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3. 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

4. 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

5. 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.

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

Author

Sartelli M, Pagani L, Iannazzo S, Moro ML, Viale P, Pan A, Ansaloni L, Coccolini F, D'Errico MM, Agreiter I, Amadio Nespola G, Barchiesi F, Benigni V, Binazzi R, Cappanera S, Chiodera A, Cola V, Corsi D, Cortese F, Crapis M, Cristini F, D'Arpino A, De Simone B, Di Bella S, Di Marzo F, Donati A, Elisei D, Fantoni M, Ferrari A, Foghetti D, Francisci D, Gattuso G, Giacometti A, Gesuelli GC, Marmorale C, Martini E, Meledandri M, Murri R, Padrini D, Palmieri D, Pauri P, Rebagliati C, Ricchizzi E, Sambri V, Schimizzi AM, Siquini W, Scoccia L, Scoppettuolo G, Sganga G, Storti N, Tavio M, Toccafondi G, Tumietto F, Viaggi B, Vivarelli M, Tranà C, Raso M, Labricciosa FM, Dhingra S, and Catena F

Subjects
Humans, Anti-Bacterial Agents therapeutic use, Antimicrobial Stewardship, Infection Control standards, Surgical Wound Infection prevention & control
Abstract

Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.

Published
2020
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8. Combination of a drug targeting the cell with a drug targeting the virus controls human immunodeficiency virus type 1 resistance.

Author

Lori F, Malykh AG, Foli A, Maserati R, De Antoni A, Minoli L, Padrini D, Degli Antoni A, Barchi E, Jessen H, Wainberg MA, Gallo RC, and Lisziewicz J

Subjects
Acquired Immunodeficiency Syndrome blood, Anti-HIV Agents therapeutic use, CD4 Lymphocyte Count, Didanosine therapeutic use, Dose-Response Relationship, Drug, Evaluation Studies as Topic, HIV-1 genetics, Humans, Hydroxyurea administration & dosage, Hydroxyurea therapeutic use, Leukocytes, Mononuclear drug effects, Leukocytes, Mononuclear virology, Time Factors, Viremia drug therapy, Viremia metabolism, Virus Replication drug effects, Acquired Immunodeficiency Syndrome drug therapy, Cells drug effects, Cells virology, Drug Therapy, Combination, HIV-1 drug effects
Abstract

Combinations of drugs targeting viral proteins have been used to limit or control drug resistance, which is the most important cause of treatment failure in HIV-1-infected individuals. We suggest an alternative approach, namely to target cellular proteins, which are less prone to mutations than viral proteins. Here we show that simultaneous inhibition of a cellular protein (by hydroxyurea) and a viral protein (by ddI) produces a consistent and sustained suppression of HIV-1 for as long as 40 weeks in the absence of virus rebound. We identified the mechanism to explain this lack of rebound: although the combination of the two drugs did not prevent the emergence of mutant viral strains resistant to didanosine (ddI) in these patients, the mutants were still sensitive to standard doses of ddI in the presence of hydroxyurea. These in vivo results were consistent with our in vitro observations: HIV-1 molecular clones resistant to ddI were rendered sensitive to this drug (at concentrations routinely achievable in vivo) after addition of hydroxyurea. This phenomenon can be explained by the observation that hydroxyurea decreases the level of dATP, the cellular competitor of ddI. A low level of dATP favors the incorporation of ddI, even if the viral reverse transcriptase is resistant to this nucleoside analog. This is a novel mechanism of control of resistance and it explains the efficacy of a treatment that is well tolerated, simple, and inexpensive.

Published
1997
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9. [Isolated renal aspergillosis in AIDS. A case report].

Author

Carella E, Burgazzi E, Conti R, Sacchini D, Padrini D, and Ratti G

Subjects
AIDS-Related Opportunistic Infections microbiology, Adult, Aspergillosis microbiology, Humans, Kidney diagnostic imaging, Kidney microbiology, Kidney Diseases microbiology, Male, Tomography, X-Ray Computed, Ultrasonography, AIDS-Related Opportunistic Infections diagnostic imaging, Aspergillosis diagnostic imaging, Aspergillus fumigatus isolation & purification, Kidney Diseases diagnostic imaging
Published
1994

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