Volume 17, Issue 4, 2009
Review
Surgical site infections in Italy
De Carlo,
Schiavone Daniela,
Di Micco Rosa,
Triassi Maria
Surgical site infections (SSIs) are recognized as a common surgical complication, occurring in about 2-5% of all surgical procedures. SSIs represent the third most frequent nosocomial infection, accounting for 14.6% of all infections observed in hospitalised patients and 38% of those observed among surgical patients.
Strategies for the prevention of SSIs also include surveillance which has proved very effective. The most recent surveillance study carried out at a national level in Italy is Kir-Nos, a multicentric study sponsored by GlaxoSmithKline and performed between 1st April and 30th June 2002 in 32 different General Surgery Units for a total of 2972 surgical patients enrolled. Results emerging from the study clearly indicate that many patients receive inappropriate antimicrobial prophylaxis, especially in terms of drug choice, route and timing of administration.
Given the high economic burden that infections provoke, beyond the increased morbidity and mortality, it appears mandatory to improve our tools in order to reduce their incidence, as a reduction of only 0.1% can result in a considerable saving of economic resources to be allocated to other activities, such as screening and prevention programs.
Original article
An active microbiological surveillance project at an Italian teaching Hospital: microbial isolates, recent epidemiological trends, major clinical concerns, and antimicrobial susceptibility rates during a four-year period
Manfredi Roberto,
Nanetti Anna
A microbiological surveillance program is currently performed at our tertiary-care teaching hospital. The temporal trend of microbial isolates from patients admitted during four calendar years (2004 to 2007) was analyzed according to the main bacterial and fungal culture organisms. The same pathogens isolated more than once from the same patient within one month were considered only once. On the whole, the main pathogen group remained that of Enterobacteriaceae (6,608 isolations out of 19,666: 33.6%, with Escherichia coli found in 60-75% of cases), with no significant difference over time. Staphylococci (4,150 isolates), and enterococci (3,276 isolates) were the two largest groups after Enterobacteriaceae, but staphylococci significantly declined during the four-year period (p<.001), mainly due to progressively reduced isolation of coagulase-negative staphylococci. By contrast, a slight increase in enterococci occurred (p<.05). Based on the frequency of isolation, Gram-negative oxidase-positive organisms accounted for 2,109 episodes, followed by other aerobic Gram-positive organisms other than Staphylococci-Enterococci (613 isolates), and anaerobes (583 isolates): no significant variations occurred over time for these last microbial groups. With regard to Gram-negative oxidase-negative microorganisms (567 isolates), non-beta-haemolytic streptococci (464 cases) and beta-haemolytic streptococci (260 isolates), a significant reduction of frequency occurred from 2004 to 2007 (p<.05 to p<.001). Finally, fungal infections accounted for 1,036 overall episodes, in over 80% of cases represented by Candida spp. Prospective microbiological monitoring is expected to contribute significantly to our knowledge of local epidemiological figures and antimicrobial sensitivity profile of hospital infections, and plays a major role in selecting both treatment and chemoprophylaxis schedules, especially on a local-regional basis. Although the major causative agents of in-patient infections remain Enterobacteriaceae, a significant decline in coagulase-negative Staphylococci, all Streptococci, and Gram-negative oxidase-negative organisms occurred over the four-year period, while Enterococci showed a mild increase over time.
Efficacy and safety of a salvage regimen based on tipranavir, enfuvirtide and three nucleoside analogues in HIV-1 infected patients with clinical progression: 96-week evaluation
Sozio Federica,
Polilli Ennio,
D’Annunzio Marco,
Falconi Luigi,
Mazzotta Elena,
Di Masi Francesco,
Tontodonati Monica,
Cosentino Luana,
Consorte Augusta,
Di Giammartino Dante,
Parruti Giustino
In recent years, novel antiretroviral drugs have become available for multi-experienced HIV-infected patients with limited options. We enrolled seven advanced HIV-patients, failing multiple previous HAART regimens, in virological failure on their current HAART regimen and showing recent clinical and immunological progression. All patients were prescribed a double-boosted tipranavir + enfuvirtide based regimen, in addition to zidovudine, tenofovir and lamivudine for salvage therapy. To assess susceptibility to tipranavir, the tipranavir genotypic resistance score was calculated and two years later this was re-evaluated on an updated tipranavir genotypic score algorithm. At baseline, CD4 were 139±145/µL, HIV-1 RNA was 822,700 cp/mL. All patients achieved HIV-1 RNA levels < 400 cp/mL between 12 weeks and 24 weeks of observation; two reached < 50 cp/mL during this period. At 48 weeks three patients had reached < 50 cp/mL; three other patients had HIV RNA < 200 cp/mL. At 72 and 96 weeks HIV viraemia was < 50 cp/mL in six patients; CD4 T-cell counts 285±198/µL. No AIDS-defining events were recorded. Adverse events did not need to stop or change HAART. “Strong” 3 NRTI backbone could help efficacy and durability, and frequent evaluations in complex patients can help to manage toxicity.
In vitro activity of tigecycline against multidrug-resistant Acinetobacter baumannii clinical isolates
Ricciardi Rosanna,
Ricciardi Anna Maria,
Danzi Gaetano
This survey was conducted to evaluate the in vitro activity of tigecycline against 50 isolates of multidrug-resistant (MDR) Acinetobacter baumannii. Isolates of A. baumannii were resistant to ciprofloxacin, chloramphenicol, imipenem, levofloxacin, piperacillin and piperacillin-tazobactam, but were always susceptible to colistin. MICs of tigecycline were determined by E-test in Mueller-Hinton agar. The results of the study showed that 50% of the A. baumannii strains were susceptible to tigecycline (MIC ≤2 µg/ml).
Case report
Antibiotic regimen including linezolid for treating prosthetic valve endocarditis with cerebral embolism due to methicillin-susceptible Staphylococcus aureus after failure with oxacillin and teicoplanin
Brugnaro Pierluigi,
Eseme Franklyn,
Morelli Erika,
Fiscon Marta,
Rosini Giorgio,
Belussi Fabio,
Ebo Francesca,
Petrucci Andrea,
Tenderini Pierluigi,
Raise Enzo
A case of prosthetic valve endocarditis due to methicillin susceptible Staphylococcus aureus (MSSA) with cerebral metastatic seeding is described. The patient is a 61-year-old man with diabetes mellitus, chronic renal failure and previous bacterial endocarditis. Despite appropriate MSSA therapy, the patient was eventually cured with the introduction of linezolid, without needing surgical intervention.
A case of community-acquired MRSA (CA-MRSA) sepsis complicated by meningoencephalitis and cerebral abscess, successfully treated with linezolid
Gattuso Gianni,
Palvarini Loredana,
Tomasoni Donatella,
Ferri Ferdinando,
Scalzini Alfredo
The authors describe a clinical case regarding a young female patient affected by sepsis due to methicillin-resistant Staphylococcus aureus (MRSA), associated to meningoencephalitis and cerebral abscess. The patient had no contact with hospitals in the months prior to illness and had always been healthy. She recovered thanks to linezolid therapy. The MRSA strain proved positive for Panton-Valentine leukocidin (PVL+) and was therefore defined as community-acquired MRSA (CA-MRSA).
Squamous cell carcinoma arising from long-term (50-year) Lupus vulgaris: is there a need for a close medical follow-up in such chronic diseases?
Leocata Pietro,
Crisman Giuliana,
Vitale Anna Rita,
Siniscalchi Giovanni,
Biondi Paolo,
Colella Giuseppe
Skin manifestations of tuberculous infection (Mycobacterium tuberculosis) are represented by miliary tuberculosis of the skin, tuberculous chancre, scrofuloderma, tuberculosis verrucosa cutis, periorificial tuberculosis, and lupus vulgaris (LV). Among this group, LV is the most common skin condition, diagnosed in 10% of tuberculotic patients. The authors report herein a case of squamous cell carcinoma (SCC) arising from long-standing (50-year) LV and underline the need of an extensive follow-up of tuberculotic lesions.
Infant botulism mimicking an acute abdomen
Pisanti Roberta,
Vitiello Renato,
Formicola Stefania,
Pisanti Antonello
Botulism is the acute, flaccid paralysis caused by a neurotoxin produced by Clostridium botulinum. In the infant, clinical symptoms are usually unspecific such as poor feeding, weak suck, feeble cry, drooling, followed by a symmetric, descending, flaccid paralysis beginning with the cranial nerve musculature. The initial symptoms of the disease are often similar to several diseases and therefore differential diagnosis is very difficult and rarely suspected by the physician. Since 2004 only 22 cases of infant botulism have been reported in Italy. Since most paediatricians are unfamiliar with the clinical manifestations of infant botulism, the diagnosis can be easily missed. Hence the disease may well be underestimated and underreported. We report a clinical case of botulism presenting initially with abdominal distention, thereby mimicking acute abdomen.
The Infections in the History of Medicine
The Antonine Plague and the decline of the Roman Empire
Sabbatani Sergio,
Fiorino Sirio
The Antonine Plague, which flared up during the reign of Marcus Aurelius from 165 AD and continued under the rule of his son Commodus, played such a major role that the pathocenosis in the Ancient World was changed. The spread of the epidemic was favoured by the occurrence of two military episodes in which Marcus Aurelius himself took part: the Parthian War in Mesopotamia and the wars against the Marcomanni in northeastern Italy, in Noricum and in Pannonia. Accounts of the clinical features of the epidemic are scant and disjointed, with the main source being Galen, who witnessed the plague. Unfortunately, the great physician provides us with only a brief presentation of the disease, his aim being to supply therapeutic approaches, thus passing over the accurate description of the disease symptoms. Although the reports of some clinical cases treated by Galen lead us to think that the Antonine plague was caused by smallpox, palaeopathological confirmation is lacking. Some archaeological evidence (such as terracotta finds) from Italy might reinforce this opinion. In these finds, some details can be observed, suggesting the artist’s purpose to represent the classic smallpox pustules, typical signs of the disease. The extent of the epidemic has been extensively debated: the majority of authors agree that the impact of the plague was severe, influencing military conscription, the agricultural and urban economy, and depleting the coffers of the State. The Antonine plague affected ancient Roman traditions, also leaving a mark on artistic expression; a renewal of spirituality and religiousness was recorded. These events created the conditions for the spread of monotheistic religions, such as Mithraism and Christianity. This period, characterized by health, social and economic crises, paved the way for the entry into the Empire of neighbouring barbarian tribes and the recruitment of barbarian troops into the Roman army; these events particularly favoured the cultural and political growth of these populations. The Antonine Plague may well have created the conditions for the decline of the Roman Empire and, afterwards, for its fall in the West in the fifth century AD.
Letters to the editor
Community–acquired streptococcal toxic shock syndrome
Sanchez-Porto Antonio,
Casanova-Roman Manuel,
Casas-Ciria Javier,
Diaz de Sousa Pedro
Abstract not available
First enteric Escherichia fergusonii from Italy
Savini Vincenzo,
Catavitello Chiara,
Bianco Azaira,
Masciarelli Gioviana,
Astolfi Daniela,
Balbinot Andrea,
Dantonio Domenico
Abstract nor available
