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Fumarola B, Signorini L, Lorenzotti S, Lanza P, Saccani B, Van Hauwermeiren E, Mulè A, Piva S, Rota M, Zuccalà F, Rasulo FA, Filippini M, Bertazzoli A, Del Fabro G, Matteelli A. Use of nebulized liposomal amphotericin B and posaconazole as antifungal prophylaxis in patients with severe SARS-CoV2 infection in intensive care unit. Infection 2024:10.1007/s15010-024-02234-9. [PMID: 38530518 DOI: 10.1007/s15010-024-02234-9] [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: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE COVID-19 associated pulmonary aspergillosis (CAPA) is common and linked with high fatality rates. To assess the impact on the incidence and outcome of CAPA of an antifungal prophylaxis (AFP) we compared two cohorts of COVID-19 patients admitted to intensive care units (ICU) in Brescia, Italy, from January to August 2021. METHODS The study cohort included all mechanically ventilated patients observed between April 2021 and August 2021 with SARS-CoV-2-pneumonia, who received AFP with oral posaconazole (200 mg every 6 h) and nebulized liposomal amphotericin B (50 mg every 2 weeks) from ICU admission to 7 days after discharge or, if applicable, until tracheostomy removal. The control cohort included COVID-19 patients admitted to the same ICU between January and March 2021 who did not receive any AFP. Subjects with CAPA at ICU admission were excluded. RESULTS We included 270 patients, of whom 64 (23.7%) received AFP. In patients in the study group, CAPA-related mortality was significantly reduced (29% vs. 48% p = 0.04), as well as the incidence of CAPA (3.1% vs 12.1%, p = 0.03). Patients who developed CAPA were older (mean of 70-y-old vs 63-y-old, p < 0.001). One subject discontinued posaconazole due to an adverse reaction. Among the 46 patients who received it, only one patient reached an effective plasma concentration of posaconazole. CONCLUSION AFP was associated with reduced incidence and mortality from CAPA and was well tolerated in patients with severe COVID-19. Posaconazole concentrations below the efficacy threshold in almost all patients may be attributable to drug interactions and prompt further studies to define its clinical significance.
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Affiliation(s)
| | - Liana Signorini
- Clinic of Infectious Diseases, ASST Spedali Civili, Brescia, Italy
| | | | - Paola Lanza
- Clinic of Infectious Diseases, ASST Spedali Civili, Brescia, Italy
| | - Barbara Saccani
- Clinic of Infectious Diseases, ASST Spedali Civili, Brescia, Italy
| | | | - Alice Mulè
- Clinic of Infectious Diseases, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Medicine, University of Brescia, Brescia, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Francesco Zuccalà
- Department of Anesthesia and Intensive Care, Spedali Civili Hospital, Brescia, Italy
| | - Francesco Antonio Rasulo
- Intensive Care and Anesthesiology, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Matteo Filippini
- Intensive Care and Anesthesiology, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Alberto Bertazzoli
- Department of Anesthesia and Intensive Care, Spedali Civili Hospital, Brescia, Italy
| | - Giovanni Del Fabro
- Department of Infectious Diseases, ASFO "Santa Maria Degli Angeli" Hospital of Pordenone, Pordenone, Italy
| | - Alberto Matteelli
- Clinic of Infectious Diseases, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Medicine, University of Brescia, Brescia, Italy
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Mulè A, Rossini F, Sollima A, Lenzi A, Fumarola B, Amadasi S, Chiari E, Lorenzotti S, Saccani B, Van Hauwermeiren E, Lanza P, Matteelli A, Castelli F, Signorini L. Trichosporon asahii Infective Endocarditis of Prosthetic Valve: A Case Report and Literature Review. Antibiotics (Basel) 2023; 12:1181. [PMID: 37508277 PMCID: PMC10376831 DOI: 10.3390/antibiotics12071181] [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: 06/15/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Trichosporon spp. endocarditis is a severe and hard-to-treat infection. Immunosuppressed subjects and carriers of prosthetic valves or intracardiac devices are at risk. This article presents the case of an immunocompetent 74-year-old man affected by endocarditis of the prosthetic aortic valve. After Bentall surgery, cultures of the removed valve demonstrated Trichosporon ashaii as the etiological agent. The patient was treated with amphotericin B at first and subsequently with fluconazole. Given the fragility of the patient and the aggressiveness of the pathogen, life-long prophylactic therapy with fluconazole was prescribed. After 5 years follow-up, no drug-related toxicities were reported and the patient never showed any signs of recurrence. The review of the literature illustrates that Trichosporon spp. endocarditis may present even many years after heart surgery, and it is often associated with massive valve vegetations, severe embolic complications, and unfavorable outcome. Due to the absence of international guidelines, there is no unanimous therapeutic approach, but amphotericin B and azoles are usually prescribed. Additionally, a prompt surgical intervention seems to be of paramount importance. When dealing with a life-threatening disease, such as mycotic endocarditis of prosthetic valves, it is essential to consider and treat even rare etiological agents such as Trichosporon spp.
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Affiliation(s)
- Alice Mulè
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Francesco Rossini
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Alessio Sollima
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Angelica Lenzi
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Benedetta Fumarola
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Silvia Amadasi
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Erika Chiari
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Silvia Lorenzotti
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Barbara Saccani
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Evelyn Van Hauwermeiren
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Paola Lanza
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Alberto Matteelli
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Francesco Castelli
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
| | - Liana Signorini
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST 'Spedali Civili di Brescia, Brescia 25123, Italy
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3
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Malagola M, Turra A, Signorini L, Corbellini S, Polverelli N, Masina L, Del Fabro G, Lorenzotti S, Fumarola B, Farina M, Morello E, Radici V, Buttini EA, Colnaghi F, Bernardi S, Re F, Caruso A, Castelli F, Russo D. Results of an Innovative Program for Surveillance, Prophylaxis, and Treatment of Infectious Complications Following Allogeneic Stem Cell Transplantation in Hematological Malignancies (BATMO Protocol). Front Oncol 2022; 12:874117. [PMID: 35785189 PMCID: PMC9247274 DOI: 10.3389/fonc.2022.874117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/11/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Infectious complications are a significant cause of morbidity and mortality in patients undergoing allogeneic haematopoietic stem cell transplantation (Allo-SCT). The BATMO (Best-Antimicrobial-Therapy-TMO) is an innovative program for infection prevention and management and has been used in our centre since 2019. The specific features of the BATMO protocol regard both prophylaxis during neutropenia (abandonment of fluoroquinolone, posaconazole use in high-risk patients, aerosolized liposomal amphotericin B use until engraftment or a need for antifungal treatment, and letermovir use in CMV-positive recipients from day 0 to day +100) and therapy (empirical antibiotics based on patient clinical history and colonization, new antibiotics used in second-line according to antibiogram with the exception of carbapenemase-producing K pneumoniae for which the use in first-line therapy is chosen). Methods Data on the infectious complications of 116 transplant patients before BATMO protocol (Cohort A; 2016 - 2018) were compared to those of 84 transplant patients following the introduction of the BATMO protocol (Cohort B; 2019 - 2021). The clinical and transplant characteristics of the 2 Cohorts were comparable, even though patients in Cohort B were at a higher risk of developing bacterial, fungal, and CMV infections, due to a significantly higher proportion of myeloablative regimens and haploidentical donors. Results No change in the incidence of infections with organ localization was observed between the two Cohorts. A significant reduction in Clostridioides difficile infections by day +100 was observed in Cohort B (47% vs. 15%; p=0.04). At day +30, a higher incidence of Gram-negative bloodstream infections (BSIs) was observed in Cohort B (12% vs. 23%; p=0.05). By day +100 and between days +100 and +180, the incidence of BSIs and of the various etiological agents, the mortality from Gram-negative bacteria, and the incidence of invasive fungal infections were not different in the two Cohorts. The incidence of CMV reactivations by day +100 dropped drastically in patients of Cohort B, following letermovir registration (51% vs. 15%; p=0.00001). Discussion The results of this study suggest that the BATMO program is safe. In particular, the choice to avoid prophylaxis with fluoroquinolone was associated with an increase in Gram-negative BSIs by day +30, but this did not translate into higher levels of mortality. Moreover, this strategy was associated with a significant reduction of Clostridiodes difficile infections. The efficacy of anti-CMV prophylaxis with letermovir was confirmed by a significant reduction in CMV reactivations. Even though patients in Cohort B were at higher risk of developing fungal infections (more haploidentical transplants with more myeloablative regimens), the extensive use of posaconazole for prophylaxis balanced this risk, and no increase in the incidence of fungal-associated complications was observed.
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Affiliation(s)
- Michele Malagola
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
- *Correspondence: Michele Malagola,
| | - Alessandro Turra
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Liana Signorini
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Silvia Corbellini
- Department of Molecular and Translational Medicine, Section of Microbiology and Virology, University of Brescia Medical School, Brescia, Italy
| | - Nicola Polverelli
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Lorenzo Masina
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Giovanni Del Fabro
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Silvia Lorenzotti
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Benedetta Fumarola
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Mirko Farina
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Enrico Morello
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Vera Radici
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Eugenia Accorsi Buttini
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Federica Colnaghi
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Simona Bernardi
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
- Centro di Ricerca Ematologico – Associazione Italiana per la Lotta alle Leucemie, Linfomi e Mieloma (AIL), Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brecia, Brescia, Italy
| | - Federica Re
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
- Centro di Ricerca Ematologico – Associazione Italiana per la Lotta alle Leucemie, Linfomi e Mieloma (AIL), Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brecia, Brescia, Italy
| | - Arnaldo Caruso
- Department of Molecular and Translational Medicine, Section of Microbiology and Virology, University of Brescia Medical School, Brescia, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Domenico Russo
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
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Meschiari M, Volpi S, Faltoni M, Dolci G, Orlando G, Franceschini E, Menozzi M, Sarti M, Del Fabro G, Fumarola B, Guarneri F, Lanza P, Lorenzotti S, Saccani B, Signorini L, Van Hauwermeiren E, Gatti M, Pea F, Castelli F, Mussini C. Real-life experience with compassionate use of cefiderocol for difficult-to-treat resistant Pseudomonas aeruginosa (DTR-P) infections. JAC Antimicrob Resist 2021; 3:dlab188. [PMID: 34909691 PMCID: PMC8665210 DOI: 10.1093/jacamr/dlab188] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To describe our real-life experience with cefiderocol in XDR and difficult-to-treat resistant Pseudomonas aeruginosa (DTR-P) infections without any other available treatment options. Methods We included patients with a proven infection due to an XDR/DTR-P, who had failed on previous regimens, and were treated with cefiderocol, following them prospectively to day 90 or until hospital discharge or death. Results Seventeen patients treated for >72 h with cefiderocol were included: 14 receiving combination regimens (82.4%) and 3 receiving monotherapy (17.6%). Fourteen patients were males (82%) with a median age of 64 years (IQR 58–73). Fifteen patients (88.2%) were admitted to the ICU and five had septic shock (29%). Seven cases (41.2%) were ventilator-associated pneumonia, of which 71% (5/7) occurred in COVID-19 patients. Four were complicated intrabdominal infections, one ecthyma gangrenosum, one nosocomial pneumonia and one empyema, one osteomyelitis, one primary bacteraemia, and one nosocomial external ventricular drainage meningitis. Clinical cure and microbiological cure rates were 70.6% and 76.5%, respectively. There were six deaths (35.3%) after a median of 8 days (IQR 3–10) from the end of treatment, but only two of them (11.7%) were associated with P. aeruginosa infection progression. Conclusions Our experience collecting this large case series of DTR-P treated with cefiderocol may help clinicians consider this new option in this hard-to-manage setting. Our results are even more relevant in the current scenario of ceftolozane/tazobactam shortage. Importantly, this is the first study providing real-life data indicating adequate cefiderocol concentrations in CSF.
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Affiliation(s)
- Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Sara Volpi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Matteo Faltoni
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Giovanni Dolci
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Gabriella Orlando
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Giovanni Del Fabro
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Benedetta Fumarola
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.,Department of Infectious Diseases, University of Brescia, Brescia, Italy
| | - Francesco Guarneri
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Paola Lanza
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Silvia Lorenzotti
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Barbara Saccani
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Liana Signorini
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Evelyn Van Hauwermeiren
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Milo Gatti
- SSD Clinical Pharmacology, Alma Mater Studiorum, University of Bologna, University Hospital IRCCS Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Federico Pea
- SSD Clinical Pharmacology, Alma Mater Studiorum, University of Bologna, University Hospital IRCCS Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.,Department of Infectious Diseases, University of Brescia, Brescia, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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5
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Signorini L, Moioli G, Calza S, Van Hauwermeiren E, Lorenzotti S, Del Fabro G, Renisi G, Lanza P, Saccani B, Zambolin G, Latronico N, Castelli F, Cattaneo S, Marshall JC, Matteelli A, Piva S. Epidemiological and Clinical Characterization of Superinfections in Critically Ill Coronavirus Disease 2019 Patients. Crit Care Explor 2021; 3:e0430. [PMID: 34136819 PMCID: PMC8202543 DOI: 10.1097/cce.0000000000000430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
To describe the epidemiology of superinfections (occurring > 48 hr after hospital admission) and their impact on the ICU and 28-day mortality in patients with coronavirus disease 2019 with acute respiratory distress syndrome, requiring mechanical ventilation. DESIGN Retrospective analysis of prospectively collected observational data. SETTING University-affiliated adult ICU. PATIENTS Ninety-two coronavirus disease 2019 patients admitted to the ICU from February 21, 2020, to May 6, 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The prevalence of superinfection at ICU admission was 21.7%, and 53 patients (57.6%) had at least one superinfection during ICU stay, with a total of 75 (82%) ventilator-associated pneumonia and 57 (62%) systemic infections. The most common pathogens responsible for ventilator-associated pneumonia were Pseudomonas aeruginosa (n = 26, 34.7%) and Stenotrophomonas maltophilia (n = 14, 18.7%). Bloodstream infection occurred in 16 cases, including methicillin-resistant Staphylococcus epidermidis (n = 8, 14.0%), Enterococcus species (n = 6, 10.5%), and Streptococcus species (n = 2, 3.5%). Fungal infections occurred in 41 cases, including 36 probable (30 by Candida albicans, six by C. nonalbicans) and five proven invasive candidiasis (three C. albicans, two C. nonalbicans). Presence of bacterial infections (odds ratio, 10.53; 95% CI, 2.31-63.42; p = 0.005), age (odds ratio, 1.17; 95% CI, 1.07-1.31; p = 0.001), and the highest Sequential Organ Failure Assessment score (odds ratio, 1.27; 95% CI, 1.06-1.63; p = 0.032) were independently associated with ICU or 28-day mortality. CONCLUSIONS Prevalence of superinfections in coronavirus disease 2019 patients requiring mechanical ventilation was high in this series, and bacterial superinfections were independently associated with ICU or 28-day mortality (whichever comes first).
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Affiliation(s)
- Liana Signorini
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
| | - Giovanni Moioli
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
| | | | - Evelyn Van Hauwermeiren
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
| | - Silvia Lorenzotti
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
| | - Giovanni Del Fabro
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
| | - Giulia Renisi
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
| | - Paola Lanza
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
| | - Barbara Saccani
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
| | - Giulia Zambolin
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Francesco Castelli
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sergio Cattaneo
- Division of Cardio-Thoracic Intensive Care, ASST Spedali Civili, Brescia, Italy
| | - John C Marshall
- Li Ka Shing Knowledge Institute, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - Alberto Matteelli
- Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
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6
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Toniati P, Piva S, Cattalini M, Garrafa E, Regola F, Castelli F, Franceschini F, Airò P, Bazzani C, Beindorf EA, Berlendis M, Bezzi M, Bossini N, Castellano M, Cattaneo S, Cavazzana I, Contessi GB, Crippa M, Delbarba A, De Peri E, Faletti A, Filippini M, Filippini M, Frassi M, Gaggiotti M, Gorla R, Lanspa M, Lorenzotti S, Marino R, Maroldi R, Metra M, Matteelli A, Modina D, Moioli G, Montani G, Muiesan ML, Odolini S, Peli E, Pesenti S, Pezzoli MC, Pirola I, Pozzi A, Proto A, Rasulo FA, Renisi G, Ricci C, Rizzoni D, Romanelli G, Rossi M, Salvetti M, Scolari F, Signorini L, Taglietti M, Tomasoni G, Tomasoni LR, Turla F, Valsecchi A, Zani D, Zuccalà F, Zunica F, Focà E, Andreoli L, Latronico N. Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev 2020; 19:102568. [PMID: 32376398 PMCID: PMC7252115 DOI: 10.1016/j.autrev.2020.102568] [Citation(s) in RCA: 541] [Impact Index Per Article: 135.3] [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: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
A hyperinflammatory syndrome (HIS) may cause a life-threatening acute respiratory distress syndrome (ARDS) in patients with COVID-19 pneumonia. A prospective series of 100 consecutive patients admitted to the Spedali Civili University Hospital in Brescia (Italy) between March 9th and March 20th with confirmed COVID-19 pneumonia and ARDS requiring ventilatory support was analyzed to determine whether intravenous administration of tocilizumab (TCZ), a monoclonal antibody that targets the interleukin 6 (IL-6) receptor, was associated with improved outcome. Tocilizumab was administered at a dosage of 8 mg/kg by two consecutive intravenous infusions 12 h apart. A third infusion was optional based on clinical response. The outcome measure was an improvement in acute respiratory failure assessed by means of the Brescia COVID Respiratory Severity Score (BCRSS 0 to 8, with higher scores indicating higher severity) at 24-72 h and 10 days after tocilizumab administration. Out of 100 treated patients (88 M, 12 F; median age: 62 years), 43 received TCZ in the intensive care unit (ICU), while 57 in the general ward as no ICU beds were available. Of these 57 patients, 37 (65%) improved and suspended noninvasive ventilation (NIV) (median BCRSS: 1 [IQR 0-2]), 7 (12%) patients remained stable in NIV, and 13 (23%) patients worsened (10 died, 3 were admitted to ICU). Of the 43 patients treated in the ICU, 32 (74%) improved (17 of them were taken off the ventilator and were discharged to the ward), 1 (2%) remained stable (BCRSS: 5) and 10 (24%) died (all of them had BCRSS≥7 before TCZ). Overall at 10 days, the respiratory condition was improved or stabilized in 77 (77%) patients, of whom 61 showed a significant clearing of diffuse bilateral opacities on chest x-ray and 15 were discharged from the hospital. Respiratory condition worsened in 23 (23%) patients, of whom 20 (20%) died. All the patients presented with lymphopenia and high levels of C-reactive protein (CRP), fibrinogen, ferritin and IL-6 indicating a HIS. During the 10-day follow-up, three cases of severe adverse events were recorded: two patients developed septic shock and died, one had gastrointestinal perforation requiring urgent surgery and was alive at day 10. In conclusion, our series showed that COVID-19 pneumonia with ARDS was characterized by HIS. The response to TCZ was rapid, sustained, and associated with significant clinical improvement.
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Affiliation(s)
- Paola Toniati
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Simone Piva
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Cattalini
- Pediatric Rheumatology, Children's Hospital, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emirena Garrafa
- Department of Laboratory Diagnostics, ASST Spedali Civili, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesca Regola
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Franco Franceschini
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Airò
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Chiara Bazzani
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Eva-Andrea Beindorf
- Division of Anesthesiology and Critical Care Medicine, Montichiari Hospital, ASST Spedali Civili, Brescia, Italy
| | | | - Michela Bezzi
- Division of Endoscopic Pneumology, ASST Spedali Civili, Brescia, Italy
| | - Nicola Bossini
- Division of Nephrology and Dialysis, ASST Spedali Civili, Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Internal Medicine and Endocrinology, ASST Spedali Civili, Brescia, Italy
| | - Sergio Cattaneo
- Division of Cardio-Thoracic Intensive Care, ASST Spedali Civili, Brescia, Italy
| | - Ilaria Cavazzana
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | | | - Massimo Crippa
- Division of Internal Medicine, Gardone Val Trompia Hospital, ASST Spedali Civili, Brescia, Italy
| | - Andrea Delbarba
- University Division of Internal Medicine and Endocrinology, ASST Spedali Civili, Brescia, Italy
| | - Elena De Peri
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Angela Faletti
- Division of Anesthesiology and Critical Care Medicine, Gardone Val Trompia Hospital, ASST Spedali Civili, Brescia, Italy
| | - Matteo Filippini
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Matteo Filippini
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Micol Frassi
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Mario Gaggiotti
- Division of Nephrology and Dialysis, ASST Spedali Civili, Brescia, Italy
| | - Roberto Gorla
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Michael Lanspa
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Silvia Lorenzotti
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Rosa Marino
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; University Division of Diagnostic Radiology, ASST Spedali Civili, Brescia, Italy
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Division of Cardiology, ASST Spedali Civili, Brescia, Italy
| | - Alberto Matteelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Denise Modina
- Division of Pneumology, ASST Spedali Civili, Brescia, Italy
| | - Giovanni Moioli
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Giovanni Montani
- Third Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Maria-Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Silvia Odolini
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Elena Peli
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Silvia Pesenti
- Division of Gastroenterology, ASST Spedali Civili, Brescia, Italy
| | - Maria-Chiara Pezzoli
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Ilenia Pirola
- University Division of Internal Medicine and Endocrinology, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Pozzi
- Division of Gastroenterology, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Proto
- Division of Internal Medicine, Gardone Val Trompia Hospital, ASST Spedali Civili, Brescia, Italy
| | - Francesco-Antonio Rasulo
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Renisi
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Chiara Ricci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Division of Gastroenterology, ASST Spedali Civili, Brescia, Italy
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Internal Medicine, Montichiari Hospital, ASST Spedali Civili, Brescia, Italy
| | - Giuseppe Romanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Geriatric Internal Medicine, Montichiari Hospital, ASST Spedali Civili, Brescia, Italy
| | - Mara Rossi
- Third Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Francesco Scolari
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Division of Nephrology and Dialysis, ASST Spedali Civili, Brescia, Italy
| | - Liana Signorini
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Marco Taglietti
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Gabriele Tomasoni
- First Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Lina-Rachele Tomasoni
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Fabio Turla
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Davide Zani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Zuccalà
- First Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Fiammetta Zunica
- Pediatric Rheumatology, Children's Hospital, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emanuele Focà
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Latronico
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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Torti C, Raffetti E, Donato F, Castelli F, Maggiolo F, Angarano G, Mazzotta F, Gori A, Sighinolfi L, Pan A, Cauda R, Scalzini A, Quiros-Roldan E, Nasta P, Gregis G, Benatti S, Digiambenedetto S, Ladisa N, Giralda M, Saracino A, Castelnuovo F, Di Pietro M, Lo Caputo S, Lapadula G, Costarelli S, Lorenzotti S, Mazzini N, Paraninfo G, Casari S, Focà E, Pezzoli C, Fabbiani M, Monno L, Pierotti P, Ble C, Leone S, Postorino MC, Fornabaio C, Zacchi F, Zoncada A, Carosi G. Cohort Profile: Standardized Management of Antiretroviral Therapy Cohort (MASTER Cohort). Int J Epidemiol 2018; 46:e12. [PMID: 26445966 DOI: 10.1093/ije/dyv192] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 12/14/2022] Open
Affiliation(s)
- Carlo Torti
- Unità di Malattie Infettive e Tropicali, Dipartimento di Scienze Mediche e Chirurgiche, Università Magna Grecia di Catanzaro, Catanzaro, Italia
| | - Elena Raffetti
- Unità di Igiene, Epidemiologia e Sanità Pubblica, Università degli Studi di Brescia, Brescia, Italia
| | - Francesco Donato
- Unità di Igiene, Epidemiologia e Sanità Pubblica, Università degli Studi di Brescia, Brescia, Italia
| | - Francesco Castelli
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Franco Maggiolo
- Malattie Infettive Ospedale Papa Giovanni XXIII, Bergamo, Italia
| | | | | | - Andrea Gori
- Malattie Infettive Ospedale San Gerardo di Monza, Monza, Italia
| | - Laura Sighinolfi
- Malattie Infettive Nuovo Polo Ospedaliero di Cona, Ferrara, Italia
| | - Angelo Pan
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Roberto Cauda
- Clinica di Malattie Infettive Policlinico A. Gemelli-Università Cattolica di Roma, Roma, Italia
| | - Alfredo Scalzini
- Divisione Ospedaliera di Malattie Infettive Spedali Civili, Brescia, Italia and
| | - Eugenia Quiros-Roldan
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Paola Nasta
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | | | - Simone Benatti
- Malattie Infettive Ospedale Papa Giovanni XXIII, Bergamo, Italia
| | - Simona Digiambenedetto
- Clinica di Malattie Infettive Policlinico A. Gemelli-Università Cattolica di Roma, Roma, Italia
| | | | - Mariarosaria Giralda
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | | | - Filippo Castelnuovo
- Divisione Ospedaliera di Malattie Infettive Spedali Civili, Brescia, Italia and
| | | | | | | | | | | | - Nicola Mazzini
- Fondazione Malattie Infettive e Salute Internazionale, Brescia, Italia
| | - Giuseppe Paraninfo
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Salvatore Casari
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Emanuele Focà
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Chiara Pezzoli
- Divisione Universitaria di Malattie Infettive Spedali Civili di Brescia-Università degli Studi di Brescia, Brescia, Italia
| | - Massimiliano Fabbiani
- Clinica di Malattie Infettive Policlinico A. Gemelli-Università Cattolica di Roma, Roma, Italia
| | - Laura Monno
- Clinica di Malattie Infettive Policlinico di Bari, Bari, Italia
| | | | - Claudio Ble
- Malattie Infettive S.M. Annunziata, Firenze, Italia
| | | | - Maria Concetta Postorino
- Unità di Malattie Infettive e Tropicali, Dipartimento di Scienze Mediche e Chirurgiche, Università Magna Grecia di Catanzaro, Catanzaro, Italia
| | - Chiara Fornabaio
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Fabio Zacchi
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Alessia Zoncada
- Malattie Infettive Istituti Ospitalieri di Cremona, Cremona, Italia
| | - Giampiero Carosi
- Fondazione Malattie Infettive e Salute Internazionale, Brescia, Italia
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Postorino MC, Quiros-Roldan E, Maggiolo F, Di Giambenedetto S, Ladisa N, Lapadula G, Lorenzotti S, Sighinolfi L, Castelnuovo F, Di Pietro M, Gotti D, Mazzini N, Torti C. Exploratory Analysis for the Evaluation of Estimated Glomerular Filtration Rate, Cholesterol and Triglycerides after Switching from Tenofovir/Emtricitabine plus Atazanavir/Ritonavir (ATV/r) to Abacavir/Lamivudine plus ATV/r in Patients with Preserved Renal Function. Open AIDS J 2016; 10:136-43. [PMID: 27563366 PMCID: PMC4968049 DOI: 10.2174/1874613601610010136] [Citation(s) in RCA: 4] [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: 01/15/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Renal toxicity due to tenofovir (TDF) has been largely described in patients with HIV infection. However, other antiretroviral drugs (such as atazanavir [ATV], especially when boosted by ritonavir, ATV/r) could perpetuate some degrees of renal impairment with or without TDF co-administration. Also, possible benefits of stopping TDF in patients without renal diseases is not well known. This study aimed at exploring evolution of renal function and lipid profile after switching from tenofovir/emtricitabine (TDF/FTC) to abacavir/lamivudine (ABC/3TC), maintaining the ATV/r component of the regimen. METHODS Patients in the Italian MASTER Cohort, who switched from TDF/FTC plus ATV/r to ABC/3TC plus ATV/r were included, provided that major renal diseases were not diagnosed before switching (i.e., baseline). Serum creatinine, estimated glomerular filtration rate (eGFR), total cholesterol, HDL and triglycerides were evaluated at baseline and at month 18 after switching. RESULTS 126 patients were selected (80% males). Patients were mostly Italians (92%). 79% had undetectable HIV-RNA and 44% were co-infected by HBV and/or HCV. Median age at switch was 47 years (IQR 43-55). A small but significant decrease in serum creatinine [from 1.06 mg/dl (SD: 0.3) to 0.94 mg/dl (SD: 0.2); p<0.001] with an improvement in eGFR [from 86.8 ml/min (SD: 33) to 96.4 ml/min (SD: 37); p<0.001] were observed in per protocol analysis at month 18. Also ITT analysis showed a decrease in mean serum creatinine [from 1.08 mg/dl (SD: 0.35) to 0.95 mg/dl (SD: 0.24); p<0.001] with an improvement in mean eGFR [from 86.9 ml/min/1.73m2 (SD: 24.11) to 95.8 ml/min/1.73m2 (SD: 19.99); p<0.001]. Total cholesterol increased [from 188 mg/dl (SD: 42) to 206 mg/dl (SD: 44); p<0.001] but also HDL increased as well [from 46 mg/dl (SD: 14) to 54 mg/dl (SD: 19); p=0.015]. An increase in triglycerides concentration was observed [from 162 mg/dl (SD: 144) to 214 mg/dl (SD: 109); p=0.027] in per protocol analysis. Also ITT analysis showed increases of both total cholesterol [from 187 mg/dl (SD: 43.69) to 203 mg/dl (SD: 44.10); p<0.001] and HDL fraction [from 46 mg/dl (SD: 15.49) to 52 mg/dl (SD: 17.13); p=0.002] at month 18. CONCLUSION This analysis reports an improvement in eGFR and an increase in total cholesterol and HDL fraction at month 18 after switching to ABC/3TC plus ATV/r. Given the fact that renal function was not significantly affected at baseline, our findings may suggest the utility of a proactive switch from TDF to ABC, when otherwise indicated, in patients who cannot avoid using a nucleoside backbone.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Daria Gotti
- Infectious and Tropical Diseases Institute, University of Brescia, Brescia, Italy
| | | | - Carlo Torti
- Unit of Infectious and Tropical Diseases, University “Magna Graecia” Catanzaro, Italy
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Pan A, Lorenzotti S, Ferrari L, Granata L, Signorini L, Carnevale G. Low Rates of Nasal Colonization With Methicillin-Resistant Staphylococcus aureus Among Staff Members of an Italian Hospital. Infect Control Hosp Epidemiol 2016; 27:218-20. [PMID: 16566080 DOI: 10.1086/501152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Pan A, Mondello P, Posfay-Barbe K, Catenazzi P, Grandi A, Lorenzotti S, Patroni A, Poli N, Soavi L, Carnevale G. Hand Hygiene and Glove Use Behavior in an Italian Hospital. Infect Control Hosp Epidemiol 2015; 28:1099-102. [DOI: 10.1086/518457] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 11/22/2006] [Indexed: 11/03/2022]
Abstract
In an Italian hospital, we observed that hand hygiene was performed in 638 (19.6%) of 3,253 opportunities, whereas gloves were worn in 538 (44.2%) 1,218 of opportunities. We observed an inverse correlation between the intensity of care and the rate of hand hygiene compliance (R2=0.057; P<.001), but no such association was observed for the rate of glove use compliance (R2 = 0.014; P = .078). Rates of compliance with hand hygiene and glove use recommendations follow different behavioral patterns.
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11
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Postorino MC, Prosperi M, Quiros-Roldan E, Maggiolo F, Di Giambenedetto S, Saracino A, Costarelli S, Lorenzotti S, Sighinolfi L, Di Pietro M, Torti C. Use of efavirenz or atazanavir/ritonavir is associated with better clinical outcomes of HAART compared to other protease inhibitors: routine evidence from the Italian MASTER Cohort. Clin Microbiol Infect 2014; 21:386.e1-9. [PMID: 25595708 DOI: 10.1016/j.cmi.2014.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/08/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
Randomized trials and observational cohorts reported higher rates of virological suppression after highly active antiretroviral therapy (HAART) including efavirenz (EFV), compared with boosted protease inhibitors (PIs). Correlations with immunological and clinical outcomes are unclear. Patients of the Italian MASTER cohort who started HAART from 2000 to 2010 were selected. Outstanding outcome (composite outcome for success (COS)) was introduced. We evaluated predictors of COS (no AIDS plus CD4+ count >500/mm(3)plus HIV-RNA <500 copies/mL) and of eight single outcomes either at month 6 or at year 3. Multivariable logistic regression was conducted. There were 6259 patients selected. Patients on EFV (43%) were younger, had greater CD4+ count, presented with AIDS less frequently, and more were Italians. At year 3, 90% of patients had HIV RNA <500 copies/mL, but only 41.4% were prescribed EFV, vs. 34.1% prescribed boosted PIs achieved COS (p <0.0001). At multivariable analysis, patients on lopinavir/ritonavir had an odds ratio of 0.70 for COS at year 3 (p <0.0001). Foreign origin and positive hepatitis C virus-Ab were independently associated with worse outcome (OR 0.54, p <0.0001 and OR 0.70, p 0.01, respectively). Patients on boosted PIs developed AIDS more frequently either at month 6 (13.8% vs. 7.6%, p <0.0001) or at year 3 (17.1% vs. 13.8%, p <0.0001). At year 3, deaths of patients starting EFV were 3%, vs. 5% on boosted PIs (p 0.008). In this study, naïve patients on EFV performed better than those on boosted PIs after adjustment for imbalances at baseline. Even when virological control is achieved, COS is relatively rare. Hepatitis C virus-positive patients and those of foreign origin are at risk of not obtaining COS.
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Affiliation(s)
- M C Postorino
- Infectious Diseases Unit, "Magna Graecia" University, Catanzaro, Italy
| | - M Prosperi
- University of Manchester, Manchester, UK
| | - E Quiros-Roldan
- Infectious and Tropical Diseases Institute, University of Brescia, Brescia, Italy
| | | | | | | | | | | | | | - M Di Pietro
- "S. M. Annunziata" Hospital ASL Florence, Bagno a Ripoli, Florence, Italy
| | - C Torti
- Infectious Diseases Unit, "Magna Graecia" University, Catanzaro, Italy; Infectious and Tropical Diseases Institute, University of Brescia, Brescia, Italy.
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Pan A, Bombana E, Tura G, Curti C, Lorenzotti S, Mondello P, Patroni A, Tacconelli E, Rigobello V, Signorini L, Vizio M, Goglio A. A survey of methicillin-resistant Staphylococcus aureus control strategies in Italy. Infection 2013; 41:783-9. [PMID: 23543436 DOI: 10.1007/s15010-013-0454-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 03/19/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Data regarding the implementation of state-of-the-art methicillin-resistant Staphylococcus aureus (MRSA) control procedures in Italy are lacking. There is a need to evaluate compliance with MRSA recommendations (CR) in Italian hospitals. METHODS A 67-question closed-answer survey was sent to all Italian hospitals, in order to analyze and evaluate program consistency with CR [hand hygiene (HH), contact precautions, screening of high-risk patients, decolonization, feedback on surveillance data, and antimicrobial guidelines and education programs]. RESULTS 205 hospitals, which account for 42 % of national admissions, returned questionnaires. 131 hospitals (64 %) did not have written MRSA control guidelines. Hospitals reported the following levels of compliance with CR: (1) HH: 67 hospitals (33 %); (2) contact precautions: 33 (16 %); (3) MRSA screening: 66 (32 %); (4) MRSA decolonization: 42 (20 %); (5) surveillance data feedback: 87 (43 %); and (6) antimicrobial guidelines and education programs: 41 (20 %). One hospital (0.5 % of responses) had implemented all recommendations and 28 hospitals (14 %) had implemented four or five recommendations. 31 % of hospitals surveyed had implemented none. Multivariate analysis showed that the only factor identified as being associated with the implementation of MRSA control recommendations was the number of meetings/year of the infection control team (ICT) (p = 0.004). CONCLUSIONS Written MRSA control guidelines are available in only one-third of Italian facilities. An organized system, with ≥4 interventions, has been implemented in just 1 out of 7 hospitals. HH programs and ICT activity are related to better MRSA control. In Italy, there is significant opportunity for improvement in MRSA control.
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Affiliation(s)
- A Pan
- Divisione di Malattie Infettive e Tropicali, Istituti Ospitalieri di Cremona, Largo Priori, 1, 26100, Cremona, Italy.
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Pan A, Battisti A, Zoncada A, Bernieri F, Boldini M, Franco A, Giorgi M, Iurescia M, Lorenzotti S, Martinotti M, Monaci M, Pantosti A. Community-acquired methicillin-resistant Staphylococcus aureus ST398 infection, Italy. Emerg Infect Dis 2009; 15:845-7. [PMID: 19402995 PMCID: PMC2687035 DOI: 10.3201/eid1505.081417] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Pan A, Domenighini F, Signorini L, Assini R, Catenazzi P, Lorenzotti S, Patroni A, Carosi G, Guerrini G. Adherence to hand hygiene in an Italian long-term care facility. Am J Infect Control 2008; 36:495-7. [PMID: 18786454 DOI: 10.1016/j.ajic.2007.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 10/09/2007] [Accepted: 10/11/2007] [Indexed: 10/21/2022]
Abstract
In an Italian long-term-care facility (LTCF), we observed a 17.5% adherence to hand hygiene (HH), as well as 47.5% rate of glove use. Performing a procedure at high risk for cross-transmission of germs was the factor most strongly associated with noncompliance (odds ratio = 13.3; 95% confidence interval = 6.2 to 28.8; P < .0001). No significant differences in compliance related to health care worker category were found. Adherence to HH in the LTCF was similar to that found in a rehabilitation medicine unit of an acute care hospital (15.8%) but significantly lower than that reported in an infectious disease unit (53.7%; P < .0001). Our findings indicate that compliance with HH is a similar problem in LTCFs as in acute care facilities.
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Pan A, Lorenzotti S, Zoncada A. Registered and investigational drugs for the treatment of methicillin-resistant Staphylococcus aureus infection. ACTA ACUST UNITED AC 2008; 3:10-33. [PMID: 18221183 DOI: 10.2174/157489108783413173] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
First isolated in the 1960s methicillin-resistant Staphylococcus aureus (MRSA) has become a leading hospital acquired (HA) pathogen, although community acquired isolates (CA-MRSA) are on the rise, particularly in the USA. Treatment of serious MRSA infections has been based for many years upon the use of glycopeptides, i.e. vancomycin and teicoplanin. Other drugs indicated in particular clinical settings, such as prosthetic valve endocarditis or osteomyelitis, are rifampin, gentamycin, fusidic acid, minocycline, co-trimoxazole, clindamycin. Quinolones and doxycycline may be active on some MRSA isolates, and add some this important clinical setting. In the last few years new anti-MRSA drugs have been registered and patented, expanding therapeutic opportunities, i.e. linezolid, the first oxazolidinone, available both as oral and parenteral formulation in being the most widely used new anti-MRSA agent, quinupristin-dalfopristin, daptomycin, a novel lipopeptide, active on germs both in the replicating and in the resting phase, and tigecycline, the first approved glycylcycline. Other drugs from different classes are in the pipeline and will further enhance in the next few years our therapeutic armamentarium: three glycopeptides, i.e. dalbavancin, telavancin, and oritavancin, two broad spectrum cephalosporins, ceftobiprole and ceftaroline, iclaprim, a diaminopyrimidine, as well as a carbapenem, CS-023/RO-4908463, and adjuvant therapies such as the monoclonal antibody tefibazumab.
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Affiliation(s)
- Angelo Pan
- Divisione di Malattie Infettive, Istituti Ospitalieri di Cremona, Cremona, Italy.
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Pan A, Soavi L, Mondello P, Catenazzi P, Lorenzotti S, Signorini L, Testa S, Carnevale G, Carosi G. P1313 Topical treatment with mupirocine/chlorexydine and long-term risk of methicillin-resistant Staphylococcus aureus infection. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71153-6] [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: 10/23/2022]
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Pan A, Ambrosini L, Lorenzotti S, Soavi L, Signorini L. R2247 Adherence to surgical site infection guidelines in Italian heart surgery units. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)72086-1] [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: 10/23/2022]
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Pea F, Furlanut M, Stellini R, Bonardelli S, Signorini L, Pavan F, Matheis A, Portolani N, Lorenzotti S, Giulini SM, Viale P, Carosi G. Pharmacokinetic–pharmacodynamic aspects of antimicrobial prophylaxis with teicoplanin in patients undergoing major vascular surgery. Int J Antimicrob Agents 2006; 27:15-9. [PMID: 16343858 DOI: 10.1016/j.ijantimicag.2005.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/21/2005] [Accepted: 09/09/2005] [Indexed: 10/25/2022]
Abstract
A prospective, two-arm, open study assessing plasma exposure to teicoplanin with two different prophylactic regimens (Group A (n = 23), 800 mg pre-operatively versus Group B (n = 24), 400 mg pre-operatively plus two doses of 200 mg 24 h apart) was carried out in patients undergoing major vascular surgery. The intent was to define the feasibility and the possible advantages of the single pre-operative high dose in ensuring therapeutically effective plasma concentrations (>10 mg/L) of teicoplanin even during long-lasting operations. At the end of the intervention, mean teicoplanin concentrations (+/-S.D.) were 14.05 +/- 5.13 mg/L and 5.39 +/- 2.13 mg/L in Groups A and B, respectively. At 24 h, average teicoplanin levels were 5.10 +/- 1.25 mg/L and 2.08 +/- 0.73 mg/L in Groups A and B, respectively; at 48 h they declined to 2.86 +/- 0.70 mg/L in Group A, whereas they rose to 2.67 +/- 0.82 mg/L after administration of 2.63 +/- 0.51 mg/kg at 24 h in Group B. Single pre-operative high-dose teicoplanin may ensure effective plasma levels even in cases of very long-lasting operations (>8 h) with no need for intraoperative re-dosing and may enable more appropriate prophylactic exposure than that achievable with the same total dose given in three administrations 24 h apart.
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Affiliation(s)
- Federico Pea
- Institute of Clinical Pharmacology & Toxicology, Department of Experimental and Clinical Pathology and Medicine, Medical School, University of Udine, Italy.
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