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4. Blood Component Therapy and Coagulopathy in Trauma: A Systematic Review of the Literature from the Trauma Update Group

Author

Poole D., Cortegiani A., Chieregato A., Russo E., Pellegrini C., De Blasio E., Mengoli F., Volpi A., Grossi S., Gianesello L., Orzalesi V., Fossi F., Chiara O., Coniglio C., Gordini G., Blasio D., Nardi G., Agostini V., Bini G., Cimbanassi S., Cingolani E., Monesi A., Sanson G., Tacconi C., Poole D., Cortegiani A., Chieregato A., Russo E., Pellegrini C., De Blasio E., Mengoli F., Volpi A., Grossi S., Gianesello L., Orzalesi V., Fossi F., Chiara O., Coniglio C., Gordini G., Blasio D., Nardi G., Agostini V., Bini G., Cimbanassi S., Cingolani E., Monesi A., Sanson G., Tacconi C., Poole, D., Cortegiani, A., Chieregato, A., Russo, E., Pellegrini, C., De Blasio, E., Mengoli, F., Volpi, A., Grossi, S., Gianesello, L., Orzalesi, V., Fossi, F., Chiara, O., Coniglio, C., Gordini, G., Nardi, G., Agostini, V., Cimbanassi, S., Cingolani, E., Monesi, A., Sanson, G., and Tacconi, C.

Subjects
Tranexamic acid, Physiology, Glycobiology, lcsh:Medicine, Cardiovascular Medicine, Pathology and Laboratory Medicine, Biochemistry, Vascular Medicine, law.invention, Database and Informatics Methods, Fresh frozen plasma, 0302 clinical medicine, Randomized controlled trial, Coagulopathy, Animal Cells, law, Antifibrinolytic agent, Fibrinogen, Medicine and Health Sciences, 030212 general & internal medicine, Database Searching, lcsh:Science, Multidisciplinary, Plasma Exchange, Hematology, Blood Coagulation Disorders, Clinical Laboratory Sciences, Antifibrinolytic Agents, Body Fluids, Blood, trauma, Tranexamic Acid, Cardiovascular Diseases, Research Design, Meta-analysis, Observational Studies, Anatomy, Cellular Types, Research Article, Platelets, medicine.medical_specialty, Death Rates, Hemorrhage, Blood Component Transfusion, Research and Analysis Methods, External validity, 03 medical and health sciences, Signs and Symptoms, Population Metrics, Diagnostic Medicine, medicine, Humans, Blood Transfusion, Mortality, Intensive care medicine, Blood Coagulation, Wounds and Injuries, Biochemistry, Genetics and Molecular Biology (all), Agricultural and Biological Sciences (all), Demography, Glycoproteins, Blood Cells, Population Biology, Coagulation Disorders, Transfusion Medicine, business.industry, lcsh:R, Bleeding, Biology and Life Sciences, 030208 emergency & critical care medicine, Cell Biology, medicine.disease, Surgery, People and Places, lcsh:Q, Observational study, Packed red blood cells, business
Abstract

Background Traumatic coagulopathy is thought to increase mortality and its treatment to reduce preventable deaths. However, there is still uncertainty in this field, and available literature results may have been overestimated. Methods We searched the MEDLINE database using the PubMed platform. We formulated four queries investigating the prognostic weight of traumatic coagulopathy defined according to conventional laboratory testing, and the effectiveness in reducing mortality of three different treatments aimed at contrasting coagulopathy (high fresh frozen plasma/packed red blood cells ratios, fibrinogen, and tranexamic acid administration). Randomized controlled trials were selected along with observational studies that used a multivariable approach to adjust for confounding. Strict criteria were adopted for quality assessment based on a two-step approach. First, we rated quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Then, this rating was downgraded if other three criteria were not met: high reporting quality according to shared standards, absence of internal methodological and statistical issues not detailed by the GRADE system, and absence of external validity issues. Results With few exceptions, the GRADE rating, reporting and methodological quality of observational studies was “very low”, with frequent external validity issues. The only two randomized trials retrieved were, instead, of high quality. Only weak evidence was found for a relation between coagulopathy and mortality. Very weak evidence was found supporting the use of fibrinogen administration to reduce mortality in trauma. On the other hand, we found high evidence that the use of 1:1 vs. 1:2 high fresh frozen plasma/packed red blood cells ratios failed to obtain a 12% mortality reduction. This does not exclude lower mortality rates, which have not been investigated. The use of tranexamic acid in trauma was supported by “high” quality evidence according to the GRADE classification but was downgraded to “moderate” for external validity issues. Conclusions Tranexamic acid is effective in reducing mortality in trauma. The other transfusion practices we investigated have been inadequately studied in the literature, as well as the independent association between mortality and coagulopathy measured with traditional laboratory testing. Overall, in this field of research literature quality is poor.

Published
2016
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5. Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels

Author

Michalopoulos, A., Groeneveld, J., Lev, A., Sprung, C., Vakalos, A., Kotanidou, A., Zakynthinos, E., Filos, K., Pneumatikos, I., Moraiti, A., Clouva-molyvdas, P., Mandragos, K., Kyriazopoulos, G., Karampela, I., Koulenti, D., Myrianthefs, P., Ioannidou, E., Mouloudi, E., Chalkiadaki, A., Bitzani, M., Routsi, C., Armaganidis, A., Sofianos, E., Harjola, V., Berezowicz, P., Jacobsen, K., Espersen, K., Fogh, B., Betsch, H., Vincent, Jean-Louis, Vanhems, Philippe, Walther, Sten M., Sakr, Yasser, Rello, Jordi, Leone, Marc, Pickkers, P., Lipman, Jeffrey, Holmbom, Martin, Antonelli, Massimo, Hanberger, Håkan, Kocak, S., Ulger, F., Guven, H., Turkmen, A., Dogruer, K., Adanir, T., Demirkiran, O., Tugrul, S., Cakar, N., Akinci, I., Uzel, N., Togal, T., Topeli, A., Turkoglu, M., Guven, M., Akan, M., Bodur, H., Bosnak, M., Kizilkaya, M., Ozgencil, E., Kaya, A., Fistikci, H., Ates, C., Atalan, K., Jacobson, S., Owall, A., Kokinsky, E., Rudenstam, J., Häggqvist, J., Hulting, J., Sellgren, J., Arvidsson, S., Schindele, M., Hammarskjöld, F., Friberg, H., Petersson, J., Paulsson, A., Lindström, I., Stiernstrom, H., Peterzén, B., Blomqvist, H., Petersen, P., Soto Ibáñez, J., González, J., Izura, J., Corcobado Márquez, C., Rico-Feijoo, J., Sierra, R., Rello, J., Posada, P., Briones Lopez, M., Jara, R., Luis, V., Maria Jesus, H., de la Torre-Prados, M., Felices, F., Sanchez Garcia, M., Macias Pingarrón, J., Garcia-Fuentes, C., Cerdá, E., Serrano, N., Barcenilla-Gaite, F., Sirvent, J., Montejo González, J., Guerrero Gomez, F., Amador Amerigo, J., Borges, M., Sánchez-Olmedo, J., López Ciudad, V., Moreno, M., Esteban, E., Vallés, J., De Rojas Román, J., Yuste, I., Ugarte Peña, P., Sole-violán, J., Bustinza, A., Albaya, A., Latour-Perez, J., Navarro, J., Garcia, F., Martin Delgado, M., Rovira, A., Ramos-gómez, L., Garro, P., Silva, J., Iglesias, L., María Jesús, L., Pueyo, L., Lorente, C., Martinon-Torres, F., Aguilar, G., Martinez-Sagasti, F., Blesa Malpica, A., Valencia, M., Zavala, E., Bustamante Munguira, E., Arribas, M., Insausti, J., Vegas Pinto, R., Bocero, L., Estella, A., Esteban-Reboll, F., Lopez Camps, V., Antón Caraballo, E., Muñoz, E., Olaechea, P., Escriba, A., Santos, I., Campiñez, Burgueño., Moreira, P., Pizzamiglio, M., Conti, V., Kahveci, A., Nydahl, A., Lind, D., Caballero Zirena, A., Guerrero, F., Palomar, M., Einar, V., Agvald-Ohman, C., Wyon, N., Johansson, L., Gil, B., Mariscal, F., Galvan, B., Espinosa, E., Lesmes Serrano, A., Mesalles Sanjuan, E., Manzano Ramirez, A., Quintana Tort-Martorell, E., Monton Dito, J., Ibañez, A., Garcia del Valle, S., Alemparte-Pardavila, E., Monedero, P., Naveira-Abeigón, E., Jorda, R., Alvarez, M., Rubio, O., Bouw, M., Afonso, Susana, Matos, Ricardo, Carneiro, A., Amaro, P., Ribeiro, R., Paiva, J., Galdos-Anuncibay, P., Nieto, M., Ruiz, J., Perez Calvo, C., Mañez, R., França, C., Moreno, R., Dias, C., Sousa, A., Rezende, A., Mourão, L., Ponce, P., Oliveira, T., Esteves, F., Den Boer, S., Bakker, J., Van Berkel, G., Borg, M., Gullo, A., Gianesello, L., Martinelli, L., Antonelli, M., Bassetti, M., Telo, L., Alves, M., Almeida, E., Leite, A., Pádua, F., Costa, H., Póvoa, P., Lopes, V., Carmo, E., Febra, C., Martins, A., Castelo-Branco Sousa, M., Bártolo, A., Junker, A., Erno, P., Klepstad, P., Loevstad, R., Bergmans, D., Rodgers, M., Pham, C., Speelberg, B., Wesselink, R., Ammann, J., Vet, J., Gille, A., Kuiper, M., Kieft, H., Blom, H., Vogelaar, J., Corsten, S., Ten Cate, J., Rosseel, P., De Pont, A., Della Rocca, G., Biancofiore, G., Morelli, A., Ranieri, MV., Cotogni, P., Alessandro, D., Clementi, S., Ferraro, F., Giuseppe, N., Sforza, D., Castiglione, G., Marino, G., Fumagalli, R., Santagostino, G., De Negri, P., De Gasperi, A., Oggioni, R., Conte, V., Sicignano, A., Marri, I., Locicero, M., Guadagnucci, A., Chieregato, A., Fiore, G., Sorbara, C., Munch, C., Ruatti, H., Lorella, P., Borrelli, F., Panella, L., De Blasi, R., Ceriani, R., Colonna, S., Abbruzzese, C., Rosano, A., Caspani, M., Emmi, V., Stelian, E., Scolz, S., Guberti, A., Margarit, O., Giarratano, A., Rosi, R., Marzorati, S., De blasio, E., Minerva, M., Petrucci, N., Mangani, V., Lazzero, A., Sapuppo, M., Cecilia, P., Borelli, M., Greco, S., Vesconi, S., Sofer, S., Cohen, J., Kishinevsky, E., Selçuk Üniversitesi, Hanberger, H, Antonelli, M, Holmbom, M, Lipman, J, Pickkers, P, Leone, M, Rello, J, Sakr, Y, Walther, S, Vanhems, P, Vincent, J, Betsch, H, Fogh, B, Espersen, K, Jacobsen, K, Berezowicz, P, Harjola, V, Sofianos, E, Armaganidis, A, Routsi, C, Bitzani, M, Chalkiadaki, A, Michalopoulos, A, Mouloudi, E, Ioannidou, E, Myrianthefs, P, Koulenti, D, Karampela, I, Kyriazopoulos, G, Mandragos, K, Clouva molyvdas, P, Moraiti, A, Pneumatikos, I, Filos, K, Zakynthinos, E, Kotanidou, A, Vakalos, A, Sprung, C, Lev, A, Kishinevsky, E, Cohen, J, Sofer, S, Vesconi, S, Greco, S, Borelli, M, Cecilia, P, Sapuppo, M, Lazzero, A, Mangani, V, Petrucci, N, Minerva, M, De blasio, E, Marzorati, S, Rosi, R, Giarratano, A, Margarit, O, Guberti, A, Scolz, S, Stelian, E, Emmi, V, Caspani, M, Rosano, A, Abbruzzese, C, Colonna, S, Ceriani, R, De Blasi, R, Panella, L, Borrelli, F, Lorella, P, Ruatti, H, Munch, C, Sorbara, C, Fiore, G, Chieregato, A, Conti, V, Guadagnucci, A, Pizzamiglio, M, Locicero, M, Marri, I, Sicignano, A, Conte, V, Oggioni, R, De Gasperi, A, De Negri, P, Santagostino, G, Fumagalli, R, Marino, G, Castiglione, G, Sforza, D, Giuseppe, N, Bassetti, M, Ferraro, F, Clementi, S, Alessandro, D, Cotogni, P, Ranieri, M, Martinelli, L, Gianesello, L, Gullo, A, Morelli, A, Biancofiore, G, Della Rocca, G, Borg, M, De Pont, A, Rosseel, P, Ten Cate, J, Van Berkel, G, Corsten, S, Bakker, J, Vogelaar, J, Blom, H, Kieft, H, Kuiper, M, Gille, A, Vet, J, Ammann, J, Den Boer, S, Wesselink, R, Speelberg, B, Pham, C, Rodgers, M, Bergmans, D, Groeneveld, J, Loevstad, R, Klepstad, P, Erno, P, Junker, A, Bártolo, A, Castelo Branco Sousa, M, Esteves, F, Martins, A, Oliveira, T, Ponce, P, Mourão, L, Febra, C, Carmo, E, Lopes, V, Póvoa, P, Rezende, A, Costa, H, Moreira, P, Pádua, F, Leite, A, Almeida, E, Alves, M, Sousa, A, Telo, L, Dias, C, Paiva, J, Ribeiro, R, Amaro, P, Carneiro, A, Moreno, R, Matos, R, Afonso, S, Bouw, M, França, C, Rubio, O, Mañez, R, Campiñez, B, Alvarez, M, Jorda, R, Naveira Abeigón, E, Monedero, P, Alemparte Pardavila, E, Garcia del Valle, S, Perez Calvo, C, Palomar, M, Guerrero, F, Caballero Zirena, A, Arribas, M, Bustamante Munguira, E, Ruiz, J, Iglesias, L, Zavala, E, Valencia, M, Blesa Malpica, A, Martinez Sagasti, F, Nieto, M, Aguilar, G, Martinon Torres, F, Lorente, C, Insausti, J, Vegas Pinto, R, Santos, I, Escriba, A, Olaechea, P, Muñoz, E, Antón Caraballo, E, Galdos Anuncibay, P, Lopez Camps, V, Esteban Reboll, F, Estella, A, Bocero, L, Ibañez, A, Pueyo, L, María Jesús, L, Silva, J, Garro, P, Ramos gómez, L, Rovira, A, Martin Delgado, M, Monton Dito, J, Garcia, F, Navarro, J, Latour Perez, J, Albaya, A, Bustinza, A, Sole violán, J, Ugarte Peña, P, Yuste, I, De Rojas Román, J, Vallés, J, Esteban, E, Quintana Tort Martorell, E, Moreno, M, López Ciudad, V, Manzano Ramirez, A, Sánchez Olmedo, J, Borges, M, Amador Amerigo, J, Guerrero Gomez, F, Montejo González, J, Sirvent, J, Mesalles Sanjuan, E, Barcenilla Gaite, F, Serrano, N, Cerdá, E, Lesmes Serrano, A, Garcia Fuentes, C, Macias Pingarrón, J, Espinosa, E, Sanchez Garcia, M, Felices, F, de la Torre Prados, M, Maria Jesus, H, Luis, V, Jara, R, Briones Lopez, M, Posada, P, Galvan, B, Mariscal, F, Gil, B, Sierra, R, Rico Feijoo, J, Corcobado Márquez, C, Izura, J, González, J, Soto Ibáñez, J, Petersen, P, Johansson, L, Blomqvist, H, Peterzén, B, Wyon, N, Stiernstrom, H, Lindström, I, Paulsson, A, Agvald Ohman, C, Petersson, J, Friberg, H, Einar, V, Hammarskjöld, F, Schindele, M, Arvidsson, S, Sellgren, J, Hulting, J, Häggqvist, J, Rudenstam, J, Lind, D, Kokinsky, E, Owall, A, Jacobson, S, Nydahl, A, Atalan, K, Ates, C, Kahveci, A, Fistikci, H, Kaya, A, Ozgencil, E, Kizilkaya, M, Bosnak, M, Bodur, H, Akan, M, Guven, M, Turkoglu, M, Topeli, A, Togal, T, Uzel, N, Akinci, I, Cakar, N, Tugrul, S, Demirkiran, O, Adanir, T, Dogruer, K, Turkmen, A, Guven, H, Ulger, F, Kocak, S, İç Hastalıkları, and OMÜ

Subjects
Male, Pediatrics, Cross-sectional study, health care facilities, manpower, and services, Antibiotics, Resistance, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Prevalence, Drug Resistance, law.invention, Medical microbiology, law, Pathologie maladies infectieuses, Antibiotic, Critically ill, Infection, Aged, Anti-Bacterial Agents, Bacteria, Bacterial Infections, Cross-Sectional Studies, Europe, Female, Hospitalization, Humans, Middle Aged, Treatment Outcome, Drug Resistance, Bacterial, Intensive Care Units, Infectious Diseases, Critically ill -- Care, Mortality rate, Bacterial, Intensive care unit, SAPS II, Beta lactam antibiotics, Research Article, Human, medicine.medical_specialty, medicine.drug_class, Intensive Care Unit, Bacterial Infection, Antibiotic resistance, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, Anti-Bacterial Agent, medicine, Cross-Sectional Studie, business.industry, Aminopeptidases -- Analysis, Klinisk medicin, Polypeptides, Bacterial diseases -- Diagnosis, Antibiotics -- Therapeutic use, Clinical Medicine, business
Abstract

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome., 0, SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2014

7. Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels

Author

Hanberger, H. Antonelli, M. Holmbom, M. Lipman, J. Pickkers, P. Leone, M. Rello, J. Sakr, Y. Walther, S.M. Vanhems, P. Vincent, J.-L. Betsch, H. Fogh, B. Espersen, K. Jacobsen, K. Berezowicz, P. Harjola, V. Sofianos, E. Armaganidis, A. Routsi, C. Bitzani, M. Chalkiadaki, A. Michalopoulos, A. Mouloudi, E. Ioannidou, E. Myrianthefs, P. Koulenti, D. Karampela, I. Kyriazopoulos, G. Mandragos, K. Clouva-molyvdas, P. Moraiti, A. Pneumatikos, I. Filos, K. Zakynthinos, E. Kotanidou, A. Vakalos, A. Sprung, C. Lev, A. Kishinevsky, E. Cohen, J. Sofer, S. Vesconi, S. Greco, S. Borelli, M. Cecilia, P. Sapuppo, M. Lazzero, A. Mangani, V. Petrucci, N. Minerva, M. De blasio, E. Marzorati, S. Rosi, R. Giarratano, A. Margarit, O. Guberti, A. Scolz, S. Stelian, E. Emmi, V. Caspani, M. Rosano, A. Abbruzzese, C. Colonna, S. Ceriani, R. De Blasi, R. Panella, L. Borrelli, F. Lorella, P. Ruatti, H. Munch, C. Sorbara, C. Fiore, G. Chieregato, A. Conti, V. Guadagnucci, A. Pizzamiglio, M. Locicero, M. Marri, I. Sicignano, A. Conte, V. Oggioni, R. De Gasperi, A. De Negri, P. Santagostino, G. Fumagalli, R. Marino, G. Castiglione, G. Sforza, D. Giuseppe, N. Bassetti, M. Ferraro, F. Clementi, S. Alessandro, D. Cotogni, P. Ranieri, MV. Antonelli, M. Martinelli, L. Gianesello, L. Gullo, A. Morelli, A. Biancofiore, G. Della Rocca, G. Borg, M. De Pont, A. Rosseel, P. Ten Cate, J. Van Berkel, G. Corsten, S. Bakker, J. Vogelaar, J. Blom, H. Kieft, H. Kuiper, M. Gille, A. Pickkers, P. Vet, J. Ammann, J. Den Boer, S. Wesselink, R. Speelberg, B. Pham, C. Rodgers, M. Bergmans, D. Groeneveld, J. Loevstad, R. Klepstad, P. Erno, P. Junker, A. Bártolo, A. Castelo-Branco Sousa, M. Esteves, F. Martins, A. Oliveira, T. Ponce, P. Mourão, L. Febra, C. Carmo, E. Lopes, V. Póvoa, P. Rezende, A. Costa, H. Moreira, P. Pádua, F. Leite, A. Almeida, E. Alves, M. Sousa, A. Telo, L. Dias, C. Paiva, J. Ribeiro, R. Amaro, P. Carneiro, A. Moreno, R. Matos, R. Afonso, S. Bouw, M. França, C. Rubio, O. Mañez, R. Campiñez, M. Alvarez, M. Jorda, R. Naveira-Abeigón, E. Monedero, P. Alemparte-Pardavila, E. Garcia del Valle, S. Perez Calvo, C. Palomar, M. Guerrero, F. Caballero Zirena, A. Arribas, M. Bustamante Munguira, E. Ruiz, J. Iglesias, L. Zavala, E. Valencia, M. Blesa Malpica, A. Martinez-Sagasti, F. Nieto, M. Aguilar, G. Martinon-Torres, F. Lorente, C. Insausti, J. Vegas Pinto, R. Santos, I. Escriba, A. Olaechea, P. Muñoz, E. Antón Caraballo, E. Galdos-Anuncibay, P. Lopez Camps, V. Esteban-Reboll, F. Estella, A. Bocero, L. Ibañez, A. Pueyo, L. María Jesús, L. Iglesias, L. Silva, J. Garro, P. Ramos-gómez, L. Rovira, A. Martin Delgado, M. Monton Dito, J. Garcia, F. Navarro, J. Latour-Perez, J. Albaya, A. Bustinza, A. Sole-violán, J. Ugarte Peña, P. Yuste, I. De Rojas Román, J. Vallés, J. Esteban, E. Quintana Tort-Martorell, E. Moreno, M. López Ciudad, V. Manzano Ramirez, A. Sánchez-Olmedo, J. Borges, M. Amador Amerigo, J. Guerrero Gomez, F. Montejo González, J. Sirvent, J. Mesalles Sanjuan, E. Barcenilla-Gaite, F. Serrano, N. Cerdá, E. Lesmes Serrano, A. Garcia-Fuentes, C. Macias Pingarrón, J. Espinosa, E. Sanchez Garcia, M. Felices, F. de la Torre-Prados, M. Maria Jesus, H. Luis, V. Jara, R. Briones Lopez, M. Posada, P. Galvan, B. Mariscal, F. Gil, B. Sierra, R. Rico-Feijoo, J. Corcobado Márquez, C. Izura, J. González, J. Soto Ibáñez, J. Petersen, P. Johansson, L. Blomqvist, H. Peterzén, B. Wyon, N. Stiernstrom, H. Lindström, I. Paulsson, A. Agvald-Ohman, C. Petersson, J. Friberg, H. Einar, V. Hammarskjöld, F. Schindele, M. Arvidsson, S. Sellgren, J. Hulting, J. Häggqvist, J. Rudenstam, J. Lind, D. Kokinsky, E. Owall, A. Jacobson, S. Nydahl, A. Atalan, K. Ates, C. Kahveci, A. Fistikci, H. Kaya, A. Ozgencil, E. Kizilkaya, M. Bosnak, M. Bodur, H. Akan, M. Guven, M. Turkoglu, M. Topeli, A. Togal, T. Uzel, N. Akinci, I. Cakar, N. Tugrul, S. Demirkiran, O. Adanir, T. Dogruer, K. Turkmen, A. Guven, H. Ulger, F. Kocak, S. the EPIC II Group of Investigators

Subjects
health care facilities, manpower, and services
Abstract

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome. © 2014 Hanberger et al.; licensee BioMed Central Ltd.

Published
2014

8. Reversal of profound and 'deep' residual rocuronium-induced neuromuscular blockade by sugammadex: a neurophysiological study

Author

Vittorio Pavoni, Gianesello, L., Scisciolo, G., Provvedi, E., Horton, D., Barbagli, R., Conti, P., Conti, R., and Giunta, F.

Subjects
Adult, Male, Adolescent, Middle Aged, Sugammadex, Young Adult, Neuromuscular Blockade, Humans, Female, Nervous System Physiological Phenomena, Androstanols, Prospective Studies, Rocuronium, Aged, Neuromuscular Nondepolarizing Agents, gamma-Cyclodextrins
Abstract

Sugammadex is the first of a new class of selective relaxant binding drugs developed for the rapid and complete reversal of neuromuscular blockade (NMB) induced by the aminosteroid neuromuscular blocking drugs rocuronium and vecuronium. Neuromuscular blocking drugs block the transmission from the peripheral nerve to the muscle units, with reduction and disappearance of the evoked electromyographic activity. Usually, neuromuscular monitoring for the investigational reversal drug is performed by calibrated acceleromyography. The efficacy of sugammadex in reversing profound and "deep" residual rocuronium-induced NMB using myogenic motor evoked potentials (mMEPs) monitoring was evaluated.In this prospective trial, 30 consenting patients undergoing propofol-remifentanil anesthesia for spine surgery were enrolled and divided into two groups: Group 1, reversal of profound NMB (sugammadex 16 mg/Kg, 3 minutes after rocuronium 1.2 mg/Kg) and Group 2, reversal of "deep" residual NMB (sugammadex 4 mg/Kg, 15 minutes after rocuronium 0.6 mg/Kg). Myogenic MEPs registrations of upper and lower limbs and the diaphragm were performed, as well as TOF monitoring.After injection of 4 mg/Kg of sugammadex, the means of recovery time of the basal mMEPs amplitudes (diaphragm, and lower limbs and upper limbs) were 124±9.6, 143±163, 151±207 sec, respectively whereas after 16 mg/Kg of sugammadex the times were 109±13.8, 124±0.6, and 135±14.1 sec. Times to TOF ratio 0.9 were 114±75 and 186±105 sec in Group 1 and 2, respectively. No serious adverse effects related to sugammadex and to electrical stimulation were reported. No reoccurrence of neuromuscular block was observed.Neurophysiological monitoring using mMEPs confirmed that sugammadex provided a complete recovery from profound and "deep" residual rocuronium-induced neuromuscular blockade.

Published
2012

9. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

Author

Keth, Th, Azoulay, E, Echeverria, Pm, Vincent, Jl, Collaboratorsmargarit, A, Valentini, R, Alan Javier, Z, Bevilacqua, C, Curone, M, Rabuffetti, R, Comignani, P, Torres Boden, M, Chertcoff, F, Cardonatti, G, Adén, F, Marcos, L, Dónofrio, M, Fernández, R, Lamberghini, R, Balasini, S, Teves, J, Las Heras, M, Sinner, J, Ceraso, D, Curcio, D, Aguilar, L, Weller, C, Cardonnet, L, Santa Cruz, R, Manrique, E, Bernardez, D, Iolster, T, Chiappero, G, Ramos, P, Vergara, J, Moine, I, Ilutovich, S, Jannello, G, Waschbusch, M, Rios Picaza, G, Raimondi, A, Miriam, M, Lovesio, C, Caridi, M, Leong, T, Orford, N, Reece, G, Ernest, D, Hawker, F, Tan, J, Giannellis, C, Ihle, B, Bersten, A, Mcinnes, J, Tallott, M, Mcfadyen, B, Vibert, J, Parr, M, Tran, K, Sutton, J, Webb, S, Groves, N, Cole, L, Long, D, Bass, F, Erickson, S, Lipman, J, Delzoppo, C, Thomas, J, Dobb, G, Daley, M, Roberts, B, Santamaria, J, Young, J, Festa, M, Holland, R, Mullany, D, Williams, P, Corkeron, M, Gales, M, Banerjee, A, Yung, M, Mutz, N, Hiesmayr, M, Faybik, P, Fitzgerald, R, Firlinger, F, Zasmeta, G, Zink, M, Sieber, W, Hildegard, J, Bakondy, R, Schlieber, J, Filzwieser, G, Beer, R, Joannidis, M, Schuster, R, Scherzer, W, Smolle, K, Fitzal, S, Manzoor, R, Brunain, J, D'Hondt, A, Huylenbroeck, G, Van der Schueren, M, 't Kindt, H, Slock, E, Rijckaert, D, Raemaekers, J, Bourgeois, M, Van Cotthem, I, Nackaerts, G, Gusu, D, Gadisseux, P, Vancollie, O, Lignian, H, Michel, P, Fraipont, V, Vander Stappen, M, Forêt, F, De Bels, D, Devriendt, J, Massaut, J, Biston, P, Roman, A, Lambermont, B, De Meulder, A, Frederic, V, Sottiaux, T, Ruyffelaere, P, Collin, V, Anane, S, Kleiren, P, Simon, M, Machayekhi, S, Frans, E, Leroy, G, Berghmans, T, Joseph, R, Eerens, J, Laterre, P, Lagrou, B, Rutsaert, R, Pisarek, W, Dive, A, De Waele, J, Spapen, H, Damas, P, Malbrain, M, Hidalgo, J, Baptista, M, Salgado, D, Braga, M, Avila, C, Westphal, G, Caser, E, Alves, A, Friedman, G, Luz, M, Assuncao, M, Reis, H, Gomes, A, Silva, U, Nogueira Fh, W, El Dash, S, Valiatti, J, Barbosa, A, Coelho, C, Knibel, M, Minelli, C, Caovilla, J, Teixeira, G, Hovnanian, A, Rea Neto, A, Lobo, S, Lugarinho, M, Souza, P, Ferreira, D, Duarte, P, Oliveira, M, Marques, J, Machado, R, Rehder, P, Mataloun, S, Grilo, M, Quesado, P, Moock, M, Ferreira, F, Teles, J, Silva, E, Morais, A, Bruzzi de Carvalho, F, Wanderley, M, Velasco, M, Brandão da Silva, N, Feijó, J, Souza Dantas, V, Costa Filho, R, Japiassú, A, Villela, D, Santos, C, Passos, R, Alheira Rocha, R, Silva, R, Houly, J, Aldrighi, J, Hatum, R, Suparregui Dias, F, Ferreira, L, Ferro, L, Gomez, J, Fleury, R, David, C, Resener, T, Mendes, C, Germano, A, De Marco, F, Lage, S, Salluh, J, Torelly, A, Sad, R, Oliveira, G, Lima, R, Paranhos, J, Rocha, M, Bitencourt, W, Grion, C, Forte, D, Guimarães, H, Piras, C, Stephanova, L, Lyubenov, L, Tsarianski, G, Dimov, G, Green, R, Levasseur, J, Ward, R, Lesur, O, Poirier, G, Wax, R, Wood, G, Cook, D, Marshall, J, Herridge, M, Ferguson, N, Espinoza, M, Valdés jimenez, S, Bruhn, A, Micolich, J, Fricke, G, Galvez, S, Escamilla Leon, I, Zhan, Q, Xu, Y, Zhao, Y, Zhang, L, Qin, T, Du, B, Li, M, Wang, X, Jing, Y, Zhang, Z, Xianyao, W, Li, F, Congshan, Y, Rebolledo, C, Diaz, D, Murillo Arboleda, R, Arias Antun, A, Montenegro, G, Granados, M, Dueñas, C, Perez, N, Libreros Duque, G, Coral, M, Ortiz, G, Rodriguez, D, Barsic, B, Cubrilo Turek, M, Gornik, I, Grljusic, M, Caballero lopez, A, Iraola Ferrer, M, Pavlik, P, Manak, J, Radej, J, Belohlavek, J, Sevcik, P, Blahut, L, Tyl, D, Steinbach, J, Herold, I, Zykova, I, Prchal, D, Bartosik, T, Kolarova, M, Hájek, R, Kohoutová, J, Marek, O, Hon, P, Chytra, I, Betsch, H, Fogh, B, Espersen, K, Jacobsen, K, Berezowicz, P, Andrade, C, Guerrero, F, Salgado, E, Barahona, D, Del Pozo Sanchez, H, Jibaja, M, Alansary, A, Reintam, A, Starkopf, J, Harjola, V, Tual, L, Leone, M, Serge, M, Leroy, O, Mallet, L, Marc, B, Dormoy, D, Pascal, H, Tronchon, L, Garrigues, B, Santré, C, Dupont, H, Duranteau, J, Leon, A, Henry, L, Canevet, C, Dube, L, Julien, H, Nadia, A, Francois, B, Gérard, J, Freysz, M, Remy, G, Blanloeil, Y, Squara, P, Korach, Jm, Durand, M, Gabriel, C, Eric, P, Jacobs, F, Bronchard, R, Kipnis, E, Moussa, M, Launoy, A, Guérin, C, Vanhems, P, Wynckel, A, Clair, B, Fulgencio, J, Gottwalles, Y, Krummel, T, Lepape, A, Lesieur, O, Payen, D, Hérvé, O, Farkas, J, Cougot, P, Mallédant, Y, Joannes Boyau, O, Standl, T, Sierig, U, Geiseler, J, Hopf, H, Conrad Opel, E, Hermann, C, Ventzke, M, Henneberg, T, Esposito, F, Loeser, H, Spies, C, Zuckermann Becker, H, Voegeler, S, Scherer, R, Pauer, A, Kljucar, S, Delfs, K, Blank, E, Busch, J, Wendt, K, Lessmann, J, Bach, F, Sakr, Y, Berlet, T, Kernchen, A, Quintel, M, Holst, D, Kilger, E, Holubarsch, T, Raufhake, C, Stolt, C, Lubasch, A, Meier Hellmann, A, Woebker, G, Scharnofske, C, Breyer, M, Risch, T, Manhold, C, Goethe, Jw, Meininger, D, Greive, C, Rau, J, Seibel, A, Henn beilharz, A, Wolbert, R, Scherke, T, Martin, J, Rudolph, M, Gleissner, J, Wolf, M, Schleibach, F, Jaschinski, U, Lunkeit, A, Welte, M, Bingold, T, Kogelmann, K, Fischer, F, Fischer, B, Schmid, M, Klein, M, Bechtold, A, Bodmann, K, Klasen, J, Meyrl, H, Goetz, J, Geldner, G, Helmes, T, Jensen, N, Eickmeyer, H, Lengfelder, W, Langenstein, B, Bogdanski, R, Jelen Esselborn, S, Umgelter, A, Dörr, F, Lüttje, K, Heinemeyer, D, Uhl, M, Schirle, P, Benad, H, Glaser, M, Panzer, W, Huettemann, E, Stierwaldt, R, Schappacher, M, Müller, E, Stadlmeyer, W, Fantini, M, Dummer, B, Thörner, M, Jost, V, Loerbroks, T, Glück, T, Zimmermann, R, Clement, R, Hering, R, Klinger, T, Mehl, J, Polozek, H, Rothhammer, A, Seidler, R, Lorenz, P, Mueritz, W, Lutze, M, Euler, M, Heintz, M, Winkler, M, Angstwurm, M, Krohe, K, Treu, T, Steiner, T, Locher, S, Walz, A, Zahn, P, Brandt, W, Marks, M, Henning, F, Janssens, U, Luethgens, M, Theelen, W, Sydow, M, Weber, M, Meiser, A, Deutschmann, C, Buttner, C, Jokiel, M, Bozzetti, C, Jürgen, B, Fiedler, F, Wresch, K, Kremer, A, Bleier, H, Rueckert, M, Ditter, H, Peckelsen, C, Friederich, P, Weber, K, Krueger, W, Lowack, R, Michalsen, A, Ragaller, M, Groeschel, A, Friedrich, T, Hinz, M, Christel, A, Hartwig, T, Kaisers, U, Schmitt, D, Vögeler, S, Weiss, M, Reiter, K, Schwab, T, Trieschmann, U, Kindgen milles, D, Engel, J, Sedemund adib, B, Lauterbach, M, Max, M, Volkert, T, Waydhas, C, Hien, S, Briegel, J, Guralnik, V, Zoremba, N, Riessen, R, Müllges, W, Nierhaus, A, Strauss, R, Utzolino, S, Thul, J, Abel, P, Gründling, M, Kessler, W, Scheuren, K, Vagts, D, Rensing, H, Schoch, B, Kopp, K, Gerlach, H, Corea, M, Uhrig, A, Schroeder, S, Jordan, F, Huber, T, Bittinger, M, Sofianos, E, Armaganidis, A, Routsi, C, Bitzani, M, Chalkiadaki, A, Michalopoulos, A, Mouloudi, E, Ioannidou, E, Myrianthefs, P, Koulenti, D, Karampela, I, Kyriazopoulos, G, Mandragos, K, Clouva molyvdas, P, Moraiti, A, Pneumatikos, I, Filos, K, Zakynthinos, E, Kotanidou, A, Vakalos, A, Cheng, A, Buckley, T, Gomersall, C, Kiss, K, Tamási, P, Sarkany, A, Csomos, A, Zöllei, É, Todi, S, Udwadia, F, Shah, R, Amin, P, Samavedam, S, Mathai, A, Patil, M, Jog, S, Gurjar, M, Vats, M, Varma, A, Gopal, P, Kapadia, F, Chawla, R, Iyer, S, Sahu, S, Bakshi, C, Ambike, D, Govil, D, Karipparambath, V, Chacko, J, Sathe, P, Rungta, N, Jani, C, Bhome, A, Prayag, S, Ray, S, Rajagopalan, R, Divatia, J, Da costa, R, Shyam Sunder, T, Wibowo, P, Maskoen, T, Sugiman, T, Nowruzinia, S, Lotfi, A, Mahmoodpoor, A, Donnelly, M, Breen, D, Ng, S, Bates, J, Sprung, C, Lev, A, Kishinevsky, E, Cohen, J, Sofer, S, Vesconi, S, Greco, S, Borelli, M, Cecilia, P, Sapuppo, M, Lazzero, A, Mangani, V, Petrucci, N, Minerva, M, Rummo, G, De blasio, E, Marzorati, S, Rosi, R, Giarratano, A, Margarit, O, Guberti, A, Scolz, S, Stelian, E, Emmi, V, Caspani, M, Rosano, A, Abbruzzese, C, Colonna, S, Ceriani, R, De Blasi, R, Panella, L, Borrelli, F, Lorella, P, Ruatti, H, Munch, C, Sorbara, C, Fiore, G, Chieregato, A, Conti, V, Guadagnucci, A, Pizzamiglio, M, Locicero, Mt, Marri, I, Sicignano, A, Conte, V, Oggioni, R, De Gasperi, A, De negri, P, Santagostino, G, Roberto, F, Marino, G, Castiglione, G, Sforza, D, Camillo, S, Giuseppe, N, Bassetti, Matteo, Napoli, D, Ferraro, F, Clementi, S, Di Filippo, A, Cotogni, P, Ranieri, Mv, Antonelli, M, Martinelli, L, Gianesello, L, Gullo, A, Morelli, A, Biancofiore, G, DELLA ROCCA, Giorgio, Hashimoto, S, Onodera, M, Kobayashi, A, Shinozuka, T, Imanaka, H, Ikeda, T, Yaguchi, A, Misane, I, Piebalga, A, Moughaghab, A, Pilvinis, V, Vosylius, S, Balciunas, M, Kekstas, G, Margaret, H, Klop, M, Grozdanovski, K, Eftimova, B, Wafa, S, Lim, C, Mat nor, M, Tai, L, Syed Mohd Tahir, S, Idris, N, Tan, C, Borg, M, Manzo, E, Gutierrez Morales, H, Miguel, P, Villagomez, A, Bassols, A, Aguirre, G, Cerón, U, Lopez ramos, J, Monjardín, J, Bermudez Aceves, E, Gonzalez Salazar, F, Rodriguez Gonzalez, D, Poblano Morales, M, Ramirez, F, Cetina, M, Navarro, J, Villagomez Ortiz, A, Sanchez, V, Chavarria, U, Fernandez Ponce, O, Serna secundino, H, Leonardo, O, Diego Manuel, R, Mijangos, J, Vazquez de Anda, G, Martin, E, Gutierrez, P, López Islas, I, Soberanes, L, Pejakov, L, Sbihi, A, Ouahid, B, Naoufel, M, De Pont, A, Rosseel, P, Ten Cate, J, Van Berkel, G, Corsten, S, Bakker, J, Vogelaar, J, Blom, H, Kieft, H, Kuiper, M, Gille, A, Pickkers, P, Vet, J, Ammann, J, Den Boer, S, Wesselink, R, Speelberg, B, Pham, C, Rodgers, M, Bergmans, D, Groeneveld, J, Mcarthur, C, Parke, R, Mehrtens, J, Celi, L, Freebairn, R, Rankin, N, Heffernan, C, Mchugh, G, Beca, J, Van haren, F, Barry, B, Kalkoff, M, Loevstad, R, Klepstad, P, Erno, P, Junker, A, Naqvi, S, Javed, I, Sinclair, J, Rivera, R, Chavez, C, Donayre Taber, Z, Quispe Sierra, R, Muñoz, J, Galvez Ruiz, J, Fang Li, J, Candiotti Herrera, M, Arroyo, A, Becerra, R, Meza, J, Mayorga, M, Garba, P, Kot, J, Gaszynski, T, Piechota, M, Renata, S, Müller, P, Stepinska, J, Jacek, K, Cieniawa, T, Mikstacki, A, Tamowicz, B, Bartkowska Sniatkowska, A, Karpel, E, Kusza, K, Smuszkiewicz, P, Mikaszewska Sokolewicz, M, Goraj, R, Kubler, A, Bártolo, A, Castelo Branco Sousa, M, Esteves, F, Martins, A, João, Hs, Oliveira, T, Ponce, P, Mourão, L, Febra, C, Carmo, E, Lopes, V, Póvoa, P, Rezende, A, Costa, H, Moreira, P, Pádua, F, Leite, A, Almeida, E, Alves, M, Sousa, A, Telo, L, João, S, Dias, C, Paiva, J, Ribeiro, R, Amaro, P, Carneiro, A, Moreno, R, Matos, R, Afonso, S, Bouw, M, França, C, Ibrahim, A, Tabacaru, R, Ionita, V, Tulbure, D, Filipescu, D, Pascanu, S, Grigoras, I, Copotoiu, S, Popov, D, Lebedev, E, Olga, I, Yaroshetskiy, A, Lugovkina, T, Dmitry, B, Malinin, O, Lekmanov, A, Abulmagd, M, Arabi, Y, Alhashemi, J, Ali, A, Maghrabi, K, Debek, A, Malik, M, Jankovic, R, Palibrk, I, Maravic stojkovic, V, Malenkovic, V, Surbatovic, M, Bumbasirevic, V, Lim, N, Loh, T, Tan, H, Sekeresova, H, Koutun, J, Firment, J, Malik, P, Trenkler, S, Muzlovic, I, Kosec, L, Ozek, B, Kasnik, D, Tomic, V, Knafelj, R, Svigelj, V, Du Plessis, H, Raine, R, Bhagwanjee, S, Richards, G, Goosen, J, De Jager, J, Schleicher, G, Rubio, O, Mañez, R, Burgueño Campiñez, M, Alvarez, M, Jorda, R, Naveira Abeigón, E, Monedero, P, Alemparte Pardavila, E, Garcia del Valle, S, Perez Calvo, C, Palomar, M, Caballero Zirena, A, Arribas, M, Bustamante Munguira, E, Ruiz, J, Blanco Vicente, A, Zavala, E, Valencia, M, Blesa Malpica, A, Martinez Sagasti, F, Nieto, M, Aguilar, G, Martinon Torres, F, Lorente, C, Insausti, J, Vegas Pinto, R, Santos, I, Escriba, A, Olaechea, P, Muñoz, E, Antón Caraballo, E, Galdos Anuncibay, P, Lopez Camps, V, Esteban Reboll, F, Estella, A, Bocero, L, Ibañez, A, Yagüe, G, Pueyo, L, María Jesús, L, Iglesias Fraile, L, Silva, J, Garro, P, Palma, L, Ramos gómez, L, Rovira, A, Martin Delgado, M, Monton Dito, J, Garcia, F, Latour Perez, J, Albaya, A, Bustinza, A, Sole violán, J, Ugarte Peña, P, Yuste, I, De Rojas Román, J, Vallés, J, Esteban, E, Quintana Tort Martorell, E, Moreno, M, López Ciudad, V, Manzano Ramirez, A, Sánchez Olmedo, J, Borges, M, Amador Amerigo, J, Guerrero Gomez, F, Montejo González, J, Sirvent, J, Pujol, I, Mesalles Sanjuan, E, Barcenilla Gaite, F, Serrano, N, Cerdá, E, Lesmes Serrano, A, Garcia Fuentes, C, Macias Pingarrón, J, Espinosa, E, Sanchez Garcia, M, Felices, F, de la Torre Prados, M, Maria Jesus, H, Luis, V, Jara, R, Briones Lopez, M, Posada, P, Galvan, B, Mariscal, F, Rello, J, Gil, B, Sierra, R, Rico Feijoo, J, Izura, J, González, J, Soto Ibáñez, J, Agabani, H, Petersen, P, Johansson, L, Blomqvist, H, Peterzén, B, Wyon, N, Lindström, I, Paulsson, A, Agvald Ohman, C, Petersson, J, Friberg, H, Einar, V, Hammarskjöld, F, Schindele, M, Arvidsson, S, Sellgren, S, Hulting, J, Häggqvist, J, Rudenstam, J, Lind, D, Kokinsky, E, Owall, A, Jacobson, S, Stiernstrom, H, Nydahl, A, Eggimann, P, Stocker, R, Loderer, G, Loetscher, R, Heer, K, Zender, H, Cottini, S, Pagnamenta, A, Eich, G, Felleiter, P, Marco, M, Pugin, J, Shu Hui, W, Hsieh, K, Toomtong, P, Khwannimit, B, Kietdumrongwong, P, Khaldi, A, Messadi, A, Labbene, I, Frikha, N, Atalan, K, Ates, C, Kahveci, A, Ozgencil, E, Kizilkaya, M, Bosnak, M, Bodur, H, Akan, M, Guven, M, Turkoglu, M, Topeli, A, Togal, T, Uzel, N, Akinci, I, Cakar, N, Tugrul, S, Demirkiran, O, Adanir, T, Dogruer, K, Turkmen, A, Guven, H, Ulger, F, Kocak, S, Nalapko, Y, Rady, S, Alsabbah, A, Elahi, N, Al rahma, H, Rahman, M, Kashef, S, Cuthbertson, B, Gunning, K, Myint, Y, Bewley, J, Burnstein, R, Haji Michael, P, Wrathall, D, Folan, L, Nesbitt, I, Ratnaparkhi, A, Pambakian, S, Booth, M, Watters, M, Sherry, T, Buehner, U, Barrera Groba, C, Bothma, P, George, N, Frater, J, Hollos, L, Mclellan, S, Hunter, J, Garrioch, M, O'Keeffe, N, Divekar, N, Eggert, S, Smith, S, Vincent, A, Withington, P, Macmillan, C, Webster, R, Vuylsteke, A, Appadu, B, Barrera groba, C, Mcquillan, P, Blunt, M, Parekh, N, William, D, Jones, C, Krige, A, Schuster Bruce, M, Boyden, J, Boulanger, C, Swann, D, Walker, J, Wigmore, T, Law, R, Baldwin, F, Muench, C, Robinson, S, Crerar Gilbert, A, Rhodes, A, Mahambrey, T, Cameron, L, Thornton, J, Stotz, M, Russell, M, Longmate, A, Kitson, R, Browne, B, Thorniley, A, Gonzalez, I, Swart, M, Singer, M, Gautam, N, Prasad, V, Watson, D, Szakmany, T, Cardy, J, Binning, A, Loveland, R, Gannon, J, Martinelli, G, Nightingale, P, Howes, J, Steingrub, J, Ammons, L, Fisher, M, Gandhi, N, Martin, G, Deutschman, C, Dean, N, Michetti, C, Belzberg, H, Hutchinson, K, Van der kloot, T, Afessa, B, Kaufman, D, Iqbal, J, Ost, D, Afifi, S, West, M, Wunderink, R, Stein, S, Hagg, D, Jimenez, E, Blosser, S, Chhangani, S, Kleinpell, R, Reich, H, Fields, E, Willms, D, Castellanos Mateus, P, Melnik, L, Oud, L, Chi, E, Halfon, R, Badr, A, Restrepo, M, Pohlman, A, Branson, R, Simpson, S, Kett, D, Jacobs, T, Park, P, Wahl, W, Patricia, C, Hammersley, J, Papadimos, T, Sawyer, R, Freire, A, Rodriguez, W, Ryan, A, Margolis, B, Groth, M, Escanda, H, Baraibar, J, Paciel, D, Bagnulo, H, Hitta, F, Nadales, P, Albornoz, H, Salmen, Z, Pacheco, C, Bui, T, Potie, F, and Nguyen Huu, C.

Published
2011

10. Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels

Author

Hanberger, H. Antonelli, M. Holmbom, M. Lipman, J. Pickkers, P. Leone, M. Rello, J. Sakr, Y. Walther, S.M. Vanhems, P. Vincent, J.-L. Betsch, H. Fogh, B. Espersen, K. Jacobsen, K. Berezowicz, P. Harjola, V. Sofianos, E. Armaganidis, A. Routsi, C. Bitzani, M. Chalkiadaki, A. Michalopoulos, A. Mouloudi, E. Ioannidou, E. Myrianthefs, P. Koulenti, D. Karampela, I. Kyriazopoulos, G. Mandragos, K. Clouva-molyvdas, P. Moraiti, A. Pneumatikos, I. Filos, K. Zakynthinos, E. Kotanidou, A. Vakalos, A. Sprung, C. Lev, A. Kishinevsky, E. Cohen, J. Sofer, S. Vesconi, S. Greco, S. Borelli, M. Cecilia, P. Sapuppo, M. Lazzero, A. Mangani, V. Petrucci, N. Minerva, M. De blasio, E. Marzorati, S. Rosi, R. Giarratano, A. Margarit, O. Guberti, A. Scolz, S. Stelian, E. Emmi, V. Caspani, M. Rosano, A. Abbruzzese, C. Colonna, S. Ceriani, R. De Blasi, R. Panella, L. Borrelli, F. Lorella, P. Ruatti, H. Munch, C. Sorbara, C. Fiore, G. Chieregato, A. Conti, V. Guadagnucci, A. Pizzamiglio, M. Locicero, M. Marri, I. Sicignano, A. Conte, V. Oggioni, R. De Gasperi, A. De Negri, P. Santagostino, G. Fumagalli, R. Marino, G. Castiglione, G. Sforza, D. Giuseppe, N. Bassetti, M. Ferraro, F. Clementi, S. Alessandro, D. Cotogni, P. Ranieri, MV. Antonelli, M. Martinelli, L. Gianesello, L. Gullo, A. Morelli, A. Biancofiore, G. Della Rocca, G. Borg, M. De Pont, A. Rosseel, P. Ten Cate, J. Van Berkel, G. Corsten, S. Bakker, J. Vogelaar, J. Blom, H. Kieft, H. Kuiper, M. Gille, A. Pickkers, P. Vet, J. Ammann, J. Den Boer, S. Wesselink, R. Speelberg, B. Pham, C. Rodgers, M. Bergmans, D. Groeneveld, J. Loevstad, R. Klepstad, P. Erno, P. Junker, A. Bártolo, A. Castelo-Branco Sousa, M. Esteves, F. Martins, A. Oliveira, T. Ponce, P. Mourão, L. Febra, C. Carmo, E. Lopes, V. Póvoa, P. Rezende, A. Costa, H. Moreira, P. Pádua, F. Leite, A. Almeida, E. Alves, M. Sousa, A. Telo, L. Dias, C. Paiva, J. Ribeiro, R. Amaro, P. Carneiro, A. Moreno, R. Matos, R. Afonso, S. Bouw, M. França, C. Rubio, O. Mañez, R. Campiñez, M. Alva and Hanberger, H. Antonelli, M. Holmbom, M. Lipman, J. Pickkers, P. Leone, M. Rello, J. Sakr, Y. Walther, S.M. Vanhems, P. Vincent, J.-L. Betsch, H. Fogh, B. Espersen, K. Jacobsen, K. Berezowicz, P. Harjola, V. Sofianos, E. Armaganidis, A. Routsi, C. Bitzani, M. Chalkiadaki, A. Michalopoulos, A. Mouloudi, E. Ioannidou, E. Myrianthefs, P. Koulenti, D. Karampela, I. Kyriazopoulos, G. Mandragos, K. Clouva-molyvdas, P. Moraiti, A. Pneumatikos, I. Filos, K. Zakynthinos, E. Kotanidou, A. Vakalos, A. Sprung, C. Lev, A. Kishinevsky, E. Cohen, J. Sofer, S. Vesconi, S. Greco, S. Borelli, M. Cecilia, P. Sapuppo, M. Lazzero, A. Mangani, V. Petrucci, N. Minerva, M. De blasio, E. Marzorati, S. Rosi, R. Giarratano, A. Margarit, O. Guberti, A. Scolz, S. Stelian, E. Emmi, V. Caspani, M. Rosano, A. Abbruzzese, C. Colonna, S. Ceriani, R. De Blasi, R. Panella, L. Borrelli, F. Lorella, P. Ruatti, H. Munch, C. Sorbara, C. Fiore, G. Chieregato, A. Conti, V. Guadagnucci, A. Pizzamiglio, M. Locicero, M. Marri, I. Sicignano, A. Conte, V. Oggioni, R. De Gasperi, A. De Negri, P. Santagostino, G. Fumagalli, R. Marino, G. Castiglione, G. Sforza, D. Giuseppe, N. Bassetti, M. Ferraro, F. Clementi, S. Alessandro, D. Cotogni, P. Ranieri, MV. Antonelli, M. Martinelli, L. Gianesello, L. Gullo, A. Morelli, A. Biancofiore, G. Della Rocca, G. Borg, M. De Pont, A. Rosseel, P. Ten Cate, J. Van Berkel, G. Corsten, S. Bakker, J. Vogelaar, J. Blom, H. Kieft, H. Kuiper, M. Gille, A. Pickkers, P. Vet, J. Ammann, J. Den Boer, S. Wesselink, R. Speelberg, B. Pham, C. Rodgers, M. Bergmans, D. Groeneveld, J. Loevstad, R. Klepstad, P. Erno, P. Junker, A. Bártolo, A. Castelo-Branco Sousa, M. Esteves, F. Martins, A. Oliveira, T. Ponce, P. Mourão, L. Febra, C. Carmo, E. Lopes, V. Póvoa, P. Rezende, A. Costa, H. Moreira, P. Pádua, F. Leite, A. Almeida, E. Alves, M. Sousa, A. Telo, L. Dias, C. Paiva, J. Ribeiro, R. Amaro, P. Carneiro, A. Moreno, R. Matos, R. Afonso, S. Bouw, M. França, C. Rubio, O. Mañez, R. Campiñez, M. Alva

Abstract

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.Conclusions: Being hospitalized in an ICU in a region wit

Published
2014

11. Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels

Author

Hanberger, H, Antonelli, M, Holmbom, M, Lipman, J, Pickkers, P, Leone, M, Rello, J, Sakr, Y, Walther, S, Vanhems, P, Vincent, J, Betsch, H, Fogh, B, Espersen, K, Jacobsen, K, Berezowicz, P, Harjola, V, Sofianos, E, Armaganidis, A, Routsi, C, Bitzani, M, Chalkiadaki, A, Michalopoulos, A, Mouloudi, E, Ioannidou, E, Myrianthefs, P, Koulenti, D, Karampela, I, Kyriazopoulos, G, Mandragos, K, Clouva molyvdas, P, Moraiti, A, Pneumatikos, I, Filos, K, Zakynthinos, E, Kotanidou, A, Vakalos, A, Sprung, C, Lev, A, Kishinevsky, E, Cohen, J, Sofer, S, Vesconi, S, Greco, S, Borelli, M, Cecilia, P, Sapuppo, M, Lazzero, A, Mangani, V, Petrucci, N, Minerva, M, De blasio, E, Marzorati, S, Rosi, R, Giarratano, A, Margarit, O, Guberti, A, Scolz, S, Stelian, E, Emmi, V, Caspani, M, Rosano, A, Abbruzzese, C, Colonna, S, Ceriani, R, De Blasi, R, Panella, L, Borrelli, F, Lorella, P, Ruatti, H, Munch, C, Sorbara, C, Fiore, G, Chieregato, A, Conti, V, Guadagnucci, A, Pizzamiglio, M, Locicero, M, Marri, I, Sicignano, A, Conte, V, Oggioni, R, De Gasperi, A, De Negri, P, Santagostino, G, Fumagalli, R, Marino, G, Castiglione, G, Sforza, D, Giuseppe, N, Bassetti, M, Ferraro, F, Clementi, S, Alessandro, D, Cotogni, P, Ranieri, M, Martinelli, L, Gianesello, L, Gullo, A, Morelli, A, Biancofiore, G, Della Rocca, G, Borg, M, De Pont, A, Rosseel, P, Ten Cate, J, Van Berkel, G, Corsten, S, Bakker, J, Vogelaar, J, Blom, H, Kieft, H, Kuiper, M, Gille, A, Vet, J, Ammann, J, Den Boer, S, Wesselink, R, Speelberg, B, Pham, C, Rodgers, M, Bergmans, D, Groeneveld, J, Loevstad, R, Klepstad, P, Erno, P, Junker, A, Bártolo, A, Castelo Branco Sousa, M, Esteves, F, Martins, A, Oliveira, T, Ponce, P, Mourão, L, Febra, C, Carmo, E, Lopes, V, Póvoa, P, Rezende, A, Costa, H, Moreira, P, Pádua, F, Leite, A, Almeida, E, Alves, M, Sousa, A, Telo, L, Dias, C, Paiva, J, Ribeiro, R, Amaro, P, Carneiro, A, Moreno, R, Matos, R, Afonso, S, Bouw, M, França, C, Rubio, O, Mañez, R, Campiñez, B, Alvarez, M, Jorda, R, Naveira Abeigón, E, Monedero, P, Alemparte Pardavila, E, Garcia del Valle, S, Perez Calvo, C, Palomar, M, Guerrero, F, Caballero Zirena, A, Arribas, M, Bustamante Munguira, E, Ruiz, J, Iglesias, L, Zavala, E, Valencia, M, Blesa Malpica, A, Martinez Sagasti, F, Nieto, M, Aguilar, G, Martinon Torres, F, Lorente, C, Insausti, J, Vegas Pinto, R, Santos, I, Escriba, A, Olaechea, P, Muñoz, E, Antón Caraballo, E, Galdos Anuncibay, P, Lopez Camps, V, Esteban Reboll, F, Estella, A, Bocero, L, Ibañez, A, Pueyo, L, María Jesús, L, Silva, J, Garro, P, Ramos gómez, L, Rovira, A, Martin Delgado, M, Monton Dito, J, Garcia, F, Navarro, J, Latour Perez, J, Albaya, A, Bustinza, A, Sole violán, J, Ugarte Peña, P, Yuste, I, De Rojas Román, J, Vallés, J, Esteban, E, Quintana Tort Martorell, E, Moreno, M, López Ciudad, V, Manzano Ramirez, A, Sánchez Olmedo, J, Borges, M, Amador Amerigo, J, Guerrero Gomez, F, Montejo González, J, Sirvent, J, Mesalles Sanjuan, E, Barcenilla Gaite, F, Serrano, N, Cerdá, E, Lesmes Serrano, A, Garcia Fuentes, C, Macias Pingarrón, J, Espinosa, E, Sanchez Garcia, M, Felices, F, de la Torre Prados, M, Maria Jesus, H, Luis, V, Jara, R, Briones Lopez, M, Posada, P, Galvan, B, Mariscal, F, Gil, B, Sierra, R, Rico Feijoo, J, Corcobado Márquez, C, Izura, J, González, J, Soto Ibáñez, J, Petersen, P, Johansson, L, Blomqvist, H, Peterzén, B, Wyon, N, Stiernstrom, H, Lindström, I, Paulsson, A, Agvald Ohman, C, Petersson, J, Friberg, H, Einar, V, Hammarskjöld, F, Schindele, M, Arvidsson, S, Sellgren, J, Hulting, J, Häggqvist, J, Rudenstam, J, Lind, D, Kokinsky, E, Owall, A, Jacobson, S, Nydahl, A, Atalan, K, Ates, C, Kahveci, A, Fistikci, H, Kaya, A, Ozgencil, E, Kizilkaya, M, Bosnak, M, Bodur, H, Akan, M, Guven, M, Turkoglu, M, Topeli, A, Togal, T, Uzel, N, Akinci, I, Cakar, N, Tugrul, S, Demirkiran, O, Adanir, T, Dogruer, K, Turkmen, A, Guven, H, Ulger, F, Kocak, S, Kocak, S., FUMAGALLI, ROBERTO, Hanberger, H, Antonelli, M, Holmbom, M, Lipman, J, Pickkers, P, Leone, M, Rello, J, Sakr, Y, Walther, S, Vanhems, P, Vincent, J, Betsch, H, Fogh, B, Espersen, K, Jacobsen, K, Berezowicz, P, Harjola, V, Sofianos, E, Armaganidis, A, Routsi, C, Bitzani, M, Chalkiadaki, A, Michalopoulos, A, Mouloudi, E, Ioannidou, E, Myrianthefs, P, Koulenti, D, Karampela, I, Kyriazopoulos, G, Mandragos, K, Clouva molyvdas, P, Moraiti, A, Pneumatikos, I, Filos, K, Zakynthinos, E, Kotanidou, A, Vakalos, A, Sprung, C, Lev, A, Kishinevsky, E, Cohen, J, Sofer, S, Vesconi, S, Greco, S, Borelli, M, Cecilia, P, Sapuppo, M, Lazzero, A, Mangani, V, Petrucci, N, Minerva, M, De blasio, E, Marzorati, S, Rosi, R, Giarratano, A, Margarit, O, Guberti, A, Scolz, S, Stelian, E, Emmi, V, Caspani, M, Rosano, A, Abbruzzese, C, Colonna, S, Ceriani, R, De Blasi, R, Panella, L, Borrelli, F, Lorella, P, Ruatti, H, Munch, C, Sorbara, C, Fiore, G, Chieregato, A, Conti, V, Guadagnucci, A, Pizzamiglio, M, Locicero, M, Marri, I, Sicignano, A, Conte, V, Oggioni, R, De Gasperi, A, De Negri, P, Santagostino, G, Fumagalli, R, Marino, G, Castiglione, G, Sforza, D, Giuseppe, N, Bassetti, M, Ferraro, F, Clementi, S, Alessandro, D, Cotogni, P, Ranieri, M, Martinelli, L, Gianesello, L, Gullo, A, Morelli, A, Biancofiore, G, Della Rocca, G, Borg, M, De Pont, A, Rosseel, P, Ten Cate, J, Van Berkel, G, Corsten, S, Bakker, J, Vogelaar, J, Blom, H, Kieft, H, Kuiper, M, Gille, A, Vet, J, Ammann, J, Den Boer, S, Wesselink, R, Speelberg, B, Pham, C, Rodgers, M, Bergmans, D, Groeneveld, J, Loevstad, R, Klepstad, P, Erno, P, Junker, A, Bártolo, A, Castelo Branco Sousa, M, Esteves, F, Martins, A, Oliveira, T, Ponce, P, Mourão, L, Febra, C, Carmo, E, Lopes, V, Póvoa, P, Rezende, A, Costa, H, Moreira, P, Pádua, F, Leite, A, Almeida, E, Alves, M, Sousa, A, Telo, L, Dias, C, Paiva, J, Ribeiro, R, Amaro, P, Carneiro, A, Moreno, R, Matos, R, Afonso, S, Bouw, M, França, C, Rubio, O, Mañez, R, Campiñez, B, Alvarez, M, Jorda, R, Naveira Abeigón, E, Monedero, P, Alemparte Pardavila, E, Garcia del Valle, S, Perez Calvo, C, Palomar, M, Guerrero, F, Caballero Zirena, A, Arribas, M, Bustamante Munguira, E, Ruiz, J, Iglesias, L, Zavala, E, Valencia, M, Blesa Malpica, A, Martinez Sagasti, F, Nieto, M, Aguilar, G, Martinon Torres, F, Lorente, C, Insausti, J, Vegas Pinto, R, Santos, I, Escriba, A, Olaechea, P, Muñoz, E, Antón Caraballo, E, Galdos Anuncibay, P, Lopez Camps, V, Esteban Reboll, F, Estella, A, Bocero, L, Ibañez, A, Pueyo, L, María Jesús, L, Silva, J, Garro, P, Ramos gómez, L, Rovira, A, Martin Delgado, M, Monton Dito, J, Garcia, F, Navarro, J, Latour Perez, J, Albaya, A, Bustinza, A, Sole violán, J, Ugarte Peña, P, Yuste, I, De Rojas Román, J, Vallés, J, Esteban, E, Quintana Tort Martorell, E, Moreno, M, López Ciudad, V, Manzano Ramirez, A, Sánchez Olmedo, J, Borges, M, Amador Amerigo, J, Guerrero Gomez, F, Montejo González, J, Sirvent, J, Mesalles Sanjuan, E, Barcenilla Gaite, F, Serrano, N, Cerdá, E, Lesmes Serrano, A, Garcia Fuentes, C, Macias Pingarrón, J, Espinosa, E, Sanchez Garcia, M, Felices, F, de la Torre Prados, M, Maria Jesus, H, Luis, V, Jara, R, Briones Lopez, M, Posada, P, Galvan, B, Mariscal, F, Gil, B, Sierra, R, Rico Feijoo, J, Corcobado Márquez, C, Izura, J, González, J, Soto Ibáñez, J, Petersen, P, Johansson, L, Blomqvist, H, Peterzén, B, Wyon, N, Stiernstrom, H, Lindström, I, Paulsson, A, Agvald Ohman, C, Petersson, J, Friberg, H, Einar, V, Hammarskjöld, F, Schindele, M, Arvidsson, S, Sellgren, J, Hulting, J, Häggqvist, J, Rudenstam, J, Lind, D, Kokinsky, E, Owall, A, Jacobson, S, Nydahl, A, Atalan, K, Ates, C, Kahveci, A, Fistikci, H, Kaya, A, Ozgencil, E, Kizilkaya, M, Bosnak, M, Bodur, H, Akan, M, Guven, M, Turkoglu, M, Topeli, A, Togal, T, Uzel, N, Akinci, I, Cakar, N, Tugrul, S, Demirkiran, O, Adanir, T, Dogruer, K, Turkmen, A, Guven, H, Ulger, F, Kocak, S, Kocak, S., and FUMAGALLI, ROBERTO

Abstract

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.Conclusions: Being hospitalized in an ICU in a region with high level

Published
2014

22. Effects of type 5-phosphodiesterase inhibition on energy metabolism and mitochondrial biogenesis in human adipose tissue ex vivo

Author

Toni, L., Strapazzon, G., Gianesello, L., Caretta, N., Pilon, C., Bruttocao, A., and Foresta, C.

Abstract

Objective:An excess of adipose tissue (AT) in obese individuals is linked to increased cardiovascular risk and mitochondria have been shown to be defective in the muscle and AT of patients with metabolic disorders such as obesity and Type 2 diabetes. Nitric oxide (NO) generated by endothelial NO synthase (eNOS) plays a role in mitochondrial biogenesis through cyclic-GMP (cGMP). AT harbors the whole molecular signaling pathway of NO, together with type 5-phosphodiesterase (PDE-5), the main cGMP catabolising enzyme. Aim:Our aim was to evaluate the effect of the modulation of NO pathway, through PDE-5 inhibition, on energy metabolism and mitochondria biogenesis in human omental AT. Methods and measurements:Cultured human omental AT was stimulated with PDE-5 inhibitor, vardenafil, at different concentration for 24 and 72 h. Analysis of the expression of both key-regulator genes of adipocyte metabolism and mitochondria- biogenesis markers was performed. Results:We found an increased gene expression of peroxisome proliferator-activated receptor-γ (PPAR-γ), adiponectin, and proliferator- activated receptor gamma coactivator- 1 α (PGC- 1α) after a 24- h stimulation with vardenafil at the lowest concentration employed compared to controls (p<0.05). After 72 h of stimulation, a significant increase of mitochondrial DNA was found compared to control samples (p<0.05). Conclusion:Our data suggest that PDE-5 inhibition could have an impact on mitochondrial content of human AT suggesting a positive effect on energy metabolism and adding new elements in the comprehension of AT pathophysiology.

Published
2011
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24. Outcome predictors and quality of life of severe burn patients admitted to intensive care unit

Author

Buoninsegni Laura, Paparella Laura, Gianesello Lara, Pavoni Vittorio, and Barboni Elisabetta

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Despite significant medical advances and improvement in overall mortality rate following burn injury, the treatment of patients with extensive burns remains a major challenge for intensivists. We present a study aimed to evaluate the short- and the long-term outcomes of severe burn patients (total body surface area, TBSA > 40%) treated in a polyvalent intensive care unit (ICU) and to assess the quality of life of survivors, one year after the injury using the EuroQol-5D (EQ-5D) questionnaire. Methods A prospective-observational study was performed in an ICU of a University-affiliated hospital. Logistic regression analysis was used to identify the factors predicting in-hospital mortality. The EQ-5D questionnaire was used to asses participant's long term self-reported general health. Results During a period of five years, 50 patients participated in the study. Their mean age was 53.8 ± 19.8; they had a mean of %TBSA burned of 54.5 ± 18.1. 44% and 10% of patients died in the ICU and in the ward after ICU discharge, respectively. Baux index, SAPS II and SOFA on admission to the ICU, infectious and respiratory complications, and time of first burn wound excision were found to have a significant predictive value for hospital mortality. The level of health of all survivors was worse than before the injury. Problems in the five dimensions studied were present as follows: mobility (moderate 68.5%; extreme 0%), self-care (moderate 21%; extreme 36.9%), usual activities (moderate 68.5%; extreme 21%), pain/discomfort (moderate 68.5%; extreme 10.5%), anxiety/depression (moderate 36.9%; extreme 42.1%). Conclusions In severe burn patients, Baux index, severity of illness on admission to the ICU, complications, and time of first burn wound excision were the major contributors to hospital mortality. Quality of life was influenced by consequences of injury both in psychological and physical health.

Published
2010
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27. Human parietal epithelial cells as Trojan horses in albumin overload.

Author

Priante G, Ceol M, Gianesello L, Radu CM, Mantese R, Stefanelli LF, Cacciapuoti M, Martino FK, Calò LA, Anglani F, Nalesso F, and Del Prete D

Subjects
Humans, Endocytosis, Albumins metabolism, Hyaluronan Receptors metabolism, Epithelial Cells metabolism
Abstract

Parietal Epithelial Cells (PECs) activation and proliferation are common to several distinct forms of glomerulopathies. Due to several stimuli, PECs can change to a progenitor (CD24 + and CD133/2 + ) or a pro-sclerotic (CD44 + ) phenotype. In addition, PECs, which are constantly exposed to filtered albumin, are known to be involved in albumin internalization, but how this mechanism occurs is unknown. We hypothesized that PECs can transport albumin via receptor-mediated endocytosis and that albumin overload may affect the state of PECs. Conditionally immortalized human PECs (hPECs) were incubated with different albumin concentrations at different times. Albumin internalization studies were performed. Protein expression was assessed using In-Cell Western and immunofluorescence. Cell morphology was analyzed by phase-contrast microscopy and F-actin staining. We demonstrate that hPECs internalize albumin via receptor-mediated mechanisms. Under albumin stimulation, megalin, cubilin, ClC-5, CD133/2, CD24, and CD44 were upregulated. The increase of pERK1/2, the upregulation of ROCK1, ROCK2, caspase -3, -6, and -7, and the morphological changes associated with loss of F-actin fibers indicated that inflammation, proliferation and apoptosis mechanisms had been activated. Our results demonstrate that long-term exposure to high doses of albumin induces up-regulation of molecules involved in the tubular protein uptake machinery and suggest that albumin overload is able to trigger a regenerative process as well as an activation state which might lead in vivo to glomerular crescent formation., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Published
2025
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28. Human parietal epithelial cells (PECs) and proteinuria in lupus nephritis: a role for ClC-5, megalin, and cubilin?

Author

Ceol M, Gianesello L, Trimarchi H, Migliorini A, Priante G, Radu CM, Naso E, Angelini A, Calò LA, Anglani F, and Del Prete D

Subjects
Humans, Kidney Tubules, Proximal, Proteinuria etiology, Albumins metabolism, Epithelial Cells metabolism, Low Density Lipoprotein Receptor-Related Protein-2 metabolism, Lupus Nephritis
Abstract

Background: Parietal epithelial cells are a heterogeneous population of cells located on Bowman's capsule. These cells are known to internalize albumin with a still undetermined mechanism, although albumin has been shown to induce phenotypic changes in parietal epithelial cells. Proximal tubular cells are the main actors in albumin handling via the macromolecular complex composed by ClC-5, megalin, and cubilin. This study investigated the role of ClC-5, megalin, and cubilin in the parietal epithelial cells of kidney biopsies from proteinuric lupus nephritis patients and control subjects and identified phenotypical changes occurring in the pathological milieu., Methods: Immunohistochemistry and immunofluorescence analyses for ClC-5, megalin, cubilin, ANXA3, podocalyxin, CD24, CD44, HSA, and LTA marker were performed on 23 kidney biopsies from patients with Lupus Nephritis and 9 control biopsies (obtained from nephrectomies for renal cancer)., Results: Two sub-populations of hypertrophic parietal epithelial cells ANXA3 + /Podocalyxin - /CD44 - , both expressing ClC-5, megalin, and cubilin and located at the tubular pole, were identified and characterized: the first one, CD24 + /HSA - /LTA -  had characteristics of human adult parietal epithelial multipotent progenitors, the second one, CD24 - /LTA + /HSA + committed to become phenotypically proximal tubular cells. The number of glomeruli presenting hypertrophic parietal epithelial cells positive for ClC-5, megalin, and cubilin were significantly higher in lupus nephritis patients than in controls., Conclusions: Our results may provide further insight into the role of hypertrophic parietal epithelial cells located at the tubular pole and their possible involvement in protein endocytosis in lupus nephritis patients. These data also suggest that the presence of hypertrophic parietal epithelial cells in Bowman's capsule represents a potential resource for responding to protein overload observed in other glomerulonephritis., (© 2023. The Author(s).)

Published
2023
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29. The clinical impact of pectoral nerve block in an 'enhanced recovery after surgery' program in breast surgery.

Author

Conti D, Valoriani J, Ballo P, Pazzi M, Gianesello L, Mengoni V, Criscenti V, Gemmi E, Stera C, Zoppi F, Galli L, and Pavoni V

Subjects
Humans, Female, Analgesics, Opioid, Case-Control Studies, Pain, Postoperative prevention & control, Thoracic Nerves, Breast Neoplasms surgery
Abstract

Background: Pectoral nerve block (PECS) is increasingly performed in breast surgery. Aim: The study evaluated the clinical impact of these blocks in the postoperative course. Patients & methods: In this case-control study, patients undergoing breast surgery with 'enhanced recovery after surgery' pathways were divided into group 1 (57 patients) in whom PECS was performed before general anesthesia, and group 2 (57 patients) in whom only general anesthesia was effected. Results: Postoperative opioid consumption (p < 0.002), pain at 32 h after surgery (p < 0.005) and the length of stay (p < 0.003) were significantly lower in group 1. Conclusion: Reducing opioid consumption and pain after surgery, PECS could favor a faster recovery with a reduction in length of stay, ensuring a higher turnover of patients undergoing breast surgery.

Published
2023
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30. Emerging Perspectives on the Rare Tubulopathy Dent Disease: Is Glomerular Damage a Direct Consequence of ClC-5 Dysfunction?

Author

Priante G, Ceol M, Gianesello L, Bizzotto D, Braghetta P, Calò LA, Del Prete D, and Anglani F

Subjects
Humans, Actins genetics, Actins metabolism, Kidney Glomerulus metabolism, Dent Disease genetics, Dent Disease pathology, Glomerulosclerosis, Focal Segmental metabolism, Podocytes metabolism, Chloride Channels metabolism
Abstract

Dent disease (DD1) is a rare tubulopathy caused by mutations in the CLCN5 gene. Glomerulosclerosis was recently reported in DD1 patients and ClC-5 protein was shown to be expressed in human podocytes. Nephrin and actin cytoskeleton play a key role for podocyte functions and podocyte endocytosis seems to be crucial for slit diaphragm regulation. The aim of this study was to analyze whether ClC-5 loss in podocytes might be a direct consequence of the glomerular damage in DD1 patients. Three DD1 kidney biopsies presenting focal global glomerulosclerosis and four control biopsies were analyzed by immunofluorescence (IF) for nephrin and podocalyxin, and by immunohistochemistry (IHC) for ClC-5. ClC-5 resulted as down-regulated in DD1 vs. control (CTRL) biopsies in both tubular and glomerular compartments (p < 0.01). A significant down-regulation of nephrin (p < 0.01) in DD1 vs. CTRL was demonstrated. CRISPR/Cas9 (Clustered Regularly Interspaced Short Palindromic Repeats/Caspase9) gene editing of CLCN5 in conditionally immortalized human podocytes was used to obtain clones with the stop codon mutation p.(R34Efs*14). We showed that ClC-5 and nephrin expression, analyzed by quantitative Reverse Transcription/Polymerase Chain Reaction (qRT/PCR) and In-Cell Western (ICW), was significantly downregulated in mutant clones compared to the wild type ones. In addition, F-actin staining with fluorescent phalloidin revealed actin derangements. Our results indicate that ClC-5 loss might alter podocyte function either through cytoskeleton disorganization or through impairment of nephrin recycling.

Published
2023
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33. The Lesson Learned from the New c.2547-1G > T Mutation Combined with p.R854Q: When a Type 2N Mutation Reveals a Quantitative von Willebrand Factor Defect.

Author

Casonato A, Cozzi MR, Ferrari S, Rubin B, Gianesello L, De Marco L, and Daidone V

Subjects
Factor VIII, Humans, Mutation, von Willebrand Factor, Hemophilia A, von Willebrand Disease, Type 2, von Willebrand Diseases
Abstract

Type 2N is a rare von Willebrand disease (VWD) variant involving an impairment in the factor VIII (FVIII) carrier function of von Willebrand factor (VWF). It has a phenotype that mimics hemophilia A, and FVIII binding to VWF (VWF:FVIIIB) is tested to differentiate between the two disorders. Type 2N VWF defects may also be associated with quantitative VWF mutations (type 2N/type 1), further complicating the identification of cases. We report on a new quantitative VWF mutation (c.2547-1G > T) revealed by a p.R854Q type 2N mutation acting as homozygous despite being carried as a heterozygous defect. The proband had near-normal VWF levels (initially ruling out a defective VWF synthesis) and slightly reduced FVIII levels, while a VWF:FVIIIB test showed significantly reduced binding. Routine tests on type 2N homozygotes or heterozygotes combined with quantitative VWF defects in our cohort showed reduced FVIII levels in both groups, but it was only in the former that the FVIII/VWF antigen (VWF:Ag) ratio was always significantly reduced. The two tests are therefore not enough to identify all forms of type 2N VWD. While relatives of type 2N homozygotes usually have normal FVIII levels and FVIII/VWF:Ag ratios, relatives of type 2N/type 1 may have high FVIII/VWF:Ag ratios, but their VWF:FVIIIB and/or VWF:FVIIIB/VWF:Ag ratios are always low. Measuring FVIII and VWF levels may therefore suggest type 2N VWD in patients carrying type 2N mutations alone, but not in type 2N combined with quantitative VWF defects. The VWF:FVIIIB test should consequently be included when exploring VWF function, whatever VWD patient's phenotype., Competing Interests: None declared., (Thieme. All rights reserved.)

Published
2022
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35. Combined pericapsular nerve group and lateral femoral cutaneous nerve blocks for hip fracture in a polytraumatized patient-A case report.

Author

Valoriani J, Conti D, Gianesello L, and Pavoni V

Abstract

Locoregional anesthetic techniques in hip fracture are significant in order to control pain, reduce postoperative opioid use, and perioperative adverse events. Pericapsular nerve group (PENG) block has been described and proved as an effective analgesic method for hip surgery as an alternative to other regional nerve blocks. The association of PENG and lateral femoral cutaneous nerve (LCFN) block can be performed to achieve skin and subcutaneous tissues analgesia or anesthesia. Direct anterior approach PENG block is considered a safe and effective anesthesia technique for total hip arthroplasty surgery. In this paper, we aim to describe a case report of a PENG and LFCN block successful association for anesthesia in a major trauma patient who undergone surgical percutaneous fixation of femoral neck fracture., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Saudi Journal of Anesthesia.)

Published
2022
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37. "In Less than No Time": Feasibility of Rotational Thromboelastometry to Detect Anticoagulant Drugs Activity and to Guide Reversal Therapy.

Author

Pavoni V, Gianesello L, Conti D, Ballo P, Dattolo P, Prisco D, and Görlinger K

Abstract

Anticoagulant drugs (i.e., unfractionated heparin, low-molecular-weight heparins, vitamin K antagonists, and direct oral anticoagulants) are widely employed in preventing and treating venous thromboembolism (VTE), in preventing arterial thromboembolism in nonvalvular atrial fibrillation (NVAF), and in treating acute coronary diseases early. In certain situations, such as bleeding, urgent invasive procedures, and surgical settings, the evaluation of anticoagulant levels and the monitoring of reversal therapy appear essential. Standard coagulation tests (i.e., activated partial thromboplastin time (aPTT) and prothrombin time (PT)) can be normal, and the turnaround time can be long. While the role of viscoelastic hemostatic assays (VHAs), such as rotational thromboelastometry (ROTEM), has successfully increased over the years in the management of bleeding and thrombotic complications, its usefulness in detecting anticoagulants and their reversal still appears unclear.

Published
2022
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38. Questions about COVID-19 associated coagulopathy: possible answers from the viscoelastic tests.

Author

Pavoni V, Gianesello L, Pazzi M, Dattolo P, and Prisco D

Subjects
Hemostasis, Humans, SARS-CoV-2, Thrombelastography adverse effects, Blood Coagulation Disorders diagnosis, Blood Coagulation Disorders etiology, COVID-19 complications
Abstract

Abnormal coagulation parameters are often observed in patients with coronavirus disease 2019 (COVID-19) and the severity of derangement has been associated with a poor prognosis. The COVID-19 associated coagulopathy (CAC) displays unique features that include a high risk of developing thromboembolic complications. Viscoelastic tests (VETs), such as thromboelastometry (ROTEM), thromboelastography (TEG) and Quantra Hemostasis Analyzer (Quantra), provide "dynamic" data on clot formation and dissolution; they are used in different critical care settings, both in hemorrhagic and in thrombotic conditions. In patients with severe COVID-19 infection VETs can supply to clinicians more information about the CAC, identifying the presence of hypercoagulable and hypofibrinolysis states. In the last year, many studies have proposed to explain the underlying characteristics of CAC; however, there remain many unanswered questions. We tried to address some of the important queries about CAC through VETs analysis., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Published
2022
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40. Genotype Phenotype Correlation in Dent Disease 2 and Review of the Literature: OCRL Gene Pleiotropism or Extreme Phenotypic Variability of Lowe Syndrome?

Author

Gianesello L, Arroyo J, Del Prete D, Priante G, Ceol M, Harris PC, Lieske JC, and Anglani F

Subjects
Adolescent, Biological Variation, Population genetics, Child, Child, Preschool, Female, Genetic Association Studies, Genetic Diseases, X-Linked diagnosis, Genetic Diseases, X-Linked epidemiology, Genotype, Humans, Kidney metabolism, Kidney pathology, Male, Mutation, Missense genetics, Nephrolithiasis diagnosis, Nephrolithiasis epidemiology, Oculocerebrorenal Syndrome diagnosis, Oculocerebrorenal Syndrome epidemiology, Phenotype, Genetic Diseases, X-Linked genetics, Genetic Pleiotropy genetics, Nephrolithiasis genetics, Oculocerebrorenal Syndrome genetics, Phosphoric Monoester Hydrolases genetics
Abstract

Dent disease is a rare X-linked renal tubulopathy due to CLCN5 and OCRL (DD2) mutations. OCRL mutations also cause Lowe syndrome (LS) involving the eyes, brain and kidney. DD2 is frequently described as a mild form of LS because some patients may present with extra-renal symptoms (ESs). Since DD2 is a rare disease and there are a low number of reported cases, it is still unclear whether it has a clinical picture distinct from LS. We retrospectively analyzed the phenotype and genotype of our cohort of 35 DD2 males and reviewed all published DD2 cases. We analyzed the distribution of mutations along the OCRL gene and evaluated the type and frequency of ES according to the type of mutation and localization in OCRL protein domains. The frequency of patients with at least one ES was 39%. Muscle findings are the most common ES (52%), while ocular findings are less common (11%). Analysis of the distribution of mutations revealed (1) truncating mutations map in the PH and linker domain, while missense mutations map in the 5-phosphatase domain, and only occasionally in the ASH-RhoGAP module; (2) five OCRL mutations cause both DD2 and LS phenotypes; (3) codon 318 is a DD2 mutational hot spot; (4) a correlation was found between the presence of ES and the position of the mutations along OCRL domains. DD2 is distinct from LS. The mutation site and the mutation type largely determine the DD2 phenotype.

Published
2021
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41. Downregulation of megalin, cubilin, ClC-5 and podocin in Fabry nephropathy: potential implications in the decreased effectiveness of enzyme replacement therapy.

Author

Trimarchi H, Ceol M, Gianesello L, Priante G, Iotti A, and Del Prete D

Subjects
Chloride Channels, Down-Regulation, Enzyme Replacement Therapy, Female, Humans, Intracellular Signaling Peptides and Proteins, Male, Membrane Proteins, Middle Aged, Receptors, Cell Surface, Fabry Disease diagnosis, Fabry Disease drug therapy, Fabry Disease genetics, Low Density Lipoprotein Receptor-Related Protein-2 genetics, Low Density Lipoprotein Receptor-Related Protein-2 metabolism
Abstract

Fabry disease is an X-linked disorder due to mutations in α-galactosidase A, resulting in the accumulation of enzyme substrates and cell malfunction. Kidney involvement is frequent, affecting all native kidney cell types. Podocyte damage results in proteinuria and chronic kidney disease. End-stage kidney disease is the rule in middle-aged males and some females with the classic phenotype. In podocytes and kidney proximal tubular cells, megalin is one of the molecules involved in enzyme replacement therapy (ERT) cellular absorption. After podocyte damage, podocin concentration is decreased and contributes to progressive proteinuria. We report in a male and a female patient the decreased expression of megalin, cubilin, ClC-5 and podocin compared to controls and chronic kidney disease (CKD) biopsies. Moreover, the decrease in ClC-5, a molecule engaged in endosomal-lysosomal acidification, could also affect ERT. These findings may partially explain some of the dysfunctions described in Fabry nephropathy and could highlight possible alterations in the pharmacokinetics of the delivered enzyme., (© 2020. Italian Society of Nephrology.)

Published
2021
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42. Antiphospholipid antibodies in critically ill COVID-19 patients with thromboembolism: cause of disease or epiphenomenon?

Author

Pavoni V, Gianesello L, and Horton A

Subjects
Animals, Antibodies, Antiphospholipid blood, Blood Coagulation, COVID-19 blood, COVID-19 complications, Critical Illness, Humans, Thromboembolism blood, Thromboembolism complications, Venous Thromboembolism blood, Venous Thromboembolism complications, Venous Thromboembolism immunology, Antibodies, Antiphospholipid immunology, COVID-19 immunology, SARS-CoV-2 immunology, Thromboembolism immunology
Abstract

Coronavirus 2019 disease (COVID-19) is associated with coagulation dysfunction that predisposes patients to an increased risk for both arterial (ATE) and venous thromboembolism (VTE) and consequent poor prognosis; in particular, the incidence of ATE and VTE in critically ill COVID-19 patients can reach 5% and 31%, respectively. The mechanism of thrombosis in COVID-19 patients is complex and still not completely clear. Recent literature suggests a link between the presence of antiphospholipid antibodies (aPLs) and thromboembolism in COVID-19 patients. However, it remains uncertain whether aPLs are an epiphenomenon or are involved in the pathogenesis of the disease., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Published
2021
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43. ACE2 and SARS-CoV-2 Infection Risk: Insights From Patients With Two Rare Genetic Tubulopathies, Gitelman's and Bartter's Syndromes.

Author

Calò LA, Rigato M, Sgarabotto L, Gianesello L, Bertoldi G, Ravarotto V, and Davis PA

Abstract

COVID-19 is spreading globally with the angiotensin converting enzyme (ACE)-2 serving as the entry point of SARS-CoV-2 virus. This raised concerns how ACE2 and the Renin-Angiotensin (Ang)-System (RAS) are to be dealt with given their roles in hypertension and their involvement in COVID-19's morbidity and mortality. Specifically, increased ACE2 expression in response to treatment with ACE inhibitors (ACEi) and Ang II receptor blockers (ARBs) might theoretically increase COVID-19 risk by increasing SARS-CoV-2 binding sites. However, ACE2 is part of the protective counter-regulatory ACE2-Ang1-7-MasR axis, which opposes the classical ACE-AngII-AT1R regulatory axis. We used Gitelman's and Bartter's syndromes (GS/BS) patients, rare genetic tubulopathies that have endogenously increased levels of ACE2, to explore these issues. Specifically, 128 genetically confirmed GS/BS patients, living in Lombardia, Emilia Romagna and Veneto, the Northern Italy hot spots for COVID-19, were surveyed via telephone survey regarding COVID-19. The survey found no COVID-19 infection and absence of COVID-19 symptoms in any patient. Comparison analysis with the prevalence of COVID-19 in those regions showed statistical significance ( p < 0.01). The results of the study strongly suggest that increased ACE2 does not increase risk of COVID-19 and that ACEi and ARBs by blocking excessive AT1R-mediated Ang II activation might favor the increase of ACE2-derived Ang 1-7. GS/BS patients' increased ACE2 and Ang 1-7 levels and their characteristic chronic metabolic alkalosis suggest a mechanism similar to that of chloroquine/hydroxychloroquine effect on ACE2 glycosylation alteration with resulting SARS-COV-2 binding inhibition and blockage/inhibition of viral entry. Studies from our laboratory are ongoing to explore GS/BS ACE2 glycosylation and other potential beneficial effects of BS/GS. Importantly, the absence of frank COVID-19 or of COVID-19 symptoms in the BS/GS patients cohort, given no direct ascertainment of COVID-19 status, suggest that elevated ACE2 levels as found in GS/BS patients at a minimum render COVID-19 infection asymptomatic and thus that COVID-19 symptoms are driven by ACE2 levels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Calò, Rigato, Sgarabotto, Gianesello, Bertoldi, Ravarotto and Davis.)

Published
2021
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45. Derangement of the coagulation process using subclinical markers and viscoelastic measurements in critically ill patients with coronavirus disease 2019 pneumonia and non-coronavirus disease 2019 pneumonia.

Author

Pavoni V, Gianesello L, Pazzi M, Horton A, and Suardi LR

Subjects
Aged, Aged, 80 and over, Blood Coagulation Disorders blood, Blood Coagulation Disorders etiology, Blood Coagulation Tests, COVID-19 complications, Critical Illness, Female, Fibrin Fibrinogen Degradation Products analysis, Humans, Intensive Care Units, Male, Middle Aged, Platelet Count, Pneumonia complications, SARS-CoV-2 isolation & purification, Thrombelastography, Blood Coagulation, COVID-19 blood, Pneumonia blood
Abstract

Systemic coagulation abnormalities including clotting activation and inhibition of anticoagulant factors have been observed in patients with pneumonia. In severe coronavirus disease 2019 (COVID-19) the alteration of coagulation parameters was associated with poor prognosis. We evaluated the difference in coagulopathy between critically ill patients with COVID-19 pneumonia (COVID group) and non-COVID-19 pneumonia (non-COVID group), using traditional coagulation markers and rotational thromboelastometry (ROTEM). Standard laboratory and ROTEM parameters were evaluated in 45 patients (20 COVID group patients and 25 non-COVID group patients) at time of admission to the Intensive Care Unit (ICU) (T0) and at 5 (T5) and 10 days (T10) later. In all evaluations times, platelet count was found higher in COVID group rather than in non-COVID group. At T0, COVID group revealed a fibrinogen value greater than non-COVID group. d-Dimer values were high in both groups and they were not statistically different. At T0 COVID group showed a significant reduction of clot formation time in INTEM and in EXTEM and a significant increase of maximum clot firmness in INTEM, EXTEM and FIBTEM respect to non-COVID group. Moreover, COVID group demonstrated a coagulability state with ROTEM profiles higher than non-COVID group at T5 and T10. Coagulation profiles showed that critically ill patients with COVID-19 pneumonia are characterized by a higher coagulable state than others; this greater procoagulative state persists over time., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2021
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46. Genetics and phenotypic heterogeneity of Dent disease: the dark side of the moon.

Author

Gianesello L, Del Prete D, Anglani F, and Calò LA

Subjects
Chloride Channels genetics, Dent Disease pathology, Humans, Mutation, Phosphoric Monoester Hydrolases genetics, Dent Disease genetics, Genetic Heterogeneity, Phenotype
Abstract

Dent disease is a rare genetic proximal tubulopathy which is under-recognized. Its phenotypic heterogeneity has led to several different classifications of the same disorder, but it is now widely accepted that the triad of symptoms low-molecular-weight proteinuria, hypercalciuria and nephrocalcinosis/nephrolithiasis are pathognomonic of Dent disease. Although mutations on the CLCN5 and OCRL genes are known to cause Dent disease, no such mutations are found in about 25-35% of cases, making diagnosis more challenging. This review outlines current knowledge regarding Dent disease from another perspective. Starting from the history of Dent disease, and reviewing the clinical details of patients with and without a genetic characterization, we discuss the phenotypic and genetic heterogeneity that typifies this disease. We focus particularly on all those confounding clinical signs and symptoms that can lead to a misdiagnosis. We also try to shed light on a concealed aspect of Dent disease. Although it is a proximal tubulopathy, its misdiagnosis may lead to patients undergoing kidney biopsy. In fact, some individuals with Dent disease have high-grade proteinuria, with or without hematuria, as in the clinical setting of glomerulopathy, or chronic kidney disease of uncertain origin. Although glomerular damage is frequently documented in Dent disease patients' biopsies, there is currently no reliable evidence of renal biopsy being of either diagnostic or prognostic value. We review published histopathology reports of tubular and glomerular damage in these patients, and discuss current knowledge regarding the role of CLCN5 and OCRL genes in glomerular function.

Published
2021
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47. Venous thromboembolism and bleeding in critically ill COVID-19 patients treated with higher than standard low molecular weight heparin doses and aspirin: A call to action.

Author

Pavoni V, Gianesello L, Pazzi M, Stera C, Meconi T, and Frigieri FC

Subjects
Adult, Aged, Critical Illness, Female, Humans, Intensive Care Units, Male, Middle Aged, Retrospective Studies, Anticoagulants adverse effects, Aspirin adverse effects, COVID-19 complications, Hemorrhage chemically induced, Heparin, Low-Molecular-Weight adverse effects, SARS-CoV-2, Venous Thromboembolism epidemiology
Abstract

Background: Critically ill COVID-19 patients have a clear pattern of inflammation and hypercoagulable state. The main aim of the study was to evaluate the outcome of severe COVID-19 patients basing on prothrombotic risk factors (i.e. D-dimer). We also evaluated the impact of different doses of low molecular weight heparin (LMWH) on the incidence of bleedings., Methods: The data of forty-two patients admitted to the Intensive Care Unit (ICU) were retrospectively analyzed. On ICU admission, patients with D-dimer < 3000 ng/mL (Group 1) received enoxaparin 4000 UI (6000 UI, if body mass index >35) subcutaneously b.i.d. and patients with D-dimer ≥ 3000 ng/mL (Group 2) received enoxaparin 100 UI/kg every 12 h. Aspirin was administered to all patients once a day., Results: Both groups presented a high incidence of perivascular thrombosis (40.9% in Group 1 and 30% in Group 2). Patients of Group 2 suffered a higher incidence of venous thromboembolism (VTE) than Group 1 (65% vs 13.6%, p = 0.001). One patient (4.5%) of Group 1 and three patients (15%) of Group 2 suffered from minor bleeding; no patient had major bleeding. Group 2 had a longer ICU and hospital stay than Group 1 (11.5 ± 5.6 vs 9.0 ± 4.8 and 30 ± 4.9 vs 21 ± 2.3, p < 0.05, respectively) as well as increased ICU mortality (25% vs 9.1%)., Conclusions: More severe critically ill COVID-19 patients have a high incidence of VTE and worse outcome, despite the use of heparin at the therapeutic dose. However, the use of heparin did not increase the incidence of bleeding complications., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Published
2020
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48. COVID-19 infection: Is the outcome time-dependent?

Author

Pavoni V and Gianesello L

Subjects
Anticoagulants therapeutic use, COVID-19 epidemiology, Critical Illness, Cytokine Release Syndrome virology, Humans, Immune System, Inflammation, Models, Theoretical, Oxygen therapeutic use, Thrombosis, Time Factors, COVID-19 therapy, Treatment Outcome, COVID-19 Drug Treatment
Published
2020
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