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2. Evolution of minimally invasive techniques and surgical outcomes of ALPPS in Italy: a comprehensive trend analysis over 10 years from a national prospective registry

Author

Serenari M., Ratti F., Guglielmo N., Zanello M., Mocchegiani F., Lenzi J., Colledan M., Mazzaferro V., Cillo U., Ferrero A., Cescon M., Di Benedetto F., Massani M., Grazi G., Valle R. D., Vivarelli M., Ettorre G. M., Aldrighetti L., Jovine E., Serenari, M, Ratti, F, Guglielmo, N, Zanello, M, Mocchegiani, F, Lenzi, J, Colledan, M, Mazzaferro, V, Cillo, U, Ferrero, A, Cescon, M, Di Benedetto, F, Massani, M, Grazi, G, Valle, R, Vivarelli, M, Ettorre, G, Aldrighetti, L, and Jovine, E

Subjects
Hepatectomy, Laparoscopy, ALPPS, Minimally invasive, Outcome
Abstract

Background: Since 2012, Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has encountered several modifications of its original technique. The primary endpoint of this study was to analyze the trend of ALPPS in Italy over a 10-year period. The secondary endpoint was to evaluate factors affecting the risk of morbidity/mortality/post-hepatectomy liver failure (PHLF). Methods: Data of patients submitted to ALPPS between 2012 and 2021 were identified from the ALPPS Italian Registry and evaluation of time trends was performed. Results: From 2012 to 2021, a total of 268 ALPPS were performed within 17 centers. The number of ALPPS divided by the total number of liver resections performed by each center slightly declined (APC = -2.0%, p = 0.111). Minimally invasive (MI) approach significantly increased over the years (APC = + 49.5%, p = 0.002). According to multivariable analysis, MI completion of stage 1 was protective against 90-day mortality (OR = 0.05, p = 0.040) as well as enrollment within high-volume centers for liver surgery (OR = 0.32, p = 0.009). Use of interstage hepatobiliary scintigraphy (HBS) and biliary tumors were independent predictors of PHLF. Conclusions: This national study showed that use of ALPPS only slightly declined over the years with an increased use of MI techniques, leading to lower 90-day mortality. PHLF still remains an open issue.

Published
2023

5. Comparison between the difficulty of laparoscopic limited liver resections of tumors located in segment 7 versus segment 8

Author

Efanov, M., Salimgereeva, D., Alikhanov, R., A. G. R., Wu, Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Graduate School, Surgery, CCA - Cancer Treatment and Quality of Life, Efanov, M., Salimgereeva, D., Alikhanov, R., Wu, A. G. R., Geller, D., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., Belli, A., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Prieto, M., Vivarelli, M., Giuliante, F., Ruzzenente, A., Yong, C. -C., Fondevila, C., Rotellar, F., Choi, G. -H., Robless Campos, R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Herman, P., Di Benedetto, F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Levi Sandri, G. B., Cherqui, D., Scatton, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Han, H. -S., Abu Hilal, M., Soubrane, O., Fuks, D., Aldrighetti, L., Edwin, B., Goh, B. K. P., Chan, C. -Y., Syn, N., D'Silva, M., Lee, B., Lim, C., Nghia, P. P., Gastaca, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Lee, L. S., Jang, J. Y., Kojima, M., Kato, Y., Ghotbi, J., Kruger, J. A. P., Coelho, F. F., Lopez-Lopez, V., Valle, B. D., Robert, M. C. I., Mishima, K., Montalti, R., Giglio, M., Wang, H. -P., Pascual, F., Saleh, M., Kadam, P., Tang, C. -N., Ardito, F., Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Dogeas, E., Magistri, P., Mazzotta, A., Efanov, Mikhail, Salimgereeva, Diana, Alikhanov, Ruslan, Wu, Andrew G R, Geller, David, Cipriani, Federica, Aghayan, Davit L, Fretland, Asmund Avdem, Sijberden, Jasper, Belli, Andrea, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Prieto, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Fondevila, Constantino, Rotellar, Fernando, Choi, Gi-Hong, Robless Campos, Ricardo, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Lai, Eric, Chong, Charing C, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Herman, Paulo, Di Benedetto, Fabrizio, Kingham, T Peter, Liu, Rong, Long, Tran Cong Duy, Ferrero, Alessandro, Levi Sandri, Giovanni Battista, Cherqui, Daniel, Scatton, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Sugioka, Atsushi, Han, Ho-Seong, Abu Hilal, Mohammad, Soubrane, Olivier, Fuks, David, Aldrighetti, Luca, Edwin, Bjorn, and Goh, Brian K P

Subjects
hepatectomy, laparoscopy, liver resection, posterosuperior segments, risk score, Hepatology, Settore MED/18 - CHIRURGIA GENERALE, Surgery, posterosuperior segment
Abstract

Background: Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies have compared the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8. Methods: A post hoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed. 1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8. Results: A total of 2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay. Conclusion: Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.

Published
2022

6. Defining Global Benchmarks for Laparoscopic Liver Resections: An International Multicenter Study

Author

Goh, B. K. P., Han, H. -S., Chen, K. -H., Chua, D. W., Chan, C. -Y., Cipriani, F., Aghayan, D. L., Fretland, A. A., Sijberden, J., D'Silva, M., Siow, T. F., Kato, Y., Lim, C., Nghia, P. P., Herman, P., Marino, M. V., Mazzaferro, V., Chiow, A. K. H., Sucandy, I., Ivanecz, A., Choi, S. H., Lee, J. H., Gastaca, M., Vivarelli, M., Giuliante, Felice, Ruzzenente, A., Yong, C. -C., Yin, M., Chen, Z., Fondevila, C., Efanov, M., Rotellar, F., Choi, G. -H., Campos, R. R., Wang, X., Sutcliffe, R. P., Pratschke, J., Lai, E., Chong, C. C., D'Hondt, M., Monden, K., Lopez-Ben, S., Coelho, F. F., Kingham, T. P., Liu, R., Long, T. C. D., Ferrero, A., Sandri, G. B. L., Saleh, M., Cherqui, D., Scatton, O., Soubrane, O., Wakabayashi, G., Troisi, R. I., Cheung, T. -T., Sugioka, A., Hilal, M. A., Fuks, D., Edwin, B., Aldrighetti, L., Syn, N., Prieto, M., Schotte, H., De Meyere, C., Krenzien, F., Schmelzle, M., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Jang, J. Y., Kojima, M., Ghotbi, J., Kruger, J. A. P., Lopez-Lopez, V., Valle, B. D., Casellas I Robert, M., Mishima, K., Montalti, R., Giglio, M., Mazzotta, A., Lee, B., Wang, H. -P., Pascual, F., Kadam, P., Tang, C. -N., Yu, S., Ardito, Francesco, Vani, S., Giustizieri, U., Citterio, D., Mocchegiani, F., Ettorre, G. M., Colasanti, M., Guzman, Y., Goh, Brian K P, Han, Ho-Seong, Chen, Kuo-Hsin, Chua, Darren W, Chan, Chung-Yip, Cipriani, Federica, Aghayan, Davit L, Fretland, Asmund A, Sijberden, Jasper, D'Silva, Mizelle, Siow, Tiing Foong, Kato, Yutaro, Lim, Chetana, Nghia, Phan Phuoc, Herman, Paulo, Marino, Marco V, Mazzaferro, Vincenzo, Chiow, Adrian K H, Sucandy, Iswanto, Ivanecz, Arpad, Choi, Sung Hoon, Lee, Jae Hoon, Gastaca, Mikel, Vivarelli, Marco, Giuliante, Felice, Ruzzenente, Andrea, Yong, Chee-Chien, Yin, Mengqui, Chen, Zewei, Fondevila, Constantino, Efanov, Mikhail, Rotellar, Fernando, Choi, Gi-Hong, Campos, Ricardo R, Wang, Xiaoying, Sutcliffe, Robert P, Pratschke, Johann, Lai, Eric, Chong, Charing C, D'Hondt, Mathieu, Monden, Kazuteru, Lopez-Ben, Santiago, Coelho, Fabricio F, Kingham, Thomas Peter, Liu, Rong, Long, Tran Cong Duy, Ferrero, Alessandro, Sandri, Giovanni B Levi, Saleh, Mansour, Cherqui, Daniel, Scatton, Olivier, Soubrane, Olivier, Wakabayashi, Go, Troisi, Roberto I, Cheung, Tan-To, Sugioka, Atsushi, Hilal, Mohammad Abu, Fuks, David, Edwin, Bjørn, and Aldrighetti, Luca

Subjects
benchmark, hepatectomy, quality assessment, Settore MED/18 - CHIRURGIA GENERALE, minimally invasive, Surgery, laparoscopic liver resection, global
Abstract

To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR).There is limited published data to date on the best achievable outcomes after L-LR.This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs.There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively.This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the "best achievable" results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.

Published
2022

7. Evolution of Techniques and Surgical Outcomes of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in Italy: A Comprehensive Trend Analysis over 9 Years

Author

Serenari, M., primary, Ratti, F., additional, Zanello, M., additional, Guglielmo, N., additional, Mocchegiani, F., additional, Di Benedetto, F., additional, Colledan, M., additional, Mazzaferro, V., additional, Cescon, M., additional, Ferrero, A., additional, Gringeri, E., additional, Massani, M., additional, Dalla Valle, R., additional, Grazi, G., additional, Nardo, B., additional, Zanus, G., additional, Romano, F., additional, Masetti, M., additional, Cillo, U., additional, Vivarelli, M., additional, Ettorre, G.M., additional, Aldrighetti, L., additional, and Jovine, E., additional

Published
2022
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8. Outcome of Major Hepatectomy in Cirrhotic Patients: Does Surgical Approach Matter? A Propensity Score Matched Analysis

Author

Cacciaguerra, A. Benedetti, primary, Gorgec, B., additional, Lanari, J., additional, Cipriani, F., additional, Russolillo, N., additional, Mocchegiani, F., additional, Alseidi, A., additional, Ruzzenente, A., additional, Edwin, B., additional, D’Hondt, M., additional, Besselink, M., additional, Giuliante, F., additional, Fuks, D., additional, Rotellar, F., additional, López-Ben, S., additional, Ferrero, A., additional, Aldrighetti, L., additional, Cillo, U., additional, Vivarelli, M., additional, and Hilal, M. Abu, additional

Published
2022
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13. Liver transplantation with fatty graft: how far can we push the steatosis limit?

Author

Conte G, Nicolini D, Palmieri M, Mocchegiani F, Pinelli D, Dalla Bona E, Romano M, Coletta M, Frosio F, Colledan M, Vivarelli M, Vecchi A, Conte, G, Nicolini, D, Palmieri, M, Mocchegiani, F, Pinelli, D, Dalla Bona, E, Romano, M, Coletta, M, Frosio, F, Colledan, M, Vivarelli, M, and Vecchi, A

Subjects
Liver transplantation
Published
2019

14. Benefits of Laparoscopy for Major Liver Resection in Cirrhotic Patients: Time for Pushing Indications Beyond the Limits? A Propensity Score Matched Analysis

Author

Benedetti Cacciaguerra, A., primary, Görgec, B., additional, Lanari, J., additional, Cipriani, F., additional, Russolillo, N., additional, Mocchegiani, F., additional, Zimmitti, G., additional, Alseidi, A., additional, Ruzzenente, A., additional, Edwin, B., additional, D’Hondt, M., additional, Besselink, M., additional, Giuliante, F., additional, Fuks, D., additional, Rotellar, F., additional, López-Ben, S., additional, Vivarelli, M., additional, Ferrero, A., additional, Aldrighetti, L., additional, Cillo, U., additional, and Abu Hilal, M., additional

Published
2021
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15. Minimally-invasive Stage 1 to Protect against the Risk of Liver Failure in ALPPS for Hepatocellular Carcinoma

Author

Serenari, M., primary, Ratti, F., additional, Zanello, M., additional, Guglielmo, N., additional, Mocchegiani, F., additional, Di Benedetto, F., additional, Nardo, B., additional, Mazzaferro, V., additional, Cillo, U., additional, Massani, M., additional, Colledan, M., additional, Dalla Valle, R., additional, Cescon, M., additional, Vivarelli, M., additional, Ettorre, G.M., additional, Aldrighetti, L., additional, and Jovine, E., additional

Published
2021
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16. Minimally invasive surgery for CRLM located in the postero-superior segments. The advantages of preoperative ICG injection in tumour detection during liver transection

Author

Mocchegiani, F., primary, Benedetti Cacciaguerra, A., additional, Dalla Bona, E., additional, Agostini, A., additional, Coletta, M., additional, Borgheresi, A., additional, Rossi, R., additional, Conte, G., additional, Nicolini, D., additional, Giovagnoni, A., additional, and Vivarelli, M., additional

Published
2021
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21. Textbook Outcome in Laparoscopic and Open Liver Surgery (TOLS): An International Multicenter Analysis of 8188 Patients

Author

Görgec, B., primary, Benedetti Cacciaguerra, A., additional, Lanari, J., additional, Russolillo, N., additional, Cipriani, F., additional, Aghayan, D., additional, Zimmitti, G., additional, Efanov, M., additional, Alseidi, A., additional, Mocchegiani, F., additional, Giuliante, F., additional, Ruzzenente, A., additional, Rotellar, F., additional, Fuks, D., additional, D’Hondt, M., additional, Vivarelli, M., additional, Edwin, B., additional, Aldrighetti, L.A., additional, Ferrero, A., additional, Cillo, U., additional, Besselink, M.G., additional, and Abu Hilal, M., additional

Published
2021
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25. Administration of protegrin peptide IB-367 to prevent endotoxin induced mortality in bile duct ligated rats. (Liver)

Author

Giacometti, A., Cirioni, O., Ghiselli, R., Mocchegiani, F., D'Amato, G., Del Prete, M. Simona, Orlando, F., Kamysz, W., Lukasiak, J., Saba, V., and Scalise, G.

Subjects
Jaundice -- Drug therapy, Endotoxins -- Physiological aspects, Peptides -- Evaluation -- Dosage and administration -- Physiological aspects, Health, Drug therapy, Evaluation, Physiological aspects, Dosage and administration
Abstract

Background: Postoperative morbidity in patients with obstructive jaundice remains high because of increased susceptibility to endotoxin and the inflammatory cascade. Aims: An experimental study was designed to investigate the efficacy [...]

Published
2003

32. Efficacy of the amphibian peptide distinctin in a neutropenic mouse model of staphylococcal sepsis

Author

Cirioni O, Ghiselli R, Orlando F, Silvestri C, De Luca S, Salzano AM, Mocchegiani F, Saba V, Scalise G, Scaloni A, and Giacometti A.

Abstract

OBJECTIVE: To investigate the efficacy of distinctin in a neutropenic mouse model of staphylococcal sepsis. DESIGN: Prospective, randomized, and controlled animal study. SETTING: Research laboratory in a University Hospital. SUBJECTS: BALB/c male mice. INTERVENTIONS: Mice were rendered neutropenic by injecting cyclophosphamide (200 mg/kg of body weight/day) on days -4 and -2 preinfection. Infection was induced at time 0 by intraperitoneal injection of 1 x 10(9) colony forming units of the staphylococcal strain. For each model, all animals were randomized to receive intravenous isotonic sodium chloride solution, 1 mg/kg distinctin, and 10 mg/kg imipenem, 10 mg/kg vancomycin, 10 mg/kg teicoplanin or 10 mg/kg linezolid alone, or combined with 1 mg/kg distinctin. MEASUREMENTS AND MAIN RESULTS: Lethality, bacterial growth in blood and peritoneum, spleen, liver, and mesenteric lymph nodes. RESULTS: All combined regimen showed lower lethality rates than singly treated-groups. Distinctin plus vancomycin or teicoplanin exerted the lowest lethality rate. All regimens were significantly superior to controls at reducing blood, spleen, peritoneum, liver and mesenteric lymph node complex bacterial burdens, whereas all combined treated groups were higher effective than singly treated groups. CONCLUSION: Our data indicate that distinctin alone or combined with other antibiotics may be useful in treating severe staphylococcal infections.

Published
2008

34. Distinctin improves the efficacies of glycopeptides and betalactams against staphylococcal biofilm in an experimental model of central venous catheter infection

Author

Giacometti A, Cirioni O, Ghiselli R, Orlando F, Silvestri C, Renzone G, Testa I, Mocchegiani F, Della Vittoria A, Saba V, Scaloni A, and Scalise G.

Abstract

The ability of microorganisms to adhere to medical implants is a problem of high visibility and has been focused in numerous investigations. To assess the efficacy of distinctin and conventional antibiotics in the treatment of central venous catheter in vitro and in vivo studies were performed. The in vitro susceptibility assay was performed against S. aureus biofilms developed on 96-well polystyrene tissue culture plates. Efficacy studies were performed in a rat model of CVC infection. Twenty-four hours after implantation, the catheters were filled with distinctin. Thirty minutes later, rats were challenged via the CVC with S. aureus. Administration of antibiotics into the CVC at a concentration equal to the MBC for adherent cells, or at 1024 microg/mL began 24 h later. The killing activities of all antibiotics against adherent bacteria were at least four- to eightfold lower than against freely growing cells. When antibiotics were used in distinctin pretreated wells, they showed a significant increase of activity. The in vivo studies showed that when CVCs were pretreated with distinctin biofilm bacterial load was further decreased to 10(1) CFU/mL and bacteremia was not detected. Distinctin displays potential as an adjunctive agent to antibiotics in the treatment of CVC-related infections. (c) 2006 Wiley Periodicals, Inc.

Published
2007

35. LL-37 protects rats against lethal Gram-negative sepsis

Author

Cirioni, O., Giacometti, A., Ghiselli, R., Bergnach, C., Orlando, F., Silvestri, C., Mocchegiani, F., Licci, A., Skerlavaj, B., Rocchi, MARCO BRUNO LUIGI, Saba, V., Zanetti, M., and Scalise, G.

Published
2006

43. F-29 Transarterial chemoembolization (TACE) with doxorubicin-eluting-bead versus conventional TACE in patients listed for liver transplantation: impact on tumor necrosis and post transplant disease-free survival

Author

Nicolini, D., primary, Baroni, G. Svegliati, additional, Candelari, R., additional, Faraci, M.G., additional, Gentili, M., additional, Vincenzi, P., additional, Martorelli, G., additional, Coletta, M., additional, Federici, A., additional, Mincarelli, C., additional, Mandolesi, A., additional, Mocchegiani, F., additional, Vecchi, A., additional, Vivarelli, M., additional, and Risaliti, A., additional

Published
2012
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44. Activity and Expression of Nitric Oxide Synthase in Rat Bladder after Sacral Neuromodulation

Author

Minardi, D., primary, Ghiselli, R., additional, Lucarini, G., additional, Mocchegiani, F., additional, Filosa, A., additional, Zizzi, A., additional, Simonetti, O., additional, Orlando, F., additional, Pelliccioni, G., additional, Parri, G., additional, Saba, V., additional, Muzio, L. Lo, additional, Biagini, G., additional, Montironi, R., additional, and Muzzonigro, G., additional

Published
2008
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50. RNAIII-inhibiting peptide significantly reduces bacterial load and enhances the effect of antibiotics in the treatment of central venous catheter-associated Staphylococcus aureus infections.

Author

Cirioni O, Giacometti A, Ghiselli R, Dell'Acqua G, Orlando F, Mocchegiani F, Silvestri C, Licci A, Saba V, Scalise G, and Balaban N

Abstract

BACKGROUND: Medical devices used in clinical practice are often associated with biofilm-associated staphylococcal infections. METHODS: An in vitro antibiotic susceptibility assay of Staphylococcus aureus biofilms using 96-well polystyrene tissue-culture plates was performed to test the effects of RNAIII-inhibiting peptide (RIP), ciprofloxacin, imipenem, and vancomycin. Efficacy studies were performed using a rat model of central venous catheter (CVC)-associated infection. Twenty-four hours after implantation, the catheters were filled with RIP (1 mg/mL). Thirty minutes later, rats were challenged, via the CVC, with 1.0 x 10(6) cfu of S. aureus strain Smith diffuse. The antibiotic-lock technique was begun 24 h later. RESULTS: Minimum inhibitory concentrations of antibiotics in biofilms were at least 4-fold higher than those against the freely growing planktonic cells. When they were first treated with RIP, the cells in biofilms became as susceptible to antibiotics as did planktonic cells. These data were confirmed by the in vivo studies. In particular, when CVCs were treated with both RIP and antibiotics, the biofilm bacterial load was further reduced to 1 x 10(1) cfu/mL, and bacteremia was not detected, suggesting that there was 100% elimination of bacteremia and a 6 log10 reduction in biofilm bacterial load. CONCLUSION: RIP significantly reduces bacterial load and enhances the effect of antibiotics in the treatment of CVC-associated S. aureus infections. Copyright © 2006 Infectious Diseases Society of America [ABSTRACT FROM AUTHOR]

Published
2006
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