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ABSTRACT: Pulmonary nocardiosis (PN) chiefly affects immunocompromised patients, particularly transplant recipients. Cotrimoxazole is still the mainstay of treatment, but it is associated with nephro- and myelo-toxicity, and can show unpredictable activity against Nocardia isolates.
Over a 20-year period, Nocardia isolates were identified from 12 heart transplant (HTx) recipients with PN. The in vitro activity of various antibacterials, alone or in combination, was assessed using disk-diffusion, minimal inhibitory concentration (MIC), and time-kill methodology. The in vitro results were compared with the clinical outcome of the patients.
Seven different Nocardia strains were identified. Disk diffusion and MIC determinations showed that all isolates were susceptible to amikacin, netilmicin, and linezolid, and that moxifloxacin was the most active of the fluoroquinolones. All but 1 of the isolates were susceptible to imipenem. Time-kill studies showed that imipenem/amikacin and imipenem/moxifloxacin combinations were bactericidal for most isolates. Of 12 patients who received 3-4 weeks' intravenous (IV) treatment with amikacin or ciprofloxacin in combination with a beta-lactam, followed by 1-3 months' oral cotrimoxazole, moxifloxacin, or linezolid, 11 were cured; 1 patient died, but not related to Nocardia.
Initial PN treatment in HTx recipients can be successfully carried out with bactericidal combinations such as imipenem plus amikacin or moxifloxacin, administered IV for 3-4 weeks. Within 1 month, a significant clinical and radiological improvement may be observed. In our experience, a <3 month oral regimen with cotrimoxazole, moxifloxacin, or doxycycline may then be used. This may allow a reduction of side effects and treatment-related burden, without any recurrence.
Transplant Infectious Disease 12/2010; 13(4):335-43. · 2.22 Impact Factor
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R Zarrilli,
R Casillo,
A Di Popolo,
M-F Tripodi,
M Bagattini, S Cuccurullo,
V Crivaro,
E Ragone,
A Mattei,
N Galdieri,
M Triassi,
R Utili
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ABSTRACT: This study investigated the molecular epidemiology of a clonal outbreak of multidrug-resistant Acinetobacter baumannii that occurred between June 2003 and June 2004 in a tertiary-care hospital in Naples, Italy. A. baumannii was isolated from 74 patients, of whom 38 were infected and 36 were colonised. Thirty-three patients had ventilator-associated pneumonia, three had hospital-acquired pneumonia, and two had sepsis. Genotypic analysis of 45 available A. baumannii isolates revealed two distinct pulsed-field gel electrophoresis (PFGE) patterns. Of these, PFGE pattern 1 was represented by isolates from 44 patients and was identical to that of an epidemic A. baumannii clone isolated in another hospital of Naples during 2002. All A. baumannii isolates of PFGE type 1 showed identical multiresistant antibiotypes, characterised by resistance to all antimicrobial agents tested, including carbapenems, with the exception of colistin. In these isolates, inhibition of OXA enzymes by 200 mM NaCl reduced the imipenem MIC by up to four-fold. Molecular analysis of antimicrobial resistance genes showed that all A. baumannii isolates of PFGE type 1 harboured a class 1 integron containing the aacA4, orfX and bla(OXA-20) gene cassettes, an ampC gene and a bla(OXA-51)-like allele. Moreover, a bla(OXA-58)-like gene surrounded by the regulatory elements ISAba2 and ISAba3 was identified in a 30-kb plasmid from A. baumannii isolates of PFGE type 1, but not PFGE type 2. Thus, selection of a single A. baumannii clone producing an OXA-58-type carbapenem-hydrolysing oxacillinase was responsible for the increase in the number of A. baumannii infections that occurred in this hospital.
Clinical Microbiology and Infection 06/2007; 13(5):481-9. · 4.54 Impact Factor
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ABSTRACT: The molecular epidemiology of Legionella pneumophila in the 'V. Monaldi' University Hospital was studied. Seven cases of nosocomial Legionnaires' disease were diagnosed between 1999 and 2003. Two clinical legionella strains obtained from two patients in the adult cardiac surgery unit (CSU) and 30 environmental legionella strains from the paediatric and adult CSUs, neonatal intensive care unit (NICU) and the cardiorespiratory intensive care unit (CR-ICU) were serotyped and genotyped. L. pneumophila serogroup 1/Philadelphia with an identical pulsed-field gel electrophoresis (PFGE) profile A was isolated from two patients in the adult CSU, and from three and one water samples taken in the adult CSU and the paediatric CSU, respectively, from 2001 to 2002. Furthermore, L. pneumophila serogroup 3 with an identical PFGE profile B was identified in 20 environmental strains from all wards, L. pneumophila serogroup 3 with PFGE profile C was identified in a single environmental strain from the CR-ICU, and non-pneumophila Legionella with identical PFGE profile D was identified in five environmental strains from the adult CSU, paediatric CSU and NICU. Ultraviolet irradiation was effective in disinfection of the hospital water supplies in the adult and paediatric CSUs contaminated by L. pneumophila clone associated with nosocomial Legionnaires' disease. In conclusion, these data demonstrate that two cases of nosocomial legionellosis were caused by the persistence of a single clone of L. pneumophila serogroup 1/Philadelphia in the hospital environment, and that disinfection by ultraviolet irradiation may represent an effective measure to prevent nosocomial Legionnaires' disease.
Journal of Hospital Infection 05/2006; 62(4):494-501. · 3.39 Impact Factor
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R Utili,
R Zampino,
F De Vivo,
C Maiello,
A Andreana,
G Mormone,
C Marra,
M F Tripodi,
G Sarnataro,
P Cione, S Cuccurullo,
M Cotrufo
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ABSTRACT: Pulmonary aspergillosis is a severe complication in heart transplant recipients. The drug of choice for this infection is amphotericin B, but its use is limited because of its side effects. We observed six cases of pulmonary aspergillosis in a group of 200 patients who had received heart transplants from January 1988 to January 1999. Predisposing factors such as previous rejection, neutropenia and/or cytomegalovirus reactivation were present in all patients. The clinical presentation was characterized by fever and a non-productive cough. X-rays showed monolateral or diffuse infiltrate with or without nodular lesions. The median interval between symptoms and diagnosis was 5 d (range 4-7). Diagnosis was made by culturing trans-tracheal aspirate samples. Aspergillus fumigatus was isolated in 3 patients and A. niger in the other 3. All patients were treated with itraconazole at 200-400 mg/day for 20-60 d and all recovered. One patient treated with the lowest dosage for the shortest term had a recurrence after 1 month and needed a second 30-day course of itraconazole at a higher dosage. No significant side effects were registered. Itraconazole is effective in the therapy of pulmonary aspergillosis, particularly when an early diagnosis is made.
Clinical Transplantation 09/2000; 14(4 Pt 1):282-6. · 1.67 Impact Factor
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ABSTRACT: The prevalence of methicillin-resistant and multiply antibiotic-resistant staphylococci causing infections in hospitalized patients was studied over a two-year period. Among 122 clinically significant staphylococci, the prevalence of methicillin resistance was 66%, with a higher prevalence of Staphylococcus haemolyticus (85%) and Staphylococcus epidermidis (83%) observed than of Staphylococcus aureus (49%). Multiple antibiotic resistance was observed more frequently among coagulase-negative staphylococcus (52 to 70%) than among Staphylococcus aureus (17%). All strains of methicillin-resistant Staphylococcus aureus were susceptible to glycopeptide antibiotics and to trimethoprim-sulfamethoxazole, whereas approximately 50% of coagulase-negative staphylococci exhibited either moderate susceptibility or resistance to teicoplanin. For these latter strains, vancomycin remains the agent of choice, whereas teicoplanin cannot be recommended unless its efficacy is established by MIC determination.
European Journal of Clinical Microbiology 03/1994; 13(2):148-52. · 2.86 Impact Factor
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Archivio Monaldi per le malattie del torace 43(4):291-304.
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Archivio Monaldi per le malattie del torace 43(6):475-85.
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Archivio Monaldi per le malattie del torace 43(4):339-47.
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ABSTRACT: Clarithromycin is a new semisynthetic macrolide, Erythromycin A derivative, which is bactericidal for the most of growing aerobic and anaerobic Gram-positive and Gram-negative organisms. The drug has also a potent activity against the pathogens surviving into intracellular medium and, just like all other macrolides, achieves its effect by inhibiting protein synthesis. Our study investigated the efficacy and tolerability of Clarithromycin in 11 ambulatory patients (8 m, 3f) suffering from bacterial relapses of chronic bronchitis. The macrolide was administered at the oral dosage of 250 mg twice daily for a period ranging from 7 to 11 days, only after microbiological evaluation of sputum. There was a withdrawal because one of the three bacteria isolated from sputum sample was resistant to Clarithromycin, 7 patients were clinically cured, 3 showed only clinical improvement. In all the ten patients there was eradication of causative agents. No adverse events or changes in biochemical and haematological tests were observed.
Rivista europea per le scienze mediche e farmacologiche = European review for medical and pharmacological sciences = Revue européenne pour les sciences médicales et pharmacologiques 13(5-6):275-83.
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ABSTRACT: The Authors have analyzed the effect of Cefotetan in 20 patients affected by bronchopulmonary pathologies supported by anaerobic bacterium. During 7 days doses of 50 mg. pro Kg/pro die were given. From beginning to end of the treatment clinical, hematochemical and radiological data were evaluated. Bacteriological analysis was made on samples drawn with BFS according to a traditional method and with microbiology specimen brush. Almost all the patients (95%) realized improvements in clinical symptomatology and in radiological picture.
Archivio Monaldi per le malattie del torace 45(5):401-10.
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ABSTRACT: Pefloxacin is an antibacterial agent belonging to the group of quinolones having a methyl-carboxylic acid which possesses a high activity as compared to other quinolonic drugs. In this study we tested the efficacy and tolerability of the drug in the treatment of 25 patients with environmental L.R.T.I. (Low Respiratory Tract Infections). The microbiological and clinical characteristics of the drug were tested in this study. Excellent results were obtained in 96% of the patients treated and the tolerability was also very good.
Archivio Monaldi per le malattie del torace 45(1):21-9.
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ABSTRACT: Bronchial fluid samples obtained from 50 patients with respiratory tract infections were analyzed for anaerobic flora isolation, identification of micro-organisms and evaluation of their sensitivity to cefotetan. Anaerobic strains were identified in 18 patients (36%), generally with exacerbations of chronic diseases: cefotetan was active on 100% of isolates.
Giornale italiano di chemioterapia 36(1-3):53-6.
