Volume 7, Issue 1, 1999
Review
Benefit/risk ratio of antibiotic therapy
Rossi Franco,
Mangrella Mario,
Mazzeo Filomena
This publication evaluates critically the benefit/risk profile of several antibiotics currently at our disposal.
The considered antibiotics are divided into pharmacological classes, because generally the drugs of the same class share the same adverse events. Moreover, the high therapeutic profile of the antibiotics puts them at the top of the safest drugs. Therefore the choice of an antibiotic is based above all on the evaluation of the patient and of the pathology to be treated, in terms of severity and possibility of achieving a response to treatment. An accurate anamnesis, the identification of the correct dosage and of the therapy duration minimise the potential risks of the chosen treatment. Detailed knowledge of the safety profile of these drugs is a further element in order for the antibiotic to perform at its best.
Original article
Mortality among drug addicts in Bologna – A cohort study (1977-1997)
Sabbatani Sergio,
Di Crecsenzo Ettore
Our study concerns the life status at the 31st december1997 of 1214 DA (drug addicts, mostly heroin addicted), enrolled by a SerT (Servizio per Tossicodipendenti, DA Healthcare Unit) in Bologna over the 1977-1996 period. All subjects were categorised by their HIV status (positive, negative or unknown), life status (alive or dead) and cause of death. Data were analysed with the Chi-square test and the test of difference between two proportions. We calculated the standard mortality ratio (SMR), the mortality rates per 100 person-years (P-Y), and the death probability according to Grevile’s formula, both in the population of Bologna and in our DA population. We observed 182 deaths (14.99%) among the 1214 monitored over a 8012 person-year period. From 1984 to 1997 the mortality rate in the DA population was 2.27 per 100 P-Y. In the 1986-1996 period the death probability among DA was 4-to 5-fold higher than in the general population for the same age groups. From 1977 to 1983 no disease was recorded among the first 200 enrolled subjects. From 1984 to 1977 mortality was 28.1% among the 426 HIV-positive DA, 0.46% among the 433 HIV-negative DA, and 17.1% among the 355 DA with unknown HIV status. AIDS caused 106 deaths (58%), overdoses 40 (22%), car accident 15 (8%), hepatic cirrhosis 9 (5%), and other causes (miscellany) 11 (6%). In 1 (0.5%) case the cause of death was unknown. The mortality rate (MR) for AIDS was 12.8% for females, 7.4% for males (p<0.05); the MR for overdose was 3.8% for males, 0% for females; the MR for car accident was 1.2% for males, 1.3% for females; the MR for the miscellany of other causes was 1.3% for males and 0% for females. The SMR in the 20-49 age group in the 1984-1990 period was 34.7, while in the 1991-1996 period it was 143.4.
Survey on ciprofloxacin resistance: the epidemiological situation in Pordenone (Italy)
Camporese Alessandro,
Tizianel Gianni,
Santini Gianfranco
An epidemiological survey on 2859 bacterial strains was performed in the first nine months of 1998, to verify the predominant susceptibility to ciprofloxacin of the main microrganisms isolated in this period. Our results showed that the use of ciprofloxacin would probably decrease in future because of increasing resistance with respect to previous period. An increase in antimicrobial resistance occurred in some gram positive (as Enterococci) and especially gram negative strains such as Escherichia coli, that are common and frequent bacterial causes of infections in hospital and in the community. The study demonstrated that there are also interesting and important variations in resistance patterns with respect to previous studies.
Conservative treatment of diabetic foot infections
Kara Inci,
Çetin Banu,
Yalçin Nevzat,
Sermez Yurdaer
Foot infections commonly occur in diabetic patients, constituting a serious problem. 15% of diabetic have foot infections during their life-time. In previous years these life- threatening infections in 50-70% of patients resulted in limb amputation. Today, using an aggressive surgical approach, broad spectrum antimicrobial chemotherapy and intensive regulation of blood glucose level, the amputation rate has decreased to 5%. During the last 2 years, we evaluated 13 diabetic foot infections. 6 of the presented cases were grade 4 and 5, 3 of them grade 3 and 4 of them grade 2. All of the patients were managed by multidisciplinary approach consisting of plastic and reconstructive surgery, endocrinology and infectious diseases specialists. All of the patients were monitored with daily wound care, regulation of blood glucose levels and administration of broad spectrum antibiotics. Only one of them required amputation. For 12 of the cases after the infection was controlled, the defects were reconstructed by plastic surgical procedures. We retrospectively analysed them to review diabetic foot infections and factors affecting prognosis.
HIV disease and bacterial superinfections due to Xanthomonas spp.: a frequent association
Manfredi Roberto,
Nanetti Anna,
Ferri Morena,
Chiodo Francesco
Sixty-four episodes of Xanthomonas spp. infection were observed in 2.400 patients hospitalised for HIV disease (~2.7%) over an 8-year period: sepsi-bacteremia in 52 cases, lower respiratory tract infection in 6 cases, urinary tract infection in three patients, pharyngitis in two cases, and lymph node resented the fourth most common non-mycobacterial bacterial pathogens responsible for bacteremia in our HIV-infected patients: 52 cases out of 878 diagnosed (5.9%). The progression of HIV-related immunodeficiency, the occurrence of leukopenia-neutropenia, hospitalisation, previous antibiotic and/or corticosteroid treatment, and instrumentation, seemed to act as risk factors for the occurrence of Xanthomonas spp. infection. In three patients suffering from severe immunodeficiency and concurrent AIDS-related disorders, Xanthomonas spp. complication contributed to death, while a relapsing disease occurred in two cases only. Because of the poor antimicrobial susceptibility of these pathogens (also confirmed in our series), Xanthomonas spp. infection associated with advanced HIV disease and concurrent risk factors, may represent a potentially severe complication.
Case report
Salmonella typhi disease in HIV-infected patients: case reports and literature review
Manfredi Roberto,
Chiodo Francesco
Two patients with AIDS and severe immunodeficiency developed typhoid fever. The diagnosis was confirmed by isolation of Salmonella typhi from blood cultures, while Widal’s serum test isolates proved in vitro sensitive to all tested antimicrobial agents, and complete recovery was obtained with i.v. cotrimoxazole and piperacillin treatment. Unlike complications by non-tiphoid Salmonellae, S. typhi infection has been infrequently reported in the context of AIDS: to our knowledge, only five cases of typhoid fever have been described in HIV-infected living industrialized countries.
Medical history and epidemiological information may play an important role in prompting the search for an S. typhi infection in patients coming from endemic regions, since most of the sign and symptoms of typhoid fever may mimic those of a sepsis. Or other AIDS-related complications.
Primary dorsal localization of invertebrate hydatidosis
Giobbia Mario,
Scotton PierGiorgio,
Carniato Antonella,
Vaglia Alberto
We describe patient with Echinococcus granulosus disease primary localized on the back. This case is uncommon because of the lack of risk exposure history and the sole muscular localization. The patient received several surgical operations on the back, without eradication of the infestation. At the end we discuss the clinical considerations that induced the choice of the usual medical therapy.
The Infections in the History of Medicine
Strascino’s compliant. Syphilis and the XVI Century Sienese theatre
Vannozzi Francesca
Niccolo Campani, known with the nickname “Strascino” (as shabby, beggarly), is among the most important poets in the XVI Century in Italian theatre. Famous for his sharp-witted humor and the perfect Tuscan rhyming, the Sienese poet left a work whose subject is syphilis, cooght by Campany from 1503 to 1511. In Strascino’s Compliant, the poet describes in rhyme the course and recovery of the illness, giving a very personal testimony of being ill with the “la malaise francaise” and a broad overview of the sixteenth Century in Italy.
