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Background: Sonication of removed implant may improve the rate of microbiologic diagnosis of prosthetic joint infections (PJI) but the value of a sonication-guided therapy is unknown. Objectives: To evaluate the impact of sonication in ameliorating quality of microbiological diagnosis and consequently in improving cure rate of PJI. Methods: PJI undergoing two-stage exchange consecutively observed during a 4-year period were enrolled. PJI were defined by clinical, microbiological and radiologic findings. In each case, we reported demographic, clinical and microbiological data, including the method employed to obtain microbiological cultures such as conventional culture of intraoperative specimens or culture of the fluid obtained by sonication of the removed implant. Cure was defined by disappearance of any evidence of infection during a 6-month follow-up period. Results: Thirty-seven cases with PJI were observed (median age 64 [range 48–82], 16 hip implants and 21 knee implants). Microbiological investigations revealed bacterial growth in 30 (81%). Staphylococcus aureus was identified in 12 (40%) cases (eight methicillin resistant), Coagulase Negative staphylococci (CoNS) were identified in 10 (33%), Pseudomonas aeruginosa in 3 (10%), and other bacteria in 5 (17%). In 15 PJI the attempt to microbiological diagnosis was made only by conventional methods reporting a 67% success rate. In 22 cases undergoing both culture of the fluid obtained by sonication and culture of conventional intraoperative specimens, bacterial growth was obtained in 20 (90%) by sonication and 15 (68%) by conventional methods. Three cases reported discordant microbiological evidences between sonication and conventional methods and received antimicrobial therapy according to sonication. Overall, cultures were positive in 90% by sonication and 68% by conventional methods (20/22 vs. 25/37; RR 1.35, 95% CI 1.04–1.74; p = 0.04) with an increase of CoNS isolated among those diagnosed by sonication. Failure after twostage replacement was reported in 3 (20%) diagnosed by conventional methods and 1 (5%) diagnosed by sonication. Conclusion: Sonication of the implant improved the accuracy of PJI microbiological diagnosis revealing a higher number of cases sustained by CoNS which are better revealed by sonication since are embedded within biofilm. Sonication resulted in slight better cure rate, probably because of the reduction of cases needing broad spectrum empiric therapy.

a b s t r a c t Background: Data on the efficacy of Peg-interferon/ribavirin therapy for chronic hepatitis C are mostly derived from treatment of selected patients enrolled in clinical trials. This study aimed to assess the effectiveness of Peg-interferon/ribavirin therapy in “real world” chronic hepatitis C patients in Italy. Methods: Independent observational multicentre study including consecutive patients receiving Peginterferon/ribavirin in the 18 months before (retrospective phase) and after (prospective phase) the start of the study. Results: 4176 patients were eligible. The final study population consisted of 2051 patients in the retrospective and 2073 in the prospective phase. Sustained virological response was achieved by 1036 patients (50.5%) during the retrospective phase: 325 were genotypes 1/4 (34.1%) and 684 were genotypes 2/3 (67.2%) and by 800 patients (38.6%) during the prospective phase: 300 were genotypes 1/4 (28.4%) and 473 were genotypes 2/3 (51.5%). During multivariate analysis genotypes 2/3 were significantly associated with higher sustained virological response rates; cirrhosis and -glutamil-transpeptidase >2 times the normal limit were associated with poorer response. Conclusions: The response to Peg-interferon/ribavirin therapy in “real world” clinical practice is distinctly lower than in registration trials. The difference in response rates was more pronounced among easy-totreat than among difficult-to-treat hepatitis C virus genotypes.

Hepatitis A virus is a widely occurring disease, with different prevalence rates between countries in the North and West and those in the South and East. In Italy endemicity is low/medium, but not homogeneously distributed: in the northern/central regions a large hepatitis A outbreak due to genotype IA, related to the consumption of contaminated mixed frozen berries, occurred between 2013 and 2014, whereas in southern Italian regions recurrent outbreaks of hepatitis A, due to the IB genotype, still result from consumption of raw seafood. In 2014 an uncommon genotype IA strain was isolated from five patients (2 adults and 3 children) with hepatitis A, living in the surroundings of Naples (Campania) who did not have any of the most common risk factors for hepatitis A in Italy, such as consumption of raw shellfish or frozen berries, or travel to endemic countries. Moreover, based on the analysis of viral sequences obtained, this strain differed from several others in the national database, which had been recently isolated during Italian outbreaks. This case report reinforces the need to implement both information campaigns about the prevention of hepatitis A and vaccination programmes in childhood; in addition, it would be suitable to sequence strains routinely not only during large outbreaks of hepatitis A in order to obtain a more detailed national database of HAV strains circulating in Italy.

The treatment of visceral leishmaniasis (VL) is poorly standardized in Italy in spite of the existing evidence. All consecutive patients with VL admitted at 15 Italian centers as inpatients or outpatients between January 2004 and December 2008 were retrospectively considered; outcome data at 1 year after treatment were obtained for all but 1 patient. Demographic characteristics, underlying diseases, diagnostic procedures, treatment regimens and outcomes, as well as side effects were recorded. A confirmed diagnosis of VL was reported for 166 patients: 120 (72.3%) immunocompetent, 21 (12.6%) patients with immune deficiencies other than HIV infection, and 25 (15.1%) coinfected with HIV. Liposomal amphotericin B (L-AmB) was the drug almost universally used for treatment, administered to 153 (92.2%) patients. Thirty-seven different regimens, including L-AmB were used. The mean doses were 29.4 ± 7.9 mg/kg in immunocompetent patients, 32.9 ± 8.6 mg/kg in patients with non-HIV-related immunodeficiencies, and 40.8 ± 6.7 mg/kg in HIV-infected patients ( P < 0.001). The mean numbers of infusion days were 7.8 ± 3.1 in immunocompetent patients, 9.6 ± 3.9 in non-HIV-immunodeficient patients, and 12.0 ± 3.4 in HIV-infected patients ( P < 0.001). Mild and reversible adverse events were observed in 12.2% of cases. Responsive patients were 154 (93.3%). Successes were 98.4% among immunocompetent patients, 90.5% among non-HIV-immunodeficient patients, and 72.0% among HIV-infected patients. Among predictors of primary response to treatment, HIV infection and age held independent associations in the final multivariate models, whereas the doses and duration of L-AmB treatment were not significantly associated. Longer treatments and higher doses of L-AmB were not able to significantly modify treatment outcomes either in the immunocompetent or in the immunocompromised population.