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3. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use

Author

Sartelli, M, Tascini, C, Coccolini, F, Dellai, F, Ansaloni, L, Antonelli, M, Bartoletti, M, Bassetti, M, Boncagni, F, Carlini, M, Cattelan, A, Cavaliere, A, Ceresoli, M, Cipriano, A, Cortegiani, A, Cortese, F, Cristini, F, Cucinotta, E, Dalfino, L, De Pascale, G, De Rosa, F, Falcone, M, Forfori, F, Fugazzola, P, Gatti, M, Gentile, I, Ghiadoni, L, Giannella, M, Giarratano, A, Giordano, A, Girardis, M, Mastroianni, C, Monti, G, Montori, G, Palmieri, M, Pani, M, Paolillo, C, Parini, D, Parruti, G, Pasero, D, Pea, F, Peghin, M, Petrosillo, N, Podda, M, Rizzo, C, Rossolini, G, Russo, A, Scoccia, L, Sganga, G, Signorini, L, Stefani, S, Tumbarello, M, Tumietto, F, Valentino, M, Venditti, M, Viaggi, B, Vivaldi, F, Zaghi, C, Labricciosa, F, Abu-Zidan, F, Catena, F, Viale, P, Sartelli M., Tascini C., Coccolini F., Dellai F., Ansaloni L., Antonelli M., Bartoletti M., Bassetti M., Boncagni F., Carlini M., Cattelan A. M., Cavaliere A., Ceresoli M., Cipriano A., Cortegiani A., Cortese F., Cristini F., Cucinotta E., Dalfino L., De Pascale G., De Rosa F. G., Falcone M., Forfori F., Fugazzola P., Gatti M., Gentile I., Ghiadoni L., Giannella M., Giarratano A., Giordano A., Girardis M., Mastroianni C., Monti G., Montori G., Palmieri M., Pani M., Paolillo C., Parini D., Parruti G., Pasero D., Pea F., Peghin M., Petrosillo N., Podda M., Rizzo C., Rossolini G. M., Russo A., Scoccia L., Sganga G., Signorini L., Stefani S., Tumbarello M., Tumietto F., Valentino M., Venditti M., Viaggi B., Vivaldi F., Zaghi C., Labricciosa F. M., Abu-Zidan F., Catena F., Viale P., Sartelli, M, Tascini, C, Coccolini, F, Dellai, F, Ansaloni, L, Antonelli, M, Bartoletti, M, Bassetti, M, Boncagni, F, Carlini, M, Cattelan, A, Cavaliere, A, Ceresoli, M, Cipriano, A, Cortegiani, A, Cortese, F, Cristini, F, Cucinotta, E, Dalfino, L, De Pascale, G, De Rosa, F, Falcone, M, Forfori, F, Fugazzola, P, Gatti, M, Gentile, I, Ghiadoni, L, Giannella, M, Giarratano, A, Giordano, A, Girardis, M, Mastroianni, C, Monti, G, Montori, G, Palmieri, M, Pani, M, Paolillo, C, Parini, D, Parruti, G, Pasero, D, Pea, F, Peghin, M, Petrosillo, N, Podda, M, Rizzo, C, Rossolini, G, Russo, A, Scoccia, L, Sganga, G, Signorini, L, Stefani, S, Tumbarello, M, Tumietto, F, Valentino, M, Venditti, M, Viaggi, B, Vivaldi, F, Zaghi, C, Labricciosa, F, Abu-Zidan, F, Catena, F, Viale, P, Sartelli M., Tascini C., Coccolini F., Dellai F., Ansaloni L., Antonelli M., Bartoletti M., Bassetti M., Boncagni F., Carlini M., Cattelan A. M., Cavaliere A., Ceresoli M., Cipriano A., Cortegiani A., Cortese F., Cristini F., Cucinotta E., Dalfino L., De Pascale G., De Rosa F. G., Falcone M., Forfori F., Fugazzola P., Gatti M., Gentile I., Ghiadoni L., Giannella M., Giarratano A., Giordano A., Girardis M., Mastroianni C., Monti G., Montori G., Palmieri M., Pani M., Paolillo C., Parini D., Parruti G., Pasero D., Pea F., Peghin M., Petrosillo N., Podda M., Rizzo C., Rossolini G. M., Russo A., Scoccia L., Sganga G., Signorini L., Stefani S., Tumbarello M., Tumietto F., Valentino M., Venditti M., Viaggi B., Vivaldi F., Zaghi C., Labricciosa F. M., Abu-Zidan F., Catena F., and Viale P.

Abstract

Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients’ safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts’ opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents

Published
2024

9. Corrigendum to: “Development and validation of a prediction model for severe respiratory failure in hospitalized patients with SARS-CoV-2 infection: a multicentre cohort study (PREDI-CO study)” Clinical Microbiology and Infection 26 (2020) 1545–1553 (Clinical Microbiology and Infection (2020) 26(11) (1545–1553), (S1198743X20304791), (10.1016/j.cmi.2020.08.003))

Author

Bartoletti M., 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, 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., Bartoletti M., 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, 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., and Viale P.

Abstract

The authors regret that an author's name which should be on the list of the PREDICO study group was mistakenly listed in the appendix at the end of the article. Further, on Pubmed (https://pubmed.ncbi.nlm.nih.gov/32781244/) the name is wrongly reported as an affiliation (19Lucia Diella Infectious Disease Unit - Department of Biomedical Sciences and Human Oncology, University of Bari, Policlinico di Bari, Italy.) It should be 19Infectious Disease Unit - Department of Biomedical Sciences and Human Oncology, University of Bari, Policlinico di Bari, Italy. This affiliation belongs to Lucia Diella. The authors would like to apologise for any inconvenience caused.

Published
2023

12. Geographical variation in therapy for bloodstream infections due to multidrug-resistant Enterobacteriaceae: a post-hoc analysis of the INCREMENT study

Author

del Toro, M.D., Gálvez, J., Falcone, M., Russob, A., Karaiskos, I., Trecarichi, E.M., Losito, A.R., García-Vázquez, E., Gómez, J., Roilides, E., Iosifidis, E., Pournaras, S., Prim, N., Navarro, F., Mirelis, B., Origüen, J., Juan, R. San, Fernández-Ruiz, M., Almela, M., de la Calle, C., Martínez, J.A., Morata, L., Larrosa, N., Puig-Asensio, M., Bou, G., Molina, J., González, V., Bermejo, J., Rucci, V., de Gopegui, E. Ruiz, Marinescu, C.I., Fariñas, M.C., Cano, M.E., Gozalo, M., Paño-Pardo, J.R., Mora-Rillo, Marta, Gómez-Zorrilla, S., Tubau, F., Tsakris, A., Zarkotou, O., Antoniadou, A., Poulakou, G., Souli, M., Lowman, W., Virmani, D., Torre-Cisneros, Julian, Machuca, I., Gracia-Ahufinger, Irene, Azap, Ö.K., Helvaci, Ö., Sahin, A.O., Cantón, R., Pintado, V., Bartoletti, M., Giannella, M., Peter, S., Hamprecht, A., Badia, C., Xercavins, M., Fontanals, D., Jové, E., Harris, Patrick N.A., Pezzani, M. Diletta, Gutiérrez-Gutiérrez, Belén, Viale, Pierluigi, Hsueh, Po-Ren, Ruiz-Garbajosa, Patricia, Venditti, Mario, Tumbarello, Mario, Navarro-Francisco, Carolina, Calbo, Esther, Akova, Murat, Giamarellou, Helen, Oliver, Antonio, Almirante, Benito, Gasch, Oriol, Martínez-Martínez, Luis, Schwaber, Mitchell J., Daikos, George, Pitout, Johann, Peña, Carmen, Hernández-Torres, Alicia, Doi, Yohei, Pérez, Federico, Tuon, Felipe Francisco, Tacconelli, Evelina, Carmeli, Yehuda, Bonomo, Robert A., Pascual, Álvaro, Paterson, David L., and Rodríguez-Baño, Jesús

Published
2017
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13. Effect of appropriate combination therapy on mortality of patients with bloodstream infections due to carbapenemase-producing Enterobacteriaceae (INCREMENT): a retrospective cohort study

Author

del Toro, M D, Gálvez, J, Falcone, M, Russo, A, Giamarellou, H, Trecarichi, E M, Losito, A R, García-Vázquez, E, Hernández, A, Gómez, J, Bou, G, Iosifidis, E, Prim, N, Navarro, F, Mirelis, B, Skiada, A, Origüen, J, Juan, R San, Fernández-Ruiz, M, Larrosa, N, Puig-Asensio, M, Cisneros, J M, Molina, J, González, V, Rucci, V, de Gopegui, E Ruiz, Marinescu, C I, Martínez-Martínez, L, Fariñas, M C, Cano, M E, Gozalo, M, Mora-Rillo, M, Francisco, C Navarro-San, Peña, C, Gómez-Zorrilla, S, Tubau, F, Tsakris, A, Zarkotou, O, Antoniadou, A, Poulakou, G, Pitout, J, Virmani, D, Torre-Cisneros, J, Guzmán-Puche, J, Helvaci, Ö, Sahin, A O, Pintado, V, Ruiz, P, Bartoletti, M, Giannella, M, Tacconelli, E, Riemenschneider, F, Calbo, E, Badia, C, Xercavins, M, Gasch, O, Fontanals, D, Jové, E, Gutiérrez-Gutiérrez, Belén, Salamanca, Elena, de Cueto, Marina, Hsueh, Po-Ren, Viale, Pierluigi, Paño-Pardo, José Ramón, Venditti, Mario, Tumbarello, Mario, Daikos, George, Cantón, Rafael, Doi, Yohei, Tuon, Felipe Francisco, Karaiskos, Ilias, Pérez-Nadales, Elena, Schwaber, Mitchell J, Azap, Özlem Kurt, Souli, Maria, Roilides, Emmanuel, Pournaras, Spyros, Akova, Murat, Pérez, Federico, Bermejo, Joaquín, Oliver, Antonio, Almela, Manel, Lowman, Warren, Almirante, Benito, Bonomo, Robert A, Carmeli, Yehuda, Paterson, David L, Pascual, Alvaro, and Rodríguez-Baño, Jesús

Published
2017
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15. Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

Author

Tonetti T., Grasselli G., Zanella A., Pizzilli G., Fumagalli R., Piva S., Lorini L., Iotti G., Foti G., Colombo S., Vivona L., Rossi S., Girardis M., Agnoletti V., Campagna A., Gordini G., Navalesi P., Boscolo A., Graziano A., Valeri I., Vianello A., Cereda D., Filippini C., Cecconi M., Locatelli F., Bartoletti M., Giannella M., Viale P., Antonelli M., Nava S., Pesenti A., Ranieri V. M., Albano G., Alborghetti A., Aldegheri G., Antonini B., Belgiorno N., Bellani G., Beretta E., Bonazzi S., Borelli M., Cabrini L., Carnevale L., Carnevale S., Castelli G., Catena E., Chiumello D., Coluccello A., Coppini D., Covello D., DeFilippi G., DeiPoli M., Dughi P., Gallioli G., Gnesin P., Greco S., Guatteri L., Guzzon D., Keim R., Landoni G., Langer T., Lombardo A., Marino G., Merli G., Merlo D., Mojoli F., Muttini S., Natalini G., Petrucci N., Pezzi A., Radrizzani D., Raimondi M., Riccio M., Storti E., Tavola M., Vitale G., Bosco E., Calo M. A., Danzi V., DeRosa S., Farnia A., Lazzari F., Meggiolaro M., Munari M., Saia M., Sella N., Serra E., Tiberio I., Baiocchi M., Benedetto M., Bordini M., Caramelli F., Cilloni N., DellaGiovampaola M., Fanelli A., Frascaroli G., Fusari M., Maitan S., Martino C., Melotti R. M., Merola R., Minardi F., Moro F., Nardi G., Nolli M., Pierucci E., Potalivo A., Repetti F., Salsi P., Terzitta M., Tosi M., Venturi S., Volta C. A., Zani G., Zanoni A (COVID-19 Northern Italian ICU Network), Landoni G, Tonetti, Tommaso, Grasselli, Giacomo, Zanella, Alberto, Pizzilli, Giacinto, Fumagalli, Roberto, Piva, Simone, Lorini, Luca, Iotti, Giorgio, Foti, Giuseppe, Colombo, Sergio, Vivona, Luigi, Rossi, Sandra, Girardis, Massimo, Agnoletti, Vanni, Campagna, Anselmo, Gordini, Giovanni, Navalesi, Paolo, Boscolo, Annalisa, Graziano, Alessandro, Valeri, Ilaria, Vianello, Andrea, Cereda, Danilo, Filippini, Claudia, Cecconi, Maurizio, Locatelli, Franco, Bartoletti, Michele, Giannella, Maddalena, Viale, Pierluigi, Antonelli, Massimo, Nava, Stefano, Pesenti, Antonio, Ranieri, V Marco, Tonetti, T, Grasselli, G, Zanella, A, Pizzilli, G, Fumagalli, R, Piva, S, Lorini, L, Iotti, G, Foti, G, Colombo, S, Vivona, L, Rossi, S, Girardis, M, Agnoletti, V, Campagna, A, Gordini, G, Navalesi, P, Boscolo, A, Graziano, A, Valeri, I, Vianello, A, Cereda, D, Filippini, C, Cecconi, M, Locatelli, F, Bartoletti, M, Giannella, M, Viale, P, Antonelli, M, Nava, S, Pesenti, A, Ranieri, V, Langer, T, Tonetti, T., Grasselli, G., Zanella, A., Pizzilli, G., Fumagalli, R., Piva, S., Lorini, L., Iotti, G., Foti, G., Colombo, S., Vivona, L., Rossi, S., Girardis, M., Agnoletti, V., Campagna, A., Gordini, G., Navalesi, P., Boscolo, A., Graziano, A., Valeri, I., Vianello, A., Cereda, D., Filippini, C., Cecconi, M., Locatelli, F., Bartoletti, M., Giannella, M., Viale, P., Antonelli, M., Nava, S., Pesenti, A., Ranieri, V. M., Albano, G., Alborghetti, A., Aldegheri, G., Antonini, B., Belgiorno, N., Bellani, G., Beretta, E., Bonazzi, S., Borelli, M., Cabrini, L., Carnevale, L., Carnevale, S., Castelli, G., Catena, E., Chiumello, D., Coluccello, A., Coppini, D., Covello, D., Defilippi, G., Deipoli, M., Dughi, P., Gallioli, G., Gnesin, P., Greco, S., Guatteri, L., Guzzon, D., Keim, R., Landoni, G., Langer, T., Lombardo, A., Marino, G., Merli, G., Merlo, D., Mojoli, F., Muttini, S., Natalini, G., Petrucci, N., Pezzi, A., Radrizzani, D., Raimondi, M., Riccio, M., Storti, E., Tavola, M., Vitale, G., Bosco, E., Calo, M. A., Danzi, V., Derosa, S., Farnia, A., Lazzari, F., Meggiolaro, M., Munari, M., Saia, M., Sella, N., Serra, E., Tiberio, I., Baiocchi, M., Benedetto, M., Bordini, M., Caramelli, F., Cilloni, N., Dellagiovampaola, M., Fanelli, A., Frascaroli, G., Fusari, M., Maitan, S., Martino, C., Melotti, R. M., Merola, R., Minardi, F., Moro, F., Nardi, G., Nolli, M., Pierucci, E., Potalivo, A., Repetti, F., Salsi, P., Terzitta, M., Tosi, M., Venturi, S., Volta, C. A., Zani, G., Zanoni, A (COVID-19 Northern Italian ICU Network), and Landoni, G

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Respiratory rate, Socio-culturale, Critical Care and Intensive Care Medicine, Acute respiratory failure, acute respiratory failure, COVID-19, ICU, non-invasive ventilation, rationing, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, Intensive care, Retrospective analysis, Medicine, 030212 general & internal medicine, Non-invasive ventilation, Rationing, Case report form, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Outbreak, lcsh:RC86-88.9, Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, 030228 respiratory system, Emergency medicine, Base excess, business
Abstract

Background A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.

Published
2020

18. Previous bloodstream infections due to other pathogens as predictors of carbapenem-resistant Klebsiella pneumoniae bacteraemia in colonized patients: results from a retrospective multicentre study

Author

Giacobbe, D. R., Del Bono, V., Bruzzi, P., Corcione, S., Giannella, M., Marchese, A., Magnasco, L., Maraolo, A. E., Pagani, N., Saffioti, C., Ambretti, S., Cardellino, C. S., Coppo, E., De Rosa, F. G., Viale, P., Viscoli, C., and on behalf of ISGRI-SITA (Italian Study Group on Resistant Infections of the Società Italiana Terapia Antinfettiva)

Published
2017
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20. The Spallation Neutron Source accelerator system design

Author

Henderson, S., Abraham, W., Aleksandrov, A., Allen, C., Alonso, J., Anderson, D., Arenius, D., Arthur, T., Assadi, S., Ayers, J., Bach, P., Badea, V., Battle, R., Beebe-Wang, J., Bergmann, B., Bernardin, J., Bhatia, T., Billen, J., Birke, T., Bjorklund, E., Blaskiewicz, M., Blind, B., Blokland, W., Bookwalter, V., Borovina, D., Bowling, S., Bradley, J., Brantley, C., Brennan, J., Brodowski, J., Brown, S., Brown, R., Bruce, D., Bultman, N., Cameron, P., Campisi, I., Casagrande, F., Catalan-Lasheras, N., Champion, M., Chen, Z., Cheng, D., Cho, Y., Christensen, K., Chu, C., Cleaves, J., Connolly, R., Cote, T., Cousineau, S., Crandall, K., Creel, J., Crofford, M., Cull, P., Cutler, R., Dabney, R., Dalesio, L., Daly, E., Damm, R., Danilov, V., Davino, D., Davis, K., Dawson, C., Day, L., Deibele, C., Delayen, J., DeLong, J., Demello, A., DeVan, W., Digennaro, R., Dixon, K., Dodson, G., Doleans, M., Doolittle, L., Doss, J., Drury, M., Elliot, T., Ellis, S., Error, J., Fazekas, J., Fedotov, A., Feng, P., Fischer, J., Fox, W., Fuja, R., Funk, W., Galambos, J., Ganni, V., Garnett, R., Geng, X., Gentzlinger, R., Giannella, M., Gibson, P., Gillis, R., Gioia, J., Gordon, J., Gough, R., Greer, J., Gregory, W., Gribble, R., Grice, W., Gurd, D., Gurd, P., Guthrie, A., Hahn, H., Hardek, T., Hardekopf, R., Harrison, J., Hatfield, D., He, P., Hechler, M., Heistermann, F., Helus, S., Hiatt, T., Hicks, S., Hill, J., Hoff, L., Hoff, M., Hogan, J., Holding, M., Holik, P., Holmes, J., Holtkamp, N., Hovater, C., Howell, M., Hseuh, H., Huhn, A., Hunter, T., Ilg, T., Jackson, J., Jain, A., Jason, A., Jeon, D., Johnson, G., Jones, A., Joseph, S., Justice, A., Kang, Y., Kasemir, K., Keller, R., Kersevan, R., Kerstiens, D., Kesselman, M., Kim, S., Kneisel, P., Kravchuk, L., Kuneli, T., Kurennoy, S., Kustom, R., Kwon, S., Ladd, P., Lambiase, R., Lee, Y.Y., Leitner, M., Leung, K.-N., Lewis, S., Liaw, C., Lionberger, C., Lo, C.C., Long, C., Ludewig, H., Ludvig, J., Luft, P., Lynch, M., Ma, H., MacGill, R., Macha, K., Madre, B., Mahler, G., Mahoney, K., Maines, J., Mammosser, J., Mann, T., Marneris, I., Marroquin, P., Martineau, R., Matsumoto, K., McCarthy, M., McChesney, C., McGahern, W., McGehee, P., Meng, W., Merz, B., Meyer, R., Jr., Meyer, R., Sr., Miller, B., Mitchell, R., Mize, J., Monroy, M., Munro, J., Murdoch, G., Musson, J., Nath, S., Nelson, R., O׳Hara, J., Olsen, D., Oren, W., Oshatz, D., Owens, T., Pai, C., Papaphilippou, I., Patterson, N., Patterson, J., Pearson, C., Pelaia, T., Pieck, M., Piller, C., Plawski, T., Plum, M., Pogge, J., Power, J., Powers, T., Preble, J., Prokop, M., Pruyn, J., Purcell, D., Rank, J., Raparia, D., Ratti, A., Reass, W., Reece, K., Rees, D., Regan, A., Regis, M., Reijonen, J., Rej, D., Richards, D., Richied, D., Rode, C., Rodriguez, W., Rodriguez, M., Rohlev, A., Rose, C., Roseberry, T., Jr., Rowton, L., Roybal, W., Rust, K., Salazer, G., Sandberg, J., Saunders, J., Schenkel, T., Schneider, W., Schrage, D., Schubert, J., Severino, F., Shafer, R., Shea, T., Shishlo, A., Shoaee, H., Sibley, C., Sims, J., Smee, S., Smith, J., Smith, K., Spitz, R., Staples, J., Stein, P., Stettler, M., Stirbet, M., Stockli, M., Stone, W., Stout, D., Stovall, J., Strelo, W., Strong, H., Sundelin, R., Syversrud, D., Szajbler, M., Takeda, H., Tallerico, P., Tang, J., Tanke, E., Tepikian, S., Thomae, R., Thompson, D., Thomson, D., Thuot, M., Treml, C., Tsoupas, N., Tuozzolo, J., Tuzel, W., Vassioutchenko, A., Virostek, S., Wallig, J., Wanderer, P., Wang, Y., Wang, J.G., Wangler, T., Warren, D., Wei, J., Weiss, D., Welton, R., Weng, J., Weng, W-T., Wezensky, M., White, M., Whitlatch, T., Williams, D., Williams, E., Wilson, K., Wiseman, M., Wood, R., Wright, P., Wu, A., Ybarrolaza, N., Young, K., Young, L., Yourd, R., Zachoszcz, A., Zaltsman, A., Zhang, S., Zhang, W., Zhang, Y., and Zhukov, A.

Published
2014
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21. Carbapenem resistant bacteria in Intensive Care Unit during COVID-19 pandemic: Multicenter before-after cross sectional study

Author

Pascale R., Bussini L., Gaibani P., Bovo F., Fornaro G., Lombardo D., Ambretti S., Pensalfine G., Appolloni L., Bartoletti M., Tedeschi S., Tumietto F., Lewis R., Viale P., Giannella M., Pascale R., Bussini L., Gaibani P., Bovo F., Fornaro G., Lombardo D., Ambretti S., Pensalfine G., Appolloni L., Bartoletti M., Tedeschi S., Tumietto F., Lewis R., Viale P., and Giannella M.

Subjects
Acinetobacter baumannii, Carbapenemase producing Enterobacteriaceae, Carbapenem resistance, COVID-19, Intensive care unit, Outbreak
Abstract

Objectives: To assess the incidence of colonization and infection with carbapenemase producing Enterobacteriaceae (CPE) and carbapenem resistant Acinetobacter baumannii (CR-Ab) in the ICUs of our city hospitals before and during COVID-19 pandemic. Methods: Multicentre before-after cross sectional study to compare the rates of colonization and infection with CPE and/or CR-Ab in two study periods, period 1 (Jan-Apr 2019) and period 2 (Jan-Apr 2020). Incidence rate ratios (IRR) and 95% CI of weekly colonization and infection rates for each period were compared for the two study periods with Poisson regression. Weekly trends in the incidence of colonization or infection for each study period were summarized using local weighted (Loess) regression. Results: There was no significant change in either IRR and weekly trend in CPE colonization and infection during the two study periods. A shift from KPC to other CPE mechanisms (OXA-48 and VIM) was observed during period 2. Compared to period 1, during period 2 the IRR of colonization and infection with CR-Ab increased of 7.5 and 5.5-fold, respectively. Genome sequencing showed that all CR-Ab strains belonged to the CC92/IC2 clonal lineage. Clinical strains clustered closely into a single monophyletic group in one of the three centres, whereas segregated in two different clusters in the other two centres, strongly appoints for the occurrence of horizontal transmission. Conclusion: Our findings remark the need of pursuing infection control activities targeted against the spread of antimicrobial resistance intra and inter hospitals during COVID-19 pandemic, and if necessary re-modulating them according to the new organizational structures imposed by the pandemic.

Published
2022

22. Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study

Author

Bartoletti, M, Marconi, L, Scudeller, L, Pancaldi, L, Tedeschi, S, Giannella, M, Rinaldi, M, Bussini, L, Valentini, I, Ferravante, A, Potalivo, A, Marchionni, E, Fornaro, G, Pascale, R, Pasquini, Z, Puoti, M, Merli, M, Barchiesi, F, Volpato, F, Rubin, A, Saracino, A, Tonetti, T, Gaibani, P, Ranieri, V, Viale, P, Cristini, F, Bartoletti M., Marconi L., Scudeller L., Pancaldi L., Tedeschi S., Giannella M., Rinaldi M., Bussini L., Valentini I., Ferravante A. F., Potalivo A., Marchionni E., Fornaro G., Pascale R., Pasquini Z., Puoti M., Merli M., Barchiesi F., Volpato F., Rubin A., Saracino A., Tonetti T., Gaibani P., Ranieri V. M., Viale P., Cristini F., Bartoletti, M, Marconi, L, Scudeller, L, Pancaldi, L, Tedeschi, S, Giannella, M, Rinaldi, M, Bussini, L, Valentini, I, Ferravante, A, Potalivo, A, Marchionni, E, Fornaro, G, Pascale, R, Pasquini, Z, Puoti, M, Merli, M, Barchiesi, F, Volpato, F, Rubin, A, Saracino, A, Tonetti, T, Gaibani, P, Ranieri, V, Viale, P, Cristini, F, Bartoletti M., Marconi L., Scudeller L., Pancaldi L., Tedeschi S., Giannella M., Rinaldi M., Bussini L., Valentini I., Ferravante A. F., Potalivo A., Marchionni E., Fornaro G., Pascale R., Pasquini Z., Puoti M., Merli M., Barchiesi F., Volpato F., Rubin A., Saracino A., Tonetti T., Gaibani P., Ranieri V. M., Viale P., and Cristini F.

Abstract

Objective: To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19). Methods: A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score. Results: Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20–1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, −0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04–0.90; p 0.036). Conclusions: The effect of corticosteroid treatment on mortality might be l

Published
2021

26. 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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27. Diagnosis and management of infections caused by multidrug-resistant bacteria: guideline endorsed by the Italian Society of Infection and Tropical Diseases (SIMIT), the Italian Society of Anti-Infective Therapy (SITA), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Association of Clinical Microbiologists (AMCLI) and the Italian Society of Microbiology (SIM)

Author

Tiseo, G., Brigante, G., Giacobbe, D. R., Maraolo, A. E., Gona, F., Falcone, Marco, Giannella, M., Grossi, Paolo, Pea, Federico, Rossolini, G. M., Sanguinetti, Maurizio, Sarti, Daniela Maria, Scarparo, C., Tumbarello, Mario, Venditti, Mario, Viale, P., Bassetti, M., Luzzaro, F., Menichetti, F., Stefani, S., Tinelli, M., Falcone M., Grossi P., Pea F., Sanguinetti M. (ORCID:0000-0002-9780-7059), Sarti M., Tumbarello M. (ORCID:0000-0002-9519-8552), Venditti M., Tiseo, G., Brigante, G., Giacobbe, D. R., Maraolo, A. E., Gona, F., Falcone, Marco, Giannella, M., Grossi, Paolo, Pea, Federico, Rossolini, G. M., Sanguinetti, Maurizio, Sarti, Daniela Maria, Scarparo, C., Tumbarello, Mario, Venditti, Mario, Viale, P., Bassetti, M., Luzzaro, F., Menichetti, F., Stefani, S., Tinelli, M., Falcone M., Grossi P., Pea F., Sanguinetti M. (ORCID:0000-0002-9780-7059), Sarti M., Tumbarello M. (ORCID:0000-0002-9519-8552), and Venditti M.

Abstract

Management of patients with infections caused by multidrug-resistant organisms is challenging and requires a multidisciplinary approach to achieve successful clinical outcomes. The aim of this paper is to provide recommendations for the diagnosis and optimal management of these infections, with a focus on targeted antibiotic therapy. The document was produced by a panel of experts nominated by the five endorsing Italian societies, namely the Italian Association of Clinical Microbiologists (AMCLI), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Society of Microbiology (SIM), the Italian Society of Infectious and Tropical Diseases (SIMIT) and the Italian Society of Anti-Infective Therapy (SITA). Population, Intervention, Comparison and Outcomes (PICO) questions about microbiological diagnosis, pharmacological strategies and targeted antibiotic therapy were addressed for the following pathogens: carbapenem-resistant Enterobacterales; carbapenem-resistant Pseudomonas aeruginosa; carbapenem-resistant Acinetobacter baumannii; and methicillin-resistant Staphylococcus aureus. A systematic review of the literature published from January 2011 to November 2020 was guided by the PICO strategy. As data from randomised controlled trials (RCTs) were expected to be limited, observational studies were also reviewed. The certainty of evidence was classified using the GRADE approach. Recommendations were classified as strong or conditional. Detailed recommendations were formulated for each pathogen. The majority of available RCTs have serious risk of bias, and many observational studies have several limitations, including small sample size, retrospective design and presence of confounders. Thus, some recommendations are based on low or very-low certainty of evidence. Importantly, these recommendations should be continually updated to reflect emerging evidence from clinical studies and real-world experience.

Published
2022

32. Risk factors for gram-negative infection of cardiovascular implantable electronic devices: retrospective multicenter study - CarDINe study

Author

Pascale, R, primary, Abdullah, TA, additional, Fabbricatore, D, additional, De Potter, T, additional, Ripa, M, additional, Durante-Mangoni, E, additional, Leventopulos, G, additional, Domenichini, G, additional, Iacopino, S, additional, Akova, M, additional, Diemberger, I, additional, Viale, P, additional, and Giannella, M, additional

Published
2022
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34. Effective Containment of a COVID-19 Subregional Outbreak in Italy Through Strict Quarantine and Rearrangement of Local Health Care Services

Author

Tedeschi S., Badia L., Berveglieri F., Ferrari R., Coladonato S., Gabrielli S., Maestri A., Peroni G., Giannella M., Rossi A., Viale P., Acanto A., Battistoni A., Bendanti N., Dalfiume G., Fina A., Gardenghi E., Giulianini S., Grassi B., Neretti A., Prantoni S., Zanotti P., Zoffoli L., Assirelli C., Barilli G., Brozyna M.S., Cafaro M., Capoccia F., Momeni L.C., Contarino G., Contos G., Kanj M., Krawczyk A., Manara F., Puica A., Tedeschi S., Badia L., Berveglieri F., Ferrari R., Coladonato S., Gabrielli S., Maestri A., Peroni G., Giannella M., Rossi A., Viale P., Acanto A., Battistoni A., Bendanti N., Dalfiume G., Fina A., Gardenghi E., Giulianini S., Grassi B., Neretti A., Prantoni S., Zanotti P., Zoffoli L., Assirelli C., Barilli G., Brozyna M.S., Cafaro M., Capoccia F., Momeni L.C., Contarino G., Contos G., Kanj M., Krawczyk A., Manara F., and Puica A.

Subjects
medicine.medical_specialty, coronavirus, Disease, 01 natural sciences, Major Articles, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Health care, Epidemiology, Quarantine, Pandemic, Medicine, Outpatient clinic, Cumulative incidence, 030212 general & internal medicine, 0101 mathematics, outbreak, business.industry, 010102 general mathematics, quarantine, Outbreak, medicine.disease, coronaviru, AcademicSubjects/MED00290, Infectious Diseases, Italy, Oncology, Medical emergency, business
Abstract

Background Since the beginning of the pandemic, the epidemiology of coronavirus disease 2019 (COVID-19) in Italy has been characterized by the occurrence of subnational outbreaks. The World Health Organization recommended building the capacity to rapidly control COVID-19 clusters of cases in order to avoid the spread of the disease. This study describes a subregional outbreak of COVID-19 that occurred in the Emilia Romagna region, Italy, and the intervention undertaken to successfully control it. Methods Cases of COVID-19 were defined by a positive reverse transcriptase polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on nasopharyngeal swab. The outbreak involved the residential area of a small town, with ~10 500 inhabitants in an area of 9 km2. After the recognition of the outbreak, local health care authorities implemented strict quarantine and a rearrangement of health care services, consisting of closure of general practitioner outpatient clinics, telephone contact with all residents, activation of health care units to visit at-home patients with symptoms consistent with COVID-19, and a dedicated Infectious Diseases ambulatory unit at the nearest hospital. Results The outbreak lasted from February 24 to April 6, 2020, involving at least 170 people with a cumulative incidence of 160 cases/10 000 inhabitants; overall, 448 inhabitants of the municipality underwent at least 1 nasopharyngeal swab to detect SARS-CoV-2 (positivity rate, 38%). Ninety-three people presented symptoms before March 11 (pre-intervention period), and 77 presented symptoms during the postintervention period (March 11–April 6). Conclusions It was possible to control this COVID-19 outbreak by prompt recognition and implementation of a targeted local intervention.

Published
2021

35. Development of a Risk Prediction Model for Carbapenem-resistant Enterobacteriaceae Infection after Liver Transplantation: A Multinational Cohort Study

Author

Giannella, M., Freire, M., Rinaldi, M., Abdala, E., Rubin, A., Mularoni, A., Gruttadauria, S., Grossi, P., Shbaklo, N., Tandoi, F., Ferrarese, A., Burra, P., Fernandes, R., Aranha Camargo, L. F., Asensio, A., Alagna, L., Bandera, A., Simkins, J., Abbo, L., Halpern, M., Santana Girao, E., Valerio, M., Munoz, P., Fernandez Yunquera, A., Statlender, L., Yahav, D., Franceschini, E., Graziano, E., Morelli, M. C., Cescon, M., Viale, P., Lewis, R., Bartoletti, M., Pascale, R., Campoli, C., Coladonato, S., Cristini, F., Tumietto, F., Siniscalchi, A., Laici, C., Ambretti, S., Romagnoli, R., De Rosa, F. G., Muscatello, A., Mangioni, D., Gori, A., Antonelli, B., Dondossola, D., Rossi, G., Invernizzi, F., Peghin, M., Cillo, U., Mussini, C., Benedetto, F. D., Terrabuio, D. R. B., Bittante, C. D., Toniolo, A. D. R., Balbi, E., Garcia, J. H. P., Morras, I., Ramos, A., Cruz, A. F., Salcedo, M., Giannella M., Freire M., Rinaldi M., Abdala E., Rubin A., Mularoni A., Gruttadauria S., Grossi P., Shbaklo N., Tandoi F., Ferrarese A., Burra P., Fernandes R., Aranha Camargo L.F., Asensio A., Alagna L., Bandera A., Simkins J., Abbo L., Halpern M., Santana Girao E., Valerio M., Munoz P., Fernandez Yunquera A., Statlender L., Yahav D., Franceschini E., Graziano E., Morelli M.C., Cescon M., Viale P., Lewis R., Bartoletti M., Pascale R., Campoli C., Coladonato S., Cristini F., Tumietto F., Siniscalchi A., Laici C., Ambretti S., Romagnoli R., De Rosa F.G., Muscatello A., Mangioni D., Gori A., Antonelli B., Dondossola D., Rossi G., Invernizzi F., Peghin M., Cillo U., Mussini C., Benedetto F.D., Terrabuio D.R.B., Bittante C.D., Toniolo A.D.R., Balbi E., Garcia J.H.P., Morras I., Ramos A., Cruz A.F., and Salcedo M.

Subjects
Microbiology (medical), Adult, medicine.medical_specialty, medicine.medical_treatment, Carbapenem-resistant enterobacteriaceae, Liver transplantation, CRE carriage, CRE infection, SOT, liver transplantation, Anti-Bacterial Agents, Carbapenems, Cohort Studies, Humans, Risk Factors, Carbapenem-Resistant Enterobacteriaceae, Enterobacteriaceae Infections, Liver Transplantation, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, Anti-Bacterial Agent, Medicine, 030212 general & internal medicine, Carbapenem, Univariate analysis, business.industry, Risk Factor, Area under the curve, Nomogram, Enterobacteriaceae Infection, Transplantation, Infectious Diseases, 030211 gastroenterology & hepatology, Cohort Studie, business, Human, Cohort study
Abstract

BackgroundPatients colonized with carbapenem-resistant Enterobacteriaceae (CRE) are at higher risk of developing CRE infection after liver transplantation (LT), with associated high morbidity and mortality. Prediction model for CRE infection after LT among carriers could be useful to target preventive strategies.MethodsMultinational multicenter cohort study of consecutive adult patients underwent LT and colonized with CRE before or after LT, from January 2010 to December 2017. Risk factors for CRE infection were analyzed by univariate analysis and by Fine-Gray subdistribution hazard model, with death as competing event. A nomogram to predict 30- and 60-day CRE infection risk was created.ResultsA total of 840 LT recipients found to be colonized with CRE before (n = 203) or after (n = 637) LT were enrolled. CRE infection was diagnosed in 250 (29.7%) patients within 19 (interquartile range [IQR], 9–42) days after LT. Pre- and post-LT colonization, multisite post-LT colonization, prolonged mechanical ventilation, acute renal injury, and surgical reintervention were retained in the prediction model. Median 30- and 60-day predicted risk was 15% (IQR, 11–24) and 21% (IQR, 15–33), respectively. Discrimination and prediction accuracy for CRE infection was acceptable on derivation (area under the curve [AUC], 74.6; Brier index, 16.3) and bootstrapped validation dataset (AUC, 73.9; Brier index, 16.6). Decision-curve analysis suggested net benefit of model-directed intervention over default strategies (treat all, treat none) when CRE infection probability exceeded 10%. The risk prediction model is freely available as mobile application at https://idbologna.shinyapps.io/CREPostOLTPredictionModel/.ConclusionsOur clinical prediction tool could enable better targeting interventions for CRE infection after transplant.

Published
2021

38. SARS-CoV-2 vaccination in solid-organ transplant recipients : What the clinician needs to know

Author

Giannella, M., Pierrotti, L.C., Helanterä, I., Manuel, O., HUS Abdominal Center, and IV kirurgian klinikka

Subjects
safety, mRNA vaccine, prevention, SARS-CoV-2, organ transplantation, COVID-19, KIDNEY-TRANSPLANT, immunogenicity, INFLUENZA VACCINATION, T-CELL, 3126 Surgery, anesthesiology, intensive care, radiology, RESPONSES
Abstract

In response to the COVID-19 pandemic, SARS-CoV-2 vaccines have been developed at an unparalleled speed, with 14 SARS-CoV-2 vaccines currently authorized. Solid-organ transplant (SOT) recipients are at risk for developing a higher rate of COVID-19-related complications and therefore they are at priority for immunization against SARS-CoV-2. Preliminary data suggest that although SARS-CoV-2 vaccines are safe in SOT recipients (with similar rate of adverse events than in the general population), the antibody responses are decreased in this population. Risk factors for poor vaccine immunogenicity include older age, shorter time from transplantation, use of mycophenolate and belatacept, and worse allograft function. SOT recipients should continue to be advised to maintain hand hygiene, use of facemasks, and social distancing after SARS-CoV-2 vaccine. Vaccination of household contacts should be also prioritized. Although highly encouraged for research purposes, systematic assessment in clinical practice of humoral and cellular immune responses after SARS-CoV-2 vaccination is controversial, since correlation between immunological findings and clinical protection from severe COVID-19, and cutoffs for protection are currently unknown in SOT recipients. Alternative immunization schemes, including a booster dose, higher doses, and modulation of immunosuppression during vaccination, need to be assessed in the context of well-designed clinical trials.

Published
2021

39. Ceftolozane/Tazobactam for Treatment of Severe ESBL-Producing

Author

Bassetti, M., Vena, A., Giacobbe, D. R., Falcone, M., Tiseo, G., Giannella, M., Pascale, R., Meschiari, M., Digaetano, M., Oliva, A., Rovelli, C., Carannante, N., Losito, A. R., Carbonara, S., Mariani, M. F., Mastroianni, A., Angarano, G., Tumbarello, M., Tascini, C., Grossi, P., Mastroianni, C. M., Mussini, C., Viale, P., Menichetti, F., Viscoli, C., Russo, A., Verdenelli, S., Fabiani, S., Castaldo, N., Pecori, D., Carnellutti, A., Givone, F., Graziano, E., Merelli, M., Cadeo, B., Peghin, M., Cattelan, A., Cipriani, L., Coletto, D., Gianluca, R., Ciardi, M. R., Ajassa, C., Tieghi, T., Pontino, P., Raffaelli, F., Artioli, S., Caruana, G., Luzzati, R., Bontempo, G., Petrosillo, N., Capone, A., Rizzardini, G., Coen, M., Passerini, M., Guadagnino, G., Urso, F., Borgia, G., Gentile, I., Maraolo, A. E., Crapis, M., Venturini, S., Parruti, G., Trave, F., Girardis, M., Cascio, A., Gioe, C., Anselmo, M., Malfatto, E., Bassetti, Matteo, Vena, Antonio, Giacobbe, Daniele Roberto, Falcone, Marco, Tiseo, Giusy, Giannella, Maddalena, Pascale, Renato, Meschiari, Marianna, Digaetano, Margherita, Oliva, Alessandra, Rovelli, Cristina, Carannante, Novella, Losito, Angela Raffaella, Carbonara, Sergio, Mariani, Michele Fabiano, Mastroianni, Antonio, Angarano, Gioacchino, Tumbarello, Mario, Tascini, Carlo, Grossi, Paolo, Mastroianni, Claudio Maria, Mussini, Cristina, Viale, Pierluigi, Menichetti, Francesco, Viscoli, Claudio, Russo, Alessandro, Bassetti M., Vena A., Giacobbe D.R., Falcone M., Tiseo G., Giannella M., Pascale R., Meschiari M., Digaetano M., Oliva A., Rovelli C., Carannante N., Losito A.R., Carbonara S., Mariani M.F., Mastroianni A., Angarano G., Tumbarello M., Tascini C., Grossi P., Mastroianni C.M., Mussini C., Viale P., Menichetti F., Viscoli C., Russo A., Verdenelli S., Fabiani S., Castaldo N., Pecori D., Carnellutti A., Givone F., Graziano E., Merelli M., Cadeo B., Peghin M., Cattelan A., Cipriani L., Coletto D., Gianluca R., Ciardi M.R., Ajassa C., Tieghi T., Pontino P., Raffaelli F., Artioli S., Caruana G., Luzzati R., Bontempo G., Petrosillo N., Capone A., Rizzardini G., Coen M., Passerini M., Guadagnino G., Urso F., Borgia G., Gentile I., Maraolo A.E., Crapis M., Venturini S., Parruti G., Trave F., Girardis M., Cascio A., Gioe C., Anselmo M., Malfatto E., Russo, Alessandro &amp, and Luzzati, R.

Subjects
medicine.medical_specialty, ceftolozane/tazobactam, medicine.medical_treatment, CRRT, Tazobactam, Enterobacterales, Enterobacterale, Internal medicine, ESBL, septic shock, Major Article, medicine, Clinical endpoint, Renal replacement therapy, business.industry, Septic shock, Retrospective cohort study, Odds ratio, medicine.disease, Ceftolozane/tazobactam, AcademicSubjects/MED00290, Infectious Diseases, Oncology, Ceftolozane, business, Empiric therapy, medicine.drug
Abstract

Background Few data are reported in the literature about the outcome of patients with severe extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) infections treated with ceftolozane/tazobactam (C/T), in empiric or definitive therapy. Methods A multicenter retrospective study was performed in Italy (June 2016–June 2019). Successful clinical outcome was defined as complete resolution of clinical signs/symptoms related to ESBL-E infection and lack of microbiological evidence of infection. The primary end point was to identify predictors of clinical failure of C/T therapy. Results C/T treatment was documented in 153 patients: pneumonia was the most common diagnosis (n = 46, 30%), followed by 34 cases of complicated urinary tract infections (22.2%). Septic shock was observed in 42 (27.5%) patients. C/T was used as empiric therapy in 46 (30%) patients and as monotherapy in 127 (83%) patients. Favorable clinical outcome was observed in 128 (83.7%) patients; 25 patients were considered to have failed C/T therapy. Overall, 30-day mortality was reported for 15 (9.8%) patients. At multivariate analysis, Charlson comorbidity index >4 (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9–3.5; P = .02), septic shock (OR, 6.2; 95% CI, 3.8–7.9; P < .001), and continuous renal replacement therapy (OR, 3.1; 95% CI, 1.9–5.3; P = .001) were independently associated with clinical failure, whereas empiric therapy displaying in vitro activity (OR, 0.12; 95% CI, 0.01–0.34; P < .001) and adequate source control of infection (OR, 0.42; 95% CI, 0.14–0.55; P < .001) were associated with clinical success. Conclusions Data show that C/T could be a valid option in empiric and/or targeted therapy in patients with severe infections caused by ESBL-producing Enterobacterales. Clinicians should be aware of the risk of clinical failure with standard-dose C/T therapy in septic patients receiving CRRT.

Published
2020

40. International survey of human herpes virus 8 screening and management in solid organ transplantation

Author

Mularoni, A, Mikulska, M, Giannella, M, Adamoli, L, Slavin, M, Van Delden, C, Garcia, JMA, Cervera, C, Grossi, PA, Mularoni, A, Mikulska, M, Giannella, M, Adamoli, L, Slavin, M, Van Delden, C, Garcia, JMA, Cervera, C, and Grossi, PA

Abstract

BACKGROUND: HHV-8/Kaposi Sarcoma herpesvirus has been associated with a broad spectrum of diseases in solid organ transplant (SOT) recipients. Primary donor-derived infection can be associated with severe and rapidly fatal non-neoplastic disease, and diagnosis is made with high HHV-8 DNAemia. METHODS: We carried out an international survey to investigate the current approach to HHV-8 screening, and management in SOT since a protocol has not been established by international guidelines. RESULTS: A total of 51 transplant centers from 15 countries filled out the survey. HHV-8-associated diseases in SOT have been diagnosed during the previous 5 years in 67% of centers. Pretransplant serological screening is performed in 17 centers (33%), and posttransplant HHV-8 nucleic acid testing (NAT) monitoring is performed in 21 centers (41%). Performing HHV-8 NAT monitoring and serological screening were found associated with having diagnosed in the previous 5 years a non-malignant HHV-8-associated disease. CONCLUSIONS: Serological pretransplant screening of donors and recipients and post-transplant HHV-8 NAT monitoring recommendations should be standardized. Even though serological assays are not optimal, they could contribute to increasing knowledge on epidemiology and management of HHV-8-associated diseases after SOT.

Published
2021

41. Ceftazidime-avibactam use for KPC-Kp infections: a retrospective observational multicenter study

Author

Tumbarello, M, Raffaelli, F, Giannella, M, Mantengoli, E, Mularoni, A, Venditti, M, De Rosa, F, Sarmati, L, Bassetti, M, Brindicci, G, Rossi, M, Luzzati, R, Grossi, P, Corona, A, Capone, A, Falcone, M, Mussini, C, Trecarichi, E, Cascio, A, Guffanti, E, Russo, A, De Pascale, G, Tascini, C, Gentile, I, Losito, A, Bussini, L, Conti, G, Ceccarelli, G, Corcione, S, Compagno, M, Giacobbe, D, Saracino, A, Fantoni, M, Antinori, S, Peghin, M, Bonfanti, P, Oliva, A, De Gasperi, A, Tiseo, G, Rovelli, C, Meschiari, M, Shbaklo, N, Spanu, T, Cauda, R, Viale, P, Tumbarello, Mario, Raffaelli, Francesca, Giannella, Maddalena, Mantengoli, Elisabetta, Mularoni, Alessandra, Venditti, Mario, De Rosa, Francesco Giuseppe, Sarmati, Loredana, Bassetti, Matteo, Brindicci, Gaetano, Rossi, Marianna, Luzzati, Roberto, Grossi, Paolo Antonio, Corona, Alberto, Capone, Alessandro, Falcone, Marco, Mussini, Cristina, Trecarichi, Enrico Maria, Cascio, Antonio, Guffanti, Elena, Russo, Alessandro, De Pascale, Gennaro, Tascini, Carlo, Gentile, Ivan, Losito, Angela Raffaella, Bussini, Linda, Conti, Giampaolo, Ceccarelli, Giancarlo, Corcione, Silvia, Compagno, Mirko, Giacobbe, Daniele Roberto, Saracino, Annalisa, Fantoni, Massimo, Antinori, Spinello, Peghin, Maddalena, Bonfanti, Paolo, Oliva, Alessandra, De Gasperi, Andrea, Tiseo, Giusy, Rovelli, Cristina, Meschiari, Marianna, Shbaklo, Nour, Spanu, Teresa, Cauda, Roberto, Viale, Pierluigi, Tumbarello, M, Raffaelli, F, Giannella, M, Mantengoli, E, Mularoni, A, Venditti, M, De Rosa, F, Sarmati, L, Bassetti, M, Brindicci, G, Rossi, M, Luzzati, R, Grossi, P, Corona, A, Capone, A, Falcone, M, Mussini, C, Trecarichi, E, Cascio, A, Guffanti, E, Russo, A, De Pascale, G, Tascini, C, Gentile, I, Losito, A, Bussini, L, Conti, G, Ceccarelli, G, Corcione, S, Compagno, M, Giacobbe, D, Saracino, A, Fantoni, M, Antinori, S, Peghin, M, Bonfanti, P, Oliva, A, De Gasperi, A, Tiseo, G, Rovelli, C, Meschiari, M, Shbaklo, N, Spanu, T, Cauda, R, Viale, P, Tumbarello, Mario, Raffaelli, Francesca, Giannella, Maddalena, Mantengoli, Elisabetta, Mularoni, Alessandra, Venditti, Mario, De Rosa, Francesco Giuseppe, Sarmati, Loredana, Bassetti, Matteo, Brindicci, Gaetano, Rossi, Marianna, Luzzati, Roberto, Grossi, Paolo Antonio, Corona, Alberto, Capone, Alessandro, Falcone, Marco, Mussini, Cristina, Trecarichi, Enrico Maria, Cascio, Antonio, Guffanti, Elena, Russo, Alessandro, De Pascale, Gennaro, Tascini, Carlo, Gentile, Ivan, Losito, Angela Raffaella, Bussini, Linda, Conti, Giampaolo, Ceccarelli, Giancarlo, Corcione, Silvia, Compagno, Mirko, Giacobbe, Daniele Roberto, Saracino, Annalisa, Fantoni, Massimo, Antinori, Spinello, Peghin, Maddalena, Bonfanti, Paolo, Oliva, Alessandra, De Gasperi, Andrea, Tiseo, Giusy, Rovelli, Cristina, Meschiari, Marianna, Shbaklo, Nour, Spanu, Teresa, Cauda, Roberto, and Viale, Pierluigi

Abstract

Background: A growing body of observational evidence supports the value of ceftazidime-avibactam (CAZ-AVI) in managing infections caused by carbapenem-resistant Enterobacteriaceae. Methods: We retrospectively analyzed observational data on use and outcomes of CAZ-AVI therapy for infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) strains. Multivariate regression analysis was used to identify variables independently associated with 30-day mortality. Results were adjusted for propensity score for receipt of CAZ-AVI combination regimens versus CAZ-AVI monotherapy. Results: The cohort comprised 577 adults with bloodstream infections (n = 391) or nonbacteremic infections involving mainly the urinary tract, lower respiratory tract, and intra-abdominal structures. All received treatment with CAZ-AVI alone (n = 165) or with ≥1 other active antimicrobials (n = 412). The all-cause mortality rate 30 days after infection onset was 25% (146/577). There was no significant difference in mortality between patients managed with CAZ-AVI alone and those treated with combination regimens (26.1% vs 25.0%, P =. 79). In multivariate analysis, mortality was positively associated with presence at infection onset of septic shock (P =. 002), neutropenia (P <. 001), or an INCREMENT score ≥8 (P =. 01); with lower respiratory tract infection (LRTI) (P =. 04); and with CAZ-AVI dose adjustment for renal function (P =. 01). Mortality was negatively associated with CAZ-AVI administration by prolonged infusion (P =. 006). All associations remained significant after propensity score adjustment. Conclusions: CAZ-AVI is an important option for treating serious KPC-Kp infections, even when used alone. Further study is needed to explore the drug's seemingly more limited efficacy in LRTIs and potential survival benefits of prolonging CAZ-AVI infusions to ≥3 hours.

Published
2021

43. 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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45. NUCEL (Cell and Molecular Therapy Center): A Multidisciplinary Center for Translational Research in Brazil

Author

Colin, C., Demasi, M. A., Degaki, T. L., Bustos-Valenzuela, J. C., Figueira, R. C. S., Montor, W. R., Cruz, L. O., Lojudice, F. H., Muras, A. G., Pereira, T. M., Winnischofer, S. M. B., Hasegawa, A. P. G., Carreira, A. C., Verbisck, N. V., Corrêa, R. G., Garay-Malpartida, H. M., Mares-Guia, T. R., Corrêa-Giannella, M. L., Granjeiro, J. M., and Sogayar, M. C.

Published
2008
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48. Neuraminidase Inhibitors and Hospital Length of Stay: A Meta-analysis of Individual Participant Data to Determine Treatment Effectiveness Among Patients Hospitalized With Nonfatal 2009 Pandemic Influenza A(H1N1) Virus Infection

Author

Venkatesan, S, Myles, PR, Bolton, KJ, Muthuri, SG, Al Khuwaitir, T, Anovadiya, AP, Azziz-Baumgartner, E, Bajjou, T, Bassetti, M, Beovic, B, Bertisch, B, Bonmarin, I, Booy, R, Borja-Aburto, VH, Burgmann, H, Cao, B, Carratala, J, Chinbayar, T, Cilloniz, C, Denholm, JT, Dominguez, SR, Duarte, PAD, Dubnov-Raz, G, Fanella, S, Gao, Z, Gerardin, P, Giannella, M, Gubbels, S, Herberg, J, Higuera Iglesias, AL, Hoeger, PH, Hu, XY, Islam, QT, Jimenez, MF, Keijzers, G, Khalili, H, Kusznierz, G, Kuzman, I, Langenegger, E, Lankarani, KB, Leo, Y-S, Libster, RP, Linko, R, Madanat, F, Maltezos, E, Mamun, A, Manabe, T, Metan, G, Mickiene, A, Mikic, D, Mohn, KG, Oliva, ME, Ozkan, M, Parekh, D, Paul, M, Rath, BA, Refaey, S, Rodriguez, AH, Sertogullarindan, B, Skret-Magierlo, J, Somer, A, Talarek, E, Tang, JW, To, K, Dat, T, Uyeki, TM, Vaudry, W, Vidmar, T, Zarogoulidis, P, Nguyen-Van-Tam, JS, Venkatesan, S, Myles, PR, Bolton, KJ, Muthuri, SG, Al Khuwaitir, T, Anovadiya, AP, Azziz-Baumgartner, E, Bajjou, T, Bassetti, M, Beovic, B, Bertisch, B, Bonmarin, I, Booy, R, Borja-Aburto, VH, Burgmann, H, Cao, B, Carratala, J, Chinbayar, T, Cilloniz, C, Denholm, JT, Dominguez, SR, Duarte, PAD, Dubnov-Raz, G, Fanella, S, Gao, Z, Gerardin, P, Giannella, M, Gubbels, S, Herberg, J, Higuera Iglesias, AL, Hoeger, PH, Hu, XY, Islam, QT, Jimenez, MF, Keijzers, G, Khalili, H, Kusznierz, G, Kuzman, I, Langenegger, E, Lankarani, KB, Leo, Y-S, Libster, RP, Linko, R, Madanat, F, Maltezos, E, Mamun, A, Manabe, T, Metan, G, Mickiene, A, Mikic, D, Mohn, KG, Oliva, ME, Ozkan, M, Parekh, D, Paul, M, Rath, BA, Refaey, S, Rodriguez, AH, Sertogullarindan, B, Skret-Magierlo, J, Somer, A, Talarek, E, Tang, JW, To, K, Dat, T, Uyeki, TM, Vaudry, W, Vidmar, T, Zarogoulidis, P, and Nguyen-Van-Tam, JS

Abstract

BACKGROUND: The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear. METHODS: We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded. RESULTS: We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78-.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS. CONCLUSIONS: When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.

Published
2020

49. Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

Author

Tonetti, T., Grasselli, G., Zanella, A., Pizzilli, G., Fumagalli, R., Piva, S., Lorini, L., Iotti, G., Foti, G., Colombo, S., Vivona, L., Rossi, S., Girardis, M., Agnoletti, V., Campagna, A., Gordini, G., Navalesi, P., Boscolo, A., Graziano, A., Valeri, I., Vianello, A., Cereda, D., Filippini, C., Cecconi, M., Locatelli, Franco, Bartoletti, M., Giannella, M., Viale, P., Antonelli, M., Nava, S., Pesenti, A., Ranieri, V. M., Albano, G., Alborghetti, A., Aldegheri, G., Antonini, B., Belgiorno, N., Bellani, G., Beretta, E., Bonazzi, S., Borelli, M., Cabrini, L., Carnevale, L., Carnevale, S., Castelli, G., Catena, E., Chiumello, D., Coluccello, A., Coppini, D., Covello, D., Defilippi, G., Deipoli, M., Dughi, P., Gallioli, G., Gnesin, P., Greco, S., Guatteri, L., Guzzon, D., Keim, R., Landoni, G., Langer, T., Lombardo, A., Marino, G., Merli, G., Merlo, D., Mojoli, F., Muttini, S., Natalini, G., Petrucci, N., Pezzi, A., Radrizzani, D., Raimondi, M., Riccio, M., Storti, E., Tavola, M., Vitale, G., Bosco, E., Calo, M. A., Danzi, V., Derosa, S., Farnia, A., Lazzari, F., Meggiolaro, M., Munari, M., Saia, M., Sella, N., Serra, E., Tiberio, I., Baiocchi, M., Benedetto, M., Bordini, M., Caramelli, F., Cilloni, N., Dellagiovampaola, M., Fanelli, A., Frascaroli, G., Fusari, M., Maitan, S., Martino, C., Melotti, R. M., Merola, R., Minardi, F., Moro, F., Nardi, G., Nolli, M., Pierucci, E., Potalivo, A., Repetti, F., Salsi, P., Terzitta, M., Tosi, M., Venturi, S., Volta, C. A., Zani, G., Zanoni, A., Locatelli F. (ORCID:0000-0002-7976-3654), Tonetti, T., Grasselli, G., Zanella, A., Pizzilli, G., Fumagalli, R., Piva, S., Lorini, L., Iotti, G., Foti, G., Colombo, S., Vivona, L., Rossi, S., Girardis, M., Agnoletti, V., Campagna, A., Gordini, G., Navalesi, P., Boscolo, A., Graziano, A., Valeri, I., Vianello, A., Cereda, D., Filippini, C., Cecconi, M., Locatelli, Franco, Bartoletti, M., Giannella, M., Viale, P., Antonelli, M., Nava, S., Pesenti, A., Ranieri, V. M., Albano, G., Alborghetti, A., Aldegheri, G., Antonini, B., Belgiorno, N., Bellani, G., Beretta, E., Bonazzi, S., Borelli, M., Cabrini, L., Carnevale, L., Carnevale, S., Castelli, G., Catena, E., Chiumello, D., Coluccello, A., Coppini, D., Covello, D., Defilippi, G., Deipoli, M., Dughi, P., Gallioli, G., Gnesin, P., Greco, S., Guatteri, L., Guzzon, D., Keim, R., Landoni, G., Langer, T., Lombardo, A., Marino, G., Merli, G., Merlo, D., Mojoli, F., Muttini, S., Natalini, G., Petrucci, N., Pezzi, A., Radrizzani, D., Raimondi, M., Riccio, M., Storti, E., Tavola, M., Vitale, G., Bosco, E., Calo, M. A., Danzi, V., Derosa, S., Farnia, A., Lazzari, F., Meggiolaro, M., Munari, M., Saia, M., Sella, N., Serra, E., Tiberio, I., Baiocchi, M., Benedetto, M., Bordini, M., Caramelli, F., Cilloni, N., Dellagiovampaola, M., Fanelli, A., Frascaroli, G., Fusari, M., Maitan, S., Martino, C., Melotti, R. M., Merola, R., Minardi, F., Moro, F., Nardi, G., Nolli, M., Pierucci, E., Potalivo, A., Repetti, F., Salsi, P., Terzitta, M., Tosi, M., Venturi, S., Volta, C. A., Zani, G., Zanoni, A., and Locatelli F. (ORCID:0000-0002-7976-3654)

Abstract

Background: A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results: In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions: Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.

Published
2020

50. Use of critical care resources during the first 2 weeks (February 24-March 8, 2020) of the Covid-19 outbreak in Italy

Author

Tonetti, T, Grasselli, G, Zanella, A, Pizzilli, G, Fumagalli, R, Piva, S, Lorini, L, Iotti, G, Foti, G, Colombo, S, Vivona, L, Rossi, S, Girardis, M, Agnoletti, V, Campagna, A, Gordini, G, Navalesi, P, Boscolo, A, Graziano, A, Valeri, I, Vianello, A, Cereda, D, Filippini, C, Cecconi, M, Locatelli, F, Bartoletti, M, Giannella, M, Viale, P, Antonelli, M, Nava, S, Pesenti, A, Ranieri, V, Langer, T, Tonetti, Tommaso, Grasselli, Giacomo, Zanella, Alberto, Pizzilli, Giacinto, Fumagalli, Roberto, Piva, Simone, Lorini, Luca, Iotti, Giorgio, Foti, Giuseppe, Colombo, Sergio, Vivona, Luigi, Rossi, Sandra, Girardis, Massimo, Agnoletti, Vanni, Campagna, Anselmo, Gordini, Giovanni, Navalesi, Paolo, Boscolo, Annalisa, Graziano, Alessandro, Valeri, Ilaria, Vianello, Andrea, Cereda, Danilo, Filippini, Claudia, Cecconi, Maurizio, Locatelli, Franco, Bartoletti, Michele, Giannella, Maddalena, Viale, Pierluigi, Antonelli, Massimo, Nava, Stefano, Pesenti, Antonio, Ranieri, V Marco, Langer, Thomas, Tonetti, T, Grasselli, G, Zanella, A, Pizzilli, G, Fumagalli, R, Piva, S, Lorini, L, Iotti, G, Foti, G, Colombo, S, Vivona, L, Rossi, S, Girardis, M, Agnoletti, V, Campagna, A, Gordini, G, Navalesi, P, Boscolo, A, Graziano, A, Valeri, I, Vianello, A, Cereda, D, Filippini, C, Cecconi, M, Locatelli, F, Bartoletti, M, Giannella, M, Viale, P, Antonelli, M, Nava, S, Pesenti, A, Ranieri, V, Langer, T, Tonetti, Tommaso, Grasselli, Giacomo, Zanella, Alberto, Pizzilli, Giacinto, Fumagalli, Roberto, Piva, Simone, Lorini, Luca, Iotti, Giorgio, Foti, Giuseppe, Colombo, Sergio, Vivona, Luigi, Rossi, Sandra, Girardis, Massimo, Agnoletti, Vanni, Campagna, Anselmo, Gordini, Giovanni, Navalesi, Paolo, Boscolo, Annalisa, Graziano, Alessandro, Valeri, Ilaria, Vianello, Andrea, Cereda, Danilo, Filippini, Claudia, Cecconi, Maurizio, Locatelli, Franco, Bartoletti, Michele, Giannella, Maddalena, Viale, Pierluigi, Antonelli, Massimo, Nava, Stefano, Pesenti, Antonio, Ranieri, V Marco, and Langer, Thomas

Abstract

Background: A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results: In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24-March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions: Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.

Published
2020

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