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1.
Int J Antimicrob Agents ; 61(2): 106723, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36642233

RESUMO

OBJECTIVES: Cefiderocol is a 'siderophore' cephalosporin active against Gram-negative bacteria, including carbapenem-resistant strains. Data on the use of cefiderocol in real life are limited. We evaluated the efficacy and safety of cefiderocol in the context of our hospital clinical practice. METHODS: This was a single-centre, observational, retrospective clinical study. We collected data for all patients who received cefiderocol therapy in our hospital, with a focus on clinical outcomes and adverse events. RESULTS: The study cohort included 28 patients, with a median age of 73 years (25-83 years) and a high burden of co-morbidities. Up to 45 Gram-negative isolates were cultured from the study patients, the most common pathogen being Acinetobacter baumannii (31.1%). Cefiderocol was mostly prescribed for pneumonia (37.8% of cases), bloodstream infection (24.4%), urinary tract infection (22.2%) and intra-abdominal infection (20%), and largely as salvage therapy (92.8%). Of the 18 patients for whom follow-up cultures were available, 14 (77.8%) achieved eradication of the causative micro-organism. Therapeutic success (improvement/resolution of infection) occurred in 64.3% of cases at 7 days and 50% at 14 days from treatment start. Treatment failed in 9 cases (32.1%). No effects on kidney, liver or bone marrow function were observed. CONCLUSIONS: Cefiderocol showed fair efficacy and excellent tolerability in highly co-morbid patients with a range of multiresistant infections. It may be an option for infections due to colistin-resistant pathogens, when other regimens fail or in cases at risk of kidney dysfunction.


Assuntos
Antibacterianos , Farmacorresistência Bacteriana Múltipla , Humanos , Idoso , Antibacterianos/efeitos adversos , Estudos Retrospectivos , Cefalosporinas/efeitos adversos , Bactérias Gram-Negativas , Resultado do Tratamento , Testes de Sensibilidade Microbiana , Cefiderocol
2.
J Clin Med ; 12(24)2023 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-38137641

RESUMO

(1) Background: Leadless pacemakers (LPs) have been proposed as a reimplantation strategy in pacing-dependent patients undergoing cardiac implantable electronic device (CIED) extraction for infection. In this study, we analysed the risk of LP infection when this device is implanted before lead extraction. (2) Methods: This was a retrospective study including patients who underwent LP implantation between 2017 and 2022. Patients were divided in two groups according to whether LP was implanted following CIED extraction for infection (Group 1) or other indications (Group 2). The primary aim was to describe the risk of LP infection. (3) Results: We included in this study 49 patients with a median age of 81 [20-94] years, mostly males (36, 73%). In Group 1 patients, 17 cases (85%) showed systemic CIED infections, and 11 (55%) had positive lead cultures. Most Group 1 cases (n = 14, 70%) underwent one stage of LP implantation and CIED extraction. Mortality rate during follow-up was 20% (nine patients). Patients were followed up for a median of 927 [41-1925], days and no cases of definite or suspected LP infections were identified. (4) Conclusions: The risk of LP infection was extremely low. LP appears as a potential option for reimplantation in this setting and should be considered in pacing-dependent patients at a high risk of CIED infection recurrence.

3.
Dermatol Reports ; 14(1): 9260, 2022 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-35371418

RESUMO

Angioma serpiginosum (AS) is a rare benign vascular lesion that typically arises in early childhood, with a prevalence in female, and then grow up over a period of months/years. It is characterized by small asymptomatic purple-red dots that cluster together and they do not disappear on diascopy. It is mainly localized on the arms but some cases on face and neck have been reported. The etiology of AS is unknown, dermoscopy may aid in the diagnosis but usually the biopsy is necessary. We report 2 cases: one male and one female with angioma serpiginosum, aged 13 and 8 years old.

4.
Microb Drug Resist ; 27(9): 1167-1175, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33600262

RESUMO

Background: The aim of this study was to assess the drivers of multidrug-resistant (MDR) bacterial infection development in coronavirus disease 2019 (COVID-19) and its impact on patient outcome. Methods: Retrospective analysis on data from 32 consecutive patients with COVID-19, admitted to our intensive care unit (ICU) from March to May 2020. Outcomes considered were MDR infection and ICU mortality. Results: Fifty percent of patients developed an MDR infection during ICU stay after a median time of 8 [4-11] days. Most common MDR pathogens were carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii, causing bloodstream infections and pneumonia. MDR infections were linked to a higher length of ICU stay (p = 0.002), steroid therapy (p = 0.011), and associated with a lower ICU mortality (odds ratio: 0.439, 95% confidence interval: 0.251-0.763; p < 0.001). Low-dose aspirin intake was associated with both MDR infection (p = 0.043) and survival (p = 0.015). Among MDR patients, mortality was related with piperacillin-tazobactam use (p = 0.035) and an earlier onset of MDR infection (p = 0.042). Conclusions: MDR infections were a common complication in critically ill COVID-19 patients at our center. MDR risk was higher among those dwelling longer in the ICU and receiving steroids. However, MDR infections were not associated with a worse outcome.


Assuntos
Infecções por Acinetobacter/mortalidade , COVID-19/mortalidade , Farmacorresistência Bacteriana Múltipla , Infecções por Klebsiella/mortalidade , Infecções Oportunistas/mortalidade , Pneumonia/mortalidade , SARS-CoV-2/patogenicidade , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Infecções por Acinetobacter/virologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/crescimento & desenvolvimento , Acinetobacter baumannii/patogenicidade , Adulto , Idoso , Antibacterianos/uso terapêutico , Aspirina/uso terapêutico , COVID-19/microbiologia , COVID-19/virologia , Carbapenêmicos/uso terapêutico , Estado Terminal , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/virologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/crescimento & desenvolvimento , Klebsiella pneumoniae/patogenicidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/virologia , Combinação Piperacilina e Tazobactam/uso terapêutico , Pneumonia/tratamento farmacológico , Pneumonia/microbiologia , Pneumonia/virologia , Estudos Retrospectivos , SARS-CoV-2/efeitos dos fármacos , SARS-CoV-2/fisiologia , Esteroides/uso terapêutico , Análise de Sobrevida , Resultado do Tratamento , Tratamento Farmacológico da COVID-19
5.
Clin Sci (Lond) ; 114(6): 413-21, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18260829

RESUMO

LYH (lymphocytic hypophysitis) is an autoimmune disease of the pituitary gland which can present with varying degrees of pituitary hormonal impairment and/or with symptoms related to pituitary enlargement. In this review, we provide an overview of the epidemiology, diagnosis, pathogenesis, treatment, and the role of organ-specific and antipituitary antibodies as potential markers of LYH. In addition, although the mechanisms underlying LYH are not completely understood, the role of prolactin, which plays an important part in maintaining immune system homoeostasis and is increased in the disease, is considered.


Assuntos
Doenças Autoimunes/imunologia , Linfocitose/imunologia , Doenças da Hipófise/imunologia , Autoanticorpos/análise , Doenças Autoimunes/etiologia , Doenças Autoimunes/patologia , Doenças Autoimunes/terapia , Humanos , Linfocitose/etiologia , Linfocitose/patologia , Linfocitose/terapia , Sistemas Neurossecretores/fisiopatologia , Doenças da Hipófise/etiologia , Doenças da Hipófise/patologia , Doenças da Hipófise/terapia , Hipófise/imunologia
6.
J Clin Endocrinol Metab ; 92(2): 604-7, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17090639

RESUMO

CONTEXT: Hypogonadotropic hypogonadism (HH) can occur at any stage of life as an isolated congenital or acquired abnormality or within a more generalized pituitary or hypothalamic impairment. However, the defect in patients with idiopathic HH is still unknown. OBJECTIVE: The aim of this study was to investigate the prevalence of antipituitary antibodies (APA) in a group of HH patients with or without Kallmann's syndrome and to characterize their pituitary target. DESIGN: We conducted a cross-sectional cohort study. SETTING: The study was performed at the Endocrinology Unit of the Second University of Naples. PATIENTS: Twenty-one HH patients with normal sense of smell (group 1), 10 patients with Kallmann's syndrome (group 2), 13 patients with HH associated with other pituitary hormone deficiencies (group 3), and 50 normal controls were studied. MAIN OUTCOME MEASURES: APA were evaluated in patients and in controls by indirect immunofluorescence. Moreover, a magnetic resonance imaging (MRI) of the hypothalamic-pituitary region was performed in all three groups of patients. RESULTS: APA were detected at high titer in eight out of 21 patients in group 1 (38%) and in five of 13 in group 3 (38.4%), and at low titers in two out of 10 in group 2 (20%) and in three of 50 controls (6%). In patients of group 1, APA immunostained selectively gonadotropin-secreting cells, whereas in those of group 3, they immunostained other pituitary hormone-secreting cells also. None of patients in group 1 showed alterations on MRI, whereas all patients in group 2 showed aplasia/hypoplasia of the olfactory bulbs/tracts and/or of olfactory sulci. Among the five APA-positive patients in group 3, three had normal MRI, one had findings of empty sella, and one had findings of autoimmune hypophysitis. CONCLUSIONS: Our results suggest that some apparently idiopathic cases of HH, both isolated and associated with other pituitary impairment, can be caused by an early autoimmune process involving the gonadotrophs at pituitary level. Future longitudinal studies are needed to clarify the natural history of this process and the possible effect of early corticosteroid therapy.


Assuntos
Autoanticorpos/sangue , Gonadotropinas Hipofisárias/imunologia , Síndrome de Kallmann/epidemiologia , Síndrome de Kallmann/imunologia , Hipófise/imunologia , Adulto , Animais , Especificidade de Anticorpos , Estudos de Coortes , Estudos Transversais , Técnica Indireta de Fluorescência para Anticorpo , Gonadotropinas Hipofisárias/deficiência , Gonadotropinas Hipofisárias/metabolismo , Humanos , Síndrome de Kallmann/patologia , Imageamento por Ressonância Magnética , Masculino , Transtornos do Olfato/epidemiologia , Transtornos do Olfato/imunologia , Transtornos do Olfato/patologia , Bulbo Olfatório/imunologia , Bulbo Olfatório/patologia , Papio , Hipófise/patologia , Estudos Soroepidemiológicos
7.
Ann N Y Acad Sci ; 1107: 129-35, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17804540

RESUMO

Hyperprolactinemia is often observed in lymphocytic hypophysitis (LYH). To clarify the possible autoimmune pituitary involvement in patients with apparently idiopathic hyperprolactinemia we investigated the presence of antipituitary antibodies (APA) in hyperprolactinemic patients with idiopathic hyperprolactinemia and in those with prolactinoma. Sixty-six hyperprolactinemic patients (52 F, 14 M age range 28-42 years, group 1) were studied. Of them, 34 out of 66 showed clinical features of hyperprolactinemia and subsequently underwent cabergoline therapy; the 32 out of 66 patients without symptoms of hyperprolactinemia did not receive cabergoline therapy. Moreover, 32 patients (24 F/8M, age range 23-44 years) with hyperprolactinemia due to microprolactinoma (group 2) were also studied. APA, by immunofluorescence method, and anterior pituitary function were evaluated in both groups of patients. APA were present in 17 out of 66 (25.7%) patients in group 1 with titers ranging from 1/16 to 1/64. All patients of group 2 were considered APA negative because these antibodies were found at low titer (

Assuntos
Autoanticorpos/imunologia , Hiperprolactinemia/imunologia , Hipófise/imunologia , Adulto , Feminino , Humanos , Hiperprolactinemia/patologia , Masculino
8.
J Clin Endocrinol Metab ; 91(7): 2484-9, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16621907

RESUMO

CONTEXT: Antipituitary antibodies (APA) recognizing GH-secreting cells may indicate an autoimmune pituitary involvement in adults with idiopathic GH deficiency (IGHD). OBJECTIVE: We aimed 1) to investigate the presence of APA in prepubertal children with IGHD or idiopathic short stature (ISS), identifying the pituitary hormone-producing cells targeted by APA; and 2) to verify whether in patients with ISS the presence of APA could predict the development of GHD. DESIGN: We performed a cross-sectional and partially longitudinal cohort study. SETTING: The study was performed at the Endocrinology Unit and Pediatric Unit of the Second University and University Federico II of Naples, respectively. PATIENTS: Twenty-six children with IGHD (group 1), 60 children with ISS (group 2), 33 children with GHD caused by lesions/abnormalities of the hypothalamus or pituitary (group 3), and 40 controls participated in the study. Nineteen children of group 2 were reevaluated after 2 yr. MAIN OUTCOME MEASURES: IGF-I levels, GH secretion, and APA (by indirect immunofluorescence) were evaluated in all participants. RESULTS: At study entry, APA recognizing GH-producing cells were detected in seven of 26 children in group 1 and in 14 of 60 in group 2. Two years later, all eight initially APA-positive and all 11 APA-negative of the 19 reevaluated patients persisted positive and negative, respectively. The reevaluation of GH secretion in these patients revealed the development of GHD in all but one of the APA-positive children but in none of the APA-negative ones. CONCLUSIONS: IGHD in children can be frequently associated with APA targeting GH-secreting cells; thus, the detection of APA in children with ISS could identify those prone to develop GHD.


Assuntos
Autoanticorpos/imunologia , Estatura , Hormônio do Crescimento Humano/biossíntese , Hormônio do Crescimento Humano/deficiência , Adeno-Hipófise/imunologia , Adeno-Hipófise/metabolismo , Animais , Autoanticorpos/sangue , Doenças Autoimunes/imunologia , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Hormônio do Crescimento Humano/metabolismo , Humanos , Fator de Crescimento Insulin-Like I/análise , Estudos Longitudinais , Masculino , Papio , Adeno-Hipófise/citologia
9.
Eur J Endocrinol ; 158(2): 147-52, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18230820

RESUMO

OBJECTIVE: While anti-pituitary antibodies (APAs) were detected in some patients with Sheehan's syndrome (SS) suggesting an autoimmune pituitary involvement in the development of their hypopituitarism, hypothalamic cell anti-hypothalamus antibodies (AHAs) have not been investigated so far. DESIGN: The aim of this study was to evaluate the presence of AHA and APA in SS patients to verify whether an autoimmune hypothalamic-pituitary process can contribute to their late hypopituitarism. METHODS: Twenty women with SS with a duration of disease ranging from 3 to 40 years (median 25.5 years) were enrolled into the study. Out of 20 patients, 12 (60%) had panhypopituitarism and the others had partial hypopituitarism well corrected with appropriate replacement therapy. None of them had clinical central diabetes insipidus. AHA and APA were investigated by immunofluorescence method in all patients. In addition, a four-layer immunofluorescence method was used to verify whether AHA immunostained vasopressin-secreting cells (AVP-c) or not. RESULTS: AHAs were found in 8 out of 20 (40%) and APAs in 7 out of 20 (35%) patients with titers ranging from 1:32 to 1:128 and 1:16 to 1:32 respectively; however, in none of these positive patients AHA immunostained vasopressin cells. None of controls resulted positive for both antibodies. CONCLUSIONS: Patients with SS, even many years after the onset of SS, can show antibodies to pituitary and/or hypothalamic but not AVP-secreting cells. Antibodies to unknown hypothalamic cells (releasing factor-secreting cells) other than APAs suggest that an autoimmune process involving both the hypothalamus and pituitary gland may contribute to late pituitary dysfunction in SS patients.


Assuntos
Autoanticorpos/sangue , Síndrome da Sela Vazia/complicações , Hipopituitarismo/imunologia , Hipotálamo/imunologia , Hipófise/imunologia , Adulto , Idoso , Autoimunidade , Estudos de Casos e Controles , Síndrome da Sela Vazia/imunologia , Feminino , Imunofluorescência , Humanos , Hipopituitarismo/sangue , Hipopituitarismo/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Hipófise/patologia , Hormônios Hipofisários/administração & dosagem , Hormônios Hipofisários/sangue , Síndrome , Fatores de Tempo
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