Nosocomial infections caused by Clostridium difficile, CP-Kp, ESBL-E or Candida spp. are usually associated with a high mortality rate. In this retrospective study, we evaluated the association between the patient characteristics and the risk of development of nosocomial BSI due to Candida or CP-Kp or ESBL-E. Moreover, we described the cumulative incidence of recurrent infections according to each group of nosocomial BSI. Enteral or parenteral nutrition and indwelling CVC at time of diagnosis were associated with an increased risk of candidemia or CP-Kp over ESBL-E and CDI. ESBL-E BSI was higher in patients undergoing hemodialysis, hematological stem cell transplant and neutropenic patients. The cumulative incidence for recurrent infections was higher for CP-Kp BSI and lower for candidemia. Our data highlight a different role of single patient comorbidities in the development of infections and the higher incidence of recurrent infections in CP-Kp BSI.

Cumulative incidence

10.1080/1120009x.2019.1669275

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Antibiotic De-escalation Experience in the Setting of Emergency Department: A Retrospective, Observational Study

Journal of Clinical Medicine (2021)

Silvia Corcione Simone Mornese Pinna Tommaso Lupia Alice Trentalange Erika Germanò

Background: Antimicrobial de-escalation (ADE) is a part of antimicrobial stewardship strategies aiming to minimize unnecessary or inappropriate antibiotic exposure to decrease the rate of antimicrobial resistance. Information regarding the effectiveness and safety of ADE in the setting of emergency medicine wards (EMW) is lacking. Methods: Adult patients admitted to EMW and receiving empiric antimicrobial treatment were retrospectively studied. The primary outcome was the rate and timing of ADE. Secondary outcomes included factors associated with early ADE, length of stay, and in-hospital mortality. Results: A total of 336 patients were studied. An initial regimen combining two agents was prescribed in 54.8%. Ureidopenicillins and carbapenems were the most frequently empiric treatment prescribed (25.1% and 13.6%). The rate of the appropriateness of prescribing was 58.3%. De-escalation was performed in 111 (33%) patients. Patients received a successful de-escalation on day 2 (21%), 3 (23%), and 5 (56%). The overall in-hospital mortality was 21%, and it was significantly lower among the de-escalation group than the continuation group (16% vs 25% p = 0.003). In multivariate analysis, de-escalation strategies as well as appropriate empiric and targeted therapy were associated with reduced mortality. Conclusions: ADE appears safe and effective in the setting of EMWs despite that further research is warranted to confirm these findings.

De-escalation

Antimicrobial Stewardship

Regimen

10.3390/jcm10153285

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An Observational Study of MDR Hospital-Acquired Infections and Antibiotic Use during COVID-19 Pandemic: A Call for Antimicrobial Stewardship Programs

Antibiotics (2022)

Nour Shbaklo Silvia Corcione Costanza Vicentini Susanna Giordano D. C. Fiorentino

The pandemic caused by the COVID-19 virus has required major adjustments to healthcare systems, especially to infection control and antimicrobial stewardship. The objective of this study was to describe the incidence of multidrug-resistant (MDR) hospital-acquired infections (HAIs) and antibiotic consumption during the three waves of COVID-19 and to compare it to the period before the outbreak at Molinette Hospital, located in the City of Health and Sciences, a 1200-bed teaching hospital with surgical, medical, and intensive care units. We demonstrated an increase in MDR infections: particularly in K. pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp), A. baumannii, and MRSA. Fluoroquinolone use showed a significant increasing trend in the pre-COVID period but saw a significant reduction in the COVID period. The use of fourth- and fifth-generation cephalosporins and piperacillin–tazobactam increased at the beginning of the COVID period. Our findings support the need for restoring stewardship and infection control practices, specifically source control, hygiene, and management of invasive devices. In addition, our data reveal the need for improved microbiological diagnosis to guide appropriate treatment and prompt infection control during pandemics. Despite the infection control practices in place during the COVID-19 pandemic, invasive procedures in critically ill patients and poor source control still increase the risk of HAIs caused by MDR organisms.

Pandemic

Antimicrobial Stewardship

Stewardship

10.3390/antibiotics11050695

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Citations (31)

Viable heterotrophic bacteria in water and sediment in ‘Mar Piccolo’ of Taranto (Ionian Sea, Italy)

Journal of Applied Microbiology (1999)

Rossana Cavallo Cláudia de Castro Rizzi T. Vozza Loredana Stabili

Journal Article Viable heterotrophic bacteria in water and sediment in 'Mar Piccolo' of Taranto (Ionian Sea, Italy) Get access R. A. Cavallo, R. A. Cavallo Istituto Sperimentale Talassografico 'A. Cerruti' CNR, Taranto, Italy Search for other works by this author on: Oxford Academic Google Scholar C. Rizzi, C. Rizzi Istituto Sperimentale Talassografico 'A. Cerruti' CNR, Taranto, Italy Search for other works by this author on: Oxford Academic Google Scholar T. Vozza, T. Vozza Istituto Sperimentale Talassografico 'A. Cerruti' CNR, Taranto, Italy Search for other works by this author on: Oxford Academic Google Scholar L. Stabili L. Stabili Istituto Sperimentale Talassografico 'A. Cerruti' CNR, Taranto, Italy Search for other works by this author on: Oxford Academic Google Scholar Journal of Applied Microbiology, Volume 86, Issue 6, 1 June 1999, Pages 906–916, https://doi.org/10.1046/j.1365-2672.1999.00767.x Published: 01 June 1999 Article history Received: 02 November 1998 Revision received: 21 January 1999 Accepted: 26 January 1999 Published: 01 June 1999

10.1046/j.1365-2672.1999.00767.x

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Safety and outcomes of routine endovascular thrombectomy in large artery occlusion recorded in the SITS Register: An observational study

Journal of Internal Medicine (2021)

Niaz Ahmed Michael V. Mazya Ana Paiva Nunes Tiago Moreira Jyrki Ollikainen

Abstract Background and objective We aimed to evaluate the safety and outcomes of thrombectomy in anterior circulation acute ischaemic stroke recorded in the SITS–International Stroke Thrombectomy Register (SITS‐ISTR) and compare them with pooled randomized controlled trials (RCTs) and two national registry studies. Methods We identified centres recording ≥10 consecutive patients in the SITS‐ISTR with at least 70% of available modified Rankin Scale (mRS) at 3 months during 2014–2019. We defined large artery occlusion as intracranial internal carotid artery, first and second segment of middle cerebral artery and first segment of anterior cerebral artery. Outcome measures were functional independence (mRS score 0‐2) and death at 3 months and symptomatic intracranial haemorrhage (SICH) per modified SITS‐MOST. Results Results are presented in the following order: SITS‐ISTR, RCTs, MR CLEAN Registry and German Stroke Registry (GSR). Median age was 73, 68, 71 and 75 years; baseline NIHSS score was 16, 17, 16 and 15; prior intravenous thrombolysis was 62%, 83%, 78% and 56%; onset to reperfusion time was 289, 285, 267 and 249 min; successful recanalization (mTICI score 2b or 3) was 86%, 71%, 59% and 83%; functional independence at 3 months was 45.5% (95% CI: 44–47), 46.0% (42–50), 38% (35–41) and 37% (35–41), respectively; death was 19.2% (19–21), 15.3% (12.7–18.4), 29.2% (27–32) and 28.6% (27–31); and SICH was 3.6% (3–4), 4.4% (3.0–6.4), 5.8% (4.7–7.1) and not available. Conclusion Thrombectomy in routine clinical use registered in the SITS‐ISTR showed safety and outcomes comparable to RCTs, and better functional outcomes and lower mortality than previous national registry studies.

Stroke

10.1111/joim.13302

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Citations (8)

Neutralizing antibodies against SARS-CoV-2 in cirrhotic patients waiting for liver transplantation

Journal of Hepatology (2021)

Margherita Saracco Silvia Martini Francesco Tandoi Fabrizia Pittaluga A. Ottobrelli

Donor-Specific Antibodies

2019-20 coronavirus outbreak

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