Research Interests: Chemistry, Biology, Macrophages, Medicine, Immunopharmacology, and 15 moreGrowth, Cell line, Humans, Bacteria, Endoplasmic Reticulum, ER stress, Immunomodulation, Naphthoquinones, CD, Major histocompatibility complex, Naphthoquinone, Immunoglobulins, Mycobacterium avium, Interleukin, and Interferon gamma
Research Interests:
Introduzione A partire dal 2011 \ue8 stato registrato un forte incremento degli isolamenti di A. baumannii resistente ai carbapenemi negli ospedali dell'Azienda Ospedaliero-Universitaria di Trieste. Questo lavoro ha avuto lo scopo di... more
Introduzione A partire dal 2011 \ue8 stato registrato un forte incremento degli isolamenti di A. baumannii resistente ai carbapenemi negli ospedali dell'Azienda Ospedaliero-Universitaria di Trieste. Questo lavoro ha avuto lo scopo di verificare l\u2019appartenenza degli isolati ad un unico clone epidemico, di individuarne il meccanismo di resistenza ai carbapenemi e di studiare i fattori che ne hanno favorito la diffusione. Metodi Identificazione e antibiogramma degli isolati sono stati eseguiti con il sistema Vitek 2 e le MIC estese sono state valutate con il test di microdiluizione in brodo. La tipizzazione \ue8 stata effettuata mediante macrorestrizione del DNA genomico con ApaI. I geni delle beta-lattamasi e delle 16S rRNA metilasi sono stati cercati mediante PCR. Il consumo di antibiotici sistemici \ue8 stato valutato in dose definita giornaliera (DDD) x 100 giornate di degenza. Risultati la tipizzazione ha confermato la diffusione di un ceppo di A. baumannii appartenente al complesso clonale 2. Tutti gli isolati ad esso correlati erano multiresistenti, ma conservavano la suscettibilit\ue0 alla colistina e MIC 642 per la tigeciclina. La resistenza ai carbapenemi (MIC di imipenem=16-32 \u3bcg/ml) era riconducibile alla presenza del gene blaOXA-23, compreso tra due copie con orientamento opposto della sequenza d\u2019inserzione ISAba1. L\u2019alto livello di resistenza agli aminoglicosidici ha indotto a sospettare la presenza di una 16S rRNA metilasi, il cui determinante (armA) \ue8 stato poi individuato mediante PCR. Il confronto con isolati resistenti ai carbapenemi, raccolti nei cinque anni antecedenti al periodo di studio, ha dimostrato che il ceppo responsabile dell\u2019epidemia \ue8 stato isolato per la prima volta nell\u2019ospedale all\u2019inizio del 2009 ed ha causato un piccolo numero di infezioni in vari reparti fino alla primavera 2011. La diffusione massiccia ha avuto luogo tra giugno ed agosto 2011, a partire da un reparto dell\u2019area di medicina. Il coinvolgimento di altri reparti \ue8 correlabile, almeno nelle fasi iniziali dell\u2019epidemia, con il trasferimento di pazienti infetti o colonizzati. Tra il 2008 ed il 2011, il consumo di antibiotici sistemici negli ospedali dell\u2019Azienda \ue8 aumentato del 16% e quello di carbapenemi del 73%. Gli incremento hanno interessato soprattutto i reparti dell\u2019area medica. Conclusioni Lo studio dimostra la diffusione nell\u2019ospedale triestino di un ceppo di A. baumannii, portatore del gene blaOXA-23 e di armA, gi\ue0 segnalato in precedenza nel Nord Europa e in un ospedale del Nord Italia
Research Interests:
Research Interests: Microbiology, Medical Microbiology, Biology, Medicine, Catheterization, and 15 moreBiological Sciences, Humans, Male, Aged, Enterococcus faecalis, Linezolid, Antibiotic, Methicillin Resistant Staphylococcus Aureus, Catheter, Oxazolidinones, Acetamides, Medical, Multiple Drug Resistance, Medical and Health Sciences, and Staphylococcal infections
An alarming increase of vancomycin-resistant Enterococcus faecium (VREfm) isolates was detected in an Italian referral hospital subjected to policies of infection control validated by the Joint Commission International. Analysis of the... more
An alarming increase of vancomycin-resistant Enterococcus faecium (VREfm) isolates was detected in an Italian referral hospital subjected to policies of infection control validated by the Joint Commission International. Analysis of the population structure of 122 consecutive, nonreplicate VREfm isolates collected over an 18-month period identified a single major clone that spread around the whole hospital, rapidly establishing an endemic state. It belonged to sequence type (ST) 17 and showed a highly multidrug-resistant phenotype, being resistant to all antimicrobial classes for the carriage of several resistance determinants. Furthermore, some strains with decreased susceptibility to daptomycin were detected. Eighteen out of the 122 isolates did not group in the major clone. They showed a low spreading potential inside the hospital wards, even if most of them displayed a multidrug-resistant phenotype and belonged to a hospital-adapted lineage. Causes that led to the VREfm endemic state have not been fully elucidated. However, it is conceivable that the increase in systemic antibiotic consumption and the use of selective digestive tract decontamination, including vancomycin in critically ill patients during the period before 2014, may have played a role in the ST17 clone dissemination, but additional traits conferring high fitness in hospital environment cannot be excluded.
Research Interests:
This study describes the dissemination of a carbapenem-resistant Acinetobacter baumannii (CRAB) strain in a university hospital in Northeast Italy. Characterization of the outbreak strain was combined with a retrospective analysis of all... more
This study describes the dissemination of a carbapenem-resistant Acinetobacter baumannii (CRAB) strain in a university hospital in Northeast Italy. Characterization of the outbreak strain was combined with a retrospective analysis of all CRAB isolates collected in the same hospital during the 5 years preceding the outbreak, with the aim of elucidating the origin of the epidemic spread. The outbreak strain was shown to belong to the International Clone II and carry the blaOXA-23 gene, flanked by two ISAba1 sequences in opposite orientation (Tn2006 arrangement). The epidemic clone harbored also the blaOXA-66 allele of the carbapenemase intrinsic to A. baumannii, the determinant of ArmA 16S rRNA methylase and a class 1 integron, with the aacA4, catB8, and aadA1 cassette array. Genotype analysis, performed by macrorestriction analysis and VRBA, revealed that isolates related to outbreak strain had been sporadically collected from inpatients in the 2 years preceding outbreak start. Carriage of blaOXA-66, armA, and the integron further supported relatedness of these isolates to the outbreak clone. Outbreak initially involved three medical wards, typically hosting elderly patients with a history of prolonged hospitalization. The study highlights the need to adopt strict infection control measures also when CRAB isolation appears to be a sporadic event.
Research Interests: Microbiology, Biology, Medicine, Molecular Epidemiology, Italy, and 15 moreBiological Sciences, Disease Outbreaks, Humans, Integron, Integrons, ARMA, Carbapenems, Acinetobacter baumannii, Acinetobacter Infections, Beta Lactamases, microbial drug resistance, Multilocus sequence typing, Carriage, alleles, and Medical and Health Sciences
Research Interests:
Research Interests:
The distribution of phenotypes of the group specific component (Gc) was examined in 85 AIDS patients and in 40 couples, each consisting of one HIV seropositive patient and one seronegative sexual partner. Phenotype and allele frequencies... more
The distribution of phenotypes of the group specific component (Gc) was examined in 85 AIDS patients and in 40 couples, each consisting of one HIV seropositive patient and one seronegative sexual partner. Phenotype and allele frequencies in these groups did not differ ...
Research Interests:
Research Interests:
Back pain and spine tenderness over the involved spine segment are common clinical findings of a number of relative benign conditions. However, back pain may be the presenting symptom of vertebral metastases in patients with systemic... more
Back pain and spine tenderness over the involved spine segment are common clinical findings of a number of relative benign conditions. However, back pain may be the presenting symptom of vertebral metastases in patients with systemic cancer, including hepatocellular carcinoma, a not uncommon complication in HCV-HIV infected patients. We describe a case of a 51-year-old intravenous drug user with HIV and HCV co-infection who developed dorsal spondylodiscitis due to Pseudomonas aeruginosa, which improved following antibiotic therapy. Three months after the end of therapy, the patient referred recurrence of back pain. The MRI showed different vertebral lesions of the dorsal spine and costal arch which turned out to be hepatocellular carcinoma metastasis at the histological examination. The patient had never been treated with the interferon-ribavirine combination therapy because of a major depressive syndrome. Interferon-free regimens are urgently required for HIV-HCV coinfected patients, especially when interferon-based regimens are contraindicated.
Research Interests:
Research Interests:
Increased susceptibility to bacterial recurrent infection is characteristically associated with impaired B cells function but also with a defective PMN function. We studied PMN CT in 15 HIV positive drug addicts patients with persistent... more
Increased susceptibility to bacterial recurrent infection is characteristically associated with impaired B cells function but also with a defective PMN function. We studied PMN CT in 15 HIV positive drug addicts patients with persistent generalized lymphoadenopathy (PGL), in 15 symptom free HIV negative drug addicts (SFDA) and in 15 healthy blood donors to evaluate influence of HIV infection on PMN functions. CT of patients with PGL was reduced to 78% (p < 0.0001) and 75% (p < 0.00001) of CT in SFDA patients and healthy blood donors, respectively. We conclude that HIV infection causes defective PMNL CT and then it can increase susceptibility to bacterial recurrent infections in these patients.
Research Interests: Immunology, Adolescent, Medicine, Humans, Female, and 7 morePubmed, Male, Chemotaxis, Neutrophils, Adult, Monocytes, and Drug Addict
Research Interests:
Research Interests:
Research Interests:
Mycobacterium chelonae belongs to a rapidly growing group of nontuberculous mycobacteria (NTM). These organisms are environmental saprophytes that can cause infection in humans. Nontuberculous mycobacteria infections have been described... more
Mycobacterium chelonae belongs to a rapidly growing group of nontuberculous mycobacteria (NTM). These organisms are environmental saprophytes that can cause infection in humans. Nontuberculous mycobacteria infections have been described in immunosuppressed patients (eg, in the setting of AIDS or immunotherapy following solid organ transplantation) as well as in immunocompetent patients with certain predisposing factors (eg, recent history of a traumatic wound, recent drug injections, impaired cell-mediated immunity). Due to the increasing prevalence of immune deficiency disorders as well as the rising number of cosmetic procedures performed on healthy individuals, NTM may become a frequent cause of serious morbidity, causing chronic infections of the skin, soft tissue, and lungs. We report a case of M chelonae infection in a 61-year-old woman who was receiving immunosuppressive therapy following renal transplantation 6 years prior to presentation. It is important for clinicians to consider NTM in the differential diagnosis for patients who present with chronic skin or soft tissue infections.
Research Interests:
Opinion statementThe global spread of multidrug-resistant strains of tuberculosis (TB) mycobacteria was one of the main reasons leading the World Health Organisation to launch the Stop TB program worldwide. In spite of a slow decline of... more
Opinion statementThe global spread of multidrug-resistant strains of tuberculosis (TB) mycobacteria was one of the main reasons leading the World Health Organisation to launch the Stop TB program worldwide. In spite of a slow decline of TB incidence and mortality worldwide, multidrug-resistant TB (MDR-TB) has increased in several countries. MDR-TB is caused by organisms that are resistant to at least isoniazid and rifampicin. The most drug-resistant forms of TB are the extensively drug-resistant TB (XDR-TB) strains caused by organisms that are resistant also to fluoroquinolones and any of the second-line anti-TB injectable drugs. XDR-TB can take 2 years or more to treat with drugs that are less effective, more toxic, and more expensive. Mortality for XDR-TB is very high, and the risk of the transmission between persons of XDR-TB strains is a matter of concern for health systems. Major issues associated with enhanced XDR-TB are non-implementation of DOT (directly observed therapy) and DOT expansion strategies, the insufficient supply or the poor quality of the anti-tuberculosis drugs, and the inadequate intake of the anti-tuberculosis medicines. Nevertheless, prior treatment of MDR-TB with second-line drugs is the strongest associated factor increasing the risk for XDR tuberculosis more than fourfold. Specialized rapid, effective diagnostic methods, including drug-sensitivity testing, are essential for a precise diagnosis of XDR-TB, and subsequent proper treatment. The global rise and spread of XDR-TB have serious effects on TB-control programs, and urge effective health policy responses. National TB control programmes working with all health services can prevent XDR-TB by ensuring that all the physicians and professionals caring for people with TB adhere to the International Standards for TB Care. Specialized centres at regional and national levels should be dedicated to care for difficult-to-treat and untreatable patients with XDR-TB.
Research Interests:
The triad of pneumonia, meningitis, and endocarditis due to Streptococcus pneumoniae is known as Austrian syndrome. We report a case with an aortic-right atrium fistula in a 39-year-old woman who had undergone splenectomy for Hodgkin's... more
The triad of pneumonia, meningitis, and endocarditis due to Streptococcus pneumoniae is known as Austrian syndrome. We report a case with an aortic-right atrium fistula in a 39-year-old woman who had undergone splenectomy for Hodgkin's lymphoma. The review of literature shows that the prevalence of Austrian syndrome is decreasing from 19% to 3% of patients with pneumococcal endocarditis in recent years. This case emphasizes that diagnosis of endocarditis should be considered early in every patient with pneumococcal meningitis or bacteremia, particularly in immunocompromised patients.
Research Interests: Fistula, Medicine, Humans, Female, Pubmed, and 15 morePneumonia, Adult, Immunocompromised host, Meningitis, Bacteremia, eNDOCARDITIS, Right Atrium, Aortic Valve, Hodgkin disease, Splenectomy, Heart Diseases, Penicillin G, Combined Modality Therapy, Heart Valve Prosthesis Implantation, and Heart atria
Research Interests:
The etiology and pathogenesis of certain types of disease remain controversial and stand like a bridge that crosses infectious, autoimmune and autoinflammatory pathways. Infection, for example, may initiate a disease, although it is the... more
The etiology and pathogenesis of certain types of disease remain controversial and stand like a bridge that crosses infectious, autoimmune and autoinflammatory pathways. Infection, for example, may initiate a disease, although it is the genetic regulation in the host, the interplay between virus or bacteria persistence and autoimmunity that produces the later phases of disease, the antigenic determinants responsible for inducing autoimmune disease, and the pathogenetic effector mechanisms. Infections agents cause pericarditis, but in 85% of cases it is "idiopathic". It has also been shown that persistent Clamydia pneumoniae, Porphyromonas gingivalis, and Helicobacter pylori infections cause host immunity and promote atherogenesis. A number of infectious agents have been suggested as potential triggers for primary biliary cirrhosis. Infections and vaccinations have also been linked to the pathogenesis of fibromyalgia syndrome, a common, chronic syndrome of widespread pain. Many factors are also responsible for fever of unknown origin such as: infections, autoimmunity disease, etc. However, it is difficult to determine a direct correlation between the infections agents in such a large group of diseases. The aim of this review is to analyze some of the controversies about the role of infections in autoimmune diseases.
Research Interests:
Seborrheic dermatitis is a common dermatosis occurring on the scalp, face and chest. In the general population, the prevalence of seborrheic dermatitis varies between 3% and 5%, while in HIV positive patients there is an increased... more
Seborrheic dermatitis is a common dermatosis occurring on the scalp, face and chest. In the general population, the prevalence of seborrheic dermatitis varies between 3% and 5%, while in HIV positive patients there is an increased prevalence of seborrheic dermatitis ranging between 30% and 83%. Seborrheic dermatitis occurs early in the course of HIV disease and may be an initial clinical marker of HIV infection.
Research Interests:
Research Interests:
Background: HIV-infected patients may contract a variety of other concurrent infections, including Mycoplasma pneumoniae, cytomegalovirus (CMV) and Epstein-Barr virus (EBV), that are known to be causes of transient cold agglutinins (CA).... more
Background: HIV-infected patients may contract a variety of other concurrent infections, including Mycoplasma pneumoniae, cytomegalovirus (CMV) and Epstein-Barr virus (EBV), that are known to be causes of transient cold agglutinins (CA). The aim of this study was to search for the prevalence, the persistence and the significance of CA in HIV antibody-positive patients. Methods: Ninety patients belonging to different risk groups (drug addicts, homosexuals and hemophiliacs), including 15 with AIDS, 20 with ARC, 25 with PGL, 30 symptom-free individuals and 100 healthy blood donors were assessed for the presence of CA for at least six months. Results: In 20 cases (22%) CA were found: 3, 7, 5 and 5 respectively, in each of the above mentioned HIV-positive groups, while the group used as control was CA-negative. There were no differences between CA-negative and CA-positive patients with regard to the presence of anemia, frequency of other infections, or development of lymphatic malignancy during the follow-up period. Serological specificity of CA included 14 of type anti-I, 5 of anti-i and 1 of anti-Pr specificity. Conclusions: It appears that CA production is another immune disorder of patients with HIV infection.
Research Interests:
Research Interests: Microbiology, Medical Microbiology, Biology, Infectious Diseases, Medicine, and 15 moreItaly, Clinical Virology, real time PCR, Sequencing, Humans, Trieste, Male, TBEV, Clinical Sciences, Aged, Immunocompromised host, Encephalitis, Antineoplastic Agents, Epidemics, and real time polymerase chain reaction
To study incidence and risk factors of heterosexually transmitted HIV infection, we followed a cohort of 343 seronegative women, stable, monogamous partners of infected men whose only risk of acquiring HIV was sexual exposure to the... more
To study incidence and risk factors of heterosexually transmitted HIV infection, we followed a cohort of 343 seronegative women, stable, monogamous partners of infected men whose only risk of acquiring HIV was sexual exposure to the infected partner. Nineteen seroconversions occurred in 529.6 person years (py) of observation, yielding an incidence rate of 3.6 per 100 py. The incidence rate was 7.2 per 100 py among women who did not always use or never used condoms and 1.1 among those who always used them [relative risk (RR) 6.6, 95% confidence interval (CI) 1.9-21.9]. Anal sex was associated with a risk increase in only those women not always using condoms (RR 1.4, 95% CI 0.4-4.8). No seroconversions were observed among 22 women using oral contraceptives. One of the women using intrauterine devices seroconverted. In couples who did not always use condoms, seroconversions occurred more frequently in partners of men with symptomatic diseases, with a low CD4+ cell number (< 400 per mm3) or with a detectable p24 antigen. In couples not always using condoms and where the man had a low CD4+ cell count, the joint presence of blood viral antigens and AIDS symptoms conditioned a fivefold increased risk of seroconversion of the woman (RR 5.4, CI 1.4-20.3). At multivariate analysis, women with longer relationships (> or = 1 year) showed a lower risk of seroconversion (RR 0.3, CI 0.1-0.8), and those partners of men positive for p24 antigen in serum had an increased risk of seroconversion (RR = 4.0, CI 0.1-0.8).
Research Interests: Demography, Incidence Geometry, Medicine, Multivariate Analysis, Humans, and 15 moreFemale, Pubmed, Male, Cohort Study, Risk factors, Longitudinal Study, Hiv seropositivity, Risk Factors, Condoms, IntraUterine Devices, Confidence Interval, Seroconversion, Relative Risk, leukocyte Count, and HIV infections
Research Interests:
Meningitis is the most common worldwide infection of the central nervous system, and bacterial meningitis is a potentially life-threatening disease that requires immediate recognition and treatment. Community-acquired bacterial meningitis... more
Meningitis is the most common worldwide infection of the central nervous system, and bacterial meningitis is a potentially life-threatening disease that requires immediate recognition and treatment. Community-acquired bacterial meningitis has an annual incidence of 4–6 cases per 100,000 adults, and Streptococcus pneumoniae and Neisseria meningitidis are responsible for at least 80% of all cases [1], [2]. In a surveillance study conducted in 1995 in USA, the incidence of bacterial meningitis was found to have declined dramatically [2]. This finding was a result of a vaccine-related decline in meningitis caused by Haemophilus influenzae type B vaccine; in the USA and in other industrialised countries, bacterial meningitis is now a disease predominantly of adults rather than infants and children. Moreover, conjugate vaccines against S. pneumoniae are expected to reduce the incidence of childhood pneumococcal meningitis significantly [3]. Bacterial meningitis is also an important problem in hospitalised patients. In a review of 493 episodes of bacterial meningitis in adults at a USA tertiary hospital from 1962 to 1988 inclusive, 40% of episodes were nosocomial in origin, with most cases (38%) caused by Gram-negative bacilli. In that study, the mortality rate remained high over time, and even in the 1980s, almost one quarter of adults with meningitis died, despite the advances in antibiotic therapy. In contrast, it was found that the mortality rate of Gram-negative bacillary meningitis had decreased since the advent of third-generation cephalosporins [4].
Research Interests:
Research Interests: Medicine and Lyme disease
Research Interests:
Research Interests:
Research Interests:
The rationale for a preformed combination of fosfomycin and amoxicillin is briefly discussed. These two antibacterial drugs block the peptidoglycal biosynthesis sequentially, thus exerting a true synergistic effect. On the other hand,... more
The rationale for a preformed combination of fosfomycin and amoxicillin is briefly discussed. These two antibacterial drugs block the peptidoglycal biosynthesis sequentially, thus exerting a true synergistic effect. On the other hand, there is no no synergism as far as toxicity is concerned. As the kinetics of the two molecules are different, further research on this topic is needed. This is especially true for renal failure patient
Research Interests:
Antibiotic therapy is a crucial and often life-saving strategy. This study assessed the ability to prescribe antibiotic therapy among a series of Italian postgraduate students in geriatrics and internal medicine. Participants were... more
Antibiotic therapy is a crucial and often life-saving strategy. This study assessed the ability to prescribe antibiotic therapy among a series of Italian postgraduate students in geriatrics and internal medicine. Participants were administered an anonymous questionnaire consisting of self-assessment of their ability to prescribe antibiotics and then manage a case of community-acquired pneumonia. The Wilcoxon test for comparisons between two independent samples was used for statistical analysis. Almost half the 70 students considered their knowledge of antibiotic therapy insufficient and were not satisfied with the notions received during their studies. Indeed, the change in antibiotic therapy required to control acute exacerbation of pneumonia was correctly identified by only 36% of students. Moreover, 38% of them gave the correct answer on factors influencing the duration of antibiotic therapy in the presence of definite improvement of pneumonia. No significant difference was found between the responses of residents in geriatrics and internal medicine. Overall, our study shows that nearly half of our students think they have inadequate antibiotic prescribing skills. This is confirmed by a low ability to establish the best management of the clinical case. To repair this severe shortcoming, different training methods need to be compared and more effective forms of instruction adopted.
Research Interests:
Research Interests:
Research Interests:
Research Interests: Epidemiology, Incidence Geometry, Hospitals, Humans, Infection Control, and 15 moreINTENSIVE CARE, Candida, Fluconazole, Candidiasis, Candida albicans, Clinical microbiology and infection control, Incidence, Clinical Sciences, Candida parapsilosis, Candida Glabrata, Antifungal Agents, Intensive Care Units, Inpatients, fungemia, and Cross Infection
We conducted a one-year prospective study on intensive care unit (ICU)-acquired infections and antimicrobial resistance patterns in an 18-bed medical-surgical ICU of a tertiary-care university hospital. We divided the study into two... more
We conducted a one-year prospective study on intensive care unit (ICU)-acquired infections and antimicrobial resistance patterns in an 18-bed medical-surgical ICU of a tertiary-care university hospital. We divided the study into two six-month periods in order to evaluate the impact of antibiotic changes in empirical therapy on antimicrobial resistance profiles of the principal isolated micro-organisms. In the first period no changes were made to the previously applied empirical antibiotic protocol; at the end of this period we found high rates of methicillin resistance (MR) among staphylococci, 93% for Staphylococcus aureus (69 isolates) and 79% for coagulase-negative staphylococci (CNS) (48 isolates), and of multiple drug resistance for Pseudomonas aeruginosa (57 isolates), in particular 67% resistance to piperacillin/tazobactam (PIP/TZ). We therefore decided to substitute PIP/TZ with imipenem in nosocomial pneumonia and with cefepime plus metronidazole in peritonitis. We also considered the previous use of amoxicillin/clavulanate (AM/CL) at admission in critically ill patients inadequate; we therefore advised that no antibiotics should be given unless fever developed and eventually to replace AM/CL with trimethoprim/sulfamethoxazole (TMP/SMX). At the end of this intervention period, we observed a significant decrease of S. aureus MR (93 vs. 73%, P = 0.003) and of P. aeruginosa resistance to PIP/TZ (67 vs. 29%, P &amp;amp;amp;amp;lt; 0.001). A reduction in MR was also seen in CNS (79 vs. 64%, P = 0.09). Other resistance patterns also improved among staphylococci; in contrast P. aeruginosa resistance to imipenem increased in the second period (24 vs. 41%, P = 0.06). A non-premeditated change of antibiotics in empirical therapy, on the basis of detected resistance patterns, provided promising results in reducing some antimicrobial resistance rates. We believe, however, that antibiotic changes must be tailored to local microbiological situation monitoring, and that a repeated rotation is crucial to limit the emergence of new resistance profiles. Furthermore the adoption of this policy should be accompanied by other infection control practices aimed at reducing antimicrobial resistance and nosocomial infection rates.
Research Interests: Hospital Infection, Medicine, Antibiotic Resistance, Italy, Humans, and 15 moreInternal Medicine, Infection Control, Hospital, Antimicrobial resistance, Antimicrobial, Clinical Sciences, Antibiotics, Intensive Care Unit, Bacterial infections, Intensive Care Units, Imipenem, Drug Utilization, Coagulase Negative Staphylococci, Cefepime, and Cross Infection
Research Interests:
Research Interests: Biology, Virology, Medicine, Western blotting, Italy, and 15 moreSerology, Humans, Q Fever, Animals, Borrelia burgdorferi, Clinical microbiology and infection control, Trees, Clinical Sciences, Occupational Exposure, Ticks and Tick Borne Diseases, Rickettsia, Coxiella Burnetii, Rickettsiosis, Ixodes, and Spotted fever
Research Interests:
Research Interests:
Research Interests:
ABSTRACT The utility of stereotactic brain biopsy (SBB) in AIDS patients still remains controversial. The authors investigated SBB-related diagnostic accuracy, complications, and postoperative sequelae in nonimmunocompromised (NIC)... more
ABSTRACT The utility of stereotactic brain biopsy (SBB) in AIDS patients still remains controversial. The authors investigated SBB-related diagnostic accuracy, complications, and postoperative sequelae in nonimmunocompromised (NIC) patients and AIDS patients. The role of bioptic yield in treatment planning was also studied in AIDS patients. From 1990-95, 200 computerized tomography (CT) or magnetic resonance imaging (MRI)-guided SBBs were performed in our Department; 172 bioptic procedures were performed in NIC patients (169), and 28 SBBs in AIDS patients (27). The statistical significance was evaluated using the Fisher exact t-test. SBB accuracy was very high in both NIC (94.8%) and AIDS (92.9%) patients. Statistical analysis indicated nonsignificant (NS) differences between the two study groups (P &gt; 0.05). Diagnostic yield resulted higher in contrast-enhancing (CE) brain lesions (98.6% in NIC and 95.0% in AIDS patients; P &gt; 0.05; NS), than in non-CE lesions (74.1% in NIC and 87.5% in AIDS patients; P &gt; 0.05; NS). The overall complication rate was similar in both groups (17.2% in NIC and 14.8% in AIDS patients, P &gt; 0.05, NS). The most frequent complication was hemorrhage, with statistically negligible differences between the two study groups (P &gt; 0.05). The frequency of complications involving minor/major morbidity or mortality was very low in NIC (5.9%, 0.6%, and 2.4%, respectively), and in AIDS (3.7%, 7.4%, and 0.0%, respectively) patients. Regarding the therapeutic impact of bioptic diagnosis for neuro-AIDS patients, the preoperative treatment attitude was modified in 23/27 cases (85.2%), and the empiric anti-toxoplasmosis regimen was changed or withdrawn in 17/21 patients (81.0%). Our experience demonstrated SBB to be an accurate, manageable, and reasonably safe diagnostic tool in both NIC and AIDS patients. These results suggest also that timely SBB indication in selected AIDS patients, reaching an early diagnosis, may on one side prevent unnecessary and potentially toxic empiric therapeutic regimens, and on the other address the appropriate treatment, thereby improving length and quality of life in such patients.
Research Interests:
In this multicenter, retrospective study of 160 brain biopsies in the assessment of HIV-related focal brain lesions, diagnostic sensitivity was acceptable (87%), but the procedure carried considerable morbidity (7.5%) and mortality... more
In this multicenter, retrospective study of 160 brain biopsies in the assessment of HIV-related focal brain lesions, diagnostic sensitivity was acceptable (87%), but the procedure carried considerable morbidity (7.5%) and mortality (3.1%). Moreover, it is not always possible to initiate the changes in therapy indicated by the results, and overall survival remains poor, with a median of 2 months. Criteria for brain biopsy for the diagnosis of focal brain lesions should be redefined to include selected patients for whom a less invasive approach does not yield a definitive diagnosis.
Research Interests:
Research Interests:
Research Interests:
not availabl