Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 9 de 9
Filter
1.
World J Emerg Surg ; 15(1): 13, 2020 02 18.
Article in English | MEDLINE | ID: mdl-32070390

ABSTRACT

Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Antimicrobial Stewardship , Infection Control/standards , Surgical Wound Infection/prevention & control , Humans
2.
Dig Liver Dis ; 52(4): 434-439, 2020 04.
Article in English | MEDLINE | ID: mdl-31874836

ABSTRACT

BACKGROUND AND AIMS: Hepatitis E Virus is endemic in Europe with increasing numbers of cases in recent years, also in Italy where this phenomenon has hitherto been modest. The aim of this study was to document the clinical features/natural history of locally acquired hepatitis E in our territory and explore factors which determine adverse outcome. METHODS: Retrospective study of patients with locally-acquired HEV (hepatitis E virus) in Marche, Italy (2011-2019). RESULTS: 1189 patients were tested for HEV with 89 confirmed cases. 81 (6.8%) had locally acquired infection; 54 (66%) were male (mean age 55.5 years) and 32 (39.5%) had active co-morbidities. 41 cases were viraemic (all HEV-3 (HEV genotype 1,2,3,4)); acute infection was found in 79 and chronic infection in 2. Forty-five cases (55%) required admission to hospital, for a total of 785 days. 4 patients developed acute on-chronic liver failure, 6 developed acute kidney injury and 8 died: all had active comorbidities. Univariate analysis showed that bilirubin, INR, immunosuppression, cirrhosis and diabetes were associated with death. On multivariant analysis the only predictor of death was the presence of diabetes (p = 0.04). CONCLUSIONS: Hepatitis E in Marche Italy is mostly locally acquired and caused by HEV-3 that impacts on the morbidity and mortality particularly for fragile patients.


Subject(s)
Acute Kidney Injury/epidemiology , Acute-On-Chronic Liver Failure/epidemiology , Hepatitis E/epidemiology , Liver Cirrhosis/epidemiology , Adult , Aged , Female , Genotype , Hepatitis E virus/genetics , Hepatitis E virus/isolation & purification , Humans , Immunocompromised Host , Italy/epidemiology , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Factors
3.
Surg Infect (Larchmt) ; 17(4): 485-90, 2016 Aug.
Article in English | MEDLINE | ID: mdl-27135794

ABSTRACT

BACKGROUND: The goal of an antimicrobial stewardship program (ASP) is to prevent the emergence of antimicrobial drug resistance and reduce adverse drug events, optimizing the selection, dosing, and duration of therapy in individual patients. METHODS: This retrospective study evaluated changes in antimicrobial agent use associated with implementation of an ASP in a general and emergency unit. The pre-intervention and post-intervention periods were defined as July 1, 2013, to December 31, 2013 (pre-intervention) and January 1, 2014, to June 30, 2014 (post-intervention). RESULTS: The mean total monthly antimicrobial use decreased by 18.8%, from 1,074.9 defined daily doses (DDD) per 1,000 patient-days to 873.0 DDD per 1,000 patient-days after the intervention. There was a significant reduction in the use of piperacillin-tazobactam, by 33.7% (p < 0.05), in imipenem/cilastatin, by 63.9% (p < 0.05), in meropenem by 68.0% (p < 0.05), and in levofloxacin by 45.0% (p < 0.05) without any negative effect on patient susceptibility to infections. Indeed, patient outcomes, including deaths, length of stay in the hospital, and re-admission within 30 days were not affected. CONCLUSIONS: The implementation of an education-based ASP achieved a significant improvement in all antimicrobial agent prescriptions in the surgical unit and a reduction in antimicrobial drug consumption, even when no restrictive measures were implemented.


Subject(s)
Anti-Infective Agents/therapeutic use , Drug Resistance, Bacterial , Emergency Service, Hospital , Emergency Treatment , Female , General Surgery/education , General Surgery/standards , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Practice Patterns, Physicians'/standards , Program Development , Retrospective Studies , Unnecessary Procedures/statistics & numerical data
4.
AIDS ; 27(5): 769-79, 2013 Mar 13.
Article in English | MEDLINE | ID: mdl-23719349

ABSTRACT

BACKGROUND: It is unclear whether lack of immunological response despite viral suppression and relatively preserved CD4 T-cell count is associated with increased risk of AIDS or severe non-AIDS events. METHODS: Patients initiating first combination antiretroviral therapy (cART) were studied from first viral load 80  copies/ml or less up to AIDS, serious non-AIDS events (malignancies, severe infections, acute kidney injury, cardiovascular events, liver decompensation) or death. Follow-up was right censored if viral load was more than 500. Immunological nonresponse (INR) was defined as current CD4 cell count less than 120% pre-cART. A Poisson regression analysis was used to investigate the association between INR and the outcome. RESULTS: Three thousand, three hundred and seventy-eight patients were followed for a median of 32 months (interquartile range: 15-67). Two hundred and twenty-two events (32 deaths, 39 AIDS-defining events, 48 malignancies, 32 severe infections, 47 acute kidney injuries, 12 cardiovascular events, 12 other nonfatal events) were observed. The rate of clinical events among INR and immunological responders was 4.41 [95% confidence interval (CI) 3.38-5.74] and 1.84 (95% CI 1.58-2.15) per 100 person years of follow-up, respectively, accounting for a crude rate ratio of 2.39 (95% CI 1.77-3.25; P < 0.001). INR remained an independent predictor of clinical progression after adjusting for baseline characteristics, including pre-cART CD4 cell count (adjusted rate ratio 2.93; 95% CI 2.06-4.16, P < 0.001) or current CD4 cell count (adjusted rate ratio 1.94; 95% CI 1.39-2.72, P < 0.001). The association did not vary by pre-cART CD4 cell counts (P for interaction = 0.93) CONCLUSION: INR are at higher risk of severe clinical events than responders. The association was consistent across different CD4 cell counts at cART initiation and was only partially explained by current CD4 cell count. INR could be a marker of immune system malfunctioning, not completely captured by absolute CD4 cell count.


Subject(s)
Anti-Retroviral Agents/therapeutic use , Antiretroviral Therapy, Highly Active/methods , HIV Infections/drug therapy , HIV-1/drug effects , Adult , Anti-Retroviral Agents/immunology , CD4 Lymphocyte Count , CD4-Positive T-Lymphocytes/immunology , Disease Progression , Drug Therapy, Combination , Female , HIV Infections/complications , HIV Infections/immunology , Humans , Italy , Male , Prospective Studies , Regression Analysis , Risk Factors , Time Factors , Viral Load
5.
Clin Infect Dis ; 51(4): 456-64, 2010 Aug 15.
Article in English | MEDLINE | ID: mdl-20597690

ABSTRACT

BACKGROUND: Although the kinetics of CD4(+) cell counts have been extensively studied in antiretroviral-naive HIV-infected patients, data on individuals who have failed combination antiretroviral therapy (cART) are lacking. METHODS: This analysis was based on the ICONA Foundation Study. Subjects with > or = 1 episode of viral suppression after starting first-line cART were included (n = 3537). Following a viral rebound, patients who achieved another episode of viral suppression could reenter the analysis. The percentage of patients with an increase in CD4(+) cell count >300 cells/mm(3) was estimated using Kaplan-Meier techniques; the rate of CD4(+) cell count increase per year was estimated using a multivariable, multilevel linear model with fixed effects of intercept and slope. Multivariable models were also fitted to include several covariates. RESULTS: The median time to reach a CD4(+) cell count increase >300 cells/mm(3) from baseline was significantly associated with the number of failed regimens: 34 months, 41 months, 51 months, and 45 months in subjects without evidence of previous virological failure, or 1, 2, or > or = 3 previous virologically failed regimens, respectively (P < .001, by log-rank test). The annual estimated increases in CD4(+) cell count were 36 cells/mm(3) (95% confidence interval [CI], 34-38 cells/mm(3)), 28 cells/mm(3) (95% CI, 11-21 cells/mm(3)), 31 cells/mm(3) (95% CI, 26-36 cells/mm(3)), and 26 cells/mm(3) (95% CI, 18-33 cells/mm(3)), respectively. Differences in the annual CD4(+) cell count increase were observed between specific antiretrovirals. CONCLUSIONS: Subjects with > or = 1 virological failure took a longer time to reach a CD4(+) cell count >300 cell/mm(3) and had a slower annual increase than those without virological failure. Efforts should be made to optimize first-line cART, because this represents the best chance of achieving an effective CD4(+) response.


Subject(s)
Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active/methods , HIV Infections/immunology , HIV Infections/virology , Viral Load , Adult , Aged , CD4 Lymphocyte Count , Female , HIV Infections/drug therapy , Humans , Male , Middle Aged , Treatment Failure
6.
Clin Infect Dis ; 45(5): 650-3, 2007 Sep 01.
Article in English | MEDLINE | ID: mdl-17683003

ABSTRACT

Recently, it was shown that cirrhotic patients without human immunodeficiency virus (HIV) infection had low CD4 cell counts and normal CD4 cell percentages, suggesting that, for HIV-infected persons, the CD4 cell percentage might be a more accurate marker of disease progression than the absolute CD4 cell count. In cirrhotic HIV-infected persons in the Italian Cohort of Antiretroviral-Naive Patients, the absolute CD4 cell count seemed to be better predictor of the risk of developing an acquired immunodeficiency syndrome-defining illness than the CD4 cell percentage.


Subject(s)
CD4 Lymphocyte Count/methods , Fibrosis/complications , HIV Infections/complications , HIV Infections/immunology , Biomarkers , Cohort Studies , Disease Progression , Female , Humans , Immunocompromised Host , Male , Predictive Value of Tests , Risk
8.
Antivir Ther ; 10(1): 109-17, 2005.
Article in English | MEDLINE | ID: mdl-15751768

ABSTRACT

The prognostic role of GB virus type C (GBV-C) viraemia in HIV-infected subjects treated with highly active antiretroviral therapy (HAART) is still undefined. The aim of this analysis is to assess the relationship between GBV-C infection and response to antiretroviral therapy among HIV-infected subjects initiating HAART when antiretroviral-naive. A prospective, observational study of 400 HIV-infected patients with measurements of GBV-C RNA, hepatitis C virus (HCV) antibodies and HCV RNA determined from plasma stored prior to HAART initiation. Time to virological (achieving HIV RNA < or =500 copies/ml) and immunological success (a CD4+ count increase of > or =200 cells/microl), and the time to virological relapse (confirmed HIV RNA >500 copies/ml) were assessed by Kaplan-Meier methods and Cox proportional hazard regression model. Of the subjects, 117 (29.3%) were GBV-C positive and, overall, 351 (87.8%) patients achieved virological success. After controlling for a number of confounders including HCV RNA, GBV-C viraemic patients experienced a significantly lower risk of HIV rebound than those who were GBV-C negative [relative hazard (RH)=0.56, 95% CI: 0.34-0.93, P=0.03]. Conversely, the probability of achieving initial virological success or CD4+ count response after HAART did not differ between GBV-C-negative and -positive subjects. These results suggest that GBV-C coinfection may play a role in determining the rate of HIV rebound possibly by competing with HIV replication after HIV load has been successfully suppressed by HAART.


Subject(s)
Flaviviridae Infections/complications , GB virus C , HIV Infections/complications , HIV Infections/drug therapy , Adult , Antiretroviral Therapy, Highly Active , Base Sequence , Cohort Studies , DNA, Viral/genetics , Female , GB virus C/genetics , GB virus C/isolation & purification , Hepatitis C Antibodies/blood , Humans , Male , Prospective Studies , RNA, Viral/blood , RNA, Viral/genetics , Viremia/complications , Viremia/drug therapy
SELECTION OF CITATIONS
SEARCH DETAIL
...