Candida Endocarditis (CE) is a deadly disease. It is of paramount importance to assess risk facto... more Candida Endocarditis (CE) is a deadly disease. It is of paramount importance to assess risk factors for acquisition of both Candida native (NVE) and prosthetic (PVE) valve endocarditis and relate clinical features and treatment strategies with the outcome of the disease. Areas covered: We searched the literature using the Pubmed database. Cases of CE from the Italian Study on Endocarditis (SEI) were also included. Overall, 140 cases of CE were analyzed. Patients with a history of abdominal surgery and antibiotic exposure had higher probability of developing NVE than PVE. In the PVE group, time to onset of CE was significantly lower for biological prosthesis compared to mechanical prosthesis. In the whole population, greater age and longer time to diagnosis were associated with increased likelihood of death. Patients with effective anti-biofilm treatment, patients who underwent cardiac surgery and patients who were administered chronic suppressive antifungal treatment showed increased survival. For PVE, moderate active anti-biofilm and highly active anti-biofilm treatment were associated with lower mortality. Expert commentary: Both NVE and PVE could be considered biofilm-related diseases, pathogenetically characterized by Candida intestinal translocation and initial transient candidemia. Cardiac surgery, EAB treatment and chronic suppressive therapy might be crucial in increasing patient survival.
<b>Introduction</b>: <i>Candida</i> Endocarditis (CE) is a deadly disease... more <b>Introduction</b>: <i>Candida</i> Endocarditis (CE) is a deadly disease. It is of paramount importance to assess risk factors for acquisition of both <i>Candida</i> native (NVE) and prosthetic (PVE) valve endocarditis and relate clinical features and treatment strategies with the outcome of the disease. <b>Areas covered</b>: We searched the literature using the Pubmed database. Cases of CE from the Italian Study on Endocarditis (SEI) were also included. Overall, 140 cases of CE were analyzed. Patients with a history of abdominal surgery and antibiotic exposure had higher probability of developing NVE than PVE. In the PVE group, time to onset of CE was significantly lower for biological prosthesis compared to mechanical prosthesis. In the whole population, greater age and longer time to diagnosis were associated with increased likelihood of death. Patients with effective anti-biofilm treatment, patients who underwent cardiac surgery and patients who were administered chronic suppressive antifungal treatment showed increased survival. For PVE, moderate active anti-biofilm and highly active anti-biofilm treatment were associated with lower mortality. <b>Expert commentary</b>: Both NVE and PVE could be considered biofilm-related diseases, pathogenetically characterized by Candida intestinal translocation and initial transient candidemia. Cardiac surgery, EAB treatment and chronic suppressive therapy might be crucial in increasing patient survival.
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2012
Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infectio... more Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infections. There are very few reports of disseminated infections sustained by members of this streptococcal group. We report a case of a highly disseminated infection and analyse previous literature reports. Disseminated pyogenic infection has been defined as an infection affecting two or more of the following organs/systems: central nervous system, lung, liver and spleen. We performed a PubMed search using the terms: S. milleri, S. anginosus, brain abscess, pulmonary abscess, hepatic abscess, spleen abscess. We reviewed 12 case reports including the one presented in this paper. Underlying conditions such as dental infections, malignancy, gastrointestinal and respiratory tract disease accounted for 42% of cases. No definite endocarditis was encountered, even though positive blood cultures were found in 67% of patients. Concomitant brain-liver, brain-lung and brain-spleen involvement occurred in...
We aimed to investigate clinical features of patients with descending necrotizing mediastinitis (... more We aimed to investigate clinical features of patients with descending necrotizing mediastinitis (DNM) in order to improve management and outcome. We prospectively examined all patients with DNM admitted to the Intensive Care Unit (ICU) during the period from April 2007 to December 2013. Demographics, clinical features, microbiology, medical and surgical treatment data were recorded. Survivor and nonsurvivor groups were analyzed to identify factors associated with mortality. Overall, 34 patients with DNM have been included. The mean age was 46.8 ± 11.2 years (range 24-70). The male/female ratio was 3.25. DNM arose from odontogenic infection in 22 (65 %) patients; from peritonsillar abscess in 9 (26 %) patients and from paranasal sinus in 3 (9 %) patients. Microbiological cultures revealed a high percentage of aerobic/anaerobic coinfection. Nonsurvivors were statistically more likely to have higher SAPS II score (mean difference 19.1, 95 % CI 12.3-25.9 P < 0.01) and more severe dis...
We compared the aetiology of 203 ICU--acquired laboratory confirmed bloodstream infections (LC--B... more We compared the aetiology of 203 ICU--acquired laboratory confirmed bloodstream infections (LC--BSI) prospectively collected between January 2000--December 2007 (first period) with 83 LC--BSI recorded between January 2010--December 2012 (second period), after the diffusion in 2008 of K. pneumoniae expressing carbapenem--resistance due to K. pneumoniae carbapenemases production (KPC--CR--Kp). In the general ICU of teaching hospital "Umberto I" in Rome, all ICU--acquired LC--BSI episodes occurring in patients admitted to ICU ≥48h were included. Baseline characteristics, clinical features, antimicrobial resistance and outcome were recorded. All isolated strains multidrug resistance (MDR) were evaluated according to the European Centre for Disease Control (ECDC) guidelines. Overall the study included 329 isolates, 214 in 2000--2007 and 115 in 2010--2012. In the second period we registered a Gram--positive reduction (55.1% vs. 26.9%; p<0.01) and Gram--negative increase (40.2...
The study evaluates the circadian rhythm of melatonin in relation to sex and age and identified c... more The study evaluates the circadian rhythm of melatonin in relation to sex and age and identified contemporary alterations in the secreton of some hypophyseal hormones, suggesting that melatonin may exert a modulatory action on the latter. The melatonin metabolite (6-hydroxymelatonin sulfate) was assayed in urine samples from 48 subjects of both sexes aged between 25 and 60 years old using the RIA method described by Arendt, modified for the ise of iodine markers. A blood sample was taken from the same subjects to assay hypophyseal hormones. Melatonin secretion does not remain constant over 24 hours in young subjects of both sexes, but instead is rhythmic. This rhythmic secretion is lacking in adults, revealing a daytime pineal secreton that is surprisingly higher than in younger persons. A difference in secretion levels was also found between sexes, a higher melatonin peak in females compared to males. Some young female subjects reveal a contemporary hypersecretion of the somatotropi...
Annali di igiene : medicina preventiva e di comunità
The present study represents a preliminary evaluation of the impact of topical nystatin prophylax... more The present study represents a preliminary evaluation of the impact of topical nystatin prophylaxis administration and adequate CVC management on reducing the chance of developing candidemia in neurosurgical intensive care unit (NICU) patients. We conducted a case-control study at the nine bed NICU of the Policlinico "Umberto I" teaching hospital in Rome, Italy, during the period from January 2011 to July 2012. We compared eight patients with culture proven Candida bloodstream infection (CBSI) with a control group of 19 patients who did not have evidence of CBSI. When the CBSI group was compared with the control group, the former were more likely than controls to not have received nystatin prophylaxis and adequate catheter care (p= 0,008). When CBSI group was matched with patients with no adequate source control and nystatin prophylaxis, average NICU stay (71.13 days vs 19.0 days) was significant (mean difference = -52.12 days, 95% CI -97.11 to -7.14, p= 0.028). The same w...
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2012
Infective endocarditis (IE) due to Abiotrophia and Granulicatella species, previously referred to... more Infective endocarditis (IE) due to Abiotrophia and Granulicatella species, previously referred to as nutritionally variant streptococci (NVS), occurs rarely and is often associated with negative blood cultures. Rates of treatment failure, infection relapse and mortality are higher than those of endocarditis caused by other viridans streptococci. We report a case of endocarditis caused by Granulicatella adiacens in a young man with no risk factors, who was successfully treated with surgery and combination antimicrobial chemotherapy, and provide a literature review of endocarditis attributable to these rare species of fastidious gram-positive cocci which have proven exceedingly difficult to treat, with high rates of relapse and therapeutic failure despite in vitro effective antibiotic treatment regimens. Analysis of literature revealed a high prevalence (61%) of valvular heart predisposing conditions associated with endocarditis caused by NVS, such as congenital valvular heart disease...
Clostridium difficile infection (CDI) and Klebsiella pneumoniae carbapenemase producing-Klebsiell... more Clostridium difficile infection (CDI) and Klebsiella pneumoniae carbapenemase producing-Klebsiella pneumoniae (KPC-Kp) bloodstream infection (BSI) are emerging health-care associated (HCA) diseases of public health concern, in terms of morbidity, mortality, and insufficient response to antibiotic therapy. Both agents can be acquired in the hospital but clinical disease can develop in a community setting, after discharge. We report here a putative link between the above-mentioned healthcare associated infections that appeared as a dramatic community onset disease with a fulminant fatal outcome. We describe the case of a 63 year old man affected by severe CDI. Even though the patient underwent 72 hours of standard CDI antibiotic treatment, the clinical course was complicated by toxic megacolon and KPC-Kp BSI. The patient died 24 hours after total colectomy. The impact of HCA-BSIs in complicating CDI is still unknown. Intestinal inflammatory injury and disruption of intestinal flora by...
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2012
Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infectio... more Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infections. There are very few reports of disseminated infections sustained by members of this streptococcal group. We report a case of a highly disseminated infection and analyse previous literature reports. Disseminated pyogenic infection has been defined as an infection affecting two or more of the following organs/systems: central nervous system, lung, liver and spleen. We performed a PubMed search using the terms: S. milleri, S. anginosus, brain abscess, pulmonary abscess, hepatic abscess, spleen abscess. We reviewed 12 case reports including the one presented in this paper. Underlying conditions such as dental infections, malignancy, gastrointestinal and respiratory tract disease accounted for 42% of cases. No definite endocarditis was encountered, even though positive blood cultures were found in 67% of patients. Concomitant brain-liver, brain-lung and brain-spleen involvement occurred in...
Candida Endocarditis (CE) is a deadly disease. It is of paramount importance to assess risk facto... more Candida Endocarditis (CE) is a deadly disease. It is of paramount importance to assess risk factors for acquisition of both Candida native (NVE) and prosthetic (PVE) valve endocarditis and relate clinical features and treatment strategies with the outcome of the disease. Areas covered: We searched the literature using the Pubmed database. Cases of CE from the Italian Study on Endocarditis (SEI) were also included. Overall, 140 cases of CE were analyzed. Patients with a history of abdominal surgery and antibiotic exposure had higher probability of developing NVE than PVE. In the PVE group, time to onset of CE was significantly lower for biological prosthesis compared to mechanical prosthesis. In the whole population, greater age and longer time to diagnosis were associated with increased likelihood of death. Patients with effective anti-biofilm treatment, patients who underwent cardiac surgery and patients who were administered chronic suppressive antifungal treatment showed increased survival. For PVE, moderate active anti-biofilm and highly active anti-biofilm treatment were associated with lower mortality. Expert commentary: Both NVE and PVE could be considered biofilm-related diseases, pathogenetically characterized by Candida intestinal translocation and initial transient candidemia. Cardiac surgery, EAB treatment and chronic suppressive therapy might be crucial in increasing patient survival.
<b>Introduction</b>: <i>Candida</i> Endocarditis (CE) is a deadly disease... more <b>Introduction</b>: <i>Candida</i> Endocarditis (CE) is a deadly disease. It is of paramount importance to assess risk factors for acquisition of both <i>Candida</i> native (NVE) and prosthetic (PVE) valve endocarditis and relate clinical features and treatment strategies with the outcome of the disease. <b>Areas covered</b>: We searched the literature using the Pubmed database. Cases of CE from the Italian Study on Endocarditis (SEI) were also included. Overall, 140 cases of CE were analyzed. Patients with a history of abdominal surgery and antibiotic exposure had higher probability of developing NVE than PVE. In the PVE group, time to onset of CE was significantly lower for biological prosthesis compared to mechanical prosthesis. In the whole population, greater age and longer time to diagnosis were associated with increased likelihood of death. Patients with effective anti-biofilm treatment, patients who underwent cardiac surgery and patients who were administered chronic suppressive antifungal treatment showed increased survival. For PVE, moderate active anti-biofilm and highly active anti-biofilm treatment were associated with lower mortality. <b>Expert commentary</b>: Both NVE and PVE could be considered biofilm-related diseases, pathogenetically characterized by Candida intestinal translocation and initial transient candidemia. Cardiac surgery, EAB treatment and chronic suppressive therapy might be crucial in increasing patient survival.
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2012
Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infectio... more Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infections. There are very few reports of disseminated infections sustained by members of this streptococcal group. We report a case of a highly disseminated infection and analyse previous literature reports. Disseminated pyogenic infection has been defined as an infection affecting two or more of the following organs/systems: central nervous system, lung, liver and spleen. We performed a PubMed search using the terms: S. milleri, S. anginosus, brain abscess, pulmonary abscess, hepatic abscess, spleen abscess. We reviewed 12 case reports including the one presented in this paper. Underlying conditions such as dental infections, malignancy, gastrointestinal and respiratory tract disease accounted for 42% of cases. No definite endocarditis was encountered, even though positive blood cultures were found in 67% of patients. Concomitant brain-liver, brain-lung and brain-spleen involvement occurred in...
We aimed to investigate clinical features of patients with descending necrotizing mediastinitis (... more We aimed to investigate clinical features of patients with descending necrotizing mediastinitis (DNM) in order to improve management and outcome. We prospectively examined all patients with DNM admitted to the Intensive Care Unit (ICU) during the period from April 2007 to December 2013. Demographics, clinical features, microbiology, medical and surgical treatment data were recorded. Survivor and nonsurvivor groups were analyzed to identify factors associated with mortality. Overall, 34 patients with DNM have been included. The mean age was 46.8 ± 11.2 years (range 24-70). The male/female ratio was 3.25. DNM arose from odontogenic infection in 22 (65 %) patients; from peritonsillar abscess in 9 (26 %) patients and from paranasal sinus in 3 (9 %) patients. Microbiological cultures revealed a high percentage of aerobic/anaerobic coinfection. Nonsurvivors were statistically more likely to have higher SAPS II score (mean difference 19.1, 95 % CI 12.3-25.9 P < 0.01) and more severe dis...
We compared the aetiology of 203 ICU--acquired laboratory confirmed bloodstream infections (LC--B... more We compared the aetiology of 203 ICU--acquired laboratory confirmed bloodstream infections (LC--BSI) prospectively collected between January 2000--December 2007 (first period) with 83 LC--BSI recorded between January 2010--December 2012 (second period), after the diffusion in 2008 of K. pneumoniae expressing carbapenem--resistance due to K. pneumoniae carbapenemases production (KPC--CR--Kp). In the general ICU of teaching hospital "Umberto I" in Rome, all ICU--acquired LC--BSI episodes occurring in patients admitted to ICU ≥48h were included. Baseline characteristics, clinical features, antimicrobial resistance and outcome were recorded. All isolated strains multidrug resistance (MDR) were evaluated according to the European Centre for Disease Control (ECDC) guidelines. Overall the study included 329 isolates, 214 in 2000--2007 and 115 in 2010--2012. In the second period we registered a Gram--positive reduction (55.1% vs. 26.9%; p<0.01) and Gram--negative increase (40.2...
The study evaluates the circadian rhythm of melatonin in relation to sex and age and identified c... more The study evaluates the circadian rhythm of melatonin in relation to sex and age and identified contemporary alterations in the secreton of some hypophyseal hormones, suggesting that melatonin may exert a modulatory action on the latter. The melatonin metabolite (6-hydroxymelatonin sulfate) was assayed in urine samples from 48 subjects of both sexes aged between 25 and 60 years old using the RIA method described by Arendt, modified for the ise of iodine markers. A blood sample was taken from the same subjects to assay hypophyseal hormones. Melatonin secretion does not remain constant over 24 hours in young subjects of both sexes, but instead is rhythmic. This rhythmic secretion is lacking in adults, revealing a daytime pineal secreton that is surprisingly higher than in younger persons. A difference in secretion levels was also found between sexes, a higher melatonin peak in females compared to males. Some young female subjects reveal a contemporary hypersecretion of the somatotropi...
Annali di igiene : medicina preventiva e di comunità
The present study represents a preliminary evaluation of the impact of topical nystatin prophylax... more The present study represents a preliminary evaluation of the impact of topical nystatin prophylaxis administration and adequate CVC management on reducing the chance of developing candidemia in neurosurgical intensive care unit (NICU) patients. We conducted a case-control study at the nine bed NICU of the Policlinico "Umberto I" teaching hospital in Rome, Italy, during the period from January 2011 to July 2012. We compared eight patients with culture proven Candida bloodstream infection (CBSI) with a control group of 19 patients who did not have evidence of CBSI. When the CBSI group was compared with the control group, the former were more likely than controls to not have received nystatin prophylaxis and adequate catheter care (p= 0,008). When CBSI group was matched with patients with no adequate source control and nystatin prophylaxis, average NICU stay (71.13 days vs 19.0 days) was significant (mean difference = -52.12 days, 95% CI -97.11 to -7.14, p= 0.028). The same w...
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2012
Infective endocarditis (IE) due to Abiotrophia and Granulicatella species, previously referred to... more Infective endocarditis (IE) due to Abiotrophia and Granulicatella species, previously referred to as nutritionally variant streptococci (NVS), occurs rarely and is often associated with negative blood cultures. Rates of treatment failure, infection relapse and mortality are higher than those of endocarditis caused by other viridans streptococci. We report a case of endocarditis caused by Granulicatella adiacens in a young man with no risk factors, who was successfully treated with surgery and combination antimicrobial chemotherapy, and provide a literature review of endocarditis attributable to these rare species of fastidious gram-positive cocci which have proven exceedingly difficult to treat, with high rates of relapse and therapeutic failure despite in vitro effective antibiotic treatment regimens. Analysis of literature revealed a high prevalence (61%) of valvular heart predisposing conditions associated with endocarditis caused by NVS, such as congenital valvular heart disease...
Clostridium difficile infection (CDI) and Klebsiella pneumoniae carbapenemase producing-Klebsiell... more Clostridium difficile infection (CDI) and Klebsiella pneumoniae carbapenemase producing-Klebsiella pneumoniae (KPC-Kp) bloodstream infection (BSI) are emerging health-care associated (HCA) diseases of public health concern, in terms of morbidity, mortality, and insufficient response to antibiotic therapy. Both agents can be acquired in the hospital but clinical disease can develop in a community setting, after discharge. We report here a putative link between the above-mentioned healthcare associated infections that appeared as a dramatic community onset disease with a fulminant fatal outcome. We describe the case of a 63 year old man affected by severe CDI. Even though the patient underwent 72 hours of standard CDI antibiotic treatment, the clinical course was complicated by toxic megacolon and KPC-Kp BSI. The patient died 24 hours after total colectomy. The impact of HCA-BSIs in complicating CDI is still unknown. Intestinal inflammatory injury and disruption of intestinal flora by...
Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2012
Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infectio... more Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infections. There are very few reports of disseminated infections sustained by members of this streptococcal group. We report a case of a highly disseminated infection and analyse previous literature reports. Disseminated pyogenic infection has been defined as an infection affecting two or more of the following organs/systems: central nervous system, lung, liver and spleen. We performed a PubMed search using the terms: S. milleri, S. anginosus, brain abscess, pulmonary abscess, hepatic abscess, spleen abscess. We reviewed 12 case reports including the one presented in this paper. Underlying conditions such as dental infections, malignancy, gastrointestinal and respiratory tract disease accounted for 42% of cases. No definite endocarditis was encountered, even though positive blood cultures were found in 67% of patients. Concomitant brain-liver, brain-lung and brain-spleen involvement occurred in...
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Papers by Simone Giuliano