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Cauda R. Personal Journey through Memory in Ukraine (Letter to the Editor). CSWHI 2022. [DOI: 10.22359/cswhi_13_2_03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The images of destruction in Ukrainian cities that we continue to see on television every day, and the dramatic reports done by journalists, reminded me of a visit I made to that tormented country more than 20 years ago that I want to share with this brief note. In particularly, I remember taking part in a series of meetings with Ukrainian colleagues in two cities, Lviv and Kiev as part of an initiative promoted by the Vicariate of Rome, in the person of His Excellency Monsignor Lorenzo Leuzzi which involved professors from the Catholic University such as myself, and from the University of Tor Vergata both from Roma, Italy. Obviously, colleagues from the University of Lviv participated, and Prof. Krcmery was also present representing at that time the University of Trnava, Slovakia. The title of the conference was 'Humanism in Medicine'. The meetings were held on the occasion of the apostolic visit of Pope St. John PauII which took place in June 2001. I still have vivid memories of that unforgettable trip and the meetings I had with Ukrainian colleagues. The topics either dealt with the ethical and scientific aspects of responsible childbirth, the use of stem cells in medicine and theology, the ethical aspects of human genetics and lastly, medical culture as an opportunity for teaching humanism. Indeed, I was a speaker in this last session (see photo). I also enclose both the bilingual program, in English and Ukrainian, with the complete list of speakers and the poster advertising the event. The opening prayer was given by His Eminence Cardinal Harchbishop Marian Yavorsky
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Seguiti C, Salvo PF, Di Stasio E, Lamonica S, Fedele AL, Manfrida S, Ciccarelli N, Corvari B, De Luca C, Tartaglione L, Pitocco D, Cauda R, Cingolani A. Health-related quality of life (HRQoL) from HIV patients' perspective: comparison of patient-reported outcome (PRO) measures among people living with hiv (PLWH) and other chronic clinical conditions. J Patient Rep Outcomes 2022; 6:27. [PMID: 35347476 PMCID: PMC8960483 DOI: 10.1186/s41687-022-00423-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/29/2021] [Accepted: 02/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background People living with HIV (PLWH) are generally known to suffer from a lower quality of life compared to the one of general population, but still very few is known about the self-perception of quality of life when comparing HIV to non-communicable diseases. We performed a comprehensive assessment of patient’s reported outcomes measures (PROMs) among PLWH and patients affected by other chronic conditions (OC) such as diabetes mellitus type 1, rheumatoid arthritis, breast cancer in hormonal therapy, in order to investigate differences in PROMs outcomes between PLWH and other pathologies. Methods A cross-sectional observational study was performed by using questionnaires investigating health-related quality of life (Medical Outcomes Study Short Form 36-item Health Survey), work productivity (WPI), and global health status (EQ-5D-3L). They were administered to patients affected by chronic diseases consecutively observed at a single University Hospital during a 10 months period, with comparable disease related aspects. Logistic regression analysis was used to analyze the association between disease group (HIV vs OC) and PROMs. Results 230 patients were enrolled (89 PLWH, 143 OC). Mean age: 49 years (SD 10), mean time of disease 12 years (10), 96% were Caucasian, 35% assumed polypharmacy, 42% of male were PLWH versus 16% OC (p < 0.001), 19% PLWH versus 6% OC had clinical complications (p < 0.001). HIV infection was independently associated to a better health-related quality of life in several domains compared with the other conditions, except in mental health, whereas a worst health-related quality of life in most domains was reported by older patients and those experiencing polypharmacy. Conclusions In this cohort of patients with chronic conditions followed within the same health setting, PLWH showed better self-reported health outcomes compared to other chronic conditions with comparable characteristics of chronicity. The potential detrimental role of older age and polypharmacy in most outcomes suggests the need of longitudinal assessment of PROMs in clinical practice.
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Affiliation(s)
- C Seguiti
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - P F Salvo
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Di Stasio
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Lamonica
- UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - A L Fedele
- Divisione Reumatologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - S Manfrida
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - N Ciccarelli
- Dipartimento di Psicologia, Università Cattolica, Milan, Italy
| | - B Corvari
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - C De Luca
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Tartaglione
- UOS Diabetologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - D Pitocco
- UOS Diabetologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - R Cauda
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - A Cingolani
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy. .,UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.
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Cauda R, Ondrusova Z, Tomanek P, Hardy M. We shall Start Health Intervention against Collateral Effect of Pandemic to Metabolic, Cardiovascular and Mental Health in Migrants, Children and Caregivers. cswhi 2021. [DOI: 10.22359/cswhi_12_3_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chieffo DPR, Delle Donne V, Massaroni V, Mastrilli L, Belella D, Monti L, Silveri MC, Cauda R. Psychopathological profile in COVID-19 patients including healthcare workers: the implications. Eur Rev Med Pharmacol Sci 2020; 24:11964-11970. [PMID: 33275271 DOI: 10.26355/eurrev_202011_23858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The effects of COVID-19 seem to extend beyond the physical pain and is showing psychiatric implications as well. Moreover, psychopathological implications seem to last also after patients' discharge. Our goal is to investigate the psychological impact and psychopathological outcome of patients affected by COVID-19. PATIENTS AND METHODS We have engaged 34 patients with COVID-19 conditions [eight of them were healthcare workers patients (HCW)] hospitalized at "Policlinico Gemelli Foundation" of Rome, Italy. All patients were evaluated through the Impact of Event Scale-Revised (IES-R) and the Symptom Checklist 90-R (SCL-90-R) first, during their hospitalization (baseline), and then, after 4 months from hospital discharge (follow-up), through phone interviews. RESULTS At baseline, 82% of patients revealed from mild to severe psychological impact of COVID-19, according to the IES-R. At follow-up, the mean IES-R total score was significantly decreased (p<0.001) even if almost half (46.6%) of our cohort still showed it. HCW patients showed a significantly higher score than other patients at IES-R scale, both at baseline (p=0.005) and at follow-up (p<0.001). Moreover, at 4 months from discharge, they showed a significantly higher percentage of moderate and severe distress (p=0.015). In addition to this, at follow-up, our cohort of patients showed an increase of anxiety symptoms, even if not significant compared to baseline (46.7% vs. 35.3% respectively; p=1.000), and HCW patients suffered more sleep disorders (p=0.019) and anxiety symptoms (p=0.019) compared to other patients. CONCLUSIONS We indicate the importance of assessing psychopathology of COVID-19 survivors, monitoring their changes over time, and providing psychological support to improve their psychological well-being.
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Affiliation(s)
- D P R Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Cingolani A, Tummolo AM, Montemurro G, Gremese E, Larosa L, Cipriani MC, Pasciuto G, Liperoti R, Murri R, Pirronti T, Cauda R, Fantoni M. Baricitinib as rescue therapy in a patient with COVID-19 with no complete response to sarilumab. Infection 2020; 48:767-771. [PMID: 32642806 PMCID: PMC7340855 DOI: 10.1007/s15010-020-01476-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/30/2020] [Accepted: 06/28/2020] [Indexed: 01/20/2023]
Abstract
A patient with COVID-19-related severe respiratory failure, with insufficient response to an antiretroviral therapy, hydroxychloroquine and Interleukin-6 (IL-6) antagonist therapy, presented a prompt resolution of the respiratory function and improvement in the radiological picture after baricitinib at an oral dose of 4 mg per day for 2 weeks.
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Affiliation(s)
- A Cingolani
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Milan, Italy
| | - A M Tummolo
- Dipartimento di Scienze dell'invecchiamento, Fondazione Policlinico Gemelli IRCCS, Rome, Italy.
- Division of Infectious Diseases, Covid 2 Columbus, Fondazione Policlinico Gemelli, IRCCS, Università Cattolica S. Cuore, L.go A. Gemelli 8, 00167, Rome, Italy.
| | - G Montemurro
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - E Gremese
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Geriatriche e Ortopediche, Università Cattolica S. Cuore, Milan, Italy
| | - L Larosa
- Dipartimento di Diagnostica per immagini, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - M C Cipriani
- Dipartimento di Scienze dell'invecchiamento, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - G Pasciuto
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - R Liperoti
- Dipartimento di Scienze dell'invecchiamento, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Geriatriche e Ortopediche, Università Cattolica S. Cuore, Milan, Italy
| | - R Murri
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Milan, Italy
| | - T Pirronti
- Dipartimento di Diagnostica per immagini, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche e Ematologiche, Università Cattolica S. Cuore, Milan, Italy
| | - R Cauda
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Milan, Italy
| | - M Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Milan, Italy
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Fantoni M, Taddei E, Cauda R, Antonelli Incalzi R, Capone A, Cortese F, Sanguinetti M, Spandonaro F, Urbani A, Murri R. The role of procalcitonin outside of the Intensive Care Unit (ICU): a multidisciplinary approach. Eur Rev Med Pharmacol Sci 2020; 23:2978-2985. [PMID: 31002168 DOI: 10.26355/eurrev_201904_17579] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Biochemical markers are commonly used in medicine to guide diagnostic investigation or therapy duration and/or monitor treatment efficacy. Due to the emergence and spread of antimicrobial resistance, markers able to prompt a more rational use of antimicrobial therapy are regarded with the greatest attention. Procalcitonin (PCT) certainly stands out among others, yet its role must be better established especially outside of the critical care area. Data about PCT utilization in non-critical patients, optimal negativity cut-offs as well as a protocol for measurement timing are all lacking. MATERIALS AND METHODS To address these issues, a focus group was set up to propose and endorse shared statements regarding the most beneficial use of PCT in real life as infection marker for non-critical patients, based on the authors' experience and a review of recent literature. RESULTS A group of nine experts in the fields of Infectious Diseases, Internal Medicine, Microbiology, Clinical Chemistry, Surgery and Medical Economics participated in the discussion of nine pre-specified statements. CONCLUSIONS The potential role for PCT in differentiating infectious and non-infectious clinical syndromes and guiding antimicrobial therapy discontinuation was acknowledged. Moreover, a shared measurement protocol and desirable cut-offs for the non-critical area were proposed. Finally, observations were made about a reasonable selection of the patient population to be tested.
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Affiliation(s)
- M Fantoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive Università Cattolica del Sacro Cuore, Rome, Italy.
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Ciccullo A, Borghetti A, Dusina A, Segala FV, Visconti E, Tamburrini E, Cauda R, Di Giambenedetto S. The need to continue testing for HIV, even during the coronavirus disease 2019 (COVID-19) pandemic. HIV Med 2020; 22:e3-e4. [PMID: 32876390 DOI: 10.1111/hiv.12936] [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: 11/27/2022]
Affiliation(s)
- A Ciccullo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - A Borghetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - A Dusina
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - F V Segala
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - E Visconti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - E Tamburrini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy.,Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - R Cauda
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy.,Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - S Di Giambenedetto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy.,Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
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Borghetti A, Ciccullo A, Paratore M, Rovedi F, Stella L, Marchetti A, Cattani P, Zileri Dal Verme L, Cauda R, Gasbarrini A, Di Giambenedetto S. Derivation and validation of a scoring system to assess pre-test probability of being COVID-19 positive. J Infect 2020; 82:159-198. [PMID: 32473233 PMCID: PMC7255159 DOI: 10.1016/j.jinf.2020.05.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Borghetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - A Ciccullo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - M Paratore
- Dipartimento di Medicina e chirurgia traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Rovedi
- Dipartimento di Medicina e chirurgia traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Stella
- Dipartimento di Medicina e chirurgia traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Marchetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - P Cattani
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Biotecnologiche di Base, Cliniche, Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Zileri Dal Verme
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - R Cauda
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Gasbarrini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e chirurgia traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Di Giambenedetto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
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Otrubova J, Kalatova D, Murgova A, Katunska M, Zacharova E, Matulnikova L, Sramkova M, Libova L, Bydzovsky J, Jankechova M, Kozon V, Olah M, Konosova H, Karvaj M, Benca J, Cauda R, Sabo A, Marks P. Education Harmonization in Nursing and Social Work as Response to Vulnerable Patient/Client Groups in the new Candidate Member States – Solidarity from European Union (Note). cswhi 2019. [DOI: 10.22359/cswhi_10_4_08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sobhie Diaz R, Giron L, Galinskas J, Hunter J, Janini M, Shytaj I, Cauda R, Sucupira M, Maricato J, Savarino A. Post-therapy viral set-point abatement following combined antiproliferative and immune-boosting interventions: results from a randomised clinical trial. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Murri R, Mastrorosa I, Taccari F, Baroni S, Giovannenze F, Palazzolo C, Lardo S, Scoppettuolo G, Ventura G, Cauda R, Fantoni M. Procalcitonin is useful in driving the choice of early antibiotic treatment in patients with bloodstream infections. Eur Rev Med Pharmacol Sci 2019; 22:3130-3137. [PMID: 29863258 DOI: 10.26355/eurrev_201805_15072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate whether PCT levels could be used to distinguish among different bacterial and fungal etiologies in patients with documented bloodstream infection (BSI). PATIENTS AND METHODS Monocentric retrospective cohort study on patients admitted to the Fondazione Policlinico Gemelli Hospital between December 2012 and November 2015 with BSI. Those who had undergone PCT determination within 48 hours of when the first positive blood culture was sampled were included in the study. RESULTS Four hundred and one patients were included in the study. Both the 24h and 48h PCT values were significantly higher in patients with Gram-negative (GN) BSI than in those with Gram-positive (GP) or candida BSI (p at ANOVA = 0.003). A PCT value of > 1 ng/ml was found in 31.5% of patients with GN BSI. Less than 7% of people with candida BSI had PCT level of > 1 ng/ml. At multivariable regression analysis, GN BSI, septic shock, and plasma creatinine were significantly correlated with PCT values. CONCLUSIONS PCT may be of value in distinguishing GN BSI from GP, and fungal BSI and PCT values of > 1 ng/ml could be used to prevent unnecessary antifungal treatment.
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Affiliation(s)
- R Murri
- Department of Infectious Diseases, School of Medicine, Catholic University of the Sacred Heart, A. Gemelli Foundation, Rome, Italy.
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Borghetti A, Moschese D, Cingolani A, Baldin G, Speziale D, Ciccullo A, Lombardi F, Emiliozzi A, Belmonti S, Antinori A, Cauda R, Di Giambenedetto S. Lamivudine-based maintenance antiretroviral therapies in patients living with HIV-1 with suppressed HIV RNA: derivation of a predictive score for virological failure. HIV Med 2019; 20:624-627. [PMID: 31240860 DOI: 10.1111/hiv.12759] [Citation(s) in RCA: 4] [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] [Accepted: 04/18/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Two-drug antiretroviral regimens based on lamivudine (3TC) plus either a protease inhibitor (PI) or dolutegravir (DTG) are becoming increasingly popular in switch strategies. Our goal was to derive a predictive score for virological failure (VF). METHODS We retrospectively analysed data for a cohort of 587 virologically suppressed (HIV RNA < 37 HIV-1 RNA copies/mL), adult (≥ 18 years old) patients starting lamivudine plus either a boosted PI or dolutegravir. Predictors of VF (defined as a single HIV RNA measurement ≥ 1000 copies/mL or two consecutive HIV RNA measurements ≥ 50 copies/mL) were identified using a multivariate Cox regression model. A 'weighted' score was assigned to each variable associated with VF; the discriminative power of the score obtained was expressed as the area under the receiver-operator characteristic curve (ROC-AUC). RESULTS During a median 2 years of follow-up time, 35 VFs occurred; predictors of VF were baseline residual HIV RNA between 20 and 36 copies/mL, African ethnicity, ≥ 10 therapeutic lines, the presence of at least one resistance-associated mutation (RAM) for resistance to current drugs (excluding M184V), a non-B viral subtype and a baseline CD4 count < 200 cells/μL. A score of 2 was assigned to non-B viral subtype, 3 to residual viraemia ≥ 20 copies/mL, ≥ 10 previous therapeutic lines and African ethnicity, 4 to baseline CD4 count < 200 cells/μL, and 7 to the presence of at least one RAM (excluding M184V). The ROC-AUC was 0.67 (95% confidence interval 0.57-0.77). CONCLUSIONS The presence of at least one RAM, higher residual viraemia and African ethnicity were among the major predictors of VF in our cohort. Studies with larger sample sizes are warranted to improve the predictive value of the derived score.
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Affiliation(s)
- A Borghetti
- Fondazione Policlinico Agostino Gemelli IRCCS, Infectious Diseases Unit, Rome, Italy
| | - D Moschese
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A Cingolani
- Fondazione Policlinico Agostino Gemelli IRCCS, Infectious Diseases Unit, Rome, Italy.,Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - G Baldin
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - D Speziale
- Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy
| | - A Ciccullo
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - F Lombardi
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A Emiliozzi
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - S Belmonti
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A Antinori
- UOC Immunodeficienze Virali, Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - R Cauda
- Fondazione Policlinico Agostino Gemelli IRCCS, Infectious Diseases Unit, Rome, Italy.,Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - S Di Giambenedetto
- Fondazione Policlinico Agostino Gemelli IRCCS, Infectious Diseases Unit, Rome, Italy.,Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
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Cauda R, Naddour A, Drgova J, Sramkova M, Suvada J, Benca J, Muss C, Subramanian S. Spectrum of Humanitarian Assistance Interventions in Acute Physiotherapy and Nursing Refugee Health Unit (Original research). cswhi 2018. [DOI: 10.22359/cswhi_9_4_02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Naddour A, Jackulikova M, Drgova J, Suvada J, Kmit I, Hochman R, Krcmery V, Liskova A, Benca J, Cauda R, Palenikova M, Olah M, Belovicova M, Herdics G. Joint, Soft Tissue and Wound Infections in Physiotherapy Patients from a Mobile Health Care Unit in a Refugee Camp in Northern Bosnia. cswhi 2018. [DOI: 10.22359/cswhi_9_3_02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Falcone M, Tiseo G, Iraci F, Raponi G, Goldoni P, Delle Rose D, Santino I, Carfagna P, Murri R, Fantoni M, Fontana C, Sanguinetti M, Farcomeni A, Antonelli G, Aceti A, Mastroianni C, Andreoni M, Cauda R, Petrosillo N, Venditti M. Risk factors for recurrence in patients with Clostridium difficile infection due to 027 and non-027 ribotypes. Clin Microbiol Infect 2018; 25:474-480. [PMID: 29964230 DOI: 10.1016/j.cmi.2018.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/01/2018] [Revised: 06/17/2018] [Accepted: 06/19/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Our objective was to evaluate factors associated with recurrence in patients with 027+ and 027- Clostridium difficile infection (CDI). METHODS Patients with CDI observed between January and December 2014 in six hospitals were consecutively included in the study. The 027 ribotype was deduced by the presence of tcdB, tcdB, cdt genes and the deletion Δ117 in tcdC (Xpert® C. difficile/Epi). Recurrence was defined as a positive laboratory test result for C. difficile more than 14 days but within 8 weeks after the initial diagnosis date with reappearance of symptoms. To identify factors associated with recurrence in 027+ and 027- CDI, a multivariate analysis was performed in each patient group. Subdistributional hazard ratios (sHRs) and 95% confidence intervals (95%CIs) were calculated. RESULTS Overall, 238 patients with 027+ CDI and 267 with 027- CDI were analysed. On multivariate analysis metronidazole monotherapy (sHR 2.380, 95%CI 1.549-3.60, p <0.001) and immunosuppressive treatment (sHR 3.116, 95%CI 1.906-5.090, p <0.001) were factors associated with recurrence in patients with 027+ CDI. In this patient group, metronidazole monotherapy was independently associated with recurrence in both mild/moderate (sHR 1.894, 95%CI 1.051-3.410, p 0.033) and severe CDI (sHR 2.476, 95%CI 1.281-4.790, p 0.007). Conversely, non-severe disease (sHR 3.704, 95%CI 1.437-9.524, p 0.007) and absence of chronic renal failure (sHR 16.129, 95%CI 2.155-125.000, p 0.007) were associated with recurrence in 027- CDI. CONCLUSIONS Compared to vancomycin, metronidazole monotherapy appears less effective in curing CDI without relapse in the 027+ patient group, independently of disease severity.
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Affiliation(s)
- M Falcone
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Rome, Italy.
| | - G Tiseo
- Department of Internal Medicine and Medical Specialties, 'Sapienza' University of Rome, Rome, Italy
| | - F Iraci
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - G Raponi
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - P Goldoni
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - D Delle Rose
- Department of Infectious Diseases, University of Rome Tor Vergata, Rome, Italy
| | - I Santino
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' University of Rome, Rome, Italy
| | - P Carfagna
- Department of Internal Medicine, Azienda Ospedaliera San Giovanni, Rome, Italy
| | - R Murri
- Institute of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - M Fantoni
- Institute of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - C Fontana
- Microbiology Section, University of Rome Tor Vergata, Rome, Italy
| | - M Sanguinetti
- Institute of Microbiology, Catholic University of Rome, Rome, Italy
| | - A Farcomeni
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - G Antonelli
- Department of Molecular Medicine, 'Sapienza' University of Rome, Rome, Italy
| | - A Aceti
- Infectious Diseases Unit, Azienda Ospedaliera Sant'Andrea, 'Sapienza' University of Rome, Rome, Italy
| | - C Mastroianni
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - M Andreoni
- Department of Infectious Diseases, University of Rome Tor Vergata, Rome, Italy
| | - R Cauda
- Institute of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - N Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - M Venditti
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
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Meciakova M, Foltin V, Olah M, Ridosko J, Gazikova E, Cauda R. Health emergencies during flights (Case reports and Mini-review). CSWHI 2017. [DOI: 10.22359/cswhi_8_3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Murri R, Taccari F, Spanu T, D'Inzeo T, Mastrorosa I, Giovannenze F, Scoppettuolo G, Ventura G, Palazzolo C, Camici M, Lardo S, Fiori B, Sanguinetti M, Cauda R, Fantoni M. A 72-h intervention for improvement of the rate of optimal antibiotic therapy in patients with bloodstream infections. Eur J Clin Microbiol Infect Dis 2017; 37:167-173. [PMID: 29052092 DOI: 10.1007/s10096-017-3117-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/04/2017] [Indexed: 01/05/2023]
Abstract
Antimicrobial stewardship programs are implemented to optimize the use of antibiotics and control the spread of antibiotic resistance. Many antimicrobial stewardship interventions have demonstrated significant efficacy in reducing unnecessary prescriptions of antibiotics, the duration of antimicrobial therapy, and mortality. We evaluated the benefits of a combination of rapid diagnostic tests and an active re-evaluation of antibiotic therapy 72 h after the onset of bloodstream infection (BSI). All patients with BSI from November 2015 to November 2016 in a 1100-bed university hospital in Rome, where an Infectious Disease Consultancy Unit (Unità di Consulenza Infettivologica, UDCI) is available, were re-evaluated at the bedside 72 h after starting antimicrobial therapy and compared to two pre-intervention periods: the UDCI was called by the ward physician for patients with BSI and the UDCI was called directly by the microbiologist immediately after a pathogen was isolated from blood cultures. Recommendations for antibiotic de-escalation or discontinuation significantly increased (54%) from the two pre-intervention periods (32% and 27.2%, p < 0.0001). Appropriate escalation also significantly increased (22.5%) from the pre-intervention periods (8.1% and 8.2%, p < 0.0001). The total duration of antibiotic therapy decreased with intervention (from 21.9 days [standard deviation, SD 15.4] in period 1 to 19.3 days [SD 13.3] in period 2 to 17.7 days in period 3 [SD 11.5]; p = 0.002) and the length of stay was significantly shorter (from 29.7 days [SD 29.3] in period 1 to 26.8 days [SD 24.7] in period 2 to 24.2 days in period 3 [SD 20.7]; p = 0.04) than in the two pre-intervention periods. Mortality was similar among the study periods (31 patients died in period 1 (15.7%), 39 (16.7%) in period 2, and 48 (15.3%) in period 3; p = 0.90). Rapid diagnostic tests and 72 h re-evaluation of empirical therapy for BSI significantly correlated with an improved rate of optimal antibiotic therapy and decreased duration of antibiotic therapy and length of stay.
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Affiliation(s)
- R Murri
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy.
| | - F Taccari
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - T Spanu
- Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - T D'Inzeo
- Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - I Mastrorosa
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - F Giovannenze
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - G Scoppettuolo
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - G Ventura
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - C Palazzolo
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - M Camici
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - S Lardo
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - B Fiori
- Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - M Sanguinetti
- Department of Microbiology, Catholic University of Rome, Rome, Italy
| | - R Cauda
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | - M Fantoni
- Department of Infectious Diseases, Catholic University of Rome, Rome, Italy
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18
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Pola E, Autore G, Formica VM, Pambianco V, Colangelo D, Cauda R, Fantoni M. Answer to the Letter to the Editor of S. Huang et al. concerning "New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years" by Enrico Pola et al. Eur Spine J (2017) doi:10.1007/s00586-017-5043-5. Eur Spine J 2017; 26:2476-2477. [PMID: 28560491 DOI: 10.1007/s00586-017-5162-z] [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] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Enrico Pola
- Spinal Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico "A. Gemelli" University Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - G Autore
- Spinal Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico "A. Gemelli" University Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - V M Formica
- Department of Orthopaedics and Traumatology, "Umberto I" University Hospital, La Sapienza University of Rome, 00185, Rome, Italy
| | - V Pambianco
- Spinal Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico "A. Gemelli" University Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - D Colangelo
- Spinal Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico "A. Gemelli" University Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - R Cauda
- Department of Infectious Diseases, Fondazione Policlinico "A. Gemelli" University Hospital, Catholic University of Rome, 00168, Rome, Italy
| | - M Fantoni
- Department of Infectious Diseases, Fondazione Policlinico "A. Gemelli" University Hospital, Catholic University of Rome, 00168, Rome, Italy
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19
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Pola E, Autore G, Formica VM, Pambianco V, Colangelo D, Cauda R, Fantoni M. New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years. Eur Spine J 2017; 26:479-488. [PMID: 28324216 DOI: 10.1007/s00586-017-5043-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/07/2017] [Accepted: 03/11/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Pyogenic spondylodiscitis (PS) is still burdened by a high rate of orthopedic and neurological complications. Despite the rising incidence, the choice of a proper orthopedic treatment is often delayed by the lack of clinical data. The aim of this study was to propose a clinical-radiological classification of pyogenic spondylodiscitis to define a standard treatment algorithm. METHODS Based on data from 250 patients treated from 2008 to 2015, a clinical-radiological classification of pyogenic spondylodiscitis was developed. According to primary classification criteria (bone destruction or segmental instability, epidural abscesses and neurological impairment), three main classes were identified. Subclasses were defined according to secondary criteria. PS without segmental instability or neurological impairment was treated conservatively. When significant bone loss or neurological impairment occurred, surgical stabilization and/or decompression were performed. All patients underwent clinical and radiological 2-year follow-up. RESULTS Type A PS occurred in 84 patients, while 46 cases were classified as type B and 120 as type C. Average time of hospitalization was 51.94 days and overall healing rate was 92.80%. 140 patients (56.00%) were treated conservatively with average time of immobilization of 218.17 ± 9.89 days. Both VAS and SF-12 scores improved across time points in all classes. Residual chronic back pain occurred in 27 patients (10.80%). Overall observed mortality was 4.80%. CONCLUSIONS Standardized treatment of PS is highly recommended to ensure patients a good quality of life. The proposed scheme includes all available orthopedic treatments and helps spine surgeons to significantly reduce complications and costs and to avoid overtreatment.
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Affiliation(s)
- Enrico Pola
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, "A. Gemelli" University Hospital, Catholic University of Rome, 00168, Rome, Italy.
| | - G Autore
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, "A. Gemelli" University Hospital, Catholic University of Rome, 00168, Rome, Italy
| | - V M Formica
- Department of Orthopaedics and Traumatology, "Umberto I" University Hospital, La Sapienza University of Rome, 00185, Rome, Italy
| | - V Pambianco
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, "A. Gemelli" University Hospital, Catholic University of Rome, 00168, Rome, Italy
| | - D Colangelo
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, "A. Gemelli" University Hospital, Catholic University of Rome, 00168, Rome, Italy
| | - R Cauda
- Department of Infectious Diseases, "A. Gemelli" University Hospital, Catholic University of Rome, 00168, Rome, Italy
| | - M Fantoni
- Department of Infectious Diseases, "A. Gemelli" University Hospital, Catholic University of Rome, 00168, Rome, Italy
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Khaled I, Cauda R, Takac B, Buriancova K, Putekova S, Martinkova J, Komlosi M, Ondova P, Jackulikova M, Svobodova H, Kafkova J, Nevolna Z, Bibza M, Kolibaba M, Mikolasova G, Zollerova K, Murgova A, Tkacova L, Jankechova M, Popelova M, Sasvary F, Krcmery V, Lachytova L. Screen or not to screen? 7 questions in prevention of infection from refugees and migrants. CSWHI 2016. [DOI: 10.22359/cswhi_7_3_04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Falcone M, Iraci F, Raponi G, Goldoni P, Belvisi V, Delle Rose D, Santino I, Murri R, Fantoni M, Carfagna P, Sanguinetti M, Fontana C, Farcomeni A, Tiseo G, Aceti A, Cauda R, Vullo V, Mastroianni C, Andreoni M, Venditti M. Nursing home residence is associated with spread of Clostridium difficile ribotype 027 in central Italy. J Hosp Infect 2016; 94:201-3. [DOI: 10.1016/j.jhin.2016.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 12/19/2022]
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22
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Cianci R, Pinti M, Nasi M, Starnino S, Cammarota G, Miele L, De Luca A, Cauda R, Raducci F, Grieco A, Rapaccini G, Gasbarrini G, Cossarizza A, Pandolfi F. Impairment of Recent Thymic Emigrants in HCV Infection. Int J Immunopathol Pharmacol 2016; 18:723-8. [PMID: 16388721 DOI: 10.1177/039463200501800415] [Citation(s) in RCA: 11] [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: 11/17/2022] Open
Abstract
Hepatitis C Virus (HCV) often has a more favorable course in younger patients. Considering the involution of the thymic function with age, we investigated the output of recent thymic emigrants (RTE) in HCV patients. To evaluate RTE, we used a competitive quantitative PCR in order to determine the percentages of cells with cj-T cell receptor excision circles (TREC). This study was performed in 14 HCV patients at diagnosis and before any anti-HCV treatment. The results obtained in this group were compared to those obtained in a group of age-matched controls. We found that in the 14 HCV patients naive for anti-HCV treatment the mean percentage of cj-TREC was 3%. We could not detect a correlation between the percentages of cj-TREC and age or patients' viremia. In contrast, in the 26 age-matched controls mean percentage of cj-TREC was 5.6% (P=0.01). Our study describes a novel immune defect in HCV patients. Additional studies are needed to get further insight in the possible role of TREC defect in the pathogenesis and prognosis of the disease.
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Affiliation(s)
- R Cianci
- Institute of Internal Medicine, Catholic University of Rome, Italy
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Tosoni A, Mirijello A, Ciervo A, Mancini F, Rezza G, Damiano F, Cauda R, Gasbarrini A, Addolorato G. Human Rickettsia aeschlimannii infection: first case with acute hepatitis and review of the literature. Eur Rev Med Pharmacol Sci 2016; 20:2630-2633. [PMID: 27383315] [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: 06/06/2023]
Abstract
OBJECTIVE Rickettsia conorii is responsible for the Mediterranean Spotted Fever. Recently, new rickettsial species have been recognized in Europe and implicated in human diseases. Clinical features often differ greatly from each other, but non-severe liver involvement is frequently observed during any rickettsial infection. CASE REPORT We describe the unique case of a patient presented with significant high aminotransferase levels due to the first human R. aeschlimannii infection ever detected in Italy. The hypothesis of rickettsiosis was made on the basis of a comprehensive medical history and was confirmed by serological tests. Molecular analyses made on a sample of hepatic tissue revealed the presence of a rickettsial species never found before in human liver. CONCLUSIONS A brief review of the literature is reported to highlight how relevant this case is and to remind that rickettsioses should be in the differential diagnoses of acute hepatitis, considering mostly the recent spread of new rickettsial species.
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Affiliation(s)
- A Tosoni
- Department of Medical Sciences, Internal Medicine and Gastroenterology Unit, Catholic University of the Sacred Heart, Gemelli Hospital, School of Medicine, Rome, Italy.
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Borghetti A, Baldin G, Ciccullo A, Gagliardini R, D'Avino A, Mondi A, Ciccarelli N, Lamonica S, Fanti I, Trecarichi E, Fabbiani M, Cauda R, De Luca A, Di Giambenedetto S. Virological control and metabolic improvement in HIV-infected, virologically suppressed patients switching to lamivudine/dolutegravir dual therapy: Table 1. J Antimicrob Chemother 2016; 71:2359-61. [DOI: 10.1093/jac/dkw147] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Mondi A, Fabbiani M, Ciccarelli N, Colafigli M, D'Avino A, Borghetti A, Gagliardini R, Cauda R, De Luca A, Di Giambenedetto S. Efficacy and safety of treatment simplification to atazanavir/ritonavir + lamivudine in HIV-infected patients with virological suppression: 144 week follow-up of the AtLaS pilot study. J Antimicrob Chemother 2015; 70:1843-9. [PMID: 25885326 DOI: 10.1093/jac/dkv037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 10/20/2014] [Accepted: 01/25/2015] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES AtLaS was a single-arm pilot study that demonstrated promising efficacy and safety of treatment simplification to a dual regimen with atazanavir/ritonavir + lamivudine in virologically suppressed HIV-positive patients. Here, we report data from the 144 week follow-up. METHODS At baseline, patients treated with a three-drug atazanavir/ritonavir-based regimen were switched to 300/100 mg of atazanavir/ritonavir plus 300 mg of lamivudine once daily. Major clinical events, laboratory parameters, neurocognitive performance, bone composition and body fat distribution were monitored. Treatment failure was defined as a discontinuation/switch of the regimen or virological failure (HIV-RNA >50 copies/mL in two consecutive determinations or a single level above 1000 copies/mL). RESULTS After 144 weeks, 9/40 (22.5%) treatment failures occurred, including two virological failures (Weeks 48 and 53, without resistance). A significant increase in the CD4 count was observed at Week 96 (+124 cells/mm(3); P = 0.002) and Week 144 (+94 cells/mm(3); P = 0.008). After 144 weeks, a significant increase in total cholesterol (+25 mg/dL; P = 0.001), HDL cholesterol (+6 mg/dL; P = 0.024) and LDL cholesterol (+12 mg/dL; P = 0.008) was observed, without any change in triglyceride levels, total cholesterol/HDL ratio or LDL/HDL ratio. A significant increase in the estimated glomerular filtration rate (+25 mL/min/1.73 m(2); P < 0.001) and lumbar spine T-score and Z-score (+0.2, P = 0.011; and +0.35, P = 0.001, respectively) and a decrease in trunk fat (-1.898 g; P = 0.005) were also observed. Neurocognitive function did not decline over time. Concerning safety, 10 moderate to severe adverse events were recorded in eight patients; overall seven cases of renal colic (possibly treatment related) were observed, leading to a discontinuation of treatment in two patients. CONCLUSIONS Data from the 144 week follow-up suggested good long-term efficacy of the simplification strategy that was investigated, with rare virological failure and a potential for improvement of the CD4 count, renal function and bone mineral density. This strategy warrants further investigation in a randomized trial.
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Affiliation(s)
- A Mondi
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - M Fabbiani
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - N Ciccarelli
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - M Colafigli
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A D'Avino
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A Borghetti
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - R Gagliardini
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - R Cauda
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - A De Luca
- Infectious Diseases Unit, Siena University Hospital, Siena, Italy
| | - S Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
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Giannella M, Trecarichi EM, De Rosa FG, Del Bono V, Bassetti M, Lewis RE, Losito AR, Corcione S, Saffioti C, Bartoletti M, Maiuro G, Cardellino CS, Tedeschi S, Cauda R, Viscoli C, Viale P, Tumbarello M. Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study. Clin Microbiol Infect 2014; 20:1357-62. [PMID: 24980276 DOI: 10.1111/1469-0691.12747] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [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: 04/07/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 01/08/2023]
Abstract
Knowledge of carbapenem-resistant Klebsiella pneumoniae (CR-KP) colonization is important to prevent nosocomial spread but also to start prompt adequate antibiotic therapy in patients with suspicion of infection. However, few studies have examined the incidence and risk factors for CR-KP bloodstream infection (BSI) among rectal carriers. To identify risk factors for CR-KP BSI among carriers, we performed a multicentre prospective matched case-control study of all adult CR-KP rectal carriers hospitalized in five tertiary teaching hospitals in Italy over a 2-year period. Carriers who developed CR-KP BSI were compared with those who did not develop subsequent BSI. Overall, 143 CR-KP BSIs were compared with 572 controls without a documented infection during their hospitalization. Multivariate analysis revealed that admission to the Intensive Care Unit (ICU) (OR, 1.65; 95% CI, 1.05-2.59; p 0.03), abdominal invasive procedure (OR, 1.87; 95% CI, 1.16-3.04; p 0.01), chemotherapy/radiation therapy (OR, 3.07; 95% CI, 1.78-5.29; p <0.0001), and number of additional colonization sites (OR, 3.37 per site; 95% CI, 2.56-4.43; p <0.0001) were independent risk factors for CR-KP BSI development among CR-KP rectal carriers. A CR-KP BSI risk score ranging from 0 to 28 was developed based on these four independent variables. At a cut-off of ≥2 the model exhibited a sensitivity, specificity, positive predictive value and negative predictive value of 93%, 42%, 29% and 93%, respectively. Colonization at multiple sites with CR-KP was the strongest predictor of BSI development in our large cohort of CR-KP rectal carriers.
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Affiliation(s)
- M Giannella
- Infectious Diseases Unit, Department of Medical and Clinical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Gagliardini R, Fabbiani M, Fortuna S, Visconti E, Navarra P, Cauda R, Colafigli M, De Luca A, Trecarichi EM, Di Giambenedetto S. Pharmacokinetics of etravirine in HIV-infected patients concomitantly treated with rifampin for tuberculosis. Infection 2014; 42:775-8. [PMID: 24531907 DOI: 10.1007/s15010-014-0599-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/31/2014] [Indexed: 11/30/2022]
Abstract
Etravirine is metabolized by three cytochrome P450 enzymes that are in turn induced by rifampin. Consequently, co-administration of etravirine and rifampin is not recommended. To date, however, no clinical studies exploring the drug-drug interaction of this combination have been conducted. Here we report two cases of off-label etravirine use concurrently with antitubercular treatment, dictated by the unavailability of other treatments. Plasma drug concentrations were monitored by regular measurements. Our results appear to confirm the increased metabolism of etravirine through the induction of cytochrome P450 enzymes, but the adequacy of drug levels in all of the measurements and subsequent virological suppression suggest that this drug interaction may not be clinically relevant.
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Affiliation(s)
- R Gagliardini
- Institute of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
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De Angelis G, Cataldo MA, De Waure C, Venturiello S, La Torre G, Cauda R, Carmeli Y, Tacconelli E. Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systematic review and meta-analysis. J Antimicrob Chemother 2014; 69:1185-92. [DOI: 10.1093/jac/dkt525] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Svicher V, Alteri C, Montano M, Nori A, D'Arrigo R, Andreoni M, Angarano G, Antinori A, Antonelli G, Allice T, Bagnarelli P, Baldanti F, Bertoli A, Borderi M, Boeri E, Bon I, Bruzzone B, Barresi R, Calderisi S, Callegaro AP, Capobianchi MR, Gargiulo F, Castelli F, Cauda R, Ceccherini-Silberstein F, Clementi M, Chirianni A, Colafigli M, D'Arminio Monforte A, De Luca A, Di Biagio A, Di Nicuolo G, Di Perri G, Di Santo F, Fadda G, Galli M, Gennari W, Ghisetti V, Costantini A, Gori A, Gulminetti R, Leoncini F, Maffongelli G, Maggiolo F, Maserati R, Mazzotta F, Meini G, Micheli V, Monno L, Mussini C, Nozza S, Paolucci S, Palù G, Parisi S, Parruti G, Pignataro AR, Quirino T, Re MC, Rizzardini G, Sanguinetti M, Santangelo R, Scaggiante R, Sterrantino G, Turriziani O, Vatteroni ML, Viscoli C, Vullo V, Zazzi M, Lazzarin A, Perno CF. Genotypic testing on HIV-1 DNA as a tool to assess HIV-1 co-receptor usage in clinical practice: results from the DIVA study group. Infection 2013; 42:61-71. [PMID: 24146352 PMCID: PMC3906530 DOI: 10.1007/s15010-013-0510-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 03/11/2013] [Accepted: 07/16/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE We have developed a sequencing assay for determining the usage of the genotypic HIV-1 co-receptor using peripheral blood mononuclear cell (PBMC) DNA in virologically suppressed HIV-1 infected patients. Our specific aims were to (1) evaluate the efficiency of V3 sequences in B versus non-B subtypes, (2) compare the efficiency of V3 sequences and tropism prediction using whole blood and PBMCs for DNA extraction, (3) compare the efficiency of V3 sequences and tropism prediction using a single versus a triplicate round of amplification. RESULTS The overall rate of successful V3 sequences ranged from 100 % in samples with >3,000 copies HIV-1 DNA/10(6) PBMCs to 60 % in samples with <100 copies total HIV-1 DNA /10(6) PBMCs. Analysis of 143 paired PBMCs and whole-blood samples showed successful V3 sequences rates of 77.6 % for PBMCs and 83.9 % for whole blood. These rates are in agreement with the tropism prediction obtained using the geno2pheno co-receptor algorithm, namely, 92.1 % with a false-positive rate (FPR) of 10 or 20 % and of 96.5 % with an FPR of 5.75 %. The agreement between tropism prediction values using single versus triplicate amplification was 98.2 % (56/57) of patients using an FPR of 20 % and 92.9 % (53/57) using an FPR of 10 or 5.75 %. For 63.0 % (36/57) of patients, the FPR obtained via the single amplification procedure was superimposable to all three FPRs obtained by triplicate amplification. CONCLUSIONS Our results show the feasibility and consistency of genotypic testing on HIV-1 DNA tropism, supporting its possible use for selecting patients with suppressed plasma HIV-1 RNA as candidates for CCR5-antagonist treatment. The high agreement between tropism prediction by single and triple amplification does not support the use of triplicate amplification in clinical practice.
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Affiliation(s)
- V Svicher
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
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Di Giambenedetto S, Fabbiani M, Colafigli M, Ciccarelli N, Farina S, Sidella L, D'Avino A, Mondi A, Cingolani A, Tamburrini E, Murri R, Navarra P, Cauda R, De Luca A. Safety and feasibility of treatment simplification to atazanavir/ritonavir + lamivudine in HIV-infected patients on stable treatment with two nucleos(t)ide reverse transcriptase inhibitors + atazanavir/ritonavir with virological suppression (Atazanavir and Lamivudine for treatment Simplification, AtLaS pilot study). J Antimicrob Chemother 2013; 68:1364-72. [DOI: 10.1093/jac/dkt007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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31
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Fabbiani M, Ciccarelli N, Tana M, Farina S, Baldonero E, Di Cristo V, Colafigli M, Tamburrini E, Cauda R, Silveri MC, Grima P, Di Giambenedetto S. Cardiovascular risk factors and carotid intima-media thickness are associated with lower cognitive performance in HIV-infected patients. HIV Med 2012; 14:136-44. [PMID: 22994586 DOI: 10.1111/j.1468-1293.2012.01044.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the relationship between metabolic comorbidities, cardiovascular risk factors or common carotid intima-media thickness (cIMT) and cognitive performance in HIV-infected patients. METHODS Asymptomatic HIV-infected subjects were consecutively enrolled during routine out-patient visits at two clinical centres. All patients underwent an extensive neuropsychological battery and assessment of metabolic comorbidities and cardiovascular risk factors. Moreover, cIMT was assessed by ultrasonography. Cognitive performance was evaluated by calculating a global cognitive impairment (GCI) score obtained by summing scores assigned to each test (0 if normal and 1 if pathological). RESULTS A total of 245 patients (median age 46 years; 84.1% with HIV RNA < 50 copies/mL; median CD4 count 527 cells/μL) were enrolled in the study. Cardiovascular risk factors were highly prevalent in our population: the most frequent were dyslipidaemia (61.2%), cigarette smoking (54.3%) and hypertension (15.1%). cIMT was abnormal (≥ 0.9mm) in 31.8% of patients. Overall, the median GCI score was 2 [interquartile range (IQR) 1-4]; it was higher in patients with diabetes (P = 0.004), hypertension (P = 0.030) or cIMT ≥ 0.9 mm (P < 0.001). In multivariate analysis, it was confirmed that diabetes (P = 0.007) and cIMT ≥ 0.9 mm (P = 0.044) had an independent association with lower cognitive performance. In an analysis of patients on combination antiretroviral therapy (cART), abacavir use was independently associated with a better cognitive performance (P = 0.011), while no association was observed for other drugs or neuroeffectiveness score. CONCLUSIONS Diabetes, cardiovascular risk factors and cIMT showed a strong association with lower cognitive performance, suggesting that metabolic comorbidities could play a relevant role in the pathogenesis of HIV-associated neurocognitive disorders in the recent cART era.
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Affiliation(s)
- M Fabbiani
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
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Colafigli M, Torti C, Trecarichi EM, Albini L, Rosi A, Micheli V, Manca N, Penco G, Bruzzone B, Punzi G, Corsi P, Parruti G, Bagnarelli P, Monno L, Gonnelli A, Cauda R, Di Giambenedetto S. Evolution of transmitted HIV-1 drug resistance in HIV-1-infected patients in Italy from 2000 to 2010. Clin Microbiol Infect 2012; 18:E299-304. [PMID: 22536753 DOI: 10.1111/j.1469-0691.2012.03847.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prevalence and predictors of transmitted drug resistance (TDR), defined as the presence of at least one WHO surveillance drug resistance mutation (SDRM), were investigated in antiretroviral-naïve HIV-1-infected patients, with a genotypic resistance test (GRT) performed ≤6 months before starting cART between 2000 and 2010. 3163 HIV-1 sequences were selected (69% subtype B). Overall, the prevalence of TDR was 12% (13.2% subtype B, 9% non-B). TDR significantly declined overall and for the single drug classes. Older age independently predicted increased odds of TDR, whereas a more recent GRT, a higher HIV-RNA and C vs. B subtype predicted lower odds of TDR.
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Affiliation(s)
- M Colafigli
- Institute of Clinical Infectious Diseases, Catholic University of S. Heart, Rome, Italy.
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Bassetti M, Trecarichi EM, Mesini A, Spanu T, Giacobbe DR, Rossi M, Shenone E, Pascale GD, Molinari MP, Cauda R, Viscoli C, Tumbarello M. Risk factors and mortality of healthcare-associated and community-acquired Staphylococcus aureus bacteraemia. Clin Microbiol Infect 2011; 18:862-9. [PMID: 21999245 DOI: 10.1111/j.1469-0691.2011.03679.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Staphylococcus aureus bacteraemia (SAB) is a leading cause of mortality and morbidity in both nosocomial and community settings. The objective of the study is to explore epidemiological characteristics and predisposing risk factors associated with healthcare-associated (HCA) and community-acquired (CA) SAB, and to evaluate any differences in mortality and efficacy of initial antimicrobial therapy on treatment outcome. We conducted a two-part analysis. First, a triple case-control study in which groups of HCA SAB with onset ≥ 48 h after hospital admission (HCA ≥ 48 h), HCA SAB with onset <48 h of hospital admission (HCA <48 h), and CA SAB were compared with controls. Second, a cohort study including all patients with SAB was performed to identify factors associated with in-hospital mortality. SAB was diagnosed in 165 patients over the study period (January 2007 to December 2007). Five variables were independently associated with HCA ≥ 48 h SAB: presence of central venous catheter, solid tumour, chronic renal failure, previous hospitalization and previous antibiotic therapy. Significant risk factors for HCA <48 h SAB were: Charlson Comorbidity Index ≥ 3, previous hospitalization, living in long-term care facilities and corticosteroid therapy. Factors independently associated with CA SAB were: diabetes mellitus, HIV infection and chronic live disease. Patients with HCA <48 h SAB were significantly more likely to receive initial inadequate antimicrobial treatment than patients with CA or HCA ≥ 48 h SAB (44.8% versus 33.3% and 31.5%, respectively). Logistic-regression analysis identified three variables as independent predictors of mortality: presentation with septic shock, infection with methicillin-resistant S. aureus, and initial inadequate antimicrobial treatment. More than half of patients with SAB have MRSA strains and presentation with septic shock, and inappropriate empirical therapy was associated with increased mortality.
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Affiliation(s)
- M Bassetti
- Infectious Diseases Division, San Martino Hospital and University of Genoa School of Medicine, Genoa, Italy.
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Fabbiani M, Bracciale L, Ragazzoni E, Santangelo R, Cattani P, Di Giambenedetto S, Fadda G, Navarra P, Cauda R, De Luca A. Relationship between antiretroviral plasma concentration and emergence of HIV-1 resistance mutations at treatment failure. Infection 2011; 39:563-9. [PMID: 21866336 DOI: 10.1007/s15010-011-0183-8] [Citation(s) in RCA: 11] [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] [Received: 04/06/2011] [Accepted: 08/09/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The relationship between antiretroviral pharmacokinetic exposure and acquisition of human immunodeficency virus-1 (HIV-1) drug resistance mutations (DRM) is not fully understood. The aim of this study was to investigate whether antiretroviral plasma concentration could predict the emergence of DRM at treatment failure. METHODS The study cohort comprised retrospectively selected patients with failing antiretroviral regimens for whom a protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) trough concentration measurement (TDM) had been obtained before failure, a genotypic resistance test (GRT1) had been performed before the TDM, and a genotypic resistance test (GRT2) had been performed at therapeutic failure. Drug levels were classified as undetectable/detectable or subtherapeutic/therapeutic according to limits of quantification of a high-performance liquid chromatography-ultraviolet assay or pre-defined efficacy thresholds, respectively. The number of DRM acquired at treatment failure was evaluated by comparing the results of the GRT2 and GRT1. RESULTS A total of ten and 57 failure episodes occurred among our patients on NNRTI-based and PI-based regimens, respectively, and included in the evaluation. PI concentration was subtherapeutic in 28.1% of patients, among which the levels were undetectable in 21.1%. Twenty-five (43.9%) patients acquired at least one new PI-DRM according to the GRT2. Patients with undetectable PI levels showed a lower emergence of PI-DRM (minor + major) than those with detectable levels (8.3 vs. 53.3%, p = 0.007). Multivariate analysis confirmed that undetectable PI levels were independent negative predictors of DRM selection. NNRTI measurements were subtherapeutic in 2/10 (20%) patients. NNRTI-DRM were acquired by all patients regardless of NNRTI levels. CONCLUSIONS A PI measurement showing undetectable drug levels prior to treatment failure predicted the lack of emergence of PI-DRM at failure. These results suggest that PI levels can help clinicians interpret the reasons for treatment failure and guide the type of interventions needed.
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Affiliation(s)
- M Fabbiani
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy.
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Ciccarelli N, Fabbiani M, Di Giambenedetto S, Fanti I, Baldonero E, Bracciale L, Tamburrini E, Cauda R, De Luca A, Silveri MC. Efavirenz associated with cognitive disorders in otherwise asymptomatic HIV-infected patients. Neurology 2011; 76:1403-9. [PMID: 21502598 DOI: 10.1212/wnl.0b013e31821670fb] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the availability of potent antiretroviral regimens (combination antiretroviral therapy [cART]), HIV-associated neurocognitive disorders (HAND) are increasingly recognized. Our aim was to investigate the prevalence and treatment-related correlates of HAND, exploring the potential neurotoxicity of antiretrovirals on cognitive functions. METHODS We performed a cross-sectional single cohort study by consecutively enrolling asymptomatic HIV+ subjects during routine outpatient visits. Each patient was submitted to a comprehensive neuropsychological battery and was considered cognitively impaired on the basis of results obtained in matched healthy HIV-negative subjects. CNS penetration effectiveness (CPE) rank was calculated for cART regimens according to 2010 CHARTER criteria. Factors associated with cognitive impairment were investigated by linear or logistic regression analysis. RESULTS A total of 146 patients were enrolled. Of these, 129 (88.4%) were on cART and 59.6% of them were on current regimen from ≥1 year. Sixty-nine patients (47%) were classified as cognitively impaired (35.6% asymptomatic and 11.6% mild neurocognitive impairment). In the multivariate analysis, efavirenz use (odds ratio [OR] = 4.00; p = 0.008) and non-Italian nationality (OR = 3.46; p = 0.035) were associated with increased risk of cognitive impairment, whereas higher education was associated with a lower risk (OR = 0.85; p = 0.002). Furthermore, efavirenz use and age ≥65 years independently predicted worse performance on the double barrage and the Stroop test (time). No association between CPE rank and cognitive impairment was observed. CONCLUSIONS A high prevalence of HAND was observed in apparently asymptomatic HIV+ individuals. HAND was associated with efavirenz use, suggesting the potential neurotoxicity of this drug. Routine neuropsychological examinations could help clinicians make correct diagnoses and manage mild, but clinically relevant, forms of HAND.
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Affiliation(s)
- N Ciccarelli
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, Rome 00168, Italy.
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De Angelis G, Cipriani M, Cauda R, Tacconelli E. Treatment of Skin and Soft Tissue Infections Due to Community-Associated Methicillin-Resistant Staphylococcus aureus in Europe: The Role of Trimethoprim-sulfamethoxazole. Clin Infect Dis 2011; 52:1471-2; author reply 1472. [DOI: 10.1093/cid/cir247] [Citation(s) in RCA: 11] [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: 11/13/2022] Open
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Giambenedetto S, Zileri Dal Verme L, Sali M, Farina S, Cristo V, Manzara S, Luca A, Pignataro G, Prosperi M, Franco A, Gentiloni Silveri N, Delogu G, Cauda R, Fabbiani M, Fadda G. Clinical presentation, microbiological features and correlates of disease severity of 2009 pandemic influenza A (H1N1) infection. Eur J Clin Microbiol Infect Dis 2010; 30:541-9. [DOI: 10.1007/s10096-010-1116-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 10/30/2010] [Indexed: 10/18/2022]
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Uglietti A, Gervasoni C, Gabrielli E, Di Giambenedetto S, Cauda R, Esposito R, Grima P, Di Perri G, Maserati R, Galli M. Smoking, female gender and PI use are associated with decreasing renal function in TDF-containing HAART. J Int AIDS Soc 2010. [PMCID: PMC3113091 DOI: 10.1186/1758-2652-13-s4-p84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Giuliani M, Tumbarello M, Marino MC, Capodiferro S, Scivetti M, Rezza G, Cauda R, Lajolo C. Dental hygienists behaviour towards HIV-positive patients in highly active antiretroviral therapy era: a pilot survey. Int J Dent Hyg 2010; 9:204-10. [DOI: 10.1111/j.1601-5037.2010.00472.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pinnetti C, Baroncelli S, Villani P, Fantoni M, Tozzi V, De Luca A, Cauda R, Anzidei G, Cusato M, Regazzi M, Floridia M, Tamburrini E. Rapid HIV-RNA decline following addition of raltegravir and tenofovir to ongoing highly active antiretroviral therapy in a woman presenting with high-level HIV viraemia at week 38 of pregnancy. J Antimicrob Chemother 2010; 65:2050-2. [DOI: 10.1093/jac/dkq264] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fabbiani M, Di Giambenedetto S, Ragazzoni E, Colafigli M, Prosperi M, Cauda R, Navarra P, De Luca A. Mid-dosing interval concentration of atazanavir and virological outcome in patients treated for HIV-1 infection. HIV Med 2010; 11:326-33. [DOI: 10.1111/j.1468-1293.2009.00785.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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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Bracciale L, Fanti I, Di Giambenedetto S, Colafigli M, Prosperi M, Bacarelli A, Santangelo R, Cattani P, Cauda R, De Luca A. Predictors of successful genotype-guided antiretroviral therapy in treatment-experienced individuals over calendar years: A cohort study. J Clin Virol 2009; 46:290-4. [DOI: 10.1016/j.jcv.2009.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 07/16/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022]
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Di Giambenedetto S, Torti C, Prosperi M, Manca N, Lapadula G, Paraninfo G, Ladisa N, Zazzi M, Trezzi M, Cicconi P, Corsi P, Nasta P, Cauda R, De Luca A. Effectiveness of antiretroviral regimens containing abacavir with tenofovir in treatment-experienced patients: predictors of virological response and drug resistance evolution in a multi-cohort study. Infection 2009; 37:438-44. [PMID: 19669091 DOI: 10.1007/s15010-009-8237-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 12/18/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND In treatment-naïve patients, a combination antiretroviral therapy (cART) containing tenofovir (TDF) and abacavir (ABC) with lamivudine leads to unacceptably high virological failure rates with frequent selection of reverse transcriptase mutations M184V and K65R. We explored the efficacy of at least 16 weeks of ABC + TDF-containing cART regimens in 307 antiretroviral-experienced HIV-1-infected individuals included in observational databases. METHODS Virological failure was defined as an HIV RNA > 400 copies/ml after at least 16 weeks of treatment. Patients had received a median of three prior cART regimens. Of these, 76% concomitantly received a potent or high genetic barrier regimen (with at least one protease inhibitor [PI]) or non-nucleoside reverse transcriptase inhibitor or thymidine analogue) while a third non-thymidine nucleoside analogue was used in the remaining patients. RESULTS The 1-year estimated probability of virological failure was 34% in 165 patients with HIV RNA > 400 copies/ ml at ABC + TDF regimen initiation. Independent predictors of virological failure were the absence of a potent or high genetic barrier cART, the higher number of cART regimens experienced, and the use of a new drug class. In the subset of 136 patients for whom there were genotypic resistance test results prior to ABC + TDF initiation, the virological failure (1-year estimated probability 46%) was independently predicted by the higher baseline viral load, the concomitant use of boosted PI, and the presence of reverse transcriptase mutation M41L. In 142 patients starting ABC + TDF therapy with HIV RNA pound < or =400 copies/ml, virological failure (1-year estimated probability 17%) was associated only with the transmission category. In a small subset of subjects for whom there were an available paired baseline and follow-up genotype (n = 28), the prevalence of most nucleoside analogue reverse transcriptase inhibitor resistance mutations decreased, suggesting a possible low adherence to treatment. No selection of K65R was detected. CONCLUSION The virological response to ABC + TDF-containing regimens in this moderately-to-heavily treatment experienced cohort was good. Higher viral load and the presence of M41L at baseline were associated with worse virological responses, while the concomitant prescription of drugs enhancing the genetic barrier of the regimen conveyed a reduced risk of virological failure. The Appendix provides the names of other members of the MASTER cohort.
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Affiliation(s)
- S Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University, Rome, Italy.
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Molina JM, Ait-Khaled M, Rinaldi R, Penco G, Baril JG, Cauda R, Soriano V, Pialoux G, Wire MB, Lou Y, Givens N, Craig C, Nichols WG, Barbosa I, Yeo J. Fosamprenavir/ritonavir in advanced HIV disease (TRIAD): a randomized study of high-dose, dual-boosted or standard dose fosamprenavir/ritonavir in HIV-1-infected patients with antiretroviral resistance. J Antimicrob Chemother 2009; 64:398-410. [DOI: 10.1093/jac/dkp198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Colafigli M, Di Giambenedetto S, Bracciale L, Fanti I, Prosperi M, Cauda R, De Luca A. Long-term follow-up of nevirapine-treated patients in a single-centre cohort. HIV Med 2009; 10:461-9. [PMID: 19459991 DOI: 10.1111/j.1468-1293.2009.00713.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We reviewed the safety and efficacy of nevirapine (NVP)-based therapy in all patients initiating NVP-containing combined antiretroviral therapy [cART (>or=3 drugs)] in our clinic since 1994. METHODS Patient characteristics and laboratory values from the start of the NVP-based cART regimen to the last available follow-up or to NVP discontinuation were retrieved from an observational database. RESULTS Five hundred and seventy-three patients were treated with NVP-based cART for a median of 18.4 (range 0.1-128.8) months. The 1-year cumulative estimated probability of discontinuing NVP-containing regimens for toxicity was 0.203. Only 1.9% developed a grade 3 alanine aminotransferase (ALT) elevation. Significant increases in high-density lipoprotein cholesterol were observed up to month 12 except in treatment-naïve patients, where the increase was limited to 3 months. Discontinuation because of cutaneous reaction was predicted independently by female gender [Hazard Ratio (HR) 3.21, P<0.001] and Centers for Disease Control class C (HR 0.50, P=0.012). Discontinuation because of liver toxicity was predicted independently by anti-hepatitis C virus positivity (HR 3.84, P<0.001). In patients starting NVP-containing cART with undetectable viral loads, the 5-year estimated probability of viral load >400 HIV-1 RNA copies/mL was 0.34. CONCLUSIONS Long-term follow-up with an NVP-containing cART showed a low rate of discontinuation caused by liver toxicity and the maintenance of virological suppression in patients switched with undetectable viral loads.
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Affiliation(s)
- Manuela Colafigli
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
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Fabbiani M, Di Giambenedetto S, Bracciale L, Bacarelli A, Ragazzoni E, Cauda R, Navarra P, De Luca A. Pharmacokinetic variability of antiretroviral drugs and correlation with virological outcome: 2 years of experience in routine clinical practice. J Antimicrob Chemother 2009; 64:109-17. [DOI: 10.1093/jac/dkp132] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Carosi G, Nasta P, Fiore S, Matteelli A, Cauda R, Ferrazzi E, Tamburrini E, Savasi V, Bini T, Ravizza M, Bucceri A, Vichi F, Murri R, Mazzotta F, d'Arminio Monforte A. Women facing HIV. Key question on women with HIV infection: Italian consensus workshop. Infection 2009; 37:168-78. [PMID: 19308320 DOI: 10.1007/s15010-008-7361-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2007] [Accepted: 10/06/2008] [Indexed: 01/13/2023]
Abstract
A panel of leading Italian specialists in infectious diseases, obstetrics and gynaecology met in a national consensus workshop on women facing HIV to review critical aspects and discuss recommendations for selected key questions on four issues: (1) women and highly active antiretroviral therapy (HAART): access to care and adherence to therapy, side effects and drug-drug interaction; (2) HIV-infected pregnant women: prevention of mother to child transmission; (3) desire for children among women living with HIV: assisted reproduction; (4) sexually transmitted diseases and genital disturbances. The method of a nominal group meeting was used, and recommendations were graded for their strength and quality of evidence using a system based on the one adopted by the Infectious Diseases Society of America. Main conclusions are summarized and critically discussed, and some of the most recent data supporting recommendations are provided.
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Affiliation(s)
- G Carosi
- Institute of Infectious and Tropical Diseases, University of Brescia, Italy
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Humphreys H, Grundmann H, Skov R, Lucet JC, Cauda R. Prevention and control of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2009; 15:120-4. [DOI: 10.1111/j.1469-0691.2009.02699.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tacconelli E, Cataldo M, Albanese A, Tumbarello M, Arduini E, Spanu T, Fadda G, Anile C, Maira G, Federico G, Cauda R. Vancomycin versus cefazolin prophylaxis for cerebrospinal shunt placement in a hospital with a high prevalence of meticillin-resistant Staphylococcus aureus. J Hosp Infect 2008; 69:337-44. [DOI: 10.1016/j.jhin.2008.04.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 04/25/2008] [Indexed: 11/30/2022]
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