M Monaco

Istituto Superiore di Sanità, Roma, Latium, Italy

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Publications (25)72.34 Total impact

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    ABSTRACT: BACKGROUND: Community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) is responsible for severe infections in previously healthy people acquired in the community in different areas of the world. AIM: To report an outbreak of CA-MRSA in a hospital newborn nursery in northern Italy in September-October 2010, its investigation and control measures. METHODS: The epidemiology of the outbreak is reported. The investigation included screening neonates, parents and staff for MRSA carriage. Molecular strain typing was performed on MRSA isolates. FINDINGS: The outbreak affected nine neonates with three severe infections. In addition, four mothers had postpartum mastitis, and three mothers and one father had skin infection. The outbreak strain belonged to the USA300 CA-MRSA clone. Asymptomatic carriage of the outbreak strain was found among neonates, parents and hospital staff. The implementation of appropriate infection control measures in the hospital terminated the outbreak. CONCLUSIONS: To our knowledge, this is the first report of a hospital outbreak caused by the USA300 CA-MRSA clone in Europe. It is important to reinforce infection control measures, particularly in high-risk groups, such as neonates, to prevent USA300 from becoming endemic in European hospitals.
    The Journal of hospital infection 11/2012; · 3.01 Impact Factor
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    ABSTRACT: Objectives: Both MSSA and MRSA PVL-positive strains can cause serious and recurrent infections in subjects without risk factors living in the community. In this work we focus the attention on the characterization of the PVL-positive MSSA strains, responsible for outbreak and sporadic infections in Italy. Methods: During the period 2005–2010, twenty-two PVL-positive MSSA were collected. The isolates have been sent to the National Laboratory by different Italian hospital laboratories on the basis of the type and the severity of the infections that appeared typical of PVL-positive strains. The presence of nuc (species confirmation), PVL and toxic shock syndrome toxin 1 (TSST-1) genes were detected by PCR. Molecular typing techniques such as agr typing, spa typing and Multi-Locus Sequence typing (MLST) were performed. Clonal Complexes (CCs) were determined by using eBurst software. Results: All the isolates were confirmed as PVL-positive MSSA. Fourteen isolates were from skin and soft tissue infections (SSTIs), 4 from nasal carrier, 2 from necrotizing pneumonia, one each from an ORL infection, sepsis and osteomielitis. One of these isolates was the strain responsible for an hospital-community outbreak in 2005. Molecular typing revealed that isolates belonged to all the four known agr alleles (from 1 to 4), to 16 different spa type and to 12 different sequence type (ST). Following eBurst analyses, the related STs were grouped in CCs except for ST1209 that was a singleton. The isolates belonged to 9 different genetic lineages. The most common were CC121/agrIV and CC30/agrIII (6 isolates each). The other lineages were: CC5/agrII, ST1209/agrIII and CC22/agrI (2 isolates each) and CC1/agrIII, CC78/agrIII, CC152/agrI and CC8/agrI (1 isolate each). Three strains were TSST-1 positive: both the ST1209/agrIII strains and one CC30/agrIII. Conclusions: This study showed the great variety of the PVL-positive MSSA clones circulating in Italy, with CC121/agrIV and CC30/agrIII being the most commons. Differently from other countries, we did not find strains belonging to the common CC80/agrIII clone. A new lineage was found (ST1209/agrIII) which also was TSST-1 positive. Further studies should be done to evaluate the circulation and the characteristics of PVL-positive MSSA since it can cause serious infections similarly to its counterpart, PVL-positive MRSA.
    . 21st ECCMID/27th ICC Milano 2011. 05/2011;
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    ABSTRACT: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates are widespread in many countries, with varying distribution and epidemiology. The aim of this study was to collect and characterise the CA-MRSA isolates circulating in Italy, since only some case reports have been published. Eighteen Panton-Valentine-positive CA-MRSA isolates were collected from different Italian hospitals during the period 2005-2009 from severe infections (skin and soft tissue infections, n = 10; necrotising pneumonia, n = 7; and sepsis, n = 1). Accessory gene regulator (agr) typing, staphylococcal cassette chromosome (SCC) mec typing, spa typing, multi-locus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) and DNA microarray were applied to categorise isolates into clones and to compare the relevant genetic features of each clone. Six different clones were identified, the most common (7 out of 18 isolates, 38.8%) being agrI/ST8/SCCmecIV, corresponding to the USA300 clone. Six out of the seven USA300 isolates did not harbour the arginine catabolic mobile element (ACME). Four strains (22.2%) were agrIII/ST80/SCCmecIV, corresponding to the European clone. Two of the other clones, namely, agrIII/ST88/SCCmecV and agrIII/ST772/SCCmecV, corresponded to CA-MRSA clones rarely found in other countries and probably originating from Africa or the Indian subcontinent. The results of microarray hybridisations showed that the distribution of resistance genes and other virulence factors was specific to each clone. Some characteristics could be exploited as specific markers for a clone or a group of isolates, e.g. the mer operon, recovered only in ACME-negative USA300 strains. DNA microarray contributed to a more complete description of the variety of different CA-MRSA clones circulating in Italy.
    European Journal of Clinical Microbiology 04/2011; 30(11):1399-408. · 3.02 Impact Factor
  • The New Microbiologica: official journal of the Italian Society for Medical Virology (SIVIM) 03/2011; · 1.67 Impact Factor
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    ABSTRACT: The aim of this study was to characterise invasive methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) strains from Italy and to investigate the presence of heteroresistant vancomycin-intermediate S. aureus (h-VISA). Eighty-two MSSA and 66 MRSA strains obtained from 19 laboratories were submitted to in vitro susceptibility testing; MRSA strains were also analysed by the macro Etest (MET) and vancomycin population analysis profiles (PAP) to detect the presence of h-VISA. Genotyping included the detection of agr locus, SCCmec typing, spa typing and multilocus sequence typing (MLST). By Etest, 66% of all isolates showed a minimum inhibitory concentration (MIC) >or=1.5 microg/ml and two MRSA strains were categorised as VISA (MIC = 3 microg/ml). Twelve MRSA strains were positive by MET; of these, 9 (14% of all MRSA) were confirmed as h-VISA by PAP. MRSA strains were assigned to 14 spa types, with t001, t008 and t041 including 77% of the isolates. The most common spa type, t041, characterised as ST228/273-MRSA-I (CC5) and comprising 24 isolates, included one VISA and eight h-VISA. This is the first description of a close association between h-VISA and t041, a spa type common in Italy and in other European countries, that highlights the importance of molecular typing to identify clones of special clinical relevance.
    European Journal of Clinical Microbiology 07/2010; 29(7):771-7. · 3.02 Impact Factor
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    ABSTRACT: To assess the prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization in HIV-1-infected men who have sex with men (MSM), a cross-sectional study was conducted on 104 persons attending a large STI/HIV unit in Rome, Italy in the period June 2007-June 2008. Swabs obtained from both anterior nares and S. aureus isolates were characterized by phenotypic and genotypic methods. A total of 24 individuals (23.1%) were colonized with S. aureus but none carried MRSA. No statistically significant association between colonization with S. aureus and behavioural, clinical, virological or immunological characteristics was identified. This study indicates a lack of circulation of CA-MRSA in HIV-1-infected MSM in Italy and underscores large epidemiological differences between the USA and a European country, so that only locally conducted epidemiological studies can provide insight into the local circulation of CA-MRSA in general and selected populations.
    Epidemiology and Infection 05/2010; 138(5):738-42. · 2.87 Impact Factor
  • The Journal of hospital infection 09/2009; 73(2):182-4. · 3.01 Impact Factor
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    The Journal of hospital infection 03/2009; 71(4):374-6. · 3.01 Impact Factor
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    ABSTRACT: A total of 773 pneumococcal isolates were collected from a nationwide surveillance of invasive pneumococcal diseases during 1999-2003 prior to the implementation of the 7-valent conjugate vaccine (PCV7) in Italy. The isolates included vaccine serotypes (VS, 393 isolates), vaccine-related serotypes (VRS, 93), and nonvaccine serotypes (NVS, 279). The ten most prevalent serotypes were: 14 (16.4%), 3 (8.4%), 23F (8%), 19F (7.4%), 4 (5.9%), 7F (5.8%), 9V (5.3%), 6B (4.9%), 19A (4.7%), and 1 (3.7%). VRS or NVS isolates showed a lower rate of penicillin or drug resistance than VS. Representative isolates of the major VS, VRS, and NVS were genotyped by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The isolates examined were found to belong to 18 international clones and to eight newly described clones. VS isolates sharing clonal groups with VRS or NVS were also detected. Evidence of a past history of capsular switching events was observed in five clones.
    European Journal of Clinical Microbiology 08/2008; 28(1):99-103. · 3.02 Impact Factor
  • Journal of chemotherapy (Florence, Italy) 07/2008; 20(3):402-4. · 0.83 Impact Factor
  • Euro surveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 05/2007; 12(4):E070412.1. · 5.49 Impact Factor
  • International Journal of Antimicrobial Agents - INT J ANTIMICROBIAL AGENTS. 01/2007; 29.
  • International Journal of Antimicrobial Agents - INT J ANTIMICROBIAL AGENTS. 01/2007; 29.
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    ABSTRACT: The most frequent agents of severe bacterial infections and their antibiotic susceptibility patterns were determined in patients admitted to 45 Italian hospitals over the years 2002-2003. The most common diagnoses were: sepsis (33.8%), pneumonia (9.4%), intravascular catheter-associated infections (9.3%) and ventilator-associated pneumonia (8.1%). Overall, 5115 bacterial isolates were identified from 4228 patients. Three bacterial species, Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli, accounted for more than 50% of the isolates. Other prevalent bacterial isolates were Staphylococcus epidermidis and Enterococcus faecalis, while Acinetobacter baumanii ranked third among all Intensive Care Unit (ICU) isolates. 7% of S. aureus had intermediate resistance to vancomycin. Although E. faecalis displayed no vancomycin resistance, 34% of vancomycin-resistant isolates were found among Enterococcus faecium, one of the highest rates found to date, emphasizing the difference between these two enterococcal species. All the Gram-positive pathogens were susceptible to linezolid, with the exception of approximately 2% of the enterococcal isolates that were intermediate with a minimum inhibitory concentration (MIC)=4 microg/ml. Almost 10% of Escherichia coli, 14% of Klebsiella pneumoniae, 22% of Serratia marcescens and 50% of Enterobacter cloacae were non-susceptible to cefotaxime. Amikacin was the most active antibiotic against P. aeruginosa that showed lack of susceptibility to ceftazidime, gentamicin, piperacillin and ciprofloxacin ranging from 20 to 35%. Finally, Acinetobacter baumanii showed a high level of resistance to all the antibiotics tested including imipenem (58%). The results obtained in this study, the first of its kind in Italy, offer indications for guiding empirical therapy and implementing specific interventions to fight antibiotic-resistant bacterial infections and their transmission in the hospital setting in Italy.
    Journal of chemotherapy (Florence, Italy) 01/2007; 18(6):589-602. · 0.83 Impact Factor
  • Journal of Hospital Infection 12/2006; 64(3):303-5. · 2.86 Impact Factor
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    ABSTRACT: In order to estimate the incidence of invasive pneumococcal diseases (IPD) and the amount of vaccine preventable serious infections, a 1-year population-based surveillance was undertaken in two comparable Italian regions (Piemonte and Puglia, representing 14% of the Italian population) prospectively collecting data and strains from all the hospital microbiological laboratories. A retrospective analysis of hospital discharge records, matched with the laboratory database, was also undertaken in nine hospitals in these two regions to determine the frequency of use of blood cultures and its impact on IPD incidence estimate. For children under 2 years of age, the incidence rates of IPD were 11.3 per 100,000 and 5.9 per 100,000 in Piemonte and in Puglia, respectively; for subjects 65 years of age and over the incidence rates were 5.7 per 100,000 and 0.2 per 100,000, in the two regions, respectively. The number of blood cultures performed was six times higher in Piemonte than that in Puglia. About 96% of isolates from IPD patients, aged 65 years and over, belonged to serogroups included in the 23-valent polysaccharide vaccine, whereas about 79% of strains isolated from patients under 5 years of age were related to serotypes included in the 7-valent conjugate vaccine. The estimate of the incidence of IPD is affected greatly by the different attitudes in performing blood cultures, especially in older patients. In Italy, bacteriological culture procedures should be undertaken more frequently to provide decision-makers with reliable estimates of serious vaccine preventable conditions.
    Vaccine 01/2005; 23:2494-2500. · 3.49 Impact Factor
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    ABSTRACT: We tested the in vitro bactericidal activity of moxifloxacin, a new 8-methoxyquinolone, alone and in combination with vancomycin or teicoplanin at different multiples of minimum inhibitory concentration (MIC) against 8 methicillin-ciprofloxacin-resistant Staphylococcus aureus (M-C-RSA) and 1 methicillin-ciprofloxacin susceptible S. aureus (M-C-SSA) recently isolated from device-associated infections unresponsive to or relapsing after glycopeptide therapy, despite device removal. MICs of vancomycin ranged from 1 to 4 microg/ml, MICs of teicoplanin ranged from 2 to 8 microg/ml; MICs of moxifloxacin were always 2 microg/ml against M-C-RSA isolates and 0.125 microg/ml against the M-C-SSA isolate. The 9 strains resulted tolerant when tested for vancomycin, teicoplanin, and moxifloxacin used alone at 2 x MIC. In all cases the combination of moxifloxacin and teicoplanin or vancomycin appeared to be bactericidal already at MIC concentration for glycopeptides plus 0.5 x MIC concentration for moxifloxacin. If these results are confirmed in vivo in animal experiments, the combination of moxifloxacin with glycopeptides might be useful for treating device-associated infections, and in preventing the frightening phenomenon of increasing MICs for glycopeptides.
    Journal of chemotherapy (Florence, Italy) 07/2003; 15(3):239-43. · 0.83 Impact Factor
  • Clinical Microbiology and Infection 02/2001; 7(1):37-9. · 4.58 Impact Factor
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    ABSTRACT: We evaluated the activity of fluconazole and voriconazole against 83 Candida albicans isolates from patients with haematological malignancies, comparing the NCCLS microdilution method (M27-A) with a modified method with RPMI-2% glucose and MIC endpoint at 50% inhibition. Both drugs were highly active regardless of the year, the site of isolation of the strain and the test method employed. In several strains isolated during the last few years, trailing growth leading to difficulty in interpretation of the endpoint of the test has been observed for both drugs by the NCCLS method, but not by the modified method. In our experience, azole resistance of C. albicans is still not a clinical problem, however, the emerging phenomenon of the 'trailing effect' by the NCCLS method, even though resolvable by technical modifications, seems at least to indicate a reduction in the inhibitory activity of the azoles.
    Journal of Antimicrobial Chemotherapy 10/2000; 46(3):479-83. · 5.34 Impact Factor
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    ABSTRACT: Predisposing factors, clinical characteristics, and antimicrobial treatment of 37 hematology patients with Stenotrophomonas maltophilia bacteremia who were seen at the department of hematology of the University La Sapienza (Rome) from 1987 to 1996 were evaluated. The results were compared with a control group of patients with Pseudomonas aeruginosa bacteremia. Profound neutropenia was more prolonged in the S. maltophilia group (P=.025), severe cellulitis occurred only in S. maltophilia-infected patients (11 [30%]; P=.0002), and the bacteremia presented as breakthrough infection in 56% of the cases due to S. maltophilia (vs. only 24% of those due to P. aeruginosa; P=.002). Acute mortality rates associated with S. maltophilia and P. aeruginosa bacteremia were 24% and 21%, respectively. In both groups, profound neutropenia and hypotension at the onset of bacteremia, duration of profound neutropenia during bacteremia, severity-of-illness score > or =4, and inappropriate antibacterial treatment were factors significantly associated with death. Most S. maltophilia isolates were resistant to aminoglycosides, beta-lactams, and ciprofloxacin. Cotrimoxazole and ticarcillin-clavulanic acid showed borderline activity. Prompt administration of in vitro-active antibiotics may improve the prognosis of S. maltophilia bacteremia, especially for immunocompromised patients, and novel drug combinations are needed for the treatment of severe infections.
    Clinical Infectious Diseases 09/2000; 31(3):705-11. · 9.37 Impact Factor

Publication Stats

342 Citations
72.34 Total Impact Points


  • 2001–2012
    • Istituto Superiore di Sanità
      • Department of Infectious, Parasitic and Immune-mediated Diseases
      Roma, Latium, Italy
  • 1998–2009
    • Sapienza University of Rome
      • • Department of Public Health and Infectious Diseases
      • • Department of Cellular Biotechnology and Hematology BCE
      Roma, Latium, Italy
  • 2008
    • LIUCBM Libera Università Campus Bio-Medico di Roma
      Roma, Latium, Italy
  • 2007
    • Ospedale Maggiore di Lodi
      Lodi, Lombardy, Italy