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Start Over Author "Alagna L" Publisher case western reserve university
3 results on '"Alagna L"'

1. Combination antifungal therapy for invasive mold infections among pediatric patients with hematological malignancies: Data from a real-life case-series

Author

Peri, A, Verna, M, Biffi, S, Alagna, L, Longhi, B, Migliorino, G, Foresti, S, Bandera, A, Rovelli, A, Rizzari, C, Gori, A, Colombini, A, Peri A. M., Verna M., Biffi S., Alagna L., Longhi B., Migliorino G. M., Foresti S., Bandera A., Rovelli A., Rizzari C., Gori A., Colombini A., Peri, A, Verna, M, Biffi, S, Alagna, L, Longhi, B, Migliorino, G, Foresti, S, Bandera, A, Rovelli, A, Rizzari, C, Gori, A, Colombini, A, Peri A. M., Verna M., Biffi S., Alagna L., Longhi B., Migliorino G. M., Foresti S., Bandera A., Rovelli A., Rizzari C., Gori A., and Colombini A.

Abstract

Background: Invasive mold infections in children with hematological malignancies are associated with high mortality rates. The use of combination antifungal therapy in cases with a severe clinical course is increasing, although information on the efficacy and safety of this approach is limited. Methods: We present a case series of 13 children affected by hemato-oncological disorders who received combination antifungal therapy for invasive mold infections at our center (Pediatric Hematology, San Gerardo Hospital, Monza, Italy) from 2011 to 2016, with the aim of describing their clinical characteristics, types of infections, treatment regimens, clinical outcomes, and treatment safety. Medical records were retrospectively reviewed in order to describe patients’ charac-teristics. Results: Combination antifungal therapy included liposomal amphotericin associated with caspofungin (5/13, 38.4%), voriconazole (5/13, 38.4%), or posaconazole (3/13, 23.1%). The 12-week treatment response rate was 69.2% (6/13 patients showed complete response, 3/13 partial re-sponse). The crude mortality was 30.7% (4/13): half was related to invasive mold infections (2/13, 15.38%) and half to disease progression (2/13, 15.38%). Overall, treatment was well tolerated, and we did not observe any permanent discontinuation of antifungals due to related side effects. Conclusions: In our experience, combination antifungal therapy seems to be a safe option in im-munocompromised children with invasive mold infections. Well-designed studies are needed to confirm the safety of this approach and to better understand its efficacy in the pediatric setting.

Published
2019

2. Combination Antifungal Therapy for Invasive Mold Infections Among Pediatric Patients with Hematological Malignancies: Data from A Real-Life Case-Series

Author

Benedetta Longhi, Andrea Gori, Alessandra Bandera, Attilio Rovelli, Laura Alagna, Guglielmo Migliorino, Antonella Colombini, Carmelo Rizzari, Sergio Foresti, Stefano Biffi, Anna Maria Peri, Marta Verna, Peri, A, Verna, M, Biffi, S, Alagna, L, Longhi, B, Migliorino, G, Foresti, S, Bandera, A, Rovelli, A, Rizzari, C, Gori, A, and Colombini, A

Subjects
lcsh:Immunologic diseases. Allergy, Microbiology (medical), Antifungal, Posaconazole, Treatment response, medicine.medical_specialty, medicine.drug_class, Immunology, chemistry.chemical_compound, Internal medicine, lcsh:Pathology, Immunology and Allergy, Medicine, hematological malignancies, Antifungal therapy, Molecular Biology, Voriconazole, business.industry, Medical record, Clinical course, Discontinuation, Infectious Diseases, chemistry, Mold, Hematological malignancie, Caspofungin, lcsh:RC581-607, business, Research Article, lcsh:RB1-214, medicine.drug
Abstract

Background: Invasive mold infections in children with hematological malignancies are associated with high mortality rates. The use of combination antifungal therapy in cases with a severe clinical course is increasing, although information on the efficacy and safety of this approach is limited. Methods: We present a case series of 13 children affected by hemato-oncological disorders who received combination antifungal therapy for invasive mold infections at our center (Pediatric Hematology, San Gerardo Hospital, Monza, Italy) from 2011 to 2016, with the aim of describing their clinical characteristics, types of infections, treatment regimens, clinical outcomes, and treatment safety. Medical records were retrospectively reviewed in order to describe patients’ characteristics. Results: Combination antifungal therapy included liposomal amphotericin associated with caspofungin (5/13, 38.4%), voriconazole (5/13, 38.4%), or posaconazole (3/13, 23.1%). The 12-week treatment response rate was 69.2% (6/13 patients showed complete response, 3/13 partial response). The crude mortality was 30.7% (4/13): half was related to invasive mold infections (2/13, 15.38%) and half to disease progression (2/13, 15.38%). Overall, treatment was well tolerated, and we did not observe any permanent discontinuation of antifungals due to related side effects. Conclusions: In our experience, combination antifungal therapy seems to be a safe option in immunocompromised children with invasive mold infections. Well-designed studies are needed to confirm the safety of this approach and to better understand its efficacy in the pediatric setting. Keywords: antifungal therapy; mold; hematological malignancies

Published
2019
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3. Clinical Usefulness of Klebsiella Pneumoniae Carbapenemase-Producing K. Pneumoniae Genotyping: The Experience of a Single-Center Epidemic.

Author

Rossi M, Chatenoud L, Viganò EF, Peri AM, Alagna L, Bramati S, Manenti M, Raggi M, Cavallero A, Bisi L, Leone S, Migliorino GM, Bandera A, and Gori A

Abstract

Background: During the last decade, the spread of Klebsiella pneumoniae -carbapenemase-producing Klebsiella pneumoniae (KPC- Kp ) has increased dramatically worldwide. In this scenario, growing interest has been addressed to genotyping of KPC- Kp strains, which emerged as an important tool for a better understanding of the epidemiological and clinical characteristics of the outbreaks., Methods: We performed a retrospective cohort study on patients infected with KPC- Kp during a 28-month outbreak period (January 2010-April 2012) at San Gerardo Hospital (Monza, Italy), investigating KPC- Kp genotypes by means of repetitive element sequence-based polymerase chain reaction (Rep-PCR)., Results: We enrolled 97 patients infected with KPC- Kp . Rep-PCR analysis identified 5 distinct clone types, with different distribution over time. During the first 12 months of the outbreak period, only 1 clone was detected (clone A, in 47 patients), while the 4 other clones were identified over the remaining 16 months (clones C, E, and F/L in 23, 24, and 3 patients respectively). Mechanical ventilation was less frequent in patients infected with clones C/E/F/L (OR = 0.14; 95% CI: 0.05-0.37) compared to clone A, and the Charlson comorbidity index (CI) was more likely to have a score >5 in patients infected with clones C/E/F/L (OR = 7.21; 95% CI: 2.24-23.14) compared to clone A.Overall mortality was higher in patients infected with clones C/E/F/L (13/20 patients, 65%) compared to those infected with clone A (7/20, 35%). Mortality in patients infected with clones C/E/F/L remained significantly higher even after adjusting for the potential confounding effect of comorbidities (ie, CI), with a hazard ratio (HR) of 4.65 (95% CI: 1.83-11.89)., Conclusions: Our results suggested a close relationship between strain genotype and clinical outcome., Competing Interests: All authors: No reported conflicts. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Published
2017
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