[Show abstract][Hide abstract] ABSTRACT: Understanding local susceptibility patterns is important when selecting antimicrobials for ini-tial empirical antibiotic-therapy of bloodstream infections. Because the determination of sus-ceptibility is dependent on the breakpoints used, the aim of the study was to compare the antimi-crobial susceptibility results to different classes of antibiotics of 512 strains of Enterobacteria-ceae (200 ESβL positive) isolated from blood-stream using CLSI 2013 and current EUCAST 2013 guidelines to evaluate the impact of break- point discrepancies. The results of the study showed that statistically significant discrepan-cies (p ≤ 0.001) were found for amoxicillin/cla- vulanic acid, piperacillin alone or with tazobac- tam, imipenem, meropenem, cefepime (only ESβL negative isolates), amikacin and gentami- cin using current CLSI or EUCAST interpretive criteria. Further harmonization of CLSI and EUCAST breakpoints is warranted. This study could give useful information to physicians for managing bloodstream infections caused by Enterobacteriaceae.
Health 01/2014; 6(2):153-157. · 2.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A variety of metallo-β-lactamase (MβL) enzymes have been reported from gram-negative organisms collected in Italy including VIM-1, the second acquired MβL to be reported, IMP-13, VIM-2, IMP-19 and FIM-1 ((1-6)).…
Antimicrobial Agents and Chemotherapy 09/2013; · 4.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The role of bacterial infections, mainly Chlamydophila pneumoniae, on atherosclerotic processes as well as the therapeutic utility of additional antibiotic treatment is still an open question. In this study we compared the serological profiles of 160 patients (80 with peripheral arterial disease (PAD), diagnosed with an ankle/brachial index (ABI) ≤ 0.9 and 80 with risk factors for cardiovascular disease - CVD) with those of 80 healthy subjects, serum levels of specific C. pneumoniae antibodies using the microimmunofluorescence test. Our results show that PAD patients had a higher frequency of C. pneumoniae infection than those with risk factors for cardiovascular disease. This frequency was lower if compared to the previous two groups in controls. 44 out of the 80 (55%) patients with PAD and 34 out of the 80 (42.58%) subjects with risk factors for cardiovascular disease were seropositive while only 24 of the 80 (30%) healthy subjects showed seropositivity to C. pneumoniae. Furthermore, higher anticorpal titers were also found in patients with peripheral arterial disease and in patients with cardiovascular risk factors if compared to healthy subjects. On the basis of these results, we confirm that C. pneumoniae infection is frequent in peripheral arterial disease patients and we believe that it could be considered as an additional risk factor involved in the pathogenesis of this disease.
[Show abstract][Hide abstract] ABSTRACT: The GIARIR study group has made a critical analysis of the most recent scientific literature on acute bacterial exacerbations of chronic bronchitis (ABECB) with the aim of proposing therapeutic recommendations applicable to the current epidemiological situation in italy. The international literature has indicated the scarcity of studies on the treatment of ABECB compared to an abundance of information regarding chronic obstructive pulmonary disease (COPD), of which ABECB is often considered the initial ore predisposing stage, even though a precise evolutionary correlation between these pathologies has not yet been demonstrated.ABECB is the principle cause of doctor visits, hospitalization and death in COPD patients. The natural course of the disease is characterized by the appearance of exacerbation episodes (a mean of two yearly). For this reason it is indispensable to prevent exacerbations, to treat them as quickly as possible, in order to minimize their negative effects on the respiratory tract and the patient's general health.The routine use of antibiotic therapy is controversial because at least 20% of exacerbations do not have an infectious origin and about 30% are viral. in most cases the choice of antibiotic is empiric, in both ABECB patients without risk factors (mild form) and in those with risk factors such as cigarette smoking or constant exposure to air pollutants (moderate form). For these reasons it is necessary to keep up to date on the local and regional bacteria etiological situation and to be aware of antibiotic resistance patterns for the most commonly involved pathogens.An analysis of the most recent information in italy has confirmed the involvement of the terrible three bacterial species-Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae-as the cause of 85-95% of ABECB cases, as well as an increase in resistance to various classes of molecules by all the respiratory pathogens. On the basis of the known resistance patterns in italy, some antibiotics are no longer considered first choice for empiric therapy such as the unprotected betalactams, tetracycline, trimethoprim/sulfamethoxazole and the macrolides) which should be used only after antibiotic susceptibility testing indicates they are still active against the pathogens. The epidemiological picture of bacterial resistance in italy has greatly restricted the choice of antibiotics which can be used for this type of infection, justifying interest in the oral beta-lactams which have the highest therapeutic index and are first choice therapy against bacterial exacerbations of chronic bronchitis. included in this group are amoxicillin-clavulanate and the new cephem molecule, cefditoren, which has been available in italy since 2008. Thanks to its good pharmacokinetics and pharmacodynamics as well as clinical performance, cefditoren may be considered a drug of choice against exacerbations of chronic bronchitis.
[Show abstract][Hide abstract] ABSTRACT: The interaction between tazobactam and several chromosome-and plasmid-encoded (TEM, SHV, PSE types) class A and C β-lactamases was studied by spectrophotometry. Tazobactam behaved as a competitive inhibitor or inactivator able to restore in several cases the efficiency of piperacillin as a partner β-lactam. A detailed kinetic analysis permitted measurement of the acy-lation efficiency for some cephalosporinases and broad-spectrum β-lactamases; the presence of a turn-over of acyl-enzyme complex was also evaluated.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the in vitro antibiotic susceptibility of respiratory pathogens recently isolated in Italy to commonly used antibiotics including cefditoren. Six clinical microbiological laboratories collected, between January and September 2009, a total of 2,510 respiratory pathogens from subjects with community-acquired respiratory tract infections (CARTI). Ceftditoren, out of all the beta-lactams studied, had the lowest MIC(90 )against 965 strains of Streptococcus pneumoniae examined, followed by cefotaxime and ceftriaxone (2% resistance in penicillin-resistant S. pneumoniae (PRSP)). Against 470 Haemophilus influenzae , independently of their production of beta-lactamases or ampicillin resistance, cefditoren was the oral cephalosporin with the best in vitro activity, comparable to that of the injectable cephalosporins and levofloxacin. Higher MIC(90)s were found for the macrolides (4 - 16 mg/l) and cefaclor (4 - 32 mg/l). As was foreseeable, Streptococcus pyogenes (225 strains) was uniformly sensitive to all the beta-lactam antibiotics, but the elevated MIC(90 )values reduced (<75%) susceptibility of this pathogen to macrolides. Beta-lactamase-negative Moraxella catarrhalis (100 strains) had reduced susceptibility only to the macrolides, while the 250 beta-lactamase-producing strains also had reduced susceptibility to cefuroxime. Levofloxacin showed the lowest MIC(50)/MIC(90 )values in the producing strains, whereas cefditoren, cefotaxime and ceftriaxone in the non-producers. As regards the enterobacteriaceae, cefditoren and levofloxacin had the lowest MIC(90)s against Klebsiella pneumoniae. Cefditoren and the third-generation injectable cephalosporins had the lowest MIC(90)s against Escherichia coli (100% susceptibility) while levofloxacin was less active (86% susceptibility).In conclusion, cefditoren's wide spectrum and high intrinsic activity, as well as its capacity to overcome most of the resistance that has become consolidated in some classes of antibiotics widely used as empiric therapy for CARTI, allows us to suggest that cefditoren might be included in the european guidelines as one of the first-choice antibiotics in the treatment of CARTI.
[Show abstract][Hide abstract] ABSTRACT: Over the last twenty years there has been an alarming increase in isolation of Streptococcus pneumoniae strains with a reduced susceptibility not only to penicillin, but also to other betalactams and macrolides. This phenomenon justifies the great interest in new antibiotics. Cefditoren, a new aminothiazolyl oral cephalosporin, recently commercialized in Italy, is characterized by an extended activity against penicillin-resistant S. pneumoniae. The aim of this study is to evaluate the incidence of the resistance/susceptibility to various antibiotics in 1000 strains of S. pneumoniae (678 SPSS, 219 SPPI and 103 SPPR), clinically isolated during 2009. The data obtained by our in vitro study show that cefditoren is the most active agent against S. pneumoniae. In fact, the MIC90 values of 0.5 micrograms/ml obtained could be particularly significant in therms of therapeutic predictivity.
International journal of immunopathology and pharmacology 01/2010; 23(3):833-40. · 2.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We estimated the proportion of drug users at treatment centres in Italy who had undergone HIV testing and the correlates of testing. Of the 1,917 drug injectors, 37.4% had been tested in the current year; of the 665 non-injectors, 28% had been tested. Among injectors, testing was associated with: being older than 35, foreign nationality, residing in central Italy, drug use for over 2 years, and having undergone both pharmacological and psychological treatment. Among non-injectors, an association was found for foreign nationality and not having been treated at other facilities. The results stress the need to facilitate access to testing.
AIDS and Behavior 10/2009; 15(4):711-7. · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The time-kill method was used to determine the bactericidal activity of cefditoren compared with oral cephalosporins, amoxicillin, amoxicillin/clavulanate and levofloxacin against a randomly selected group of strains isolated from community-acquired respiratory tract infections (CARTIs). Cefditoren was the only agent showing significant bactericidal activity (>or=3 log(10 )reduction of viable cells) within 4 h against all Streptococcus pneumoniae strains, both penicillin-susceptible (PEN S) or -resistant (PEN R), as well as against Streptococcus pyogenes, and Moraxella catarrhalis. Against beta-lactamase positive strains of Haemophilus influenzae, cefditoren was comparable to the quinolone and more active than other cephalosporins at 24 h. Cefditoren showed the best killing kinetic profiles and this observation may be important when choosing an oral third-generation cephalosporin as initial or sequential therapy.
[Show abstract][Hide abstract] ABSTRACT: Intra-abdominal infections (IAIs) are commonly encountered in clinical practice. The etiology of these infections, often polymicrobial in nature, can be variable and usually includes organisms derived from the gut microbiota. in community-acquired IAIs enterobacteria predominate (mostly Escherichia coli) in combination with anaerobes (mostly Bacteroides fragilis). In nosocomial IAIs, which can complicate abdominal surgery, other pathogens can also play a role, such as Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus spp. and Candida spp. Diagnostic microbiology of IAIs is complex and plays a relevant role, especially in some situations (e.g. presence of foreign bodies, potential presence of resistant or uncommon pathogens, nosocomial infections in subjects with risk factors). Antibiotic resistance issues are currently encountered in most pathogenic species causing IAIs. Resistance affects all major classes of antimicrobial agents, often involving multiple classes and resulting in complex resistance phenotypes for which only a very limited number of drugs remain active.
[Show abstract][Hide abstract] ABSTRACT: This study presents the results of the italian "Severe infections project" involving bacteria that can be considered rare causes of disease. we isolated 30 uncommon human pathogens from a total of 60 strains (1.2% of all the isolates). The most frequent sources of uncommon human pathogens were primary bloodstream infections (48.3%) and pneumonia (20%). Species such as Comamonas testosteroni, Enterococcus hirae, Kluyvera ascorbata, Kluyvera cryocrescens, Leclercia adecarboxylata and Ochrobactrum anthropi were recovered from bacteremia patients. Clinically useful antimicrobial agents were tested against each isolate. Resistance to 4 or more antibiotics tested was found in Achromobacter xylosoxidans, O. anthropi, Pseudomonas stutzeri, Citrobacter braakii, Enterobacter sakazakii, K. ascorbata, Proteus penneri and Serratia plymuthica. About 16% of the Gram-negative species were resistant to third-generation cephalosporins and 28.6% of the staphylococci were oxacillin-resistant. the results from this study offer indications for empirical therapy for severe infections from uncommon human pathogens.
[Show abstract][Hide abstract] ABSTRACT: In this study we evaluated the in vitro activities of cefditoren--a broad-spectrum oral cephalosporin--and other comparator agents against 2,396 fresh isolates from community-acquired respiratory tract infections, collected from 6 clinical Italian microbiology laboratories. On penicillin-susceptible pneumococci and Streptococcus pyogenes, cefditoren demonstrated to be the most active antibiotic (MIC(90)values of 0.03 and 0.06 mg/L respectively), showing only a slight decrease in potency on penicillin-intermediate and resistant pneumococci (MIC(90)value 0.5 mg/L, 1.0 mg/L respectively). All the other comparators displayed MIC(90 )values of 4 - 8 mg/L for penicillins and of 4 to >64 mg/L for the oral cephalosporins. Cefditoren and levofloxacin were the most active against MSSA (MIC(90)0.5 mg/mL). Cefditoren displayed a uniformly potent inhibitory activity (MIC(90)of 0.03 mg/L) against all strains of Haemophilus influenzae, regardless of their ampicillin resistance (mediated or not by beta-lactamase production), while against Moraxella catarrhalis MIC(90)values were higher against beta-lactamase-positive (0.25 mg/L). Cefditoren was active also against Klebsiella pneumoniae and Escherichia coli : in this case its activity was comparable with that of levofloxacin. In conclusion, cefditoren, due to its potent activity, is a new effective therapeutic option for the treatment of respiratory tract infections.
[Show abstract][Hide abstract] ABSTRACT: This preliminary study evaluated the use of the Platelia Candida antigen kit for the diagnosis of invasive candidosis in 70 of 184 pre-term infants admitted to a neonatal intensive care unit between March 2004 and March 2006. The frequency of confirmed candidaemia was 6.5%. The sensitivity and specificity of the assay were 94.4% and 94.2%, respectively, with a positive predictive value of 85% and a negative predictive value of 98%. These results suggest that the inclusion of regular serological surveillance for mannanaemia in some pre-term infants would complement blood cultures for the early detection of candidosis.
Clinical Microbiology and Infection 05/2008; 14(4):391-3. · 4.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In a recent multi-centre Italian survey (2003-2004), conducted in 45 laboratories throughout Italy with the aim of monitoring microorganisms responsible for severe infections and their antibiotic resistance, Acinetobacter baumannii was isolated from various wards of 9 hospitals as one of the most frequent pathogens. One hundred and seven clinically significant strains of A. baumannii isolates were included in this study to determine the in vitro activity of tigecycline and comparator agents.
Tests for the susceptibility to antibiotics were performed by the broth microdilution method as recommended by CLSI guidelines. The following antibiotics were tested: aztreonam, piperacillin/tazobactam, ampicillin/sulbactam, ceftazidime, cefepime, imipenem, meropenem tetracycline, doxycycline, tigecycline, gentamicin, amikacin, ciprofloxacin, colistin, and trimethoprim/sulphametoxazole. The PCR assay was used to determine the presence of OXA, VIM, or IMP genes in the carbapenem resistant strains.
A. baumannii showed widespread resistance to ceftazidime, ciprofloxacin and aztreonam in more than 90% of the strains; resistance to imipenem and meropenem was 50 and 59% respectively, amikacin and gentamicin were both active against about 30% of the strains and colistin about 99%, with only one strain resistant. By comparison with tetracyclines, tigecycline and doxycycline showed a higher activity. In particular, tigecycline showed a MIC90 value of 2 mg/L and our strains displayed a unimodal distribution of susceptibility being indistinctly active against carbapenem-susceptible and resistant strains, these latter possessed OXA-type variant enzymes.
In conclusion, tigecycline had a good activity against the MDR A. baumannii strains while maintaining the same MIC(90) of 2 mg/L against the carbapenem-resistant strains.
Annals of Clinical Microbiology and Antimicrobials 03/2008; 7:4. · 1.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Intra-abdominal infections (IAIs) are commonly encountered in clinical practice. The etiology of these infections, often polymicrobial in nature, can be variable and usually includes organisms derived from the gut microbiota. In community-acquired IAIs enterobacteria predominate (mostly Escherichia coli) in combination with anaerobes (mostly Bacteroides fragilis). In nosocomial IAIs, which can complicate abdominal surgery, other pathogens can also play a role, such as Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus spp. e Candida spp. Diagnostic microbiology of IAIs is complex and plays a relevant role especially in some situations (e. g. presence of foreign bodies, potential presence of resistant or uncommon pathogens, nosocomial infections in subjects with risk factors). Antibiotic resistance issues are currently encountered in most pathogenic species causing IAIs. Resistance affects all major classes of antimicrobial agents, often involving multiple classes and resulting in complex resistance phenotypes for which only a very limited number of drugs remain active.
Le infezioni in medicina: rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive 03/2008; 16 Suppl 1:8-18.