Volume 31, Issue 2, 2023
Review
Comparative study of pandemics and their impact on children and adolescents: COVID-19 and Spanish Flu
Dalekou Sofia,
Michaleas Spyros N.,
Tsitsika Artemis K.,
Karamanou Marianna
Overview: Pandemics are characterized by an abrupt and sudden outburst and absence of preparation for its management. The focus during pandemics is on the medical aspect of the disease and not on its impact on the citizens’ or vulnerable groups’ psychosocial wellbeing.
Aim: The purpose of this study was to highlight the impact of the pandemics of the Spanish Flu and COVID-19 on children and adolescents as well as to recognize their short and long-terms effects on children’s and adolescents’ physical and mental health.
Materials and Methods: The material of this review constituted of publications regarding the impact of the Spanish Flu and COVID-19 on children and adolescents via relative search through valid databases and websites of trustworthy organizations.
Results: The main finding of the present review was that pandemics negatively affect children and adolescents undermining their mental and physical health. The factors that negatively impact on this population’s normal development include parental death, financial hardships, restrictive measures, disruption of daily routine and absence of social contact. The short-term effects include anxiety, depression, aggressive behavior as well as fear and grief. Mental disorders, disability, poor academic performance and low socioeconomic level are among the long-term effects of the two under study pandemics.
Conclusions: Children and adolescents constitute a vulnerable group amidst pandemics and there is a need for coordinated worldwide and national actions to prevent and timely manage a pandemic’s impact.
Cerebrovascular disease in COVID-19: a systematic review and meta-analysis
Menezes Ritesh G.,
Alabduladhem Tamim Omar,
Siddiqi Ahmed Kamal,
Maniya Muhammad Talha,
Al Dahlawi Abdulaziz Mazen,
Almulhim Mohammed Waleed Abdulaziz,
Almulhim Hadeel Waleed,
Saeed Yasmeen Abdulwahab Ali,
Alotaibi Moath Saad,
Alarifi Sarah Saud,
Alkathiry Abdulrahman Mohammed,
Almas Talal
Background. The association between COVID-19 and acute cerebrovascular disease (CVD) has not been explored extensively. New data has come to light which may change previous results.
Methods.We queried the PubMed electronic database from its inception until February 2022 for studies evaluating the incidence of stroke in COVID-19 patients. Results of the analysis were pooled using a random-effects model and presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).
Results. 37 studies consisting of 294,249 patients were included in our analysis. Pooled results show that the incidence of acute CVD events in COVID-19 positive patients is 2.6% (95% CI: 2.0-3.3; P < 0.001). Cardioembolic (OR = 14.15, 95% CI: 11.01 to 18.19, P < 0.00001) and cryptogenic (OR = 2.87, 95% CI: 1.91 to 4.32, P < 0.00001) etiologies were associated with COVID-19 positivity. Risk factors for CVD events in patients with COVID-19 were atrial fibrillation (OR = 2.60, 95% CI: 1.15 to 5.87, P= 0.02), coronary artery disease (OR = 2.24, 95% CI: 1.38 to 3.61, P= 0.0010), diabetes (OR = 2.46, 95% CI: 1.36 to 4.44, P= 0.003) and hypertension (OR = 3.65, 95% CI: 1.69 to 7.90, P= 0.005).
Conclusion. COVID-19 infection is associated with an increased risk for acute CVD and is associated with cardioembolic and cryptogenic etiologies and the risk factors of atrial fibrillation, coronary artery disease, diabetes and hypertension in COVID-19 positive patients.
Zoonotic febrile illnesses misdiagnosed as COVID-19: a review of reported clinical cases
Silva-Ramos Carlos Ramiro,
Mejorano-Fonseca Julián A.,
Rodríguez-Morales Alfonso J.,
Hidalgo Marylin,
Faccini-Martínez Álvaro A.
COVID-19 is a zoonotic coronavirus disease caused by SARS-CoV-2. Its fast spreading by aerosol transmission has made it a highly contagious disease, causing the most recent 2020 pandemic. Although it mainly affects the respiratory system, atypical forms of the disease have been described, including developing an undifferentiated febrile illness without respiratory symptoms, that can represent a diagnostic challenge, mainly in tropical areas where several zoonotic febrile diseases are circulating. Thus, despite the broad clinical spectrum of COVID-19, in the tropics, other zoonotic etiologies should always be considered as differential diagnoses. According to our case reports review, eight different zoonotic febrile diseases misdiagnosed as COVID-19 have been reported in the available scientific literature of four databases. These were only suspected due to the epidemiological history. Thus, making a complete and detailed clinical history of a febrile patient in the tropics is essential to suspect the etiology and request the necessary confirmatory tests. Therefore, COVID-19 must be included as a differential diagnosis of undifferentiated febrile illness in the tropics, but other zoonotic infectious diseases must not be ruled out.
Fosfomycin for Non-Urinary Tract Infections: A Systematic Review
Adhikari Shreya Das,
Chaudhuri Souvik,
Boodman Carl,
Gupta Mukund,
Schito Marco,
Stone Heather,
Gupta Nitin
Introduction: Although fosfomycin is currently approved for treating urinary tract infections, it is increasingly being used as salvage therapy for various infectious syndromes outside the urinary tract. This systematic review evaluates clinical and microbiological cure rates in patients with bacterial infections not restricted to the urinary tract where fosfomycin was used off-label.
Materials and methods: Articles from two databases (Pubmed and Scopus) were reviewed. The dosage, route, and duration of fosfomycin therapy along with the details of adjunctive antimicrobial agents were noted. The final outcomes captured were clinical or microbiological cures.
Results: A total of 649 articles, not including duplicates, were selected for the title and abstract screening. After title and abstract screening, 102 articles were kept for full-text screening. Of the 102 articles, 23 studies (n=1227 patients) were kept in the final analysis. Of the 1227 patients, 301 (25%) received fosfomycin as monotherapy, and the remaining 926 (75%) received fosfomycin in combination with at least one other antimicrobial agent. Most of the patients received intravenous fosfomycin (n=1046, 85%). Staphylococcus spp and Enterobacteriaceae were the most common organisms. The pooled clinical and microbiological cure rates were 75% and 84%, respectively.
Conclusion: Fosfomycin has moderate clinical success in patients with non-urinary tract infections, especially when used with other antimicrobials. Due to the paucity of randomized controlled trials, fosfomycin's use should be limited to situations where no alternatives are supported by better clinical evidence.
Vaccine Derived Poliovirus (VDPV)
Mohanty Aroop,
Rohilla Ranjana,
Zaman Kamran,
Hada Vivek,
Dhakal Surakchhya,
Shah Abhishek,
Padhi Bijaya Kumar,
Al-quaim Zahra Haleem,
Altawfiq Kauthar Jaffar A.,
Tirupathi Raghavendra,
Sah Ranjit,
Al-Tawfiq Jaffar A.
Poliomyelitis is caused by Poliovirus, a member of a large group of enteroviruses. Vaccine-derived polioviruses (VDPVs) stem from mutated live poliovirus, which is contained in the Oral Polio Virus vaccine (OPV). In addition, the emergence of VDPV is one of the global challenges for the eradication of poliomyelitis. VDPVs continue to affect different parts of the world; 1081 cases occurred in 2020 and 682 cases in 2021. There are several reasons that may have caused the increase in circulating vaccine-derived poliovirus (cVDPV) after the “switch” from the trivalent to the bivalent oral polio vaccine. One reason is the low vaccination rate among the targeted population, which has been further aggravated by the COVID-19 pandemic. Several strategies could control the spread of VDPV including the use of the monovalent OPV (mOPV-2). The risk of VDPV can be minimized through increased immunization rates and the use of safer vaccine alternatives. The global effort to eradicate polio has made significant progress over the years, but continued vigilance and investment in immunization programs are needed to achieve the ultimate goal of a polio-free world.
Antivirals for the treatment of Monkeypox: utilization in the general and HIV-positive population and gaps for research. A short narrative review.
Ivanov Daniel Toshkov,
Slabakova Yoanna Andreeva,
Argirova Radka Mladenova,
Valkov Trifon Kostadinov
Monkeypox (Mpox) is an emerging viral disease caused by the monkeypox virus (MPXV), a double-stranded DNA virus member of the genus Orthopoxvirus, first reported in humans in 1970. Since May 2022, a global spread of the infection has occurred that the World Health Organization (WHO) declared a public health emergency. In view of the global threat, efforts have been devoted to bolstering the disease spread as well as identifying viable therapeutic modalities. People living with HIV may be at an increased risk of adverse outcomes and may require antiviral treatment. With regard to antiretroviral drugs agents, the anticipated adverse drug reactions do not preclude the co-administration of combined antiretroviral therapy and antivirals for Mpox. More data on treatment recommendations and efficacy in patients with immunodeficiency due to HIV is needed. In this review, tecovirimat, cidofovir and brincidofovir - antiviral agents with activity against MPXV and other Orthopoxviruses are reviewed, their utilization in vulnerable patient groups affected by Mpox such as people living with HIV and possible gaps for future research. Tecovirimat is an inhibitor of the Orthopoxvirus VP37 envelope wrapping protein thus rendering enveloped virus formation impossible. Cidofovir and its prodrug brincidofovir interfere with DNA synthesis through DNA polymerase inhibition. Ongoing research is intensified to verify efficacy and applicability.
Original article
Effects of COVID-19 pandemic on healthcare-associated infections, antibiotic resistance and consumption rates in intensive care units
Önal Uğur,
Tüzemen Ülkü,
Kazak Esra,
Gençol Neval,
Souleiman Esma,
İmer Habibe,
Heper Yasemin,
Yilmaz Emel,
Özakin Cüneyt,
Ener Beyza,
Akalin Halis
Purpose: This paper aimed to evaluate the effects of the COVID-19 pandemic on healthcare-associated infections (HAIs), antibiotic resistance and consumption rates in intensive care units (ICUs) of a tertiary care university hospital.
Patients and Methods: Between 1 January 2018 and 31 December 2021, adult patients diagnosed with HAIs in ICUs were investigated retrospectively. Patients were divided into pre-pandemic (2018–2019) and pandemic periods (2020–2021). Antibiotic consumption index was calculated via using the formula of (total dose (grams) / defined daily dose (DDD) x total patient days) x1000. A p value below 0.05 was accepted as statistically significant.
Results: The incidence of HAIs (per 1000 patient days) in the ICU of COVID-19 patients was 16.59, while it was 13.42 in the other ICUs during the pandemic period (p=0.107). The bloodstream infection (BSI) incidence was 3.32 in the pre-pandemic period and 5.41 in the pandemic period in ICUs other than the ICU of COVID-19 patients (p<0.001). In the pandemic period, the BSI incidence rate was significantly higher in the ICU of COVID-19 patients than in the other ICUs (14.26 vs 5.41, p<0.001). Central venous catheter bloodstream infections incidence rate was 4.72 in the pre-pandemic and 7.52 in the pandemic period in ICUs other than the ICU of COVID-19 patients (p=0.0019). During the pandemic period, the bacteraemia episode rates of Acinetobacter baumannii (5.375 vs 0.984, p<0.001), Enterococcus spp. (1.635 vs 0.268, p<0.001) and Stenotrophomonas maltophilia (3.038 vs 1.297, p=0.0086) in the ICU of COVID-19 patients were significantly found higher than others. The extended-spectrum beta-lactamase (ESBL) positivity rates for Klebsiella pneumoniae and Escherichia coli were 61% and 42% in the pre-pandemic period; 73% and 69% in the pandemic period in ICUs other than the ICU of COVID-19 patients (p>0.05). In the pandemic period, the ESBL positivity rates for K. pneumoniae and E. coli were 83% and 100% in the ICU of COVID-19 patients, respectively. Meropenem (p<0.001), teicoplanin (p<0.001) and ceftriaxone (p<0.001) consumptions were increased while ciprofloxacin (p=0.003) consumption was decreased in all ICUs after the pre-pandemic period.
Conclusions: BSI and CVCBSI incidence rates were significantly increased in all ICUs after the COVID-19 pandemic in our hospital. Bacteraemia episode rates of
A. baumannii, Enterococcus spp. and S. maltophilia in ICU of COVID-19 patients were significantly found higher than others. In addition, meropenem, teicoplanin and ceftriaxone consumptions were increased in all ICUs after the COVID-19 pandemic.
Unexpected effects of COVID-19 outbreak: adaption of Anti-Retroviral Therapy (ART) delivery policies improved adherence in a population of People Living With HIV (PLWH)
Fusco Francesco Maria,
Sangiovanni Nadia,
Papa Nunzia,
Mattera Iacono Valentina,
Cuomo Nunzia,
Viglietti Rosaria,
Tambaro Orsola,
Borrelli Francesco,
Pisapia Raffaella,
Carleo Maria Aurora,
Rizzo Viviana,
Spatarella Micaela,
Esposito Vincenzo,
Sangiovanni Vincenzo
Background: Adherence to Anti-Retroviral Therapy (ART) is crucial for People Living With HIV (PLWH). In Italy, ART is delivered by Hospital Pharmacies, on a renewable prescription from the hospital physician. The measurement of package-refill (the rate of ART packages actually collected out of those to be collected in order to comply with therapy) is an effective tool to evaluate the adherence.
During COVID-19 outbreak, at “D. Cotugno” hospital in Naples, Italy, the ART delivery policies have been adapted, in order to reduce the number of patients’ access. We analysed the impact of these changes on the pill-refill of ART in January-August 2020, compared with 2018-2019.
Methods: “D. Cotugno” hospital is a mono-specialistic Infectious Diseases hospital, caring for about 2500 PLWH. Since February 2020, the hospital was almost entirely dedicated to COVID-19 patients. All out-patient activities were interrupted, except for those dedicated to HIV/AIDS patients.
In this preliminary study we included all patients assigned to one of the three Medical Divisions dedicated to HIV, who were already under treatment since at least 2017. Rate of package-refill was obtained by the Hospital Pharmacy registry, demographic and clinical data were derived from clinical database.
During COVID-19, many measures were adopted in order to increase safety of PLWH attending to hospital. Among these, medical prescription validity increased from 4 to 6 months, and number of packages to be collected increased from 2 to 4, adopting a multi-month dispensing strategy.
Package-refill is adequate if at least 95% of ART have been actually collected; partial and inadequate if 75%-94% or less than 75% of ART, respectively, have been collected. Package-refill was measured during the first year of COVID-19 (March 2020 – February 2021), compared to the same period in the two years before
Results: A total of 594 PLWH were included. PLWH with optimal pill-refill significantly increased in 2020-21 compared to 2018-2020 (62% vs 55%, p 0.013).
Discussion: Due to COVID-19, we would have expected a reduction in ART deliveries. Surprisingly, the opposite occurred. The increase of pill-refill rates may be due to different reasons, but we hypothesized that the adaption of delivery policies, with a higher number of packages allowed to be collected, strongly contributed to this result. This study suggests that multi-month dispensing policies may contribute to the improvement of adherence among PLWH.
Markers of liver function as potential prognostic indicators of SARS-CoV-2 infection: a retrospective analysis during the first and second waves of COVID-19 pandemic
Esposito Ludovica,
Guarino Matteo,
Perna Benedetta,
Ciccarone Andrea,
Cesaro Alice Eleonora,
Manza Francesca,
Pretula Adriana,
Costanzini Anna,
Maritati Martina,
Forini Elena,
Spampinato Michele Domenico,
DeGiorgio Roberto,
Contini Carlo
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is known to cause a predominant respiratory disease, although extrapulmonary manifestations can also occur. One of the targets of Coronavirus disease 2019 (COVID-19) is the hepatobiliary system. The present study aims to describe the correlation between the increase of liver damage markers (i.e. alanine aminotransferase [ALT], aspartate aminotransferase [AST], total bilirubin [TB]) and COVID-19 outcomes (i.e., in-hospital mortality [IHM] and intensive care unit [ICU] transfer).
Methods: All patients with confirmed SARS-CoV-2 infection admitted to the Infectious Diseases Unit of the St. Anna University-Hospital of Ferrara from March 2020 to October 2021 were retrospectively included in this single-centre study. ALT, AST and TB levels were tested in all patients and IHM or ICU transfer were considered as main outcomes. Co-morbidities were assessed using Charlson Comorbidity Index.
Results: A total of 106 patients were retrieved. No hepatic marker was able to predict IHM, whereas all of them negatively predicted ICU transfer (ALT: OR 1.005, 95%CI 1.001-1.009, p= 0.011; AST: OR 1.018, 95%CI 1.006-1.030, p= 0.003; TB: OR 1.329, 95%CI 1.025-1.724, p= 0.032). Age was the only parameter significantly related to mortality.
Conclusions: The present study, by correlating liver damage markers with COVID-19 outcome, showed that an increase of ALT, AST and TB predicted patients’ severity, although not mortality.
Mortality predictors in hospitalised COVID-19 patients and the role of anti- SARS-CoV-2 IgG antibodies and remdesivir
Venturini Sergio,
Orso Daniele,
Cugini Francesco,
Villalta Danilo,
Tonizzo Maurizio,
Grembiale Alessandro,
Zanier Ada,
Cecco Serena,
Callegari Astrid,
Duranti Silvia,
del Fabro Giovanni,
Crapis Massimo
Background: In a pre-vaccination era serologic tests may be used to evaluate the seroprevalence and efficacy of containment strategies applied to the community. Subsequently, SARS-CoV-2 vaccination has successfully reduced hospitalization and admission to intensive care. The role of antiviral treatment for COVID-19 remains debated.
Objective: We investigated the effect of SARS-CoV-2 IgG Spike (S) antibody responses in hospitalized patients on 30-day mortality. Finally, we assessed whether other predictive factors affected mortality after 30 days.
Methods: Observational study on COVID-19 patients admitted from October 1, 2021, to January 30, 2022.
Results: 520 patients were studied; 108 died at the 30-day follow-up (21%). A borderline significance for mortality was observed in favour of the high antibody titer group (24% vs. 17%, p=0.05). From the univariate Cox regression analysis, a high IgG-S titer was significantly correlated to lower 30-day mortality (p=0.04, HR: 0.7; 95%CI: 0.44 – 0.98). The administration of remdesivir (p=0.01) and the age <65 years (p=2.3e-05) were found to be protective for the considered outcome (respectively, HR: 0.5, 95%CI: 0.34 - 0.86, and HR: 0.1, 95%CI: 0.04 – 0.30).
Conclusions: S-antibodies and remdesivir could play a protecting role in increasing the survival of hospitalized COVID-19 patients who are not suffering from a critical disease. Advanced age is a risk factor for poor outcomes among infected people.
Comparative efficacy of methods for early diagnosis of tuberculosis pleuritis with rifampicin-resistance
Almagambetova Altyn,
Yermekbayeva Kalzhan,
Dilmagambetov Daniyar,
Tanzharykova Galiya,
Baisalbayev Bakytzhan
The purpose of the article was to explore the effectiveness of a complex morphological study of pleural biopsies and molecular genetic study (GeneXpert MBT/Rif) of pleural effusion in verifying the diagnosis of pleurisy of tuberculous aetiology.
The participants of the study were 120 patients with a exudative pleurisy who were admitted to the department of extrapulmonary tuberculosis of the Regional Phthisiopulmonology Center (RPPC) in Aktobe (Republic of Kazakhstan) in the period from 2018 to 2020.
Significant differences were obtained in the compared groups (p<0.05), which testifies to the rather high diagnostic efficiency of the GeneXpert MBT/RIF molecular genetic method in comparison with bacterioscopy in detecting Mycobacterium tuberculosis (MBT) in pleural fluid obtained by video thoracoscopy.
Using the GeneXpert method, positive results of the presence of MBT in the pleural fluid were obtained in 26.3% of patients of the main group, while in patients of the control group, MBT was detected only in 3.2% of cases by simple bacterioscopy (p<0.05). The high diagnostic efficiency of the GeneXpert express method (26.3%) is confirmed and proven by the “gold standard” of bacteriological examination of pleural fluid – the growth of MBT colonies in 24.6% of cases by the BACTEC MGIT-960 method and in 28.1% of cases of MBT growth on solid nutrient medium Lowenstein-Jensen in patients of the main group.
The combination of the invasive method of video thoracoscopy diagnostics with the GeneXpert microbiological express method for detecting MBT in the pleural fluid is today, the optimal method for early diagnosis of a drug-resistant form of exudative pleurisy of tuberculous etiology.
Assessment of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis prevalence using a molecular Point of Care: Findings from a respondent driven sampling study among MSM
Aitlhaj-mhand Rokaya,
Bellaji Bahija,
Jennane Sanae,
Remz Chaimae,
Charof Reda,
Khoudri Ibtissam,
Kettani Amina,
El Rhilani Houssine,
Alami Kamal,
Ghargui Latifa,
Youbi Mohamed,
Abdelmoumen Hanaa,
Hançali Amina,
Oumzil Hicham
Objectives: Due to the limited data available within the Moroccan context, the aim of the study was therefore to estimate the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) infection and co-infection among men who have sex with men (MSM) as well as to update the behavioral indicators for this population.
Methods: During the period of November 2020 to January 2021, 275 and 303 MSM in Agadir and Fes respectively, were recruited by using respondent-driven sampling protocol (RDS). Eligibility criteria for participants included men identified as having anal sex with another man in the last 6 months, aged 18 years or older and residing in either Agadir or Fes, regardless of their nationality, for the past 6 months.
Anal swabs were collected from 445 respondents for molecular investigation of CT, NG, and TV. GeneXpert (Cepheid, USA) was used to test all samples. A survey on the socio-demographic, and risk behavior was then administered to participants.
Results: Most MSM subjects were identified as being young, and homosexual. CT prevalence was 11.3% (95%CI, 7.2 to 15.4) and 12.5% (95%CI, 7.5 to 17.5) in Agadir and Fes respectively; NG was 13.3% (95%CI, 8.5 to 18.1) in Agadir and 5.5% (95%CI, 1.9 to 9.2) in Fes. Meanwhile, TV prevalence was 0.4% (95%CI, 0 to 1.1) in Agadir and 0.2% (95%CI, -0.2 to 0.6) in Fes. A CT/NG co-infection was found in 4.5% (95%CI, 3.5 to 5.9) of cases in Agadir and 2.7% (95%CI, 1.9 to 3.9), in Fes.
Conclusion: It follows that a regular risk assessment and Sexually Transmitted Infectious (STIs) screening should be administered in these two cities as part of a global strategy to enhance the sexual health of the key populations in question.
Prevention of congenital Chagas disease by screening of mothers and monitoring of serological tests of neonates: the seven years’ experience
Raglio Annibale,
Clemente Libera,
Guarneri Davide,
Arosio Marco,
Maino Marzia,
Patanè Luisa,
Cavallini Marco,
Rodari Paola,
Mangili Giovanna,
Farina Claudio
Approximately 14000 immigrants coming from the Cochabamba area of Bolivia, with an increased risk of congenital Chagas Disease (CD), are currently living in Bergamo, Italy. According to the World Health Organization (WHO) recommendation (2011), prevention of congenital CD involves testing all pregnant women at risk of infection and performing follow-up of their newborns.
In our study, all pregnant women of Latin American origin were tested for the presence of Trypanosoma cruzi antibodies and children, born to mothers found to be positive, were followed up after delivery.
T. cruzi antibodies were detected using a chemiluminescence immunoassay. The test was also performed on siblings and fathers of children with CD, and women of childbearing age to prevent the congenital infection, as proposed by 2011 WHO recommendation.
In the study period 1105 patients were tested for CD, using a serological test: 934 (85%) were females and 171 (15%) were males. Of the 62 newborns, from mothers who tested positive, 28 were females and 34 were males. The number of positive adults and siblings identified was 148 (14%).
Among the adults and siblings born between 1991 and 2011 only 3 (2%) of females tested positive to serological test.
All neonates, with the exception of one, were classified as non-infected according to the follow-up of index value of CD serology.
This study confirms the usefulness of serological tests and of their index value as follow-up.
The difference of positivity rate for CD antibodies between people born before and after 1990 should be further investigated to generate information that potentially improve the prevention and control of CD.
Dalbavancin in catheter-related bloodstream infections: a pilot study
Venturini Sergio,
Reffo Ingrid,
Avolio Manuela,
Basaglia Giancarlo,
del Fabro Giovanni,
Callegari Astrid,
Grembiale Alessandro,
Garlatti Elena,
Castaldo Viviana,
Tonizzo Maurizio,
Balbi Massimiliano,
Cevolani Michele,
Basso Barbara,
Pellis Tommaso,
Crapis Massimo
Background: Catheter-related bloodstream infections (CRBSI) represent a frequent complication of vascular catheterization, with high morbidity, mortality, and associated costs. Most infections are caused by Gram-positive bacteria; thus dalbavancin, a new long-acting lipoglicopeptide, may have a role in early patient discharge strategies optimizing treatment and reducing overall costs.
Methods: In this small pilot feasibility study, we assessed the efficacy and safety of a “single step” treatment strategy combining dalbavancin administration (1500 mg IV single dose), catheter removal, and early discharge in adult patients admitted to medical wards in a three-year period.
Results: We enrolled sixteen patients with confirmed Gram-positive CRBSI, with a mean age of 68 years and relevant comorbidities (median Charlson Comorbidity index=7). The most frequent causative agents were staphylococci, with 25% of methicillin-resistant strains, and the majority of infected devices were short term central venous catheter (CVC) and peripherally inserted central catheter (PICC).
Ten out of sixteen patients had been treated empirically before dalbavancin administration. The mean time from dalbavancin administration to discharge was 2 days; none of the patients had adverse drug-related reactions; at 30- and 90-day follow-up, no patients have been readmitted to the hospital due to bacteraemia recurrence.
Conclusions: Our results indicate that single-dose dalbavancin is highly effective, well-tolerated, and cost-saving for Gram-positive CRBSI.
The Infections in the History of Medicine
Dracunculiasis over the centuries: the history of a parasite unfamiliar to the West
Simonetti Omar,
Zerbato Verena,
Di Bella Stefano,
Luzzati Roberto,
Cavalli Fabio
Dracunculiasis (Guinea Worm Disease) is a terrible disease limited, even historically, to the arid and poor areas of our planet and which in the West has always been seen as an exotic disease and therefore has never taken root in the collective imagination. This parasitosis is transmitted to humans by drinking water contaminated with crustacean harboring larvae of Dracunculus medinensis, a nematode. The natural history of the disease is caused by adult worms invading connective tissues and causing blistering, ulceration and edema. Well known in Ancient Egypt where the disease was endemic in its southern area, was known in Europe mainly from the reports of medical writers starting from the Roman imperial period but without direct knowledge. In Middle age the descriptions of this disease that physicians and surgeons could read on medical books, at the end, were attributed to veterinary parasitic disease. In Modern age only during the colonialist era dracunculiasis was perceived as a problem, however sporadic. In 1986 Guinea Worm Eradication Program (GWEP) was launch without success. Thus, the disappearance of this parasitosis should still be postponed but not abandoned.
Letters to the editor
Dark Brown Urine in a patient treated with cefiderocol
Lupia Tommaso,
Salvador Elena,
Corcione Silvia,
De Rosa Francesco Giuseppe
Not available
