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11. A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients

Author

Campoli, C., Siccardi, G., Ambretti, S., Stallmach, A., Venditti, M., Lucidi, C., Ludovisi, S., De Cueto, M., Navarro, M.D., Lopez Cortes, E., Bouza, E., Valerio, M., Eworo, A., Losito, R., Senzolo, M., Nadal, E., Ottobrelli, A., Varguvic, M., Badia, C., Borgia, G., Gentile, I., Buonomo, A.R., Boumis, E., Beteta-Lopez, A., Rianda, A., Taliani, G., Grieco, S., Bartoletti, M., Giannella, M., Lewis, R., Caraceni, P., Tedeschi, S., Paul, M., Schramm, C., Bruns, T., Merli, M., Cobos-Trigueros, N., Seminari, E., Retamar, P., Muñoz, P., Tumbarello, M., Burra, P., Torrani Cerenzia, M., Barsic, B., Calbo, E., Maraolo, A.E., Petrosillo, N., Galan-Ladero, M.A., D'Offizi, G., Bar Sinai, N., Rodríguez-Baño, J., Verucchi, G., Bernardi, M., and Viale, P.

Published
2018
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17. Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: results from a multicenter case–control–control study

Author

Giacobbe, D.R., Del Bono, V., Trecarichi, E.M., De Rosa, F.G., Giannella, M., Bassetti, M., Bartoloni, A., Losito, A.R., Corcione, S., Bartoletti, M., Mantengoli, E., Saffioti, C., Pagani, N., Tedeschi, S., Spanu, T., Rossolini, G.M., Marchese, A., Ambretti, S., Cauda, R., Viale, P., Viscoli, C., and Tumbarello, M.

Published
2015
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20. A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients

Author

Bartoletti, M., primary, Giannella, M., additional, Lewis, R., additional, Caraceni, P., additional, Tedeschi, S., additional, Paul, M., additional, Schramm, C., additional, Bruns, T., additional, Merli, M., additional, Cobos-Trigueros, N., additional, Seminari, E., additional, Retamar, P., additional, Muñoz, P., additional, Tumbarello, M., additional, Burra, P., additional, Torrani Cerenzia, M., additional, Barsic, B., additional, Calbo, E., additional, Maraolo, A.E., additional, Petrosillo, N., additional, Galan-Ladero, M.A., additional, D'Offizi, G., additional, Bar Sinai, N., additional, Rodríguez-Baño, J., additional, Verucchi, G., additional, Bernardi, M., additional, Viale, P., additional, Campoli, C., additional, Siccardi, G., additional, Ambretti, S., additional, Stallmach, A., additional, Venditti, M., additional, Lucidi, C., additional, Ludovisi, S., additional, De Cueto, M., additional, Navarro, M.D., additional, Lopez Cortes, E., additional, Bouza, E., additional, Valerio, M., additional, Eworo, A., additional, Losito, R., additional, Senzolo, M., additional, Nadal, E., additional, Ottobrelli, A., additional, Varguvic, M., additional, Badia, C., additional, Borgia, G., additional, Gentile, I., additional, Buonomo, A.R., additional, Boumis, E., additional, Beteta-Lopez, A., additional, Rianda, A., additional, Taliani, G., additional, and Grieco, S., additional

Published
2018
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22. Development and validation of a prediction model for severe respiratory failure in hospitalized patients with SARS-Cov-2 infection: a multicenter cohort study (PREDI-CO study)

Author

Ciro Fulgaro, Ioannis Tzimas, Luigi Raumer, Marianna Meschiari, Marianna Menozzi, Gabriella Verucchi, Giada Rossini, Filippo Trapani, Giacomo Fornaro, Michela Semprini, Alessandra Cascavilla, Emanuele Campaci, Maddalena Giannella, Luigia Scudeller, Alessandro Zuccotti, Irid Baxhaku, Lucia Angelelli, Eleonora Zamparini, Annalisa Saracino, Alberto Zuppiroli, Cristina Basso, Elisabetta Pierucci, Agostino Rossi, Giulia Santangelo, Paolo Gaibani, Francesco Cristini, Francesca Volpato, Elisa Fronti, Giovanni Guaraldi, Alberto Sarti, Giorgio Legnani, Mattia Neri, Mauro Codeluppi, Adriana Badeanu, Giulio Virgili, Chiara Pironi, Lorenzo Marconi, Sara K. Tedeschi, Vidak Koprivika, Francesco Barchiesi, Luciano Attard, Matteo Rinaldi, Paola Laghetti, Stefano Antonini, Linda Bussini, Caterina Campoli, Giacomo Urbinati, Marco Merli, Nicholas Roncagli, Agnese Pratelli, Elena Rosselli Del Turco, Silvia Rapuano, Luca Guerra, Stefano Ianniruberto, Francesco Dell'Omo, Michele Bartoletti, Livia Pancaldi, Viola Guardigni, Fabio Tumietto, Giuseppe Sasdelli, Vito Marco Ranieri, Flovia Dauti, Giovanni Fasulo, Eugenia Francalanci, Nicola Dentale, Amalia Sanna Passino, Tommaso Zanaboni, Arianna Rubin, Davide Fiore Bavaro, Idina Zavatta, Massimo Puoti, Letizia Pasinelli, Maria Cristina Leoni, Pierluigi Viale, Oana Vatamanu, Elena Piccini, Renato Pascale, Cristina Mussini, Luca Esposito, Simona Coladonato, Alice Gori, Giulia Tesini, Lorenzo Badia, Mara D'Onofrio, Alberto Licci, Enrico Evangelisti, Guido Maria Liuzzi, Giacinto Pizzilli, Nicolò Rossi, Tommaso Tonetti, Marina Tadolini, Zeno Pasquini, Caterina Vocale, Bartoletti M., Giannella M., Scudeller L., Tedeschi S., Rinaldi M., Bussini L., Fornaro G., Pascale R., Pancaldi L., Pasquini Z., Trapani F., Badia L., Campoli C., Tadolini M., Attard L., Puoti M., Merli M., Mussini C., Menozzi M., Meschiari M., Codeluppi M., Barchiesi F., Cristini F., Saracino A., Licci A., Rapuano S., Tonetti T., Gaibani P., Ranieri V.M., Viale P., Raumer L., Guerra L., Tumietto F., Cascavilla A., Zamparini E., Verucchi G., Coladonato S., Rubin A., Ianniruberto S., Francalanci E., Volpato F., Virgili G., Rossi N., Del Turco E.R., Guardigni V., Fasulo G., Dentale N., Fulgaro C., Legnani G., Campaci E., Basso C., Zuppiroli A., Passino A.S., Tesini G., Angelelli L., Badeanu A., Rossi A., Santangelo G., Dauti F., Koprivika V., Roncagli N., Tzimas I., Liuzzi G.M., Baxhaku I., Pasinelli L., Neri M., Zanaboni T., Dell'Omo F., Vatamanu O., Gori A., Zavatta I., Antonini S., Pironi C., Piccini E., Esposito L., Zuccotti A., Urbinati G., Pratelli A., Sarti A., Semprini M., Evangelisti E., D'Onofrio M., Sasdelli G., Pizzilli G., Pierucci E., Rossini G., Vocale C., Marconi L., Leoni M.C., Fronti E., Guaraldi G., Bavaro D., Laghetti P., Bartoletti, M, Giannella, M, Scudeller, L, Tedeschi, S, Rinaldi, M, Bussini, L, Fornaro, G, Pascale, R, Pancaldi, L, Pasquini, Z, Trapani, F, Badia, L, Campoli, C, Tadolini, M, Attard, L, Puoti, M, Merli, M, Mussini, C, Menozzi, M, Meschiari, M, Codeluppi, M, Barchiesi, F, Cristini, F, Saracino, A, Licci, A, Rapuano, S, Tonetti, T, Gaibani, P, Ranieri, V, Viale, P, Raumer, L, Guerra, L, Tumietto, F, Cascavilla, A, Zamparini, E, Verucchi, G, Coladonato, S, Rubin, A, Ianniruberto, S, Francalanci, E, Volpato, F, Virgili, G, Rossi, N, Del Turco, E, Guardigni, V, Fasulo, G, Dentale, N, Fulgaro, C, Legnani, G, Campaci, E, Basso, C, Zuppiroli, A, Passino, A, Tesini, G, Angelelli, L, Badeanu, A, Rossi, A, Santangelo, G, Dauti, F, Koprivika, V, Roncagli, N, Tzimas, I, Liuzzi, G, Baxhaku, I, Pasinelli, L, Neri, M, Zanaboni, T, Dell'Omo, F, Vatamanu, O, Gori, A, Zavatta, I, Antonini, S, Pironi, C, Piccini, E, Esposito, L, Zuccotti, A, Urbinati, G, Pratelli, A, Sarti, A, Semprini, M, Evangelisti, E, D'Onofrio, M, Sasdelli, G, Pizzilli, G, Pierucci, E, Rossini, G, Vocale, C, Marconi, L, Leoni, M, Fronti, E, Guaraldi, G, Bavaro, D, and Laghetti, P

Subjects
0301 basic medicine, Male, Logistic regression, prognostic tool, 0302 clinical medicine, Risk Factors, Positive predicative value, Severe acute respiratory syndrome coronavirus 2, 030212 general & internal medicine, Child, Aged, 80 and over, Framingham Risk Score, Coronavirus disease 2019, Respiratory distress, Lactate dehydrogenase, General Medicine, Middle Aged, Prognosis, Hospitalization, Infectious Diseases, Italy, Child, Preschool, Female, Coronavirus Infections, Respiratory Insufficiency, Cohort study, Microbiology (medical), Adult, medicine.medical_specialty, Respiratory rate, Adolescent, COVID-19, SARS-CoV-2, severe respiratory failure, 030106 microbiology, Pneumonia, Viral, Risk Assessment, Sensitivity and Specificity, Article, 03 medical and health sciences, Betacoronavirus, Young Adult, Age, Internal medicine, medicine, Humans, Obesity, Pandemics, Aged, Retrospective Studies, business.industry, Reproducibility of Results, Retrospective cohort study, Logistic Models, Respiratory failure, Multivariate Analysis, business, C-reactive proteine
Abstract

Objectives: We aimed to develop and validate a risk score to predict severe respiratory failure (SRF) among patients hospitalized with coronavirus disease-2019 (COVID-19). Methods: We performed a multicentre cohort study among hospitalized (>24 hours) patients diagnosed with COVID-19 from 22 February to 3 April 2020, at 11 Italian hospitals. Patients were divided into derivation and validation cohorts according to random sorting of hospitals. SRF was assessed from admission to hospital discharge and was defined as: SpO2 30 breaths/min or respiratory distress. Multivariable logistic regression models were built to identify predictors of SRF, β-coefficients were used to develop a risk score. Trial Registration NCT04316949. Results: We analysed 1113 patients (644 derivation, 469 validation cohort). Mean (±SD) age was 65.7 (±15) years, 704 (63.3%) were male. SRF occurred in 189/644 (29%) and 187/469 (40%) patients in the derivation and validation cohorts, respectively. At multivariate analysis, risk factors for SRF in the derivation cohort assessed at hospitalization were age ≥70 years (OR 2.74; 95% CI 1.66–4.50), obesity (OR 4.62; 95% CI 2.78–7.70), body temperature ≥38°C (OR 1.73; 95% CI 1.30–2.29), respiratory rate ≥22 breaths/min (OR 3.75; 95% CI 2.01–7.01), lymphocytes ≤900 cells/mm3 (OR 2.69; 95% CI 1.60–4.51), creatinine ≥1 mg/dL (OR 2.38; 95% CI 1.59–3.56), C-reactive protein ≥10 mg/dL (OR 5.91; 95% CI 4.88–7.17) and lactate dehydrogenase ≥350 IU/L (OR 2.39; 95% CI 1.11–5.11). Assigning points to each variable, an individual risk score (PREDI-CO score) was obtained. Area under the receiver-operator curve was 0.89 (0.86–0.92). At a score of >3, sensitivity, specificity, and positive and negative predictive values were 71.6% (65%–79%), 89.1% (86%–92%), 74% (67%–80%) and 89% (85%–91%), respectively. PREDI-CO score showed similar prognostic ability in the validation cohort: area under the receiver-operator curve 0.85 (0.81–0.88). At a score of >3, sensitivity, specificity, and positive and negative predictive values were 80% (73%–85%), 76% (70%–81%), 69% (60%–74%) and 85% (80%–89%), respectively. Conclusion: PREDI-CO score can be useful to allocate resources and prioritize treatments during the COVID-19 pandemic.

Published
2020

23. A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients

Author

Ivan Gentile, Jesús Rodríguez-Baño, Alia Eworo, Gloria Taliani, E. Nadal, M. Valerio, A. Beteta-Lopez, Christoph Schramm, Pierluigi Viale, Bruno Baršić, Cristina Badia, S. Ludovisi, Alberto Enrico Maraolo, Gabriella Verucchi, Elena Seminari, M. de Cueto, Maddalena Giannella, E. Boumis, S. Grieco, Pilar Retamar, Nazaret Cobos-Trigueros, Caterina Campoli, Emilio Bouza, Mauro Bernardi, Patrizia Burra, M. Varguvic, Sara K. Tedeschi, Esther Calbo, María Dolores González-Ripoll Navarro, N. Bar Sinai, Mario Venditti, Andreas Stallmach, Russell E. Lewis, Guglielmo Borgia, Patricia Muñoz, Antonio Riccardo Buonomo, Mical Paul, Gianpiero D'Offizi, Michele Bartoletti, Paolo Caraceni, M.A. Galan-Ladero, Mario Tumbarello, Manuela Merli, Marco Senzolo, G. Siccardi, R. Losito, A. Ottobrelli, E. Lopez Cortes, A. Rianda, Cristina Lucidi, Simone Ambretti, Nicola Petrosillo, M. Torrani Cerenzia, Tony Bruns, Bartoletti, M., Giannella, M., Lewis, R., Caraceni, P., Tedeschi, S., Paul, M., Schramm, C., Bruns, T., Merli, M, Cobos-Trigueros, N., Seminari, E., Retamar, P., Muñoz, P., Tumbarello, M., Burra, P., Torrani Cerenzia, M., Barsic, B., Calbo, E., Maraolo, A.E., Petrosillo, N., Galan-Ladero, M.A., D'Offizi, G., Bar Sinai, N., Rodríguez-Baño, J., Verucchi, G., Bernardi, M., Viale, P., Bartoletti, M, Giannella, M, Lewis, R, Caraceni, P, Tedeschi, S, Paul, M, Schramm, C, Bruns, T, Cobos-trigueros, N, Seminari, E, Retamar, P, Muñoz, P, Tumbarello, M, Burra, P, Torrani Cerenzia, M, Barsic, B, Calbo, E, Maraolo, Ae, Petrosillo, N, Galan-ladero, Ma, D'Offizi, G, Bar Sinai, N, Rodríguez-baño, J, Verucchi, G, Bernardi, M, Viale, P, Campoli, C, Siccardi, G, Ambretti, S, Stallmach, A, Venditti, M, Lucidi, C, Ludovisi, S, De Cueto, M, Navarro, Md, Lopez Cortes, E, Bouza, E, Valerio, M, Eworo, A, Losito, R, Senzolo, M, Nadal, E, Ottobrelli, A, Varguvic, M, Badia, C, Borgia, G, Gentile, I, Buonomo, Ar, Boumis, E, Beteta-lopez, A, Rianda, A, Taliani, G, and Grieco, S.

Subjects
Liver Cirrhosis, Male, Microbiology (medical), medicine.medical_specialty, Multidrug-resistant pathogen, Comorbidity, Bloodstream infection, Bacterial infections, Bloodstream infections, CLIF-SOFA, Multidrug-resistant pathogens, Logistic regression, Liver cirrhosi, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Sepsis, Internal medicine, Epidemiology, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Mortality, Risk factor, Intensive care medicine, Prospective cohort study, Aged, Proportional hazards model, business.industry, Liver cirrhosis, Infectious Diseases, Mortality rate, Hazard ratio, Disease Management, Drug Resistance, Microbial, General Medicine, Middle Aged, Prognosis, Patient Outcome Assessment, Population Surveillance, Female, 030211 gastroenterology & hepatology, Bacterial infection, business, Cohort study
Abstract

ESGBIS/BICHROME Study Group: C. Campoli, G. Siccardi, S. Ambretti, A. Stallmach, M. Venditti, C. Lucidi, S. Ludovisi, M. De Cueto, M. D. Navarro, E. Lopez Cortes, E. Bouza, M. Valerio, A. Eworo, R. Losito, M. Senzolo, E. Nadal, A. Ottobrelli, M. Varguvic, C. Badia, G. Borgia, I. Gentile, A. R. Buonomo, E. Boumis, A. Beteta-Lopez, A. Rianda, G. Taliani, S. Grieco., [Objectives] To describe the current epidemiology of bloodstream infection (BSI) in patients with cirrhosis; and to analyse predictors of 30-day mortality and risk factors for antibiotic resistance., [Methods] Cirrhotic patients developing a BSI episode were prospectively included at 19 centres in five countries from September 2014 to December 2015. The discrimination of mortality risk scores for 30-day mortality were compared by area under the receiver operator risk and Cox regression models. Risk factors for multidrug-resistant organisms (MDRO) were assessed with a logistic regression model., [Results] We enrolled 312 patients. Gram-negative bacteria, Gram-positive bacteria and Candida spp. were the cause of BSI episodes in 53%, 47% and 7% of cases, respectively. The 30-day mortality rate was 25% and was best predicted by the Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure–SOFA (CLIF-SOFA) score. In a Cox regression model, delayed (>24 hours) antibiotic treatment (hazard ratio (HR) 7.58; 95% confidence interval (CI) 3.29–18.67; p < 0.001), inadequate empirical therapy (HR 3.14; 95% CI 1.93–5.12; p < 0.001) and CLIF-SOFA score (HR 1.35; 95% CI 1.28–1.43; p < 0.001) were independently associated with 30-day mortality. Independent risk factors for MDRO (31% of BSIs) were previous antimicrobial exposure (odds ratio (OR) 2.91; 95% CI 1.73–4.88; p < 0.001) and previous invasive procedures (OR 2.51; 95% CI 1.48–4.24; p 0.001), whereas spontaneous bacterial peritonitis as BSI source was associated with a lower odds of MDRO (OR 0.30; 95% CI 0.12–0.73; p 0.008)., [Conclusions] MDRO account for nearly one-third of BSI in cirrhotic patients, often resulting in delayed or inadequate empirical antimicrobial therapy and increased mortality rates. Our data suggest that improved prevention and treatment strategies for MDRO are urgently needed in the liver cirrhosis patients.

Published
2018

24. Follow-up blood cultures are associated with improved outcome of patients with gram-negative bloodstream infections: retrospective observational cohort study

Author

Michele Bartoletti, P. Viale, Russel Edward Lewis, Simone Ambretti, Renato Pascale, Livia Pancaldi, Maddalena Giannella, Linda Bussini, Sara K. Tedeschi, Pietro Malosso, Stefano Ianniruberto, C. Monari, Giannella M., Pascale R., Pancaldi L., Monari C., Ianniruberto S., Malosso P., Bussini L., Bartoletti M., Tedeschi S., Ambretti S., Lewis R., and Viale P.

Subjects
Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Organ Dysfunction Scores, Follow-up blood cultures, Urinary system, medicine.medical_treatment, 030106 microbiology, Gram negative, Bacteremia, Bloodstream infection, Tertiary Care Centers, 03 medical and health sciences, All-cause 30-day mortality, 0302 clinical medicine, Enterobacteriaceae, Risk Factors, Follow-up blood culture, Internal medicine, medicine, Humans, 030212 general & internal medicine, Mortality, Bacteremia management, Nonfermentative Gram negative, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Septic shock, Hazard ratio, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Survival Analysis, Anti-Bacterial Agents, Infectious Diseases, Blood Culture, Multivariate Analysis, Cohort, Female, Gram-Negative Bacterial Infections, business, Empiric therapy, Central venous catheter, Cohort study
Abstract

Objectives We examined factors associated with follow-up blood cultures (FUBCs) in patients with monomicrobial Gram-negative (GN) bloodstream infection (BSI) and investigated the impact of FUBCs on therapeutic management and patient outcome. Methods A retrospective cohort analysis was conducted of adult patients diagnosed with GN-BSI at a tertiary-care university hospital during 2013–2016. FUBCs performed between 24 hours and 7 days after index BCs was the exposure variable. Risk factors for 30-day mortality were analysed by multivariate Cox analysis on the overall cohort, including FUBCs as a time-varying covariate and on 1:1 matched patients according to Sequential Organ Failure Assessment (SOFA) score and time to FUBC. Results In 278 (17.6%) of 1576 patients, FUBCs were performed within a median of 3 and 2 days after index BCs and active antibiotic therapy initiation. Persistent BSI was found in 107 (38.5%) of 278 patients. FUBCs were performed in more severely ill patients, with nonurinary sources, difficult-to-treat pathogens and receipt of initial inappropriate therapy. Source control and infectious disease consultation rates were higher among patients with preceding FUBCs and was associated with longer treatment duration. Thirty-day mortality was 10.4%. Independent risk factors for mortality were Charlson comorbidity index (hazard ratio (HR) 1.12) SOFA (HR 1.11), septic shock (HR 2.64), urinary source (HR 0.60), central venous catheter source (HR 2.30), complicated BSI (HR 2.10), carbapenem resistance (HR 2.34), active empiric therapy (HR 0.68), source control (HR 0.34) and FUBCs (HR 0.48). Association between FUBCs and lower mortality was confirmed in the 274 matched pairs. Conclusions FUBCs were performed in more severe GN-BSIs, yielding a high rate of persistent BSI. In this context, FUBCs were associated with lower mortality.

Published
2020

25. Superficial swab versus deep-tissue biopsy for the microbiological diagnosis of local infection in advanced-stage pressure ulcers of spinal-cord-injured patients: a prospective study

Author

R. Capirossi, Fabio Tumietto, Michele Bartoletti, M. Battilana, Luca Negosanti, Filippo Trapani, Maddalena Giannella, Pierluigi Viale, Sara K. Tedeschi, D. Brillanti Ventura, Rossella Sgarzani, Salvatore Pignanelli, Francesco Cristini, Tedeschi, S, Negosanti, L, Sgarzani, R, Trapani, F, Pignanelli, S, Battilana, M, Capirossi, R, Brillanti Ventura, D, Giannella, M, Bartoletti, M, Tumietto, F, Cristini, F, and Viale, P

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Swab culture, Biopsy, medicine.medical_treatment, Spinal cord injury, Staphylococcal infections, medicine.disease_cause, Sensitivity and Specificity, Pressure ulcer, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Pseudomonas Infections, Prospective Studies, Deep wound infection, 030212 general & internal medicine, Prospective cohort study, Proteus mirabilis, Spinal Cord Injuries, Aged, Debridement, medicine.diagnostic_test, business.industry, Osteomyelitis, General Medicine, Middle Aged, Staphylococcal Infections, medicine.disease, Surgery, Infectious Diseases, Superinfection, Wound Infection, Female, Proteus Infections, Paraplegia, business
Abstract

Objective: To assess the predictive value of superficial ulcer swab culture to make a microbiological diagnosis of deep wound infections in spinal cord injury (SCI) patients with advanced-stage pressure ulcers.Methods: From July 2011 to February 2014, we performed a prospective, single-centre study on adult SCI patients undergoing scheduled surgical debridement and reconstruction for advanced-stage pressure ulcers, at Montecatone Rehabilitation Institute, a 150-bed hospital dedicated to SCI care. Three superficial ulcer swabs were preoperatively collected using the Levine technique, then sent for culture. In surgery, multiple bone and soft-tissue specimens were taken and sent for culture and histological examination. No antibiotics were administered before surgery. The results of swabs and intraoperative specimens were compared.Results: In all, 116 patients were included, median age 49 years; a majority were males with post-traumatic paraplegia. According to intraoperative specimen cultures, the most common microorganisms were Staphylococcus aureus, Proteus mirabilis, and Pseudomonas aeruginosa, found in 31, 27, and 16 cases, respectively. Concordance between superficial swabs and intraoperative specimen culture was found in only in 25 out of 116 cases (22%). The main reason for non-concordance was the yielding of different micro-organisms (41 out of 116); false negatives (swab negative/intraoperative positive) accounted for 31 out of 116 and false positives (swab positive/intraoperative negative) for 19 out of 116. When compared with intraoperative specimens, sensitivity and specificity of the swab culture were 80% and 54%, respectively.Conclusions: Our results confirm that in patients with advanced-stage pressure ulcers, the cultures of a superficial ulcer swab are not useful in either the diagnosis of a superinfection or the prediction of the role of involved micro-organisms. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Published
2017

26. Pandemic influenza A(H1N1) virus infection in solid organ transplant recipients: impact of viral and non-viral co-infection

Author

Emilio Bouza, Maddalena Giannella, Joan Gavaldà, Pilar Martín-Dávila, MIGUEL ANGEL GOMEZ BRAVO, Carlos Cervera, Carmen Bernal-Bellido, Oscar Len, Jerónimo Pachón, Núria Sabé, Jesus Fortun, Patricia Carmen Muñoz García, Jordi Carratala, Teresa Allende Aydillo Gomez, Elisa Cordero, Cordero, E, Pérez-Romero, P., Moreno, A., Len, O., Montejo, M., Vidal, E., Martín-Dávila, P., Fariñas, M.C., Fernández-Sabé, N., Giannella, M., and Pachón, J.

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Adolescent, medicine.disease_cause, Article, Diabetes Complications, Young Adult, Influenza A Virus, H1N1 Subtype, Risk Factors, Pandemic influenza A(H1N1), Intensive care, Internal medicine, Diabetes mellitus, Diabetes Complication, Influenza, Human, Diabetes Mellitus, Influenza A virus, Humans, Medicine, Prospective Studies, Intensive care medicine, Prospective cohort study, Outcome, Aged, Cross Infection, business.industry, Septic shock, Coinfection, Risk Factor, Diabetes Mellitu, General Medicine, Organ Transplantation, Pneumonia, Middle Aged, medicine.disease, Co-infection, Transplantation, Solid organ transplant, Prospective Studie, Treatment Outcome, Infectious Diseases, Female, business, Human
Abstract

Solid organ transplant recipients (SOTR) are at risk of serious influenza-related complications. The impact of respiratory co-infection in SOTR with 2009 pandemic influenza A(H1N1) is unknown. A multicentre prospective study of consecutive cases of pandemic influenza A(H1N1) in SOTR was carried out to assess the clinical characteristics and outcome and the risk factors for co-infection. Overall, 51 patients were included. Median time from transplant was 3.7years, 5.9% of the cases occurred perioperatively and 7.8% were hospital-acquired. Pneumonia was diagnosed in 15 (29.4%) patients. Ten cases were severe (19.6%): 13.7% were admitted to intensive care units, 5.9% suffered septic shock, 5.9% developed acute graft rejection and 7.8% died. Co-infection was detected in 15 patients (29.4%): eight viral, six bacterial and one fungal. Viral co-infection did not affect the outcome. Patients with non-viral co-infection had a worse outcome: longer hospital stay (26.2±20.7 vs. 5.5±10.2) and higher rate of severe diseases (85.7% vs. 2.3%) and mortality (42.8% vs. 2.3%). Independent risk factors for non-viral co-infection were: diabetes mellitus and septic shock. Other factors associated with severe influenza were: delayed antiviral therapy, diabetes mellitus, time since transplantation

Published
2012
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27. Candida tropicalis fungaemia: incidence, risk factors and mortality in a general hospital

Author

Jesús Guinea, M. Valerio, Emilio Bouza, Patricia Muñoz, Maddalena Giannella, C. Fanciulli, Marta Rodríguez-Créixems, Loreto Rojas, Muñoz, P., Giannella, M, Fanciulli, C., Guinea, J., Valerio, M., Rojas, L., Rodríguez-Créixems, M., and Bouza, E.

Subjects
Male, Invasive candidiasi, Adrenal Cortex Hormone, Candida tropicalis, Candida tropicali, Retrospective Studie, Adrenal Cortex Hormones, Risk Factors, Neoplasms, Non-albicans Candida specie, Hospital Mortality, non-albicans Candida species, Multivariate Analysi, Aged, 80 and over, Cross Infection, Microbial Sensitivity Test, Incidence (epidemiology), Mortality rate, Incidence, fungaemia, General Medicine, invasive candidiasis, Middle Aged, Shock, Septic, Infectious Diseases, Female, Case-Control Studie, Human, Adult, Microbiology (medical), medicine.medical_specialty, Neutropenia, Urinary system, Microbial Sensitivity Tests, Biology, Hospitals, General, Young Adult, Internal medicine, medicine, candidaemia, Humans, Aged, Retrospective Studies, Septic shock, Risk Factor, Case-control study, Candidemia, Retrospective cohort study, medicine.disease, biology.organism_classification, Surgery, Spain, Case-Control Studies, Multivariate Analysis, Neoplasm
Abstract

The risk factors and clinical features of patients with Candida tropicalis fungaemia have not been fully defined. We performed a case-control study comparing 59 cases of C. tropicalis fungaemia with 177 episodes of fungaemia caused by other species of Candida in our hospital over a 24-year period (January 1985 to December 2008). Patients with C. tropicalis fungaemia were more likely to be older (median age, 67 vs. 56 years; p0.01), to have cancer (45.5% vs. 31.6%, p0.04), and to have the abdomen as the portal of entry (32.2% vs. 11.9%, p0.001), and had a higher in-hospital mortality rate (61% vs. 44%, p0.03). Multivariate analysis showed that the independent risk factors for C. tropicalis fungaemia were cancer (OR 4.5; 95% CI 1.05-3.83; p0.03) and the abdomen as the portal of entry (OR 13.6; 95% CI 1.9-8.2; p

Published
2011
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28. Impact of a hospital-wide multifaceted programme for reducing carbapenem-resistant Enterobacteriaceae infections in a large teaching hospital in northern Italy

Author

M.L. Moro, S. Venturi, C. Gibertoni, Michele Bartoletti, Sara K. Tedeschi, Francesco Cristini, Maddalena Giannella, M.C. Puggioli, R. Masina, E. Callea, D. Mosci, A. De Palma, Simone Ambretti, Russell E. Lewis, M. Cavalli, Pierluigi Viale, Fabio Tumietto, Viale, P, Tumietto, F., Giannella, M., Bartoletti, M., Tedeschi, S., Ambretti, S., Cristini, F., Gibertoni, C., Venturi, S., Cavalli, M., De Palma, A., Puggioli, M.C., Mosci, D., Callea, E., Masina, R., Moro, M.L., and Lewis, R.E.

Subjects
Microbiology (medical), medicine.medical_specialty, Infection control, Bacteremia, Carbapenem-resistant enterobacteriaceae, beta-Lactam Resistance, Enterobacteriaceae, Internal medicine, Anti-Bacterial Agent, medicine, Antimicrobial stewardship, Humans, Rectal swab, Intensive care medicine, Hospitals, Teaching, Carbapenem, Screening procedures, Cross Infection, business.industry, Incidence (epidemiology), Incidence, Enterobacteriaceae Infections, General Medicine, Enterobacteriaceae Infection, rectal swabs, Anti-Bacterial Agents, Transplantation, Regimen, Carbapenem-resistant Enterobacteriaceae, antimicrobial stewardship, Carriage, Infectious Diseases, Carbapenems, Italy, Active screening, Population Surveillance, Season, Seasons, business, Human
Abstract

We performed a quasi-experimental study of a multifaceted infection control programme for reducing carbapenem-resistant Enterobacteriaceae (CRE) transmission and bloodstream infections (BSIs) in a 1420-bed university-affiliated teaching hospital during 2010–2014, with 30 months of follow-up. The programme consisted of the following: (a) rectal swab cultures were performed in all patients admitted to high-risk units (intensive-care units, transplantation, and haematology) to screen for CRE carriage, or for any room-mates of CRE-positive patients in other units; (b) cohorting of carriers, managed with strict contact precautions; (c) intensification of education, cleaning and hand-washing programmes; and (d) promotion of an antibiotic stewardship programme carbapenem-sparing regimen. The 30-month incidence rates of CRE-positive rectal cultures and BSIs were analysed with Poisson regression. Following the intervention, the incidence rate of CRE BSI (risk reduction 0.96, 95% CI 0.92–0.99, p 0.03) and CRE colonization (risk reduction 0.96, 95% CI 0.95–0.97, p

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29. Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia

Author

GIANNELLA, MADDALENA, Pinilla, B., Capdevila, J. A., Martínez Alarcón, J., Muñoz, P., López Álvarez, J., Bouza, E., de Henares, Alcalá, Álvarez, Joaquín López, Ruiz, Eduardo Montero, de Lis Muñoz, José María, Narrillos, Carmen Cano, Sánchez, Pascual Sesma, Díaz, Hortensia Álvarez, Martínez, María Paloma Geijo, Ruiz Capilla, Juan José Jusdado, López, Daniel Ferreiro, Lechuz, Juan Manuel García, Martínez, Valentín Cuervas Mons, del Campo, Pedro Durán, Montaud, Alberto Roldán, Vivanco Martínez, Francisco Javier, Pinedo, Amaya Egoluz, Leizaola, Katixa, Vidal, Rafael Pérez, El Boutrouki, Omar, San Román Terán, Carlos Made, Sepúlveda, Sonsoles Fernández, Piñero, Emilio Santín, Santos, Javier Solera, de Tomas Labat, Maelena, Olavarrieta, Juan Custardoy, Zaragoza, José Manuel Murcia, Liaño, Francisco Pasquau, Prous, Concepción Amador, Pou, Jordi Casademont, Marcuello, Jordi Martín, Salva, Joaquín Oristrell, Martínez, Susana Herranz, Palao, José Soriano, Marco, Francisco de Asis Sarabia, Suárez, Pedro Cancelo, Álvarez, Pedro Luis Álvarez, Gaviria, Antonio Zapatero, Mena Bernal, Juan Hinojosa, Fuster, Peter Reth, Camacho, Sandra Milena Bacca, Fernández, Carmen Suárez, Ramos, Laura Prosper, Bejar, Carmen Sáez, Calabuig, Eva, Garau, Javier, Calbo, Esther, Pascual, Vanesa, Audibert, Luis, Bunsow, Eleonora, Castaño, Jesús García, Esteban, Elena Trigo, Antúnez, María Gómez, Polo, Naiara Aldezábal, Rubio, José Santiago Filgueira, Berastegui, Olga López, Rodríguez, Miguel Ángel Artacho, González Cobos, Cristina López, Acebes, Eduardo Oliveros, Martín, María Jesús Granda, Hernández, Belén Mora, Huerta, Faustino Herrero, Marina, Gandia Herrero, Fernández, Francisco Santolaria, Rodríguez, José Juan Viña, Salomó, Antoni Castro, Iftimie, Simona, de Casadola, Gonzalo García, Quero, José Luis Pérez, Casanova, Pere Comas, Molina, Juan Valencia, Miranda, José López, Fernández, Rafael Martínez, Perea, Carmelo Perea, Hernández, Carmen González, Calvet, Paloma Lucena, Pujol, Ramón, Losa, Carlos Ferre, O. Callaghan, Francisco Cabades, Babiloni, Manuel Arnal, Company, José Bisbe, Igual, Jesús Javier González, Otin, Elena Castellar, Porras, Miguel Carrascosa, Saiz Quevedo García, José Antonio, Del Villar Sordo, Valentín, Sánchez, Mario Del Valle, Rodríguez, José Perales, Fariña, Sergio Diz, Ugarte, Carlos Pereda, Alabau, Filomena Ceres, Santos, Pedro González, Linares, Juan Luis Carrillo, Farre, José Barbera, Salinas, Miguel Torres, Méndez, Luis Miguel Sarmiento, Torres, María Sánchez, Planas, Joaquín Vila, Amorós, Jordi Grau, Paires, Joan Colomer, Ferrer, Cristina Soler, Moreno, Agustín Zamarrón, Carrillo, Laura Hurtado, López, MaDolores Díaz, Rodríguez, Ricardo Fernánder, Manuel, Elpidio Calvo, Camacho, Cesar Augusto Henríquez, Cruz, Arturo Fernández, Biezma, Cristina Gómez Sánchez, González, Baltasar Orejas, Navacerrada, Gema Fresco, Peláez, Vanesa López, Bellver, Salvador, Estebanez, Carlos Tornero, Carruez, Antonio Jimeno, Muñoz, Luis Ángel Sánchez, Montoro, Domingo Bofill, Ribera, Mercé Cardona, Martínez, Andrés Tutor, Berrocal, María Antonia Sepúlveda, Moraleja, Julio González, Terradellas, Joan Brugues, Sosa, Esteban Reynaga, Mora, Arturo Artero, Gimeno, Francesc Puchades, Cerezo, Jorge Francisco Gómez, Cantero, Rafael del Castillo, Aragoneses, Lourdes Mancebo, Cortés, Eduardo Aguilar, Mariscal, María Ruiz, Serrano, Carmen Piqueras, Calderón, Juan L. Rodríguez, Ruiz, Pablo Robles, Legarre, Ángel Samperiz, Gómez, Raquel Carrillo, Asensio, Arturo Noguerado, Sánchez, Fernando Marcos, Cuerda, Elena Nuñez, Arberas, Victoria Egurbide, López, Ramiro de la Prieta, Sánchez, Pilar Román, Serra, Josep Masferrer, Martín, José Felipe Morales, Pérez, José Luis Beato, Puig, Rita Massa, Rosell, Nuria Costa, Moya, Miguel de Paco, Llinares, Juan Ramón Sánchez, Bohórquez, Francisco José Castro, Giannella, M, Pinilla, B., Capdevila, J.A., Martínez Alarcón, J., Muñoz, P., López Álvarez, J., Bouza, E., de Henares, Alcalá, Álvarez, Joaquín López, Ruiz, Eduardo Montero, de Lis Muñoz, José María, Narrillos, Carmen Cano, Sánchez, Pascual Sesma, Díaz, Hortensia Álvarez, Martínez, María Paloma Geijo, Ruiz-Capilla, Juan José Jusdado, López, Daniel Ferreiro, Lechuz, Juan Manuel García, Martínez, Valentín Cuervas-Mon, del Campo, Pedro Durán, Montaud, Alberto Roldán, Vivanco Martínez, Francisco Javier, Pinedo, Amaya Egoluz, Leizaola, Katixa, Vidal, Rafael Pérez, El Boutrouki, Omar, San Román Terán, Carlos Made, Sepúlveda, Sonsoles Fernández, Piñero, Emilio Santín, Santos, Javier Solera, de Tomas Labat, Maelena, Olavarrieta, Juan Custardoy, Zaragoza, José Manuel Murcia, Liaño, Francisco Pasquau, Prous, Concepción Amador, Pou, Jordi Casademont, Marcuello, Jordi Martín, Salva, Joaquín Oristrell, Martínez, Susana Herranz, Palao, José Soriano, Marco, Francisco de Asis Sarabia, Suárez, Pedro Cancelo, Álvarez, Pedro Luis Álvarez, Gaviria, Antonio Zapatero, Mena-Bernal, Juan Hinojosa, Fuster, Peter Reth, Camacho, Sandra Milena Bacca, Fernández, Carmen Suárez, Ramos, Laura Prosper, Bejar, Carmen Sáez, Calabuig, Eva, Garau, Javier, Calbo, Esther, Pascual, Vanesa, Audibert, Lui, Bunsow, Eleonora, Castaño, Jesús García, Esteban, Elena Trigo, Antúnez, María Gómez, Polo, Naiara Aldezábal, Rubio, José Santiago Filgueira, Berastegui, Olga López, Rodríguez, Miguel Ángel Artacho, González-Cobos, Cristina López, Acebes, Eduardo Olivero, Martín, María Jesús Granda, Hernández, Belén Mora, Huerta, Faustino Herrero, Marina, Gandia Herrero, Fernández, Francisco Santolaria, Rodríguez, José Juan Viña, Salomó, Antoni Castro, Iftimie, Simona, de Casadola, Gonzalo García, Quero, José Luis Pérez, Casanova, Pere Coma, Molina, Juan Valencia, Miranda, José López, Fernández, Rafael Martínez, Perea, Carmelo Perea, Hernández, Carmen González, Calvet, Paloma Lucena, Pujol, Ramón, Losa, Carlos Ferre, O-Callaghan, Francisco Cabade, Babiloni, Manuel Arnal, Company, José Bisbe, Igual, Jesús Javier González, Otin, Elena Castellar, Porras, Miguel Carrascosa, Saiz-Quevedo García, José Antonio, Del Villar Sordo, Valentín, Sánchez, Mario Del Valle, Rodríguez, José Perale, Fariña, Sergio Diz, Ugarte, Carlos Pereda, Alabau, Filomena Cere, Santos, Pedro González, Linares, Juan Luis Carrillo, Farre, José Barbera, Salinas, Miguel Torre, Méndez, Luis Miguel Sarmiento, Torres, María Sánchez, Planas, Joaquín Vila, Amorós, Jordi Grau, Paires, Joan Colomer, Ferrer, Cristina Soler, Moreno, Agustín Zamarrón, Carrillo, Laura Hurtado, López, MaDolores Díaz, Rodríguez, Ricardo Fernánder, Manuel, Elpidio Calvo, Camacho, Cesar Augusto Henríquez, Cruz, Arturo Fernández, Biezma, Cristina Gómez Sánchez, González, Baltasar Oreja, Navacerrada, Gema Fresco, Peláez, Vanesa López, Bellver, Salvador, Estebanez, Carlos Tornero, Carruez, Antonio Jimeno, Muñoz, Luis Ángel Sánchez, Montoro, Domingo Bofill, Ribera, Mercé Cardona, Martínez, Andrés Tutor, Berrocal, María Antonia Sepúlveda, Moraleja, Julio González, Terradellas, Joan Brugue, Sosa, Esteban Reynaga, Mora, Arturo Artero, Gimeno, Francesc Puchade, Cerezo, Jorge Francisco Gómez, Cantero, Rafael del Castillo, Aragoneses, Lourdes Mancebo, Cortés, Eduardo Aguilar, Mariscal, María Ruiz, Serrano, Carmen Piquera, Calderón, Juan L. Rodríguez, Ruiz, Pablo Roble, Legarre, Ángel Samperiz, Gómez, Raquel Carrillo, Asensio, Arturo Noguerado, Sánchez, Fernando Marco, Cuerda, Elena Nuñez, Arberas, Victoria Egurbide, López, Ramiro de la Prieta, Sánchez, Pilar Román, Serra, Josep Masferrer, Martín, José Felipe Morale, Pérez, José Luis Beato, Puig, Rita Massa, Rosell, Nuria Costa, Moya, Miguel de Paco, Llinares, Juan Ramón Sánchez, and Bohórquez, Francisco José Castro

Subjects
Male, Microbiology (medical), medicine.medical_specialty, Community-acquired pneumonia, Population, Aspiration pneumonia, medicine.disease_cause, Hospital-acquired pneumonia, Risk Factors, Internal medicine, Streptococcus pneumoniae, medicine, Pneumonia, Bacterial, hospital-acquired pneumonia, Humans, Community-Acquired Infection, education, Aged, Aged, 80 and over, education.field_of_study, Cross Infection, Pseudomonas aeruginosa, business.industry, Risk Factor, healthcare-associated pneumonia, General Medicine, medicine.disease, Community-Acquired Infections, Pneumonia, hospitalized pneumonia patient, internal medicine, Infectious Diseases, Etiology, Female, Guideline Adherence, Health Services Research, business, Human
Abstract

Patients with pneumonia treated in the internal medicine department (IMD) are often at risk of healthcare-associated pneumonia (HCAP). The importance of HCAP is controversial. We invited physicians from 72 IMDs to report on all patients with pneumonia hospitalized in their department during 2weeks (one each in January and June 2010) to compare HCAP with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). We analysed 1002 episodes of pneumonia: 58.9% were CAP, 30.6% were HCAP and 10.4% were HAP. A comparison between CAP, HCAP and HAP showed that HCAP patients were older (77, 83 and 80.5years; p

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