Emmanuel Mavromanolakis

University Hospital of Heraklion, Irákleio, Attica, Greece

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Publications (13)32.82 Total impact

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    ABSTRACT: The advancing antimicrobial drug resistance among Enterobacteriaceae renders the evaluation of potential novel therapeutic options necessary. We sought to evaluate the in vitro antimicrobial activity of fosfomycin against multidrug-resistant (MDR) Enterobacteriaceae isolates. Antimicrobial susceptibility to fosfomycin and 12 additional antibiotics of MDR Enterobacteriaceae isolates collected between November 2007 and April 2009 at the University Hospital of Heraklion, Crete, Greece, was examined using the Etest method. A total of 152 MDR Enterobacteriaceae isolates were studied, including Klebsiella pneumoniae (76.3%), Escherichia coli (17.1%), Proteus mirabilis (4.6%) and other species (2.0%). Antimicrobial susceptibility rates were highest for fosfomycin (92.8%), tigecycline (92.1%) and colistin (73.0%) followed by imipenem (35.5%), tetracycline (20.4%), gentamicin (19.7%), trimethoprim/sulfamethoxazole (12.5%) and ciprofloxacin (10.5%). Of the 152 isolates, 85 (55.9%) were extensively drug-resistant (XDR), of which 78 (91.8%) remained susceptible to fosfomycin. Susceptibility to fosfomycin of the 79 carbapenemase-producing, 34 extended-spectrum beta-lactamase-producing and 24 metallo-beta-lactamase-producing isolates was 94.9%, 94.1% and 83.3%, respectively. In conclusion, in this study fosfomycin exhibited good in vitro antimicrobial activity against MDR and XDR Enterobacteriaceae. We suggest further evaluation of the potential clinical utility of fosfomycin against infections caused by these pathogens.
    Full-text · Article · Mar 2010 · International journal of antimicrobial agents

  • No preview · Article · Jan 2010
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    ABSTRACT: We evaluated the in vitro activity of fosfomycin against urinary isolates in a region in Greece that exhibits considerable antimicrobial resistance by evaluating retrospectively relevant susceptibility data retrieved from the microbiological library of the University Hospital of Heraklion, Crete, Greece. We examined 578 urinary isolates. In total, 516 (89.2%) were susceptible to fosfomycin; 415 isolates were gram negative, and 101 isolates were gram positive. Fosfomycin appears to exhibit good levels of in vitro activity against the examined urinary isolates.
    Full-text · Article · Sep 2009 · Antimicrobial Agents and Chemotherapy
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    ABSTRACT: To report our experience in patients with spontaneous perirenal hemorrhage (SPH) seen at our institution over a 10-year period. Over the years from 1992 to 2002, 13 patients with SPH without a history of trauma, were treated at our hospital. There were 5 male and 8 female patients with a mean age of 55.7 years (range 36-79 years). The patients' records were reviewed retrospectively with respect to etiology, clinical presentation, radiologic findings and therapeutic management of SPH. All patients were presented with flank or abdominal pain. Radiological evaluation included ultrasonography (U/S) in 7 cases and computed tomography (CT) in 13 cases. An underlying renal mass was indentified employing U/S in 2 cases and using CT in 10 cases respectively. The etiology of SPH was determined in 12 cases. The most common causes were angiomyolipoma (5 patients) and renal cell carcinoma (4 patients). Out of the remaining 4 cases with SPH, one was associated with anticoagulant therapy; polyarteritis nodosa and Wegener angeitis were the underlying diseases in 2 cases respectively; finally, the etiology could not be determined in 1 case. All but two patients were managed surgically. Complete nephrectomy was performed in 6 cases, partial nephrectomy in 4 and simple evacuation of the haematoma was performed in 1 case. SPH presence should arouse suspicions concerning its etiology, since the most common cause is a renal tumor and approximately 50% of such tumors are malignant. CT scanning is a useful imaging modality for the initial evaluation of SPH, permitting identification of the underlying cause in most instances.
    No preview · Article · Feb 2004 · International Urology and Nephrology
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    ABSTRACT: To define factors associated with the failure of shockwave lithotripsy (SWL) in the treatment of ureteral stones. We retrospectively studied 405 men and 283 women (mean age 52.6 years) who underwent SWL with a second-generation lithotripter in the period 1994 to 2001. We evaluated available clinical and radiologic features that might have been related to failure of SWL therapy. Treatment was successful in 502 patients (73%). The 186 patients (27%) in whom treatment failed underwent endourologic alternatives or open surgery. Multivariate logistic regression analysis revealed that unsuccessful outcome was significantly related to: (1) pelvic ureteral stones (odds ratio [OR] 4.02; 95% CI 1.97, 8.19); (2) stone size >10 mm (OR 3.46; 95% CI 2.16, 5.53); (3) obstruction (OR 1.93; 95% CI 0.99, 3.77); and (4) obesity (OR 1.87; 95% CI 0.95, 3.77). Although the predictive value of each individual parameter was relatively low (15.3%-27.9%) the cumulative risk was 82.95% when patients had all four features. The strongest independent predictors of failure were pelvic stones and stones >10 mm (cumulative predictive value 57.3%). These variables may enable identification of a subgroup of patients who will fail initial SWL. These patients may be candidates for endourologic alternatives as first-line treatment.
    No preview · Article · May 2003 · Journal of Endourology
  • S. Maraki · E. Mavromanolakis · M. Dialynas · S. Kavvalos · G. Samonis · Y. Tselentis

    No preview · Article · Aug 2002 · Mycoses
  • E Mavromanolakis · S Maraki · A Cranidis · Y Tselentis · D.P. Kontoyiannis · G Samonis
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    ABSTRACT: We studied gastrointestinal (GI) colonization by Candida albicans in patients receiving oral norfloxacin, ciprofloxacin or ofloxacin as monotherapy for urinary tract infections. Quantitative stool cultures for C. albicans were performed before, at the end and 1 week after the end of treatment. All 3 quinolones increased GI colonization by C. albicans. Ciprofloxacin caused the highest increase, which was not statistically significant.
    No preview · Article · Feb 2001 · Infectious Diseases
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    ABSTRACT: A phenolypic analysis of peripheral blood lymphocytes was carried out in order to investigate the lymphopenia developed in some patients with solid tumors treated with systemic chemotherapy. Peripheral blood was obtained from 53 cancer patients receiving chemotherapy with more than grade 2 neutropenia, before treatment, during the nadir of neutrophils and after bone marrow recovery. Cell phenotype was performed using monoclonal antibodies while cell proliferation, using 3HTdR uptake, was evaluated after cell stimulation with PHA-P and anti-CD3 moAb. Post-chemotherapy myelosuppression and rhG-CSF-induced bone marrow recovery were associated with lymphopenia and lymphocytosis reaching pre-treatment values, respectively; both lymphopenia and lymphocytosis concerned all lymphocyte subpopulations. Lymphocytosis was positively correlated with the absolute number of CD3+, CD4+ and CD20+ cells; in addition, the absolute number of HLA-DR+ and CD25+ cells was also increased. During bone marrow recovery, the absolute number of CD25+ cells was correlated with the increased number of both CD3+/CD25+ and CD4+/CD25+ but not of CD8+/CD25+ or CD20+/CD25+ cells. CD4+ lymphopenia (less than 400 cells/dL) was detected in 58% and 21% of the patients during myelosuppression and bone marrow recovery, respectively. PHA-P and anti-CD3 moAb failed to enhance lymphocyte proliferation in 60% and 44% of the patients during bone marrow recovery, respectively. Post-chemotherapy CD4+ cell repopulation is an active phenomenon. However, in several patients CD4 lymphopenia, which could be associated with functional cell abnormalities, may persist during bone marrow recovery leading to impaired cell-mediated immunity.
    No preview · Article · Jan 1999 · Anticancer research
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    ABSTRACT: Two unusual cases of xanthogranulomatous pyelonephritis studied by both magnetic resonance imaging and computed tomography, are presented. Extension of the disease depicted by both computed tomography and magnetic resonance imaging was compatible with the findings at surgery. Computed tomography seems to be sufficient for xanthogranulomatous pyelonephritis imaging evaluation, while magnetic resonance imaging is not recommended on a routine basis, since no additional valuable information is yielded.
    No preview · Article · Sep 1998 · European Journal of Radiology
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    ABSTRACT: To evaluate the efficacy and safety of the docetaxel-cisplatin combination in patients with advanced non-small-cell lung cancer (NSCLC). Chemotherapy-naïve patients with histologically confirmed, measurable stage IIIB or IV NSCLC, a World Health Organization (WHO) performance status of 0-2 and adequate bone marrow, renal, hepatic and cardiac function were eligible for the study. Patients received docetaxel (100 mg/m2) as an one-hour infusion on day 1 and cisplatin (80 mg/m2) as a 30-min infusion with appropriate hydration on day 2. Granulocyte colony-stimulating factor (G-CSF; 150 micrograms/m2, SC) was given on days 3 to 13. Treatment was repeated every three weeks. Fifty-three patients were enrolled (28 with stage IIIB and 25 with stage IV). One complete and 23 partial responses were observed (overall response rate (OR): 45%; 95% CI: 34.1%-61.8%). The response rate was 57% and 32% in patients with stages IIIB and IV disease (P = NS). The median time to progression was 36 weeks and the median survival 48 weeks; the one-year survival was 48%. Grade 3-4 neutropenia occurred in 23 patients, 15 of whom were hospitalized for neutropenic fever; two patients died of sepsis. Grade 2 neurotoxicity was observed in six patients and grade 3 in five patients; grade 3 fatigue occurred in seven patients, grade 3-4 mucositis in four patients and grade 3-4 diarrhea in six patients. Mild allergic reactions and oedema were observed in five and four patients, respectively. The median dose intensity was 30 mg/m2/week for docetaxel and 24 mg/m2/week for cisplatin, corresponding to 91% and 89% of the specified protocol doses, respectively. The docetaxel-cisplatin combination is an active regimen in advanced NSCLC, but hematologic toxicity remains high despite the prophylactic use of G-CSF.
    Preview · Article · Apr 1998 · Annals of Oncology
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    ABSTRACT: The present study aims to evaluate the feasibility, toxicity, and efficacy of concurrent chemotherapy with cisplatinum and docetaxel, and external radical radiotherapy for transitional cell carcinoma of urinary bladder. 42 patients (34 men, 8 females) with invasive bladder carcinoma (clinical stages T1-4) were treated after transurethral biopsy with chemotherapy and concomitant external radiotherapy. Chemotherapy consisting of cisplatin infusion (30 mg/m2) and Docetaxel (40 mg/m2) was given twice a week simultaneously with-irradiation during the whole treatment period (6-8 weeks) as follows: Cisplatin (D1,D8,D15,D22, D25,D36,D43,D50) and Docetaxel (D4, D11, D18, D25, D32, D39, D46, D53). An external irradiation scheme 1.8 to 2.0 Gy per fraction, 5 days a week was used up to 68-74 Gy (6MeV photons) total tumor dose. All but S patients completed the planned chemoradiation protocol. The complete response rate (CR-rate) assessed at 3 months after completion of combined treatment was 100%, 63.6%, 46.15% and 95% for clinical stage (c) cT1 (9/9), cT2 (7/11), cT3 (6/13) and cT4 (1/4) cases respectively. None of 9 patients with T1 tumors had any local failure at 36.1 months mean follow-up time. In total, 9 of 37 patients (24.32%) relapsed locally and/or distantly and were followed for 25.04 months (mean time), 50% of the relapses occurred at a mean time of 7.25 months. The mortality rate was 10.81% (4/37). All these patients died with a mean time of 11 months. 32 cases remain alive 19-46 months after treatment; 27 of those are with no evidence of disease with a mean follow-up time of 32.24 months. In total, there was a 78.50% (30/37) and a 75.67%, (28/37) rate of overall survival and pelvic control respectively at 25.04 months mean follow-up time. Chemotherapy was discontinued in 2 cases due to acute gastrointestinal toxicity and in 3 more, due to patient compliance. There was 1 toxic death 2 months after treatment completion due to ureteral obstruction and impaired renal function. The acute toxicity was estimated as moderate to severe and caused the interruption of treatment for 5 to 10 days in 8 of 37 patients (21.62%). Myelotoxicity appeared in 22/37 patients but febrile grade III and IV neutropenia was observed in 3 patients (8.10%) and thrombocytopenia (Grade I-III) in 8 (21.62%). Concerning late effects a sigmoid stricture, a transient small bowel obstruction, 4 patients with contracted bladder and 1 case with renal failure were found. Grade I to III hypersensitivity reactions appeared in 8/37 patients (21.62%) while stomatitis (grade I-II) and grade II skin toxicity appeared in 3 and 4 patients respectively. These and other symptoms (Grade I to II peripheral edema, transient myalgias and arthralgias in 7/37 cases), paresthesias or numbness (3/37) and peripheral motor dysfunction (1/37) were responsible for early reduction of docetaxel dose from 40 mg/m2 to 20 mg/m2. This preliminary analysis suggest that the radiosensitizing effect of cisplatin and docetaxel to megavoltage irradiation yielded a high CR-rate in transitional cell bladder carcinoma patients with medium to severe early and late side effects. The value of such a combined treatment as far as the tumor eradication is concerned requires further evaluation, because of the small number of patients, the short follow-up, and the absence of other studies using docetaxel as a radiosensitizer in urothelial cell cancer.
    No preview · Article · Nov 1997 · Anticancer research
  • E Mavromanolakis · S Maraki · G Samonis · Y Tselentis · A Cranidis
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    ABSTRACT: The effects of antibiotics used for prophylaxis in women with recurrent urinary tract infections (UTIs) on the aerobic intestinal flora were investigated. Twenty-one patients with recurrent UTIs were randomly divided into three groups. The patients of each group received monotherapy with oral norfloxacin, trimethoprim-sulfamethoxazole or nitrofurantoin for one month. Urine and stool quantitative aerobic cultures were performed before prophylaxis, 2 and 4 weeks after the initiation of therapy, and 2 weeks after antibiotics were discontinued. The gram-negative aerobic flora was strongly suppressed during the administration of norfloxacin and trimethoprim-sulfamethoxazole, while Enterococcus spp. were not affected. Resistant strains of Escherichia coli were detected in two patients, one in the norfloxacin and one in the trimethoprim-sulfamethoxazole group. The aerobic intestinal flora was not affected by nitrofurantoin. These findings help in the selection of the most appropriate antimicrobial agent for prophylaxis in recurrent UTIs, so as to reduce the possibility of emergence of resistant bacterial strains.
    No preview · Article · Jul 1997 · Journal of chemotherapy (Florence, Italy)
  • E Mavromanolakis · G Samonis · A Cranidis
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    ABSTRACT: A case of mucinous adenocarcinoma probably originating in the renal pelvis of an ectopic pyelic kidney with infiltration of the adjacent urinary bladder is reported. Review of the literature shows that this is the 42nd case of such a tumor, the second one reported in the pelvis of an ectopic pyelic kidney, and the first infiltrating the urinary bladder.
    No preview · Article · Jan 1995 · Oncology