Volume 15, Issue 4, 2007
Review
Antibacterial activity and pharmacological features of fluoroquinolones and considerations on their use in a nosocomial setting
Cornaglia Giuseppe,
Koncan Raffaella,
Arrigucci Silvia,
Novelli Andrea
The need for appropriate use of antimicrobials limiting the insurgence, selection and spread of bacterial resistance and preventing its diffusion to the community is increasingly widely felt. Based on some CDC expert recommendations, an antibiotic therapy should be driven by the following criteria: scientifically proven clinical evidence, high probability of being beneficial to patients, safety and tolerability, drug and regimen choice made according to the infection to be treated, and cost/efficacy ratio. In this article, we compare the microbiological and pharmacological characteristics of the three most frequently used fluoroquinolones in Italy - ciprofloxacin, levofloxacin, and moxifloxacin - highlighting the main differences and peculiar aspects for each of them. We describe the microbiological profile, providing details on bacterial resistance mechanisms, the pharmacological profile, giving details on tolerability, and the clinical profile, showing the individual therapeutic efficacy, underlining the main differences in their pharmacodynamic and pharmacokinetic aspects.
The main national and international guidelines recommend ciprofloxacin and levofloxacin and, to a lesser extent, moxifloxacin, for treating nosocomial infections localised in different organs and apparatuses, including severe infections in critical patients. In addition, they represent a basic therapeutic option for treatment of community-acquired infections, such as urinary and respiratory tract infections.
Original article
Effect of omega-3 fatty acids on the lipid structure of HIV positive patients on antiretroviral therapy: personal observation of 20 subjects
Ranieri Roberto
Hyperlipidaemia related to antiretroviral therapy is a major issue in the management of HIV infection. In HIV positive patients, interventions on their lifestyles and dietary habits are only partially effective and pharmacological support is often required. However, fibrates and statins, interacting with antiretroviral therapy, may cause toxicity. A number of clinical trials have shown the effectiveness of omega-3 fatty acids on the hyperlipidaemia of HIV patients. In this study, the effect of six-month daily administration of omega-3 fatty acids on triglycerides, total and LDL cholesterol, and CD4 cell count was evaluated in a group of 20 HIV positive patients. Triglyceride levels significantly decreased, whilst total, LDL cholesterol and CD4 cell count did not vary. Fish oil therapy was well tolerated by all patients. Omega-3 fatty acids may contribute to reduce cardiovascular risk in HIV positive patients.
Reduced incidence of Staphylococcus isolation in nosocomial setting after introducing preoperative antibiotic prophylaxis guidelines.
Gattuso Gianni,
Berra Davide,
Palvarini Loredana,
Tomasoni Donatella,
Chiarelli Cristina,
Stradoni Raffaello,
Scalzini Alfredo
We compare epidemiological data from two twelve-month periods, before and after the introduction of preoperative antibiotic prophylaxis guidelines at “Carlo Poma” hospital in Mantova, Italy, in June 2003. Considering the results from the microbiology laboratory and the data from the pharmacy, concerning the consumption of some antimicrobials, we noted a significant decrease in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in surgical wards, where the incidence of MRSA had previously exceeded that in medical wards. At the same time, analysis of antibiotic consumption revealed a considerable decrease in third and fourth-generation cephalosporins and an increasing use of cephazolin, in compliance with prophylaxis protocol rules. This trend was confirmed by analysis of the same data regarding the first six months of 2006.
Time trends in health care needs of non-EU citizens from developing countries, admitted to a general hospital in northern Italy
Sabbatani Sergio,
Baldi Elena,
Manfredi Roberto
Hospitalizations of foreign patients from developing countries outside the European Union were examined for the period 1999-2004, focusing on infectious diseases and on pregnancy issues. Patients over 14 years old had 6,003 admissions, leading to 7,231 overall diagnoses. During the 6-year study period, female hospitalizations increased steadily, with a peak in 2002 (p<.001). This trend was mainly due to the rise in women from Eastern Europe (p<.001), which occurs at a younger mean age versus that of males (p<.001). Admission of illegal immigrants, performed on an emergency basis, accounted for an average of 9.4%. This phenomenon was very frequent in 1999 (43% of admissions), but dropped sharply after 2002 (p<.001), caused by changes in Italian law. The prevalent women diagnoses were ob/gyn ones: voluntary pregnancy interruption, spontaneous abortion or pregnancy complications in 30.6% of cases, and childbirths or controls of pregnancies with a favourable outcome in 18.2% of patients. These diagnoses covered nearly 50% of hospitalizations of migrant women: other admissions were due to organic, dysmetabolic, or functional disorders, while infectious diseases were less frequent (4.6%). Among men, dysmetabolic disorder and organic-degenerative diseases, or functional illnesses (36.2%), were prominent, and significantly more frequent versus women (p<.001), as well as post-traumatic diseases (16.5%), and infectious illnesses (12.1%; p<.001). Also generic-undefined diagnoses were proportionally numerous (6.6%): cultural-language deficiencies affected the physician-patient relationship. Among infectious diseases, the main causative organisms were Mycobacterium tuberculosis (14.9%), HIV (7.1%), HBV (3.3%), and HCV (2.6%). Upper-lower airways represented the most involved organ system (45% of discharges), followed by the gastroenteric tract (16.4%), and skin-soft tissues (7.4%), while systemic infectious diseases accounted for 14.9% of episodes. Such disorders predominated (up to 90% of cases) among non-regular migrants during 1999-2000, while after 2002 an increase in infectious disorders was observed among patients from Eastern Europe.
From a health care-social perspective, although a reduced incidence of infectious diseases did not occur, the possibility of attributing them to individuals of ascertained identity and housing makes it possible to trace index patients, and ultimately strive towards well-planned and effective therapeutic-preventive interventions.
Case report
Infected atrial myxoma: case report and literature review
Leone Sebastiano,
dell’Aquila Giuseppina,
Giglio Sergio,
Magliocca Mario,
Maio Patrizia,
Nigro Francesco Saverio,
Pacifico Piera,
De Chiara Giovanni,
Acone Nicola,
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Myxoma is the most common type of cardiac tumour in all age groups. It may simulate infective endocarditis but is rarely infected. We describe one case of infected left atrial myxoma caused by Enterococcus faecalis. Combined therapy, consisting of surgical management and antimicrobial therapy, was used. Histological examination of the excised tumour revealed a typical myxoma with infiltrates of neutrophils. Few cases of infected atrial myxomas have been reported in the literature.
Invasive aspergillosis in an immunocompromised patient: clinical and therapeutic considerations
De Rosa Francesco Giuseppe,
Garazzino Silvia,
Audagnotto Sabrina,
Michelazzo Marianna,
Gobbi Federico,
Di Perri Giovanni
The paper describes a case report of a young female with invasive aspergillosis diagnosed after brief treatment with high-dose steroids for autoimmune thrombocytopenia. Early diagnosis of invasive aspergillosis was made with cultures of tracheoaspirates and bronchoalveolar lavage and was confirmed with a transbronchial biopsy. After initial ineffective treatment with liposomal amphotericin B and dissemination from pulmonary to central nervous system involvement, treatment was switched to a combination of voriconazole and caspofungin. After marked clinical and radiological improvement, treatment was switched to the orally administered formulation of voriconazole until the complete disappearance of central nervous system lesion was observed. In the discussion section we underscore the most significant data of the host susceptibility, diagnosis of invasive aspergillosis, complications and treatment. This case ably demonstrates the efficacy of new antifungal agents, even when administered orally, and underscores the variability of host susceptibility to atypical and often unexpected invasive fungal infections.
Difficulty in diagnosing pediatric tuberculosis
Losurdo Giuseppe,
Natalizia Anna Rita,
Amisano Alice,
Bertoluzzo Luisella,
Mantero Enrico,
Giacchino Raffaella
Tuberculosis (TB) in children is an important warning sign in a community, as it could signal recent infection of a cavitary form in an adult. Thus, while early diagnosis is crucial for effective treatment in children, it is also imperative for the control of tuberculosis at the public health level since it allows rapid identification of contagious adult cases. Here we report four cases of difficult and delayed diagnosis of TB in children. From this experience we highlight the need for an extensive medical history of the patient during diagnostic work-up. This includes: the positive history for contact with infected adults, especially for immigrant children; exclusion of TB diagnosis for persistent respiratory symptoms (2-3 weeks) after antibiotic therapy; and the need for high-definition CT scan when the radiological picture is not specific, especially for children under 5 years of age.
The Infections in the History of Medicine
The “Spanish influenza” pandemic
Sabbatani Sergio,
Fiorino Sirio
The influenza pandemic of 1918-1919, so-called Spanish influenza, spread to almost all nations worldwide. This outbreak is thought to have killed 25 million people, although some have claimed that the epidemic resulted in as many as 40 million deaths. This pandemic was a particularly dramatic event, because it occurred at the end of World War I, when both armies and the civilian population, in nations involved in the war, were exhausted. In Italy 600,000 people are estimated to have died of Spanish influenza. Together with the death of 650,000 soldiers during the war, this had a major demographic impact.
We describe the course of the epidemic in Italy as a whole and in Bologna in particular. In Bologna and in its province we analysed the lists drawn up at the end of the World War I by the Central Records Office in Bologna, which coordinated research into causes of death of soldiers engaged in the conflict. We also examined the trend of burials at Certosa in Bologna in the first decades of the last century in order to establish, during the two-year period 1918-1919, the impact of the epidemic upon annual mortality.
In Bologna the impact of the epidemic, albeit important in comparison to other situations, was not particularly dramatic. No special preventive measures were adopted, with the exception of isolating seriously ill patients in a former school converted by the military authorities into a hospital. Family doctors worked together actively with the city’s medical authorities when the epidemiological survey was carried out.
