/c, p = .9]. Patients on DRV/c had higher rates of mortality (25.2% vs. 10.1%, p < .0001. The rate of composite outcome of mechanical ventilation and death was higher in the DRV/c group (37.4% vs. 25.3%, p = .03). Multiple serious DDI associated with DRV/c were observed in the 19 patients who died. DRV/c should not be recommended as a treatment option for COVID-19 pneumonia outside clinical trials.
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Affiliation(s)
- Jovana Milic
- Department of Surgical, Medical, Dental, and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessio Novella
- Pharmacotherapy and Appropriateness of Drug Prescription Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Marianna Meschiari
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Marianna Menozzi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Antonella Santoro
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Andrea Bedini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Gianluca Cuomo
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Erica Franceschini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Margherita Digaetano
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Federica Carli
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giacomo Ciusa
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Sara Volpi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Erica Bacca
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giacomo Franceschi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Dina Yaacoub
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Carlotta Rogati
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Marco Tutone
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giulia Burastero
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Matteo Faltoni
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Vittorio Iadisernia
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giovanni Dolci
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental, and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Luca Pasina
- Pharmacotherapy and Appropriateness of Drug Prescription Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental, and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
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7
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Granata G, Petrosillo N, Adamoli L, Bartoletti M, Bartoloni A, Basile G, Bassetti M, Bonfanti P, Borromeo R, Ceccarelli G, De Luca AM, Di Bella S, Fossati S, Franceschini E, Gentile I, Giacobbe DR, Giacometti E, Ingrassia F, Lagi F, Lobreglio G, Lombardi A, Lupo LI, Luzzati R, Maraolo AE, Mikulska M, Mondelli MU, Mularoni A, Mussini C, Oliva A, Pandolfo A, Rogati C, Trapani FF, Venditti M, Viale P, Caraffa E, Cataldo MA. Prospective Study on Incidence, Risk Factors and Outcome of Recurrent Clostridioides difficile Infections. J Clin Med 2021; 10:jcm10051127. [PMID: 33800334 PMCID: PMC7962640 DOI: 10.3390/jcm10051127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/29/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Limited and wide-ranging data are available on the recurrent Clostridioides difficile infection (rCDI) incidence rate. Methods: We performed a cohort study with the aim to assess the incidence of and risk factors for rCDI. Adult patients with a first CDI, hospitalized in 15 Italian hospitals, were prospectively included and followed-up for 30 d after the end of antimicrobial treatment for their first CDI. A case–control study was performed to identify risk factors associated with 30-day onset rCDI. Results: Three hundred nine patients with a first CDI were included in the study; 32% of the CDI episodes (99/309) were severe/complicated; complete follow-up was available for 288 patients (19 died during the first CDI episode, and 2 were lost during follow-up). At the end of the study, the crude all-cause mortality rate was 10.7% (33 deaths/309 patients). Two hundred seventy-one patients completed the follow-up; rCDI occurred in 21% of patients (56/271) with an incidence rate of 72/10,000 patient-days. Logistic regression analysis identified exposure to cephalosporin as an independent risk factor associated with rCDI (RR: 1.7; 95% CI: 1.1–2.7, p = 0.03). Conclusion: Our study confirms the relevance of rCDI in terms of morbidity and mortality and provides a reliable estimation of its incidence.
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Affiliation(s)
- Guido Granata
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani IRCCS, 00149 Rome, Italy; (G.G.); (E.C.); (M.A.C.)
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani IRCCS, 00149 Rome, Italy; (G.G.); (E.C.); (M.A.C.)
- Correspondence: ; Tel.: +39-0655-170-432
| | - Lucia Adamoli
- Infectious Diseases ISMETT IRCCS, 90127 Palermo, Italy; (L.A.); (A.M.D.L.); (A.M.)
| | - Michele Bartoletti
- Department of Medical and Surgical Sciences, “Alma Mater Studiorum”, IRCCS S. Orsola Teaching Hospital, University of Bologna, 40126 Bologna, Italy; (M.B.); (F.F.T.); (P.V.)
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (A.B.); (G.B.); (F.L.)
| | - Gregorio Basile
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (A.B.); (G.B.); (F.L.)
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy; (M.B.); (D.R.G.); (M.M.)
- Infectious Diseases Unit, San Martino Polyclinic Hospital—IRCCS, 16132 Genoa, Italy
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy;
| | - Paolo Bonfanti
- Department of Infectious Diseases, San Gerardo Hospital, Monza—University of Milano-Bicocca, 20126 Milan, Italy;
| | | | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy; (G.C.); (A.O.); (M.V.)
| | - Anna Maria De Luca
- Infectious Diseases ISMETT IRCCS, 90127 Palermo, Italy; (L.A.); (A.M.D.L.); (A.M.)
| | - Stefano Di Bella
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, 34128 Trieste, Italy; (S.D.B.); (S.F.); (R.L.)
| | - Sara Fossati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, 34128 Trieste, Italy; (S.D.B.); (S.F.); (R.L.)
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, 41121 Modena, Italy; (E.F.); (C.M.); (C.R.)
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (I.G.); (A.E.M.)
| | - Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy; (M.B.); (D.R.G.); (M.M.)
- Infectious Diseases Unit, San Martino Polyclinic Hospital—IRCCS, 16132 Genoa, Italy
| | - Enrica Giacometti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy;
| | | | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (A.B.); (G.B.); (F.L.)
| | | | - Andrea Lombardi
- Division of Infectious Diseases and Immunology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.L.); (M.U.M.)
| | | | - Roberto Luzzati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, 34128 Trieste, Italy; (S.D.B.); (S.F.); (R.L.)
| | - Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (I.G.); (A.E.M.)
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy; (M.B.); (D.R.G.); (M.M.)
- Infectious Diseases Unit, San Martino Polyclinic Hospital—IRCCS, 16132 Genoa, Italy
| | - Mario Umberto Mondelli
- Division of Infectious Diseases and Immunology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.L.); (M.U.M.)
| | - Alessandra Mularoni
- Infectious Diseases ISMETT IRCCS, 90127 Palermo, Italy; (L.A.); (A.M.D.L.); (A.M.)
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, 41121 Modena, Italy; (E.F.); (C.M.); (C.R.)
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy; (G.C.); (A.O.); (M.V.)
| | | | - Carlotta Rogati
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, 41121 Modena, Italy; (E.F.); (C.M.); (C.R.)
| | - Filippo Fabio Trapani
- Department of Medical and Surgical Sciences, “Alma Mater Studiorum”, IRCCS S. Orsola Teaching Hospital, University of Bologna, 40126 Bologna, Italy; (M.B.); (F.F.T.); (P.V.)
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy; (G.C.); (A.O.); (M.V.)
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, “Alma Mater Studiorum”, IRCCS S. Orsola Teaching Hospital, University of Bologna, 40126 Bologna, Italy; (M.B.); (F.F.T.); (P.V.)
| | - Emanuela Caraffa
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani IRCCS, 00149 Rome, Italy; (G.G.); (E.C.); (M.A.C.)
| | - Maria Adriana Cataldo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani IRCCS, 00149 Rome, Italy; (G.G.); (E.C.); (M.A.C.)
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8
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Ferrari D, Milic J, Tonelli R, Ghinelli F, Meschiari M, Volpi S, Faltoni M, Franceschi G, Iadisernia V, Yaacoub D, Ciusa G, Bacca E, Rogati C, Tutone M, Burastero G, Raimondi A, Menozzi M, Franceschini E, Cuomo G, Corradi L, Orlando G, Santoro A, Digaetano M, Puzzolante C, Carli F, Borghi V, Bedini A, Fantini R, Tabbì L, Castaniere I, Busani S, Clini E, Girardis M, Sarti M, Cossarizza A, Mussini C, Mandreoli F, Missier P, Guaraldi G. Machine learning in predicting respiratory failure in patients with COVID-19 pneumonia-Challenges, strengths, and opportunities in a global health emergency. PLoS One 2020; 15:e0239172. [PMID: 33180787 PMCID: PMC7660476 DOI: 10.1371/journal.pone.0239172] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/02/2020] [Indexed: 01/15/2023] Open
Abstract
AIMS The aim of this study was to estimate a 48 hour prediction of moderate to severe respiratory failure, requiring mechanical ventilation, in hospitalized patients with COVID-19 pneumonia. METHODS This was an observational prospective study that comprised consecutive patients with COVID-19 pneumonia admitted to hospital from 21 February to 6 April 2020. The patients' medical history, demographic, epidemiologic and clinical data were collected in an electronic patient chart. The dataset was used to train predictive models using an established machine learning framework leveraging a hybrid approach where clinical expertise is applied alongside a data-driven analysis. The study outcome was the onset of moderate to severe respiratory failure defined as PaO2/FiO2 ratio <150 mmHg in at least one of two consecutive arterial blood gas analyses in the following 48 hours. Shapley Additive exPlanations values were used to quantify the positive or negative impact of each variable included in each model on the predicted outcome. RESULTS A total of 198 patients contributed to generate 1068 usable observations which allowed to build 3 predictive models based respectively on 31-variables signs and symptoms, 39-variables laboratory biomarkers and 91-variables as a composition of the two. A fourth "boosted mixed model" included 20 variables was selected from the model 3, achieved the best predictive performance (AUC = 0.84) without worsening the FN rate. Its clinical performance was applied in a narrative case report as an example. CONCLUSION This study developed a machine model with 84% prediction accuracy, which is able to assist clinicians in decision making process and contribute to develop new analytics to improve care at high technology readiness levels.
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Affiliation(s)
- Davide Ferrari
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Tonelli
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Francesco Ghinelli
- Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Sara Volpi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Matteo Faltoni
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Giacomo Franceschi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Vittorio Iadisernia
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Dina Yaacoub
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Giacomo Ciusa
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Erica Bacca
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Carlotta Rogati
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Marco Tutone
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Giulia Burastero
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Alessandro Raimondi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Gianluca Cuomo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Luca Corradi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Gabriella Orlando
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Antonella Santoro
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Margherita Digaetano
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Cinzia Puzzolante
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Federica Carli
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Andrea Bedini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Riccardo Fantini
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Luca Tabbì
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Ivana Castaniere
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Stefano Busani
- Department of Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Girardis
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology, Ospedale Civile di Baggiovara, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Federica Mandreoli
- Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Missier
- School of Computing, Newcastle University, Newcastle upon Tyne, United kingdom
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
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9
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Santoro A, Franceschini E, Meschiari M, Menozzi M, Zona S, Venturelli C, Digaetano M, Rogati C, Guaraldi G, Paul M, Gyssens IC, Mussini C. Epidemiology and Risk Factors Associated With Mortality in Consecutive Patients With Bacterial Bloodstream Infection: Impact of MDR and XDR Bacteria. Open Forum Infect Dis 2020; 7:ofaa461. [PMID: 33209951 PMCID: PMC7652098 DOI: 10.1093/ofid/ofaa461] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 06/17/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022] Open
Abstract
Background Mortality related to bloodstream infections (BSIs) is high. The epidemiology of BSIs is changing due to the increase in multidrug resistance, and it is unclear whether the presence of multidrug-resistant (MDR) organisms, per se, is an independent risk factor for mortality. Our objectives were, first, to describe the epidemiology and outcome of BSIs and, second, to determine the risk factors associated with mortality among patients with BSI. Methods This research used a single-center retrospective observational study design. Patients were identified through microbiological reports. Data on medical history, clinical condition, bacteria, antimicrobial therapy, and mortality were collected. The primary outcome was crude mortality at 30 days. The relationships between mortality and demographic, clinical, and microbiological variables were analyzed by multivariate analysis. Results A total of 1049 inpatients were included. MDR bacteria were isolated in 27.83% of patients, where 2.14% corresponded to an extremely drug-resistant (XDR) isolate. The crude mortality rates at days 7, 30, and 90 were 12.11%, 25.17%, and 36.13%, respectively. Pitt score >2, lung and abdomen as site of infection, and XDR Pseudomonas aeruginosa were independent risk factors for 7-, 30-, and 90-day mortality. Charlson score >4, carbapenem-resistant Klebsiella pneumoniae, and XDR Acinetobacter baumannii were independent risk factors for 30- and 90-day mortality. Infection by XDR gram-negative bacteria, Charlson score >4, and immunosuppression were independent risk factors for mortality in patients who were stable at the time of BSI. Conclusions BSI is an event with an extreme impact on mortality. Patients with severe clinical condition are at higher risk of death. The presence of XDR gram-negative bacteria in blood is strongly and independently associated with patient death.
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Affiliation(s)
- Antonella Santoro
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Stefano Zona
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Claudia Venturelli
- Department of Microbiology, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Margherita Digaetano
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Carlotta Rogati
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Giovanni Guaraldi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Mical Paul
- Rambam Medical Center, Infectious Diseases Department, Haifa, Israel
| | - Inge C Gyssens
- Radboud University Medical Center and Radboud Center for Infectious Diseases (RCI), Nijmegen, the Netherlands
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
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