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106. Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study.

Author

Bartoletti, Michele, Pascale, Renato, Cricca, Monica, Rinaldi, Matteo, Maccaro, Angelo, Bussini, Linda, Fornaro, Giacomo, Tonetti, Tommaso, Pizzilli, Giacinto, Francalanci, Eugenia, Giuntoli, Lorenzo, Rubin, Arianna, Moroni, Alessandra, Ambretti, Simone, Trapani, Filippo, Vatamanu, Oana, Ranieri, Vito Marco, Castelli, Andrea, Baiocchi, Massimo, and Lewis, Russell

Subjects
RESEARCH, COVID-19, SARS-CoV-2, CONFIDENCE intervals, VORICONAZOLE, MEDICAL cooperation, PATIENTS, PULMONARY aspergillosis, HOSPITAL admission & discharge, KAPLAN-Meier estimator, ODDS ratio, LOGISTIC regression analysis, TRACHEA intubation, LONGITUDINAL method
Abstract

Background We evaluated the incidence of invasive pulmonary aspergillosis among intubated patients with critical COVID-19 and evaluated different case definitions of invasive aspergillosis. Methods Prospective, multicenter study in adult patients with microbiologically confirmed COVID-19 receiving mechanical ventilation. All included participants underwent a screening protocol for invasive pulmonary aspergillosis with bronchoalveolar lavage galactomannan and cultures performed on admission at 7 days and in case of clinical deterioration. Cases were classified as coronavirus-associated pulmonary aspergillosis (CAPA) according to previous consensus definitions. The new definition was compared with putative invasive pulmonary aspergillosis (PIPA). Results 108 patients were enrolled. Probable CAPA was diagnosed in 30 (27.7%) patients after a median of 4 (2–8) days from intensive care unit (ICU) admission. Kaplan-Meier curves showed a significantly higher 30-day mortality rate from ICU admission among patients with either CAPA (44% vs 19%, P =.002) or PIPA (74% vs 26%, P <.001) when compared with patients not fulfilling criteria for aspergillosis. The association between CAPA (OR, 3.53; 95% CI, 1.29–9.67; P =.014) or PIPA (OR, 11.60; 95% CI, 3.24–41.29; P <.001) with 30-day mortality from ICU admission was confirmed, even after adjustment for confounders with a logistic regression model. Among patients with CAPA receiving voriconazole treatment (13 patients; 43%) a trend toward lower mortality (46% vs 59%; P =.30) and reduction in galactomannan index in consecutive samples were observed. Conclusions We found a high incidence of CAPA among critically ill COVID-19 patients and its occurrence seems to change the natural course of disease. [ABSTRACT FROM AUTHOR]

Published
2021
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107. Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia After Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey

Author

Girmenia, Corrado, Bertaina, Alice, Piciocchi, Alfonso, Perruccio, Katia, Algarotti, Alessandra, Busca, Alessandro, Cattaneo, Chiara, Raiola, Anna Maria, Guidi, Stefano, Iori, Anna Paola, Candoni, Anna, Irrera, Giuseppe, Milone, Giuseppe, Marcacci, Giampaolo, Scimè, Rosanna, Musso, Maurizio, Cudillo, Laura, Sica, Simona, Castagna, Luca, Corradini, Paolo, Marchesi, Francesco, Pastore, Domenico, Alessandrino, Emilio Paolo, Annaloro, Claudio, Ciceri, Fabio, Santarone, Stella, Nassi, Luca, Farina, Claudio, Viscoli, Claudio, Rossolini, Gian Maria, Bonifazi, Francesca, Rambaldi, Alessandro, Capria, Saveria, Bertaina, A., Mastronuzzi, Angela, Pagliara, Daria, Bernaschi, Paola, Amico, Lucia, Carotti, Alessandra, Mencacci, Antonella, Busca, A., Bruno, Benedetto, Costa, Cristina, Passi, Angela, Ravizzola, Giuseppe, Angelucci, Emanuele, Marchese, Anna, Pecile, Patrizia, Candoni, A., Ventura, Giovanna, Fanin, Renato, Scarparo, Claudio, Barbaro, Angelo, Milone, G., Leotta, Salvatore, Marchese, Anna Elisa, Marcacci, G., Becchimanzi, Cristina, Donnarumma, Daniela, Tringali, Stefania, Baldi, Maria Teresa, Scalone, Renato, Cudillo, L., Picardi, Alessandra, Arcese, William, Fontana, Carla, Sica, S., Giammarco, Sabrina, Spanu, Teresa, Castagna, L., Crocchiolo, Roberto, Casari, Erminia, Mussetti, Alberto, Conte, Eutilia, Ensoli, Fabrizio, Miragliotta, Giuseppe, Marone, Piero, Arghittu, Milena, Greco, Raffaella, Forcina, Alessandra, Chichero, Paola, Santarone, S., Di Bartolomeo, Paolo, Fazii, Paolo, Kroumova, Vesselina, Decembrino, Nunzia, Zecca, Marco, Pisapia, Giovanni, Palazzo, Giulia, Lanino, Edoardo, Faraci, Maura, Castagnola, Elio, Bandettini, Roberto, Pastano, Rocco, Sammassimo, Simona, Passerini, Rita, Stefani, Piero Maria, Gherlinzoni, Filippo, Rigoli, Roberto, Prezioso, Lucia, Cambò, Benedetta, Calderaro, Adriana, Carella, Angelo Michele, Cascavilla, Nicola, Labonia, Maria Teresa, Celeghini, Ivana, Mordini, Nicola, Piana, Federica, Vacca, Adriana, Sanna, Marco, Podda, Giovanni, Corsetti, Maria Teresa, Rocchetti, Andrea, Cilloni, Daniela, De Gobbi, Marco, Bianco, Ornella, Fagioli, Franca, Carraro, Francesca, De Intinis, Gianfranco, Severino, Alessandro, Proia, Anna, Parisi, Gabriella, Vallisa, Daniele, Confalonieri, Massimo, Russo, Domenico, Malagola, Michele, Galieni, Piero, Falcioni, Sadia, Travaglini, Valeria, Raimondi, Roberto, Borghero, Carlo, Pavan, Giacomina, Prete, Arcangelo, Belotti, Tamara, Ambretti, Simone, Imola, Manuela, Mianulli, Anna Maria, Pedna, Maria Federica, Cesaro, Simone, Lo Cascio, Giuliana, Ferrari, Antonella, Piedimonte, Monica, Santino, Iolanda, Calandrelli, Monica, Olivieri, Attilio, Orecchioni, Francesca, Mirabile, Milena, Centurioni, Riccardo, Gironacci, Luciana, Caravelli, Daniela, Gallo, Susanna, De Filippi, Marco, Cupelli, Luca, Dentamaro, Teresa, Falco, Silvana, Eugenio, Ospedale S, Marotta, Serena, Risitano, Antonio, Lula, Dora, Musto, Pellegrino, Pietrantuono, Giuseppe, Traficante, Antonio, Cerchiara, Elisabetta, Tirindelli, Maria Cristina, Dicuonzo, Giordano, Chierichini, Anna, Anaclerico, Barbara, Placanica, Paola, Girmenia, C, Bertaina, A, Piciocchi, A, Perruccio, K, Algarotti, A, Busca, A, Cattaneo, C, Raiola, Am, Guidi, S, Iori, Ap, Candoni, A, Irrera, G, Milone, G, Marcacci, G, Scimè, R, Musso, M, Cudillo, L, Sica, S, Castagna, L, Corradini, P, Marchesi, F, Pastore, D, Alessandrino, Ep, Annaloro, C, Ciceri, F, Santarone, S, Nassi, L, Farina, C, Viscoli, C, Rossolini, Gm, Bonifazi, F, Rambaldi, A, for the Gruppo Italiano Trapianto di Midollo Osseo, (GITMO), Associazione Microbiologi Clinici Italiani, (AMCLI), Girmenia, Corrado, Bertaina, Alice, Piciocchi, Alfonso, Perruccio, Katia, Algarotti, Alessandra, Busca, Alessandro, Cattaneo, Chiara, Raiola, Anna Maria, Guidi, Stefano, Iori, Anna Paola, Candoni, Anna, Irrera, Giuseppe, Milone, G., Marcacci, Giampaolo, Scimè, Rosanna, Musso, Maurizio, Cudillo, Laura, Sica, Simona, Castagna, Luca, Corradini, Paolo, Marchesi, Francesco, Pastore, Domenico, Alessandrino, Emilio Paolo, Annaloro, Claudio, Ciceri, Fabio, Santarone, Stella, Nassi, Luca, Farina, Claudio, Viscoli, Claudio, Rossolini, Gian Maria, Bonifazi, Francesca, Rambaldi, Alessandro, Capria, Saveria, Bertaina, A., Mastronuzzi, Angela, Pagliara, Daria, Bernaschi, Paola, Amico, Lucia, Carotti, Alessandra, Mencacci, Antonella, Busca, A., Bruno, Benedetto, Costa, Cristina, Passi, Angela, Ravizzola, Giuseppe, Angelucci, Emanuele, Marchese, Anna, Pecile, Patrizia, Candoni, A., Ventura, Giovanna, Fanin, Renato, Scarparo, Claudio, Barbaro, Angelo, Leotta, Salvatore, Marchese, Anna Elisa, Marcacci, G., Becchimanzi, Cristina, Donnarumma, Daniela, Tringali, Stefania, Baldi, Maria Teresa, Scalone, Renato, Cudillo, L., Picardi, Alessandra, Arcese, William, Fontana, Carla, Sica, S., Giammarco, Sabrina, Spanu, Teresa, Castagna, L., Crocchiolo, Roberto, Casari, Erminia, Mussetti, Alberto, Conte, Eutilia, Ensoli, Fabrizio, Miragliotta, Giuseppe, Marone, Piero, Arghittu, Milena, Greco, Raffaella, Forcina, Alessandra, Chichero, Paola, Santarone, S., Di Bartolomeo, Paolo, Fazii, Paolo, Kroumova, Vesselina, Decembrino, Nunzia, Zecca, Marco, Pisapia, Giovanni, Palazzo, Giulia, Lanino, Edoardo, Faraci, Maura, Castagnola, Elio, Bandettini, Roberto, Pastano, Rocco, Sammassimo, Simona, Passerini, Rita, Stefani, Piero Maria, Gherlinzoni, Filippo, Rigoli, Roberto, Prezioso, Lucia, Cambò, Benedetta, Calderaro, Adriana, Carella, Angelo Michele, Cascavilla, Nicola, Labonia, Maria Teresa, Celeghini, Ivana, Mordini, Nicola, Piana, Federica, Vacca, Adriana, Sanna, Marco, Podda, Giovanni, Corsetti, Maria Teresa, Rocchetti, Andrea, Cilloni, Daniela, De Gobbi, Marco, Bianco, Ornella, Fagioli, Franca, Carraro, Francesca, De Intinis, Gianfranco, Severino, Alessandro, Proia, Anna, Parisi, Gabriella, Vallisa, Daniele, Confalonieri, Massimo, Russo, Domenico, Malagola, Michele, Galieni, Piero, Falcioni, Sadia, Travaglini, Valeria, Raimondi, Roberto, Borghero, Carlo, Pavan, Giacomina, Prete, Arcangelo, Belotti, Tamara, Ambretti, Simone, Imola, Manuela, Mianulli, Anna Maria, Pedna, Maria Federica, Cesaro, Simone, Lo Cascio, Giuliana, Ferrari, Antonella, Piedimonte, Monica, Santino, Iolanda, Calandrelli, Monica, Olivieri, Attilio, Orecchioni, Francesca, Mirabile, Milena, Centurioni, Riccardo, Gironacci, Luciana, Caravelli, Daniela, Gallo, Susanna, De Filippi, Marco, Cupelli, Luca, Dentamaro, Teresa, Falco, Silvana, Eugenio, Ospedale S, Marotta, Serena, Risitano, Antonio, Lula, Dora, Musto, Pellegrino, Pietrantuono, Giuseppe, Traficante, Antonio, Cerchiara, Elisabetta, Tirindelli, Maria Cristina, Dicuonzo, Giordano, Chierichini, Anna, Anaclerico, Barbara, and Placanica, Paola

Subjects
0301 basic medicine, Male, Transplantation Conditioning, Drug Resistance, Bacteremia, 0302 clinical medicine, epidemiology, Gram negative bacteremia, multidrug resistance, stem cell transplant, survival, Risk Factors, Drug Resistance, Multiple, Bacterial, Epidemiology, Medicine, Age Factor, Prospective Studies, Prospective cohort study, Child, Transplantation, Homologou, education.field_of_study, Incidence (epidemiology), Incidence, Bacterial, Age Factors, Hematopoietic Stem Cell Transplantation, Middle Aged, Transplantation, Autologou, surgical procedures, operative, Infectious Diseases, Italy, Child, Preschool, Female, medicine.symptom, Multiple, Autologous, Human, Homologous, Microbiology (medical), Adult, medicine.medical_specialty, Adolescent, 030106 microbiology, Population, Transplantation, Autologous, 03 medical and health sciences, Young Adult, Internal medicine, Gram-Negative Bacteria, Gram-Negative Bacterial Infection, Escherichia coli, Humans, Transplantation, Homologous, Preschool, education, Aged, Gram-Negative Bacterial Infections, Infant, Transplantation, business.industry, Risk Factor, medicine.disease, Prospective Studie, Carriage, Otitis, business, Settore MED/15 - Malattie del Sangue, 030215 immunology
Abstract

Background Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable. Methods We prospectively evaluated the epidemiology of pre-engraftment GNB in 1118 allogeneic HSCTs (allo-HSCTs) and 1625 autologous HSCTs (auto-HSCTs) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods. we identified risk factors for GNB and evaluated the impact of GNB on the 4-month overall-survival after transplant. Results The cumulative incidence of pre-engraftment GNB was 17.3% in allo-HSCT and 9% in auto-HSCT. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most common isolates. By multivariate analysis, variables associated with GNB were a diagnosis of acute leukemia, a transplant from a HLA-mismatched donor and from cord blood, older age, and duration of severe neutropenia in allo-HSCT, and a diagnosis of lymphoma, older age, and no antibacterial prophylaxis in auto-HSCT. A pretransplant infection by a resistant pathogen was significantly associated with an increased risk of posttransplant infection by the same microorganism in allo-HSCT. Colonization by resistant gram-negative bacteria was significantly associated with an increased rate of infection by the same pathogen in both transplant procedures. GNB was independently associated with increased mortality at 4 months both in allo-HSCT (hazard ratio, 2.13; 95% confidence interval, 1.45–3.13; P Conclusions Pre-engraftment GNB is an independent factor associated with increased mortality rate at 4 months after auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB. Clinical Trials registration NCT02088840.

Published
2017

108. Epidemiologic case investigation on the zoonotic transmission of Staphylococcusaureus infection from goat to veterinarians.

Author

Piva, Silvia, Mariella, Jole, Cricca, Monica, Giacometti, Federica, Brunetti, Barbara, Mondo, Elisabetta, De Castelli, Lucia, Romano, Angelo, Ferrero, Irene, Ambretti, Simone, Roccaro, Mariana, Merialdi, Giuseppe, Scagliarini, Alessandra, Serraino, Andrea, and Peli, Angelo

Subjects
STAPHYLOCOCCUS aureus infections, VETERINARIANS, GOATS, INFECTIOUS disease transmission, THYMUS, COTYLEDONS, GOAT diseases, SCROTUM
Abstract

Staphylococcus aureus infection led to a case of goat abortion, and four veterinarians contracted S. aureus infection from the goat during and after the abortion. Three veterinarians assisted a doe during the dystocic delivery of a dead foetus. Seventy‐two hours after the dystocia, which ended with the goat's death, the veterinarians who assisted during the kidding and the veterinarian who performed the necropsy showed the presence of multiple, isolated, painful pustules 1–5 mm in diameter located along their forearms and knees. S. aureus was isolated from the pustules of the veterinarians, the placenta and uterus of the goat, the organs (brain, thymus gland, abomasum, liver and spleen) of the foetus, the scrotum and eye swabs of the buck, and mammary pustules of another goat from the same herd. Histological analysis revealed purulent metritis and inflammation of the placental cotyledons. Additional investigations eliminated the chances of other infections. S. aureus isolates recovered from the veterinarians, goats, foetus and buck were sensitive to the tested anti‐microbials and did not encode staphylococcal enterotoxin genes (sea, ser, sep, see, seg and sei). The isolates were closely related, as indicated by the results of Fourier‐transform infrared spectroscopy and comparative whole‐genome sequencing analysis. The results of this study clearly support the hypothesis that an episode of professional zoonosis was caused by S. aureus infection during the abortion and also highlight the need for bacterial subtyping in epidemiological surveys. [ABSTRACT FROM AUTHOR]

Published
2021
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109. Prognostic Utility of the New Definition of Difficult-to-Treat Resistance Among Patients With Gram-Negative Bloodstream Infections

Author

Giannella, Maddalena, primary, Bussini, Linda, additional, Pascale, Renato, additional, Bartoletti, Michele, additional, Malagrinò, Matteo, additional, Pancaldi, Livia, additional, Toschi, Alice, additional, Ferraro, Giuseppe, additional, Marconi, Lorenzo, additional, Ambretti, Simone, additional, Lewis, Russell, additional, and Viale, Pierluigi, additional

Published
2019
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110. Epidemiology and complications of late-onset sepsis: an Italian area-based study

Author

Berardi, Alberto, primary, Sforza, Francesca, additional, Baroni, Lorenza, additional, Spada, Caterina, additional, Ambretti, Simone, additional, Biasucci, Giacomo, additional, Bolognesi, Serenella, additional, Capretti, Mariagrazia, additional, Carretto, Edoardo, additional, Ciccia, Matilde, additional, Lanari, Marcello, additional, Pedna, Maria Federica, additional, Rizzo, Vittoria, additional, Venturelli, Claudia, additional, Tzialla, Crisoula, additional, Lucaccioni, Laura, additional, and Reggiani, Maria Letizia Bacchi, additional

Published
2019
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111. Impact on mortality of a bundle for the management of enterococcal bloodstream infection

Author

Bartoletti, Michele, primary, Tedeschi, Sara, additional, Scudeller, Luigia, additional, Pascale, Renato, additional, Del Turco, Elena Rosselli, additional, Trapani, Filippo, additional, Tumietto, Fabio, additional, Virgili, Giulio, additional, Marconi, Lorenzo, additional, Ianniruberto, Stefano, additional, Rinaldi, Matteo, additional, Contadini, Ilaria, additional, Cristini, Francesco, additional, Bussini, Linda, additional, Campoli, Caterina, additional, Ambretti, Simone, additional, Berlingeri, Andrea, additional, Viale, Pierluigi, additional, and Giannella, Maddalena, additional

Published
2019
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113. Risk factors for group B streptococcus early-onset disease: an Italian, area-based, case-control study

Author

Berardi, Alberto, primary, Spada, Caterina, additional, Creti, Roberta, additional, Ambretti, Simone, additional, Chiarabini, Rossana, additional, Barozzi, Agostino, additional, Pagano, Rossella, additional, Sarti, Mario, additional, Pedna, Maria Federica, additional, Fornaciari, Sara, additional, Azzalli, Milena, additional, Dodi, Icilio, additional, Bacchi Reggiani, Maria Letizia, additional, Lanzoni, Angela, additional, Vaccina, Eleonora, additional, Iughetti, Lorenzo, additional, and Lucaccioni, Laura, additional

Published
2019
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114. Carbapenem-resistant bacteria in an intensive care unit during the coronavirus disease 2019 (COVID-19) pandemic: A multicenter before-and-after cross-sectional study

Author

Pascale, Renato, Bussini, Linda, Gaibani, Paolo, Bovo, Federica, Fornaro, Giacomo, Lombardo, Donatella, Ambretti, Simone, Pensalfine, Giulia, Appolloni, Lucia, Bartoletti, Michele, Tedeschi, Sara, Tumietto, Fabio, Lewis, Russell, Viale, Pierluigi, and Giannella, Maddalena

Abstract

AbstractObjective:To assess the incidence of colonization and infection with carbapenemase-producing Enterobacteriaceae (CPE) and carbapenem-resistant Acinetobacter baumannii(CR-Ab) in the ICUs of our city hospitals before and during the coronavirus disease 2019 (COVID-19) pandemic.Methods:We conducted a multicenter, before-and-after, cross-sectional study to compare the rates of colonization and infection with CPE and/or CR-Ab in 2 study periods, period 1 (January–April 2019) and period 2 (January–April 2020). Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of weekly colonization and infection rates for each period were compared for the 2 study periods using Poisson regression. Weekly trends in the incidence of colonization or infection for each study period were summarized using local weighted (Loess) regression.Results:We detected no significant change in either IRR and weekly trend in CPE colonization and infection during the 2 study periods. A shift from KPC to other CPE mechanisms (OXA-48 and VIM) was observed during period 2. Compared to period 1, during period 2 the IRR of colonization and infection with CR-Ab increased 7.5- and 5.5-fold, respectively. Genome sequencing showed that all CR-Ab strains belonged to the CC92/IC2 clonal lineage. Clinical strains clustered closely into a single monophyletic group in 1 of the 3 centers, whereas they segregated in 2 different clusters in the other 2 centers, which strongly indicates horizontal transmission.Conclusions:Our findings indicate the need to conduct infection control activities targeted against the spread of antimicrobial resistance between and within hospitals during the COVID-19 pandemic, and if necessary, remodulating them according to the new organizational structures imposed by the pandemic.

Published
2022
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116. The burden of early-onset sepsis in Emilia-Romagna (Italy): a 4-year, population-based study

Author

Berardi, Alberto, Baroni, Lorenza, Bacchi Reggiani, Maria Letizia, Ambretti, Simone, Biasucci, Giacomo, Bolognesi, Serenella, Capretti, Maria Grazia, Carretto, Edoardo, Ciccia, Matilde, Fiorini, Valentina, Fortini, Cinzia, Gargano, Giancarlo, Pedna, Maria Federica, Rizzo, Vittoria, Creti, Roberta, Ferrari, Fabrizio, Memo, L., Nicolini, G., Campanile, A., Tridapalli, E., Ciccia, M., Bastelli, A., Sandri, F., Ambretti, S., Capretti, M. G., Gentili, A., Ragni, L., Albarelli, A., Piscina, A., Borghi, A., Simoni, A., Fiorini, V., Grande, E. D., Polese, A., Biasini, A., China, M. C., Rizzo, V., Zucchini, A., Malaguti, L., Contiero, R., Fortini, C., Garani, G., Rossi, M. R., Nasi, S., Bacchini, P., Baldassarri, P., Pulvirenti, R. M., Vaienti, F., Venturoli, V., Bidetti, M. L., Colla, R., Toniato, M., Carlo, C. D., Lanari, M., Serra, L., Silvestrini, D., Facchinetti, F., Ferrari, F., Lugli, L., Venturelli, C., Sarti, M., Volta, A., Dodi, I., Gambini, L., Guidi, B., Bertelli, M., Biasucci, G., Chiarabini, R., Padrini, D., Piepoli, M., Riboni, S., Rubbi, P., Pedna, M. F., Sambri, V., Perrone, A., Preti, P., Marchetti, F., Piccinini, G. C., Amarri, S., Carretto, E., Gargano, G., Pedori, S., Riva, M., Rossi, C., Zuelli, C., Bolognesi, S., Papa, I., Vergine, G., Viola, L., Chiossi, C., Pagano, R., Zanacca, C., Palmieri, R., Berardi, Alberto, Baroni, Lorenza, Bacchi Reggiani, Maria Letizia, Ambretti, Simone, Biasucci, Giacomo, Bolognesi, Serenella, Capretti, Maria Grazia, Carretto, Edoardo, Ciccia, Matilde, Fiorini, Valentina, Fortini, Cinzia, Gargano, Giancarlo, Pedna, Maria Federica, Rizzo, Vittoria, Creti, Roberta, Ferrari, Fabrizio, and GBS Prevention Working Group Emilia-Romagna [,Lanari, Marcello,]

Subjects
Pediatrics, Antibiotics, group B streptococcu, Logistic regression, medicine.disease_cause, Severity of Illness Index, Group B, 0302 clinical medicine, Risk Factors, Medicine, Birth Weight, 030212 general & internal medicine, Escherichia coli Infections, Streptococcus, Gestational age, meningitis, Obstetrics and Gynecology, Drug Resistance, Microbial, intrapartum chemoprophylaxi, Perinatology and Child Health, meningiti, Anti-Bacterial Agents, Italy, Regression Analysis, Neonatal Sepsis, Meningitis, Early-onset sepsis, group B streptococcus, intrapartum chemoprophylaxis, newborn infant, Pediatrics, Perinatology and Child Health, Infant, Premature, Cohort study, medicine.medical_specialty, medicine.drug_class, Statistics, Nonparametric, Streptococcus agalactiae, Sepsis, 03 medical and health sciences, 030225 pediatrics, Streptococcal Infections, Escherichia coli, Humans, Retrospective Studies, business.industry, Infant, Newborn, Infant, medicine.disease, Early-onset sepsi, Ampicillin, Gentamicins, business
Abstract

Objective: To provide the first Italian data on pathogens causing early-onset sepsis (EOS) and their antimicrobial susceptibility, after the successfully prevention of Group B streptococcus (GBS) EOS. Methods: Retrospective area-based cohort study from Emilia-Romagna (Italy). Cases of EOS registered (from 2009 to 2012) in all gestational age neonates were reviewed. Results: Live births (LB) numbered 146 682. Ninety neonates had EOS and 12 died (incidence rates of 0.61 and 0.08/1000 LB, respectively). EOS and mortality were the highest among neonates with a birth weight n = 27, 0.18/1000 LB) and Escherichia coli (n = 19, 0.13/1000 LB). Most infants affected by E. coli EOS were born preterm (n = 13), had complications (n = 4) or died (n = 7). Among 90 isolates tested, only 3 were resistant to both first line empirical antibiotics. Multivariate logistic regression analysis showed that low gestational age, caesarean section and low platelet count at presentation were significantly associated with death or brain lesions (area under ROC curve = 0.939, H-L = 0.944, sensitivity 76.0%, specificity 90.7%). Conclusions: GBS slightly exceeds E. coli as a cause of EOS. However, E. coli is the prominent cause of death, complications and in most cases affects preterm neonates. Empirical antimicrobial therapy of EOS seems appropriate.

Published
2015

118. Risk factors for group B streptococcus early-onset disease: an Italian, area-based, case-control study.

Author

Berardi, Alberto, Spada, Caterina, Creti, Roberta, Ambretti, Simone, Chiarabini, Rossana, Barozzi, Agostino, Pagano, Rossella, Sarti, Mario, Pedna, Maria Federica, Fornaciari, Sara, Azzalli, Milena, Dodi, Icilio, Bacchi Reggiani, Maria Letizia, Lanzoni, Angela, Vaccina, Eleonora, Iughetti, Lorenzo, and Lucaccioni, Laura

Subjects
STREPTOCOCCAL disease prevention, COMMUNICABLE disease diagnosis, BETA lactam antibiotics, PRENATAL diagnosis, DISEASE incidence, STREPTOCOCCAL diseases, CASE-control method, ANTIBIOTIC prophylaxis, STREPTOCOCCUS, PREGNANCY complications, IMPACT of Event Scale, QUESTIONNAIRES, VERTICAL transmission (Communicable diseases)
Abstract

Purpose: Intrapartum antibiotic prophylaxis (IAP) prevents group B streptococcus (GBS) early-onset disease (EOD). No European study evaluates the relative impact of risk factors (RFs) for EOD after a screening-based strategy and widespread IAP use We aimed to evaluate the risks of EOD in an Italian region where a screening-based strategy for preventing EOD was implemented.Materials and methods: Cases of EOD born at or above 35 weeks' gestation were reviewed and matched with controls.Results: There were 109 cases of EOD among 532,154 live births. Most cases had negative GBS prenatal screening (56/91, 61.5%) and were unexposed to IAP (86/109, 78.9%). At multivariate analysis, GBS bacteriuria (OR = 6.99), positive prenatal screening (OR = 13.7) and maternal intrapartum fever (OR = 188.3) were associated with an increased risk of EOD, whereas intrapartum beta-lactam antibiotics were associated with a decreased risk of EOD (≥4 h: OR = 0.008; <4 h: OR = 0.04). Neonates born to nonfebrile, GBS positive pregnant women, receiving beta-lactam antibiotics had very low probability of EOD, particularly if IAP was adequate.Conclusions: GBS positive prenatal screening, GBS bacteriuria and intrapartum fever are associated with EOD. Intrapartum beta-lactam antibiotics reduce the probability of EOD in neonates born to nonfebrile mothers. [ABSTRACT FROM AUTHOR]

Published
2020
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119. Genome characterization of a Klebsiella pneumoniaeco-producing OXA-181 and KPC-121 resistant to ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam and cefiderocol isolated from a critically ill patient

Author

Gaibani, Paolo, Amadesi, Stefano, Lazzarotto, Tiziana, and Ambretti, Simone

Abstract

: Carbapenemase-producing Enterobacterales (CPE) represent a public health concern. The limited antimicrobial options against CPE have led to the development of novel antimicrobial molecules. In the present study, we characterized the genetic determinants associated with the resistance to ceftazidime/avibactam (CAZ-AVI), meropenem/vaborbactam (MER-VAB), imipenem/relebactam (IMI-REL) and cefiderocol (CFD) in a carbapenemase-producing Klebsiella pneumoniaestrain isolated from a critically ill patient.

Published
2022
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124. Potential role of T2Candida in the management of empirical antifungal treatment in patients at high risk of candidaemia: a pilot single-centre study

Author

Giannella, Maddalena, primary, Paolucci, Michela, additional, Roncarati, Greta, additional, Vandi, Giacomo, additional, Pascale, Renato, additional, Trapani, Filippo, additional, Bartoletti, Michele, additional, Tedeschi, Sara, additional, Ambretti, Simone, additional, Lewis, Russell, additional, Re, Maria Carla, additional, and Viale, Pierluigi, additional

Published
2018
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125. Management of immunosuppressive therapy in liver transplant recipients who develop bloodstream infection

Author

Bartoletti, Michele, primary, Vandi, Giacomo, additional, Furii, Francesca, additional, Bertuzzo, Valentina, additional, Ambretti, Simone, additional, Tedeschi, Sara, additional, Pascale, Renato, additional, Cristini, Francesco, additional, Campoli, Caterina, additional, Morelli, Maria Cristina, additional, Cescon, Matteo, additional, Pinna, Antonio Daniele, additional, Viale, Pierluigi, additional, and Giannella, Maddalena, additional

Published
2018
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126. In vivo evolution of resistant subpopulations of KPC-producing Klebsiella pneumoniae during ceftazidime/avibactam treatment

Author

Gaibani, Paolo, primary, Campoli, Caterina, additional, Lewis, Russell E, additional, Volpe, Silvia Lidia, additional, Scaltriti, Erika, additional, Giannella, Maddalena, additional, Pongolini, Stefano, additional, Berlingeri, Andrea, additional, Cristini, Francesco, additional, Bartoletti, Michele, additional, Tedeschi, Sara, additional, and Ambretti, Simone, additional

Published
2018
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127. Differences in the rate of carbapenem-resistant Enterobacteriaceae colonisation or Clostridium difficile infection following frontline treatment with tigecycline vs. meropenem for intra-abdominal infections

Author

Bartoletti, Michele, primary, Tedeschi, Sara, additional, Pascale, Renato, additional, Raumer, Luigi, additional, Maraolo, Alberto Enrico, additional, Palmiero, Giulia, additional, Tumietto, Fabio, additional, Cristini, Francesco, additional, Ambretti, Simone, additional, Giannella, Maddalena, additional, Lewis, Russell Edward, additional, and Viale, Pierluigi, additional

Published
2018
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129. Effect of combination therapy containing a high-dose carbapenem on mortality in patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infection

Author

Giannella, Maddalena, Trecarichi, Enrico Maria, Giacobbe, Daniele Roberto, De Rosa, Francesco Giuseppe, Bassetti, Matteo, Bartoloni, Alessandro, Bartoletti, Michele, Losito, Angela Raffaella, del Bono, Valerio, Corcione, Silvia, Tedeschi, Sara, Raffaelli, Francesca, Saffioti, Carolina, Spanu, Teresa, Rossolini, Gian Maria, Marchese, Anna, Ambretti, Simone, Cauda, Roberto, Viscoli, Claudio, Lewis, Russell Edward, Viale, Pierluigi, Tumbarello, Mario, Spanu, Teresa (ORCID:0000-0003-1864-5184), Cauda, Roberto (ORCID:0000-0002-1498-4229), Tumbarello, Mario (ORCID:0000-0002-9519-8552), Giannella, Maddalena, Trecarichi, Enrico Maria, Giacobbe, Daniele Roberto, De Rosa, Francesco Giuseppe, Bassetti, Matteo, Bartoloni, Alessandro, Bartoletti, Michele, Losito, Angela Raffaella, del Bono, Valerio, Corcione, Silvia, Tedeschi, Sara, Raffaelli, Francesca, Saffioti, Carolina, Spanu, Teresa, Rossolini, Gian Maria, Marchese, Anna, Ambretti, Simone, Cauda, Roberto, Viscoli, Claudio, Lewis, Russell Edward, Viale, Pierluigi, Tumbarello, Mario, Spanu, Teresa (ORCID:0000-0003-1864-5184), Cauda, Roberto (ORCID:0000-0002-1498-4229), and Tumbarello, Mario (ORCID:0000-0002-9519-8552)

Abstract

Objectives: To evaluate the impact of high-dose (HD) carbapenem-based combination therapy on clinical outcome in patients with monomicrobial carbapenem-resistant Klebsiella pneumoniae (CR-KP) bloodstream-infection (BSI). Methods: Post hoc analysis of all adult patients with CR-KP BSI who were treated with a combination antibiotic regimen, collected over a six-year period in six large Italian teaching hospitals. To control for confounding effects of HD carbapenem combination on 14-day mortality, a multivariate Cox regression analysis was performed. Due to imbalances between patients, a propensity score for receiving HD carbapenem was added to the model. Results: 595 patients with CR-KP BSI were analysed, 77% of isolates showed a carbapenem MIC ≥16 mg/L, 428 (71.9%) received HD carbapenem-based combination therapy. Overall, 127 patients (21.3%) died within 14 days after BSI onset. Multivariate analysis showed the Charlson comorbidity index (HR 1.31, 95%CI 1.20–1.43, P < 0.001), septic shock at BSI onset (HR 3.14, 95%CI 2.19–4.50, P < 0.001), and colistin-resistant strain (HR 1.52, 95%CI 1.02–2.24, P = 0.03) were independently associated with 14-day mortality, whereas admission to surgical ward (HR 0.44, 95%CI 0.25–0.78, P = 0.005) and HD carbapenem use (HR 0.69, 95%CI 0.47–1.00, P = 0.05) were protective factors. When adjusted for the propensity score, HD carbapenem use showed a greater protective effect (HR 0.64, 95%CI 0.43–0.95, P = 0.03). Stratifying the model for carbapenem MIC, the benefit of HD carbapenem was also observed for strains with carbapenem MIC ≥16 mg/L. Conclusions: In patients receiving combination therapy for CR-KP BSI, the use of HD carbapenem seems to be associated with better outcome, even in the presence of high-level carbapenem resistance.

Published
2018

130. Stewardship antimicrobica nel neonato e nel piccolo lattante: Perché e come praticarla

Author

Berardi, Alberto, Ficara, Monica, Pietrella, Elisa, Boncompagni, Alessandra, Toffoli, Carlotta, Bianchini, Anastasia, Della Casa, Elisa, Spada, Caterina, Spaggiari, Eugenio, Ciccia, Matilde, Gargano, Giancarlo, Rizzo, Vittoria, Azzalli, Milena, Biasucci, Giacomo, Gambini, Lucia, Bolognesi, Serenella, Ferrari, Fabrizio, Memo, L., Nicolini, G., Ciccia, M., Sandri, F., Capretti, M. G., Dondi, A., Pasini, L., Ragni, L., Albarelli, A., Fiorini, V., Giugno, C., Lanzoni, P., Di Grande, E., Polese, A., China, M. C., Rizzo, V., Stella, M., Zucchini, A., Malaguti, L., Azzalli, M., Garani, G., Nasi, S., Bacchini, P., Fragni, G., Baldassarri, P., Pulvirenti, R. M., Valletta, E., Bidetti, M. L., Incerti, S. Storchi, Di Carlo, C., Lanzoni, A., Serra, L., Silvestrini, D., Berardi, A., Ferrari, F., Lugli, L., Venturelli, C., Sarti, M., Volta, A., Dodi, I., Magnani, C., Guidi, B., Biasucci, G., Chiarabini, R., De Paulis, N., Padrini, D., Riboni, S., Pedna, M. F., Casadio, L., Marchetti, F., Muratori, C., Piccinini, G., Renzelli, C., Amarri, S., Baroni, L., Carretto, E., Gargano, G., Pedori, S., Riva, M., Zuelli, C., Ancona, G., Bolognesi, S., Vergine, G., Viola, L., Chiossi, C., Pagano, R., Zanacca, C., Palmieri, R., PICCININI, GIANCARLO, BASTELLI, ANNALISA, AMBRETTI, SIMONE, CORVAGLIA, LUIGI TOMMASO, LANARI, MARCELLO, LAMA, CARLA, VENTUROLI, VINCENZO, ALESSANDRINI, CATERINA, FACCHINETTI, FABRIZIO, GAMBINI, LUIGI, BERTELLI, MICHELE, SAMBRI, VITTORIO, FORNACIARI, SILVIA, PAPA, IRENE, RIVI, CLAUDIA, BONVICINI, CARLOTTA, Berardi, Alberto, Ficara, Monica, Pietrella, Elisa, Boncompagni, Alessandra, Toffoli, Carlotta, Bianchini, Anastasia, Della Casa, Elisa, Spada, Caterina, Spaggiari, Eugenio, Ciccia, Matilde, Gargano, Giancarlo, Rizzo, Vittoria, Azzalli, Milena, Biasucci, Giacomo, Gambini, Lucia, Bolognesi, Serenella, Piccinini, Giancarlo, Ferrari, Fabrizio, Memo, L., Nicolini, G., Ciccia, M., Bastelli, A., Sandri, F., Ambretti, S., Capretti, M. G., Corvaglia, L., Dondi, A., Lanari, M., Pasini, L., Ragni, L., Albarelli, A., Fiorini, V., Giugno, C., Lanzoni, P., Di Grande, E., Polese, A., China, M. C., Rizzo, V., Stella, M., Zucchini, A., Malaguti, L., Azzalli, M., Garani, G., Lama, C., Nasi, S., Bacchini, P., Fragni, G., Baldassarri, P., Pulvirenti, R. M., Valletta, E., Venturoli, V., Alessandrini, C., Bidetti, M. L., Incerti, S. Storchi, Di Carlo, C., Lanzoni, A., Serra, L., Silvestrini, D., Berardi, A., Facchinetti, F., Ferrari, F., Lugli, L., Venturelli, C., Sarti, M., Volta, A., Dodi, I., Gambini, L., Magnani, C., Guidi, B., Bertelli, M., Biasucci, G., Chiarabini, R., De Paulis, N., Padrini, D., Riboni, S., Pedna, M. F., Sambri, V., Casadio, L., Marchetti, F., Muratori, C., Piccinini, G., Renzelli, C., Amarri, S., Baroni, L., Carretto, E., Fornaciari, S., Gargano, G., Pedori, S., Riva, M., Zuelli, C., Ancona, G., Bolognesi, S., Papa, I., Vergine, G., Viola, L., Chiossi, C., Pagano, R., Rivi, C., Zanacca, C., Bonvicini, C., and Palmieri, R.

Subjects
Sepsi, Pediatrics, Perinatology and Child Health, Antibiotic, Antimicrobial stewardship, Prophylaxi, Infection, Newborn
Abstract

Antimicrobial resistances are increasing worldwide, due to the misuse of antibiotic therapies in humans as well as in animals. It is expected that within a few decades multi-resistant pathogens will become the leading cause of death worldwide. The misuse of antibiotics in the neonatal period depends on the lack of predictive diagnostic tests and the peculiarity of symptoms of sepsis, which frequently are vague and unspecific at the time of presentation. Policies to prevent the emergence of antimicrobial resistances rely on a judicious use of antibiotics, on protocols and additional measures shared by health care providers. This document summarizes recent indications issued in the Emilia-Romagna subsequent to a review of the literature.

Published
2017

131. Effect of combination therapy containing a high-dose carbapenem on mortality in patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infection

Author

Giannella, Maddalena, primary, Trecarichi, Enrico Maria, additional, Giacobbe, Daniele Roberto, additional, De Rosa, Francesco Giuseppe, additional, Bassetti, Matteo, additional, Bartoloni, Alessandro, additional, Bartoletti, Michele, additional, Losito, Angela Raffaella, additional, del Bono, Valerio, additional, Corcione, Silvia, additional, Tedeschi, Sara, additional, Raffaelli, Francesca, additional, Saffioti, Carolina, additional, Spanu, Teresa, additional, Rossolini, Gian Maria, additional, Marchese, Anna, additional, Ambretti, Simone, additional, Cauda, Roberto, additional, Viscoli, Claudio, additional, Lewis, Russell Edward, additional, Viale, Pierluigi, additional, and Tumbarello, Mario, additional

Published
2018
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132. Klebsiella pneumoniae Bloodstream Infection

Author

Girometti, Nicolò, Lewis, Russell E., Giannella, Maddalena, Ambretti, Simone, Bartoletti, Michele, Tedeschi, Sara, Tumietto, Fabio, Cristini, Francesco, Trapani, Filippo, Gaibani, Paolo, and Viale, Pierluigi

Subjects
Male, Klebsiella pneumoniae, Treatment Outcome, Humans, Bacteremia, Female, Inappropriate Prescribing, bacterial infections and mycoses, Article, Aged, Anti-Bacterial Agents, Klebsiella Infections, Retrospective Studies
Abstract

Multidrug resistance associated with extended-spectrum beta-lactamase (ESBL) and Klebsiella pneumoniae carbapenemase (KPC) among K. pneumoniae is endemic in southern Europe. We retrospectively analyzed the impact of resistance on the appropriateness of empirical therapy and treatment outcomes of K. pneumoniae bloodstream infections (BSIs) during a 2-year period at a 1420-bed tertiary-care teaching hospital in northern Italy. We identified 217 unique patient BSIs, including 92 (42%) KPC-positive, 49 (23%) ESBL-positive, and 1 (0.5%) metallo-beta-lactamase-positive isolates. Adequate empirical therapy was administered in 74% of infections caused by non-ESBL non-KPC strains, versus 33% of ESBL and 23% of KPC cases (p

Published
2014

133. Infectious agents after liver transplant: etiology, timeline and patients’ cell-mediated immunity responses

Author

Chiereghin, Angela, primary, Petrisli, Evangelia, additional, Ravaioli, Matteo, additional, Morelli, Maria Cristina, additional, Turello, Gabriele, additional, Squarzoni, Diego, additional, Piccirilli, Giulia, additional, Ambretti, Simone, additional, Gabrielli, Liliana, additional, Pinna, Antonio Daniele, additional, Landini, Maria Paola, additional, and Lazzarotto, Tiziana, additional

Published
2016
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136. Antimicrobial resistance determinants in the oropharyngeal microbiome of ‘men having sex with men’ attending an sexually transmitted infection clinic

Author

Djusse, Marielle Ezekielle, Gaspari, Valeria, Morselli, Sara, Rapparini, Luca, Foschi, Claudio, Ambretti, Simone, Lazzarotto, Tiziana, Piraccini, Bianca Maria, and Marangoni, Antonella

Abstract

Background ‘Men having sex with men’ (MSM) represent a key population with a significant prevalence of pharyngeal Neisseria gonorrhoeae(NG) infections and a high rate of antimicrobial resistance genes in the pharyngeal microbiome. As NG can acquire antibiotic resistance genes from other commensal oropharyngeal bacteria, monitoring the prevalence of these resistance determinants is critical to curtail the spread of NG-resistant strains.Purpose and Research Design Here, we assessed the distribution of five resistance genes (pen (A), mtr (R), gyr (A), par (C), msr (D)) in the oropharynx of 164 MSM, attending an Outpatient clinic for STI screening.Results The most frequently detected resistance gene was msr (D)(88.4%), followed by gyr (A)(67.1%). The distribution of resistance genes was not influenced by pharyngeal gonorrhea nor by the HIV status, whereas a younger age was associated with mtr (R)presence (p= .008). Subjects using mouthwash exhibited significantly lower levels of mtr (R)(p= .0005). Smoking habit was associated with a higher prevalence of par (C)(p= .02). A noteworthy association was observed between the presence of msr (D)gene and the use of antibiotics (p= .014).Conclusions Our findings reveal an enrichment of antimicrobial resistance genes in the oropharynx of MSM. These insights could aid in the development of screening programs and antimicrobial stewardship initiatives targeting populations at heightened risk of pharyngeal gonorrhea.

Published
2024
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137. Reporting epidemiology of antibiotic resistance

Author

Ambretti, Simone, primary, Gagliotti, Carlo, additional, Luzzaro, Francesco, additional, Malacarne, Paolo, additional, Pan, Angelo, additional, Pieretti, Barbara, additional, Tascini, Carlo, additional, Sarti, Mario, additional, and CoSIAS-AMCLI, Comitato, additional

Published
2015
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138. Matrix-Assisted Laser Desorption Ionization–Time of Flight and Comparative Genomic Analysis of M-18 Group A Streptococcus Strains Associated with an Acute Rheumatic Fever Outbreak in Northeast Italy in 2012 and 2013

Author

Gaibani, Paolo, primary, Scaltriti, Erika, additional, Foschi, Claudio, additional, Baggio, Enrico, additional, Tamburini, Maria Vittoria, additional, Creti, Roberta, additional, Pascucci, Maria Grazia, additional, Fagioni, Marco, additional, Ambretti, Simone, additional, Comandatore, Francesco, additional, Pongolini, Stefano, additional, and Landini, Maria Paola, additional

Published
2015
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148. Quantitative immunohistochemistry and in situ hybridization with luminescence detection: a new potential diagnostic tool

Author

RODA, ALDO, GUARDIGLI, MASSIMO, MIRASOLI, MARA, AMBRETTI, SIMONE, VENTUROLI, SIMONA, MUSIANI, MONICA, CASANOVA, SILVIA, RODA, ENRICO, SZALAY AA, HILL PJ, KRICKA LJ, Roda A., Guardigli M., Mirasoli M., Ambretti S., Venturoli S., Musiani M., Casanova S., Roda E., and SZALAY, HILL, KRICKA, STANLEY

Abstract

The ultrasensitive localization and quantification of target molecules inside tissues and cells is fundamental both for the understanding of physiopathological events and for the early diagnosis of pathologies. Luminescence imaging techniques allow to perform multiplexed detection via the combination of different detection principles and/or labels, while chemiluminescence imaging of enzyme-labeled biospecific probes joins high sensitivity with easy and reliable evaluation of the amount of the probe, thus enabling for quantitative analysis of the target molecules. Here we report applications of luminescence immunohistochemistry (IHC) and in situ hybridization (ISH) procedures for the detection and quantification of target proteins and nucleic acids, including the quantitative detection of the Multidrug Resistance Protein 2 (MRP2) in liver biopsies, the evaluation of the progression risk of cervical intraepithelial neoplastic lesions by analysis of the p16INK4A neoplastic marker concentration profile, and the co-localization of mucosal human papillomaviruses (HPVs) and the HMB-45 melanoma antigen marker using a combined ISH/IHC method with fluorescence and chemiluminescence detection.

Published
2006

150. Implicazioni nella progressione della patologia cervicale

Author

VENTUROLI, SIMONA, CRICCA, MONICA, AMBRETTI, SIMONE, GALLINELLA, GIORGIO, GENTILOMI, GIOVANNA ANGELA, MUSIANI, MONICA, ZERBINI, MARIALUISA, S.Venturoli, M.Cricca, S.Ambretti, G.Gallinella, G.Gentilomi, M.Musiani, and M.Zerbini

Published
2005

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