Emanuele Durante-Mangoni

AORN Ospedali dei Colli, Napoli, Campania, Italy

Are you Emanuele Durante-Mangoni?

Claim your profile

Publications (62)233.8 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: BACKGROUND. The use of daptomycin in Gram-positive left-sided infective endocarditis (IE) has significantly increased. The purpose of this study was to assess the influence of high-dose daptomycin on the outcome of left-sided IE due to Gram-positive pathogens.METHODS. Prospective cohort study based on 1,112 cases from the International Collaboration on Endocarditis (ICE)-Plus database and the ICE-Daptomycin Substudy database from 2008 to 2010. Among patients with left-sided IE due to Staphylococcus aureus, coagulase-negative staphylococci, and Enterococcus faecalis, we compared those treated with daptomycin (Cohort A) to those treated with standard-of-care (SOC) antibiotics (Cohort B). Primary outcome was in-hospital mortality. Time-to-clearance of bacteremia, 6-month mortality, and adverse events (AEs) ascribable to daptomycin were also assessed.RESULTS. There were 29 and 149 patients included in Cohort A and Cohort B, respectively. Baseline comorbidities did not differ between the two cohorts, except for a significantly higher prevalence of diabetes and previous episodes of IE among patients treated with daptomycin. The median daptomycin dose was 9.2 mg/kg/day. Two-thirds of the patients treated with daptomycin had failed a previous antibiotic regimen. In-hospital and 6-month mortalities were similar in the two cohorts. In Cohort A, median time-to-clearance of MRSA bacteremia was 1.0 d, irrespective of daptomycin dose, representing a significantly faster bacteremia clearance as compared to SOC (1.0 vs. 5.0 d; p <0.01). Higher daptomycin dose-regimens were not associated with increased incidence of AEs.CONCLUSIONS. Higher-dose daptomycin may be an effective and safe alternative to SOC in the treatment of left-sided IE due to common Gram-positive pathogens.
    Antimicrobial Agents and Chemotherapy 09/2013; · 4.57 Impact Factor
  • Riccardo Utili, Emanuele Durante-Mangoni
    Clinical Infectious Diseases 09/2013; · 9.37 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Hepatitis C virus core antigen (HCVcoreAg) may be measured in serum with a sensitive, recently validated assay. Beyond its value as a marker of viral infection, there are little data on its relation with clinical, histological, and virological parameters. In this study, the significance of HCVcoreAg levels was studied in a prospective cohort of 114 patients with chronic hepatitis C. HCVcoreAg was measured by a commercial chemiluminescent microparticle immunoassay. Clinical and virological data included quantitative HCV-RNA, HCV genotype, ALT, GGT, IL28B rs12979860 polymorphism as well as liver histology parameters. HCVcoreAg levels were correlated significantly with HCV-RNA (r = 0.56; P < 0.0001) but also with ALT levels (r = 0.258; P < 0.01) and liver necroinflammatory activity (r = 0.205; P < 0.04). Patients harbouring HCV genotype 3 showed lower levels of HCVcoreAg than both genotype 1 and two patients. In genotype 3, a direct correlation between steatosis and HCVcoreAg was found. Levels of HCVcoreAg also varied according to the IL28B genotype. These data suggest that the evaluation of HCVcoreAg serum levels may provide relevant data for the baseline clinical evaluation of chronic hepatitis C patients. HCVcoreAg serum levels may be a useful tool to further the understanding of chronic hepatitis C pathobiology. J. Med. Virol. © 2013 Wiley Periodicals, Inc.
    Journal of Medical Virology 07/2013; · 2.37 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: IMPORTANCE There are limited prospective, controlled data evaluating survival in patients receiving early surgery vs medical therapy for prosthetic valve endocarditis (PVE). OBJECTIVE To determine the in-hospital and 1-year mortality in patients with PVE who undergo valve replacement during index hospitalization compared with patients who receive medical therapy alone, after controlling for survival and treatment selection bias. DESIGN, SETTING, AND PARTICIPANTS Participants were enrolled between June 2000 and December 2006 in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a prospective, multinational, observational cohort of patients with infective endocarditis. Patients hospitalized with definite right- or left-sided PVE were included in the analysis. We evaluated the effect of treatment assignment on mortality, after adjusting for biases using a Cox proportional hazards model that included inverse probability of treatment weighting and surgery as a time-dependent covariate. The cohort was stratified by probability (propensity) for surgery, and outcomes were compared between the treatment groups within each stratum. INTERVENTIONS Valve replacement during index hospitalization (early surgery) vs medical therapy. MAIN OUTCOMES AND MEASURES In-hospital and 1-year mortality. RESULTS Of the 1025 patients with PVE, 490 patients (47.8%) underwent early surgery and 535 individuals (52.2%) received medical therapy alone. Compared with medical therapy, early surgery was associated with lower in-hospital mortality in the unadjusted analysis and after controlling for treatment selection bias (in-hospital mortality: hazard ratio [HR], 0.44 [95% CI, 0.38-0.52] and lower 1-year mortality: HR, 0.57 [95% CI, 0.49-0.67]). The lower mortality associated with surgery did not persist after adjustment for survivor bias (in-hospital mortality: HR, 0.90 [95% CI, 0.76-1.07] and 1-year mortality: HR, 1.04 [95% CI, 0.89-1.23]). Subgroup analysis indicated a lower in-hospital mortality with early surgery in the highest surgical propensity quintile (21.2% vs 37.5%; P = .03). At 1-year follow-up, the reduced mortality with surgery was observed in the fourth (24.8% vs 42.9%; P = .007) and fifth (27.9% vs 50.0%; P = .007) quintiles of surgical propensity. CONCLUSIONS AND RELEVANCE Prosthetic valve endocarditis remains associated with a high 1-year mortality rate. After adjustment for differences in clinical characteristics and survival bias, early valve replacement was not associated with lower mortality compared with medical therapy in the overall cohort. Further studies are needed to define the effect and timing of surgery in patients with PVE who have indications for surgery.
    JAMA Internal Medicine 07/2013; · 10.58 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Background. Extensively drug resistant (XDR) Acinetobacter baumannii (Acb) may cause serious infections in critically ill patients. Colistin often remains the only therapeutic option. Addition of rifampicin to colistin may be synergistic in vitro. In this study, we assessed whether the combination of colistin and rifampicin reduced the mortality of XDR Acb infections compared to colistin alone. Methods. This multicentre, parallel, randomised, open-label clinical trial enrolled 210 patients with life-threatening infections due to XDR Acb from intensive care units of five tertiary care hospitals. Patients were randomly allocated (1:1) to either colistin alone, 2 MU every 8 hours intravenously or colistin (as above), plus rifampicin 600&emsp14;mg every 12 hours intravenously. Primary end point was overall 30 day mortality. Secondary end points were infection-related death, microbiological eradication and hospitalization length. Results. Death within 30 days from randomization occurred in 90 (43%) subjects, without difference between treatment arms (p=0.95). This was confirmed by multivariable analysis (OR 0.88, 95% C.I.s 0.46 to 1.69, p=0.71). A significant increase of microbiological eradication rate was observed in the colistin plus rifampicin arm (p=0.034). No difference was observed for infection-related death and length of hospitalization. Conclusions. In serious XDR Acb infections, 30-day mortality is not reduced by addition of rifampicin to colistin. These results indicate that, at present, rifampicin should not be routinely combined with colistin in clinical practice. The increased rate of Acb eradication with combination treatment could still imply a clinical benefit (Registered in ClinicalTrials.gov, number NCT01577862).
    Clinical Infectious Diseases 04/2013; · 9.37 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Chronic hepatitis B is prevalent in the transplant setting and may cause significant complications. Effective control of viral replication is needed. Besides lamivudine, very little data are available on safety and efficacy of other drugs. We describe our experience with adefovir dipivoxil (ADV) in eight heart transplant recipients. Studies included a baseline liver biopsy, thrice-monthly clinical, biochemical, and virological evaluations, including genotyping and viral load, polymerase gene sequencing for resistance mutations, liver and kidney function tests, and liver ultrasound. Of eight patients, six had fibrosis score ≤2 and negative HBeAg and seven had hepatitis B virus (HBV) genotype D. Upon ADV start, median HBV-DNA was 5.8 logs IU/mL and alanine aminotransferase (ALT) levels were mostly normal. All patients had prior mild-to-moderate renal functional impairment. Seven of eight patients started ADV after a previous course of lamivudine. Five of these seven patients became HBV-DNA undetectable within eight months. One patient with low baseline viremia started ADV de novo and suppressed HBV-DNA. Median treatment duration was 66 months. ADV daily dose was halved in one patient due to renal function worsening. No ALT flares, hypophosphatemia, liver decompensation, liver cancer, or emergence of resistance was observed. Our data suggest that ADV may be a safe and effective rescue treatment for heart transplant recipients with lamivudine-resistant chronic hepatitis B.
    Clinical Transplantation 03/2013; · 1.63 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Cardiac implantable electronic device (CIED) infections are an emerging clinical problem. A growing number of dedicated and high quality clinical studies are currently being generated. We here review the most recent advances in the diagnosis and treatment of patients with CIED infection including intracardiac lead endocarditis. We discuss the current etiology and risk factors, and appraise the major diagnostic issues, describing our center's therapeutic approach. We also address the management of CIED infection complications.
    Internal and Emergency Medicine 06/2012; · 2.35 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: The characteristics of patients with infective endocarditis (IE) vary significantly by region of the world. The aim of this study was to evaluate the contemporary epidemiology, characteristics, and outcome of IE in a large, nationwide cohort of Italian patients. We conducted a prospective, observational study at 24 medical centers in Italy, including all the consecutive patients with a definite or possible diagnosis of IE (modified Duke criteria) admitted from January 2004 through December 2009. A number of clinical variables were collected through an electronic case report form and analyzed to comprehensively delineate the features of IE. We report the data on patients with definite IE. A total of 1,082 patients with definite IE were included. Of these, 753 (69.6 %) patients had infection on a native valve, 277 (25.6 %) on a prosthetic valve, and 52 (4.8 %) on an implantable electronic device. Overall, community-acquired (69.2 %) was more common than nosocomial (6.2 %) or non-nosocomial (24.6 %) health care-associated IE. Staphylococcus aureus was the most common pathogen (22.0 %). In-hospital mortality was 15.1 %. From the multivariate analysis, congestive heart failure (CHF), stroke, prosthetic valve infection, S. aureus, and health care-associated acquisition were independently associated with increased in-hospital mortality, while surgery was associated with decreased mortality. The current mortality of IE remains high, and is mainly due to its complications, such as CHF and stroke.
    Infection 06/2012; 40(5):527-35. · 2.44 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Infection of implantable cardiac devices is an emerging disease with significant morbidity, mortality, and health care costs. To describe the clinical characteristics and outcome of cardiac device infective endocarditis (CDIE) with attention to its health care association and to evaluate the association between device removal during index hospitalization and outcome. Prospective cohort study using data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), conducted June 2000 through August 2006 in 61 centers in 28 countries. Patients were hospitalized adults with definite endocarditis as defined by modified Duke endocarditis criteria. In-hospital and 1-year mortality. CDIE was diagnosed in 177 (6.4% [95% CI, 5.5%-7.4%]) of a total cohort of 2760 patients with definite infective endocarditis. The clinical profile of CDIE included advanced patient age (median, 71.2 years [interquartile range, 59.8-77.6]); causation by staphylococci (62 [35.0% {95% CI, 28.0%-42.5%}] Staphylococcus aureus and 56 [31.6% {95% CI, 24.9%-39.0%}] coagulase-negative staphylococci); and a high prevalence of health care-associated infection (81 [45.8% {95% CI, 38.3%-53.4%}]). There was coexisting valve involvement in 66 (37.3% [95% CI, 30.2%-44.9%]) patients, predominantly tricuspid valve infection (43/177 [24.3%]), with associated higher mortality. In-hospital and 1-year mortality rates were 14.7% (26/177 [95% CI, 9.8%-20.8%]) and 23.2% (41/177 [95% CI, 17.2%-30.1%]), respectively. Proportional hazards regression analysis showed a survival benefit at 1 year for device removal during the initial hospitalization (28/141 patients [19.9%] who underwent device removal during the index hospitalization had died at 1 year, vs 13/34 [38.2%] who did not undergo device removal; hazard ratio, 0.42 [95% CI, 0.22-0.82]). Among patients with CDIE, the rate of concomitant valve infection is high, as is mortality, particularly if there is valve involvement. Early device removal is associated with improved survival at 1 year.
    JAMA The Journal of the American Medical Association 04/2012; 307(16):1727-35. · 29.98 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Background The characteristics of patients with infective endocarditis (IE) vary significantly by region of the world. The aim of this study was to evaluate the contemporary epidemiology, characteristics, and outcome of IE in a large, nationwide cohort of Italian patients. Methods We conducted a prospective, observational study at 24 medical centers in Italy, including all the consecutive patients with a definite or possible diagnosis of IE (modified Duke criteria) admitted from January 2004 through December 2009. A number of clinical variables were collected through an electronic case report form and analyzed to comprehensively delineate the features of IE. We report the data on patients with definite IE. Results A total of 1,082 patients with definite IE were included. Of these, 753 (69.6 %) patients had infection on a native valve, 277 (25.6 %) on a prosthetic valve, and 52 (4.8 %) on an implantable electronic device. Overall, community-acquired (69.2 %) was more common than nosocomial (6.2 %) or non-nosocomial (24.6 %) health care-associated IE. Staphylococcus aureus was the most common pathogen (22.0 %). In-hospital mortality was 15.1 %. From the multivariate analysis, congestive heart failure (CHF), stroke, prosthetic valve infection, S. aureus, and health care-associated acquisition were independently associated with increased in-hospital mortality, while surgery was associated with decreased mortality. Conclusions The current mortality of IE remains high, and is mainly due to its complications, such as CHF and stroke.
    Infection 02/2012; 2(40):527-535. · 2.44 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Heart failure (HF) is the most common complication of infective endocarditis. However, clinical characteristics of HF in patients with infective endocarditis, use of surgical therapy, and their associations with patient outcome are not well described. To determine the clinical, echocardiographic, and microbiological variables associated with HF in patients with definite infective endocarditis and to examine variables independently associated with in-hospital and 1-year mortality for patients with infective endocarditis and HF, including the use and association of surgery with outcome. The International Collaboration on Endocarditis-Prospective Cohort Study, a prospective, multicenter study enrolling 4166 patients with definite native- or prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006. In-hospital and 1-year mortality. Of 4075 patients with infective endocarditis and known HF status enrolled, 1359 (33.4% [95% CI, 31.9%-34.8%]) had HF, and 906 (66.7% [95% CI, 64.2%-69.2%]) were classified as having New York Heart Association class III or IV symptom status. Within the subset with HF, 839 (61.7% [95% CI, 59.2%-64.3%]) underwent valvular surgery during the index hospitalization. In-hospital mortality was 29.7% (95% CI, 27.2%-32.1%) for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (20.6% [95% CI, 17.9%-23.4%] vs 44.8% [95% CI, 40.4%-49.0%], respectively; P < .001). One-year mortality was 29.1% (95% CI, 26.0%-32.2%) in patients undergoing valvular surgery vs 58.4% (95% CI, 54.1%-62.6%) in those not undergoing surgery (P < .001). Cox proportional hazards modeling with propensity score adjustment for surgery showed that advanced age, diabetes mellitus, health care-associated infection, causative microorganism (Staphylococcus aureus or fungi), severe HF (New York Heart Association class III or IV), stroke, and paravalvular complications were independently associated with 1-year mortality, whereas valvular surgery during the initial hospitalization was associated with lower mortality. In this cohort of patients with infective endocarditis complicated by HF, severity of HF was strongly associated with surgical therapy and subsequent mortality, whereas valvular surgery was associated with lower in-hospital and 1-year mortality.
    JAMA The Journal of the American Medical Association 11/2011; 306(20):2239-47. · 29.98 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Cardiac implantable electronic device (CIED)-related endocarditis is a growing challenge because of increasing incidence and significant mortality. Current treatment is based on complete hardware removal coupled with long-term administration of effective and safe antimicrobials. Daptomycin at the dose of 6 mg/kg/day has been found to be effective in staphylococcal endocarditis, but limited data exist on CIED endocarditis. Moreover, whether higher doses could be more effective but equally safe in this setting is currently unknown. We report here our experience with high-dose daptomycin in the treatment of 25 cases of CIED endocarditis due to staphylococci. Patients were mostly elderly and male, with large lead vegetations and severe comorbidities. Pathogens were Staphylococcus epidermidis (56%), Staphylococcus aureus (28%), and other coagulase-negative staphylococci (16%). Only 4 patients (16%) had a normal pretreatment renal function. The median daptomycin daily dose was 8.3 mg/kg (range, 6.4-10.7). Daptomycin was administered for a median of 20 days (range, 8-52). Percutaneous lead extraction was performed in 88% of patients. Two patients (8%) failed to clear bacteremia. The overall clinical success of treatment was 80%, whereas a complete microbiological success was observed in 92% of patients. Creatine phosphokinase values were monitored and increased above normal in 5 cases (20%). No serious adverse event related to high-dose daptomycin was observed and no patient required discontinuation because of muscle toxicity. Our experience suggests that high-dose daptomycin may be a safe therapeutic option in staphylococcal CIED endocarditis and may be associated with high microbiological responses and clinical success.
    Clinical Infectious Diseases 11/2011; 54(3):347-54. · 9.37 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Use of rifampicin (RIF) in combination with colistin (COL) has been proposed for the treatment of multidrug-resistant Acinetobacter baumannii infections owing to in vitro synergism. The aim of the present study was to evaluate the molecular epidemiology and mechanisms of RIF resistance in 57 clinical isolates of A. baumannii in two tertiary care hospitals in Naples (Italy) from 2006 to 2010. Amongst the collection, 36 isolates showed high RIF minimum inhibitory concentrations (MICs) (256 mg/L to ≥512 mg/L), 16 showed intermediate MICs (8-16 mg/L) and 5 had low MICs (4 mg/L). Of the 36 isolates with elevated RIF MICs, 35 were assigned to sequence type ST2 and 1 to ST78. Amongst the 57 isolates, 35 carried at least one mutation in rpoB, including H535L in 9 isolates and double mutations D525N and P544L in 7 isolates, whilst 22 showed no rpoB mutations. Treatment with the efflux pump inhibitor phenyl-arginine-β-naphthylamide (PAβN) of resistant isolates with no mutations in rpoB and different RIF MICs reduced the MIC by >10-fold and restored the synergism between RIF and COL in time-kill studies, whilst it had no effect on strains carrying rpoB mutations. In conclusion, the emergence of elevated RIF MICs in A. baumannii isolates from our geographical area was mostly caused by mutations in rpoB; low to intermediate RIF MICs were also caused by altered membrane permeability to the drug. The phenomenon was contributed by the selection of two prevalent clones both assigned to ST2 genotype. These data may have implications for the correct identification of cases with A. baumannii infection that would not benefit from addition of RIF to COL.
    International journal of antimicrobial agents 11/2011; 39(1):58-63. · 3.03 Impact Factor
  • Emanuele Durante-Mangoni, Ciro Maiello, Costanza Sbreglia
    The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 07/2011; 30(7):845. · 3.54 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Rib chondro-osteitis is rare and usually caused by tuberculosis. A 63-year-old man presented with fever, painful swelling, and a burning sensation in the parasternal right submammary region. He had a history of cardiac interventions: percutaneous transcatheter angioplasty with stenting 1 year prior and coronary artery bypass graft surgery 16 years before; therefore, he was on dual antiplatelet therapy. He sustained blunt chest trauma 5 months before admission. A chest wall abscess was suspected and fine needle aspiration of the lesion revealed the presence of purulent fluid. Culture results were positive for Staphylococcus aureus and intravenous antibiotic therapy was started. Computed tomography showed a lesion involving the sternal, chondral, and proximal costal portions of the fourth, fifth, and sixth anterior costal arches. The patient was diagnosed with costal chondo-osteitis following blunt trauma. Following aggressive surgical debridement, the wound was managed with topical negative pressure therapy (constant -125 mm Hg setting with daily dressing changes). After 15 days, culture results were negative, the wound bed contained healthy granulation tissue, and the defect was surgically closed using a myocutaneous flap. No recurrence or complications have been observed during the 2-year follow-up. This is the first reported case of pyogenic, posttraumatic, costal chondro-osteitis secondary to a blunt trauma of the chest wall.
    Ostomy/wound management 06/2011; 57(6):30-3. · 1.03 Impact Factor
  • Source
    Emanuele Durante-Mangoni, Raffaele Zarrilli
    [show abstract] [hide abstract]
    ABSTRACT: Acinetobacter baumannii is an opportunistic Gram-negative pathogen with increasing relevance in a variety of hospital-acquired infections especially among intensive care unit patients. Resistance to antimicrobial agents is the main reason for A. baumannii spread. A. baumannii outbreaks described worldwide are caused by a limited number of genotypic clusters of multidrug-resistant strains that successfully spread among hospitals of different cities and countries. In this article, we will focus on the mechanisms responsible for resistance to antimicrobials and disinfectants in A. baumannii and the epidemiology of drug-resistant A. baumannii in healthcare facilities. We will also discuss the therapeutic and infection control strategies for management of drug-resistant A. baumannii epidemics.
    Future Microbiology 04/2011; 6(4):407-22. · 4.02 Impact Factor
  • Emanuele Durante-Mangoni, Domenico Iossa, Felice Nappi, Riccardo Utili
    [show abstract] [hide abstract]
    ABSTRACT: Despite high rates of valve disease, non-bacterial thrombotic endocarditis remains an uncommon condition, the individual susceptibility to which might be influenced by an inherited thrombophilic state. A comprehensive hemostasis study was conducted in a 17-year-old patient with definite nonbacterial thrombotic endocarditis, including a genetic screening for all major inherited thrombophilias. Non-bacterial thrombotic endocarditis was detected on a bicuspid aortic valve. A hemostasis work-up showed that the patient had severe hyperhomocysteinemia, and was homozygous for the C677T mutation of the methylenetetrahydrofolate reductase gene. Based on the present clinical case, a novel hypothesis was proposed that the pathophysiology of non-bacterial thrombotic endocarditis might be affected by a genetic predisposition, such as an inherited thrombophilic state.
    The Journal of heart valve disease 03/2011; 20(2):232-3. · 1.07 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Chronic hepatitis C patients with coexisting heart disease are often denied antiviral treatment due to safety concerns. However, this is not evidence-based. To evaluate safety and efficacy of pegylated interferon and ribavirin in chronic hepatitis C patients with heart disease. Patients with overt heart disease (ischaemic heart disease, prior mechanical heart valve replacement, chronic arrhythmias and cardiomyopathy) and chronic hepatitis C were treated with standard pegylated interferon/ribavirin doses for standard duration. Cardiovascular safety was monitored by electrocardiography, echocardiography and measurement of troponin and B-type natriuretic peptide. Twenty-three patients (65.2% male, median age 57 years, 47.8% genotype 1) were treated. Three patients (13%) suspended treatment prematurely; 52% obtained sustained virological response, 39% relapsed, 9% were non-responders. No serious adverse event was observed. Post-treatment clinical examination, electrocardiography and echocardiography did not show any sign of progression of the pre-existing heart disease. Treatment with pegylated interferon/ribavirin may be safely offered to carefully selected chronic hepatitis C patients with coexisting, clinically significant heart disease. In these patients, the outcome of antiviral treatment overlaps that observed in other patient subgroups.
    Digestive and Liver Disease 02/2011; 43(5):411-5. · 3.16 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: The combination of pegylated interferon (PEG-IFN) and ribavirin (RBV) is the current treatment for chronic hepatitis C (CHC). The treatment is thought to suppress viral replication and induce viral clearance via immunomodulatory effects. For this reason, concern exists for the use of this treatment in recipients of a solid organ transplantation. We sought to evaluate the safety and efficacy of PEG-IFN/RBV in heart transplant recipients with CHC. From June 2005 to September 2009, we treated three CHC patients with heart transplantation. PEG-IFN alpha2b and RBV doses and treatment duration were set according to the hepatitis C virus (HCV) genotype and body weight as per current recommendations. Dose reductions were dictated by individual patient tolerability. Cardiac safety was monitored by clinical examinations, echocardiography, and measurement of troponin I and B-type natriuretic peptide, as well as endomyocardial biopsies. All three patients, displayed HCV genotype 1b infection, viral loads of >5 logs, and a Scheuer fibrosis score ≥ 2. Two of them completed the prescribed treatment course becoming sustained virological responders. The other patient had an initial complete virological response, but subsequently experienced a viral breakthrough after reduction of PEG-IFN and withdrawal of RBV due to severe anemia. We observed no cardiovascular adverse events nor rejection episodes. Posttreatment clinical history and examination, electrocardiography, and echocardiography did not show any sign of graft dysfunction. Treatment with PEG-IFN/RBV may be safely offered to stable heart transplant recipients with CHC and signs of liver disease progression. Close monitoring of treatment safety is mandatory.
    Transplantation Proceedings 01/2011; 43(1):299-303. · 0.95 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Bacterial infections are a contraindication to organ transplantation, but infective endocarditis may require heart transplantation when otherwise untreatable. We describe a heart transplant patient with cardiomyopathy and ongoing defibrillator endocarditis due to Staphylococcus epidermidis. An initial attempt at percutaneous extraction of the 5 implanted leads was unable to eradicate the infection and was complicated by severe decompensation, requiring a new implant for biventricular pacing. Despite continuing bactericidal treatment, the patient showed persistent infection on the implanted leads with further hemodynamic deterioration. The decision was therefore made to list the patient for heart transplantation. The procedure was successful in removing all of the hardware. No recurrence of infection was observed despite persistence of large vegetations on the removed defibrillator leads. The patient had an uneventful postoperative course, remaining free of symptoms with negative blood cultures at 3 months' follow-up. Our experience showed that active infection of defibrillator leads may not represent an absolute contraindication to heart transplantation when all other medical and surgical treatments have been proven to be ineffective.
    Transplantation Proceedings 01/2011; 43(1):304-6. · 0.95 Impact Factor

Publication Stats

396 Citations
505 Downloads
3k Views
233.80 Total Impact Points

Institutions

  • 2013
    • AORN Ospedali dei Colli
      Napoli, Campania, Italy
  • 2008–2013
    • Monaldi Hospital
      Napoli, Campania, Italy
  • 2004–2012
    • Second University of Naples
      • Faculty of Medicine and Surgery
      Caserta, Campania, Italy
  • 2011
    • Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon
      Napoli, Campania, Italy
    • Duke University Medical Center
      Durham, North Carolina, United States
  • 2003–2011
    • University of Naples Federico II
      • Department of Molecular Medicine and Health Biotechnology
      Napoli, Campania, Italy