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1. 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

2. 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

4. Antimicrobial stewardship in newborns and young infants: Why and how to do it,Stewardship antimicrobica nel neonato e nel piccolo lattante: Perché e come praticarla

Author

Berardi, A., Ficara, M., Pietrella, E., Boncompagni, A., Toffoli, C., Bianchini, A., Della Casa, E., Spada, C., Spaggiari, E., Ciccia, M., Gargano, G., Rizzo, V., Azzalli, M., Biasucci, G., Gambini, L., Bolognesi, S., Piccinini, G., Ferrari, F., Memo, L., Nicolini, G., 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., Stella, M., Zucchini, A., Malaguti, L., 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. S., Di Carlo, C., Lanzoni, A., Serra, L., Silvestrini, D., Facchinetti, F., licia lugli, Venturelli, C., Sarti, M., Volta, A., Dodi, I., Magnani, C., Guidi, B., Bertelli, M., Chiarabini, R., Paulis, N., Padrini, D., Riboni, S., Pedna, M. F., Sambri, V., Casadio, L., Marchetti, F., Muratori, C., Renzelli, C., Amarri, S., Baroni, L., Carretto, E., Fornaciari, S., Pedori, S., Riva, M., Zuelli, C., Ancona, G., Papa, I., Vergine, G., Viola, L., Chiossi, C., Pagano, R., Rivi, C., Zanacca, C., Bonvicini, C., and Palmieri, R.

5. Neonatal bacterial meningitis

Author

Berardi, A., Lugli, L., Rossi, C., China, M. C., Vellani, G., Contiero, R., Calanca, F., Camerlo, F., Casula, F., Di Carlo, C., Rossi, M. R., Chiarabini, R., Ferrari, M., Minniti, S., Venturelli, C., Silvestrini, D., ICILIO DODI, Zucchini, A., Ferrari, F., and Della Regione Emilia Romagna, Infezioni Da Streptococco B.

Subjects
Italy, Infant, Newborn, Humans, Multicenter Studies as Topic, meningitis, Infant, Premature, Diseases, Prospective Studies, Age of Onset, Spinal Puncture, Anti-Bacterial Agents, Cerebrospinal Fluid, Meningitis, Bacterial
Abstract

Neonatal bacterial meningitis (NM) continues to be a serious disease with an unchanging rate of adverse outcome of 20-60%, despite a worldwide decline in mortality. The 3 major pathogens in developed countries are: Group B streptococcus, gram negative rods and Lysteria monocytogenes. Signs and symptoms of NM may be subtle, unspecific, vague, atypical or absent. In order to exclude NM, all infants with proven or suspected sepsis should undergo lumbar puncture. Positive culture of cerebrospinal fluid may be the only way to diagnose NM and to identify the pathogen, as CSF parameters Smay be normal at early stages and NM may occur frequently (up to 30% of cases) in the absence of bacteraemia. When NM is suspected, treatment must be aggressive, as the goal is to achieve bactericidal concentration of antibiotics and to sterilize CSF as soon as possible. Antibiotics should be administered intravenously, at the highest clinically validated doses. Empiric antibiotic treatment should include agents active against all main pathogens; currently the recommended empiric treatment of NM is ampicillin, plus an aminoglycoside and a third-generation cephalosporn. Therapy should be reassessed after cultures and antibiotic susceptibility is available. Prevention of neonatal sepsis, early recognition of infants at risk, prompt treatment and future adjunctive therapies will improve prognosis. Finally, we present the first preliminary Italian data on GBS meningitis. Data are obtained from an area-based study conducted In Emilia-Romagna during 2003 to 2009.

6. Antimicrobial stewardship in newborns and young infants: Why and how to do it,Stewardship antimicrobica nel neonato e nel piccolo lattante: Perché e come praticarla

Author

Berardi, A., Ficara, M., Pietrella, E., Boncompagni, A., Toffoli, C., Bianchini, A., Della Casa, E., Spada, C., Spaggiari, E., Ciccia, M., Gargano, G., Rizzo, V., Azzalli, M., Biasucci, G., Gambini, L., Bolognesi, S., Piccinini, G., Ferrari, F., Memo, L., Nicolini, G., 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., Stella, M., Zucchini, A., Malaguti, L., 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. S., Di Carlo, C., Lanzoni, A., Serra, L., Silvestrini, D., Facchinetti, F., Lugli, L., Venturelli, C., Sarti, M., Volta, A., Dodi, I., Magnani, C., Guidi, B., Bertelli, M., Chiarabini, R., Paulis, N., Padrini, D., Riboni, S., Pedna, M. F., Sambri, V., Casadio, L., Marchetti, F., Muratori, C., Renzelli, C., Amarri, S., Baroni, L., Edoardo Carretto, Fornaciari, S., Pedori, S., Riva, M., Zuelli, C., Ancona, G., Papa, I., Vergine, G., Viola, L., Chiossi, C., Pagano, R., Rivi, C., Zanacca, C., Bonvicini, C., and Palmieri, R.

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

Author

Berardi A, Spada C, Creti R, Ambretti S, Chiarabini R, Barozzi A, Pagano R, Sarti M, Pedna MF, Fornaciari S, Azzalli M, Dodi I, Bacchi Reggiani ML, Lanzoni A, Vaccina E, Iughetti L, and Lucaccioni L

Subjects
Case-Control Studies, Female, Humans, Incidence, Infant, Newborn, Italy epidemiology, Pregnancy, Pregnancy Complications, Infectious diagnosis, Prenatal Diagnosis methods, Risk Factors, Streptococcal Infections epidemiology, Streptococcus agalactiae isolation & purification, Antibiotic Prophylaxis methods, Infectious Disease Transmission, Vertical prevention & control, Streptococcal Infections prevention & control, beta-Lactams administration & dosage
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.

Published
2020
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8. Neonatal bacterial meningitis.

Author

Berardi A, Lugli L, Rossi C, China MC, Vellani G, Contiero R, Calanca F, Camerlo F, Casula F, Di Carlo C, Rossi MR, Chiarabini R, Ferrari M, Minniti S, Venturelli C, Silvestrini D, Dodi I, Zucchini A, and Ferrari F

Subjects
Age of Onset, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Cerebrospinal Fluid microbiology, Humans, Infant, Newborn, Infant, Premature, Diseases epidemiology, Italy epidemiology, Multicenter Studies as Topic statistics & numerical data, Prospective Studies, Spinal Puncture, Meningitis, Bacterial cerebrospinal fluid, Meningitis, Bacterial diagnosis, Meningitis, Bacterial drug therapy, Meningitis, Bacterial epidemiology, Meningitis, Bacterial microbiology
Abstract

Neonatal bacterial meningitis (NM) continues to be a serious disease with an unchanging rate of adverse outcome of 20-60%, despite a worldwide decline in mortality. The 3 major pathogens in developed countries are: Group B streptococcus, gram negative rods and Lysteria monocytogenes. Signs and symptoms of NM may be subtle, unspecific, vague, atypical or absent. In order to exclude NM, all infants with proven or suspected sepsis should undergo lumbar puncture. Positive culture of cerebrospinal fluid may be the only way to diagnose NM and to identify the pathogen, as CSF parameters Smay be normal at early stages and NM may occur frequently (up to 30% of cases) in the absence of bacteraemia. When NM is suspected, treatment must be aggressive, as the goal is to achieve bactericidal concentration of antibiotics and to sterilize CSF as soon as possible. Antibiotics should be administered intravenously, at the highest clinically validated doses. Empiric antibiotic treatment should include agents active against all main pathogens; currently the recommended empiric treatment of NM is ampicillin, plus an aminoglycoside and a third-generation cephalosporn. Therapy should be reassessed after cultures and antibiotic susceptibility is available. Prevention of neonatal sepsis, early recognition of infants at risk, prompt treatment and future adjunctive therapies will improve prognosis. Finally, we present the first preliminary Italian data on GBS meningitis. Data are obtained from an area-based study conducted In Emilia-Romagna during 2003 to 2009.

Published
2010

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