C Santini

Sapienza University of Rome, Roma, Latium, Italy

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Publications (38)86.46 Total impact

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    ABSTRACT: The molecular epidemiology and the genetic basis of antibiotic resistance in 88 multidrug-resistant (MDR) Acinetobacter baumannii strains isolated during 18 months from infected patients in seven intensive care units (ICUs) in Rome were investigated. Random amplified polymorphic DNA and macrorestriction analysis identified two predominant clonal types, genetically related to the European epidemic clones I (type 2) and II (type 1), accounting for 98.9% of A. baumannii ICU isolates. Type 1 was isolated from all ICUs under survey. Class 1 integrons of 2.2 and 2.5 kb were detected in type 1 and type 2 isolates, respectively. The integron structures were similar to those previously determined for epidemic A. baumannii strains from various European countries, and suggestive of integron rearrangement/exchange among isolates related to the European epidemic clones I and II. Carbapenem resistance was associated with the presence of the bla(OXA-58) gene in type 1 isolates. The results indicate that the A. baumannii type 1 clone has a high potential of spreading among hospitals.
    Clinical Microbiology and Infection 05/2009; 15(4):347-57. · 4.58 Impact Factor
  • International Journal of Antimicrobial Agents - INT J ANTIMICROBIAL AGENTS. 01/2009; 34.
  • International Journal of Antimicrobial Agents - INT J ANTIMICROBIAL AGENTS. 01/2007; 29.
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    ABSTRACT: This study was performed to evaluate the utility of Tc-99m HMPAO-labeled leukocyte total-body scans (TBLS) for detecting remote septic foci before operation in patients undergoing aortofemoral vascular surgery. Fifty-eight patients were screened before operation for inflammatory or infective disease, and a clinical score was assigned to each patient. Each patient had TBLSs. The relation between the clinical score and the TBLS result was determined. Patients with positive results of the TBLSs were examined, and the causes of these findings were treated before surgery. Ten of the 58 (17%) patients had a positive result of TBLSs. Of 31 patients with a clinical score of zero, 3 had positive findings of TBLS. No TBLS was positive in the 13 patients with a clinical score of 1. TBLS findings were positive in 7 of 14 of the combined patients with clinical scores of 2, 3, or 4. None of the patients showed signs of prosthetic vascular graft infection during the postoperative follow-up period. In conclusion, TBLSs can be used before aortofemoral vascular surgery, but only in patients with high clinical scores for inflammatory or infective disease to identify relevant infective foci that could cause vascular graft infection.
    Clinical Nuclear Medicine 01/2002; 26(12):1024-7. · 2.96 Impact Factor
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    ABSTRACT: Sternal wound infections (SWIs) can be subdivided into two types, superficial or deep, that require different treatments. The clinical diagnosis of superficial SWI is normally easy to perform, whereas the involvement of deep tissues is frequently difficult to detect. Therefore, there is a need for an imaging study that permits the assessment of SWIs and is able to distinguish between superficial and deep SWI. The present work was a prospective study aiming to evaluate the role of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) labelled leucocyte scan in SWI management. Twenty-eight patients with suspected SWIs were included in the study. On the basis of clinical examination they were subdivided into three groups: patients with signs of superficial SWI (group 1), patients with signs of superficial SWI and suspected deep infection (group 2) and patients with suspected deep SWI without superficial involvement (group 3). Ten patients previously submitted to median sternotomy, but without suspected SWI, were also included in the study as a control group (group 4). All patients with suspected SWI had bacteriological examinations of wound secretion, if present. In addition 99mTc-HMPAO labelled leucocyte scan was performed in all patients. The patients of groups 1, 2 and 3 were treated on the basis of the clinical signs and microbiological findings, independently of the scintigraphic results. The patients of group 4 did not receive treatment. The final assessment of infection was based on histological and microbiological findings or on long-term clinical follow-up. Sensitivity, specificity, accuracy and positive and negative predictive values for scintigraphic and non-scintigraphic results were calculated. In the diagnosis of superficial and deep SWI, clinical and microbiological examination (combined) yielded, respectively, a sensitivity of 68.7% and 100%, a specificity of 77.3% and 80.8%, an accuracy of 73.7% and 86.8%, a positive predictive value of 68.7% and 70.6% and a negative predictive value of 77.3% and 100%. The scintigraphic results obtained in superficial SWI yielded a sensitivity of 56.2%, a specificity of 90.9%, an accuracy of 76.3%, a positive predictive value of 81.8% and a negative predictive value of 74.1%, while, by contrast, in deep SWI all of these values were 100%. Therefore, one can conclude that 99mTc-HMPAO labelled leucocyte scan permits accurate diagnosis of deep SWI, solving the main clinical problem in this field. In the present study the categorisation of patients without taking into account 99mTc-HMPAO labelled leucocyte planar scan findings caused a non-negligible number of cases of superficial SWI to be treated as though they were deep SWI. This "overestimation" led to unnecessary surgery, increased and prolonged use of antibiotics with more (higher) toxicity and additional expense.
    European Journal of Nuclear Medicine 07/2000; 27(6):660-7.
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    ABSTRACT: Sternal wound infections (SWIs) can be subdivided into two types, superficial or deep, that require different treatments. The clinical diagnosis of superficial SWI is normally easy to perform, whereas the involvement of deep tissues is frequently difficult to detect. Therefore, there is a need for an imaging study that permits the assessment of SWIs and is able to distinguish between superficial and deep SWI. The present work was a prospective study aiming to evaluate the role of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) labelled leucocyte scan in SWI management. Twenty-eight patients with suspected SWIs were included in the study. On the basis of clinical examination they were subdivided into three groups: patients with signs of superficial SWI (group 1), patients with signs of superficial SWI and suspected deep infection (group 2) and patients with suspected deep SWI without superficial involvement (group 3). Ten patients previously submitted to median sternotomy, but without suspected SWI, were also included in the study as a control group (group 4). All patients with suspected SWI had bacteriological examinations of wound secretion, if present. In addition 99mTc-HMPAO labelled leucocyte scan was performed in all patients. The patients of groups 1, 2 and 3 were treated on the basis of the clinical signs and microbiological findings, independently of the scintigraphic results. The patients of group 4 did not receive treatment. The final assessment of infection was based on histological and microbiological findings or on long-term clinical follow-up. Sensitivity, specificity, accuracy and positive and negative predictive values for scintigraphic and non-scintigraphic results were calculated. In the diagnosis of superficial and deep SWI, clinical and microbiological examination (combined) yielded, respectively, a sensitivity of 68.7% and 100%, a specificity of 77.3% and 80.8%, an accuracy of 73.7% and 86.8%, a positive predictive value of 68.7% and 70.6% and a negative predictive value of 77.3% and 100%. The scintigraphic results obtained in superficial SWI yielded a sensitivity of 56.2%, a specificity of 90.9%, an accuracy of 76.3%, a positive predictive value of 81.8% and a negative predictive value of 74.1%, while, by contrast, in deep SWI all of these values were 100%. Therefore, one can conclude that 99mTc-HMPAO labelled leucocyte scan permits accurate diagnosis of deep SWI, solving the main clinical problem in this field. In the present study the categorisation of patients without taking into account 99mTc-HMPAO labelled leucocyte planar scan findings caused a non-negligible number of cases of superficial SWI to be treated as though they were deep SWI. This ”overestimation” led to unnecessary surgery, increased and prolonged use of antibiotics with more (higher) toxicity and additional expense.
    European journal of nuclear medicine and molecular imaging 01/2000; 27(6):660-667. · 5.11 Impact Factor
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    ABSTRACT: The infection of a prosthetic vascular graft (PVGI), although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication reduces the death rate from surgery. Aortofemoral graft infections differ clinically from peripheral graft infections in significant ways. The aim of this article is to evaluate separately the reliability of the 99mTc-HMPAO-labeled leukocyte scan or white blood cell count (WBC) in the early detection of both aortofemoral and peripheral graft infections. One hundred sixty-two WBCs were performed on 129 consecutive patients with suspected aortofemoral (122 scans) and peripheral (40 scans) graft infection and in a 12-patient control group. Patients with suspected PVGI were categorized into three groups on the basis of their signs and symptoms on readmission: (a) patients with specific signs of graft infection (Group A); (b) patients with nonspecific signs of graft infection (Group B); and (c) patients with anastomotic aneurysms (Group C). Gram's stains of the perigraft exudate and graft cultures were performed and used as the gold standard in patients who underwent surgery. An 18-mo clinical follow-up was done to assess the presence or absence of graft infection in patients who did not have surgery. In patients with suspected aortofemoral graft infections, the overall sensitivity, specificity and accuracy of WBCs (Groups A, B, C) were 100%, 92.5% and 97.5%, respectively, whereas sensitivity, specificity and accuracy calculated in the patients with nonspecific signs of graft infection (Groups B, C) were 100%, 92.3% and 96.9%, respectively. In patients with suspected peripheral graft infections, sensitivity, specificity and accuracy were 100%. The white blood cell scan seems a reliable diagnostic method for early diagnosis of PVGI, and it is more useful in aortofemoral graft infections.
    Journal of Nuclear Medicine 06/1998; 39(5):875-9. · 5.77 Impact Factor
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    ABSTRACT: Changes in antibiotic susceptibility was evaluated in 77 consecutive nosocomial clinical isolates of Staphylococcus aureus collected from 1986 to 1994 at the Umberto I Polyclinic of the University of Rome (63 isolates) and from 7 other Roman hospitals (14 isolates). Oxacillin resistance in these isolates increased from 39% during the 1980s to 69% during the 1990s. Significant increases in resistance to ciprofloxacin, clindamycin and rifampicin were observed among oxacillin-resistant strains. No resistance to glycopeptides was observed although both teicoplanin and vancomycin had slightly reduced antistaphylococcal activity.
    Journal of chemotherapy (Florence, Italy) 02/1998; 10(1):25-8. · 0.83 Impact Factor
  • European Journal of Vascular and Endovascular Surgery 01/1998; 14 Suppl A:27-9. · 2.82 Impact Factor
  • C Santini, P Baiocchi, P Serra
    European Journal of Vascular and Endovascular Surgery 01/1998; 14 Suppl A:13-4. · 2.82 Impact Factor
  • Nuclear Medicine Communications - NUCL MED COMMUN. 01/1997; 18(5).
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    ABSTRACT: Changes in antibiotics susceptibilities were evaluated among 374 nosocomial clinical isolates of Staphylococcus aureus collected from 1986 to 1994 in a tertiary-care University hospital where methicillin-resistant S. aureus (MRSA) is an increasing cause of infection. Significant increases in resistance to ciprofloxacin, clindamycin and rifampicin were observed among MRSA isolates in recent years. No resistance to glycopeptides was observed. However, during the last 2 years a significant trend towards a decreasing susceptibility to teicoplanin was observed among MRSA isolates.
    International Journal of Antimicrobial Agents 08/1996; 7(2):93-6. · 4.42 Impact Factor
  • Infectious Diseases in Clinical Practice - INFECT DIS CLIN PRAC. 01/1996; 5(5):325-330.
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    ABSTRACT: We observed seven patients with persistent fever and staphylococcemia under vancomycin-containing antimicrobial regimens who promptly improved as clindamycin was added to the initial antibiotics. Moreover, in all these patients a striking increase in peak and trough serum inhibitory activity (SIR) and serum bactericidal activity (SBA) levels was observed after addition of clindamycin. SIA and SBA levels after administration of a single dose of vancomycin (500 mg), clindamycin (600 mg) or vancomycin + clindamycin were also measured in three healthy volunteers against six ORSA isolates. Unsatisfactory peak SBA levels (0% of cases 1:8) were obtained after vancomycin administration. Vice versa, peak SBA levels 1:8 were obtained in 94% of the cases after clindamycin and in 100% of cases after vancomycin + clindamycin. Time-kill studies showed a borderline or incomplete bactericidal activity of vancomycin against three ORSA isolates from infections that manifested poor or slow response to vancomycin therapy. The combination with clindamycin did not result in a synergistic interaction between the two drugs. It is concluded that addition of clindamycin may be useful in some cases of ORSA septicemia that show poor or slow response to vancomycin therapy. The recommendation for a wider use of this combination of antibiotics requires further documentation of efficacy.
    International Journal of Antimicrobial Agents 05/1995; 5(2):123-8. · 4.42 Impact Factor
  • Recenti progressi in medicina 03/1995; 86(2):78-80.
  • Clinical Infectious Diseases 12/1994; 19(5):977-8. · 9.37 Impact Factor
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    ABSTRACT: We identified 17 (20%) of 83 consecutive enterococcal isolates from hospitalized patients with documented infection as high-level ampicillin-resistant enterococci (ARE). Of these, 16 isolates were identified as Enterococcus faecium and 1 isolate as Enterococcus raffinosus. A case-control study found no significant differences with respect to underlying diseases, central venous catheterization, nosocomial acquisition of the infection and sites of infection. Patients with ARE infection were older and had a higher inhospital fatality rate than those with ampicillin-susceptible Enterococcus (ASE) infection. Hospitalization in a surgery service (usually for an abdominal procedure), prolonged hospital stay, prior treatment with antibiotics (in particular imipenem and metronidazole), were also more frequent among patients with ARE infection. ARE isolates were more frequently resistant to imipenem, ciprofloxacin and streptomycin than ASE isolates.
    Journal of chemotherapy (Florence, Italy) 05/1994; 6(2):121-6. · 0.83 Impact Factor
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    ABSTRACT: We reviewed our routine clinical laboratory records from January 1990 to March 1993 to evaluate the rate of oxacillin-resistance among nosocomial isolates of Staphylococcus aureus. Of 265 clinically significant isolates, 174 (65%) were oxacillin-resistant S. aureus (ORSA). Most of these strains were obtained from surgery patients and/or were isolated from surgical wounds. The isolations of S. aureus increased during the study period: 45 in 1990, 50 in 1991, 130 in 1992 and 40 in the first trimester of 1993. The annual rates of ORSA among S. aureus isolated varied from 62 to 68% through these years. Most ORSA isolates proved resistant to ciprofloxacin, gentamicin and rifampicin, and susceptible to vancomycin, netilmicin and cotrimoxazole. Based on these results, the need for a stringent application of infection control measures is outlined.
    Journal of chemotherapy (Florence, Italy) 03/1994; 6(1):25-8. · 0.83 Impact Factor
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    ABSTRACT: A 5-year experience of 19 aortic graft infections is reviewed. Of these, 13 (68%) had a late onset (more than 4 months after graft implantation) and usually presented with anastomotic pseudo-aneurysm or thrombosis. The remaining six infections (32%) had an early onset and presented more often with surgical wound infection. Aorto-enteric fistulae and inguinal sinus tracts were observed in both early and late onset infections. Coagulase-negative staphylococci (all slime negative, oxacillin susceptible strains) were the prevalent pathogens in both groups of infections and were isolated in six (32%) patients. Next most commonly seen were Pseudomonas aeruginosa in four (21%) patients, Enterococcus spp. in three (16%) patients, Staphylococcus aureus in three (16%) patients, other bacteria in six (32%) patients. No organisms were isolated in three (16%) patients. Mortality and major amputation rates were 47.3% and 31.6%, respectively. The therapeutic procedures included total graft removal (15 patients), partial graft excision (two patients), partial graft excision followed by total graft removal (one patient) and local treatment without graft removal (one patient). Six patients recovered, including two who underwent total graft removal associated with a non-conventional 'in situ' graft replacement and one patient treated conservatively with local treatment and antibiotics. The three patients undergoing partial graft excision showed signs of active infection of the residual graft.
    Journal of Infection 08/1993; 27(1):17-26. · 4.07 Impact Factor
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    ABSTRACT: To reduce the rates of morbidity and mortality in aortic graft infection, a new diagnostic approach is needed to help identify low-grade stages, specifically when there are minimal or no clinical signs of overt infection. The aim of this study was to evaluate the role of technetium 99m--hexametazime white blood cell scanning (99mTc scanning) in detecting aortic graft infection, particularly in the low-grade stages. Thirty-seven patients with suspected aortic graft infection were categorized into three groups according to their signs and symptoms on readmission. Ten patients (group A) had advanced graft infections that were correctly diagnosed by use of computed tomography (CT) scanning and 99mTc scanning and confirmed by intraoperative findings and culture results. Eighteen patients (group B) had nonspecific signs and symptoms of graft infection. Patients only underwent CT and 99mTc scanning for graft infection after standard clinical work-ups failed to reveal disease processes that accounted for the clinical symptoms. In this group of patients 99mTc scanning identified four cases of low-grade graft infection, which was confirmed by intraoperative findings and graft cultures. None of these four cases was confirmed by results of CT scanning. On an average 18-month follow-up in patients who did not undergo surgery graft infections developed. Nine patients (group C) had anastomotic aneurysms; CT scanning and 99mTc scanning correctly diagnosed five patients as being infected. The result of 99mTc scanning was false-positive in one patient. The diagnostic accuracy of 99mTc scanning in patients who did not have specific signs of graft infection (groups B and C) was 100% for sensitivity, 94.4% for specificity, 90% for the positive predictive value, and 100% for the negative predictive value. 99mTc scanning seems to be a useful diagnostic technique for detecting aortic graft infection, particularly in low-grade stages.
    Journal of Vascular Surgery 02/1993; 17(1):87-95; discussion 95-6. · 2.88 Impact Factor