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1. A Machine Learning Predictive Model of Bloodstream Infection in Hospitalized Patients

Author

Murri, Rita, De Angelis, Giulia, Antenucci, Laura, Fiori, Barbara, Rinaldi, Riccardo, Fantoni, Massimo, Damiani, Andrea, Patarnello, Stefano, Sanguinetti, Maurizio, Valentini, Vincenzo, Posteraro, Brunella, Masciocchi, Carlotta, Murri, Rita (ORCID:0000-0003-4263-7854), De Angelis, Giulia (ORCID:0000-0002-7087-7399), Fiori, Barbara (ORCID:0000-0003-3318-5809), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Valentini, Vincenzo (ORCID:0000-0003-4637-6487), Posteraro, Brunella (ORCID:0000-0002-1663-7546), Murri, Rita, De Angelis, Giulia, Antenucci, Laura, Fiori, Barbara, Rinaldi, Riccardo, Fantoni, Massimo, Damiani, Andrea, Patarnello, Stefano, Sanguinetti, Maurizio, Valentini, Vincenzo, Posteraro, Brunella, Masciocchi, Carlotta, Murri, Rita (ORCID:0000-0003-4263-7854), De Angelis, Giulia (ORCID:0000-0002-7087-7399), Fiori, Barbara (ORCID:0000-0003-3318-5809), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Valentini, Vincenzo (ORCID:0000-0003-4637-6487), and Posteraro, Brunella (ORCID:0000-0002-1663-7546)

Abstract

The aim of the study was to build a machine learning-based predictive model to discriminate between hospitalized patients at low risk and high risk of bloodstream infection (BSI). A Data Mart including all patients hospitalized between January 2016 and December 2019 with suspected BSI was built. Multivariate logistic regression was applied to develop a clinically interpretable machine learning predictive model. The model was trained on 2016-2018 data and tested on 2019 data. A feature selection based on a univariate logistic regression first selected candidate predictors of BSI. A multivariate logistic regression with stepwise feature selection in five-fold cross-validation was applied to express the risk of BSI. A total of 5660 hospitalizations (4026 and 1634 in the training and the validation subsets, respectively) were included. Eleven predictors of BSI were identified. The performance of the model in terms of AUROC was 0.74. Based on the interquartile predicted risk score, 508 (31.1%) patients were defined as being at low risk, 776 (47.5%) at medium risk, and 350 (21.4%) at high risk of BSI. Of them, 14.2% (72/508), 30.8% (239/776), and 64% (224/350) had a BSI, respectively. The performance of the predictive model of BSI is promising. Computational infrastructure and machine learning models can help clinicians identify people at low risk for BSI, ultimately supporting an antibiotic stewardship approach.

Published
2024

2. Ursodeoxycholic acid does not affect the clinical outcome of SARS-CoV-2 infection: A retrospective study of propensity score-matched cohorts

Author

Marrone, Giuseppe, Covino, Marcello, Merra, Giuseppe, Piccioni, Andrea, Amodeo, Annamaria, Novelli, Angela, Murri, Rita, Pompili, Maurizio, Gasbarrini, Antonio, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Murri, Rita (ORCID:0000-0003-4263-7854), Pompili, Maurizio (ORCID:0000-0001-6699-7980), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Marrone, Giuseppe, Covino, Marcello, Merra, Giuseppe, Piccioni, Andrea, Amodeo, Annamaria, Novelli, Angela, Murri, Rita, Pompili, Maurizio, Gasbarrini, Antonio, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Murri, Rita (ORCID:0000-0003-4263-7854), Pompili, Maurizio (ORCID:0000-0001-6699-7980), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Background: Ursodeoxycholic acid (UDCA) has been recently proposed as a modulator of angiotensin-converting enzyme 2 (ACE2) receptor expression, with potential effects on COVID-19.Aim and Study Design: We retrospectively evaluated the clinical course and outcome of subjects taking UDCA admitted to the hospital for COVID-19 compared with matched infected subjects. Differences regarding the severity and outcome of the disease between treated and non-treated subjects were assessed. The Kaplan-Meier survival analysis and log-rank test were used to evaluate the effect of UDCA on all-cause intra-hospital mortality.Results: Among 6444 subjects with confirmed COVID-19 admitted to the emergency department (ED) from 1 March 2020 to 31 December 2022, 109 subjects were taking UDCA. After matching 629 subjects were included in the study: 521 in the no UDCA group and 108 in the UDCA group. In our matched cohort, 144 subjects (22.9%) died, 118 (22.6%) in the no-UDCA group and 26 (24.1%) in the UDCA group. The Kaplan-Meier analysis showed no significant difference in survival between groups. In univariate regression analysis, the presence of pneumonia, National Early Warning Score (NEWS) score, and Charlson Comorbidity Index (CCI) were significant independent predictors of death. At multivariate Cox regression analysis, age, NEWS, pneumonia and CCI index were confirmed significant independent predictors of death. UDCA treatment was not a predictor of survival both in univariate and multivariate regressions.Conclusions: UDCA treatment does not appear to have significant effects on the outcome of COVID-19. Specially designed prospective studies are needed to evaluate efficacy in preventing infection and severe disease.

Published
2024

3. Association of piperacillin/tazobactam MIC and mortality in a cohort of ceftriaxone-resistant Escherichia coli bloodstream infections treated with piperacillin/tazobactam and carbapenems: a multicentric propensity score-weighted observational cohort study

Author

Rando, Emanuele, Salvati, Federica, Sangiorgi, Flavio, Catania, Francesca, Leone, Elisa, Oliva, Alessandra, Di Gennaro, Francesco, Fiori, Barbara, Cancelli, Francesca, Figliomeni, Sara, Bobbio, Francesca, Sacco, Federica, Bavaro, Davide Fiore, Diella, Lucia, Belati, Alessandra, Saracino, Annalisa, Mastroianni, Claudio Maria, Fantoni, Massimo, Murri, Rita, Fiori, Barbara (ORCID:0000-0003-3318-5809), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Murri, Rita (ORCID:0000-0003-4263-7854), Rando, Emanuele, Salvati, Federica, Sangiorgi, Flavio, Catania, Francesca, Leone, Elisa, Oliva, Alessandra, Di Gennaro, Francesco, Fiori, Barbara, Cancelli, Francesca, Figliomeni, Sara, Bobbio, Francesca, Sacco, Federica, Bavaro, Davide Fiore, Diella, Lucia, Belati, Alessandra, Saracino, Annalisa, Mastroianni, Claudio Maria, Fantoni, Massimo, Murri, Rita, Fiori, Barbara (ORCID:0000-0003-3318-5809), Fantoni, Massimo (ORCID:0000-0001-6913-8460), and Murri, Rita (ORCID:0000-0003-4263-7854)

Abstract

Objectives To assess the impact of piperacillin/tazobactam MICs on in-hospital 30 day mortality in patients with third-generation cephalosporin-resistant Escherichia coli bloodstream infection treated with piperacillin/tazobactam, compared with those treated with carbapenems.Methods A multicentre retrospective cohort study was conducted in three large academic hospitals in Italy between 2018 and 2022. The study population comprised patients with monomicrobial third-generation cephalosporin-resistant E. coli bloodstream infection, who received either piperacillin/tazobactam or carbapenem therapy within 48 h of blood culture collection. The primary outcome was in-hospital 30 day all-cause mortality. A propensity score was used to estimate the likelihood of receiving empirical piperacillin/tazobactam treatment. Cox regression models were performed to ascertain risk factors independently associated with in-hospital 30 day mortality.Results Of the 412 consecutive patients included in the study, 51% received empirical therapy with piperacillin/tazobactam, while 49% received carbapenem therapy. In the propensity-adjusted multiple Cox model, the Pitt bacteraemia score [HR 1.38 (95% CI, 0.85-2.16)] and piperacillin/tazobactam MICs of 8 mg/L [HR 2.35 (95% CI, 1.35-3.95)] and >= 16 mg/L [HR 3.69 (95% CI, 1.86-6.91)] were significantly associated with increased in-hospital 30 day mortality, while the empirical use of piperacillin/tazobactam was not found to predict in-hospital 30 day mortality [HR 1.38 (95% CI, 0.85-2.16)].Conclusions Piperacillin/tazobactam use might not be associated with increased mortality in treating third-generation cephalosporin-resistant E. coli bloodstream infections when the MIC is <8 mg/L.

Published
2024

4. Vaccines and Myocardial Injury in Patients Hospitalized for COVID-19 Infection: the CardioCOVID-Gemelli Study

Author

Montone, Rocco Antonio, Rinaldi, Riccardo, Masciocchi, Carlotta, Lilli, Livia, Damiani, Andrea, La Vecchia, Giulia, Iannaccone, Giulia, Basile, Mattia, Salzillo, Carmine, Caff, Andrea, Bonanni, Alice, De Pascale, Gennaro, Grieco, Domenico Luca, Tanzarella, Eloisa Sofia, Buonsenso, Danilo, Murri, Rita, Fantoni, Massimo, Liuzzo, Giovanna, Sanna, Tommaso, Richeldi, Luca, Sanguinetti, Maurizio, Massetti, Massimo, Trani, Carlo, Tshomba, Yamume, Gasbarrini, Antonio, Valentini, Vincenzo, Antonelli, Massimo, Crea, Filippo, De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Grieco, Domenico Luca (ORCID:0000-0002-4557-6308), Murri, Rita (ORCID:0000-0003-4263-7854), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Liuzzo, Giovanna (ORCID:0000-0002-5714-0907), Sanna, Tommaso (ORCID:0000-0002-5760-6885), Richeldi, Luca (ORCID:0000-0001-8594-1448), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Massetti, Massimo (ORCID:0000-0002-7100-8478), Trani, Carlo (ORCID:0000-0001-9777-013X), Tshomba, Yamume (ORCID:0000-0001-7304-7553), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Valentini, Vincenzo (ORCID:0000-0003-4637-6487), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Crea, Filippo (ORCID:0000-0001-9404-8846), Montone, Rocco Antonio, Rinaldi, Riccardo, Masciocchi, Carlotta, Lilli, Livia, Damiani, Andrea, La Vecchia, Giulia, Iannaccone, Giulia, Basile, Mattia, Salzillo, Carmine, Caff, Andrea, Bonanni, Alice, De Pascale, Gennaro, Grieco, Domenico Luca, Tanzarella, Eloisa Sofia, Buonsenso, Danilo, Murri, Rita, Fantoni, Massimo, Liuzzo, Giovanna, Sanna, Tommaso, Richeldi, Luca, Sanguinetti, Maurizio, Massetti, Massimo, Trani, Carlo, Tshomba, Yamume, Gasbarrini, Antonio, Valentini, Vincenzo, Antonelli, Massimo, Crea, Filippo, De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Grieco, Domenico Luca (ORCID:0000-0002-4557-6308), Murri, Rita (ORCID:0000-0003-4263-7854), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Liuzzo, Giovanna (ORCID:0000-0002-5714-0907), Sanna, Tommaso (ORCID:0000-0002-5760-6885), Richeldi, Luca (ORCID:0000-0001-8594-1448), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Massetti, Massimo (ORCID:0000-0002-7100-8478), Trani, Carlo (ORCID:0000-0001-9777-013X), Tshomba, Yamume (ORCID:0000-0001-7304-7553), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Valentini, Vincenzo (ORCID:0000-0003-4637-6487), Antonelli, Massimo (ORCID:0000-0003-3007-1670), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

Background: Myocardial injury is prevalent among patients hospitalized for COVID-19. However, the role of COVID-19 vaccines in modifying the risk of myocardial injury is unknown. Objectives: To assess the role of vaccines in modifying the risk of myocardial injury in COVID-19. Methods: We enrolled COVID-19 patients admitted from March 2021 to February 2022 with known vaccination status and ≥1 assessment of hs-cTnI within 30 days from the admission. The primary endpoint was the occurrence of myocardial injury (hs-cTnI levels >99th percentile upper reference limit). Results: 1019 patients were included (mean age 67.7±14.8 years, 60.8% male, 34.5% vaccinated against COVID-19). Myocardial injury occurred in 145 (14.2%) patients. At multivariate logistic regression analysis, advanced age, chronic kidney disease and hypertension, but not vaccination status, were independent predictors of myocardial injury. In the analysis according to age tertiles distribution, myocardial injury occurred more frequently in the III tertile (≥76 years) compared to other tertiles (I tertile:≤60 years;II tertile:61-75 years) (p<0.001). Moreover, in the III tertile, vaccination was protective against myocardial injury (OR 0.57, CI 95% 0.34-0.94; p=0.03), while a previous history of coronary artery disease was an independent positive predictor. In contrast, in the I tertile, chronic kidney disease (OR 6.94, 95% CI 1.31-36.79, p=0.02) and vaccination (OR 4.44, 95% CI 1.28-15.34, p=0.02) were independent positive predictors of myocardial injury. Conclusions: In patients ≥76 years, COVID-19 vaccines were protective for the occurrence of myocardial injury, while in patients ≤60 years, myocardial injury was associated with previous COVID-19 vaccination. Further studies are warranted to clarify the underlying mechanisms.

Published
2024

5. Malnutrition in COVID-19 survivors: prevalence and risk factors

Author

Tosato, Matteo, Calvani, Riccardo, Ciciarello, Francesca, Galluzzo, Vincenzo, Martone, Anna Maria, Zazzara, Maria Beatrice, Pais, Cristina, Savera, Giulia, Robles, Maria Camprubi, Ramirez, Maria, Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Settanni, Carlo Romano, Porcari, Serena, Benvenuto, Francesca, Bramato, Giulia, Brandi, Vincenzo, Carfì, Angelo, Lo Monaco, Maria Rita, Marzetti, Emanuele, Napolitano, Carmen, Pagano, Francesco Cosimo, Rocchi, Sara, Rota, Elisabetta, Salerno, Andrea Maria, Tritto, Marcello, Catalano, Lucio, Picca, Anna, D’Elia, Mariaelena, Biscotti, Damiano, Cauda, Roberto, Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, Davide, Ciccullo, Arturo, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Gertrude, Zocco, Maria Assunta, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, Michela, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, Grazia Maria, Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Di Cintio, Giovanni, Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Di Cesare, Tiziana, Guarino, Mariateresa, Corbò, Marco, Settimi, Stefano, Mele, Dario Antonio, Brigato, Francesca, Buonsenso, Danilo, Valentini, Piero, Sinatti, Dario, De Rose, Gabriella, Richeldi, Luca, Lombardi, Francesco, Calabrese, Angelo, Varone, Francesco, Leone, Paolo Maria, Siciliano, Matteo, Corbo, Giuseppe Maria, Montemurro, Giuliano, Calvello, Mariarosaria, Intini, Enrica, Simonetti, Jacopo, Pasciuto, Giuliana, Adiletta, Veronica, Sofia, Carmelo, Licata, Maria Angela Vittoria Anna Chiara, Sani, Gabriele, Janiri, Delfina, Simonetti, Alessio, Modica, Marco, Montanari, Silvia, Catinari, Antonello, Terenzi, Beatrice, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Pirronti, Tommaso, Infante, Amato, Paglionico, Annamaria, Petricca, Luca, Tolusso, Barbara, Alivernini, Stefano, Di Mario, Clara, Santoliquido, Angelo, Santoro, Luca, Nesci, Antonio, Di Giorgio, Angela, D’Alessandro, Alessia, Null, Null, Calvani, Riccardo (ORCID:0000-0001-5472-2365), Zazzara, Maria Beatrice (ORCID:0000-0001-9155-3388), Landi, Francesco (ORCID:0000-0002-3472-1389), Gremese, Elisa (ORCID:0000-0002-2248-1058), Bernabei, Roberto (ORCID:0000-0002-9197-004X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Lo Monaco, Maria Rita (ORCID:0000-0002-1457-7981), Marzetti, Emanuele (ORCID:0000-0001-9567-6983), Pagano, Francesco, Salerno, Andrea, Cauda, Roberto (ORCID:0000-0002-1498-4229), Murri, Rita (ORCID:0000-0003-4263-7854), Cingolani, Antonella (ORCID:0000-0002-3793-2755), Ventura, Giulio (ORCID:0000-0002-0304-7264), Addolorato, Giovanni (ORCID:0000-0002-1522-9946), Zocco, Maria Assunta (ORCID:0000-0002-0814-9542), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Cattani, Paola (ORCID:0000-0003-4678-4763), Posteraro, Brunella (ORCID:0000-0002-1663-7546), Sali, Michela (ORCID:0000-0003-3609-2990), Rizzo, Stanislao (ORCID:0000-0001-6302-063X), Savastano, Maria Cristina (ORCID:0000-0003-1397-4333), Passali, Giulio Cesare (ORCID:0000-0002-8176-0962), Paludetti, Gaetano (ORCID:0000-0003-2480-1243), Galli, Jacopo (ORCID:0000-0001-6353-6249), Settimi, Stefano (ORCID:0000-0003-0104-1501), Mele, Dario, Valentini, Piero (ORCID:0000-0001-6095-9510), Richeldi, Luca (ORCID:0000-0001-8594-1448), Corbo, Giuseppe Maria (ORCID:0000-0002-8104-4659), Licata, Maria Angela, Sani, Gabriele (ORCID:0000-0002-9767-8752), Silvia, Montanari, Natale, Luigi (ORCID:0000-0002-7949-5119), Larici, Anna Rita (ORCID:0000-0002-1882-6244), Marano, Riccardo (ORCID:0000-0003-2710-2093), Pirronti, Tommaso (ORCID:0000-0003-3138-4097), Tolusso, Barbara (ORCID:0000-0002-9108-6609), Alivernini, Stefano (ORCID:0000-0002-7383-4212), Santoliquido, Angelo (ORCID:0000-0003-1539-4017), Tosato, Matteo, Calvani, Riccardo, Ciciarello, Francesca, Galluzzo, Vincenzo, Martone, Anna Maria, Zazzara, Maria Beatrice, Pais, Cristina, Savera, Giulia, Robles, Maria Camprubi, Ramirez, Maria, Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Settanni, Carlo Romano, Porcari, Serena, Benvenuto, Francesca, Bramato, Giulia, Brandi, Vincenzo, Carfì, Angelo, Lo Monaco, Maria Rita, Marzetti, Emanuele, Napolitano, Carmen, Pagano, Francesco Cosimo, Rocchi, Sara, Rota, Elisabetta, Salerno, Andrea Maria, Tritto, Marcello, Catalano, Lucio, Picca, Anna, D’Elia, Mariaelena, Biscotti, Damiano, Cauda, Roberto, Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, Davide, Ciccullo, Arturo, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Gertrude, Zocco, Maria Assunta, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, Michela, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, Grazia Maria, Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Di Cintio, Giovanni, Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Di Cesare, Tiziana, Guarino, Mariateresa, Corbò, Marco, Settimi, Stefano, Mele, Dario Antonio, Brigato, Francesca, Buonsenso, Danilo, Valentini, Piero, Sinatti, Dario, De Rose, Gabriella, Richeldi, Luca, Lombardi, Francesco, Calabrese, Angelo, Varone, Francesco, Leone, Paolo Maria, Siciliano, Matteo, Corbo, Giuseppe Maria, Montemurro, Giuliano, Calvello, Mariarosaria, Intini, Enrica, Simonetti, Jacopo, Pasciuto, Giuliana, Adiletta, Veronica, Sofia, Carmelo, Licata, Maria Angela Vittoria Anna Chiara, Sani, Gabriele, Janiri, Delfina, Simonetti, Alessio, Modica, Marco, Montanari, Silvia, Catinari, Antonello, Terenzi, Beatrice, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Pirronti, Tommaso, Infante, Amato, Paglionico, Annamaria, Petricca, Luca, Tolusso, Barbara, Alivernini, Stefano, Di Mario, Clara, Santoliquido, Angelo, Santoro, Luca, Nesci, Antonio, Di Giorgio, Angela, D’Alessandro, Alessia, Null, Null, Calvani, Riccardo (ORCID:0000-0001-5472-2365), Zazzara, Maria Beatrice (ORCID:0000-0001-9155-3388), Landi, Francesco (ORCID:0000-0002-3472-1389), Gremese, Elisa (ORCID:0000-0002-2248-1058), Bernabei, Roberto (ORCID:0000-0002-9197-004X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Lo Monaco, Maria Rita (ORCID:0000-0002-1457-7981), Marzetti, Emanuele (ORCID:0000-0001-9567-6983), Pagano, Francesco, Salerno, Andrea, Cauda, Roberto (ORCID:0000-0002-1498-4229), Murri, Rita (ORCID:0000-0003-4263-7854), Cingolani, Antonella (ORCID:0000-0002-3793-2755), Ventura, Giulio (ORCID:0000-0002-0304-7264), Addolorato, Giovanni (ORCID:0000-0002-1522-9946), Zocco, Maria Assunta (ORCID:0000-0002-0814-9542), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Cattani, Paola (ORCID:0000-0003-4678-4763), Posteraro, Brunella (ORCID:0000-0002-1663-7546), Sali, Michela (ORCID:0000-0003-3609-2990), Rizzo, Stanislao (ORCID:0000-0001-6302-063X), Savastano, Maria Cristina (ORCID:0000-0003-1397-4333), Passali, Giulio Cesare (ORCID:0000-0002-8176-0962), Paludetti, Gaetano (ORCID:0000-0003-2480-1243), Galli, Jacopo (ORCID:0000-0001-6353-6249), Settimi, Stefano (ORCID:0000-0003-0104-1501), Mele, Dario, Valentini, Piero (ORCID:0000-0001-6095-9510), Richeldi, Luca (ORCID:0000-0001-8594-1448), Corbo, Giuseppe Maria (ORCID:0000-0002-8104-4659), Licata, Maria Angela, Sani, Gabriele (ORCID:0000-0002-9767-8752), Silvia, Montanari, Natale, Luigi (ORCID:0000-0002-7949-5119), Larici, Anna Rita (ORCID:0000-0002-1882-6244), Marano, Riccardo (ORCID:0000-0003-2710-2093), Pirronti, Tommaso (ORCID:0000-0003-3138-4097), Tolusso, Barbara (ORCID:0000-0002-9108-6609), Alivernini, Stefano (ORCID:0000-0002-7383-4212), and Santoliquido, Angelo (ORCID:0000-0003-1539-4017)

Abstract

Background Nutritional status is a critical factor throughout COVID-19 disease course. Malnutrition is associated with poor outcomes in hospitalized COVID-19 patients.Aim To assess the prevalence of malnutrition and identify its associated factors in COVID-19 survivors.Methods Study cohort included 1230 COVID-19 survivors aged 18-86 attending a post-COVID-19 outpatient service. Data on clinical parameters, anthropometry, acute COVID-19 symptoms, lifestyle habits were collected through a comprehensive medical assessment. Malnutrition was assessed according to Global Leadership Initiative on Malnutrition (GLIM) criteria.Results Prevalence of malnutrition was 22% at 4-5 months after acute disease. Participants who were not hospitalized during acute COVID-19 showed a higher frequency of malnutrition compared to those who needed hospitalization (26% versus 19%, p < 0.01). Malnutrition was found in 25% COVID-19 survivors over 65 years of age compared to 21% younger participants (p < 0.01). After multivariable adjustment, the likelihood of being malnourished increased progressively and independently with advancing age (Odds ratio [OR] 1.02; 95% CI 1.01-1.03) and in male participants (OR 5.56; 95% CI 3.53-8.74). Malnutrition was associated with loss of appetite (OR 2.50; 95% CI 1.73-3.62), and dysgeusia (OR 4.05; 95% CI 2.30-7.21) during acute COVID-19.Discussion In the present investigation we showed that malnutrition was highly prevalent in a large cohort of COVID-19 survivors at 4-5 months from acute illness.Conclusions Our findings highlight the need to implement comprehensive nutritional assessment and therapy as an integral part of care for COVID-19 patients.

Published
2023

6. A New Clinical Prediction Rule for Infective Endocarditis in Emergency Department Patients With Fever: Definition and First Validation of the CREED Score

Author

Covino, Marcello, De Vita, Antonio, D'Aiello, Alessia, Ravenna, Salvatore Emanuele, Ruggio, Aureliano, Genuardi, Lorenzo, Simeoni, Benedetta, Piccioni, Andrea, De Matteis, Giuseppe, Murri, Rita, Leone, Antonio Maria, Flex, Andrea, Gasbarrini, Antonio, Liuzzo, Giovanna, Massetti, Massimo, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), d'Aiello, Alessia, Murri, Rita (ORCID:0000-0003-4263-7854), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Flex, Andrea (ORCID:0000-0003-2664-4165), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Liuzzo, Giovanna (ORCID:0000-0002-5714-0907), Massetti, Massimo (ORCID:0000-0002-7100-8478), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Covino, Marcello, De Vita, Antonio, D'Aiello, Alessia, Ravenna, Salvatore Emanuele, Ruggio, Aureliano, Genuardi, Lorenzo, Simeoni, Benedetta, Piccioni, Andrea, De Matteis, Giuseppe, Murri, Rita, Leone, Antonio Maria, Flex, Andrea, Gasbarrini, Antonio, Liuzzo, Giovanna, Massetti, Massimo, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), d'Aiello, Alessia, Murri, Rita (ORCID:0000-0003-4263-7854), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Flex, Andrea (ORCID:0000-0003-2664-4165), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Liuzzo, Giovanna (ORCID:0000-0002-5714-0907), Massetti, Massimo (ORCID:0000-0002-7100-8478), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Background Infective endocarditis (IE) could be suspected in any febrile patients admitted to the emergency department (ED). This study was aimed at assessing clinical criteria predictive of IE and identifying and prospectively validating a sensible and easy-to-use clinical prediction score for the diagnosis of IE in the ED. Methods and Results We conducted a retrospective observational study, enrolling consecutive patients with fever admitted to the ED between January 2015 and December 2019 and subsequently hospitalized. Several clinical and anamnestic standardized variables were collected and evaluated for the association with IE diagnosis. We derived a multivariate prediction model by logistic regression analysis. The identified predictors were assigned a score point value to obtain the Clinical Rule for Infective Endocarditis in the Emergency Department (CREED) score. To validate the CREED score we conducted a prospective observational study between January 2020 and December 2021, enrolling consecutive febrile patients hospitalized after the ED visit, and evaluating the association between the CREED score values and the IE diagnosis. A total of 15 689 patients (median age, 71 [56-81] years; 54.1% men) were enrolled in the retrospective cohort, and IE was diagnosed in 267 (1.7%). The CREED score included 12 variables: male sex, anemia, dialysis, pacemaker, recent hospitalization, recent stroke, chest pain, specific infective diagnosis, valvular heart disease, valvular prosthesis, previous endocarditis, and clinical signs of suspect endocarditis. The CREED score identified 4 risk groups for IE diagnosis, with an area under the receiver operating characteristic curve of 0.874 (0.849-0.899). The prospective cohort included 13 163 patients, with 130 (1.0%) IE diagnoses. The CREED score had an area under the receiver operating characteristic curve of 0.881 (0.848-0.913) in the validation cohort, not significantly different from the one calculated in the retrospectiv

Published
2023

7. Incidence of bloodstream infections due to multidrug-resistant pathogens in ordinary wards and intensive care units before and during the COVID-19 pandemic: a real-life, retrospective observational study

Author

Segala, Francesco Vladimiro, Pafundi, Pia Clara, Masciocchi, Carlotta, Fiori, Barbara, Taddei, Eleonora, Antenucci, Laura, De Angelis, Giulia, Guerriero, Silvia, Pastorino, Roberta, Damiani, Andrea, Posteraro, Brunella, Sanguinetti, Maurizio, De Pascale, Gennaro, Fantoni, Massimo, Murri, Rita, Fiori, Barbara (ORCID:0000-0003-3318-5809), De Angelis, Giulia (ORCID:0000-0002-7087-7399), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Posteraro, Brunella (ORCID:0000-0002-1663-7546), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Murri, Rita (ORCID:0000-0003-4263-7854), Segala, Francesco Vladimiro, Pafundi, Pia Clara, Masciocchi, Carlotta, Fiori, Barbara, Taddei, Eleonora, Antenucci, Laura, De Angelis, Giulia, Guerriero, Silvia, Pastorino, Roberta, Damiani, Andrea, Posteraro, Brunella, Sanguinetti, Maurizio, De Pascale, Gennaro, Fantoni, Massimo, Murri, Rita, Fiori, Barbara (ORCID:0000-0003-3318-5809), De Angelis, Giulia (ORCID:0000-0002-7087-7399), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Posteraro, Brunella (ORCID:0000-0002-1663-7546), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Fantoni, Massimo (ORCID:0000-0001-6913-8460), and Murri, Rita (ORCID:0000-0003-4263-7854)

Abstract

PurposeSARS-COV-2 pandemic led to antibiotic overprescription and unprecedented stress on healthcare systems worldwide. Knowing the comparative incident risk of bloodstream infection due to multidrug-resistant pathogens in COVID ordinary wards and intensive care-units may give insights into the impact of COVID-19 on antimicrobial resistance.MethodsSingle-center observational data extracted from a computerized dataset were used to identify all patients who underwent blood cultures from January 1, 2018 to May 15, 2021. Pathogen-specific incidence rates were compared according to the time of admission, patient's COVID status and ward type.ResultsAmong 14,884 patients for whom at least one blood culture was obtained, a total of 2534 were diagnosed with HA-BSI. Compared to both pre-pandemic and COVID-negative wards, HA-BSI due to S. aureus and Acinetobacter spp. (respectively 0.3 [95% CI 0.21-0.32] and 0.11 [0.08-0.16] new infections per 100 patient-days) showed significantly higher incidence rates, peaking in the COVID-ICU setting. Conversely, E. coli incident risk was 48% lower in COVID-positive vs COVID-negative settings (IRR 0.53 [0.34-0.77]). Among COVID + patients, 48% (n = 38/79) of S. aureus isolates were resistant to methicillin and 40% (n = 10/25) of K. pneumoniae isolates were resistant to carbapenems.ConclusionsThe data presented here indicate that the spectrum of pathogens causing BSI in ordinary wards and intensive care units varied during the pandemic, with the greatest shift experienced by COVID-ICUs. Antimicrobial resistance of selected high-priority bacteria was high in COVID positive settings.

Published
2023

8. Prevalence and Antimicrobial Resistance Patterns of Hospital Acquired Infections through the COVID-19 Pandemic: Real-Word Data from a Tertiary Urological Centre

Author

Gavi, Filippo, Fiori, Barbara, Gandi, Carlo, Campetella, Marco, Bientinesi, Riccardo, Marino, Filippo, Fettucciari, Daniele, Rossi, Francesco, Moretto, Stefano, Murri, Rita, Pierconti, Francesco, Racioppi, Marco, Sacco, Emilio, Fiori, Barbara (ORCID:0000-0003-3318-5809), Bientinesi, Riccardo (ORCID:0000-0003-0757-152X), Murri, Rita (ORCID:0000-0003-4263-7854), Pierconti, Francesco (ORCID:0000-0003-0951-4131), Racioppi, Marco (ORCID:0000-0001-9129-8479), Sacco, Emilio (ORCID:0000-0003-4640-8354), Gavi, Filippo, Fiori, Barbara, Gandi, Carlo, Campetella, Marco, Bientinesi, Riccardo, Marino, Filippo, Fettucciari, Daniele, Rossi, Francesco, Moretto, Stefano, Murri, Rita, Pierconti, Francesco, Racioppi, Marco, Sacco, Emilio, Fiori, Barbara (ORCID:0000-0003-3318-5809), Bientinesi, Riccardo (ORCID:0000-0003-0757-152X), Murri, Rita (ORCID:0000-0003-4263-7854), Pierconti, Francesco (ORCID:0000-0003-0951-4131), Racioppi, Marco (ORCID:0000-0001-9129-8479), and Sacco, Emilio (ORCID:0000-0003-4640-8354)

Abstract

Background: Antimicrobial resistance (AMR) remains a significant public health concern, closely linked to antibiotic overuse. During the COVID-19 pandemic, broad-spectrum antibiotics were frequently administered, potentially exacerbating AMR. This study aimed to assess AMR patterns in our urology department before and after the pandemic. Methods: The study encompassed patients admitted to our urology department from January 2016 to December 2022, with confirmed urinary tract infection, bloodstream infection, or wound infection based on positive culture results. Descriptive statistics, including mean, frequency, and percentage, summarized the data. Trends were analyzed using the Joinpoint Regression program. Results: A total of 506 patients were included. Escherichia coli and Klebsiella pneumoniae displayed resistance rates of 65% and 62% to ciprofloxacin, respectively. K. pneumoniae showed resistance rates of 41% to piperacillin tazobactam and 3rd generation cephalosporins (3GC). Carbapenem resistance was observed in 38% of K. pneumoniae isolates. Additionally, 26% of E. coli, 26% of K. pneumoniae, and 59% of Proteus mirabilis isolates were ESBL-positive. Among gram+, 72% of Staphylococcus aureus isolates were MRSA, and 23% of Enterococcus faecium isolates were VRE. Trends in antimicrobial susceptibility patterns over the 7-year study period revealed a statistically significant decrease in E. coli resistance to amoxicillin-clavulanic acid (APC: -5.85; C.I. 95% p < 0.05) and a statistically significant increase in K. pneumoniae resistance to 3GC (APC: 9.93; CI (-19.9-14.4 95% p < 0.05). There were no statistically significant differences in AMR incidence pre- and post-COVID-19. Conclusion: The COVID-19 pandemic did not appear to influence the AMR incidence in our urology department. However, the overall prevalence of AMR and MDROs in our department remains high compared to European AMR.

Published
2023

9. Machine Learning and Antibiotic Management

Author

Maviglia, Riccardo, Michi, Teresa, Passaro, Davide, Raggi, Valeria, Bocci, Maria Grazia, Piervincenzi, Edoardo, Mercurio, Giovanna, Lucente, Monica Christine, Murri, Rita, Lucente, Monica, Murri, Rita (ORCID:0000-0003-4263-7854), Maviglia, Riccardo, Michi, Teresa, Passaro, Davide, Raggi, Valeria, Bocci, Maria Grazia, Piervincenzi, Edoardo, Mercurio, Giovanna, Lucente, Monica Christine, Murri, Rita, Lucente, Monica, and Murri, Rita (ORCID:0000-0003-4263-7854)

Abstract

Machine learning and cluster analysis applied to the clinical setting of an intensive care unit can be a valuable aid for clinical management, especially with the increasing complexity of clinical monitoring. Providing a method to measure clinical experience, a proxy for that automatic gestalt evaluation that an experienced clinician sometimes effortlessly, but often only after long, hard consideration and consultation with colleagues, relies upon for decision making, is what we wanted to achieve with the application of machine learning to antibiotic therapy and clinical monitoring in the present work. This is a single-center retrospective analysis proposing methods for evaluation of vitals and antimicrobial therapy in intensive care patients. For each patient included in the present study, duration of antibiotic therapy, consecutive days of treatment and type and combination of antimicrobial agents have been assessed and considered as single unique daily record for analysis. Each parameter, composing a record was normalized using a fuzzy logic approach and assigned to five descriptive categories (fuzzy domain sub-sets ranging from "very low" to "very high"). Clustering of these normalized therapy records was performed, and each patient/day was considered to be a pertaining cluster. The same methodology was used for hourly bed-side monitoring. Changes in patient conditions (monitoring) can lead to a shift of clusters. This can provide an additional tool for assessing progress of complex patients. We used Fuzzy logic normalization to descriptive categories of parameters as a form nearer to human language than raw numbers.

Published
2022

10. Myocardial Injury Portends a Higher Risk of Mortality and Long-Term Cardiovascular Sequelae after Hospital Discharge in COVID-19 Survivors

Author

Rinaldi, Riccardo, Basile, Mattia, Salzillo, Carmine, Grieco, Domenico Luca, Caffè, Andrea, Masciocchi, Carlotta, Lilli, Livia, Damiani, Andrea, La Vecchia, Giulia, Iannaccone, Giulia, Bonanni, Alice, De Pascale, Gennaro, Murri, Rita, Fantoni, Massimo, Liuzzo, Giovanna, Sanna, Tommaso, Massetti, Massimo, Gasbarrini, Antonio, Valentini, Vincenzo, Antonelli, Massimo, Crea, Filippo, Montone, Rocco Antonio, On Behalf Of The Gemelli Against Covid Group, Null, De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Murri, Rita (ORCID:0000-0003-4263-7854), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Liuzzo, Giovanna (ORCID:0000-0002-5714-0907), Sanna, Tommaso (ORCID:0000-0002-5760-6885), Massetti, Massimo (ORCID:0000-0002-7100-8478), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Valentini, Vincenzo (ORCID:0000-0003-4637-6487), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Crea, Filippo (ORCID:0000-0001-9404-8846), Rinaldi, Riccardo, Basile, Mattia, Salzillo, Carmine, Grieco, Domenico Luca, Caffè, Andrea, Masciocchi, Carlotta, Lilli, Livia, Damiani, Andrea, La Vecchia, Giulia, Iannaccone, Giulia, Bonanni, Alice, De Pascale, Gennaro, Murri, Rita, Fantoni, Massimo, Liuzzo, Giovanna, Sanna, Tommaso, Massetti, Massimo, Gasbarrini, Antonio, Valentini, Vincenzo, Antonelli, Massimo, Crea, Filippo, Montone, Rocco Antonio, On Behalf Of The Gemelli Against Covid Group, Null, De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Murri, Rita (ORCID:0000-0003-4263-7854), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Liuzzo, Giovanna (ORCID:0000-0002-5714-0907), Sanna, Tommaso (ORCID:0000-0002-5760-6885), Massetti, Massimo (ORCID:0000-0002-7100-8478), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Valentini, Vincenzo (ORCID:0000-0003-4637-6487), Antonelli, Massimo (ORCID:0000-0003-3007-1670), and Crea, Filippo (ORCID:0000-0001-9404-8846)

Abstract

Background: Cardiovascular sequelae after COVID-19 are frequent. However, the predictors for their occurrence are still unknown. In this study, we aimed to assess whether myocardial injury during COVID-19 hospitalization is associated to CV sequelae and death after hospital discharge. Methods: In this prospective observational study, consecutive patients who were admitted for COVID-19 in a metropolitan COVID-19 hub in Italy, between March 2021 and January 2022, with a >= 1 assessment of high sensitivity cardiac troponin I (hs-cTnI) were included in the study, if they were alive at hospital discharge. Myocardial injury was defined as elevation hs-cTnI > 99th percentile of the upper reference limit. The incidence of all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE, including cardiovascular death, admission for acute or chronic coronary syndrome, hospitalization for heart failure, and stroke/transient ischemic attack) at follow-up were the primary outcomes. Arrhythmias, inflammatory heart diseases, and/or thrombotic disorders were analyzed as well. Results: Among the 701 COVID-19 survivors (mean age 66.4 +/- 14.4 years, 40.2% female), myocardial injury occurred in 75 (10.7%) patients. At a median follow-up of 270 days (IQR 165, 380), all-cause mortality (21.3% vs. 6.1%, p < 0.001), MACCE (25.3% vs. 4.5%, p < 0.001), arrhythmias (9.3% vs. 5.0%, p = 0.034), and inflammatory heart disease (8.0% vs. 1.1%, p < 0.001) were more frequent in patients with myocardial injury compared to those without. At multivariate analysis, myocardial injury (HR 1.95 [95% CI:1.05-3.61]), age (HR 1.09 [95% CI:1.06-1.12]), and chronic kidney disease (HR 2.63 [95% CI:1.33-5.21]) were independent predictors of death. Myocardial injury (HR 3.92 [95% CI:2.07-7.42]), age (HR 1.05 [95% CI:1.02-1.08]), and diabetes (HR 2.35 [95% CI:1.25-4.43]) were independent predictors of MACCE. Conclusion: In COVID-19 survivors, myocardial injury during the hospi

Published
2022

11. Effect of Lockdowns on Hospital Staff in a COVID Center: A Retrospective Observational Study

Author

Vetrugno, Giuseppe, Sanguinetti, Maurizio, Murri, Rita, Sali, Michela, Marchetti, Simona, Santangelo, Rosaria, Fantoni, Massimo, Cingolani, Antonella, Scoppettuolo, Giancarlo, Di Donato, Michele, Grassi, Vincenzo M, Foti, Federica, Marchese, Luca, De Giorgio, Fabio, Oliva, Antonio, Staiti, Domenico, De Simone, Francesco Maria, Pascucci, Domenico, Cascini, Fidelia, Pastorino, Roberta, Pires Marafon, Denise, Cambieri, Andrea, Laurenti, Patrizia, Boccia, Stefania, Ricciardi, Walter, Franceschi, Francesco, On Behalf Of Gemelli-Against-Covid, Null, Vetrugno, Giuseppe (ORCID:0000-0003-0181-2855), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Murri, Rita (ORCID:0000-0003-4263-7854), Sali, Michela (ORCID:0000-0003-3609-2990), Santangelo, Rosaria (ORCID:0000-0002-8056-218X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cingolani, Antonella (ORCID:0000-0002-3793-2755), De-Giorgio, Fabio (ORCID:0000-0002-9447-9707), Oliva, Antonio (ORCID:0000-0001-7120-616X), Staiti, Domenico (ORCID:0000-0001-5179-9690), Pascucci, Domenico (ORCID:0000-0002-5804-2284), Cascini, Fidelia (ORCID:0000-0001-6499-0734), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Pires-Marafon, Denise, Laurenti, Patrizia (ORCID:0000-0002-8532-0593), Boccia, Stefania (ORCID:0000-0002-1864-749X), Ricciardi, Walter (ORCID:0000-0002-5655-688X), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Vetrugno, Giuseppe, Sanguinetti, Maurizio, Murri, Rita, Sali, Michela, Marchetti, Simona, Santangelo, Rosaria, Fantoni, Massimo, Cingolani, Antonella, Scoppettuolo, Giancarlo, Di Donato, Michele, Grassi, Vincenzo M, Foti, Federica, Marchese, Luca, De Giorgio, Fabio, Oliva, Antonio, Staiti, Domenico, De Simone, Francesco Maria, Pascucci, Domenico, Cascini, Fidelia, Pastorino, Roberta, Pires Marafon, Denise, Cambieri, Andrea, Laurenti, Patrizia, Boccia, Stefania, Ricciardi, Walter, Franceschi, Francesco, On Behalf Of Gemelli-Against-Covid, Null, Vetrugno, Giuseppe (ORCID:0000-0003-0181-2855), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Murri, Rita (ORCID:0000-0003-4263-7854), Sali, Michela (ORCID:0000-0003-3609-2990), Santangelo, Rosaria (ORCID:0000-0002-8056-218X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cingolani, Antonella (ORCID:0000-0002-3793-2755), De-Giorgio, Fabio (ORCID:0000-0002-9447-9707), Oliva, Antonio (ORCID:0000-0001-7120-616X), Staiti, Domenico (ORCID:0000-0001-5179-9690), Pascucci, Domenico (ORCID:0000-0002-5804-2284), Cascini, Fidelia (ORCID:0000-0001-6499-0734), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Pires-Marafon, Denise, Laurenti, Patrizia (ORCID:0000-0002-8532-0593), Boccia, Stefania (ORCID:0000-0002-1864-749X), Ricciardi, Walter (ORCID:0000-0002-5655-688X), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

At the onset of the SARS-CoV-2 pandemic, individual and social measures were strengthened through restrictive non-pharmaceutical interventions, labelled with the term "lockdown". In Italy, there were two lockdowns (9 March 2020-3 May 2020 and 3 November 2020-27 March 2021). As part of preventive measures, healthcare workers and the administrative staff population of Policlinico A. Gemelli underwent nasopharyngeal swab tests from 1 March 2020 to 9 February 2022, a long time interval that includes the two aforementioned lockdowns. The population included 8958 people from 1 March 2020 to 31 December 2020; 8981 people from 1 January 2021 to 31 December 2021; and 8981 people from 1 January 2022 to 9 February 2022. We then analysed pseudo-anonymized data, using a retrospective observational approach to evaluate the impact of the lockdown on the incidence of SARS-CoV-2 infections within the population. Given the 14 day contagious period, the swab positivity rate (SPR) among the staff decreased significantly at the end of the first lockdown, every day prior to 18 May 2020, by 0.093 (p < 0.0001, CI = (-0.138--0.047)). After the fourteenth day post the end of the first lockdown (18 May 2020), the SPR increased daily at a rate of 0.024 (p < 0.0001, 95% CI = (0.013-0.034)). In addition, the SPR appeared to increase significantly every day prior to 17 November 2020 by 0.024 (p < 0.0001, CI = (0.013-0.034)). After the fourteenth day post the start of the second lockdown (17 November 2020), the SPR decreased daily at a rate of 0.039 (p < 0.0001, 95% CI = (-0.050--0.027)). These data demonstrate that, in our Institution, the lockdowns helped to both protect healthcare workers and maintain adequate standards of care for COVID and non-COVID patients for the duration of the state of emergency in Italy.

Published
2022

12. Effect of Lockdowns on Hospital Staff in a COVID Center: A Retrospective Observational Study

Author

Vetrugno, Giuseppe, Sanguinetti, Maurizio, Murri, Rita, Sali, Michela, Marchetti, Simona, Santangelo, Rosaria, Fantoni, Massimo, Cingolani, Antonella, Scoppettuolo, Giancarlo, Di Donato, Michele, Grassi, Vincenzo M, Foti, Federica, Marchese, Luca, De Giorgio, Fabio, Oliva, Antonio, Staiti, Domenico, De Simone, Francesco Maria, Pascucci, Domenico, Cascini, Fidelia, Pastorino, Roberta, Pires-Marafon, Denise, Cambieri, Andrea, Laurenti, Patrizia, Boccia, Stefania, Ricciardi, Walter, Franceschi, Francesco, On Behalf Of Gemelli-Against-Covid, Null, Vetrugno, Giuseppe (ORCID:0000-0003-0181-2855), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Murri, Rita (ORCID:0000-0003-4263-7854), Sali, Michela (ORCID:0000-0003-3609-2990), Santangelo, Rosaria (ORCID:0000-0002-8056-218X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cingolani, Antonella (ORCID:0000-0002-3793-2755), De-Giorgio, Fabio (ORCID:0000-0002-9447-9707), Oliva, Antonio (ORCID:0000-0001-7120-616X), Staiti, Domenico (ORCID:0000-0001-5179-9690), Pascucci, Domenico (ORCID:0000-0002-5804-2284), Cascini, Fidelia (ORCID:0000-0001-6499-0734), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Laurenti, Patrizia (ORCID:0000-0002-8532-0593), Boccia, Stefania (ORCID:0000-0002-1864-749X), Ricciardi, Walter (ORCID:0000-0002-5655-688X), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Vetrugno, Giuseppe, Sanguinetti, Maurizio, Murri, Rita, Sali, Michela, Marchetti, Simona, Santangelo, Rosaria, Fantoni, Massimo, Cingolani, Antonella, Scoppettuolo, Giancarlo, Di Donato, Michele, Grassi, Vincenzo M, Foti, Federica, Marchese, Luca, De Giorgio, Fabio, Oliva, Antonio, Staiti, Domenico, De Simone, Francesco Maria, Pascucci, Domenico, Cascini, Fidelia, Pastorino, Roberta, Pires-Marafon, Denise, Cambieri, Andrea, Laurenti, Patrizia, Boccia, Stefania, Ricciardi, Walter, Franceschi, Francesco, On Behalf Of Gemelli-Against-Covid, Null, Vetrugno, Giuseppe (ORCID:0000-0003-0181-2855), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Murri, Rita (ORCID:0000-0003-4263-7854), Sali, Michela (ORCID:0000-0003-3609-2990), Santangelo, Rosaria (ORCID:0000-0002-8056-218X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cingolani, Antonella (ORCID:0000-0002-3793-2755), De-Giorgio, Fabio (ORCID:0000-0002-9447-9707), Oliva, Antonio (ORCID:0000-0001-7120-616X), Staiti, Domenico (ORCID:0000-0001-5179-9690), Pascucci, Domenico (ORCID:0000-0002-5804-2284), Cascini, Fidelia (ORCID:0000-0001-6499-0734), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Laurenti, Patrizia (ORCID:0000-0002-8532-0593), Boccia, Stefania (ORCID:0000-0002-1864-749X), Ricciardi, Walter (ORCID:0000-0002-5655-688X), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

At the onset of the SARS-CoV-2 pandemic, individual and social measures were strengthened through restrictive non-pharmaceutical interventions, labelled with the term "lockdown". In Italy, there were two lockdowns (9 March 2020-3 May 2020 and 3 November 2020-27 March 2021). As part of preventive measures, healthcare workers and the administrative staff population of Policlinico A. Gemelli underwent nasopharyngeal swab tests from 1 March 2020 to 9 February 2022, a long time interval that includes the two aforementioned lockdowns. The population included 8958 people from 1 March 2020 to 31 December 2020; 8981 people from 1 January 2021 to 31 December 2021; and 8981 people from 1 January 2022 to 9 February 2022. We then analysed pseudo-anonymized data, using a retrospective observational approach to evaluate the impact of the lockdown on the incidence of SARS-CoV-2 infections within the population. Given the 14 day contagious period, the swab positivity rate (SPR) among the staff decreased significantly at the end of the first lockdown, every day prior to 18 May 2020, by 0.093 (p < 0.0001, CI = (-0.138--0.047)). After the fourteenth day post the end of the first lockdown (18 May 2020), the SPR increased daily at a rate of 0.024 (p < 0.0001, 95% CI = (0.013-0.034)). In addition, the SPR appeared to increase significantly every day prior to 17 November 2020 by 0.024 (p < 0.0001, CI = (0.013-0.034)). After the fourteenth day post the start of the second lockdown (17 November 2020), the SPR decreased daily at a rate of 0.039 (p < 0.0001, 95% CI = (-0.050--0.027)). These data demonstrate that, in our Institution, the lockdowns helped to both protect healthcare workers and maintain adequate standards of care for COVID and non-COVID patients for the duration of the state of emergency in Italy.

Published
2022

13. COVID-19 atypical Parsonage-Turner syndrome: a case report

Author

Zazzara, Maria Beatrice, Modoni, Anna, Bizzarro, Alessandra, Lauria, Alessandra, Ciciarello, Francesca, Pais, Cristina, Galluzzo, Vincenzo, Landi, Francesco, Tostato, Matteo, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Settanni, Carlo Romano, Porcari, Serena, Benvenuto, Francesca, Bramato, Giulia, Brandi, Vincenzo, Carfì, Angelo, Lo Monaco, Maria Rita, Martone, Anna Maria, Marzetti, Emanuele, Napolitano, Carmen, Pagano, Francesco Cosimo, Rocchi, Sara, Rota, Elisabetta, Salerno, Andrea Maria, Tosato, Matteo, Tritto, Marcello, Calvani, Riccardo, Catalano, Lucio, Picca, Anna, Savera, Giulia, Cauda, Roberto, Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, Davide, Ciccullo, Arturo, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Gertrude, Zocco, Maria Assunta, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, Michela, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, Maria Grazia, Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Di Cintio, Giovanni, Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Di Cesare, Tiziana, Guarino, Mariateresa, Corbò, Marco, Settimi, Stefano, Mele, Dario Antonio, Brigato, Francesca, Buonsenso, Danilo, Valentini, Piero, Sinatti, Dario, De Rose, Gabriella, Richeldi, Luca, Lombardi, Francesco, Calabrese, Angelo, Varone, Francesco, Leone, Paolo Maria, Siciliano, Matteo, Corbo, Giuseppe Maria, Montemurro, Giuliano, Calvello, Mariarosaria, Intini, Enrica, Simonetti, Jacopo, Pasciuto, Giuliana, Adiletta, Veronica, Sofia, Carmelo, Licata, Maria Angela Vittoria Anna Chiara, Sani, Gabriele, Janiri, Delfina, Simonetti, Alessio, Modica, Marco, Montanari, Silvia, Catinari, Antonello, Terenzi, Beatrice, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Pirronti, Tommaso, Infante, Amato, Paglionico, Annamaria, Petricca, Luca, Tolusso, Barbara, Alivernini, Stefano, Di Mario, Clara, Santoliquido, Angelo, Santoro, Luca, Nesci, Antonio, Di Giorgio, Angela, Null, Null, Zazzara, Maria Beatrice (ORCID:0000-0001-9155-3388), Landi, Francesco (ORCID:0000-0002-3472-1389), Gremese, Elisa (ORCID:0000-0002-2248-1058), Bernabei, Roberto (ORCID:0000-0002-9197-004X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Lo Monaco, Maria Rita (ORCID:0000-0002-1457-7981), Marzetti, Emanuele (ORCID:0000-0001-9567-6983), Pagano, Francesco, Salerno, Andrea, Calvani, Riccardo (ORCID:0000-0001-5472-2365), Cauda, Roberto (ORCID:0000-0002-1498-4229), Murri, Rita (ORCID:0000-0003-4263-7854), Cingolani, Antonella (ORCID:0000-0002-3793-2755), Ventura, Giulio (ORCID:0000-0002-0304-7264), Addolorato, Giovanni (ORCID:0000-0002-1522-9946), Zocco, Maria Assunta (ORCID:0000-0002-0814-9542), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Cattani, Paola (ORCID:0000-0003-4678-4763), Posteraro, Brunella (ORCID:0000-0002-1663-7546), Sali, Michela (ORCID:0000-0003-3609-2990), Rizzo, Stanislao (ORCID:0000-0001-6302-063X), Savastano, Maria Cristina (ORCID:0000-0003-1397-4333), Passali, Giulio Cesare (ORCID:0000-0002-8176-0962), Paludetti, Gaetano (ORCID:0000-0003-2480-1243), Galli, Jacopo (ORCID:0000-0001-6353-6249), Settimi, Stefano (ORCID:0000-0003-0104-1501), Mele, Dario, Valentini, Piero (ORCID:0000-0001-6095-9510), Richeldi, Luca (ORCID:0000-0001-8594-1448), Corbo, Giuseppe Maria (ORCID:0000-0002-8104-4659), Licata, Maria Angela, Sani, Gabriele (ORCID:0000-0002-9767-8752), Natale, Luigi (ORCID:0000-0002-7949-5119), Larici, Anna Rita (ORCID:0000-0002-1882-6244), Marano, Riccardo (ORCID:0000-0003-2710-2093), Pirronti, Tommaso (ORCID:0000-0003-3138-4097), Tolusso, Barbara (ORCID:0000-0002-9108-6609), Alivernini, Stefano (ORCID:0000-0002-7383-4212), Santoliquido, Angelo (ORCID:0000-0003-1539-4017), Zazzara, Maria Beatrice, Modoni, Anna, Bizzarro, Alessandra, Lauria, Alessandra, Ciciarello, Francesca, Pais, Cristina, Galluzzo, Vincenzo, Landi, Francesco, Tostato, Matteo, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Settanni, Carlo Romano, Porcari, Serena, Benvenuto, Francesca, Bramato, Giulia, Brandi, Vincenzo, Carfì, Angelo, Lo Monaco, Maria Rita, Martone, Anna Maria, Marzetti, Emanuele, Napolitano, Carmen, Pagano, Francesco Cosimo, Rocchi, Sara, Rota, Elisabetta, Salerno, Andrea Maria, Tosato, Matteo, Tritto, Marcello, Calvani, Riccardo, Catalano, Lucio, Picca, Anna, Savera, Giulia, Cauda, Roberto, Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, Davide, Ciccullo, Arturo, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Gertrude, Zocco, Maria Assunta, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, Michela, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, Maria Grazia, Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Di Cintio, Giovanni, Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Di Cesare, Tiziana, Guarino, Mariateresa, Corbò, Marco, Settimi, Stefano, Mele, Dario Antonio, Brigato, Francesca, Buonsenso, Danilo, Valentini, Piero, Sinatti, Dario, De Rose, Gabriella, Richeldi, Luca, Lombardi, Francesco, Calabrese, Angelo, Varone, Francesco, Leone, Paolo Maria, Siciliano, Matteo, Corbo, Giuseppe Maria, Montemurro, Giuliano, Calvello, Mariarosaria, Intini, Enrica, Simonetti, Jacopo, Pasciuto, Giuliana, Adiletta, Veronica, Sofia, Carmelo, Licata, Maria Angela Vittoria Anna Chiara, Sani, Gabriele, Janiri, Delfina, Simonetti, Alessio, Modica, Marco, Montanari, Silvia, Catinari, Antonello, Terenzi, Beatrice, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Pirronti, Tommaso, Infante, Amato, Paglionico, Annamaria, Petricca, Luca, Tolusso, Barbara, Alivernini, Stefano, Di Mario, Clara, Santoliquido, Angelo, Santoro, Luca, Nesci, Antonio, Di Giorgio, Angela, Null, Null, Zazzara, Maria Beatrice (ORCID:0000-0001-9155-3388), Landi, Francesco (ORCID:0000-0002-3472-1389), Gremese, Elisa (ORCID:0000-0002-2248-1058), Bernabei, Roberto (ORCID:0000-0002-9197-004X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Lo Monaco, Maria Rita (ORCID:0000-0002-1457-7981), Marzetti, Emanuele (ORCID:0000-0001-9567-6983), Pagano, Francesco, Salerno, Andrea, Calvani, Riccardo (ORCID:0000-0001-5472-2365), Cauda, Roberto (ORCID:0000-0002-1498-4229), Murri, Rita (ORCID:0000-0003-4263-7854), Cingolani, Antonella (ORCID:0000-0002-3793-2755), Ventura, Giulio (ORCID:0000-0002-0304-7264), Addolorato, Giovanni (ORCID:0000-0002-1522-9946), Zocco, Maria Assunta (ORCID:0000-0002-0814-9542), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Cattani, Paola (ORCID:0000-0003-4678-4763), Posteraro, Brunella (ORCID:0000-0002-1663-7546), Sali, Michela (ORCID:0000-0003-3609-2990), Rizzo, Stanislao (ORCID:0000-0001-6302-063X), Savastano, Maria Cristina (ORCID:0000-0003-1397-4333), Passali, Giulio Cesare (ORCID:0000-0002-8176-0962), Paludetti, Gaetano (ORCID:0000-0003-2480-1243), Galli, Jacopo (ORCID:0000-0001-6353-6249), Settimi, Stefano (ORCID:0000-0003-0104-1501), Mele, Dario, Valentini, Piero (ORCID:0000-0001-6095-9510), Richeldi, Luca (ORCID:0000-0001-8594-1448), Corbo, Giuseppe Maria (ORCID:0000-0002-8104-4659), Licata, Maria Angela, Sani, Gabriele (ORCID:0000-0002-9767-8752), Natale, Luigi (ORCID:0000-0002-7949-5119), Larici, Anna Rita (ORCID:0000-0002-1882-6244), Marano, Riccardo (ORCID:0000-0003-2710-2093), Pirronti, Tommaso (ORCID:0000-0003-3138-4097), Tolusso, Barbara (ORCID:0000-0002-9108-6609), Alivernini, Stefano (ORCID:0000-0002-7383-4212), and Santoliquido, Angelo (ORCID:0000-0003-1539-4017)

Abstract

Background Neurological manifestations of Sars-CoV-2 infection have been described since March 2020 and include both central and peripheral nervous system manifestations. Neurological symptoms, such as headache or persistent loss of smell and taste, have also been documented in COVID-19 long-haulers. Moreover, long lasting fatigue, mild cognitive impairment and sleep disorders appear to be frequent long term neurological manifestations after hospitalization due to COVID-19. Less is known in relation to peripheral nerve injury related to Sars-CoV-2 infection. Case presentation We report the case of a 47-year-old female presenting with a unilateral chest pain radiating to the left arm lasting for more than two months after recovery from Sars-CoV-2 infection. After referral to our post-acute outpatient service for COVID-19 long haulers, she was diagnosed with a unilateral, atypical, pure sensory brachial plexus neuritis potentially related to COVID-19, which occurred during the acute phase of a mild Sars-CoV-2 infection and persisted for months after resolution of the infection. Conclusions We presented a case of atypical Parsonage-Turner syndrome potentially triggered by Sars-CoV-2 infection, with symptoms and repercussion lasting after viral clearance. A direct involvement of the virus remains uncertain, and the physiopathology is unclear. The treatment of COVID-19 and its long-term consequences represents a relatively new challenge for clinicians and health care providers. A multidisciplinary approach to following-up COVID-19 survivors is strongly advised.

Published
2022

14. Malnutrition in COVID-19 survivors: prevalence and risk factors

Author

Tosato, Matteo, Calvani, Riccardo, Ciciarello, Francesca, Galluzzo, Vincenzo, Martone, Anna Maria, Zazzara, Maria Beatrice, Pais, Cristina, Savera, Giulia, Camprubi Robles, Maria, Ramirez, Maria, Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Romano Settanni, Carlo, Porcari, Serena, Benvenuto, Francesca, Bramato, Giulia, Brandi, Vincenzo, Carfì, Angelo, Rita Lo Monaco, Maria, Maria Martone, Anna, Marzetti, Emanuele, Napolitano, Carmen, Pagano, Francesco, Rocchi, Sara, Rota, Elisabetta, Salerno, Andrea, Tritto, Marcello, Beatrice Zazzara, Maria, Catalano, Lucio, Picca, Anna, D’Elia, Mariaelena, Biscotti, Damiano, Cauda, Roberto, Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, Davide, Ciccullo, Arturo, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Gertrude, Assunta Zocco, Maria, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, Michela, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Maria Cozzupoli, Grazia, Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Di Cintio, Giovanni, Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Di Cesare, Tiziana, Guarino, Mariateresa, Corbò, Marco, Settimi, Stefano, Mele, Dario, Brigato, Francesca, Buonsenso, Danilo, Valentini, Piero, Sinatti, Dario, De Rose, Gabriella, Richeldi, Luca, Lombardi, Francesco, Calabrese, Angelo, Varone, Francesco, Maria Leone, Paolo, Siciliano, Matteo, Corbo, Giuseppe Maria, Montemurro, Giuliano, Calvello, Mariarosaria, Intini, Enrica, Simonetti, Jacopo, Pasciuto, Giuliana, Adiletta, Veronica, Sofia, Carmelo, Angela Licata, Maria, Sani, Gabriele, Janiri, Delfina, Simonetti, Alessio, Modica, Marco, Silvia, Montanari, Catinari, Antonello, Terenzi, Beatrice, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Pirronti, Tommaso, Infante, Amato, Paglionico, Annamaria, Petricca, Luca, Tolusso, Barbara, Alivernini, Stefano, Di Mario, Clara, Santoliquido, Angelo, Santoro, Luca, Nesci, Antonio, Di Giorgio, Angela, D’Alessandro, Alessia, Matteo Tosato, Riccardo Calvani (ORCID:0000-0001-5472-2365), Francesca Ciciarello, Vincenzo Galluzzo, Anna Maria Martone, Maria Beatrice Zazzara (ORCID:0000-0001-9155-3388), Giulia Savera, Francesco Landi (ORCID:0000-0002-3472-1389), Elisa Gremese (ORCID:0000-0002-2248-1058), Roberto Bernabei (ORCID:0000-0002-9197-004X), Massimo Fantoni (ORCID:0000-0001-6913-8460), Emanuele Marzetti (ORCID:0000-0001-9567-6983), Roberto Cauda (ORCID:0000-0002-1498-4229), Giulio Ventura (ORCID:0000-0002-0304-7264), Giovanni Addolorato (ORCID:0000-0002-1522-9946), Francesco Franceschi (ORCID:0000-0001-6266-445X), Maurizio Sanguinetti (ORCID:0000-0002-9780-7059), Paola Cattani (ORCID:0000-0003-4678-4763), Brunella Posteraro (ORCID:0000-0002-1663-7546), Stanislao Rizzo (ORCID:0000-0001-6302-063X), Maria Cristina Savastano (ORCID:0000-0003-1397-4333), Giulio Cesare Passali (ORCID:0000-0002-8176-0962), Jacopo Galli (ORCID:0000-0001-6353-6249), Piero Valentini (ORCID:0000-0001-6095-9510), Luca Richeldi (ORCID:0000-0001-8594-1448), Giuseppe Maria Corbo (ORCID:0000-0002-8104-4659), Gabriele Sani (ORCID:0000-0002-9767-8752), Luigi Natale (ORCID:0000-0002-7949-5119), Anna Rita Larici (ORCID:0000-0002-1882-6244), Riccardo Marano (ORCID:0000-0003-2710-2093), Stefano Alivernini (ORCID:0000-0002-7383-4212), Angelo Santoliquido (ORCID:0000-0003-1539-4017), Tosato, Matteo, Calvani, Riccardo, Ciciarello, Francesca, Galluzzo, Vincenzo, Martone, Anna Maria, Zazzara, Maria Beatrice, Pais, Cristina, Savera, Giulia, Camprubi Robles, Maria, Ramirez, Maria, Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Romano Settanni, Carlo, Porcari, Serena, Benvenuto, Francesca, Bramato, Giulia, Brandi, Vincenzo, Carfì, Angelo, Rita Lo Monaco, Maria, Maria Martone, Anna, Marzetti, Emanuele, Napolitano, Carmen, Pagano, Francesco, Rocchi, Sara, Rota, Elisabetta, Salerno, Andrea, Tritto, Marcello, Beatrice Zazzara, Maria, Catalano, Lucio, Picca, Anna, D’Elia, Mariaelena, Biscotti, Damiano, Cauda, Roberto, Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, Davide, Ciccullo, Arturo, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Gertrude, Assunta Zocco, Maria, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, Michela, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Maria Cozzupoli, Grazia, Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Di Cintio, Giovanni, Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Di Cesare, Tiziana, Guarino, Mariateresa, Corbò, Marco, Settimi, Stefano, Mele, Dario, Brigato, Francesca, Buonsenso, Danilo, Valentini, Piero, Sinatti, Dario, De Rose, Gabriella, Richeldi, Luca, Lombardi, Francesco, Calabrese, Angelo, Varone, Francesco, Maria Leone, Paolo, Siciliano, Matteo, Corbo, Giuseppe Maria, Montemurro, Giuliano, Calvello, Mariarosaria, Intini, Enrica, Simonetti, Jacopo, Pasciuto, Giuliana, Adiletta, Veronica, Sofia, Carmelo, Angela Licata, Maria, Sani, Gabriele, Janiri, Delfina, Simonetti, Alessio, Modica, Marco, Silvia, Montanari, Catinari, Antonello, Terenzi, Beatrice, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Pirronti, Tommaso, Infante, Amato, Paglionico, Annamaria, Petricca, Luca, Tolusso, Barbara, Alivernini, Stefano, Di Mario, Clara, Santoliquido, Angelo, Santoro, Luca, Nesci, Antonio, Di Giorgio, Angela, D’Alessandro, Alessia, Matteo Tosato, Riccardo Calvani (ORCID:0000-0001-5472-2365), Francesca Ciciarello, Vincenzo Galluzzo, Anna Maria Martone, Maria Beatrice Zazzara (ORCID:0000-0001-9155-3388), Giulia Savera, Francesco Landi (ORCID:0000-0002-3472-1389), Elisa Gremese (ORCID:0000-0002-2248-1058), Roberto Bernabei (ORCID:0000-0002-9197-004X), Massimo Fantoni (ORCID:0000-0001-6913-8460), Emanuele Marzetti (ORCID:0000-0001-9567-6983), Roberto Cauda (ORCID:0000-0002-1498-4229), Giulio Ventura (ORCID:0000-0002-0304-7264), Giovanni Addolorato (ORCID:0000-0002-1522-9946), Francesco Franceschi (ORCID:0000-0001-6266-445X), Maurizio Sanguinetti (ORCID:0000-0002-9780-7059), Paola Cattani (ORCID:0000-0003-4678-4763), Brunella Posteraro (ORCID:0000-0002-1663-7546), Stanislao Rizzo (ORCID:0000-0001-6302-063X), Maria Cristina Savastano (ORCID:0000-0003-1397-4333), Giulio Cesare Passali (ORCID:0000-0002-8176-0962), Jacopo Galli (ORCID:0000-0001-6353-6249), Piero Valentini (ORCID:0000-0001-6095-9510), Luca Richeldi (ORCID:0000-0001-8594-1448), Giuseppe Maria Corbo (ORCID:0000-0002-8104-4659), Gabriele Sani (ORCID:0000-0002-9767-8752), Luigi Natale (ORCID:0000-0002-7949-5119), Anna Rita Larici (ORCID:0000-0002-1882-6244), Riccardo Marano (ORCID:0000-0003-2710-2093), Stefano Alivernini (ORCID:0000-0002-7383-4212), and Angelo Santoliquido (ORCID:0000-0003-1539-4017)

Abstract

Background: Nutritional status is a critical factor throughout COVID-19 disease course. Malnutrition is associated with poor outcomes in hospitalized COVID-19 patients. Aim: To assess the prevalence of malnutrition and identify its associated factors in COVID-19 survivors. Methods: Study cohort included 1230 COVID-19 survivors aged 18-86 attending a post-COVID-19 outpatient service. Data on clinical parameters, anthropometry, acute COVID-19 symptoms, lifestyle habits were collected through a comprehensive medical assessment. Malnutrition was assessed according to Global Leadership Initiative on Malnutrition (GLIM) criteria. Results: Prevalence of malnutrition was 22% at 4-5 months after acute disease. Participants who were not hospitalized during acute COVID-19 showed a higher frequency of malnutrition compared to those who needed hospitalization (26% versus 19%, p < 0.01). Malnutrition was found in 25% COVID-19 survivors over 65 years of age compared to 21% younger participants (p < 0.01). After multivariable adjustment, the likelihood of being malnourished increased progressively and independently with advancing age (Odds ratio [OR] 1.02; 95% CI 1.01-1.03) and in male participants (OR 5.56; 95% CI 3.53-8.74). Malnutrition was associated with loss of appetite (OR 2.50; 95% CI 1.73-3.62), and dysgeusia (OR 4.05; 95% CI 2.30-7.21) during acute COVID-19. Discussion: In the present investigation we showed that malnutrition was highly prevalent in a large cohort of COVID-19 survivors at 4-5 months from acute illness. Conclusions: Our findings highlight the need to implement comprehensive nutritional assessment and therapy as an integral part of care for COVID-19 patients.

Published
2023

15. EPI-Net One Health reporting guideline for antimicrobial consumption and resistance surveillance data: a Delphi approach

Author

Babu Rajendran, N., Arieti, F., Mena-Benitez, C. A., Galia, L., Tebon, M., Alvarez, J., Gladstone, B. P., Collineau, L., De Angelis, Giulia, Duro, R., Gaze, W., Gopel, S., Kanj, S. S., Kasbohrer, A., Limmathurotsakul, D., Lopez de Abechuco, E., Mazzolini, E., Mutters, N. T., Pezzani, M. D., Presterl, E., Renk, H., Rodriguez-Bano, J., Sandulescu, O., Scali, F., Skov, R., Velavan, T. P., Vuong, C., Tacconelli, Evelina, Adegnika, A. A., Avery, L., Bonten, M., Cassini, A., Chauvin, C., Compri, M., Damborg, P., De Greeff, S., Del Toro, M. D., Filter, M., Franklin, A., Gonzalez-Zorn, B., Grave, K., Hocquet, D., Hoelzle, L. E., Kalanxhi, E., Laxminarayan, R., Leibovici, L., Malhotra-Kumar, S., Mendelson, M., Paul, M., Munoz Madero, C., Murri, Rita, Piddock, L. J. V., Ruesen, C., Sanguinetti, Maurizio, Schilling, T., Schrijver, R., Schwaber, M. J., Scudeller, L., Torumkuney, D., Van Boeckel, T., Vanderhaeghen, W., Voss, A., Wozniak, T., De Angelis G. (ORCID:0000-0002-7087-7399), Tacconelli E. (ORCID:0000-0001-8722-5824), Murri R. (ORCID:0000-0003-4263-7854), Sanguinetti M. (ORCID:0000-0002-9780-7059), Babu Rajendran, N., Arieti, F., Mena-Benitez, C. A., Galia, L., Tebon, M., Alvarez, J., Gladstone, B. P., Collineau, L., De Angelis, Giulia, Duro, R., Gaze, W., Gopel, S., Kanj, S. S., Kasbohrer, A., Limmathurotsakul, D., Lopez de Abechuco, E., Mazzolini, E., Mutters, N. T., Pezzani, M. D., Presterl, E., Renk, H., Rodriguez-Bano, J., Sandulescu, O., Scali, F., Skov, R., Velavan, T. P., Vuong, C., Tacconelli, Evelina, Adegnika, A. A., Avery, L., Bonten, M., Cassini, A., Chauvin, C., Compri, M., Damborg, P., De Greeff, S., Del Toro, M. D., Filter, M., Franklin, A., Gonzalez-Zorn, B., Grave, K., Hocquet, D., Hoelzle, L. E., Kalanxhi, E., Laxminarayan, R., Leibovici, L., Malhotra-Kumar, S., Mendelson, M., Paul, M., Munoz Madero, C., Murri, Rita, Piddock, L. J. V., Ruesen, C., Sanguinetti, Maurizio, Schilling, T., Schrijver, R., Schwaber, M. J., Scudeller, L., Torumkuney, D., Van Boeckel, T., Vanderhaeghen, W., Voss, A., Wozniak, T., De Angelis G. (ORCID:0000-0002-7087-7399), Tacconelli E. (ORCID:0000-0001-8722-5824), Murri R. (ORCID:0000-0003-4263-7854), and Sanguinetti M. (ORCID:0000-0002-9780-7059)

Abstract

Strategic and standardised approaches to analysis and reporting of surveillance data are essential to inform antimicrobial resistance (AMR) mitigation measures, including antibiotic policies. Targeted guidance on linking full-scale AMR and antimicrobial consumption (AMC)/antimicrobial residues (AR) surveillance data from the human, animal, and environmental sectors is currently needed. This paper describes the initiative whereby a multidisciplinary panel of experts (56 from 20 countries—52 high income, 4 upper middle or lower income), representing all three sectors, elaborated proposals for structuring and reporting full-scale AMR and AMC/AR surveillance data across the three sectors. An evidence-supported, modified Delphi approach was adopted to reach consensus among the experts for dissemination frequency, language, and overall structure of reporting; core elements and metrics for AMC/AR data; core elements and metrics for AMR data. The recommendations can support multisectoral national and regional plans on antimicrobials policy to reduce resistance rates applying a One Health approach.

Published
2023

16. A machine-learning parsimonious multivariable predictive model of mortality risk in patients with Covid-19

Author

Murri, Rita, Lenkowicz, Jacopo, Masciocchi, Carlotta, Iacomini, Chiara, Fantoni, Massimo, Damiani, Andrea, Marchetti, Antonio, Sergi, Paolo Domenico Angelo, Arcuri, Giovanni, Cesario, Alfredo, Patarnello, Stefano, Antonelli, Massimo, Bellantone, Rocco Domenico Alfonso, Bernabei, Roberto, Boccia, Stefania, Calabresi, Paolo, Cambieri, Andrea, Cauda, Roberto, Colosimo, Cesare, Crea, Filippo, De Maria Marchiano, Ruggero, De Stefano, Valerio, Franceschi, Francesco, Gasbarrini, Antonio, Parolini, Ornella, Richeldi, Luca, Sanguinetti, Maurizio, Urbani, Andrea, Zega, Maurizio, Scambia, Giovanni, Valentini, Vincenzo, Armuzzi, Alessandro, Barba, Marta, Baroni, Silvia, Bellesi, Silvia, Bentivoglio, Annarita, Biasucci, Luigi Marzio, Biscetti, Federico, Candelli, Marcello, Capalbo, Gennaro, Cattani Franchi, Paola, Chiusolo, Patrizia, Cingolani, Antonella, Corbo, Giuseppe Maria, Covino, Marcello, Cozzolino, Angela Maria, D’Alfonso, Marilena, De Angelis, Giulia, De Pascale, Gennaro, Frisullo, Giovanni, Gabrielli, Maurizio, Gambassi, Giovanni, Garcovich, Matteo, Gremese, Elisa, Grieco, Domenico Luca, Iaconelli, Amerigo, Iorio, Raffaele, Landi, Francesco, Larici, Annarita, Liuzzo, Giovanna, Maviglia, Riccardo, Miele, Luca, Montalto, Massimo, Natale, Luigi, Nicolotti, Nicola, Ojetti, Veronica, Pompili, Maurizio, Posteraro, Brunella, Rapaccini, Gianni, Rinaldi, Riccardo, Rossi, Elena, Santoliquido, Angelo, Sica, Simona, Tamburrini, Enrica, Teofili, Luciana, Testa, Antonia Carla, Tosoni, Alberto, Trani, Carlo, Varone, Francesco, Zileri Dal Verme, Lorenzo, Null, Null, Murri, Rita (ORCID:0000-0003-4263-7854), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cesario, Alfredo (ORCID:0000-0003-4687-0709), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Bellantone, Rocco (ORCID:0000-0002-0844-3469), Bernabei, Roberto (ORCID:0000-0002-9197-004X), Boccia, Stefania (ORCID:0000-0002-1864-749X), Calabresi, Paolo (ORCID:0000-0003-0326-5509), Cauda, Roberto (ORCID:0000-0002-1498-4229), Colosimo, Cesare (ORCID:0000-0003-3800-3648), Crea, Filippo (ORCID:0000-0001-9404-8846), De Maria, Ruggero (ORCID:0000-0003-2255-0583), De Stefano, Valerio (ORCID:0000-0002-5178-5827), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Parolini, Ornella (ORCID:0000-0002-5211-6430), Richeldi, Luca (ORCID:0000-0001-8594-1448), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Zega, Maurizio (ORCID:0000-0002-7821-2615), Scambia, Giovanni (ORCID:0000-0003-2758-1063), Valentini, Vincenzo (ORCID:0000-0003-4637-6487), Armuzzi, Alessandro (ORCID:0000-0003-1572-0118), Barba, Marta (ORCID:0000-0001-6084-7666), Baroni, Silvia (ORCID:0000-0002-3410-2617), Biasucci, Luigi Marzio (ORCID:0000-0002-6921-6497), Biscetti, Federico (ORCID:0000-0001-7449-657X), Candelli, Marcello (ORCID:0000-0001-8443-7880), Cattani, Paola (ORCID:0000-0003-4678-4763), Chiusolo, Patrizia (ORCID:0000-0002-1355-1587), Cingolani, Antonella (ORCID:0000-0002-3793-2755), Corbo, Giuseppe (ORCID:0000-0002-8104-4659), Covino, Marcello (ORCID:0000-0002-6709-2531), De Angelis, Giulia (ORCID:0000-0002-7087-7399), De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Gambassi, Giovanni (ORCID:0000-0002-7030-9359), Gremese, Elisa (ORCID:0000-0002-2248-1058), Grieco, Domenico Luca (ORCID:0000-0002-4557-6308), Iorio, Raffaele (ORCID:0000-0002-6270-0956), Landi, Francesco (ORCID:0000-0002-3472-1389), Liuzzo, Giovanna (ORCID:0000-0002-5714-0907), Miele, Luca (ORCID:0000-0003-3464-0068), Montalto, Massimo (ORCID:0000-0001-8819-3684), Natale, Luigi (ORCID:0000-0002-7949-5119), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Pompili, Maurizio (ORCID:0000-0001-6699-7980), Posteraro, Brunella (ORCID:0000-0002-1663-7546), Rossi, Elena (ORCID:0000-0002-7572-9379), Santoliquido, Angelo (ORCID:0000-0003-1539-4017), Tamburrini, Enrica (ORCID:0000-0003-4930-426X), Teofili, Luciana (ORCID:0000-0002-7214-1561), Testa, Antonia (ORCID:0000-0003-2217-8726), Trani, Carlo (ORCID:0000-0001-9777-013X), Verme, Lorenzo Zileri Dal, Murri, Rita, Lenkowicz, Jacopo, Masciocchi, Carlotta, Iacomini, Chiara, Fantoni, Massimo, Damiani, Andrea, Marchetti, Antonio, Sergi, Paolo Domenico Angelo, Arcuri, Giovanni, Cesario, Alfredo, Patarnello, Stefano, Antonelli, Massimo, Bellantone, Rocco Domenico Alfonso, Bernabei, Roberto, Boccia, Stefania, Calabresi, Paolo, Cambieri, Andrea, Cauda, Roberto, Colosimo, Cesare, Crea, Filippo, De Maria Marchiano, Ruggero, De Stefano, Valerio, Franceschi, Francesco, Gasbarrini, Antonio, Parolini, Ornella, Richeldi, Luca, Sanguinetti, Maurizio, Urbani, Andrea, Zega, Maurizio, Scambia, Giovanni, Valentini, Vincenzo, Armuzzi, Alessandro, Barba, Marta, Baroni, Silvia, Bellesi, Silvia, Bentivoglio, Annarita, Biasucci, Luigi Marzio, Biscetti, Federico, Candelli, Marcello, Capalbo, Gennaro, Cattani Franchi, Paola, Chiusolo, Patrizia, Cingolani, Antonella, Corbo, Giuseppe Maria, Covino, Marcello, Cozzolino, Angela Maria, D’Alfonso, Marilena, De Angelis, Giulia, De Pascale, Gennaro, Frisullo, Giovanni, Gabrielli, Maurizio, Gambassi, Giovanni, Garcovich, Matteo, Gremese, Elisa, Grieco, Domenico Luca, Iaconelli, Amerigo, Iorio, Raffaele, Landi, Francesco, Larici, Annarita, Liuzzo, Giovanna, Maviglia, Riccardo, Miele, Luca, Montalto, Massimo, Natale, Luigi, Nicolotti, Nicola, Ojetti, Veronica, Pompili, Maurizio, Posteraro, Brunella, Rapaccini, Gianni, Rinaldi, Riccardo, Rossi, Elena, Santoliquido, Angelo, Sica, Simona, Tamburrini, Enrica, Teofili, Luciana, Testa, Antonia Carla, Tosoni, Alberto, Trani, Carlo, Varone, Francesco, Zileri Dal Verme, Lorenzo, Null, Null, Murri, Rita (ORCID:0000-0003-4263-7854), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cesario, Alfredo (ORCID:0000-0003-4687-0709), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Bellantone, Rocco (ORCID:0000-0002-0844-3469), Bernabei, Roberto (ORCID:0000-0002-9197-004X), Boccia, Stefania (ORCID:0000-0002-1864-749X), Calabresi, Paolo (ORCID:0000-0003-0326-5509), Cauda, Roberto (ORCID:0000-0002-1498-4229), Colosimo, Cesare (ORCID:0000-0003-3800-3648), Crea, Filippo (ORCID:0000-0001-9404-8846), De Maria, Ruggero (ORCID:0000-0003-2255-0583), De Stefano, Valerio (ORCID:0000-0002-5178-5827), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Parolini, Ornella (ORCID:0000-0002-5211-6430), Richeldi, Luca (ORCID:0000-0001-8594-1448), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Zega, Maurizio (ORCID:0000-0002-7821-2615), Scambia, Giovanni (ORCID:0000-0003-2758-1063), Valentini, Vincenzo (ORCID:0000-0003-4637-6487), Armuzzi, Alessandro (ORCID:0000-0003-1572-0118), Barba, Marta (ORCID:0000-0001-6084-7666), Baroni, Silvia (ORCID:0000-0002-3410-2617), Biasucci, Luigi Marzio (ORCID:0000-0002-6921-6497), Biscetti, Federico (ORCID:0000-0001-7449-657X), Candelli, Marcello (ORCID:0000-0001-8443-7880), Cattani, Paola (ORCID:0000-0003-4678-4763), Chiusolo, Patrizia (ORCID:0000-0002-1355-1587), Cingolani, Antonella (ORCID:0000-0002-3793-2755), Corbo, Giuseppe (ORCID:0000-0002-8104-4659), Covino, Marcello (ORCID:0000-0002-6709-2531), De Angelis, Giulia (ORCID:0000-0002-7087-7399), De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Gambassi, Giovanni (ORCID:0000-0002-7030-9359), Gremese, Elisa (ORCID:0000-0002-2248-1058), Grieco, Domenico Luca (ORCID:0000-0002-4557-6308), Iorio, Raffaele (ORCID:0000-0002-6270-0956), Landi, Francesco (ORCID:0000-0002-3472-1389), Liuzzo, Giovanna (ORCID:0000-0002-5714-0907), Miele, Luca (ORCID:0000-0003-3464-0068), Montalto, Massimo (ORCID:0000-0001-8819-3684), Natale, Luigi (ORCID:0000-0002-7949-5119), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Pompili, Maurizio (ORCID:0000-0001-6699-7980), Posteraro, Brunella (ORCID:0000-0002-1663-7546), Rossi, Elena (ORCID:0000-0002-7572-9379), Santoliquido, Angelo (ORCID:0000-0003-1539-4017), Tamburrini, Enrica (ORCID:0000-0003-4930-426X), Teofili, Luciana (ORCID:0000-0002-7214-1561), Testa, Antonia (ORCID:0000-0003-2217-8726), Trani, Carlo (ORCID:0000-0001-9777-013X), and Verme, Lorenzo Zileri Dal

Abstract

The COVID-19 pandemic is impressively challenging the healthcare system. Several prognostic models have been validated but few of them are implemented in daily practice. The objective of the study was to validate a machine-learning risk prediction model using easy-to-obtain parameters to help to identify patients with COVID-19 who are at higher risk of death. The training cohort included all patients admitted to Fondazione Policlinico Gemelli with COVID-19 from March 5, 2020, to November 5, 2020. Afterward, the model was tested on all patients admitted to the same hospital with COVID-19 from November 6, 2020, to February 5, 2021. The primary outcome was in-hospital case-fatality risk. The out-of-sample performance of the model was estimated from the training set in terms of Area under the Receiving Operator Curve (AUROC) and classification matrix statistics by averaging the results of fivefold cross validation repeated 3-times and comparing the results with those obtained on the test set. An explanation analysis of the model, based on the SHapley Additive exPlanations (SHAP), is also presented. To assess the subsequent time evolution, the change in paO2/FiO2 (P/F) at 48 h after the baseline measurement was plotted against its baseline value. Among the 921 patients included in the training cohort, 120 died (13%). Variables selected for the model were age, platelet count, SpO2, blood urea nitrogen (BUN), hemoglobin, C-reactive protein, neutrophil count, and sodium. The results of the fivefold cross-validation repeated 3-times gave AUROC of 0.87, and statistics of the classification matrix to the Youden index as follows: sensitivity 0.840, specificity 0.774, negative predictive value 0.971. Then, the model was tested on a new population (n=1463) in which the case-fatality rate was 22.6%. The test model showed AUROC 0.818, sensitivity 0.813, specificity 0.650, negative predictive value 0.922. Considering the first quartile of the predicted risk score (low-risk score gro

Published
2021

17. Cefiderocol for severe carbapenem-resistant a. Baumannii pneumonia: Towards the comprehension of its place in therapy

Author

Rando, Emanuele, Segala, F. V., Vargas, J., Seguiti, C., De Pascale, Gennaro, Murri, Rita, Fantoni, Massimo, Rando E., De Pascale G. (ORCID:0000-0002-8255-0676), Murri R. (ORCID:0000-0003-4263-7854), Fantoni M. (ORCID:0000-0001-6913-8460), Rando, Emanuele, Segala, F. V., Vargas, J., Seguiti, C., De Pascale, Gennaro, Murri, Rita, Fantoni, Massimo, Rando E., De Pascale G. (ORCID:0000-0002-8255-0676), Murri R. (ORCID:0000-0003-4263-7854), and Fantoni M. (ORCID:0000-0001-6913-8460)

Abstract

Cefiderocol use in A. baumannii pneumonia still represents an important matter of debate. The aim of this study is to describe 13 cases of carbapenem-resistant A. baumannii (CRAB) pneumonia treated with cefiderocol in real-life practice. We retrospectively included patients with CRAB pneumonia hospitalized at Fondazione Policlinico Universitario Agostino Gemelli Hospital treated with cefiderocol either in the general ward or the intensive care unit. A total of 11 patients out of 13 had ventilator-associated pneumonia caused by CRAB, and 12/13 patients had polymicrobial infection. We found a 30-day success rate of 54%. Cefiderocol may have a role when facing severe XDR A. baumannii pneumonia. Future studies are warranted to better define its place in therapy in CRAB infections.

Published
2022

18. Fatigue in Covid-19 survivors: The potential impact of a nutritional supplement on muscle strength and function

Author

Galluzzo, Vincenzo, Zazzara, Maria Beatrice, Ciciarello, Francesca, Savera, Giulia, Pais, C., Calvani, Riccardo, Picca, A., Marzetti, Emanuele, Landi, Francesco, Tosato, Matteo, Steering, Committee, Gremese, Elisa, Coordination, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Field, Investigator, Gastroenterology, Team, Porcari, Serena, Settanni, Carlo Romano, Geriatric, Team, Benvenuto, F., Bramato, Giulia, Brandi, Vincenzo, Carfi, A., Fabrizi, Sofia, Lo Monaco, Maria Rita, Martone, Anna Maria, Napolitano, C., Pagano, Francesco Cosimo, Rocchi, Sara, Rota, E., Salerno, Andrea Maria, Tritto, M., Catalano, Lucio, Damiano, Francesco Paolo, Rocconi, Alessandra, Galliani, Alessandro, Spaziani, G., Tupputi, Salvatore, Cocchi, Camilla, Pirone, Flavia, D'Ignazio, F., Cacciatore, Stefano, Infectious disease, Team, Cauda, Roberto, Tamburrini, Enrica, Borghetti, Alberto, Di Gianbenedetto, S., Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, E., Moschese, D., Ciccullo, A., Dusina, A., Internal Medicine, Team, Stella, L., Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Zocco, Maria Assunta, Microbiology, Team, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, M., Neurology, Team, Bizzarro, Alessandra, Lauria, Alessandra, Ophthalmology, Team, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, G. M., Culiersi, Carola, Otolaryngology, Team, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, F., Di Cintio, G., Longobardi, Ylenia, Tricarico, Laura, Santantonio, M., Pediatric, Team, Buonsenso, Danilo, Valentini, Piero, Pata, D., Sinatti, Dario, De Rose, Cristina, Pneumology, Team, Richeldi, Luca, Lombardi, F., Calabrese, Anna Chiara, Leone, Paolo Maria, Calvello, M. R., Intini, Enrica, Montemurro, G., Psychiatric, Team, Sani, Gabriele, Janiri, Delfina, Simonetti, Alessio, Giuseppin, G., Molinaro, M., Odica, M., Radiology, Team, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Rheumatology, Team, Paglionico, A., Petricca, Luca, Gigante, Lavinia, Natalello, G., Fedele, Anna Laura, Lizzio, Marco Maria, Tolusso, Barbara, Di Mario, Clara, Alivernini, Stefano, Vascular, Team, Santoliquido, Angelo, Santoro, L., Di Giorgio, A., Nesci, A., Popolla, Valentina, Galluzzo V., Zazzara M. B. (ORCID:0000-0001-9155-3388), Ciciarello F., Savera G., Calvani R. (ORCID:0000-0001-5472-2365), Marzetti E. (ORCID:0000-0001-9567-6983), Landi F. (ORCID:0000-0002-3472-1389), Tosato M., Gremese E. (ORCID:0000-0002-2248-1058), Bernabei R. (ORCID:0000-0002-9197-004X), Fantoni M. (ORCID:0000-0001-6913-8460), Gasbarrini A. (ORCID:0000-0002-7278-4823), Porcari S., Settanni C. R., Bramato G., Brandi V., Fabrizi S., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Martone A. M., Pagano F. C., Rocchi S., Salerno A., Catalano L., Damiano F. P., Rocconi A., Galliani A., Tupputi S., Cocchi C., Pirone F., Cacciatore S., Cauda R. (ORCID:0000-0002-1498-4229), Tamburrini E. (ORCID:0000-0003-4930-426X), Borghetti A., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Ventura G. (ORCID:0000-0002-0304-7264), Addolorato G. (ORCID:0000-0002-1522-9946), Franceschi F. (ORCID:0000-0001-6266-445X), Mingrone G. (ORCID:0000-0003-2021-528X), Zocco M. A. (ORCID:0000-0002-0814-9542), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cattani P. (ORCID:0000-0003-4678-4763), Marchetti S., Posteraro B. (ORCID:0000-0002-1663-7546), Bizzarro A., Lauria A., Rizzo S. (ORCID:0000-0001-6302-063X), Savastano M. C. (ORCID:0000-0003-1397-4333), Gambini G., Culiersi C., Passali G. C. (ORCID:0000-0002-8176-0962), Paludetti G. (ORCID:0000-0003-2480-1243), Galli J. (ORCID:0000-0001-6353-6249), Longobardi Y., Tricarico L., Buonsenso D., Valentini P. (ORCID:0000-0001-6095-9510), Sinatti D., De Rose C., Richeldi L. (ORCID:0000-0001-8594-1448), Calabrese A., Leone P. M., Intini E., Sani G. (ORCID:0000-0002-9767-8752), Janiri D., Simonetti A., Natale L. (ORCID:0000-0002-7949-5119), Larici A. R. (ORCID:0000-0002-1882-6244), Marano R. (ORCID:0000-0003-2710-2093), Petricca L., Gigante L., Fedele A. L., Lizzio M. M., Tolusso B. (ORCID:0000-0002-9108-6609), Di Mario C., Alivernini S. (ORCID:0000-0002-7383-4212), Santoliquido A. (ORCID:0000-0003-1539-4017), Popolla V., Galluzzo, Vincenzo, Zazzara, Maria Beatrice, Ciciarello, Francesca, Savera, Giulia, Pais, C., Calvani, Riccardo, Picca, A., Marzetti, Emanuele, Landi, Francesco, Tosato, Matteo, Steering, Committee, Gremese, Elisa, Coordination, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Field, Investigator, Gastroenterology, Team, Porcari, Serena, Settanni, Carlo Romano, Geriatric, Team, Benvenuto, F., Bramato, Giulia, Brandi, Vincenzo, Carfi, A., Fabrizi, Sofia, Lo Monaco, Maria Rita, Martone, Anna Maria, Napolitano, C., Pagano, Francesco Cosimo, Rocchi, Sara, Rota, E., Salerno, Andrea Maria, Tritto, M., Catalano, Lucio, Damiano, Francesco Paolo, Rocconi, Alessandra, Galliani, Alessandro, Spaziani, G., Tupputi, Salvatore, Cocchi, Camilla, Pirone, Flavia, D'Ignazio, F., Cacciatore, Stefano, Infectious disease, Team, Cauda, Roberto, Tamburrini, Enrica, Borghetti, Alberto, Di Gianbenedetto, S., Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, E., Moschese, D., Ciccullo, A., Dusina, A., Internal Medicine, Team, Stella, L., Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Zocco, Maria Assunta, Microbiology, Team, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, M., Neurology, Team, Bizzarro, Alessandra, Lauria, Alessandra, Ophthalmology, Team, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, G. M., Culiersi, Carola, Otolaryngology, Team, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, F., Di Cintio, G., Longobardi, Ylenia, Tricarico, Laura, Santantonio, M., Pediatric, Team, Buonsenso, Danilo, Valentini, Piero, Pata, D., Sinatti, Dario, De Rose, Cristina, Pneumology, Team, Richeldi, Luca, Lombardi, F., Calabrese, Anna Chiara, Leone, Paolo Maria, Calvello, M. R., Intini, Enrica, Montemurro, G., Psychiatric, Team, Sani, Gabriele, Janiri, Delfina, Simonetti, Alessio, Giuseppin, G., Molinaro, M., Odica, M., Radiology, Team, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Rheumatology, Team, Paglionico, A., Petricca, Luca, Gigante, Lavinia, Natalello, G., Fedele, Anna Laura, Lizzio, Marco Maria, Tolusso, Barbara, Di Mario, Clara, Alivernini, Stefano, Vascular, Team, Santoliquido, Angelo, Santoro, L., Di Giorgio, A., Nesci, A., Popolla, Valentina, Galluzzo V., Zazzara M. B. (ORCID:0000-0001-9155-3388), Ciciarello F., Savera G., Calvani R. (ORCID:0000-0001-5472-2365), Marzetti E. (ORCID:0000-0001-9567-6983), Landi F. (ORCID:0000-0002-3472-1389), Tosato M., Gremese E. (ORCID:0000-0002-2248-1058), Bernabei R. (ORCID:0000-0002-9197-004X), Fantoni M. (ORCID:0000-0001-6913-8460), Gasbarrini A. (ORCID:0000-0002-7278-4823), Porcari S., Settanni C. R., Bramato G., Brandi V., Fabrizi S., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Martone A. M., Pagano F. C., Rocchi S., Salerno A., Catalano L., Damiano F. P., Rocconi A., Galliani A., Tupputi S., Cocchi C., Pirone F., Cacciatore S., Cauda R. (ORCID:0000-0002-1498-4229), Tamburrini E. (ORCID:0000-0003-4930-426X), Borghetti A., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Ventura G. (ORCID:0000-0002-0304-7264), Addolorato G. (ORCID:0000-0002-1522-9946), Franceschi F. (ORCID:0000-0001-6266-445X), Mingrone G. (ORCID:0000-0003-2021-528X), Zocco M. A. (ORCID:0000-0002-0814-9542), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cattani P. (ORCID:0000-0003-4678-4763), Marchetti S., Posteraro B. (ORCID:0000-0002-1663-7546), Bizzarro A., Lauria A., Rizzo S. (ORCID:0000-0001-6302-063X), Savastano M. C. (ORCID:0000-0003-1397-4333), Gambini G., Culiersi C., Passali G. C. (ORCID:0000-0002-8176-0962), Paludetti G. (ORCID:0000-0003-2480-1243), Galli J. (ORCID:0000-0001-6353-6249), Longobardi Y., Tricarico L., Buonsenso D., Valentini P. (ORCID:0000-0001-6095-9510), Sinatti D., De Rose C., Richeldi L. (ORCID:0000-0001-8594-1448), Calabrese A., Leone P. M., Intini E., Sani G. (ORCID:0000-0002-9767-8752), Janiri D., Simonetti A., Natale L. (ORCID:0000-0002-7949-5119), Larici A. R. (ORCID:0000-0002-1882-6244), Marano R. (ORCID:0000-0003-2710-2093), Petricca L., Gigante L., Fedele A. L., Lizzio M. M., Tolusso B. (ORCID:0000-0002-9108-6609), Di Mario C., Alivernini S. (ORCID:0000-0002-7383-4212), Santoliquido A. (ORCID:0000-0003-1539-4017), and Popolla V.

Abstract

Background: Fatigue with reduced tolerance to exercise is a common persistent long-lasting feature amongst COVID-19 survivors. The assessment of muscle function in this category of patients is often neglected.Aim.: To evaluate the potential impact of a daily supplementation based on amino acids, minerals, vi-tamins, and plant extracts (Apportal (R)) on muscle function, body composition, laboratory parameters and self-rated health in a small group of COVID-19 survivors affected by fatigue.Methods: Thirty participants were enrolled among patients affected by physical fatigue during or after acute COVID-19 and admitted to the post-COVID-19 outpatient service at Fondazione Policlinico Gemelli in Rome between 1st March 2021 and 30th April 2021. All participants were evaluated at first visit (t0) and at control visit (t1), after taking a daily sachet of Apportal (R) for 28 days. Muscle function was analyzed using hand grip strength test, exhaustion strength time and the number of repetitions at one -minute chair stand test. Body composition was assessed with bioelectrical impedance analysis (BIA). Laboratory parameters, including standard blood biochemistry and ferritin levels, were evaluated at the first visit and during the control visit. A quick evaluation of self-rated health, before COVID-19, at t0 and t1, was obtained through a visual analogue scale (VAS). Results: Participants aged 60 years and older were 13 (43%). Females represented the 70% of the study sample. Participants hospitalized for COVID-19 with low -flow oxygen supplementation represented the 43.3% of the study sample while 3.3% received noninvasive ventilation (NIV) or invasive ventilation. Hand grip strength improved from 26.3 Kg to 28.9 Kg (p < 0.05) at t1 as compared to t0. The mean time of strength exhaustion increased from 31.7 s (sec) at t0 to 47.5 s at t1 (p < 0.05). Participants performed a higher number of repetitions (28.3 vs. 22.0; p < 0.05) during the one-minute chair stand test at

Published
2022

19. Fatigue in Covid-19 survivors: The potential impact of a nutritional supplement on muscle strength and function

Author

Galluzzo, Vincenzo, Zazzara, M. B., Ciciarello, Francesca, Savera, Giulia, Pais, C., Calvani, Riccardo, Picca, A., Marzetti, Emanuele, Landi, Francesco, Tosato, Matteo, Steering, Committee, Gremese, Elisa, Coordination, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Field, Investigator, Gastroenterology, Team, Porcari, Serena, Settanni, Carlo Romano, Geriatric, Team, Benvenuto, F., Bramato, Giulia, Brandi, Vincenzo, Carfi, A., Fabrizi, Sofia, Lo Monaco, Maria Rita, Martone, Anna Maria, Napolitano, C., Pagano, Francesco Cosimo, Rocchi, Sara, Rota, E., Salerno, Andrea Maria, Tritto, M., Catalano, Lucio, Damiano, Francesco Paolo, Rocconi, Alessandra, Galliani, Alessandro, Spaziani, Giovanni, Tupputi, Salvatore, Cocchi, Camilla, Pirone, Flavia, D'Ignazio, Federica, Cacciatore, Stefano, Infectious disease, Team, Cauda, Roberto, Tamburrini, Enrica, Borghetti, Alberto, Di Gianbenedetto, S., Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, E., Moschese, D., Ciccullo, A., Dusina, A., Internal Medicine, Team, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Zocco, Maria Assunta, Microbiology, Team, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, Michela, Neurology, Team, Bizzarro, Alessandra, Lauria, Alessandra, Ophthalmology, Team, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, G. M., Culiersi, Carola, Otolaryngology, Team, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, F., Di Cintio, G., Longobardi, Ylenia, Tricarico, Laura, Santantonio, M., Pediatric, Team, Buonsenso, Danilo, Valentini, Piero, Pata, D., Sinatti, Dario, De Rose, Cristina, Pneumology, Team, Richeldi, Luca, Lombardi, Francesco, Calabrese, Anna Chiara, Leone, Paolo Maria, Calvello, M. R., Intini, Enrica, Montemurro, G., Psychiatric, Team, Sani, Gabriele, Janiri, Delfina, Simonetti, Alessio, Giuseppin, G., Molinaro, M., Odica, M., Radiology, Team, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Rheumatology, Team, Paglionico, A., Petricca, Luca, Gigante, Lavinia, Natalello, G., Fedele, Anna Laura, Lizzio, Marco Maria, Tolusso, Barbara, Di Mario, Clara, Alivernini, Stefano, Vascular, Team, Santoliquido, Angelo, Santoro, Luca, Di Giorgio, Angela, Nesci, Antonio, Popolla, Valentina, Galluzzo V., Ciciarello F., Savera G., Calvani R. (ORCID:0000-0001-5472-2365), Marzetti E. (ORCID:0000-0001-9567-6983), Landi F. (ORCID:0000-0002-3472-1389), Tosato M., Gremese E. (ORCID:0000-0002-2248-1058), Bernabei R. (ORCID:0000-0002-9197-004X), Fantoni M. (ORCID:0000-0001-6913-8460), Gasbarrini A. (ORCID:0000-0002-7278-4823), Porcari S., Settanni C. R., Bramato G., Brandi V., Fabrizi S., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Martone A. M., Pagano F. C., Rocchi S., Salerno A., Catalano L., Damiano F. P., Rocconi A., Galliani A., Spaziani G., Tupputi S., Cocchi C., Pirone F., D'Ignazio F., Cacciatore S., Cauda R. (ORCID:0000-0002-1498-4229), Tamburrini E. (ORCID:0000-0003-4930-426X), Borghetti A., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Ventura G. (ORCID:0000-0002-0304-7264), Stella L., Addolorato G. (ORCID:0000-0002-1522-9946), Franceschi F. (ORCID:0000-0001-6266-445X), Mingrone G. (ORCID:0000-0003-2021-528X), Zocco M. A. (ORCID:0000-0002-0814-9542), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cattani P. (ORCID:0000-0003-4678-4763), Marchetti S., Posteraro B. (ORCID:0000-0002-1663-7546), Sali M. (ORCID:0000-0003-3609-2990), Bizzarro A., Lauria A., Rizzo S. (ORCID:0000-0001-6302-063X), Savastano M. C. (ORCID:0000-0003-1397-4333), Gambini G., Culiersi C., Passali G. C. (ORCID:0000-0002-8176-0962), Paludetti G. (ORCID:0000-0003-2480-1243), Galli J. (ORCID:0000-0001-6353-6249), Longobardi Y., Tricarico L., Buonsenso D., Valentini P. (ORCID:0000-0001-6095-9510), Sinatti D., De Rose C., Richeldi L. (ORCID:0000-0001-8594-1448), Lombardi F., Calabrese A., Leone P. M., Intini E., Sani G. (ORCID:0000-0002-9767-8752), Janiri D., Simonetti A., Natale L. (ORCID:0000-0002-7949-5119), Larici A. R. (ORCID:0000-0002-1882-6244), Marano R. (ORCID:0000-0003-2710-2093), Petricca L., Gigante L., Fedele A. L., Lizzio M. M., Tolusso B. (ORCID:0000-0002-9108-6609), Di Mario C., Alivernini S. (ORCID:0000-0002-7383-4212), Santoliquido A. (ORCID:0000-0003-1539-4017), Santoro L., Di Giorgio A., Nesci A., Popolla V., Galluzzo, Vincenzo, Zazzara, M. B., Ciciarello, Francesca, Savera, Giulia, Pais, C., Calvani, Riccardo, Picca, A., Marzetti, Emanuele, Landi, Francesco, Tosato, Matteo, Steering, Committee, Gremese, Elisa, Coordination, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Field, Investigator, Gastroenterology, Team, Porcari, Serena, Settanni, Carlo Romano, Geriatric, Team, Benvenuto, F., Bramato, Giulia, Brandi, Vincenzo, Carfi, A., Fabrizi, Sofia, Lo Monaco, Maria Rita, Martone, Anna Maria, Napolitano, C., Pagano, Francesco Cosimo, Rocchi, Sara, Rota, E., Salerno, Andrea Maria, Tritto, M., Catalano, Lucio, Damiano, Francesco Paolo, Rocconi, Alessandra, Galliani, Alessandro, Spaziani, Giovanni, Tupputi, Salvatore, Cocchi, Camilla, Pirone, Flavia, D'Ignazio, Federica, Cacciatore, Stefano, Infectious disease, Team, Cauda, Roberto, Tamburrini, Enrica, Borghetti, Alberto, Di Gianbenedetto, S., Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, E., Moschese, D., Ciccullo, A., Dusina, A., Internal Medicine, Team, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Zocco, Maria Assunta, Microbiology, Team, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, Michela, Neurology, Team, Bizzarro, Alessandra, Lauria, Alessandra, Ophthalmology, Team, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, G. M., Culiersi, Carola, Otolaryngology, Team, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, F., Di Cintio, G., Longobardi, Ylenia, Tricarico, Laura, Santantonio, M., Pediatric, Team, Buonsenso, Danilo, Valentini, Piero, Pata, D., Sinatti, Dario, De Rose, Cristina, Pneumology, Team, Richeldi, Luca, Lombardi, Francesco, Calabrese, Anna Chiara, Leone, Paolo Maria, Calvello, M. R., Intini, Enrica, Montemurro, G., Psychiatric, Team, Sani, Gabriele, Janiri, Delfina, Simonetti, Alessio, Giuseppin, G., Molinaro, M., Odica, M., Radiology, Team, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Rheumatology, Team, Paglionico, A., Petricca, Luca, Gigante, Lavinia, Natalello, G., Fedele, Anna Laura, Lizzio, Marco Maria, Tolusso, Barbara, Di Mario, Clara, Alivernini, Stefano, Vascular, Team, Santoliquido, Angelo, Santoro, Luca, Di Giorgio, Angela, Nesci, Antonio, Popolla, Valentina, Galluzzo V., Ciciarello F., Savera G., Calvani R. (ORCID:0000-0001-5472-2365), Marzetti E. (ORCID:0000-0001-9567-6983), Landi F. (ORCID:0000-0002-3472-1389), Tosato M., Gremese E. (ORCID:0000-0002-2248-1058), Bernabei R. (ORCID:0000-0002-9197-004X), Fantoni M. (ORCID:0000-0001-6913-8460), Gasbarrini A. (ORCID:0000-0002-7278-4823), Porcari S., Settanni C. R., Bramato G., Brandi V., Fabrizi S., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Martone A. M., Pagano F. C., Rocchi S., Salerno A., Catalano L., Damiano F. P., Rocconi A., Galliani A., Spaziani G., Tupputi S., Cocchi C., Pirone F., D'Ignazio F., Cacciatore S., Cauda R. (ORCID:0000-0002-1498-4229), Tamburrini E. (ORCID:0000-0003-4930-426X), Borghetti A., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Ventura G. (ORCID:0000-0002-0304-7264), Stella L., Addolorato G. (ORCID:0000-0002-1522-9946), Franceschi F. (ORCID:0000-0001-6266-445X), Mingrone G. (ORCID:0000-0003-2021-528X), Zocco M. A. (ORCID:0000-0002-0814-9542), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cattani P. (ORCID:0000-0003-4678-4763), Marchetti S., Posteraro B. (ORCID:0000-0002-1663-7546), Sali M. (ORCID:0000-0003-3609-2990), Bizzarro A., Lauria A., Rizzo S. (ORCID:0000-0001-6302-063X), Savastano M. C. (ORCID:0000-0003-1397-4333), Gambini G., Culiersi C., Passali G. C. (ORCID:0000-0002-8176-0962), Paludetti G. (ORCID:0000-0003-2480-1243), Galli J. (ORCID:0000-0001-6353-6249), Longobardi Y., Tricarico L., Buonsenso D., Valentini P. (ORCID:0000-0001-6095-9510), Sinatti D., De Rose C., Richeldi L. (ORCID:0000-0001-8594-1448), Lombardi F., Calabrese A., Leone P. M., Intini E., Sani G. (ORCID:0000-0002-9767-8752), Janiri D., Simonetti A., Natale L. (ORCID:0000-0002-7949-5119), Larici A. R. (ORCID:0000-0002-1882-6244), Marano R. (ORCID:0000-0003-2710-2093), Petricca L., Gigante L., Fedele A. L., Lizzio M. M., Tolusso B. (ORCID:0000-0002-9108-6609), Di Mario C., Alivernini S. (ORCID:0000-0002-7383-4212), Santoliquido A. (ORCID:0000-0003-1539-4017), Santoro L., Di Giorgio A., Nesci A., and Popolla V.

Abstract

Background: Fatigue with reduced tolerance to exercise is a common persistent long-lasting feature amongst COVID-19 survivors. The assessment of muscle function in this category of patients is often neglected. Aim.: To evaluate the potential impact of a daily supplementation based on amino acids, minerals, vi- tamins, and plant extracts (Apportal®) on muscle function, body composition, laboratory parameters and self-rated health in a small group of COVID-19 survivors affected by fatigue. Methods: Thirty participants were enrolled among patients affected by physical fatigue during or after acute COVID-19 and admitted to the post-COVID-19 outpatient service at Fondazione Policlinico Gemelli in Rome between 1st March 2021 and 30th April 2021. All participants were evaluated at first visit (t0) and at control visit (t1), after taking a daily sachet of Apportal® for 28 days. Muscle function was analyzed using hand grip strength test, exhaustion strength time and the number of repetitions at one- minute chair stand test. Body composition was assessed with bioelectrical impedance analysis (BIA). Laboratory parameters, including standard blood biochemistry and ferritin levels, were evaluated at the first visit and during the control visit. A quick evaluation of self-rated health, before COVID-19, at t0 and t1, was obtained through a visual analogue scale (VAS). Results: Participants aged 60 years and older were 13 (43%). Females represented the 70% of the study sample. Participants hospitalized for COVID-19 with low-flow oxygen supplementation represented the 43.3% of the study sample while 3.3% received noninvasive ventilation (NIV) or invasive ventilation. Hand grip strength improved from 26.3 Kg to 28.9 Kg (p < 0.05) at t1 as compared to t0. The mean time of strength exhaustion increased from 31.7 s (sec) at t0 to 47.5 s at t1 (p < 0.05). Participants performed a higher number of repetitions (28.3 vs. 22.0; p < 0.05) during the one-minute chair stand test at t1

Published
2022

20. A real-time integrated framework to support clinical decision making for covid-19 patients

Author

Murri, Rita, Masciocchi, Carlotta, Lenkowicz, Jacopo, Fantoni, Massimo, Damiani, Andrea, Marchetti, A., Sergi, P. D. A., Arcuri, Giovanni, Cesario, Alfredo, Patarnello, S., Antonelli, Massimo, Bellantone, Rocco Domenico Alfonso, Bernabei, Roberto, Boccia, Stefania, Calabresi, Paolo, Cambieri, Andrea, Cauda, Roberto, Colosimo, Cesare, Crea, Filippo, De Maria Marchiano, Ruggero, De Stefano, Valerio, Franceschi, Francesco, Gasbarrini, Antonio, Landolfi, Raffaele, Parolini, Ornella, Richeldi, Luca, Sanguinetti, Maurizio, Urbani, Andrea, Zega, Maurizio, Scambia, Giovanni, Valentini, Vincenzo, Murri R. (ORCID:0000-0003-4263-7854), Masciocchi C., Lenkowicz J., Fantoni M. (ORCID:0000-0001-6913-8460), Damiani A., Arcuri G., Cesario A. (ORCID:0000-0003-4687-0709), Antonelli M. (ORCID:0000-0003-3007-1670), Bellantone R. (ORCID:0000-0002-0844-3469), Bernabei R. (ORCID:0000-0002-9197-004X), Boccia S. (ORCID:0000-0002-1864-749X), Calabresi P. (ORCID:0000-0003-0326-5509), Cambieri A., Cauda R. (ORCID:0000-0002-1498-4229), Colosimo C. (ORCID:0000-0003-3800-3648), Crea F. (ORCID:0000-0001-9404-8846), De Maria R. (ORCID:0000-0003-2255-0583), De Stefano V. (ORCID:0000-0002-5178-5827), Franceschi F. (ORCID:0000-0001-6266-445X), Gasbarrini A. (ORCID:0000-0002-7278-4823), Landolfi R. (ORCID:0000-0002-7913-8576), Parolini O. (ORCID:0000-0002-5211-6430), Richeldi L. (ORCID:0000-0001-8594-1448), Sanguinetti M. (ORCID:0000-0002-9780-7059), Urbani A. (ORCID:0000-0001-9168-3174), Zega M. (ORCID:0000-0002-7821-2615), Scambia G. (ORCID:0000-0003-2758-1063), Valentini V. (ORCID:0000-0003-4637-6487), Murri, Rita, Masciocchi, Carlotta, Lenkowicz, Jacopo, Fantoni, Massimo, Damiani, Andrea, Marchetti, A., Sergi, P. D. A., Arcuri, Giovanni, Cesario, Alfredo, Patarnello, S., Antonelli, Massimo, Bellantone, Rocco Domenico Alfonso, Bernabei, Roberto, Boccia, Stefania, Calabresi, Paolo, Cambieri, Andrea, Cauda, Roberto, Colosimo, Cesare, Crea, Filippo, De Maria Marchiano, Ruggero, De Stefano, Valerio, Franceschi, Francesco, Gasbarrini, Antonio, Landolfi, Raffaele, Parolini, Ornella, Richeldi, Luca, Sanguinetti, Maurizio, Urbani, Andrea, Zega, Maurizio, Scambia, Giovanni, Valentini, Vincenzo, Murri R. (ORCID:0000-0003-4263-7854), Masciocchi C., Lenkowicz J., Fantoni M. (ORCID:0000-0001-6913-8460), Damiani A., Arcuri G., Cesario A. (ORCID:0000-0003-4687-0709), Antonelli M. (ORCID:0000-0003-3007-1670), Bellantone R. (ORCID:0000-0002-0844-3469), Bernabei R. (ORCID:0000-0002-9197-004X), Boccia S. (ORCID:0000-0002-1864-749X), Calabresi P. (ORCID:0000-0003-0326-5509), Cambieri A., Cauda R. (ORCID:0000-0002-1498-4229), Colosimo C. (ORCID:0000-0003-3800-3648), Crea F. (ORCID:0000-0001-9404-8846), De Maria R. (ORCID:0000-0003-2255-0583), De Stefano V. (ORCID:0000-0002-5178-5827), Franceschi F. (ORCID:0000-0001-6266-445X), Gasbarrini A. (ORCID:0000-0002-7278-4823), Landolfi R. (ORCID:0000-0002-7913-8576), Parolini O. (ORCID:0000-0002-5211-6430), Richeldi L. (ORCID:0000-0001-8594-1448), Sanguinetti M. (ORCID:0000-0002-9780-7059), Urbani A. (ORCID:0000-0001-9168-3174), Zega M. (ORCID:0000-0002-7821-2615), Scambia G. (ORCID:0000-0003-2758-1063), and Valentini V. (ORCID:0000-0003-4637-6487)

Abstract

Background: The COVID-19 pandemic affected healthcare systems worldwide. Predictive models developed by Artificial Intelligence (AI) and based on timely, centralized and standardized real world patient data could improve management of COVID-19 to achieve better clinical outcomes. The objectives of this manuscript are to describe the structure and technologies used to construct a COVID-19 Data Mart architecture and to present how a large hospital has tackled the challenge of supporting daily management of COVID-19 pandemic emergency, by creating a strong retrospective knowledge base, a real time environment and integrated information dashboard for daily practice and early identification of critical condition at patient level. This framework is also used as an informative, continuously enriched data lake, which is a base for several on-going predictive studies. Methods: The information technology framework for clinical practice and research was described. It was developed using SAS Institute software analytics tool and SAS® Vyia® environment and Open-Source environment R ® and Python ® for fast prototyping and modeling. The included variables and the source extraction procedures were presented. Results: The Data Mart covers a retrospective cohort of 5528 patients with SARS-CoV-2 infection. People who died were older, had more comorbidities, reported more frequently dyspnea at onset, had higher D-dimer, C-reactive protein and urea nitrogen. The dashboard was developed to support the management of COVID-19 patients at three levels: hospital, single ward and individual care level. Interpretation: The COVID-19 Data Mart based on integration of a large collection of clinical data and an AI-based integrated framework has been developed, based on a set of automated procedures for data mining and retrieval, transformation and integration, and has been embedded in the clinical practice to help managing daily care. Benefits from the availability of a Data Mart include the oppor

Published
2022

21. Characteristic of IgA and IgG antibody response to SARS-CoV-2 infection in an Italian referral COVID-19 Hospital

Author

Carnicelli, A., Fiori, Barbara, Ricci, Rosalba, Piano, A., Bonadia, N., Taddei, Eleonora, Fantoni, Massimo, Murri, Rita, Cingolani, Antonella, Barillaro, Christian, Cutuli, S. L., Marchesini, Debora, Della Polla, D. A., Forte, E., Fuorlo, M., Di Maurizio, L., Amorini, Paola, Cattani Franchi, Paola, Franceschi, Francesco, Sanguinetti, Maurizio, Fiori B. (ORCID:0000-0003-3318-5809), Ricci R., Taddei E., Fantoni M. (ORCID:0000-0001-6913-8460), Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Barillaro C., Marchesini D., Amorini P., Cattani P. (ORCID:0000-0003-4678-4763), Franceschi F. (ORCID:0000-0001-6266-445X), Sanguinetti M. (ORCID:0000-0002-9780-7059), Carnicelli, A., Fiori, Barbara, Ricci, Rosalba, Piano, A., Bonadia, N., Taddei, Eleonora, Fantoni, Massimo, Murri, Rita, Cingolani, Antonella, Barillaro, Christian, Cutuli, S. L., Marchesini, Debora, Della Polla, D. A., Forte, E., Fuorlo, M., Di Maurizio, L., Amorini, Paola, Cattani Franchi, Paola, Franceschi, Francesco, Sanguinetti, Maurizio, Fiori B. (ORCID:0000-0003-3318-5809), Ricci R., Taddei E., Fantoni M. (ORCID:0000-0001-6913-8460), Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Barillaro C., Marchesini D., Amorini P., Cattani P. (ORCID:0000-0003-4678-4763), Franceschi F. (ORCID:0000-0001-6266-445X), and Sanguinetti M. (ORCID:0000-0002-9780-7059)

Abstract

Introduction: Antibody response plays a fundamental role in the natural history of infectious disease. A better understanding of the immune response in patients with SARS-CoV-2 infection could be important for identifying patients at greater risk of developing a more severe form of disease and with a worse prognosis. Methods: We performed a cross-sectional analysis to determine the presence and the levels of both anti-SARS-CoV-2 IgG and IgA in a cohort of hospitalized patients with confirmed infection at different times in the natural history of the disease. Patients enrolled when admitted at the emergency department were prospectively followed up during hospital stay. Results: Overall, 131 patients were considered with a total of 237 samples processed. Cross-sectional analysis showed that seroconversion for IgA seems to occur between days 6 and 15, while IgG response seems to occur slightly later, peaking at day 20 after symptoms onset. Both IgA and IgG were maintained beyond 2 months. Severe patients showed a higher IgA response compared with mild patients when analyzing optical density (8.3 versus 5.6, p < 0.001). Prospective analysis conducted on 55 patients confirmed that IgA appear slightly earlier than IgG. After stratifying for the severity of disease, both the IgA and IgG responses were more vigorous in severe cases. Moreover, while IgG tended to stabilize, there was a relevant decline after the first month of IgA levels in mild cases. Conclusion: IgA and IgG antibody response is closely related, although seroconversion for IgA occurs earlier. Both IgA and IgG are maintained beyond 2 months. Severe patients showed a more vigorous IgA and IgG response. IgA levels seem to decline after 1 month since the onset of symptoms in mild cases. Our results should be interpreted with cautions due to several limitations in our study, mainly the small number of cases, lack of data on viral load and clinical setting.

Published
2022

22. Social media as a tool for scientific updating at the time of COVID pandemic: Results from a national survey in Italy

Author

Murri, Rita, Segala, Francesco Vladimiro, Del Vecchio, Pierluigi, Cingolani, Antonella, Taddei, Eleonora, Micheli, Giulia, Fantoni, Massimo, Murri Rita (ORCID:0000-0003-4263-7854), Segala Francesco Vladimiro, Del Vecchio Pierluigi, Cingolani Antonella (ORCID:0000-0002-3793-2755), Taddei Eleonora, Micheli Giulia, Fantoni Massimo (ORCID:0000-0001-6913-8460), Murri, Rita, Segala, Francesco Vladimiro, Del Vecchio, Pierluigi, Cingolani, Antonella, Taddei, Eleonora, Micheli, Giulia, Fantoni, Massimo, Murri Rita (ORCID:0000-0003-4263-7854), Segala Francesco Vladimiro, Del Vecchio Pierluigi, Cingolani Antonella (ORCID:0000-0002-3793-2755), Taddei Eleonora, Micheli Giulia, and Fantoni Massimo (ORCID:0000-0001-6913-8460)

Abstract

In the face of the rapid evolution of the COVID-19 pandemic, healthcare professionals on the frontline are in urgent need of frequent updates in the accomplishment of their practice. Hence, clinicians started to search for prompt, valid information on sources that are parallel to academic journals. Aim of this work is to investigate the extent of this phenomenon. We administered an anonymous online cross-sectional survey to 645 Italian clinicians. Target of the survey were all medical figures potentially involved in the management of COVID-19 cases. 369 questionnaires were returned. 19.5% (n = 72) of respondents were younger than 30 years-old; 49,3% (n = 182) worked in Infectious Diseases, Internal Medicine or Respiratory Medicine departments, 11.5% (n = 42) in Intensive Care Unit and 7.4% (n = 27) were general practitioner. 70% (n = 261) of respondents reported that their use of social media to seek medical information increased during the pandemic. 39.3% (n = 145) consistently consulted Facebook groups and 53.1% (n = 196) Whatsapp chats. 47% (n = 174) of respondents reported that information shared on social media had a consistent impact on their daily practice. In the present study, we found no difference in social media usage between age groups or medical specialties. Given the urgent need for scientific update during the present pandemic, these findings may help understanding how clinicians access new evidences and implement them in their daily practice

Published
2020

23. A proposal for a comprehensive approach to infections across the surgical pathway

Author

Sartelli, Massimo, Pagani, Leonardo, Iannazzo, Stefania, Moro, Maria Luisa, Viale, Pierluigi, Pan, Angelo, Ansaloni, Luca, Coccolini, Federico, D'Errico, Marcello Mario, Agreiter, Iri, Amadio Nespola, Giorgio, Barchiesi, Francesco, Benigni, Valeria, Binazzi, Raffaella, Cappanera, Stefano, Chiodera, Alessandro, Cola, Valentina, Corsi, Daniela, Cortese, Francesco, Crapis, Massimo, Cristini, Francesco, D'Arpino, Alessandro, De Simone, Belinda, Di Bella, Stefano, Di Marzo, Francesco, Donati, Abele, Elisei, Daniele, Fantoni, Massimo, Ferrari, Anna, Foghetti, Domitilla, Francisci, Daniela, Gattuso, Gianni, Giacometti, Andrea, Gesuelli, Guido Cesare, Marmorale, Cristina, Martini, Enrica, Meledandri, Marcello, Murri, Rita, Padrini, Daniela, Palmieri, Dalia, Pauri, Paola, Rebagliati, Carla, Ricchizzi, Enrico, Sambri, Vittorio, Schimizzi, Anna Maria, Siquini, Walter, Scoccia, Loredana, Scoppettuolo, Giancarlo, Sganga, Gabriele, Storti, Nadia, Tavio, Marcello, Toccafondi, Giulio, Tumietto, Fabio, Viaggi, Bruno, Vivarelli, Marco, Tranà, Cristian, Raso, Melina, Labricciosa, Francesco Maria, Dhingra, Sameer, Catena, Fausto, Fantoni, Massimo (ORCID:0000-0001-6913-8460), Murri, Rita (ORCID:0000-0003-4263-7854), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Sartelli, Massimo, Pagani, Leonardo, Iannazzo, Stefania, Moro, Maria Luisa, Viale, Pierluigi, Pan, Angelo, Ansaloni, Luca, Coccolini, Federico, D'Errico, Marcello Mario, Agreiter, Iri, Amadio Nespola, Giorgio, Barchiesi, Francesco, Benigni, Valeria, Binazzi, Raffaella, Cappanera, Stefano, Chiodera, Alessandro, Cola, Valentina, Corsi, Daniela, Cortese, Francesco, Crapis, Massimo, Cristini, Francesco, D'Arpino, Alessandro, De Simone, Belinda, Di Bella, Stefano, Di Marzo, Francesco, Donati, Abele, Elisei, Daniele, Fantoni, Massimo, Ferrari, Anna, Foghetti, Domitilla, Francisci, Daniela, Gattuso, Gianni, Giacometti, Andrea, Gesuelli, Guido Cesare, Marmorale, Cristina, Martini, Enrica, Meledandri, Marcello, Murri, Rita, Padrini, Daniela, Palmieri, Dalia, Pauri, Paola, Rebagliati, Carla, Ricchizzi, Enrico, Sambri, Vittorio, Schimizzi, Anna Maria, Siquini, Walter, Scoccia, Loredana, Scoppettuolo, Giancarlo, Sganga, Gabriele, Storti, Nadia, Tavio, Marcello, Toccafondi, Giulio, Tumietto, Fabio, Viaggi, Bruno, Vivarelli, Marco, Tranà, Cristian, Raso, Melina, Labricciosa, Francesco Maria, Dhingra, Sameer, Catena, Fausto, Fantoni, Massimo (ORCID:0000-0001-6913-8460), Murri, Rita (ORCID:0000-0003-4263-7854), and Sganga, Gabriele (ORCID:0000-0001-5079-0395)

Published
2020

24. Incidence of Bloodstream Infections, Length of Hospital Stay, and Survival in Patients With Recurrent Clostridioides difficile Infection Treated With Fecal Microbiota Transplantation or Antibiotics: A Prospective Cohort Study

Author

Ianiro, Gianluca, Murri, Rita, Sciumè, Giusi Desirè, Impagnatiello, Michele, Masucci, Luca, Ford, Alexander C, Law, Graham R, Tilg, Herbert, Sanguinetti, Maurizio, Cauda, Roberto, Gasbarrini, Antonio, Fantoni, Massimo, Cammarota, Giovanni, Ianiro, Gianluca (ORCID:0000-0002-8318-0515), Murri, Rita (ORCID:0000-0003-4263-7854), Masucci, Luca (ORCID:0000-0002-8358-6726), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Cauda, Roberto (ORCID:0000-0002-1498-4229), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cammarota, Giovanni (ORCID:0000-0002-3626-6148), Ianiro, Gianluca, Murri, Rita, Sciumè, Giusi Desirè, Impagnatiello, Michele, Masucci, Luca, Ford, Alexander C, Law, Graham R, Tilg, Herbert, Sanguinetti, Maurizio, Cauda, Roberto, Gasbarrini, Antonio, Fantoni, Massimo, Cammarota, Giovanni, Ianiro, Gianluca (ORCID:0000-0002-8318-0515), Murri, Rita (ORCID:0000-0003-4263-7854), Masucci, Luca (ORCID:0000-0002-8358-6726), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Cauda, Roberto (ORCID:0000-0002-1498-4229), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Fantoni, Massimo (ORCID:0000-0001-6913-8460), and Cammarota, Giovanni (ORCID:0000-0002-3626-6148)

Abstract

Background: Clostridioides difficile infection (CDI) is a risk factor for bloodstream infection (BSI). Fecal microbiota transplantation (FMT) is more effective than antibiotics in treating recurrent CDI, but its efficacy in preventing CDI-related BSI is uncertain. Objective: To assess incidence of primary BSI in patients with recurrent CDI treated with FMT versus antibiotics. Design: Prospective cohort study. Patients treated with FMT and those treated with antibiotics were matched on propensity score. Setting: Single academic medical center. Patients: 290 inpatients with recurrent CDI (57 patients per treatment in matched cohort). Intervention: FMT or antibiotics. Measurements: The primary outcome was primary BSI within 90 days. Secondary outcomes were length of hospitalization and overall survival (OS) at 90 days. Results: Of the 290 patients, 109 were treated with FMT and 181 received antibiotics. Five patients in the FMT group and 40 in the antibiotic group developed BSI. Because of differences in the patients treated with FMT versus antibiotics in many baseline characteristics, including number of recurrences and CDI severity, comparative analyses were limited to the matched cohort. Risk for BSI was 23 percentage points (95% CI, 10 to 35 percentage points) lower in the FMT group; the FMT group also had 14 fewer days of hospitalization (CI, 9 to 20 fewer days) and a 32-percentage point increase in OS (CI, 16 to 47 percentage points) compared with the antibiotic group. Limitation: Nonrandomized study with potential for unmeasured or residual confounding; limited generalizability of the propensity score-matched cohort. Conclusion: In a propensity score-matched cohort, patients with recurrent CDI treated with FMT were less likely to develop primary BSI.

Published
2019

25. Prognostic role of serum procalcitonin measurement in adult patients admitted to the emergency department with fever

Author

Covino, Marcello, Manno, Alberto, De Matteis, Giuseppe, Taddei, Eleonora, Carbone, Luigi, Piccioni, Andrea, Simeoni, B., Fantoni, Massimo, Franceschi, Francesco, Murri, Rita, Covino M. (ORCID:0000-0002-6709-2531), Manno A., De Matteis G., Taddei E., Carbone L., Piccioni A., Fantoni M. (ORCID:0000-0001-6913-8460), Franceschi F. (ORCID:0000-0001-6266-445X), Murri R. (ORCID:0000-0003-4263-7854), Covino, Marcello, Manno, Alberto, De Matteis, Giuseppe, Taddei, Eleonora, Carbone, Luigi, Piccioni, Andrea, Simeoni, B., Fantoni, Massimo, Franceschi, Francesco, Murri, Rita, Covino M. (ORCID:0000-0002-6709-2531), Manno A., De Matteis G., Taddei E., Carbone L., Piccioni A., Fantoni M. (ORCID:0000-0001-6913-8460), Franceschi F. (ORCID:0000-0001-6266-445X), and Murri R. (ORCID:0000-0003-4263-7854)

Published
2021

26. Prognostic role of serum procalcitonin measurement in adult patients admitted to the emergency department with fever

Author

Covino, Marcello, Manno, Alberto, De Matteis, Giuseppe, Taddei, E., Carbone, Luigi, Piccioni, Andrea, Simeoni, B., Fantoni, Massimo, Franceschi, Francesco, Murri, Rita, Covino M. (ORCID:0000-0002-6709-2531), Manno A., De Matteis G., Carbone L., Piccioni A., Fantoni M. (ORCID:0000-0001-6913-8460), Franceschi F. (ORCID:0000-0001-6266-445X), Murri R. (ORCID:0000-0003-4263-7854), Covino, Marcello, Manno, Alberto, De Matteis, Giuseppe, Taddei, E., Carbone, Luigi, Piccioni, Andrea, Simeoni, B., Fantoni, Massimo, Franceschi, Francesco, Murri, Rita, Covino M. (ORCID:0000-0002-6709-2531), Manno A., De Matteis G., Carbone L., Piccioni A., Fantoni M. (ORCID:0000-0001-6913-8460), Franceschi F. (ORCID:0000-0001-6266-445X), and Murri R. (ORCID:0000-0003-4263-7854)

Published
2021

27. Residual respiratory impairment after COVID-19 pneumonia

Author

Lombardi, F., Calabrese, Anna Chiara, Iovene, Bruno, Pierandrei, C., Lerede, M., Varone, Francesco, Richeldi, Luca, Sgalla, Giacomo, Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Romano Settanni, C., Benvenuto, F., Bramato, Giulia, Carfi, A., Ciciarello, Francesca, Lo Monaco, Maria Rita, Maria Martone, A., Marzetti, Emanuele, Napolitano, C., Pagano, Francesco Cosimo, Rocchi, Sara, Rota, E., Salerno, Andrea Maria, Tosato, Matteo, Tritto, M., Calvani, Riccardo, Catalano, Lucio, Picca, A., Savera, Giulia, Tamburrini, Enrica, Borghetti, Alberto, Di Gianbenedetto, S., Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, E., Moschese, D., Ciccullo, A., Stella, L., Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Assunta Zocco, M., Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Cristina Savastano, M., Gambini, Gloria, Grazia Cozzupoli, M., Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, F., Di Cintio, G., Longobardi, Ylenia, Tricarico, Laura, Santantonio, M., Buonsenso, Danilo, Valentini, Piero, Pata, D., Sinatti, Dario, De Rose, Cristina, Sani, Gabriele, Janiri, Delfina, Giuseppin, G., Molinaro, M., Modica, Marco, Natale, Luigi, Rita Larici, A., Marano, Riccardo, Paglionico, A., Petricca, Luca, Gigante, Lavinia, Natalello, G., Laur, a. Fedele A., Maria Lizzio, M., Santoliquido, Angelo, Santoro, L., Nesci, A., Popolla, Valentina, Calabrese A., Iovene B., Varone F., Richeldi L. (ORCID:0000-0001-8594-1448), Sgalla G. (ORCID:0000-0003-3130-9388), Landi F. (ORCID:0000-0002-3472-1389), Gremese E. (ORCID:0000-0002-2248-1058), Bernabei R. (ORCID:0000-0002-9197-004X), Fantoni M. (ORCID:0000-0001-6913-8460), Gasbarrini A. (ORCID:0000-0002-7278-4823), Bramato G., Ciciarello F., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Marzetti E. (ORCID:0000-0001-9567-6983), Pagano F., Rocchi S., Salerno A., Tosato M., Calvani R. (ORCID:0000-0001-5472-2365), Catalano L., Savera G., Tamburrini E. (ORCID:0000-0003-4930-426X), Borghetti A., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Ventura G. (ORCID:0000-0002-0304-7264), Addolorato G. (ORCID:0000-0002-1522-9946), Franceschi F. (ORCID:0000-0001-6266-445X), Mingrone G. (ORCID:0000-0003-2021-528X), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cattani P. (ORCID:0000-0003-4678-4763), Marchetti S., Bizzarro A., Lauria A., Rizzo S. (ORCID:0000-0001-6302-063X), Gambini G., Culiersi C., Cesare Passali G. (ORCID:0000-0002-8176-0962), Paludetti G. (ORCID:0000-0003-2480-1243), Galli J. (ORCID:0000-0001-6353-6249), Longobardi Y., Tricarico L., Buonsenso D., Valentini P. (ORCID:0000-0001-6095-9510), Sinatti D., De Rose C., Sani G. (ORCID:0000-0002-9767-8752), Janiri D., Modica M., Natale L. (ORCID:0000-0002-7949-5119), Marano R. (ORCID:0000-0003-2710-2093), Petricca L., Gigante L., Santoliquido A. (ORCID:0000-0003-1539-4017), Popolla V., Lombardi, F., Calabrese, Anna Chiara, Iovene, Bruno, Pierandrei, C., Lerede, M., Varone, Francesco, Richeldi, Luca, Sgalla, Giacomo, Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Romano Settanni, C., Benvenuto, F., Bramato, Giulia, Carfi, A., Ciciarello, Francesca, Lo Monaco, Maria Rita, Maria Martone, A., Marzetti, Emanuele, Napolitano, C., Pagano, Francesco Cosimo, Rocchi, Sara, Rota, E., Salerno, Andrea Maria, Tosato, Matteo, Tritto, M., Calvani, Riccardo, Catalano, Lucio, Picca, A., Savera, Giulia, Tamburrini, Enrica, Borghetti, Alberto, Di Gianbenedetto, S., Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, E., Moschese, D., Ciccullo, A., Stella, L., Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Assunta Zocco, M., Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Cristina Savastano, M., Gambini, Gloria, Grazia Cozzupoli, M., Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, F., Di Cintio, G., Longobardi, Ylenia, Tricarico, Laura, Santantonio, M., Buonsenso, Danilo, Valentini, Piero, Pata, D., Sinatti, Dario, De Rose, Cristina, Sani, Gabriele, Janiri, Delfina, Giuseppin, G., Molinaro, M., Modica, Marco, Natale, Luigi, Rita Larici, A., Marano, Riccardo, Paglionico, A., Petricca, Luca, Gigante, Lavinia, Natalello, G., Laur, a. Fedele A., Maria Lizzio, M., Santoliquido, Angelo, Santoro, L., Nesci, A., Popolla, Valentina, Calabrese A., Iovene B., Varone F., Richeldi L. (ORCID:0000-0001-8594-1448), Sgalla G. (ORCID:0000-0003-3130-9388), Landi F. (ORCID:0000-0002-3472-1389), Gremese E. (ORCID:0000-0002-2248-1058), Bernabei R. (ORCID:0000-0002-9197-004X), Fantoni M. (ORCID:0000-0001-6913-8460), Gasbarrini A. (ORCID:0000-0002-7278-4823), Bramato G., Ciciarello F., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Marzetti E. (ORCID:0000-0001-9567-6983), Pagano F., Rocchi S., Salerno A., Tosato M., Calvani R. (ORCID:0000-0001-5472-2365), Catalano L., Savera G., Tamburrini E. (ORCID:0000-0003-4930-426X), Borghetti A., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Ventura G. (ORCID:0000-0002-0304-7264), Addolorato G. (ORCID:0000-0002-1522-9946), Franceschi F. (ORCID:0000-0001-6266-445X), Mingrone G. (ORCID:0000-0003-2021-528X), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cattani P. (ORCID:0000-0003-4678-4763), Marchetti S., Bizzarro A., Lauria A., Rizzo S. (ORCID:0000-0001-6302-063X), Gambini G., Culiersi C., Cesare Passali G. (ORCID:0000-0002-8176-0962), Paludetti G. (ORCID:0000-0003-2480-1243), Galli J. (ORCID:0000-0001-6353-6249), Longobardi Y., Tricarico L., Buonsenso D., Valentini P. (ORCID:0000-0001-6095-9510), Sinatti D., De Rose C., Sani G. (ORCID:0000-0002-9767-8752), Janiri D., Modica M., Natale L. (ORCID:0000-0002-7949-5119), Marano R. (ORCID:0000-0003-2710-2093), Petricca L., Gigante L., Santoliquido A. (ORCID:0000-0003-1539-4017), and Popolla V.

Abstract

Introduction: The novel coronavirus SARS-Cov-2 can infect the respiratory tract causing a spectrum of disease varying from mild to fatal pneumonia, and known as COVID-19. Ongoing clinical research is assessing the potential for long-term respiratory sequelae in these patients. We assessed the respiratory function in a cohort of patients after recovering from SARS-Cov-2 infection, stratified according to PaO2/FiO2 (p/F) values. Method: Approximately one month after hospital discharge, 86 COVID-19 patients underwent physical examination, arterial blood gas (ABG) analysis, pulmonary function tests (PFTs), and six-minute walk test (6MWT). Patients were also asked to quantify the severity of dyspnoea and cough before, during, and after hospitalization using a visual analogic scale (VAS). Seventy-six subjects with ABG during hospitalization were stratified in three groups according to their worst p/F values: above 300 (n = 38), between 200 and 300 (n = 30) and below 200 (n = 20). Results: On PFTs, lung volumes were overall preserved yet, mean percent predicted residual volume was slightly reduced (74.8 ± 18.1%). Percent predicted diffusing capacity for carbon monoxide (DLCO) was also mildly reduced (77.2 ± 16.5%). Patients reported residual breathlessness at the time of the visit (VAS 19.8, p < 0.001). Patients with p/F below 200 during hospitalization had lower percent predicted forced vital capacity (p = 0.005), lower percent predicted total lung capacity (p = 0.012), lower DLCO (p < 0.001) and shorter 6MWT distance (p = 0.004) than patients with higher p/F. Conclusion: Approximately one month after hospital discharge, patients with COVID-19 can have residual respiratory impairment, including lower exercise tolerance. The extent of this impairment seems to correlate with the severity of respiratory failure during hospitalization.

Published
2021

28. Gemelli decision tree Algorithm to Predict the need for home monitoring or hospitalization of confirmed and unconfirmed COVID-19 patients (GAP-Covid19): preliminary results from a retrospective cohort study

Author

Vetrugno, Giuseppe, Laurenti, Patrizia, Franceschi, Francesco, Foti, Francesco, D'Ambrosio, Francesca, Cicconi, M, La Milia, Daniele Ignazio, Di Pumpo, Marcello, Carini, E, Pascucci, Domenico, Boccia, Stefania, Pastorino, Roberta, Damiani, Gianfranco, De-Giorgio, F, Oliva, Antonio, Nicolotti, Nicola, Cambieri, Andrea, Ghisellini, R, Murri, Rita, Sabatelli, G, Musolino, M, Gasbarrini, Antonio, Bosello, Silvia Laura, Gemelli-Against-Covid, Group, Vetrugno, G (ORCID:0000-0003-0181-2855), Laurenti, P (ORCID:0000-0002-8532-0593), Franceschi, F (ORCID:0000-0001-6266-445X), Foti, F, D'Ambrosio, F, LA Milia, D I, Di Pumpo, M, Pascucci, D (ORCID:0000-0002-5804-2284), Boccia, S (ORCID:0000-0002-1864-749X), Pastorino, R (ORCID:0000-0001-5013-0733), Damiani, G (ORCID:0000-0003-3028-6188), Oliva, A (ORCID:0000-0001-7120-616X), Nicolotti, N, Cambieri, A, Murri, R (ORCID:0000-0003-4263-7854), Gasbarrini, A (ORCID:0000-0002-7278-4823), Bosello, S (ORCID:0000-0002-4837-447X), Vetrugno, Giuseppe, Laurenti, Patrizia, Franceschi, Francesco, Foti, Francesco, D'Ambrosio, Francesca, Cicconi, M, La Milia, Daniele Ignazio, Di Pumpo, Marcello, Carini, E, Pascucci, Domenico, Boccia, Stefania, Pastorino, Roberta, Damiani, Gianfranco, De-Giorgio, F, Oliva, Antonio, Nicolotti, Nicola, Cambieri, Andrea, Ghisellini, R, Murri, Rita, Sabatelli, G, Musolino, M, Gasbarrini, Antonio, Bosello, Silvia Laura, Gemelli-Against-Covid, Group, Vetrugno, G (ORCID:0000-0003-0181-2855), Laurenti, P (ORCID:0000-0002-8532-0593), Franceschi, F (ORCID:0000-0001-6266-445X), Foti, F, D'Ambrosio, F, LA Milia, D I, Di Pumpo, M, Pascucci, D (ORCID:0000-0002-5804-2284), Boccia, S (ORCID:0000-0002-1864-749X), Pastorino, R (ORCID:0000-0001-5013-0733), Damiani, G (ORCID:0000-0003-3028-6188), Oliva, A (ORCID:0000-0001-7120-616X), Nicolotti, N, Cambieri, A, Murri, R (ORCID:0000-0003-4263-7854), Gasbarrini, A (ORCID:0000-0002-7278-4823), and Bosello, S (ORCID:0000-0002-4837-447X)

Abstract

OBJECTIVE: To develop a deep learning-based decision tree for the primary care setting, to stratify adult patients with confirmed and unconfirmed coronavirus disease 2019 (COVID-19), and to predict the need for hospitalization or home monitoring.PATIENTS AND METHODS: We performed a retrospective cohort study on data from patients admitted to a COVID hospital in Rome, Italy, between 5 March 2020 and 5 June 2020. A confirmed case was defined as a patient with a positive nasopharyngeal RT-PCR test result, while an unconfirmed case had negative results on repeated swabs. Patients' medical history and clinical, laboratory and radiological findings were collected, and the dataset was used to train a predictive model for COVID-19 severity.RESULTS: Data of 198 patients were included in the study. Twenty-eight (14.14%) had mild disease, 62 (31.31%) had moderate disease, 64 (32.32%) had severe disease, and 44 (22.22%) had critical disease. The G(2) value assessed the contribution of each collected value to decision tree building. On this basis, SpO2 (%) with a cut point at 92 was chosen for the optimal first split. Therefore, the decision tree was built using values maximizing G(2) and LogWorth. After the tree was built, the correspondence between inputs and outcomes was validated.CONCLUSIONS: We developed a machine learning-based tool that is easy to understand and apply. It provides good discrimination in stratifying confirmed and unconfirmed COVID-19 patients with different prognoses in every context. Our tool might allow general practitioners visiting patients at home to decide whether the patient needs to be hospitalized.

Published
2021

29. Gemelli decision tree Algorithm to Predict the need for home monitoring or hospitalization of confirmed and unconfirmed COVID-19 patients (GAP-Covid19): preliminary results from a retrospective cohort study

Author

Vetrugno, Giuseppe, Laurenti, Patrizia, Franceschi, Francesco, Foti, Francesco, D'Ambrosio, Floriana, Cicconi, M, La Milia, Daniele Ignazio, Di Pumpo, Marcello, Carini, E, Pascucci, Domenico, Boccia, Stefania, Pastorino, Roberta, Damiani, Gianfranco, De-Giorgio, F, Oliva, Antonio, Nicolotti, Nicola, Cambieri, Andrea, Ghisellini, R, Murri, Rita, Sabatelli, G, Musolino, M, Gasbarrini, Antonio, Montini, Luca, Miele, Luca, Gemelli-Against-Covid, Group, Vetrugno, G (ORCID:0000-0003-0181-2855), Laurenti, P (ORCID:0000-0002-8532-0593), Franceschi, F (ORCID:0000-0001-6266-445X), Foti, F, D'Ambrosio, F, LA Milia, D I, Di Pumpo, M, Pascucci, D (ORCID:0000-0002-5804-2284), Boccia, S (ORCID:0000-0002-1864-749X), Pastorino, R (ORCID:0000-0001-5013-0733), Damiani, G (ORCID:0000-0003-3028-6188), Oliva, A (ORCID:0000-0001-7120-616X), Nicolotti, N, Cambieri, A, Murri, R (ORCID:0000-0003-4263-7854), Gasbarrini, A (ORCID:0000-0002-7278-4823), Montini, L (ORCID:0000-0003-4602-5134), Miele, L (ORCID:0000-0003-3464-0068), Vetrugno, Giuseppe, Laurenti, Patrizia, Franceschi, Francesco, Foti, Francesco, D'Ambrosio, Floriana, Cicconi, M, La Milia, Daniele Ignazio, Di Pumpo, Marcello, Carini, E, Pascucci, Domenico, Boccia, Stefania, Pastorino, Roberta, Damiani, Gianfranco, De-Giorgio, F, Oliva, Antonio, Nicolotti, Nicola, Cambieri, Andrea, Ghisellini, R, Murri, Rita, Sabatelli, G, Musolino, M, Gasbarrini, Antonio, Montini, Luca, Miele, Luca, Gemelli-Against-Covid, Group, Vetrugno, G (ORCID:0000-0003-0181-2855), Laurenti, P (ORCID:0000-0002-8532-0593), Franceschi, F (ORCID:0000-0001-6266-445X), Foti, F, D'Ambrosio, F, LA Milia, D I, Di Pumpo, M, Pascucci, D (ORCID:0000-0002-5804-2284), Boccia, S (ORCID:0000-0002-1864-749X), Pastorino, R (ORCID:0000-0001-5013-0733), Damiani, G (ORCID:0000-0003-3028-6188), Oliva, A (ORCID:0000-0001-7120-616X), Nicolotti, N, Cambieri, A, Murri, R (ORCID:0000-0003-4263-7854), Gasbarrini, A (ORCID:0000-0002-7278-4823), Montini, L (ORCID:0000-0003-4602-5134), and Miele, L (ORCID:0000-0003-3464-0068)

Abstract

OBJECTIVE: To develop a deep learning-based decision tree for the primary care setting, to stratify adult patients with confirmed and unconfirmed coronavirus disease 2019 (COVID-19), and to predict the need for hospitalization or home monitoring.PATIENTS AND METHODS: We performed a retrospective cohort study on data from patients admitted to a COVID hospital in Rome, Italy, between 5 March 2020 and 5 June 2020. A confirmed case was defined as a patient with a positive nasopharyngeal RT-PCR test result, while an unconfirmed case had negative results on repeated swabs. Patients' medical history and clinical, laboratory and radiological findings were collected, and the dataset was used to train a predictive model for COVID-19 severity.RESULTS: Data of 198 patients were included in the study. Twenty-eight (14.14%) had mild disease, 62 (31.31%) had moderate disease, 64 (32.32%) had severe disease, and 44 (22.22%) had critical disease. The G(2) value assessed the contribution of each collected value to decision tree building. On this basis, SpO2 (%) with a cut point at 92 was chosen for the optimal first split. Therefore, the decision tree was built using values maximizing G(2) and LogWorth. After the tree was built, the correspondence between inputs and outcomes was validated.CONCLUSIONS: We developed a machine learning-based tool that is easy to understand and apply. It provides good discrimination in stratifying confirmed and unconfirmed COVID-19 patients with different prognoses in every context. Our tool might allow general practitioners visiting patients at home to decide whether the patient needs to be hospitalized.

Published
2021

30. Gemelli decision tree Algorithm to Predict the need for home monitoring or hospitalization of confirmed and unconfirmed COVID-19 patients (GAP-Covid19): Preliminary results from a retrospective cohort study

Author

Vetrugno, Giuseppe, Laurenti, Patrizia, Franceschi, Francesco, Foti, F., D'Ambrosio, Floriana, Cicconi, M., La Milia, Daniele Ignazio, Di Pumpo, Marcello, Carini, Elettra, Pascucci, Domenico, Boccia, Stefania, Pastorino, Roberta, Damiani, Gianfranco, De Giorgio, Fabio, Oliva, Antonio, Nicolotti, Nicola, Cambieri, Andrea, Ghisellini, R., Murri, Rita, Sabatelli, G., Musolino, M., Gasbarrini, Antonio, Vetrugno G. (ORCID:0000-0003-0181-2855), Laurenti P. (ORCID:0000-0002-8532-0593), Franceschi F. (ORCID:0000-0001-6266-445X), D'Ambrosio F., la Milia D. I., Di Pumpo M., Carini E., Pascucci D. (ORCID:0000-0002-5804-2284), Boccia S. (ORCID:0000-0002-1864-749X), Pastorino R. (ORCID:0000-0001-5013-0733), Damiani G. (ORCID:0000-0003-3028-6188), De Giorgio F. (ORCID:0000-0002-9447-9707), Oliva A. (ORCID:0000-0001-7120-616X), Nicolotti N., Cambieri A., Murri R. (ORCID:0000-0003-4263-7854), Gasbarrini A. (ORCID:0000-0002-7278-4823), Vetrugno, Giuseppe, Laurenti, Patrizia, Franceschi, Francesco, Foti, F., D'Ambrosio, Floriana, Cicconi, M., La Milia, Daniele Ignazio, Di Pumpo, Marcello, Carini, Elettra, Pascucci, Domenico, Boccia, Stefania, Pastorino, Roberta, Damiani, Gianfranco, De Giorgio, Fabio, Oliva, Antonio, Nicolotti, Nicola, Cambieri, Andrea, Ghisellini, R., Murri, Rita, Sabatelli, G., Musolino, M., Gasbarrini, Antonio, Vetrugno G. (ORCID:0000-0003-0181-2855), Laurenti P. (ORCID:0000-0002-8532-0593), Franceschi F. (ORCID:0000-0001-6266-445X), D'Ambrosio F., la Milia D. I., Di Pumpo M., Carini E., Pascucci D. (ORCID:0000-0002-5804-2284), Boccia S. (ORCID:0000-0002-1864-749X), Pastorino R. (ORCID:0000-0001-5013-0733), Damiani G. (ORCID:0000-0003-3028-6188), De Giorgio F. (ORCID:0000-0002-9447-9707), Oliva A. (ORCID:0000-0001-7120-616X), Nicolotti N., Cambieri A., Murri R. (ORCID:0000-0003-4263-7854), and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

OBJECTIVE: To develop a deep learning-based decision tree for the primary care setting, to stratify adult patients with confirmed and unconfirmed coronavirus disease 2019 (COVID-19), and to predict the need for hospitalization or home monitoring. PATIENTS AND METHODS: We performed a retrospective cohort study on data from patients admitted to a COVID hospital in Rome, Italy, between 5 March 2020 and 5 June 2020. A confirmed case was defined as a patient with a positive nasopharyngeal RT-PCR test result, while an unconfirmed case had negative results on repeated swabs. Patients’ medical history and clinical, laboratory and radiological findings were collected, and the dataset was used to train a predictive model for COVID-19 severity. RESULTS: Data of 198 patients were included in the study. Twenty-eight (14.14%) had mild disease, 62 (31.31%) had moderate disease, 64 (32.32%) had severe disease, and 44 (22.22%) had critical disease. The G2 value assessed the contribution of each collected value to decision tree building. On this basis, SpO2 (%) with a cut point at 92 was chosen for the optimal first split. Therefore, the decision tree was built using values maximizing G2 and LogWorth. After the tree was built, the correspondence between inputs and outcomes was validated. CONCLUSIONS: We developed a machine learning-based tool that is easy to understand and apply. It provides good discrimination in stratifying confirmed and unconfirmed COVID-19 patients with different prognoses in every context. Our tool might allow general practitioners visiting patients at home to decide whether the patient needs to be hospitalized.

Published
2021

31. Post-prescription audit plus beta-d-glucan assessment decrease echinocandin use in people with suspected invasive candidiasis

Author

Murri, Rita, Lardo, S., De Luca, Alessio, Posteraro, Brunella, Torelli, Riccardo, De Angelis, Giulia, Giovannenze, Francesca, Taccari, Francesco, Pavan, L., Parroni, L., Sanguinetti, Maurizio, Fantoni, Massimo, Murri R. (ORCID:0000-0003-4263-7854), De Luca A., Posteraro B. (ORCID:0000-0002-1663-7546), Torelli R., De Angelis G. (ORCID:0000-0002-7087-7399), Giovannenze F., Taccari F., Sanguinetti M. (ORCID:0000-0002-9780-7059), Fantoni M. (ORCID:0000-0001-6913-8460), Murri, Rita, Lardo, S., De Luca, Alessio, Posteraro, Brunella, Torelli, Riccardo, De Angelis, Giulia, Giovannenze, Francesca, Taccari, Francesco, Pavan, L., Parroni, L., Sanguinetti, Maurizio, Fantoni, Massimo, Murri R. (ORCID:0000-0003-4263-7854), De Luca A., Posteraro B. (ORCID:0000-0002-1663-7546), Torelli R., De Angelis G. (ORCID:0000-0002-7087-7399), Giovannenze F., Taccari F., Sanguinetti M. (ORCID:0000-0002-9780-7059), and Fantoni M. (ORCID:0000-0001-6913-8460)

Abstract

Background and Objectives: Overtreatment with antifungal drugs is often observed. Antifungal stewardship (AFS) focuses on optimizing the treatment for invasive fungal diseases. The objective of the present study was to evaluate the utility of a post-prescription audit plus beta-D-glucan (BDG) assessment on reducing echinocandin use in persons with suspected invasive candidiasis. Materials and Methods: This is a prospective, pre-post quasi-experimental study of people starting echinocandins for suspected invasive candidiasis. The intervention of the study included review of each echinocandin prescription and discontinuation of treatment if a very low probability of fungal disease or a negative BDG value were found. Pre-intervention data were compared with the intervention phase. The primary outcome of the study was the duration of echinocandin therapy. Secondary outcomes were length of hospital stay and mortality. Results: Ninety-two echinocan-din prescriptions were reviewed, 49 (53.3%) in the pre-intervention phase and 43 (46.7%) in the intervention phase. Discontinuation of antifungal therapy was possible in 21 of the 43 patients in the intervention phase (48.8%). The duration of echinocandin therapy was 7.4 (SD 4.7) in the pre-intervention phase, 4.1 days (SD 2.9) in persons undergoing the intervention, and 8.6 (SD 7.3) in persons in whom the intervention was not feasible (p at ANOVA = 0.016). Length of stay and mortality did not differ between pre-intervention and intervention phases. Conclusions: An intervention based on pre-prescription restriction and post-prescription audit when combined with BDG measurement is effective in optimizing antifungal therapy by significantly reducing excessive treatment duration.

Published
2021

32. A machine-learning parsimonious multivariable predictive model of mortality risk in patients with Covid-19

Author

Murri, Rita, Lenkowicz, Jacopo, Masciocchi, Carlotta, Iacomini, C., Fantoni, Massimo, Damiani, Andrea, Marchetti, A., Sergi, P. D. A., Arcuri, G., Cesario, Alfredo, Patarnello, S., Antonelli, Massimo, Bellantone, Rocco Domenico Alfonso, Bernabei, Roberto, Boccia, Stefania, Calabresi, Paolo, Cambieri, Andrea, Cauda, Roberto, Colosimo, Cesare, Crea, Filippo, De Maria Marchiano, Ruggero, De Stefano, Valerio, Franceschi, Francesco, Gasbarrini, Antonio, Parolini, Ornella, Richeldi, Luca, Sanguinetti, Maurizio, Urbani, Andrea, Zega, Maurizio, Scambia, Giovanni, Valentini, Vincenzo, Armuzzi, Alessandro, Barba, Marta, Baroni, Silvia, Bellesi, Silvia, Bentivoglio, Anna Rita, Biasucci, Luigi Marzio, Biscetti, Federico, Candelli, Marcello, Capalbo, Gennaro, Cattani Franchi, Paola, Chiusolo, Patrizia, Cingolani, Antonella, Corbo, Giuseppe Maria, Covino, Marcello, Cozzolino, A. M., D'Alfonso, Maria Elena, De Angelis, Giulia, De Pascale, Gennaro, Frisullo, Giovanni, Gabrielli, M., Gambassi, Giovanni, Garcovich, M., Gremese, Elisa, Grieco, Domenico Luca, Iaconelli, A., Iorio, Raffaele, Landi, Francesco, Larici, Anna Rita, Liuzzo, Giovanna, Maviglia, Riccardo, Miele, Luca, Montalto, Massimo, Natale, Luigi, Nicolotti, Nicola, Ojetti, Veronica, Pompili, Maurizio, Posteraro, Brunella, Rapaccini, Gian Ludovico, Rinaldi, R., Rossi, Elena, Santoliquido, Angelo, Sica, Simona, Tamburrini, Enrica, Teofili, Luciana, Testa, Antonia Carla, Tosoni, A., Trani, Carlo, Varone, Francesco, Verme, L. Z. D., Murri R. (ORCID:0000-0003-4263-7854), Lenkowicz J., Masciocchi C., Fantoni M. (ORCID:0000-0001-6913-8460), Damiani A., Cesario A. (ORCID:0000-0003-4687-0709), Antonelli M. (ORCID:0000-0003-3007-1670), Bellantone R. (ORCID:0000-0002-0844-3469), Bernabei R. (ORCID:0000-0002-9197-004X), Boccia S. (ORCID:0000-0002-1864-749X), Calabresi P. (ORCID:0000-0003-0326-5509), Cambieri A., Cauda R. (ORCID:0000-0002-1498-4229), Colosimo C. (ORCID:0000-0003-3800-3648), Crea F. (ORCID:0000-0001-9404-8846), De Maria R. (ORCID:0000-0003-2255-0583), De Stefano V. (ORCID:0000-0002-5178-5827), Franceschi F. (ORCID:0000-0001-6266-445X), Gasbarrini A. (ORCID:0000-0002-7278-4823), Parolini O. (ORCID:0000-0002-5211-6430), Richeldi L. (ORCID:0000-0001-8594-1448), Sanguinetti M. (ORCID:0000-0002-9780-7059), Urbani A. (ORCID:0000-0001-9168-3174), Zega M. (ORCID:0000-0002-7821-2615), Scambia G. (ORCID:0000-0003-2758-1063), Valentini V. (ORCID:0000-0003-4637-6487), Armuzzi A. (ORCID:0000-0003-1572-0118), Barba M. (ORCID:0000-0001-6084-7666), Baroni S. (ORCID:0000-0002-3410-2617), Bellesi S., Bentivoglio A. (ORCID:0000-0002-9663-095X), Biasucci L. M. (ORCID:0000-0002-6921-6497), Biscetti F. (ORCID:0000-0001-7449-657X), Candelli M. (ORCID:0000-0001-8443-7880), Capalbo G., Cattani P. (ORCID:0000-0003-4678-4763), Chiusolo P. (ORCID:0000-0002-1355-1587), Cingolani A. (ORCID:0000-0002-3793-2755), Corbo G. (ORCID:0000-0002-8104-4659), Covino M. (ORCID:0000-0002-6709-2531), D'Alfonso M., De Angelis G. (ORCID:0000-0002-7087-7399), De Pascale G. (ORCID:0000-0002-8255-0676), Frisullo G., Gambassi G. (ORCID:0000-0002-7030-9359), Gremese E. (ORCID:0000-0002-2248-1058), Grieco D. L. (ORCID:0000-0002-4557-6308), Iorio R. (ORCID:0000-0002-6270-0956), Landi F. (ORCID:0000-0002-3472-1389), Larici A. (ORCID:0000-0002-1882-6244), Liuzzo G. (ORCID:0000-0002-5714-0907), Maviglia R., Miele L. (ORCID:0000-0003-3464-0068), Montalto M. (ORCID:0000-0001-8819-3684), Natale L. (ORCID:0000-0002-7949-5119), Nicolotti N., Ojetti V. (ORCID:0000-0002-8953-0707), Pompili M. (ORCID:0000-0001-6699-7980), Posteraro B. (ORCID:0000-0002-1663-7546), Rapaccini G. (ORCID:0000-0002-6467-857X), Rossi E. (ORCID:0000-0002-7572-9379), Santoliquido A. (ORCID:0000-0003-1539-4017), Sica S. (ORCID:0000-0003-2426-3465), Tamburrini E. (ORCID:0000-0003-4930-426X), Teofili L. (ORCID:0000-0002-7214-1561), Testa A. (ORCID:0000-0003-2217-8726), Trani C. (ORCID:0000-0001-9777-013X), Varone F., Murri, Rita, Lenkowicz, Jacopo, Masciocchi, Carlotta, Iacomini, C., Fantoni, Massimo, Damiani, Andrea, Marchetti, A., Sergi, P. D. A., Arcuri, G., Cesario, Alfredo, Patarnello, S., Antonelli, Massimo, Bellantone, Rocco Domenico Alfonso, Bernabei, Roberto, Boccia, Stefania, Calabresi, Paolo, Cambieri, Andrea, Cauda, Roberto, Colosimo, Cesare, Crea, Filippo, De Maria Marchiano, Ruggero, De Stefano, Valerio, Franceschi, Francesco, Gasbarrini, Antonio, Parolini, Ornella, Richeldi, Luca, Sanguinetti, Maurizio, Urbani, Andrea, Zega, Maurizio, Scambia, Giovanni, Valentini, Vincenzo, Armuzzi, Alessandro, Barba, Marta, Baroni, Silvia, Bellesi, Silvia, Bentivoglio, Anna Rita, Biasucci, Luigi Marzio, Biscetti, Federico, Candelli, Marcello, Capalbo, Gennaro, Cattani Franchi, Paola, Chiusolo, Patrizia, Cingolani, Antonella, Corbo, Giuseppe Maria, Covino, Marcello, Cozzolino, A. M., D'Alfonso, Maria Elena, De Angelis, Giulia, De Pascale, Gennaro, Frisullo, Giovanni, Gabrielli, M., Gambassi, Giovanni, Garcovich, M., Gremese, Elisa, Grieco, Domenico Luca, Iaconelli, A., Iorio, Raffaele, Landi, Francesco, Larici, Anna Rita, Liuzzo, Giovanna, Maviglia, Riccardo, Miele, Luca, Montalto, Massimo, Natale, Luigi, Nicolotti, Nicola, Ojetti, Veronica, Pompili, Maurizio, Posteraro, Brunella, Rapaccini, Gian Ludovico, Rinaldi, R., Rossi, Elena, Santoliquido, Angelo, Sica, Simona, Tamburrini, Enrica, Teofili, Luciana, Testa, Antonia Carla, Tosoni, A., Trani, Carlo, Varone, Francesco, Verme, L. Z. D., Murri R. (ORCID:0000-0003-4263-7854), Lenkowicz J., Masciocchi C., Fantoni M. (ORCID:0000-0001-6913-8460), Damiani A., Cesario A. (ORCID:0000-0003-4687-0709), Antonelli M. (ORCID:0000-0003-3007-1670), Bellantone R. (ORCID:0000-0002-0844-3469), Bernabei R. (ORCID:0000-0002-9197-004X), Boccia S. (ORCID:0000-0002-1864-749X), Calabresi P. (ORCID:0000-0003-0326-5509), Cambieri A., Cauda R. (ORCID:0000-0002-1498-4229), Colosimo C. (ORCID:0000-0003-3800-3648), Crea F. (ORCID:0000-0001-9404-8846), De Maria R. (ORCID:0000-0003-2255-0583), De Stefano V. (ORCID:0000-0002-5178-5827), Franceschi F. (ORCID:0000-0001-6266-445X), Gasbarrini A. (ORCID:0000-0002-7278-4823), Parolini O. (ORCID:0000-0002-5211-6430), Richeldi L. (ORCID:0000-0001-8594-1448), Sanguinetti M. (ORCID:0000-0002-9780-7059), Urbani A. (ORCID:0000-0001-9168-3174), Zega M. (ORCID:0000-0002-7821-2615), Scambia G. (ORCID:0000-0003-2758-1063), Valentini V. (ORCID:0000-0003-4637-6487), Armuzzi A. (ORCID:0000-0003-1572-0118), Barba M. (ORCID:0000-0001-6084-7666), Baroni S. (ORCID:0000-0002-3410-2617), Bellesi S., Bentivoglio A. (ORCID:0000-0002-9663-095X), Biasucci L. M. (ORCID:0000-0002-6921-6497), Biscetti F. (ORCID:0000-0001-7449-657X), Candelli M. (ORCID:0000-0001-8443-7880), Capalbo G., Cattani P. (ORCID:0000-0003-4678-4763), Chiusolo P. (ORCID:0000-0002-1355-1587), Cingolani A. (ORCID:0000-0002-3793-2755), Corbo G. (ORCID:0000-0002-8104-4659), Covino M. (ORCID:0000-0002-6709-2531), D'Alfonso M., De Angelis G. (ORCID:0000-0002-7087-7399), De Pascale G. (ORCID:0000-0002-8255-0676), Frisullo G., Gambassi G. (ORCID:0000-0002-7030-9359), Gremese E. (ORCID:0000-0002-2248-1058), Grieco D. L. (ORCID:0000-0002-4557-6308), Iorio R. (ORCID:0000-0002-6270-0956), Landi F. (ORCID:0000-0002-3472-1389), Larici A. (ORCID:0000-0002-1882-6244), Liuzzo G. (ORCID:0000-0002-5714-0907), Maviglia R., Miele L. (ORCID:0000-0003-3464-0068), Montalto M. (ORCID:0000-0001-8819-3684), Natale L. (ORCID:0000-0002-7949-5119), Nicolotti N., Ojetti V. (ORCID:0000-0002-8953-0707), Pompili M. (ORCID:0000-0001-6699-7980), Posteraro B. (ORCID:0000-0002-1663-7546), Rapaccini G. (ORCID:0000-0002-6467-857X), Rossi E. (ORCID:0000-0002-7572-9379), Santoliquido A. (ORCID:0000-0003-1539-4017), Sica S. (ORCID:0000-0003-2426-3465), Tamburrini E. (ORCID:0000-0003-4930-426X), Teofili L. (ORCID:0000-0002-7214-1561), Testa A. (ORCID:0000-0003-2217-8726), Trani C. (ORCID:0000-0001-9777-013X), and Varone F.

Abstract

The COVID-19 pandemic is impressively challenging the healthcare system. Several prognostic models have been validated but few of them are implemented in daily practice. The objective of the study was to validate a machine-learning risk prediction model using easy-to-obtain parameters to help to identify patients with COVID-19 who are at higher risk of death. The training cohort included all patients admitted to Fondazione Policlinico Gemelli with COVID-19 from March 5, 2020, to November 5, 2020. Afterward, the model was tested on all patients admitted to the same hospital with COVID-19 from November 6, 2020, to February 5, 2021. The primary outcome was in-hospital case-fatality risk. The out-of-sample performance of the model was estimated from the training set in terms of Area under the Receiving Operator Curve (AUROC) and classification matrix statistics by averaging the results of fivefold cross validation repeated 3-times and comparing the results with those obtained on the test set. An explanation analysis of the model, based on the SHapley Additive exPlanations (SHAP), is also presented. To assess the subsequent time evolution, the change in paO2/FiO2 (P/F) at 48 h after the baseline measurement was plotted against its baseline value. Among the 921 patients included in the training cohort, 120 died (13%). Variables selected for the model were age, platelet count, SpO2, blood urea nitrogen (BUN), hemoglobin, C-reactive protein, neutrophil count, and sodium. The results of the fivefold cross-validation repeated 3-times gave AUROC of 0.87, and statistics of the classification matrix to the Youden index as follows: sensitivity 0.840, specificity 0.774, negative predictive value 0.971. Then, the model was tested on a new population (n = 1463) in which the case-fatality rate was 22.6%. The test model showed AUROC 0.818, sensitivity 0.813, specificity 0.650, negative predictive value 0.922. Considering the first quartile of the predicted risk score (low-risk sc

Published
2021

34. Residual respiratory impairment after COVID-19 pneumonia

Author

Lombardi, Francesco, Calabrese, Angelo, Iovene, Bruno, Pierandrei, Chiara, Lerede, Marialessia, Varone, Francesco, Richeldi, Luca, Sgalla, Giacomo, Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Settanni, Carlo Romano, Benvenuto, Francesca, Bramato, Giulia, Carfi', Angelo, Ciciarello, Francesca, Lo Monaco, Maria Rita, Martone, Anna Maria, Marzetti, Emanuele, Napolitano, Carmen, Pagano, Francesco Cosimo, Rocchi, Sara, Rota, Elisabetta, Salerno, Andrea, Tosato, Matteo, Tritto, Marcello, Calvani, Riccardo, Catalano, Lucio, Picca, Anna, Savera, Giulia, Tamburrini, Enrica, Borghetti, Alberto, Simona Di Gianbenedetto, Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, Davide, Ciccullo, Arturo, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Gertrude, Zocco, Maria Assunta, Sanguinetti, Mauirizio, Cattani Franchi, Paola, Marchetti, Simona, Bizzarro, Alessandro, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Maria Grazia Cozzupoli, Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Giovanni Di Cintio, Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Buonsenso, Danilo, Valentini, Piero, Pata, Davide, Sinatti, Davide, De Rose, Cristina, Calabrese, Aangelo, Sani, Gabriele, Janiri, Delfina, Giuseppin, Giulia, Molinaro, Marzia, Modica, Marco, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Paglionico, Annamaria, Petricca, Luca, Gigante, Laura, Natalello, Gerlando, Fedele, Anna Laura, Lizzio, Marco Maria, Santoliquido, Angelo, Santoro, Luca, Nesci, Antonio, Popolla, Valentina, Richeldi, Luca (ORCID:0000-0001-8594-1448), Sgalla, Giacomo (ORCID:0000-0003-3130-9388), Francesco Landi (ORCID:0000-0002-3472-1389), Elisa Gremese (ORCID:0000-0002-2248-1058), Roberto Bernabei (ORCID:0000-0002-9197-004X), Massimo Fantoni (ORCID:0000-0001-6913-8460), Antonio Gasbarrini (ORCID:0000-0002-7278-4823), Carlo Romano Settanni, Francesca Benvenuto, Giulia Bramato, Angelo Carfì, Francesca Ciciarello, Maria Rita Lo Monaco (ORCID:0000-0002-1457-7981), Anna Maria Martone, Emanuele Marzetti (ORCID:0000-0001-9567-6983), Francesco Pagano, Sara Rocchi, Elisabetta Rota, Andrea Salerno, Matteo Tosato, Marcello Tritto, Riccardo Calvani (ORCID:0000-0001-5472-2365), Lucio Catalano, Enrica Tamburrini (ORCID:0000-0003-4930-426X), Alberto Borghetti, Rita Murri (ORCID:0000-0003-4263-7854), Antonella Cingolani (ORCID:0000-0002-3793-2755), Giulio Ventura (ORCID:0000-0002-0304-7264), Eleonora Taddei, Leonardo Stella, Giovanni Addolorato (ORCID:0000-0002-1522-9946), Francesco Franceschi (ORCID:0000-0001-6266-445X), Maria Assunta Zocco (ORCID:0000-0002-0814-9542), Paola Cattani (ORCID:0000-0003-4678-4763), Simona Marchetti, Alessandra Lauria, Stanislao Rizzo (ORCID:0000-0001-6302-063X), Maria Cristina Savastano (ORCID:0000-0003-1397-4333), Gloria Gambini, Carola Culiersi, Giulio Cesare Passali (ORCID:0000-0002-8176-0962), Gaetano Paludetti (ORCID:0000-0003-2480-1243), Jacopo Galli (ORCID:0000-0001-6353-6249), Fabrizio Crudo, Mariaconsiglia Santantonio, Danilo Buonsenso, Piero Valentini (ORCID:0000-0001-6095-9510), Cristina De Rose, Luca Richeldi (ORCID:0000-0001-8594-1448), Francesco Lombardi, Gabriele Sani (ORCID:0000-0002-9767-8752), Marco Modica, Luigi Natale (ORCID:0000-0002-7949-5119), Anna Rita Larici (ORCID:0000-0002-1882-6244), Riccardo Marano (ORCID:0000-0003-2710-2093), Luca Petricca, Anna Laura Fedele, Marco Maria Lizzio, Angelo Santoliquido (ORCID:0000-0003-1539-4017), Luca Santoro, Antonio Nesci, Lombardi, Francesco, Calabrese, Angelo, Iovene, Bruno, Pierandrei, Chiara, Lerede, Marialessia, Varone, Francesco, Richeldi, Luca, Sgalla, Giacomo, Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Settanni, Carlo Romano, Benvenuto, Francesca, Bramato, Giulia, Carfi', Angelo, Ciciarello, Francesca, Lo Monaco, Maria Rita, Martone, Anna Maria, Marzetti, Emanuele, Napolitano, Carmen, Pagano, Francesco Cosimo, Rocchi, Sara, Rota, Elisabetta, Salerno, Andrea, Tosato, Matteo, Tritto, Marcello, Calvani, Riccardo, Catalano, Lucio, Picca, Anna, Savera, Giulia, Tamburrini, Enrica, Borghetti, Alberto, Simona Di Gianbenedetto, Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, Davide, Ciccullo, Arturo, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Gertrude, Zocco, Maria Assunta, Sanguinetti, Mauirizio, Cattani Franchi, Paola, Marchetti, Simona, Bizzarro, Alessandro, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Maria Grazia Cozzupoli, Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Giovanni Di Cintio, Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Buonsenso, Danilo, Valentini, Piero, Pata, Davide, Sinatti, Davide, De Rose, Cristina, Calabrese, Aangelo, Sani, Gabriele, Janiri, Delfina, Giuseppin, Giulia, Molinaro, Marzia, Modica, Marco, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Paglionico, Annamaria, Petricca, Luca, Gigante, Laura, Natalello, Gerlando, Fedele, Anna Laura, Lizzio, Marco Maria, Santoliquido, Angelo, Santoro, Luca, Nesci, Antonio, Popolla, Valentina, Richeldi, Luca (ORCID:0000-0001-8594-1448), Sgalla, Giacomo (ORCID:0000-0003-3130-9388), Francesco Landi (ORCID:0000-0002-3472-1389), Elisa Gremese (ORCID:0000-0002-2248-1058), Roberto Bernabei (ORCID:0000-0002-9197-004X), Massimo Fantoni (ORCID:0000-0001-6913-8460), Antonio Gasbarrini (ORCID:0000-0002-7278-4823), Carlo Romano Settanni, Francesca Benvenuto, Giulia Bramato, Angelo Carfì, Francesca Ciciarello, Maria Rita Lo Monaco (ORCID:0000-0002-1457-7981), Anna Maria Martone, Emanuele Marzetti (ORCID:0000-0001-9567-6983), Francesco Pagano, Sara Rocchi, Elisabetta Rota, Andrea Salerno, Matteo Tosato, Marcello Tritto, Riccardo Calvani (ORCID:0000-0001-5472-2365), Lucio Catalano, Enrica Tamburrini (ORCID:0000-0003-4930-426X), Alberto Borghetti, Rita Murri (ORCID:0000-0003-4263-7854), Antonella Cingolani (ORCID:0000-0002-3793-2755), Giulio Ventura (ORCID:0000-0002-0304-7264), Eleonora Taddei, Leonardo Stella, Giovanni Addolorato (ORCID:0000-0002-1522-9946), Francesco Franceschi (ORCID:0000-0001-6266-445X), Maria Assunta Zocco (ORCID:0000-0002-0814-9542), Paola Cattani (ORCID:0000-0003-4678-4763), Simona Marchetti, Alessandra Lauria, Stanislao Rizzo (ORCID:0000-0001-6302-063X), Maria Cristina Savastano (ORCID:0000-0003-1397-4333), Gloria Gambini, Carola Culiersi, Giulio Cesare Passali (ORCID:0000-0002-8176-0962), Gaetano Paludetti (ORCID:0000-0003-2480-1243), Jacopo Galli (ORCID:0000-0001-6353-6249), Fabrizio Crudo, Mariaconsiglia Santantonio, Danilo Buonsenso, Piero Valentini (ORCID:0000-0001-6095-9510), Cristina De Rose, Luca Richeldi (ORCID:0000-0001-8594-1448), Francesco Lombardi, Gabriele Sani (ORCID:0000-0002-9767-8752), Marco Modica, Luigi Natale (ORCID:0000-0002-7949-5119), Anna Rita Larici (ORCID:0000-0002-1882-6244), Riccardo Marano (ORCID:0000-0003-2710-2093), Luca Petricca, Anna Laura Fedele, Marco Maria Lizzio, Angelo Santoliquido (ORCID:0000-0003-1539-4017), Luca Santoro, and Antonio Nesci

Abstract

Introduction: The novel coronavirus SARS-Cov-2 can infect the respiratory tract causing a spectrum of disease varying from mild to fatal pneumonia, and known as COVID-19. Ongoing clinical research is assessing the potential for long-term respiratory sequelae in these patients. We assessed the respiratory function in a cohort of patients after recovering from SARS-Cov-2 infection, stratified according to PaO2/FiO2 (p/F) values. Method: Approximately one month after hospital discharge, 86 COVID-19 patients underwent physical examination, arterial blood gas (ABG) analysis, pulmonary function tests (PFTs), and six-minute walk test (6MWT). Patients were also asked to quantify the severity of dyspnoea and cough before, during, and after hospitalization using a visual analogic scale (VAS). Seventy-six subjects with ABG during hospitalization were stratified in three groups according to their worst p/F values: above 300 (n = 38), between 200 and 300 (n = 30) and below 200 (n = 20). Results: On PFTs, lung volumes were overall preserved yet, mean percent predicted residual volume was slightly reduced (74.8 ± 18.1%). Percent predicted diffusing capacity for carbon monoxide (DLCO) was also mildly reduced (77.2 ± 16.5%). Patients reported residual breathlessness at the time of the visit (VAS 19.8, p < 0.001). Patients with p/F below 200 during hospitalization had lower percent predicted forced vital capacity (p = 0.005), lower percent predicted total lung capacity (p = 0.012), lower DLCO (p < 0.001) and shorter 6MWT distance (p = 0.004) than patients with higher p/F. Conclusion: Approximately one month after hospital discharge, patients with COVID-19 can have residual respiratory impairment, including lower exercise tolerance. The extent of this impairment seems to correlate with the severity of respiratory failure during hospitalization.

Published
2021

35. Predictors of mortality among adult, old and the oldest old patients with bloodstream infections: An age comparison

Author

Giovannenze, F., Murri, Rita, Palazzolo, C., Taccari, F., Camici, M., Spanu, Teresa, Posteraro, Brunella, Sanguinetti, Maurizio, Cauda, Roberto, Onder, Graziano, Fantoni, Massimo, Murri R. (ORCID:0000-0003-4263-7854), Spanu T. (ORCID:0000-0003-1864-5184), Posteraro B. (ORCID:0000-0002-1663-7546), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cauda R. (ORCID:0000-0002-1498-4229), Onder G. (ORCID:0000-0003-3400-4491), Fantoni M. (ORCID:0000-0001-6913-8460), Giovannenze, F., Murri, Rita, Palazzolo, C., Taccari, F., Camici, M., Spanu, Teresa, Posteraro, Brunella, Sanguinetti, Maurizio, Cauda, Roberto, Onder, Graziano, Fantoni, Massimo, Murri R. (ORCID:0000-0003-4263-7854), Spanu T. (ORCID:0000-0003-1864-5184), Posteraro B. (ORCID:0000-0002-1663-7546), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cauda R. (ORCID:0000-0002-1498-4229), Onder G. (ORCID:0000-0003-3400-4491), and Fantoni M. (ORCID:0000-0001-6913-8460)

Abstract

Background: Bloodstream infections (BSIs) are a major cause of mortality in elderly. Objective of the study is to identify factors predictive of mortality in old and oldest old patients. Methods: This is a single centre retrospective observational study, including all patients admitted to Fondazione Policlinico A. Gemelli university hospital and diagnosed with BSI. Patients were stratified into three groups according to age: adult (A), younger than 65; old (O), aged between 65 and 80; oldest old (OO), older than 80. Primary outcome was 30-day in-hospital mortality. Secondary outcomes were duration of antimicrobial therapy (DOT) and length of hospital stay (LOS). Results: Of the 1034 patients included in the study, 346 were in group A, 447 in group O and 241 in group OO. The rate of 30-day mortality raised from 6.9% (24/346) in group A to 10.8% (84/447) in group O and 33.2% (80/241) in group OO (p<0.01), while DOT and LOS significantly decreased moving from adults to oldest old (p<0.01). Methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus spp were both independently correlated to an increased 30-day mortality risk selectively in patients older than 80 (MRSA: HR 2.37, p=0.03; Enterococcus spp: HR 2.44, p=0.01). Conclusions: BSIs have a high impact on survival in old and oldest old patients. BSIs by gram-positive pathogens, in particular MRSA and Enterococcus spp, should be a wake-up call for physicians, who should focus efforts on adequate and prompt antibiotic and support treatment.

Published
2021

36. COVID-19 and RA share an SPP1 myeloid pathway that drives PD-L1+ neutrophils and CD14+ monocytes

Author

Macdonald, L., Alivernini, Stefano, Tolusso, Barbara, Elmesmari, A., Somma, D., Perniola, S., Paglionico, A., Petricca, Luca, Bosello, Silvia Laura, Carfi, A., Sali, M., Stigliano, Egidio, Cingolani, Antonella, Murri, Rita, Arena, Vincenzo, Fantoni, Massimo, Antonelli, Massimo, Landi, Francesco, Franceschi, Francesco, Sanguinetti, Maurizio, Mcinnes, I. B., Mcsharry, C., Gasbarrini, Antonio, Otto, T. D., Kurowska-Stolarska, M., Gremese, Elisa, Alivernini S. (ORCID:0000-0002-7383-4212), Tolusso B. (ORCID:0000-0002-9108-6609), Petricca L., Bosello S. L. (ORCID:0000-0002-4837-447X), Stigliano E., Cingolani A. (ORCID:0000-0002-3793-2755), Murri R. (ORCID:0000-0003-4263-7854), Arena V. (ORCID:0000-0002-7562-223X), Fantoni M. (ORCID:0000-0001-6913-8460), Antonelli M. (ORCID:0000-0003-3007-1670), Landi F. (ORCID:0000-0002-3472-1389), Franceschi F. (ORCID:0000-0001-6266-445X), Sanguinetti M. (ORCID:0000-0002-9780-7059), Gasbarrini A. (ORCID:0000-0002-7278-4823), Gremese E. (ORCID:0000-0002-2248-1058), Macdonald, L., Alivernini, Stefano, Tolusso, Barbara, Elmesmari, A., Somma, D., Perniola, S., Paglionico, A., Petricca, Luca, Bosello, Silvia Laura, Carfi, A., Sali, M., Stigliano, Egidio, Cingolani, Antonella, Murri, Rita, Arena, Vincenzo, Fantoni, Massimo, Antonelli, Massimo, Landi, Francesco, Franceschi, Francesco, Sanguinetti, Maurizio, Mcinnes, I. B., Mcsharry, C., Gasbarrini, Antonio, Otto, T. D., Kurowska-Stolarska, M., Gremese, Elisa, Alivernini S. (ORCID:0000-0002-7383-4212), Tolusso B. (ORCID:0000-0002-9108-6609), Petricca L., Bosello S. L. (ORCID:0000-0002-4837-447X), Stigliano E., Cingolani A. (ORCID:0000-0002-3793-2755), Murri R. (ORCID:0000-0003-4263-7854), Arena V. (ORCID:0000-0002-7562-223X), Fantoni M. (ORCID:0000-0001-6913-8460), Antonelli M. (ORCID:0000-0003-3007-1670), Landi F. (ORCID:0000-0002-3472-1389), Franceschi F. (ORCID:0000-0001-6266-445X), Sanguinetti M. (ORCID:0000-0002-9780-7059), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Gremese E. (ORCID:0000-0002-2248-1058)

Abstract

We explored the potential link between chronic inflammatory arthritis and COVID-19 pathogenic and resolving macrophage pathways and their role in COVID-19 pathogenesis. We found that bronchoalveolar lavage fluid (BALF) macrophage clusters FCN1+ and FCN1+SPP1+ predominant in severe COVID-19 were transcriptionally related to synovial tissue macrophage (STM) clusters CD48hiS100A12+ and CD48+SPP1+ that drive rheumatoid arthritis (RA) synovitis. BALF macrophage cluster FABP4+ predominant in healthy lung was transcriptionally related to STM cluster TREM2+ that governs resolution of synovitis in RA remission. Plasma concentrations of SPP1 and S100A12 (key products of macrophage clusters shared with active RA) were high in severe COVID-19 and predicted the need for Intensive Care Unit transfer, and they remained high in the post–COVID-19 stage. High plasma levels of SPP1 were unique to severe COVID-19 when compared with other causes of severe pneumonia, and IHC localized SPP1+ macrophages in the alveoli of COVID-19 lung. Investigation into SPP1 mechanisms of action revealed that it drives proinflammatory activation of CD14+ monocytes and development of PD-L1+ neutrophils, both hallmarks of severe COVID-19. In summary, COVID-19 pneumonitis appears driven by similar pathogenic myeloid cell pathways as those in RA, and their mediators such as SPP1 might be an upstream activator of the aberrant innate response in severe COVID-19 and predictive of disease trajectory including post–COVID-19 pathology.

Published
2021

37. Systematic clinical management of patients with candidemia improves survival

Author

Murri, Rita, Giovannenze, Francesca, Camici, Marta, Torelli, Riccardo, Ventura, Giulio, Scoppettuolo, Giancarlo, Sanguinetti, Maurizio, Cauda, Roberto, Fantoni, Massimo, Murri, Rita (ORCID:0000-0003-4263-7854), Ventura, Giulio (ORCID:0000-0002-0304-7264), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Cauda, Roberto (ORCID:0000-0002-1498-4229), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Murri, Rita, Giovannenze, Francesca, Camici, Marta, Torelli, Riccardo, Ventura, Giulio, Scoppettuolo, Giancarlo, Sanguinetti, Maurizio, Cauda, Roberto, Fantoni, Massimo, Murri, Rita (ORCID:0000-0003-4263-7854), Ventura, Giulio (ORCID:0000-0002-0304-7264), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Cauda, Roberto (ORCID:0000-0002-1498-4229), and Fantoni, Massimo (ORCID:0000-0001-6913-8460)

Abstract

Objectives: Taking into account the significant morbidity, mortality, and hospital costs related to Candidemia, our objective is to define if improving appropriateness in candidemia management was associated with better clinical outcomes. Methods: A prospective observational monocentric cohort study was conducted. Adherence to five main elements was examined: appropriate selection of initial therapy; follow-up blood culture; echocardiography; ophthalmological examination; and removal of a central venous catheter. The correlation between the number of appropriate elements achieved and 30 day survival was examined. Results: Patients with candidemia (n = 213) were enrolled. Adherence to all five elements was achieved in 36 cases (16.9%), while the majority adhered to three or four elements (28.2% and 37.1%, respectively). Multivariable Cox regression analysis revealed that the number of elements achieved was associated with survival [HR: 0.39 (0.30–0.52); p < 0.001]. Also, the number of elements achieved correlated positively with duration of therapy (p = 0.01), but not length of hospital stay (p = 0.56). Conclusions: Five elements, including therapeutic and non-therapeutic-related aspects, of care were good indicators of appropriate management of patients with candidemia. Implementation of evidence-based practice regarding optimal clinical management is crucial for any antimicrobial stewardship program.

Published
2018

38. Idsa Did Not Endorse the Surviving Sepsis Campaign Guidelines

Author

Murri, Rita, Taccari, Francesco, Palazzolo, Claudia, Fantoni, Massimo, Cauda, Roberto, Murri, Rita (ORCID:0000-0003-4263-7854), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cauda, Roberto (ORCID:0000-0002-1498-4229), Murri, Rita, Taccari, Francesco, Palazzolo, Claudia, Fantoni, Massimo, Cauda, Roberto, Murri, Rita (ORCID:0000-0003-4263-7854), Fantoni, Massimo (ORCID:0000-0001-6913-8460), and Cauda, Roberto (ORCID:0000-0002-1498-4229)

Abstract

The SSC 2016 sepsis definition is based on some studies in which the rate of proven infection is very low or unknown. The new definition does not consider patients with <2 points at Sequential Organ Failure Assessment (SOFA) score but with bloodstream infection (BSI). Even though this population is not formally a “septic population,” patients may require intense care and appropriate therapy. To highlight this issue, we analyzed data on people with BSI seen in a large university hospital in Rome. Four hundred three patients were considered: mean age, 66.3 years, 56% were males, 36% were hospitalized within the previous 90 days before the BSI, and 29% received at least 1 antibiotic in the previous month. Forty percent had a central venous catheter at the onset. Sixty-five percent had no SIRS criteria and 35% only 1 criterion. The 30-day mortality was 11.2%; median of duration of antibiotic therapy was 17 days (interquartile range, 11–25 days). The 30-day mortality of people with Candida BSI was 24.7%. According to our results, the SSC 2016 sepsis definition, may omit diagnosis of infected patients who need appropriate therapy (such as Candida BSI) and who also have a high mortality. To manage the delicate balance between not starting useless therapy and not neglecting demanding conditions such as Candida BSI, we strongly suggest improving rate of diagnostic tests in patients with suspected infections to achieve the highest diagnostic sensitivity.

Published
2018

39. Psychological Distress After Covid-19 Recovery: Reciprocal Effects With Temperament and Emotional Dysregulation. An Exploratory Study of Patients Over 60 Years of Age Assessed in a Post-acute Care Service

Author

Janiri, D., Kotzalidis, G. D., Giuseppin, G., Molinaro, M., Modica, Marco, Montanari, Silvia, Terenzi, Beatrice, Carfi, A., Landi, Francesco, Sani, Gabriele, Gremese, Elisa, Bernabei, Roberto, Gasbarrini, Antonio, Settanni, Carlo Romano, Benvenuto, Francesca, Bramato, Giulia, Brandi, Vincenzo, Carfi', Angelo, Ciciarello, Francesca, Rita, M., Lo Monaco, Andrea, Martone, Anna Maria, Marzetti, Emanuele, Carmennapolitano, Pagano, Francesco Cosimo, Rocchi, Sara, Elisabettarota, Salerno, Andrea, Tosato, Matteo, Tritto, Marcello, Calvani, Riccardo, Catalano, Lucio, Picca, Anna, Savera, Giulia, Cauda, Roberto, Tamburrini, Enrica, Borghetti, Alberto, Simona Di Gianbenedetto, Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, Davide, Ciccullo, Arturo, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Zocco, Maria Assunta, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, Michela, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Grazia Maria Cozzupoli, Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, D'Alatri, Lucia, Crudo, Fabrizio, Giovanni Di Cintio, Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Buonsenso, Danilo, Valentini, Piero, Pata, Davide, Sinatti, Dario, De Rose, Cristina, Richeldi, Luca, Lombardi, Francesco, Giuseppin, Giulia, Molinaro, Marzia, Natale, Luigi, Larici, Annrita, Marano, Riccardo, Paglionico, Annamaria, Petricca, Luca, Natalello, Gerlando, Fedele, Anna Laura, Lizzio, Marco Maria, Tolusso, Barbara, Alivernini, Stefano, Santoliquido, Angelo, Santoro, Luca, Nesci, Antonio, Popolla, Valentina, Mari, Giorgia, Marchese, Maria Raffaella, Ausili Cefaro, Carolina, Calabrese, Angelo, Janiri, Delfina, Gigante, Laura, Modica M., Montanari S., Terenzi B., Landi F. (ORCID:0000-0002-3472-1389), Sani G (ORCID:0000-0002-9767-8752), rancesco Landi, Elisa Gremese (ORCID:0000-0002-2248-1058), Roberto Bernabei, Massimo Fantoni (ORCID:0000-0002-9197-004X), Antonio Gasbarrini (ORCID:0000-0002-7278-4823), Carlo Romano Settanni, Francesca Benvenuto, Giulia Bramato, Vincenzo Brandi, Angelo Carfì, Francesca Ciciarello, Lo Monaco, Anna Maria Martone, Emanuele Marzetti (ORCID:0000-0001-9567-6983), Francesco Cosimo Pagano, Sara Rocchi, Andrea Salerno, Matteo Tosato, Marcello Tritto, Riccardo Calvani (ORCID:0000-0001-5472-2365), Lucio Catalano, Giulia Savera, RobertoCauda (ORCID:0000-0002-1498-4229), Enrica Tamburrini (ORCID:0000-0003-4930-426X), Alberto Borghetti, Rita Murri (ORCID:0000-0003-4263-7854), Antonella Cingolani (ORCID:0000-0002-3793-2755), Giulio Ventura (ORCID:0000-0002-0304-7264), Eleonora Taddei, Leonardo Stella, Giovanni Addolorato (ORCID:0000-0002-1522-9946), Francesco Franceschi (ORCID:0000-0001-6266-445X), Geltrude Mingrone (ORCID:0000-0003-2021-528X), Maria Assunta Zocco (ORCID:0000-0002-0814-9542), Maurizio Sanguinetti (ORCID:0000-0002-9780-7059), Paola Cattani (ORCID:0000-0003-4678-4763), Simona Marchetti, Brunella Posteraro (ORCID:0000-0002-1663-7546), Michela Sali (ORCID:0000-0003-3609-2990), Alessandra Bizzarro, Alessandra Lauria, Stanislao Rizzo (ORCID:0000-0001-6302-063X), Maria Cristina Savastano (ORCID:0000-0003-1397-4333), Gloria Gambini, Carola Culiersi, Giulio Cesare Passali (ORCID:0000-0002-8176-0962), Gaetano Paludetti (ORCID:0000-0003-2480-1243), Jacopo Galli (ORCID:0000-0001-6353-6249), Lucia D’Alatri (ORCID:0000-0003-3104-958X), Fabrizio Crudo, Ylenia Longobardi, Mariaconsiglia Santantonio, Danilo Buonsenso, Piero Valentini (ORCID:0000-0001-6095-9510), Dario Sinatti, Cristina De Rose, Luca Richeldi (ORCID:0000-0001-8594-1448), Francesco Lombardi, Gabriele Sani (ORCID:0000-0002-9767-8752), Marco Modica, Luigi Natale (ORCID:0000-0002-7949-5119), Riccardo Marano (ORCID:0000-0003-2710-2093), Luca Petricca, Anna Laura Fedele, Marco Maria Lizzio, Barbara Tolusso (ORCID:0000-0002-9108-6609), Stefano Alivernini (ORCID:0000-0002-7383-4212), Angelo Santoliquido (ORCID:0000-0003-1539-4017), Luca Santoro, Antonio Nesci, Giorgia Mari, Raffaella Marchese (ORCID:0000-0003-0751-0882), Carolina Ausili Cefaro., Janiri, D., Kotzalidis, G. D., Giuseppin, G., Molinaro, M., Modica, Marco, Montanari, Silvia, Terenzi, Beatrice, Carfi, A., Landi, Francesco, Sani, Gabriele, Gremese, Elisa, Bernabei, Roberto, Gasbarrini, Antonio, Settanni, Carlo Romano, Benvenuto, Francesca, Bramato, Giulia, Brandi, Vincenzo, Carfi', Angelo, Ciciarello, Francesca, Rita, M., Lo Monaco, Andrea, Martone, Anna Maria, Marzetti, Emanuele, Carmennapolitano, Pagano, Francesco Cosimo, Rocchi, Sara, Elisabettarota, Salerno, Andrea, Tosato, Matteo, Tritto, Marcello, Calvani, Riccardo, Catalano, Lucio, Picca, Anna, Savera, Giulia, Cauda, Roberto, Tamburrini, Enrica, Borghetti, Alberto, Simona Di Gianbenedetto, Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, Davide, Ciccullo, Arturo, Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Zocco, Maria Assunta, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Posteraro, Brunella, Sali, Michela, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Grazia Maria Cozzupoli, Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, D'Alatri, Lucia, Crudo, Fabrizio, Giovanni Di Cintio, Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Buonsenso, Danilo, Valentini, Piero, Pata, Davide, Sinatti, Dario, De Rose, Cristina, Richeldi, Luca, Lombardi, Francesco, Giuseppin, Giulia, Molinaro, Marzia, Natale, Luigi, Larici, Annrita, Marano, Riccardo, Paglionico, Annamaria, Petricca, Luca, Natalello, Gerlando, Fedele, Anna Laura, Lizzio, Marco Maria, Tolusso, Barbara, Alivernini, Stefano, Santoliquido, Angelo, Santoro, Luca, Nesci, Antonio, Popolla, Valentina, Mari, Giorgia, Marchese, Maria Raffaella, Ausili Cefaro, Carolina, Calabrese, Angelo, Janiri, Delfina, Gigante, Laura, Modica M., Montanari S., Terenzi B., Landi F. (ORCID:0000-0002-3472-1389), Sani G (ORCID:0000-0002-9767-8752), rancesco Landi, Elisa Gremese (ORCID:0000-0002-2248-1058), Roberto Bernabei, Massimo Fantoni (ORCID:0000-0002-9197-004X), Antonio Gasbarrini (ORCID:0000-0002-7278-4823), Carlo Romano Settanni, Francesca Benvenuto, Giulia Bramato, Vincenzo Brandi, Angelo Carfì, Francesca Ciciarello, Lo Monaco, Anna Maria Martone, Emanuele Marzetti (ORCID:0000-0001-9567-6983), Francesco Cosimo Pagano, Sara Rocchi, Andrea Salerno, Matteo Tosato, Marcello Tritto, Riccardo Calvani (ORCID:0000-0001-5472-2365), Lucio Catalano, Giulia Savera, RobertoCauda (ORCID:0000-0002-1498-4229), Enrica Tamburrini (ORCID:0000-0003-4930-426X), Alberto Borghetti, Rita Murri (ORCID:0000-0003-4263-7854), Antonella Cingolani (ORCID:0000-0002-3793-2755), Giulio Ventura (ORCID:0000-0002-0304-7264), Eleonora Taddei, Leonardo Stella, Giovanni Addolorato (ORCID:0000-0002-1522-9946), Francesco Franceschi (ORCID:0000-0001-6266-445X), Geltrude Mingrone (ORCID:0000-0003-2021-528X), Maria Assunta Zocco (ORCID:0000-0002-0814-9542), Maurizio Sanguinetti (ORCID:0000-0002-9780-7059), Paola Cattani (ORCID:0000-0003-4678-4763), Simona Marchetti, Brunella Posteraro (ORCID:0000-0002-1663-7546), Michela Sali (ORCID:0000-0003-3609-2990), Alessandra Bizzarro, Alessandra Lauria, Stanislao Rizzo (ORCID:0000-0001-6302-063X), Maria Cristina Savastano (ORCID:0000-0003-1397-4333), Gloria Gambini, Carola Culiersi, Giulio Cesare Passali (ORCID:0000-0002-8176-0962), Gaetano Paludetti (ORCID:0000-0003-2480-1243), Jacopo Galli (ORCID:0000-0001-6353-6249), Lucia D’Alatri (ORCID:0000-0003-3104-958X), Fabrizio Crudo, Ylenia Longobardi, Mariaconsiglia Santantonio, Danilo Buonsenso, Piero Valentini (ORCID:0000-0001-6095-9510), Dario Sinatti, Cristina De Rose, Luca Richeldi (ORCID:0000-0001-8594-1448), Francesco Lombardi, Gabriele Sani (ORCID:0000-0002-9767-8752), Marco Modica, Luigi Natale (ORCID:0000-0002-7949-5119), Riccardo Marano (ORCID:0000-0003-2710-2093), Luca Petricca, Anna Laura Fedele, Marco Maria Lizzio, Barbara Tolusso (ORCID:0000-0002-9108-6609), Stefano Alivernini (ORCID:0000-0002-7383-4212), Angelo Santoliquido (ORCID:0000-0003-1539-4017), Luca Santoro, Antonio Nesci, Giorgia Mari, Raffaella Marchese (ORCID:0000-0003-0751-0882), and Carolina Ausili Cefaro.

Published
2020

40. Post-COVID-19 global health strategies: the need for an interdisciplinary approach

Author

Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Settanni, Carlo Romano, Benvenuto, Francesca, Bramato, Giulia, Carfi, A., Ciciarello, Francesca, Lomonaco, M. R., Martone, Anna Maria, Marzetti, Emanuele, Napolitano, C., Pagano, Francesco Cosimo, Rocchi, Sara, Rota, Elisabetta, Salerno, A., Tosato, Matteo, Tritto, Marcello, Calvani, Riccardo, Catalano, Lucio, Picca, A., Savera, Giulia, Tamburrini, Enrica, Borghetti, Alberto, Di Gianbenedetto, S., Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, D., Ciccullo, A., Stella, L., Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Zocco, Maria Assunta, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, G. M., Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Di Cintio, G., Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Buonsenso, Danilo, Valentini, Piero, Pata, Davide, Sinatti, Dario, De Rose, Cristina, Richeldi, Luca, Lombardi, F., Calabrese, Anna Chiara, Sani, Gabriele, Janiri, D., Giuseppin, Giulia, Molinaro, Marzia, Modica, Marco, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Paglionico, A., Petricca, L., Gigante, Laura, Natalello, Gerlando, Fedele, A. L., Lizzio, Marco Maria, Santoliquido, Angelo, Santoro, Luca, Nesci, Domenico Arturo, Popolla, Valentina, Landi F. (ORCID:0000-0002-3472-1389), Gremese E. (ORCID:0000-0002-2248-1058), Bernabei R. (ORCID:0000-0002-9197-004X), Fantoni M. (ORCID:0000-0001-6913-8460), Gasbarrini A. (ORCID:0000-0002-7278-4823), Settanni C. R., Benvenuto F., Bramato G., Ciciarello F., Martone A. M., Marzetti E. (ORCID:0000-0001-9567-6983), Pagano F., Rocchi S., Rota E., Tosato M., Tritto M., Calvani R. (ORCID:0000-0001-5472-2365), Catalano L., Savera G., Tamburrini E. (ORCID:0000-0003-4930-426X), Borghetti A., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Ventura G. (ORCID:0000-0002-0304-7264), Taddei E., Addolorato G. (ORCID:0000-0002-1522-9946), Franceschi F. (ORCID:0000-0001-6266-445X), Mingrone G. (ORCID:0000-0003-2021-528X), Zocco M. A. (ORCID:0000-0002-0814-9542), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cattani P. (ORCID:0000-0003-4678-4763), Marchetti S., Bizzarro A., Lauria A., Rizzo S. (ORCID:0000-0001-6302-063X), Savastano M. C. (ORCID:0000-0003-1397-4333), Gambini G., Culiersi C., Passali G. C. (ORCID:0000-0002-8176-0962), Paludetti G. (ORCID:0000-0003-2480-1243), Galli J. (ORCID:0000-0001-6353-6249), Crudo F., Longobardi Y., Tricarico L., Santantonio M., Buonsenso D., Valentini P. (ORCID:0000-0001-6095-9510), Pata D., Sinatti D., De Rose C., Richeldi L. (ORCID:0000-0001-8594-1448), Calabrese A., Sani G. (ORCID:0000-0002-9767-8752), Giuseppin G., Molinaro M., Modica M., Natale L. (ORCID:0000-0002-7949-5119), Larici A. R. (ORCID:0000-0002-1882-6244), Marano R. (ORCID:0000-0003-2710-2093), Gigante L., Natalello G., Lizzio M. M., Santoliquido A. (ORCID:0000-0003-1539-4017), Santoro L., Nesci A. (ORCID:0000-0001-9466-1755), Popolla V., Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Settanni, Carlo Romano, Benvenuto, Francesca, Bramato, Giulia, Carfi, A., Ciciarello, Francesca, Lomonaco, M. R., Martone, Anna Maria, Marzetti, Emanuele, Napolitano, C., Pagano, Francesco Cosimo, Rocchi, Sara, Rota, Elisabetta, Salerno, A., Tosato, Matteo, Tritto, Marcello, Calvani, Riccardo, Catalano, Lucio, Picca, A., Savera, Giulia, Tamburrini, Enrica, Borghetti, Alberto, Di Gianbenedetto, S., Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, D., Ciccullo, A., Stella, L., Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Zocco, Maria Assunta, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, G. M., Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Di Cintio, G., Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Buonsenso, Danilo, Valentini, Piero, Pata, Davide, Sinatti, Dario, De Rose, Cristina, Richeldi, Luca, Lombardi, F., Calabrese, Anna Chiara, Sani, Gabriele, Janiri, D., Giuseppin, Giulia, Molinaro, Marzia, Modica, Marco, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Paglionico, A., Petricca, L., Gigante, Laura, Natalello, Gerlando, Fedele, A. L., Lizzio, Marco Maria, Santoliquido, Angelo, Santoro, Luca, Nesci, Domenico Arturo, Popolla, Valentina, Landi F. (ORCID:0000-0002-3472-1389), Gremese E. (ORCID:0000-0002-2248-1058), Bernabei R. (ORCID:0000-0002-9197-004X), Fantoni M. (ORCID:0000-0001-6913-8460), Gasbarrini A. (ORCID:0000-0002-7278-4823), Settanni C. R., Benvenuto F., Bramato G., Ciciarello F., Martone A. M., Marzetti E. (ORCID:0000-0001-9567-6983), Pagano F., Rocchi S., Rota E., Tosato M., Tritto M., Calvani R. (ORCID:0000-0001-5472-2365), Catalano L., Savera G., Tamburrini E. (ORCID:0000-0003-4930-426X), Borghetti A., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Ventura G. (ORCID:0000-0002-0304-7264), Taddei E., Addolorato G. (ORCID:0000-0002-1522-9946), Franceschi F. (ORCID:0000-0001-6266-445X), Mingrone G. (ORCID:0000-0003-2021-528X), Zocco M. A. (ORCID:0000-0002-0814-9542), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cattani P. (ORCID:0000-0003-4678-4763), Marchetti S., Bizzarro A., Lauria A., Rizzo S. (ORCID:0000-0001-6302-063X), Savastano M. C. (ORCID:0000-0003-1397-4333), Gambini G., Culiersi C., Passali G. C. (ORCID:0000-0002-8176-0962), Paludetti G. (ORCID:0000-0003-2480-1243), Galli J. (ORCID:0000-0001-6353-6249), Crudo F., Longobardi Y., Tricarico L., Santantonio M., Buonsenso D., Valentini P. (ORCID:0000-0001-6095-9510), Pata D., Sinatti D., De Rose C., Richeldi L. (ORCID:0000-0001-8594-1448), Calabrese A., Sani G. (ORCID:0000-0002-9767-8752), Giuseppin G., Molinaro M., Modica M., Natale L. (ORCID:0000-0002-7949-5119), Larici A. R. (ORCID:0000-0002-1882-6244), Marano R. (ORCID:0000-0003-2710-2093), Gigante L., Natalello G., Lizzio M. M., Santoliquido A. (ORCID:0000-0003-1539-4017), Santoro L., Nesci A. (ORCID:0000-0001-9466-1755), and Popolla V.

Abstract

For survivors of severe COVID-19 disease, having defeated the virus is just the beginning of an uncharted recovery path. What follows after the acute phase of SARS-CoV-2 infection depends on the extension and severity of viral attacks in different cell types and organs. Despite the ridiculously large number of papers that have flooded scientific journals and preprint-hosting websites, a clear clinical picture of COVID-19 aftermath is vague at best. Without larger prospective observational studies that are only now being started, clinicians can retrieve information just from case reports and or small studies. This is the time to understand how COVID-19 goes forward and what consequences survivors may expect to experience. To this aim, a multidisciplinary post-acute care service involving several specialists has been established at the Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). Although COVID-19 is an infectious disease primarily affecting the lung, its multi-organ involvement requires an interdisciplinary approach encompassing virtually all branches of internal medicine and geriatrics. In particular, during the post-acute phase, the geriatrician may serve as the case manager of a multidisciplinary team. The aim of this article is to describe the importance of the interdisciplinary approach––coordinated by geriatrician––to cope the potential post-acute care needs of recovered COVID-19 patients.

Published
2020

41. Increased CD95 (Fas) and PD-1 expression in peripheral blood T lymphocytes in COVID-19 patients

Author

Bellesi, Silvia, Metafuni, Elisabetta, Hohaus, Stefan, Maiolo, E., Marchionni, F., D'Innocenzo, S., La Sorda, M., Ferraironi, M., Ramundo, Francesco, Fantoni, M., Murri, Rita, Cingolani, Antonella, Sica, Simona, Gasbarrini, Antonio, Sanguinetti, Maurizio, Chiusolo, Patrizia, De Stefano, Valerio, Bellesi S., Metafuni E., Hohaus S. (ORCID:0000-0002-5534-7197), Ramundo F., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Sica S. (ORCID:0000-0003-2426-3465), Gasbarrini A. (ORCID:0000-0002-7278-4823), Sanguinetti M. (ORCID:0000-0002-9780-7059), Chiusolo P. (ORCID:0000-0002-1355-1587), De Stefano V. (ORCID:0000-0002-5178-5827), Bellesi, Silvia, Metafuni, Elisabetta, Hohaus, Stefan, Maiolo, E., Marchionni, F., D'Innocenzo, S., La Sorda, M., Ferraironi, M., Ramundo, Francesco, Fantoni, M., Murri, Rita, Cingolani, Antonella, Sica, Simona, Gasbarrini, Antonio, Sanguinetti, Maurizio, Chiusolo, Patrizia, De Stefano, Valerio, Bellesi S., Metafuni E., Hohaus S. (ORCID:0000-0002-5534-7197), Ramundo F., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Sica S. (ORCID:0000-0003-2426-3465), Gasbarrini A. (ORCID:0000-0002-7278-4823), Sanguinetti M. (ORCID:0000-0002-9780-7059), Chiusolo P. (ORCID:0000-0002-1355-1587), and De Stefano V. (ORCID:0000-0002-5178-5827)

Abstract

A low count of CD4+ and CD8+ lymphocytes is a hallmark laboratory finding in the coronavirus disease 2019 (COVID-19). Using flow cytometry, we observed significantly higher CD95 (Fas) and PD-1 expression on both CD4+ T and CD8+ T cells in 42 COVID-19 patients when compared to controls. Higher CD95 expression in CD4+ cells correlated with lower CD4+ counts. A higher expression of CD95 in CD4+ and CD8+ lymphocytes correlated with a lower percentage of naive events. Our results might suggest a shift to antigen-activated T cells, expressing molecules increasing their propensity to apoptosis and exhaustion during COVID-19 infection.

Published
2020

42. Post-COVID-19 global health strategies: the need for an interdisciplinary approach

Author

Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Settanni, Carlo Romano, Benvenuto, Francesca, Bramato, Giulia, Carfi, A., Ciciarello, Francesca, Lomonaco, M. R., Martone, Anna Maria, Marzetti, Emanuele, Napolitano, C., Pagano, Francesco Cosimo, Rocchi, Sara, Rota, Elisabetta, Salerno, Andrea, Tosato, Matteo, Tritto, Marcello, Calvani, Riccardo, Catalano, L., Picca, A., Savera, Giulia, Tamburrini, Enrica, Borghetti, Alberto, Di Gianbenedetto, S., Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, D., Ciccullo, A., Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Zocco, Maria Assunta, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, G. M., Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Di Cintio, G., Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Buonsenso, Danilo, Valentini, Piero, Pata, Davide, Sinatti, Dario, De Rose, Cristina, Richeldi, Luca, Lombardi, Francesco, Calabrese, Anna Chiara, Sani, Gabriele, Janiri, D., Giuseppin, Giulia, Molinaro, Marzia, Modica, Marco, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Paglionico, A., Petricca, L., Gigante, Laura, Natalello, Gerlando, Fedele, A. L., Lizzio, Marco Maria, Santoliquido, Angelo, Santoro, Luca, Nesci, Domenico Arturo, Popolla, Valentina, Landi F. (ORCID:0000-0002-3472-1389), Gremese E. (ORCID:0000-0002-2248-1058), Bernabei R. (ORCID:0000-0002-9197-004X), Fantoni M. (ORCID:0000-0001-6913-8460), Gasbarrini A. (ORCID:0000-0002-7278-4823), Settanni C. R., Benvenuto F., Bramato G., Ciciarello F., Martone A. M., Marzetti E. (ORCID:0000-0001-9567-6983), Pagano F., Rocchi S., Rota E., Salerno A., Tosato M., Tritto M., Calvani R. (ORCID:0000-0001-5472-2365), Savera G., Tamburrini E. (ORCID:0000-0003-4930-426X), Borghetti A., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Ventura G. (ORCID:0000-0002-0304-7264), Taddei E., Stella L., Addolorato G. (ORCID:0000-0002-1522-9946), Franceschi F. (ORCID:0000-0001-6266-445X), Mingrone G. (ORCID:0000-0003-2021-528X), Zocco M. A. (ORCID:0000-0002-0814-9542), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cattani P. (ORCID:0000-0003-4678-4763), Marchetti S., Bizzarro A., Lauria A., Rizzo S. (ORCID:0000-0001-6302-063X), Savastano M. C. (ORCID:0000-0003-1397-4333), Gambini G., Culiersi C., Passali G. C. (ORCID:0000-0002-8176-0962), Paludetti G. (ORCID:0000-0003-2480-1243), Galli J. (ORCID:0000-0001-6353-6249), Crudo F., Longobardi Y., Tricarico L., Santantonio M., Buonsenso D., Valentini P. (ORCID:0000-0001-6095-9510), Pata D., Sinatti D., De Rose C., Richeldi L. (ORCID:0000-0001-8594-1448), Lombardi F., Calabrese A., Sani G. (ORCID:0000-0002-9767-8752), Giuseppin G., Molinaro M., Modica M., Natale L. (ORCID:0000-0002-7949-5119), Larici A. R. (ORCID:0000-0002-1882-6244), Marano R. (ORCID:0000-0003-2710-2093), Gigante L., Natalello G., Lizzio M. M., Santoliquido A. (ORCID:0000-0003-1539-4017), Santoro L., Nesci A. (ORCID:0000-0001-9466-1755), Popolla V., Landi, Francesco, Gremese, Elisa, Bernabei, Roberto, Fantoni, Massimo, Gasbarrini, Antonio, Settanni, Carlo Romano, Benvenuto, Francesca, Bramato, Giulia, Carfi, A., Ciciarello, Francesca, Lomonaco, M. R., Martone, Anna Maria, Marzetti, Emanuele, Napolitano, C., Pagano, Francesco Cosimo, Rocchi, Sara, Rota, Elisabetta, Salerno, Andrea, Tosato, Matteo, Tritto, Marcello, Calvani, Riccardo, Catalano, L., Picca, A., Savera, Giulia, Tamburrini, Enrica, Borghetti, Alberto, Di Gianbenedetto, S., Murri, Rita, Cingolani, Antonella, Ventura, Giulio, Taddei, Eleonora, Moschese, D., Ciccullo, A., Stella, Leonardo, Addolorato, Giovanni, Franceschi, Francesco, Mingrone, Geltrude, Zocco, Maria Assunta, Sanguinetti, Maurizio, Cattani Franchi, Paola, Marchetti, Simona, Bizzarro, Alessandra, Lauria, Alessandra, Rizzo, Stanislao, Savastano, Maria Cristina, Gambini, Gloria, Cozzupoli, G. M., Culiersi, Carola, Passali, Giulio Cesare, Paludetti, Gaetano, Galli, Jacopo, Crudo, Fabrizio, Di Cintio, G., Longobardi, Ylenia, Tricarico, Laura, Santantonio, Mariaconsiglia, Buonsenso, Danilo, Valentini, Piero, Pata, Davide, Sinatti, Dario, De Rose, Cristina, Richeldi, Luca, Lombardi, Francesco, Calabrese, Anna Chiara, Sani, Gabriele, Janiri, D., Giuseppin, Giulia, Molinaro, Marzia, Modica, Marco, Natale, Luigi, Larici, Anna Rita, Marano, Riccardo, Paglionico, A., Petricca, L., Gigante, Laura, Natalello, Gerlando, Fedele, A. L., Lizzio, Marco Maria, Santoliquido, Angelo, Santoro, Luca, Nesci, Domenico Arturo, Popolla, Valentina, Landi F. (ORCID:0000-0002-3472-1389), Gremese E. (ORCID:0000-0002-2248-1058), Bernabei R. (ORCID:0000-0002-9197-004X), Fantoni M. (ORCID:0000-0001-6913-8460), Gasbarrini A. (ORCID:0000-0002-7278-4823), Settanni C. R., Benvenuto F., Bramato G., Ciciarello F., Martone A. M., Marzetti E. (ORCID:0000-0001-9567-6983), Pagano F., Rocchi S., Rota E., Salerno A., Tosato M., Tritto M., Calvani R. (ORCID:0000-0001-5472-2365), Savera G., Tamburrini E. (ORCID:0000-0003-4930-426X), Borghetti A., Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Ventura G. (ORCID:0000-0002-0304-7264), Taddei E., Stella L., Addolorato G. (ORCID:0000-0002-1522-9946), Franceschi F. (ORCID:0000-0001-6266-445X), Mingrone G. (ORCID:0000-0003-2021-528X), Zocco M. A. (ORCID:0000-0002-0814-9542), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cattani P. (ORCID:0000-0003-4678-4763), Marchetti S., Bizzarro A., Lauria A., Rizzo S. (ORCID:0000-0001-6302-063X), Savastano M. C. (ORCID:0000-0003-1397-4333), Gambini G., Culiersi C., Passali G. C. (ORCID:0000-0002-8176-0962), Paludetti G. (ORCID:0000-0003-2480-1243), Galli J. (ORCID:0000-0001-6353-6249), Crudo F., Longobardi Y., Tricarico L., Santantonio M., Buonsenso D., Valentini P. (ORCID:0000-0001-6095-9510), Pata D., Sinatti D., De Rose C., Richeldi L. (ORCID:0000-0001-8594-1448), Lombardi F., Calabrese A., Sani G. (ORCID:0000-0002-9767-8752), Giuseppin G., Molinaro M., Modica M., Natale L. (ORCID:0000-0002-7949-5119), Larici A. R. (ORCID:0000-0002-1882-6244), Marano R. (ORCID:0000-0003-2710-2093), Gigante L., Natalello G., Lizzio M. M., Santoliquido A. (ORCID:0000-0003-1539-4017), Santoro L., Nesci A. (ORCID:0000-0001-9466-1755), and Popolla V.

Abstract

For survivors of severe COVID-19 disease, having defeated the virus is just the beginning of an uncharted recovery path. What follows after the acute phase of SARS-CoV-2 infection depends on the extension and severity of viral attacks in different cell types and organs. Despite the ridiculously large number of papers that have flooded scientific journals and preprint-hosting websites, a clear clinical picture of COVID-19 aftermath is vague at best. Without larger prospective observational studies that are only now being started, clinicians can retrieve information just from case reports and or small studies. This is the time to understand how COVID-19 goes forward and what consequences survivors may expect to experience. To this aim, a multidisciplinary post-acute care service involving several specialists has been established at the Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). Although COVID-19 is an infectious disease primarily affecting the lung, its multi-organ involvement requires an interdisciplinary approach encompassing virtually all branches of internal medicine and geriatrics. In particular, during the post-acute phase, the geriatrician may serve as the case manager of a multidisciplinary team. The aim of this article is to describe the importance of the interdisciplinary approach––coordinated by geriatrician––to cope the potential post-acute care needs of recovered COVID-19 patients.

Published
2020

43. Antibiotic appropriateness and adherence to local guidelines in perioperative prophylaxis: results from an antimicrobial stewardship intervention

Author

Segala, Francesco Vladimiro, Murri, Rita, Taddei, Eleonora, Giovannenze, F., Del Vecchio, Pierluigi, Birocchi, E., Taccari, F., Cauda, Roberto, Fantoni, Massimo, Segala F. V., Murri R. (ORCID:0000-0003-4263-7854), Taddei E., Del Vecchio P., Cauda R. (ORCID:0000-0002-1498-4229), Fantoni M. (ORCID:0000-0001-6913-8460), Segala, Francesco Vladimiro, Murri, Rita, Taddei, Eleonora, Giovannenze, F., Del Vecchio, Pierluigi, Birocchi, E., Taccari, F., Cauda, Roberto, Fantoni, Massimo, Segala F. V., Murri R. (ORCID:0000-0003-4263-7854), Taddei E., Del Vecchio P., Cauda R. (ORCID:0000-0002-1498-4229), and Fantoni M. (ORCID:0000-0001-6913-8460)

Abstract

Objectives: Surgical antibiotic prophylaxis (SAP) represents a major indication of antibiotic consumption worldwide. The present study aims to report the results of an enabling, long-term AMS intervention conducted between 2013 and 2019 on an Italian University Hospital performing more than 40.000 surgical interventions per year. Methods: SAP inappropriateness was defined according to the ASHP guidelines and divided in four main categories: indication, selection and dosing, duration, timing. Between 2013 and 2019, we conducted a continuative AMS intervention over 14 surgical departments that included enablement, review of selected clinical records and feedback. Results: We collected a total of 789 SAP prescribed to 735 patients (mean age 56.7 ± 17.8y). Overall, guideline adherence improved from 36.6% (n = 149) at baseline to 57.9% (n = 221) post-intervention (P < 0.0001). A significant improvement (P < 0.001) was also detected for each category: indication (from 58.5 to 93.2%), selection and dosing (from 58.5 to 80.6%), timing (from 92.4 to 97.6%), duration (from 71 to 80.1%). Conclusions: Though results cannot be generalized to all hospital populations, enabling AMS interventions may be effective in establishing a sustained improvement in SAP appropriateness rates. Once identified the main causes of SAP inappropriateness, tailored AMS interventions for each department may be beneficial. Further studies are needed to evaluate specific outcomes as incidence of surgical site infections and antimicrobial resistance.

Published
2020

44. Sarilumab use in severe SARS-CoV-2 pneumonia

Author

Gremese, Elisa, Cingolani, Antonella, Bosello, Silvia Laura, Alivernini, Stefano, Tolusso, Barbara, Perniola, S., Landi, Francesco, Pompili, Maurizio, Murri, Rita, Santoliquido, Angelo, Garcovich, M., Sali, Michela, De Pascale, Gennaro, Gabrielli, Maurizio, Biscetti, Federico, Montalto, Massimo, Tosoni, Alessio, Gambassi, Giovanni, Rapaccini, Gian Ludovico, Iaconelli, Amerigo, Zileri Del Verme, L., Petricca, L., Fedele, A. L., Lizzio, Marco Maria, Tamburrini, Enrica, Natalello, Gerlando, Gigante, Laura, Bruno, D., Verardi, Lucrezia, Taddei, Eleonora, Calabrese, Anna Chiara, Lombardi, Francesca, Bernabei, Roberto, Cauda, Roberto, Franceschi, Francesco, Landolfi, Raffaele, Richeldi, Luca, Sanguinetti, Maurizio, Fantoni, Massimo, Antonelli, Massimo, Gasbarrini, Antonio, Gremese E. (ORCID:0000-0002-2248-1058), Cingolani A. (ORCID:0000-0002-3793-2755), Bosello S. L. (ORCID:0000-0002-4837-447X), Alivernini S. (ORCID:0000-0002-7383-4212), Tolusso B. (ORCID:0000-0002-9108-6609), Landi F. (ORCID:0000-0002-3472-1389), Pompili M. (ORCID:0000-0001-6699-7980), Murri R. (ORCID:0000-0003-4263-7854), Santoliquido A. (ORCID:0000-0003-1539-4017), Sali M. (ORCID:0000-0003-3609-2990), De Pascale G. (ORCID:0000-0002-8255-0676), Gabrielli M., Biscetti F. (ORCID:0000-0001-7449-657X), Montalto M. (ORCID:0000-0001-8819-3684), Tosoni A., Gambassi G. (ORCID:0000-0002-7030-9359), Rapaccini G. L. (ORCID:0000-0002-6467-857X), Iaconelli A., Lizzio M. M., Tamburrini E. (ORCID:0000-0003-4930-426X), Natalello G., Gigante L., Verardi L., Taddei E., Calabrese A., Lombardi F. (ORCID:0000-0001-5757-8346), Bernabei R. (ORCID:0000-0002-9197-004X), Cauda R. (ORCID:0000-0002-1498-4229), Franceschi F. (ORCID:0000-0001-6266-445X), Landolfi R. (ORCID:0000-0002-7913-8576), Richeldi L. (ORCID:0000-0001-8594-1448), Sanguinetti M. (ORCID:0000-0002-9780-7059), Fantoni M. (ORCID:0000-0001-6913-8460), Antonelli M. (ORCID:0000-0003-3007-1670), Gasbarrini A. (ORCID:0000-0002-7278-4823), Gremese, Elisa, Cingolani, Antonella, Bosello, Silvia Laura, Alivernini, Stefano, Tolusso, Barbara, Perniola, S., Landi, Francesco, Pompili, Maurizio, Murri, Rita, Santoliquido, Angelo, Garcovich, M., Sali, Michela, De Pascale, Gennaro, Gabrielli, Maurizio, Biscetti, Federico, Montalto, Massimo, Tosoni, Alessio, Gambassi, Giovanni, Rapaccini, Gian Ludovico, Iaconelli, Amerigo, Zileri Del Verme, L., Petricca, L., Fedele, A. L., Lizzio, Marco Maria, Tamburrini, Enrica, Natalello, Gerlando, Gigante, Laura, Bruno, D., Verardi, Lucrezia, Taddei, Eleonora, Calabrese, Anna Chiara, Lombardi, Francesca, Bernabei, Roberto, Cauda, Roberto, Franceschi, Francesco, Landolfi, Raffaele, Richeldi, Luca, Sanguinetti, Maurizio, Fantoni, Massimo, Antonelli, Massimo, Gasbarrini, Antonio, Gremese E. (ORCID:0000-0002-2248-1058), Cingolani A. (ORCID:0000-0002-3793-2755), Bosello S. L. (ORCID:0000-0002-4837-447X), Alivernini S. (ORCID:0000-0002-7383-4212), Tolusso B. (ORCID:0000-0002-9108-6609), Landi F. (ORCID:0000-0002-3472-1389), Pompili M. (ORCID:0000-0001-6699-7980), Murri R. (ORCID:0000-0003-4263-7854), Santoliquido A. (ORCID:0000-0003-1539-4017), Sali M. (ORCID:0000-0003-3609-2990), De Pascale G. (ORCID:0000-0002-8255-0676), Gabrielli M., Biscetti F. (ORCID:0000-0001-7449-657X), Montalto M. (ORCID:0000-0001-8819-3684), Tosoni A., Gambassi G. (ORCID:0000-0002-7030-9359), Rapaccini G. L. (ORCID:0000-0002-6467-857X), Iaconelli A., Lizzio M. M., Tamburrini E. (ORCID:0000-0003-4930-426X), Natalello G., Gigante L., Verardi L., Taddei E., Calabrese A., Lombardi F. (ORCID:0000-0001-5757-8346), Bernabei R. (ORCID:0000-0002-9197-004X), Cauda R. (ORCID:0000-0002-1498-4229), Franceschi F. (ORCID:0000-0001-6266-445X), Landolfi R. (ORCID:0000-0002-7913-8576), Richeldi L. (ORCID:0000-0001-8594-1448), Sanguinetti M. (ORCID:0000-0002-9780-7059), Fantoni M. (ORCID:0000-0001-6913-8460), Antonelli M. (ORCID:0000-0003-3007-1670), and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

Background: Interleukin-6 signal blockade showed preliminary beneficial effects in treating inflammatory response against SARS-CoV-2 leading to severe respiratory distress. Herein we describe the outcomes of off-label intravenous use of Sarilumab in severe SARS-CoV-2-related pneumonia. Methods: 53 patients with SARS-CoV-2 severe pneumonia received intravenous Sarilumab; pulmonary function improvement or Intensive Care Unit (ICU) admission rate in medical wards, live discharge rate in ICU treated patients and safety profile were recorded. Sarilumab 400 mg was administered intravenously on day 1, with eventual additional infusion based on clinical judgement, and patients were followed for at least 14 days, unless previously discharged or dead. Findings: Of the 53 SARS-CoV-2pos patients receiving Sarilumab, 39(73·6%) were treated in medical wards [66·7% with a single infusion; median PaO2/FiO2:146(IQR:120–212)] while 14(26·4%) in ICU [92·6% with a second infusion; median PaO2/FiO2: 112(IQR:100–141.5)]. Within the medical wards, 7(17·9%) required ICU admission, 4 of whom were re-admitted to the ward within 5–8 days. At 19 days median follow-up, 89·7% of medical inpatients significantly improved (46·1% after 24 h, 61·5% after 3 days), 70·6% were discharged from the hospital and 85·7% no longer needed oxygen therapy. Within patients receiving Sarilumab in ICU, 64·2% were discharged from ICU to the ward and 35·8% were still alive at the last follow-up. Overall mortality rate was 5·7%. Interpretation: IL-6R inhibition appears to be a potential treatment strategy for severe SARS-CoV-2 pneumonia and intravenous Sarilumab seems a promising treatment approach showing, in the short term, an important clinical outcome and good safety.

Published
2020

45. Common cardiovascular risk factors and in-hospital mortality in 3,894 patients with COVID-19: survival analysis and machine learning-based findings from the multicentre Italian CORIST Study

Author

Di Castelnuovo, A., Bonaccio, M., Costanzo, S., Gialluisi, A., Antinori, A., Berselli, N., Blandi, L., Bruno, Rosa Anna, Cauda, Roberto, Guaraldi, G., My, I., Menicanti, L., Parruti, G., Patti, G., Perlini, S., Santilli, F., Signorelli, C., Stefanini, G. G., Vergori, A., Abdeddaim, A., Ageno, W., Agodi, A., Agostoni, P., Aiello, L., Al Moghazi, S., Aucella, F., Barbieri, G., Bartoloni, A., Bologna, C., Bonfanti, P., Brancati, S., Cacciatore, F., Caiano, L., Cannata, F., Carrozzi, L., Cascio, A., Cingolani, Antonella, Cipollone, F., Colomba, C., Crisetti, A., Crosta, F., Danzi, G. B., D'Ardes, D., De Gaetano Donati, Katleen, Di Gennaro, F., Di Palma, G., Di Tano, G., Fantoni, Massimo, Filippini, T., Fioretto, P., Fusco, F. M., Gentile, I., Grisafi, L., Guarnieri, G., Landi, Francesco, Larizza, G., Leone, A., Maccagni, G., Maccarella, S., Mapelli, M., Maragna, R., Marcucci, R., Maresca, G., Marotta, C., Marra, L., Mastroianni, F., Mengozzi, A., Menichetti, F., Milic, J., Murri, Rita, Montineri, A., Mussinelli, R., Mussini, C., Musso, M., Odone, A., Olivieri, M., Pasi, E., Petri, F., Pinchera, B., Pivato, C. A., Pizzi, R., Poletti, V., Raffaelli, Francesca, Ravaglia, C., Righetti, G., Rognoni, A., Rossato, M., Rossi, M., Sabena, A., Salinaro, F., Sangiovanni, V., Sanrocco, C., Scarafino, A., Scorzolini, L., Sgariglia, R., Simeone, P. G., Spinoni, E., Torti, Carlo, Trecarichi, Enrico Maria, Vezzani, F., Veronesi, G., Vettor, R., Vianello, A., Vinceti, M., De Caterina, R., Iacoviello, L., Bruno R., Cauda R. (ORCID:0000-0002-1498-4229), Cingolani A. (ORCID:0000-0002-3793-2755), de Gaetano Donati K., Fantoni M. (ORCID:0000-0001-6913-8460), Landi F. (ORCID:0000-0002-3472-1389), Murri R. (ORCID:0000-0003-4263-7854), Raffaelli F., Torti C., Trecarichi E. M., Di Castelnuovo, A., Bonaccio, M., Costanzo, S., Gialluisi, A., Antinori, A., Berselli, N., Blandi, L., Bruno, Rosa Anna, Cauda, Roberto, Guaraldi, G., My, I., Menicanti, L., Parruti, G., Patti, G., Perlini, S., Santilli, F., Signorelli, C., Stefanini, G. G., Vergori, A., Abdeddaim, A., Ageno, W., Agodi, A., Agostoni, P., Aiello, L., Al Moghazi, S., Aucella, F., Barbieri, G., Bartoloni, A., Bologna, C., Bonfanti, P., Brancati, S., Cacciatore, F., Caiano, L., Cannata, F., Carrozzi, L., Cascio, A., Cingolani, Antonella, Cipollone, F., Colomba, C., Crisetti, A., Crosta, F., Danzi, G. B., D'Ardes, D., De Gaetano Donati, Katleen, Di Gennaro, F., Di Palma, G., Di Tano, G., Fantoni, Massimo, Filippini, T., Fioretto, P., Fusco, F. M., Gentile, I., Grisafi, L., Guarnieri, G., Landi, Francesco, Larizza, G., Leone, A., Maccagni, G., Maccarella, S., Mapelli, M., Maragna, R., Marcucci, R., Maresca, G., Marotta, C., Marra, L., Mastroianni, F., Mengozzi, A., Menichetti, F., Milic, J., Murri, Rita, Montineri, A., Mussinelli, R., Mussini, C., Musso, M., Odone, A., Olivieri, M., Pasi, E., Petri, F., Pinchera, B., Pivato, C. A., Pizzi, R., Poletti, V., Raffaelli, Francesca, Ravaglia, C., Righetti, G., Rognoni, A., Rossato, M., Rossi, M., Sabena, A., Salinaro, F., Sangiovanni, V., Sanrocco, C., Scarafino, A., Scorzolini, L., Sgariglia, R., Simeone, P. G., Spinoni, E., Torti, Carlo, Trecarichi, Enrico Maria, Vezzani, F., Veronesi, G., Vettor, R., Vianello, A., Vinceti, M., De Caterina, R., Iacoviello, L., Bruno R., Cauda R. (ORCID:0000-0002-1498-4229), Cingolani A. (ORCID:0000-0002-3793-2755), de Gaetano Donati K., Fantoni M. (ORCID:0000-0001-6913-8460), Landi F. (ORCID:0000-0002-3472-1389), Murri R. (ORCID:0000-0003-4263-7854), Raffaelli F., Torti C., and Trecarichi E. M.

Abstract

Background and aims: There is poor knowledge on characteristics, comorbidities and laboratory measures associated with risk for adverse outcomes and in-hospital mortality in European Countries. We aimed at identifying baseline characteristics predisposing COVID-19 patients to in-hospital death. Methods and results: Retrospective observational study on 3894 patients with SARS-CoV-2 infection hospitalized from February 19th to May 23rd, 2020 and recruited in 30 clinical centres distributed throughout Italy. Machine learning (random forest)-based and Cox survival analysis. 61.7% of participants were men (median age 67 years), followed up for a median of 13 days. In-hospital mortality exhibited a geographical gradient, Northern Italian regions featuring more than twofold higher death rates as compared to Central/Southern areas (15.6% vs 6.4%, respectively). Machine learning analysis revealed that the most important features in death classification were impaired renal function, elevated C reactive protein and advanced age. These findings were confirmed by multivariable Cox survival analysis (hazard ratio (HR): 8.2; 95% confidence interval (CI) 4.6–14.7 for age ≥85 vs 18–44 y); HR = 4.7; 2.9–7.7 for estimated glomerular filtration rate levels <15 vs ≥ 90 mL/min/1.73 m2; HR = 2.3; 1.5–3.6 for C-reactive protein levels ≥10 vs ≤ 3 mg/L). No relation was found with obesity, tobacco use, cardiovascular disease and related-comorbidities. The associations between these variables and mortality were substantially homogenous across all sub-groups analyses. Conclusions: Impaired renal function, elevated C-reactive protein and advanced age were major predictors of in-hospital death in a large cohort of unselected patients with COVID-19, admitted to 30 different clinical centres all over Italy.

Published
2020

46. Day 10 post-prescription audit optimizes antibiotic therapy in patients with bloodstream infections

Author

Murri, Rita, Palazzolo, C., Giovannenze, F., Taccari, F., Camici, M., Spanu, Teresa, Posteraro, Brunella, Sanguinetti, Maurizio, Cauda, Roberto, Fantoni, Massimo, Murri R. (ORCID:0000-0003-4263-7854), Spanu T. (ORCID:0000-0003-1864-5184), Posteraro B. (ORCID:0000-0002-1663-7546), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cauda R. (ORCID:0000-0002-1498-4229), Fantoni M. (ORCID:0000-0001-6913-8460), Murri, Rita, Palazzolo, C., Giovannenze, F., Taccari, F., Camici, M., Spanu, Teresa, Posteraro, Brunella, Sanguinetti, Maurizio, Cauda, Roberto, Fantoni, Massimo, Murri R. (ORCID:0000-0003-4263-7854), Spanu T. (ORCID:0000-0003-1864-5184), Posteraro B. (ORCID:0000-0002-1663-7546), Sanguinetti M. (ORCID:0000-0002-9780-7059), Cauda R. (ORCID:0000-0002-1498-4229), and Fantoni M. (ORCID:0000-0001-6913-8460)

Abstract

This study aimed to investigate the clinical and organizational impact of an active re-evaluation (on day 10) of patients on antibiotic treatment diagnosed with bloodstream infections (BSIs). A prospective, single center, pre-post quasi-experimental study was performed. Patients were enrolled at the time of microbial BSI confirmation. In the pre-intervention phase (August 2014–August 2015), clinical status and antibiotic regimen were re-evaluated at day 3. In the intervention phase (January 2016–January 2017), clinical status and antibiotic regimen were re-evaluated at day 3 and day 10. Primary outcomes were rate of optimal therapy, duration of antibiotic therapy, length of hospitalization, and 30-day mortality. A total of 632 patients were enrolled (pre-intervention period, n = 303; intervention period, n = 329). Average duration of therapy reduced from 18.1 days (standard deviation (SD), 11.4) in the pre-intervention period to 16.8 days (SD, 12.7) in the intervention period (p < 0.001). Similarly, average length of hospitalization decreased from 24.1 days (SD, 20.8) to 20.6 days (SD, 17.7) (p = 0.001). No inter-group difference was found for the rate of 30-day mortality. In patients with BSI, re-evaluation of clinical status and antibiotic regimen at day 3 and 10 after microbiological diagnosis was correlated with a reduction in the duration of antibiotic therapy and hospital stay. The intervention is simple and has a low impact on overall costs.

Published
2020

47. Challenges in COVID-19: is pulmonary thromboembolism related to overall severity?

Author

Bellieni, Agnese, Intini, Enrica, Taddei, Eleonora, Baldi, Fabiana, Larosa, Luigi, Murri, Rita, Richeldi, Luca, Bernabei, Roberto, Cauda, Roberto, Landi, Francesco, Corbo, Giuseppe Maria, Fantoni, Massimo, Bellieni A., Intini E., Taddei E., Baldi F., Larosa L., Murri R. (ORCID:0000-0003-4263-7854), Richeldi L. (ORCID:0000-0001-8594-1448), Bernabei R. (ORCID:0000-0002-9197-004X), Cauda R. (ORCID:0000-0002-1498-4229), Landi F. (ORCID:0000-0002-3472-1389), Corbo G. M. (ORCID:0000-0002-8104-4659), Fantoni M. (ORCID:0000-0001-6913-8460), Bellieni, Agnese, Intini, Enrica, Taddei, Eleonora, Baldi, Fabiana, Larosa, Luigi, Murri, Rita, Richeldi, Luca, Bernabei, Roberto, Cauda, Roberto, Landi, Francesco, Corbo, Giuseppe Maria, Fantoni, Massimo, Bellieni A., Intini E., Taddei E., Baldi F., Larosa L., Murri R. (ORCID:0000-0003-4263-7854), Richeldi L. (ORCID:0000-0001-8594-1448), Bernabei R. (ORCID:0000-0002-9197-004X), Cauda R. (ORCID:0000-0002-1498-4229), Landi F. (ORCID:0000-0002-3472-1389), Corbo G. M. (ORCID:0000-0002-8104-4659), and Fantoni M. (ORCID:0000-0001-6913-8460)

Abstract

Not available

Published
2020

48. Assessment of neurological manifestations in hospitalized patients with COVID-19

Author

Luigetti, Marco, Iorio, Raffaele, Bentivoglio, Anna Rita, Tricoli, Luca, Riso, Vittorio, Marotta, Jessica, Piano, Carla, Primiano, Guido Alessandro, Zileri Del Verme, L., Lo Monaco, Maria Rita, Calabresi, Paolo, Abbate, V., Acampora, N., Addolorato, G., Agostini, F., Ainora, M. E., Akacha, K., Amato, E., Andreani, F., Andriollo, G., Annetta, Maria Giuseppina, Annicchiarico, B. E., Antonelli, Massimo, Antonucci, G., Anzellotti, G. M., Armuzzi, A., Baldi, F., Barattucci, I., Barillaro, C., Barone, F., Bellantone, R. D. A., Bellieni, A., Bello, G., Benicchi, A., Benvenuto, F., Berardini, L., Berloco, F., Bernabei, R., Bianchi, A., Biasucci, D. G., Biasucci, L. M., Bibbo, S., Bini, A., Bisanti, A., Biscetti, F., Bocci, M. G., Bonadia, N., Bongiovanni, F., Borghetti, A., Bosco, G., Bosello, Silvia Laura, Bove, V., Bramato, G., Brandi, V., Bruni, T., Bruno, C., Bruno, D., Bungaro, M. C., Buonomo, A., Burzo, L., Calabrese, A., Calvello, M. R., Cambieri, A., Cambise, C., Camma, G., Candelli, M., Canistro, G., Cantanale, A., Capalbo, G., Capaldi, L., Capone, E., Capristo, E., Carbone, L., Cardone, S., Carelli, S., Carfi, A., Carnicelli, A., Caruso, C., Casciaro, F. A., Catalano, L., Cauda, R., Cecchini, A. L., Cerrito, L., Cesarano, M., Chiarito, A., Cianci, Rossella, Cicchinelli, S., Ciccullo, A., Cicetti, M., Ciciarello, F., Cingolani, A., Cipriani, M. C., Consalvo, M. L., Coppola, G., Corbo, G. M., Corsello, A., Costante, F., Costanzi, M., Covino, M., Crupi, D., Cutuli, S. L., D'Addio, S., D'Alessandro, A., D'Alfonso, M. E., D'Angelo, E., D'Aversa, F., Damiano, F., De Berardinis, G. M., De Cunzo, T., De Gaetano, D. K., De Luca, G., De Matteis, G., De Pascale, G., De Santis, P., De Siena, M., De Vito, F., Del Gatto, V., Del Giacomo, P., Del Zompo, F., Dell'Anna, A. M., Della, P. D., Di Gialleonardo, L., Di Giambenedetto, S., Di Luca, R., Di Maurizio, L., Di Muro, M., Dusina, A., Eleuteri, D., Esperide, A., Fachechi, D., Faliero, D., Falsiroli, C., Fantoni, M., Fedele, A., Feliciani, D., Ferrante, C., Ferrone, G., Festa, R., Fiore, M. C., Flex, A., Forte, E., Franceschi, Francesco, Francesconi, A., Franza, L., Funaro, B., Fuorlo, M., Fusco, D., Gabrielli, M., Gaetani, E., Galletta, C., Gallo, A., Gambassi, G., Garcovich, M., Gasbarrini, A., Gasparrini, I., Gelli, S., Giampietro, A., Gigante, L., Giuliano, G., Giupponi, B., Gremese, E., Grieco, Domenico Luca, Guerrera, M., Guglielmi, V., Guidone, C., Gulli, A., Iaconelli, A., Iafrati, A., Ianiro, Gianluca, Iaquinta, A., Impagnatiello, M., Inchingolo, R., Intini, E., Iorio, R., Izzi, I. M., Jovanovic, T., Kadhim, C., La Macchia, R., La Milia, D. I., Landi, F., Landi, G., Landi, R., Landolfi, R., Leo, M., Leone, P. M., Levantesi, L., Liguori, A., Liperoti, R., Lizzio, M. M., Lo Monaco Maria, R., Locantore, P., Lombardi, F., Lombardi, G., Lopetuso, L., Loria, V., Losito, A. R., Lucia, M. B. P., Macagno, F., Macerola, N., Maggi, G., Maiuro, G., Mancarella, F., Mangiola, F., Manno, A., Marchesini, D., Maresca, G. M., Marrone, G., Martis, I., Martone, A. M., Marzetti, Emanuele, Mattana, C., Matteo, M. V., Maviglia, R., Mazzarella, A., Memoli, C., Miele, Luca, Migneco, A., Mignini, I., Milani, A., Milardi, D., Montalto, M., Montemurro, G., Monti, F., Montini, Luca, Morena, T. C., Morra, V., Morretta, C., Moschese, D., Murace, C. A., Murdolo, M., Murri, Rita, Napoli, M., Nardella, E., Natalello, G., Natalini, D., Navarra, S. M., Nesci, A., Nicoletti, A., Nicoletti, R., Nicoletti, T. F., Nicolo, R., Nicolotti, N., Nista, E. C., Nuzzo, E., Oggiano, M., Ojetti, V., Pagano, F. C., Paiano, G., Pais, C., Pallavicini, F., Palombo, A., Paolillo, F., Papa, Alfredo, Papanice, D., Papparella, L. G., Paratore, M., Parrinello, G., Pasciuto, G., Pasculli, P., Pecorini, G., Perniola, S., Pero, E., Petricca, L., Petrucci, M., Picarelli, C., Piccioni, A., Piccolo, A., Piervincenzi, E., Pignataro, G., Pignataro, R., Pintaudi, G., Pisapia, L., Pizzoferrato, M., Pizzolante, F., Pola, R., Policola, C., Pompili, M., Pontecorvi, F., Pontecorvi, V., Ponziani, F., Popolla, V., Porceddu, E., Porfidia, A., Porro, L. M., Potenza, A., Pozzana, F., Privitera, G., Pugliese, D., Pulcini, G., Racco, S., Raffaelli, F., Ramunno, V., Rapaccini, G. L., Richeldi, Luca, Rinninella, Emanuele, Rocchi, S., Romano, B., Romano, S., Rosa, F., Rossi, L., Rossi, R., Rossini, E., Rota, E., Rovedi, F., Rubino, C., Rumi, G., Russo, A., Sabia, L., Salerno, A., Salini, S., Salvatore, L., Samori, D., Sandroni, Claudio, Sanguinetti, M., Santarelli, L., Santini, P., Santolamazza, D., Santoliquido, A., Santopaolo, F., Santoro, M. C., Sardeo, F., Sarnari, C., Saviano, A., Saviano, L., Scaldaferri, Franco, Scarascia, R., Schepis, T., Schiavello, F., Scoppettuolo, G., Sedda, D., Sessa, F., Sestito, L., Settanni, C., Siciliano, M., Siciliano, V., Sicuranza, R., Simeoni, B., Simonetti, J., Smargiassi, A., Soave, P. M., Sonnino, C., Staiti, D., Stella, C., Stella, L., Stival, E., Taddei, E., Talerico, R., Tamburello, E., Tamburrini, E., Tanzarella, E. S., Tarascio, E., Tarli, C., Tersali, A., Tilli, P., Timpano, J., Torelli, E., Torrini, F., Tosato, M., Tosoni, A., Tricoli, L., Tritto, M., Tumbarello, M., Tummolo, A. M., Vallecoccia, M. S., Valletta, F., Varone, F., Vassalli, F., Ventura, G., Verardi, L., Vetrone, L., Vetrugno, G., Visconti, E., Visconti, F., Viviani, A., Zaccaria, R., Zaccone, C., Zelano, L., Zileri Dal Verme, L., Zuccala, G., Luigetti M. (ORCID:0000-0001-7539-505X), Iorio R. (ORCID:0000-0002-6270-0956), Bentivoglio A. R. (ORCID:0000-0002-9663-095X), Tricoli L., Riso V., Marotta J., Piano C., Primiano G., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Calabresi P. (ORCID:0000-0003-0326-5509), Annetta M. G. (ORCID:0000-0001-7574-1311), Antonelli M. (ORCID:0000-0003-3007-1670), Bosello S. (ORCID:0000-0002-4837-447X), Cianci R. (ORCID:0000-0001-5378-8442), Franceschi F. (ORCID:0000-0001-6266-445X), Grieco D. L. (ORCID:0000-0002-4557-6308), Ianiro G. (ORCID:0000-0002-8318-0515), Marzetti E. (ORCID:0000-0001-9567-6983), Miele L. (ORCID:0000-0003-3464-0068), Montini L. (ORCID:0000-0003-4602-5134), Murri R. (ORCID:0000-0003-4263-7854), Papa A. (ORCID:0000-0002-4186-7298), Richeldi L. (ORCID:0000-0001-8594-1448), Rinninella E. (ORCID:0000-0002-9165-2367), Sandroni C. (ORCID:0000-0002-8878-2611), Scaldaferri F. (ORCID:0000-0001-8334-7541), Luigetti, Marco, Iorio, Raffaele, Bentivoglio, Anna Rita, Tricoli, Luca, Riso, Vittorio, Marotta, Jessica, Piano, Carla, Primiano, Guido Alessandro, Zileri Del Verme, L., Lo Monaco, Maria Rita, Calabresi, Paolo, Abbate, V., Acampora, N., Addolorato, G., Agostini, F., Ainora, M. E., Akacha, K., Amato, E., Andreani, F., Andriollo, G., Annetta, Maria Giuseppina, Annicchiarico, B. E., Antonelli, Massimo, Antonucci, G., Anzellotti, G. M., Armuzzi, A., Baldi, F., Barattucci, I., Barillaro, C., Barone, F., Bellantone, R. D. A., Bellieni, A., Bello, G., Benicchi, A., Benvenuto, F., Berardini, L., Berloco, F., Bernabei, R., Bianchi, A., Biasucci, D. G., Biasucci, L. M., Bibbo, S., Bini, A., Bisanti, A., Biscetti, F., Bocci, M. G., Bonadia, N., Bongiovanni, F., Borghetti, A., Bosco, G., Bosello, Silvia Laura, Bove, V., Bramato, G., Brandi, V., Bruni, T., Bruno, C., Bruno, D., Bungaro, M. C., Buonomo, A., Burzo, L., Calabrese, A., Calvello, M. R., Cambieri, A., Cambise, C., Camma, G., Candelli, M., Canistro, G., Cantanale, A., Capalbo, G., Capaldi, L., Capone, E., Capristo, E., Carbone, L., Cardone, S., Carelli, S., Carfi, A., Carnicelli, A., Caruso, C., Casciaro, F. A., Catalano, L., Cauda, R., Cecchini, A. L., Cerrito, L., Cesarano, M., Chiarito, A., Cianci, Rossella, Cicchinelli, S., Ciccullo, A., Cicetti, M., Ciciarello, F., Cingolani, A., Cipriani, M. C., Consalvo, M. L., Coppola, G., Corbo, G. M., Corsello, A., Costante, F., Costanzi, M., Covino, M., Crupi, D., Cutuli, S. L., D'Addio, S., D'Alessandro, A., D'Alfonso, M. E., D'Angelo, E., D'Aversa, F., Damiano, F., De Berardinis, G. M., De Cunzo, T., De Gaetano, D. K., De Luca, G., De Matteis, G., De Pascale, G., De Santis, P., De Siena, M., De Vito, F., Del Gatto, V., Del Giacomo, P., Del Zompo, F., Dell'Anna, A. M., Della, P. D., Di Gialleonardo, L., Di Giambenedetto, S., Di Luca, R., Di Maurizio, L., Di Muro, M., Dusina, A., Eleuteri, D., Esperide, A., Fachechi, D., Faliero, D., Falsiroli, C., Fantoni, M., Fedele, A., Feliciani, D., Ferrante, C., Ferrone, G., Festa, R., Fiore, M. C., Flex, A., Forte, E., Franceschi, Francesco, Francesconi, A., Franza, L., Funaro, B., Fuorlo, M., Fusco, D., Gabrielli, M., Gaetani, E., Galletta, C., Gallo, A., Gambassi, G., Garcovich, M., Gasbarrini, A., Gasparrini, I., Gelli, S., Giampietro, A., Gigante, L., Giuliano, G., Giupponi, B., Gremese, E., Grieco, Domenico Luca, Guerrera, M., Guglielmi, V., Guidone, C., Gulli, A., Iaconelli, A., Iafrati, A., Ianiro, Gianluca, Iaquinta, A., Impagnatiello, M., Inchingolo, R., Intini, E., Iorio, R., Izzi, I. M., Jovanovic, T., Kadhim, C., La Macchia, R., La Milia, D. I., Landi, F., Landi, G., Landi, R., Landolfi, R., Leo, M., Leone, P. M., Levantesi, L., Liguori, A., Liperoti, R., Lizzio, M. M., Lo Monaco Maria, R., Locantore, P., Lombardi, F., Lombardi, G., Lopetuso, L., Loria, V., Losito, A. R., Lucia, M. B. P., Macagno, F., Macerola, N., Maggi, G., Maiuro, G., Mancarella, F., Mangiola, F., Manno, A., Marchesini, D., Maresca, G. M., Marrone, G., Martis, I., Martone, A. M., Marzetti, Emanuele, Mattana, C., Matteo, M. V., Maviglia, R., Mazzarella, A., Memoli, C., Miele, Luca, Migneco, A., Mignini, I., Milani, A., Milardi, D., Montalto, M., Montemurro, G., Monti, F., Montini, Luca, Morena, T. C., Morra, V., Morretta, C., Moschese, D., Murace, C. A., Murdolo, M., Murri, Rita, Napoli, M., Nardella, E., Natalello, G., Natalini, D., Navarra, S. M., Nesci, A., Nicoletti, A., Nicoletti, R., Nicoletti, T. F., Nicolo, R., Nicolotti, N., Nista, E. C., Nuzzo, E., Oggiano, M., Ojetti, V., Pagano, F. C., Paiano, G., Pais, C., Pallavicini, F., Palombo, A., Paolillo, F., Papa, Alfredo, Papanice, D., Papparella, L. G., Paratore, M., Parrinello, G., Pasciuto, G., Pasculli, P., Pecorini, G., Perniola, S., Pero, E., Petricca, L., Petrucci, M., Picarelli, C., Piccioni, A., Piccolo, A., Piervincenzi, E., Pignataro, G., Pignataro, R., Pintaudi, G., Pisapia, L., Pizzoferrato, M., Pizzolante, F., Pola, R., Policola, C., Pompili, M., Pontecorvi, F., Pontecorvi, V., Ponziani, F., Popolla, V., Porceddu, E., Porfidia, A., Porro, L. M., Potenza, A., Pozzana, F., Privitera, G., Pugliese, D., Pulcini, G., Racco, S., Raffaelli, F., Ramunno, V., Rapaccini, G. L., Richeldi, Luca, Rinninella, Emanuele, Rocchi, S., Romano, B., Romano, S., Rosa, F., Rossi, L., Rossi, R., Rossini, E., Rota, E., Rovedi, F., Rubino, C., Rumi, G., Russo, A., Sabia, L., Salerno, A., Salini, S., Salvatore, L., Samori, D., Sandroni, Claudio, Sanguinetti, M., Santarelli, L., Santini, P., Santolamazza, D., Santoliquido, A., Santopaolo, F., Santoro, M. C., Sardeo, F., Sarnari, C., Saviano, A., Saviano, L., Scaldaferri, Franco, Scarascia, R., Schepis, T., Schiavello, F., Scoppettuolo, G., Sedda, D., Sessa, F., Sestito, L., Settanni, C., Siciliano, M., Siciliano, V., Sicuranza, R., Simeoni, B., Simonetti, J., Smargiassi, A., Soave, P. M., Sonnino, C., Staiti, D., Stella, C., Stella, L., Stival, E., Taddei, E., Talerico, R., Tamburello, E., Tamburrini, E., Tanzarella, E. S., Tarascio, E., Tarli, C., Tersali, A., Tilli, P., Timpano, J., Torelli, E., Torrini, F., Tosato, M., Tosoni, A., Tricoli, L., Tritto, M., Tumbarello, M., Tummolo, A. M., Vallecoccia, M. S., Valletta, F., Varone, F., Vassalli, F., Ventura, G., Verardi, L., Vetrone, L., Vetrugno, G., Visconti, E., Visconti, F., Viviani, A., Zaccaria, R., Zaccone, C., Zelano, L., Zileri Dal Verme, L., Zuccala, G., Luigetti M. (ORCID:0000-0001-7539-505X), Iorio R. (ORCID:0000-0002-6270-0956), Bentivoglio A. R. (ORCID:0000-0002-9663-095X), Tricoli L., Riso V., Marotta J., Piano C., Primiano G., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Calabresi P. (ORCID:0000-0003-0326-5509), Annetta M. G. (ORCID:0000-0001-7574-1311), Antonelli M. (ORCID:0000-0003-3007-1670), Bosello S. (ORCID:0000-0002-4837-447X), Cianci R. (ORCID:0000-0001-5378-8442), Franceschi F. (ORCID:0000-0001-6266-445X), Grieco D. L. (ORCID:0000-0002-4557-6308), Ianiro G. (ORCID:0000-0002-8318-0515), Marzetti E. (ORCID:0000-0001-9567-6983), Miele L. (ORCID:0000-0003-3464-0068), Montini L. (ORCID:0000-0003-4602-5134), Murri R. (ORCID:0000-0003-4263-7854), Papa A. (ORCID:0000-0002-4186-7298), Richeldi L. (ORCID:0000-0001-8594-1448), Rinninella E. (ORCID:0000-0002-9165-2367), Sandroni C. (ORCID:0000-0002-8878-2611), and Scaldaferri F. (ORCID:0000-0001-8334-7541)

Abstract

Background and purpose: The objective of this study was to assess the neurological manifestations in a series of consecutive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients, comparing their frequency with a population hospitalized in the same period for flu/respiratory symptoms, finally not related to SARS-CoV-2. Methods: Patients with flu/respiratory symptoms admitted to Fondazione Policlinico Gemelli hospital from 14 March 2020 to 20 April 2020 were retrospectively enrolled. The frequency of neurological manifestations of patients with SARS-CoV-2 infection was compared with a control group. Results: In all, 213 patients were found to be positive for SARS-CoV-2, after reverse transcriptase polymerase chain reaction on nasal or throat swabs, whilst 218 patients were found to be negative and were used as a control group. Regarding central nervous system manifestations, in SARS-CoV-2-positive patients a higher frequency of headache, hyposmia and encephalopathy always related to systemic conditions (fever or hypoxia) was observed. Furthermore, muscular involvement was more frequent in SARS-CoV-2 infection. Conclusions: Patients with COVID-19 commonly have neurological manifestations but only hyposmia and muscle involvement seem more frequent compared with other flu diseases.

Published
2020

49. Challenges in COVID-19: is pulmonary thromboembolism related to overall severity?

Author

Bellieni, Agnese, Intini, Enrica, Taddei, Eleonora, Baldi, Fabiana, Larosa, Luigi, Murri, Rita, Richeldi, Luca, Bernabei, Roberto, Cauda, Roberto, Landi, Francesco, Corbo, Giuseppe Maria, Fantoni, Massimo, Bellieni A., Intini E., Taddei E., Baldi F., Larosa L., Murri R. (ORCID:0000-0003-4263-7854), Richeldi L. (ORCID:0000-0001-8594-1448), Bernabei R. (ORCID:0000-0002-9197-004X), Cauda R. (ORCID:0000-0002-1498-4229), Landi F. (ORCID:0000-0002-3472-1389), Corbo G. M. (ORCID:0000-0002-8104-4659), Fantoni M. (ORCID:0000-0001-6913-8460), Bellieni, Agnese, Intini, Enrica, Taddei, Eleonora, Baldi, Fabiana, Larosa, Luigi, Murri, Rita, Richeldi, Luca, Bernabei, Roberto, Cauda, Roberto, Landi, Francesco, Corbo, Giuseppe Maria, Fantoni, Massimo, Bellieni A., Intini E., Taddei E., Baldi F., Larosa L., Murri R. (ORCID:0000-0003-4263-7854), Richeldi L. (ORCID:0000-0001-8594-1448), Bernabei R. (ORCID:0000-0002-9197-004X), Cauda R. (ORCID:0000-0002-1498-4229), Landi F. (ORCID:0000-0002-3472-1389), Corbo G. M. (ORCID:0000-0002-8104-4659), and Fantoni M. (ORCID:0000-0001-6913-8460)

Published
2020

50. Reduced utility of early procalcitonin and blood culture determination in patients with febrile urinary tract infections in the emergency department

Author

Covino, Marcello, Manno, Alberto, Merra, Giuseppe, Simeoni, Benedetta, Piccioni, Andrea, Carbone, Luigi, Forte, Evelina, Ojetti, Veronica, Franceschi, Francesco, Murri, Rita, Marcello Covino (ORCID:0000-0002-6709-2531), Alberto Manno, Giuseppe Merra, Benedetta Simeoni, Andrea Piccioni, Luigi Carbone, Veronica Ojetti (ORCID:0000-0002-8953-0707), Francesco Franceschi (ORCID:0000-0001-6266-445X), Rita Murri (ORCID:0000-0003-4263-7854), Covino, Marcello, Manno, Alberto, Merra, Giuseppe, Simeoni, Benedetta, Piccioni, Andrea, Carbone, Luigi, Forte, Evelina, Ojetti, Veronica, Franceschi, Francesco, Murri, Rita, Marcello Covino (ORCID:0000-0002-6709-2531), Alberto Manno, Giuseppe Merra, Benedetta Simeoni, Andrea Piccioni, Luigi Carbone, Veronica Ojetti (ORCID:0000-0002-8953-0707), Francesco Franceschi (ORCID:0000-0001-6266-445X), and Rita Murri (ORCID:0000-0003-4263-7854)

Abstract

To investigate the prognostic role of procalcitonin (PCT) assessment and blood culture (BC) acquisition in the emergency department (ED) in patients with urinary tract infection (UTI) or urosepsis. We enrolled patients admitted for UTI to our ED over a 10-year period. Mortality and in hospital length of stay (LOS) were compared between patients with UTI or urosepsis who had sampling for PCT levels and BC taken in the ED (ePCT group–eBC group) and those who had not (noePCT group–no-eBC group). 1029 patients were analyzed, 52.7% of which were female. Median age was 77 [65–83]; 139 patients (13.5%) had complicated UTI. Median LOS was 10 [7–17] days. In the ePCT group, LOS was 10 [7–16] days, vs. 10 [7–17] (p = 0.428) in the no-ePCT group. In the eBC group, LOS was 10 [6–16] days vs. 10 [7–17] days (p = 0.369) in the no-eBC group. The overall mortality rate was 6.6%. The mortality rate was not affected by early PCT determination (6% in the ePCT group vs. 6.9% in the no-ePCT group, p = 0.584). Similarly, the mortality rate was not different in the eBC group as compared to the no-eBC group (5.4% vs. 6.9%, p = 0.415). Performance of ePCT or eBC testing made no significant difference in terms of improvement of mortality rates in septic patients (11.4% vs. 7.2%; p = 0.397 and 8.8% vs. 9.8%; p = 0.845, respectively). The prognostic relevance of early evaluation of PCT and BC in the ED of patients with febrile UTI appears limited. In complicated UTI patients, PCT and BC testing may be more appropriate in the context of improving antibiotic stewardship, or as an integral component of PCT-guided standardized protocols.

Published
2020

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