Filippo Ansaldi

Università degli Studi di Genova, Genova, Liguria, Italy

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Publications (158)489.59 Total impact

  • Intensive Care Medicine 08/2015; DOI:10.1007/s00134-015-4021-9 · 7.21 Impact Factor
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    ABSTRACT: Candida is an important cause of bloodstream infections (BSI) in nosocomial settings causing significant mortality and morbidity. This study was performed to evaluate contemporary epidemiology, species distribution, antifungal susceptibility and outcome of candida BSI in an Italian hospital. All consecutive patients who developed candidemia at Santa Maria della Misericordia University Hospital (Italy) between January 2009 and June 2014 were enrolled in the study. A total of 204 episodes of candidemia were identified during the study period with an incidence of 0.79 episodes/1000 admissions. C. albicans was isolated in 60.3% of cases, followed by C. parapsilosis (16.7%), C. glabrata (11.8%) and C. tropicalis (6.4%). Of all Candida BSI, 124 (60.8 %) occurred in patients admitted to IMW, 31/204 (15.2 %) in ICUs, 33/204 (16.2%) in surgical units and 16/204 (7.8%) in Hematology/Oncology wards. Overall, 47% of patients died within 30 days from the onset of candidemia. C. parapsilosis and C. glabrata candidemia were associated with the lowest mortality rate (36%), while patients with C. tropicalis BSI had the highest mortality rate (58.3%). Lower mortality rates were detected in patients receiving therapy within 48 hours from the time of execution of the blood cultures (57,1% vs 38,9%, P <0.05). At multivariate analysis, steroids treatment (OR= 0.27, p=0.005) and CVC removal (OR=3.77, p=0.014) were independently associated with lower and higher survival probability, respectively. Candidemia in patients with peripherally inserted central catheters (PICC) showed to be associated with higher mortality in comparison with central venous catheters (CVC, Short catheters and Portacath) and no CVC use. For each point increase of APACHE III score, survival probability decreased of 2%. Caspofungin (OR=3.45, p=0.015) and Amphothericin B lipid formulation (OR=15.26, p=0.033) were independently associated with higher survival probability compared with no treatment.
    PLoS ONE 05/2015; 10(5):e0127534. DOI:10.1371/journal.pone.0127534 · 3.23 Impact Factor
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    ABSTRACT: Clinical data on patients with intra-abdominal candidiasis (IAC) is still scarce. We collected data from 13 hospitals in Italy, Spain, Brazil, and Greece over a 3-year period (2011-2013) including patients from ICU, medical, and surgical wards. A total of 481 patients were included in the study. Of these, 27 % were hospitalized in ICU. Mean age was 63 years and 57 % of patients were male. IAC mainly consisted of secondary peritonitis (41 %) and abdominal abscesses (30 %); 68 (14 %) cases were also candidemic and 331 (69 %) had concomitant bacterial infections. The most commonly isolated Candida species were C. albicans (n = 308 isolates, 64 %) and C. glabrata (n = 76, 16 %). Antifungal treatment included echinocandins (64 %), azoles (32 %), and amphotericin B (4 %). Septic shock was documented in 40.5 % of patients. Overall 30-day hospital mortality was 27 % with 38.9 % mortality in ICU. Multivariate logistic regression showed that age (OR 1.05, 95 % CI 1.03-1.07, P < 0.001), increments in 1-point APACHE II scores (OR 1.05, 95 % CI 1.01-1.08, P = 0.028), secondary peritonitis (OR 1.72, 95 % CI 1.02-2.89, P = 0.019), septic shock (OR 3.29, 95 % CI 1.88-5.86, P < 0.001), and absence of adequate abdominal source control (OR 3.35, 95 % CI 2.01-5.63, P < 0.001) were associated with mortality. In patients with septic shock, absence of source control correlated with mortality rates above 60 % irrespective of administration of an adequate antifungal therapy. Low percentages of concomitant candidemia and high mortality rates are documented in IAC. In patients presenting with septic shock, source control is fundamental.
    Intensive Care Medicine 05/2015; DOI:10.1007/s00134-015-3866-2 · 7.21 Impact Factor
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    ABSTRACT: The surveillance of latent tuberculosis infection (LTBI) in both healthcare workers and healthcare students is considered fundamental for tuberculosis (TB) prevention. The aim of the present study was to estimate LTBI prevalence and evaluate potential risk-factors associated with this condition in a large cohort of medical students in Italy. In a cross-sectional study, performed between March and December 2012, 1511 eligible subjects attending the Medical School of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the tuberculin skin test (TST). All the TST positive cases were confirmed with an interferon-gamma release assay (IGRA). A standardized questionnaire was collected for multivariate risk analysis. A total of 1302 (86.2%) students underwent TST testing and completed the questionnaire. Eleven subjects (0.8%) resulted TST positive and LTBI diagnosis was confirmed in 2 (0.1%) cases. Professional exposure to active TB patients (OR 21.7, 95% CI 2.9–160.2; p value 0.003) and previous BCG immunization (OR 28.3, 95% CI 3.0–265.1; p value 0.003) are independently associated with TST positivity. Despite the low prevalence of LTBI among Italian medicalstudents, an occupational risk of TB infection still exists in countries with low circulation of Mycobacterium tuberculosis.
    BioMed Research International 02/2015; 2015. DOI:10.1155/2015/746895 · 2.71 Impact Factor
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  • International Journal of Cardiology 12/2014; 177(2):636-8. DOI:10.1016/j.ijcard.2014.09.184 · 6.18 Impact Factor
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    ABSTRACT: Dear Editor,Daptomycin use is increasing in clinical practice and in intensive care units due to both its concentration-dependent fast bactericidal activity against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus, and high vancomycin minimum inhibitory concentrations (MICs) [1]. Standard recommended doses (4–6 mg/kg/day) are questioned in favor of higher ones (8–10 mg/kg/day), which could provide higher clinical and microbiological cure rates [2], overcome the augmented renal clearance in septic patients [3], and prevent the onset of antimicrobial non-susceptibility [4]. Therapeutic failure due to the emergence of non-susceptible strains is documented in those infections characterized by high inoculum and deep-seated localizations, such as endocarditis or osteomyelitis, or in cases of standard-dose regimens [5]. Furthermore, prior exposure to vancomycin is a recognized risk factor for decreased susceptibility to daptomycin due to induced changes on the ba ...
    Intensive Care Medicine 12/2014; 41(2). DOI:10.1007/s00134-014-3571-6 · 5.54 Impact Factor
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    ABSTRACT: Introduction. The European Regional Office of the World Health Organization developed a strategic approach to stop the indigenous transmission of measles in its 53 Member States by 2015. In Italy, laboratory surveillance activity is implemented by the National Reference Laboratory for Measles and Rubella at the Italian National Institute of Health (Istituto Superiore di Sanità, Rome). The role of the National Reference Laboratory is to strengthen surveillance systems through rigorous case investigation and laboratory confirmation of suspected sporadic cases and outbreaks. Genetic characterization of wild-type measles virus is an essential component of the laboratory-based surveillance. This study describes the molecular characterization of measles virus strains isolated during 2010. Methods. Dried blood spots, urine and oral fluid samples were collected from patients with a suspected measles infection. Serological tests were performed on capillary blood, and viral detection was performed on urine and oral fluid samples through molecular assay. Positive samples were sequenced and phylogenetically analysed. Results and discussion. The phylogenetic analysis showed a co-circulation of genotypes D4 and D8, and sporadic cases associated to genotypes D9 and B3. Then, molecular epidemiology of measles cases permitted to establish that D4 and D8 were the endemic genotypes in Italy during 2010.
    Annali dell'Istituto superiore di sanita 12/2014; 50(4):345-350. DOI:10.4415/ANN_14_04_09 · 0.77 Impact Factor
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    ABSTRACT: To assess the impact of the immunization program with 13-valent Pneumococcal Conjugate Vaccine (PCV13) in adults, from October 2013 in Liguria, Italy, both in terms of effectiveness, and tolerability and safety. First study: descriptive epidemiology of the clinical burden of lower respiratory tract infections (LRTI) and the role of risk factors or co-morbidity in adults >18 years of age. Second study: crossover evaluation of the effect of PCV13 introduction in adults aged ≥70 years, in terms of ED accesses for LRTI, obtained by a Syndrome Surveillance System (SSS) operating in Liguria from 2007. Third study: evaluation of safety and tolerability profile of PCV13 in terms of local and systemic solicited and unsolicited adverse events. During pre-PCV period, annual cumulative incidence of ED accesses for LRTI was equal to 7/1000 and 2% in ≥65 and ≥85 year adults, respectively. In ≥65 years adults, more than 70% of identified subjects has at least one risk condition. A significant reduction in the incidence of ED accesses for LRTI in the vaccinated population, compared to non-vaccinated subjects, has already been observed: the preventive fraction, adjusted for age and seasonality, was estimated to be nearly 20%. PCV13 had a good safety and tolerability profile: rates of local (32%) and systemic (22%) solicited reactions resulted generally lower than those registered in clinical trials previously performed in the elderly. Preliminary PCV13 assessments regarding safety and tolerability profile, together with the initial effects of the immunization program in terms of reduction of ED accesses for LRTI, confirmed the effectiveness of current Liguria Region recommendations for the prevention of pneumococcal disease in adult population.
    Epidemiologia e prevenzione 11/2014; 38(6 Suppl 2):66-72. · 1.46 Impact Factor
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    ABSTRACT: Neuromuscular diseases (NMDs) encompass a broad spectrum of conditions. Because infections may be relevant to the final prognosis of most NMDs, vaccination appears to be the simplest and most effective solution for protecting NMD patients from vaccine-preventable infections. However, very few studies have evaluated the immunogenicity, safety, tolerability, and efficacy of different vaccines in NMD patients; therefore, detailed vaccination recommendations for NMD patients are not available. Here, we present vaccination recommendations from a group of Italian Scientific Societies for optimal disease prevention in NMD patients that maintain high safety levels. We found that NMD patients can be classified into two groups according to immune function: patients with normal immunity and patients who are immunocompromised, including those who intermittently or continuously take immunosuppressive therapy. Patients with normal immunity and do not take immunosuppressive therapy can be vaccinated as healthy subjects. In contrast, immunocompromised patients, including those who take immunosuppressive therapy, should receive all inactivated vaccines as well as influenza and pneumococcal vaccines; these patients should not be administered live attenuated vaccines. In all cases, the efficacy and long-term persistence of immunity from vaccination in NMD patients can be lower than in normal subjects. Household contacts of immunocompromised NMD patients should also be vaccinated appropriately.
    Vaccine 10/2014; 32(45). DOI:10.1016/j.vaccine.2014.09.003 · 3.49 Impact Factor
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    ABSTRACT: Background:It has been recently shown that during therapeutic apheresis procedure, a large amount of soluble HLA class I molecules settles onto plastic apheresis circuits, inducing sustained TGFβ1 pre/post-transcriptional modulation in activated patients' leukocytes. Reportedly, donors' leukocytes may be exposed to similar immunosuppressing activities during donor apheresis procedures. On this basis, it could be hypothesized that such events can cause immune modulation. It is uncertain which blood cell population is most impacted by these events. This study is focused on the effects on the T lymphocytes.Study design and methods:To assess if such events occur, lymphocytes from 20 apheresis donors collected before and after three closely timed plasma and platelet donation procedures were analyzed for sHLA-I mediated immunomodulation.Results:The results confirmed that sHLA-I molecules bind to the apheresis circuit surfaces. Circuits can also transiently activate donors' CD8+ T lymphocytes, to which sHLA-I molecules can bind, thus modulating short-lasting immune effects, such as transcriptional and post-transcriptional TGFβ1 modulation and soluble Fas ligand release. However, no significant change in relative proportions, absolute number and cell viability of lymphocyte subpopulations was found and no ex vivo immune effect was detectable longer than 14 days after procedure in any cell type in all donors.Conclusion:Short-lived sHLA-I mediated immunomodulation was demonstrable in lymphocytes from every donor as a consequence of apheresis procedures, but no enrolled subject experienced any adverse reaction or showed any sign of immunosuppression during 24 months of follow-up after the donations. J. Clin. Apheresis, 2014. © 2014 Wiley Periodicals, Inc.
    Journal of Clinical Apheresis 09/2014; DOI:10.1002/jca.21362 · 1.58 Impact Factor
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    ABSTRACT: Liguria, an administrative region in northern Italy characterized by a decade of high PCV coverage in paediatric age group, has issued new PCV13 recommendations for free active immunization in adults with risk factors and subjects aged ≥ 70 years old. Main aims of this study are: (1) a descriptive epidemiology of the clinical burden of lower respiratory tract infections (LRTI) in adults ≥18 years of age; and (2) a crossover evaluation of the effect of introduction of PCV13 vaccination in adults aged ≥70 years old, in terms of ED accesses for LRTI, obtained by a Syndrome Surveillance System (SSS). The ED access, chief complaint based SSS will allow an active surveillance of a population cohort of>430 000 individuals resident in Genoa metropolitan area, aged ≥18 years old, for a period of 60 months. During pre-PCV period, annual cumulative incidence of ED accesses for LRTI was equal to 7/1000 and 2% in ≥65 and ≥85 year adults, respectively. In ≥65 years adults, more than 70% of subjects identified by the SSS has at least one risk condition, with a peak of 87% in ≥85 year cohort. New Ligurian PCV13 recommendations can potentially reach more than 75% of ED accesses for LRTI. Data highlights the heavy impact of LRTI in terms of ED accesses, especially in the elderly and subjects with chronic conditions and the usefulness of SSS tool for monitoring PCV vaccination effect.
    Human Vaccines and Immunotherapeutics 08/2014; 11(1). DOI:10.4161/hv.34419 · 3.64 Impact Factor
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    ABSTRACT: Influenza vaccination is a fundamental tool for the prevention of influenza in healthcare settings and its administration to healthcare workers (HCWs) is recommended in more than 40 countries including United States of America and many countries of the European Union. Despite these recommendations, the compliance of HCWs to influenza vaccination is largely inadequate in Italy. Since 2005/06 season, a comprehensive multifaceted intervention project aimed at increasing the seasonal influenza vaccination coverage rates among HCWs was performed at the IRCCS AOU San Martino IST teaching hospital in Genoa, Italy, the regional tertiary adult acute-care reference center with a 1300 bed capacity. Despite almost a decade of efforts, the vaccination coverage rates registered at our hospital steadily remain unsatisfactory and very distant by the minimum objective of 75% defined by the Italian Ministry of Health. During the last influenza season (2013/14), vaccination coverage rates by occupation type resulted 30% among physicians, 11% among nurses and 9% among other clinical personnel. Further efforts are necessary to prevent the transmission of influenza to patient and novel strategies need to be identified and implemented in order to increase the compliance of HCWs, particularly nurses, with the seasonal influenza vaccination.
    Human Vaccines and Immunotherapeutics 08/2014; 11(1). DOI:10.4161/hv.34362 · 3.64 Impact Factor
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    ABSTRACT: Despite the great successes achieved in the fields of virology and diagnostics, several difficulties affect improvements in hepatitis C virus (HCV) infection control and eradication in the new era. New HCV infections still occur, especially in some of the poorest regions of the world, where HCV is endemic and long-term sequelae have a growing economic and health burden. An HCV vaccine is still no available, despite years of researches and discoveries about the natural history of infection and host-virus interactions: several HCV vaccine candidates have been developed in the last years, targeting different HCV antigens or using alternative delivery systems, but viral variability and adaption ability constitute major challenges for vaccine development. Many new antiviral drugs for HCV therapy are in preclinical or early clinical development, but different limitations affect treatment validity. Treatment predictors are important tools, as they provide some guidance for the management of therapy in patients with chronic HCV infection: in particular, the role of host genomics in HCV infection outcomes in the new era of direct-acting antivirals may evolve for new therapeutic targets, representing a chance for modulated and personalized treatment management, when also very potent therapies will be available. In the present review we discuss the most recent data about HCV epidemiology, the new perspectives for the prevention of HCV infection and the most recent evidence regarding HCV diagnosis, therapy and predictors of response to it.
    World Journal of Gastroenterology 08/2014; 20(29):9633-9652. DOI:10.3748/wjg.v20.i29.9633 · 2.43 Impact Factor
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    ABSTRACT: Candida is the most common cause of severe yeast infections worldwide, especially in critically ill patients. In this setting, septic shock attributable to Candida is characterized by high mortality rates. The aim of this multicenter study was to investigate the determinants of outcome in critically ill patients with septic shock due to candidemia. This was a retrospective study in which patients with septic shock attributable to Candida who were treated during the 3-year study period at one or more of the five participating teaching hospitals in Italy and Spain were eligible for enrolment. Patient characteristics, infection-related variables, and therapy-related features were reviewed. Multiple logistic regression analysis was performed to identify the risk factors significantly associated with 30-day mortality. A total of 216 patients (mean age 63.4 ± 18.5 years; 58.3 % males) were included in the study. Of these, 163 (75 %) were admitted to the intensive care unit. Overall 30-day mortality was 54 %. Significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, dysfunctional organs, and inadequate antifungal therapy were compared in nonsurvivors and survivors. No differences in survivors versus nonsurvivors were found in terms of the time from positive blood culture to initiation of adequate antifungal therapy. Multivariate logistic regression identified inadequate source control, inadequate antifungal therapy, and 1-point increments in the APACHE II score as independent variables associated with a higher 30-day mortality rate.
    Intensive Care Medicine 05/2014; 40(6). DOI:10.1007/s00134-014-3310-z · 7.21 Impact Factor
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    ABSTRACT: Nonadherence to recommended pneumococcal conjugate vaccine (PCV) schedules may have implications for protection against pneumococcal disease. In this commentary, we have assessed adherence to the recommended dosing schedules (the completion of the primary PCV and booster series) in different European countries. We found that adherence with the PCV schedule was lower than that for diphtheria-tetanus-acellular pertussis (DTaP) and that higher adherence was observed in countries where PCV vaccination is recommended and funded. Adherence with the booster dose is often lower than that with the primary series completion, and it is often given after the recommended age. These data highlight the need to encourage timely vaccination of children with PCV, in line with local immunization schedules. There is no single solution to improve adherence; actions need to be tailored to the context of individual countries through initiatives at the national, regional, and local levels and should target different stakeholders.
    Clinical Therapeutics 04/2014; 36(5). DOI:10.1016/j.clinthera.2014.03.001 · 2.59 Impact Factor
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    ABSTRACT: Neisseria meningitidis is an obligate human commensal which commonly colonizes the oropharyngeal mucosa. Carriage is age-dependent and very common in young adults. The relationships between carriage and invasive disease are not completely understood.In this work, we performed a longitudinal carrier study in adolescents and young adults (173 subjects). Overall, 32 subjects (18.5%) resulted positive to meningococcal carriage at least at one visit (average monthly carriage rate 12.1%). Only five subjects were positive at all four visits. All meningococcal isolates were characterized by molecular and serological techniques. Multilocus sequence typing, PorA typing and sequencing of the 4CMenB vaccine antigens were used to assess strain diversity. The majority of positive subjects were colonized by Capsule-null (34.4%) and by capsular group B strains (28.1%), accounting for 23.5% and 29.4% of the total isolates, respectively. Fhbp and nhba genes were present in all isolates, while nadA in 5% of the isolates. The genetic variability of the 4CMenB vaccine antigens in this collection was relatively high if compared with other disease-causing strain panels. Indications about the persistence of the carriage state were limited to the time span of the study. All strains isolated from the same subject were identical, or cumulated minor changes overtime. The expression levels and antigenicity of the 4CMenB vaccine antigens in each strain were analyzed by the meningoccoccal antigen typing system (MATS), and it revealed that expression can change overtime in the same individual. Future analysis of antigen variability and expression in carrier strains after the MenB vaccine introduction will allow to define its impact on naso/oropharyngeal carriage.
    Journal of clinical microbiology 03/2014; 52(6). DOI:10.1128/JCM.03584-13 · 4.23 Impact Factor
  • Digestive and Liver Disease 03/2014; 46:S122. DOI:10.1016/S1590-8658(14)60361-3 · 2.89 Impact Factor
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    ABSTRACT: The morbidity and mortality related to many communicable infectious diseases have significantly decreased in Western countries largely because of the use of antibiotics, and the implementation of well-planned vaccination strategies and national immunisation schedules specifically aimed at infants and children. However, although immunisation has proved to be highly effective for public health, more effort is needed to improve the currently sub-optimal rates of vaccination against various diseases among adults who may be at risk because of their age, medical condition or occupation. The vaccines currently licenced in Western countries are safe, immunogenic and effective against many infectious diseases and their complications, but the availability of newer vaccines or vaccines with new indications, the evolving ecology and epidemiology of many infections, population ageing, and other demographic changes (i.e. the increasing prevalence of chronic comorbidities and immunodeficiencies, mass migration, new working relationships, and widespread international tourism) require changes in the approach to immunisation. There is now a need for appropriate preventive measures for adults and the elderly aimed at protecting people at risk by using every possible catch-up opportunity and recommending specific age-related schedules on the basis of local epidemiology.
    European Journal of Internal Medicine 03/2014; 25(3). DOI:10.1016/j.ejim.2013.12.004 · 2.30 Impact Factor

Publication Stats

2k Citations
489.59 Total Impact Points

Institutions

  • 1999–2015
    • Università degli Studi di Genova
      • Dipartimento di Scienze della salute (DISSAL)
      Genova, Liguria, Italy
  • 2013
    • American Cancer Society
      Atlanta, Georgia, United States
  • 2011
    • IRCCS Istituto G. Gaslini
      Genova, Liguria, Italy
    • CRO Centro di Riferimento Oncologico di Aviano
      • Division of Medical Oncology A
      Aviano, Friuli Venezia Giulia, Italy
  • 1993–2010
    • Azienda Ospedaliera Universitaria San Martino di Genova
      • Department of Surgical Oncology
      Genova, Liguria, Italy
  • 2002–2005
    • Università degli Studi di Trieste
      • Department of Life Sciences
      Trst, Friuli Venezia Giulia, Italy