Gabriele Bianco

Azienda Ospedaliera Citta' della Salute e della Scienza di Torino

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Rossana Cavallo

University of Turin

Cristina Costa

Azienda Ospedaliera Citta' della Salute e della Scienza di Torino

Matteo Boattini

Azienda Ospedaliera Citta' della Salute e della Scienza di Torino

Sara Comini

University of Turin

Marco Iannaccone

Azienda Ospedaliera Citta' della Salute e della Scienza di Torino

Paolo Gaibani

University of Verona

Francesca Sidoti

Azienda Ospedaliera Citta' della Salute e della Scienza di Torino

Francesco Giuseppe De Rosa

University of Turin

Giuliana Banche

University of Turin

Silvia Corcione

University of Turin

Cooperative Institutions

University of Turin

109

Azienda Ospedaliera Citta' della Salute e della Scienza di Torino

Istituti di Ricovero e Cura a Carattere Scientifico

University of Bologna

Azienda Ospedaliero Universitaria San Giovanni Battista

Sapienza University of Rome

Fondazione Ricerca Molinette

Piedmont Reference Center for Epidemiology and Cancer Prevention

University of Milan

Policlinico S.Orsola-Malpighi

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Occurrence of adenovirus infection and clinical impact in paediatric stem cell transplant recipients

Microbiologia medica (2016)

Gabriele Bianco Cristina Costa Andrea Piceghello Francesca Sidoti M Giacchino

In this study, the occurrence and clinical impact of adenovirus (AdV) infection was investigated in paediatric hematopoietic stem cell transplantation (HSCT) recipients. A number of 603 specimens (including whole blood, respiratory and other samples) from 181 patients were tested by real-time polymerase chain reaction; clinical outcome was investigated. Overall, 118/603 (19.6%) specimens from 21/181 (11.6%) patients resulted positive to AdV (including 17.3, 29.9, 17.6, and 15.8% of total number of whole blood, respiratory, urine and other specimens, respectively). On whole blood specimens, viral loads ranged from <600 (limit of detection) to >5×10<sup>6</sup> copies/mL, with a median value 2×104. Multiple specimens were positive in patients in which viral load on whole blood was high. Adenoviral positivity on whole blood was associated to poor prognosis, as death occurred in three of ten (30%) patients with persistent positivity on whole blood specimens, also despite the administration of an antiviral agent (cidofovir). Adenovirus infection can account for systemic and/or organ-specific signs/symptoms in approximately 10% of paediatric HSCT recipients. At moment, there is no indication for routine monitor of AdV in these patients, although AdV aetiology of infectious transplant complications should be taken in account.

Cidofovir

Adenovirus infection

10.4081/mm.2016.5850

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Citations (0)

In vivo emergence of ceftazidime/avibactam, cefiderocol and aztreonam/avibactam cross-resistance in a patient with KPC-producing Klebsiella pneumoniae infection after Cefiderocol-based treatment

International Journal of Antimicrobial Agents (2024)

Gabriele Bianco Matteo Boattini Sara Comini Davide Gibellini Paolo Gaibani

Ceftazidime/avibactam

Aztreonam

Avibactam

10.1016/j.ijantimicag.2024.107343

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Citations (2)

From Forgotten Pathogen to Target for New Vaccines: What Clinicians Need to Know about Respiratory Syncytial Virus Infection in Older Adults

Viruses (2024)

Matteo Boattini André Almeida Sara Comini Gabriele Bianco Rossana Cavallo

Respiratory syncytial virus (RSV) is increasingly recognized as being implicated in acute illness in older adults, with a significant weight in hospitalizations for respiratory illness and death. By means of a best-evidence review, this paper aims to investigate whether RSV can be considered a forgotten pathogen in older patients, looking at trends in the literature volume and exploring possible epidemiological and clinical features underlying the focus given to it. We then present an assessment of its disease burden and present and future strategies for its reduction, particularly in light of the recent availability of new vaccines.

Respiratory illness

10.3390/v16040531

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Citations (7)

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)

IN VITRO DALBAVANCIN ACTIVITY AGAINST CLINICAL ISOLATES OF STAPHYLOCOCCUS SPP. AND SUBSEQUENT INTERACTION WITH HUMAN PHAGOCYTES

Giuliana Banche Allizond Sara Scutera Giorgia Piersigilli Es Marra

Dalbavancin

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Prevalence and mortality of ceftazidime/avibactam-resistant KPC-producing Klebsiella pneumoniae bloodstream infections (2018–2022)

European Journal of Clinical Microbiology & Infectious Diseases (2023)

Matteo Boattini Gabriele Bianco Paulo Bastos Sara Comini Silvia Corcione

Abstract Introduction Ceftazidime/avibactam-resistance in Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) is a topic of great interest for epidemiological, diagnostic, and therapeutical reasons. However, data on its prevalence and burden on mortality in patients with bloodstream infection (BSI) are lacking. This study was aimed at identifying risk factors for mortality in patients suffering from ceftazidime/avibactam-resistant KPC-Kp BSI. Methods An observational retrospective study (January 2018–December 2022) was conducted at a tertiary hospital including all consecutive hospitalized adult patients with a ceftazidime/avibactam-resistant KPC-Kp BSI. Data on baseline clinical features, management, and admission outcomes were analyzed. Results Over the study period, among all the KPC-Kp BSI events recorded, 38 (10.5%) were caused by ceftazidime/avibactam-resistant KPC-Kp strains, 37 events being finally included. The ceftazidime/avibactam-resistant KPC-Kp strains revealed susceptibility restoration to at least one carbapenem in more than 60% of cases. In-hospital and 30-day all-cause mortality rates were 22% and 16.2%, respectively. Non-survivors suffered from more baseline comorbidities and experienced a more severe ceftazidime/avibactam-resistant KPC-Kp BSI presentation (i.e., both the Pitt Bacteremia and INCREMENT-CPE scores were significantly higher). Presenting with a higher Charlson Comorbidity Index, chronic kidney disease—KDIGO stage 3A or worse—having recently gone through renal replacement therapy, having suffered from an acute kidney injury following the ceftazidime/avibactam-resistant KPC-Kp BSI, and being admitted for cardiac surgery were the strongest predictors of mortality. Conclusion Ceftazidime/avibactam resistance in KPC-Kp BSI easily emerged in our highly KPC-Kp endemic area with remarkable mortality rates. Our findings might provide physicians possibly actionable information when managing patients with a ceftazidime/avibactam-resistant KPC-Kp BSI.

Ceftazidime/avibactam

Avibactam

Bacteremia

10.1007/s10096-023-04712-8

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Citations (9)

Direct detection of extended-spectrum-β-lactamase-producers in Enterobacterales from blood cultures: a comparative analysis

European Journal of Clinical Microbiology & Infectious Diseases (2021)

Matteo Boattini Gabriele Bianco Sara Comini Marco Iannaccone Roberto Casale

Medical microbiology

Blood Culture

10.1007/s10096-021-04385-1

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Citations (13)

In vitro activity and genomic characterization of KPC-producing Klebsiella pneumoniae clinical blood culture isolates resistant to ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam: an Italian nationwide multicentre observational study (2022–23)

Journal of Antimicrobial Chemotherapy (2024)

Gabriele Bianco Matteo Boattini Laura Isabella Lupo Simone Ambretti Rita Greco

To evaluate the in vitro activity of ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam and comparators against KPC-producing Klebsiella pneumoniae (KPC-Kp) clinical isolates collected from a multicentre study in Italy (2022-23) and genomic characterization of the molecular mechanisms causing resistance. Consecutive KPC-Kp isolates from blood cultures (n = 264) were collected from 14 hospital centres in the period 2022-23. Antimicrobial susceptibility testing was performed using broth microdilution. WGS was used to investigate KPC-Kp strains resistant to the new approved β-lactam/β-lactam inhibitor combinations (BLICs). Overall, meropenem/vaborbactam (95.1% susceptible by EUCAST and 93.9% susceptible by CLSI; MIC50 = 0.5 mg/L; MIC90 = 4 mg/L) and imipenem/relebactam (97% susceptible by EUCAST and 92.8% susceptible by CLSI; MIC50 = 0.25 mg/L; MIC90 = 0.5 mg/L) showed similar activity, followed by ceftazidime/avibactam (93.9% susceptible by both EUCAST and CLSI; MIC50 = 2 mg/L; MIC90 = 8 mg/L). Ten out of 13 (76.9%) KPC-Kp resistant to ceftazidime/avibactam carried a blaKPC variant including blaKPC-31, blaKPC-205, blaKPC-203 and blaKPC-93. Among KPC-Kp resistant to meropenem/vaborbactam and imipenem/relebactam, 90.9% (10/11) and 80% (4/5) harboured a WT carbapenemase (i.e. blaKPC-2 or blaKPC-3), respectively. All strains resistant to meropenem/vaborbactam and/or imipenem/relebactam carried truncated OmpK35 and/or mutated (ins135GD) OmpK36. New BLICs were shown to be the most widely active therapeutic option against KPC-Kp clinical isolates collected in Italy. Ceftazidime/avibactam resistance is mainly driven by the expression of KPC variants, whereas the loss of function of the OmpK35 and OmpK36 porins appears to play a key but not exclusive role in the development of meropenem/vaborbactam and/or imipenem/relebactam resistance.

Ceftazidime/avibactam

Avibactam

Blood Culture

10.1093/jac/dkae450

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Occurrence of multi-carbapenemases producers among carbapenemase-producing Enterobacterales and in vitro activity of combinations including cefiderocol, ceftazidime-avibactam, meropenem-vaborbactam, and aztreonam in the COVID-19 era

European Journal of Clinical Microbiology & Infectious Diseases (2022)

Gabriele Bianco Matteo Boattini Sara Comini Roberto Casale Marco Iannaccone

Ceftazidime/avibactam

Aztreonam

Broth microdilution

Avibactam

10.1007/s10096-022-04408-5

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Citations (37)

Multicentre Evaluation of the EUCAST Rapid Antimicrobial Susceptibility Testing (RAST) Extending Analysis to 16–20 Hours Reading Time

Antibiotics (2022)

Gabriele Bianco Donatella Lombardo Guido Ricciardelli Matteo Boattini Sara Comini

The aim of the study was to evaluate the EUCAST RAST method by extending analysis to 16–20 h reading time and performance with new β-lactam/β-lactamase inhibitor combinations. A total of 676 positive blood cultures (BCs) were enrolled. Results at 4 h, 6 h, 8 h and 16–20 h were interpreted according to bacterial species using EUCAST RAST breakpoints (version 5.1). For species for which no breakpoints were available, tentative breakpoints were used. Categorical agreement with the Microscan microdilution system was analysed. Among the 676 BCs enrolled, 641 were monomicrobial and were included in the analysis. Categorical agreement ranged from 98.9% at 4 h to 99.4% at 16–20 h. The rates of very major errors were 3.3%, 3.7% and 3.4% at 4 h, 6 h and 8 h, respectively, and decreased to 1% at 16–20 h (p < 0.001). The number of major errors was low for each reading time (0.2% and 0.4% at 4 h and 6 h, respectively, and 0.3% at both 8 h and 16–20 h). The proportions of results in the area of technical uncertainty were 9.9%, 5.9%, 5% and 5.2% for readings at 4 h, 6 h, 8 h and 16–20 h, respectively. Tentative breakpoints proposed for Enterobacterales other than E.coli/K.pneumoniae and coagulase-negative staphylococci showed overall performances comparable to those observed for E. coli/K. pneumoniae and S. aureus. In conclusion, EUCAST RAST has been shown to be reliable to determine microbial susceptibility to main antimicrobials, including ceftazidime/avibactam and ceftolozane/tazobactam. A poorer performance was observed for certain species/antimicrobial agent combinations. The better performance observed at 16–20 h compared to the early readings may confer to the method greater potential for antimicrobial de-escalation interventions.

Broth microdilution

10.3390/antibiotics11101404

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Citations (9)