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M Venditti

Publications and source records attributed to M Venditti.

123 records · Page 7Linked to original sources
PubMedDate not supplied

Catheter-related right-sided endocarditis in bone marrow transplant recipients.

Bone marrow transplant recipients are at increased risk of severe central venous catheter-related septicemias that may be complicated by endocardial infection. In view of this, we prospectively evaluated 141 consecutive patients receiving allogeneic or autologous bone marrow infusion. Seven (5%) of 141 patients developed eight episodes of a clinical syndrome compatible with catheter-related right-sided infective endocarditis; this diagnosis was confirmed at autopsy in two patients who died. Staphylococcus epidermidis was the most frequent isolate (four cases). Other offending pathogens were, in one case each, Enterococcus faecalis, Corynebacterium jeikeium, Pseudomonas alcaligenes, and Achromobacter xylosoxidans plus Candida species. Three- to 7-week courses of antibacterial therapy were associated with a favorable outcome in six of the seven cases. Infective endocarditis may be a complication of the use of central venous catheters and should be actively sought in septicemic bone marrow transplant recipients.

Adolescent↗
PubMedDate not supplied

Blastoschizomyces capitatus: an emerging cause of invasive fungal disease in leukemia patients.

Blastoschizomyces capitatus (formerly named Trichosporon capitatum or Geotrichum capitatum) is a rare cause of invasive fungal disease in immunocompromised hosts. We retrospectively studied epidemiologic, clinical, pathologic, and microbiologic features of this infection during a 68-month period at the Division of Hematology of the University La Sapienza in Rome. Twenty patients with evidence of B. capitatus were identified: 12 were infected, four were possibly infected, and four had evidence of B. capitatus colonization but were not infected by this fungus. Pulmonary infiltrates were seen in seven infected patients; four of these patients eventually developed mycetomalike cavitations. Eight infected patients presented clinical and radiologic features of focal hepatitis compatible with hepatosplenic candidiasis. Of the 12 infected patients, two did not receive any antifungal treatment and died, five did not show any response to systemic antifungal therapy, and five received prolonged amphotericin B plus 5-fluorocytosine therapy. Of the last group, three patients achieved stable remission of their acute leukemia and were cured, and two improved but had an apparent relapse of B. capitatus infection after their acute leukemia recurred.

Adolescent↗
PubMedDate not supplied

Spontaneous pneumothorax complicating pulmonary mycetoma in patients with acute leukemia.

Pneumothorax caused by the rupture of a mycetoma into the pleural space is rarely reported in patients undergoing intensive cytotoxic therapy for hematologic malignancies. We reviewed 46 episodes of mycetoma that developed in 43 patients undergoing antineoplastic therapy; six (13%) of these episodes were further complicated by the occurrence of pneumothorax that developed after bone marrow recovery with return to normal granulocyte count. Etiologic agents included Aspergillus fumigatus, Aspergillus fumigatus plus Blastoschizomyces capitatus, and Mucor (one case each). No pathogen was detected in the remaining three cases of pneumothorax. Four of the six patients died (7, 10, 27, and 50 days after the onset of pneumothorax). Two of the six patients with pneumothorax died of massive hemoptysis, whereas only one of the 40 patients who did not develop pneumothorax died of hemoptysis. This suggests that both pneumothorax and hemoptysis may represent the clinical expression of a more destructive course of invasive fungal diseases.

Adult↗
PubMedDate not supplied

Cryptosporidiosis in patients with hematologic malignancies.

The clinical features of cryptosporidial infection in 20 patients with hematologic malignancies were assessed. Five patients had severe diarrhea, 10 had moderate diarrhea, and five were asymptomatic carriers of Cryptosporidium. Extraintestinal cryptosporidiosis with pulmonary involvement was observed in one case and relapse of cryptosporidiosis in four. All but one patient recovered from cryptosporidiosis whether or not spiramycin was administered. Cryptosporidiosis in T cell-depleted recipients of allogeneic bone marrow transplants did not appear more severe than that in patients undergoing autologous bone marrow transplantation or conventional chemotherapy.

Adolescent↗
PubMedDate not supplied

Cotrimoxazole prophylaxis in patients with leukemia and prolonged granulocytopenia.

Sixty-three patients with acute nonlymphoid leukemia (ANLL) under cytostatic treatment were investigated in a randomized trial to determine whether oral administration of cotrimoxazole (TMP/STX) would reduce the rate of infection. Four significant differences were observed between the group given TMP/STX (30 patients) and the control group (33 patients): 1) the mean duration of severe granulocytopenia (less than or equal to 500 PMN/mm3) before the first febrile episode was longer in prophylaxis group, 14.26 days versus four in the control group (p less than 0.001); 2) the number of febrile episodes was 37 in TMP/STX group and 69 in control group (p less than 0.01); 3) 23 patients on prophylaxis presented at least one febrile episode versus 33 in the control group (p less than 0.01); 4) deaths due to infection were two in the TMP/STX group versus 11 in control group (p less than 0.05). Prophylaxis with TMP/STX appears to be useful since by reducing the number of febrile episodes and deaths due to infection, it increases the survival of leukemia patients under cytostatic drugs. Nevertheless, further studies on a larger number of patients are necessary in order to confirm the true efficacy of the drug in the reduction of sepsis and death due to infection.

Acute Disease↗
PubMedDate not supplied

[Hospital infection surveillance in 5 Roman intensive care units].

The A.A. carried out a survey on hospital acquired infection (HAI) in the intensive care units (ICU) of five roman hospitals. The study monitored the following site-specific infection rates: pneumonia (PNE), blood stream infections (BSI), urinary tract infections (UTI), surgical site infections (SSI). According to CDC definitions all patients developing infection 48 hours or more after ward admission were included. Furthermore risk factors (i.e. age, sex, SAPS II), invasive procedures (i.e. endotracheal intubation, vascular and urinary catheterisation), microbiological isolates and their antibiotic susceptibility were screened. The overall 503 patients characteristics (i.e., age, length of stay, case-mix...) showed the wards as general ICU's. Although the SAPS II score was similar, mortality (18.2%-42.9%) and general infection rates (15.4%-40.4%) among the five ICU's were considerably variable (p < 0.05), as HAI episodes distribution by type: PNE (37-88%), BSI (6-42%), UTI (6-24%), SSI (3-7%) (p < 0.05). Also device-associated infection rates such as Ventilator-associated PNE (11.6-24.6@1000), Vascular catheter-associated BSI (3.4-19.2@1000). Urinary catheter-associated UTI (2.6-14.0@1000) and invasive procedures management were different. Among the infected patients the most commonly isolated microorganisms were P. aeruginosa and Staphylococcus spp., which presented a considerable antibiotic resistance. The study showed: 1) sampling (i.e. blood cultures, tracheal aspirate and urine samples) and laboratory methodology indispensable for a correct HAI diagnosis were not standardized in the five ICU's; 2) hospital infection control policy was not carried out in all ICU's. The study showed a lack of standardization which limits the comparability of the general roman ICU's.

Adult↗
PubMedDate not supplied

[Hospital infection prevention in an intensive care unit].

Aim of the study was to evaluate the efficacy of the hospital infection preventive procedures adopted in the intensive care unit (ICU) of the "S. Camillo-Forlanini" hospital in Rome. First the following prevention protocols were analysed: invasive procedures (intubation, CVC and urinary catheter), surveillance cultures, infection management and antimicrobial prophylaxis. Comparison with international guidelines was carried out and protocols enforcement by the personnel was verified. Secondly a one year longitudinal surveillance study was performed in order to monitor the following site-specific infection rates: pneumonia (PNE), blood stream infections (BSI), urinary tract infections (UTI), surgical site infections (SSI). According to CDC definitions all patients developing infection 48 hours or more after ward admission were included. Furthermore risk factors (i.e. age, sex, SAPS II), invasive procedures (i.e. endotracheal intubation, vascular and urinary catheterisation), microbiological isolates and their antibiotic susceptibility were screened. Overall 302 patients (191 men and 111 women) were admitted; age 55.1 +/- 20.7 years (mean), SAPS II 42.4 +/- 16.2 (mean) and average ward stay 12.5 +/- 21.7 days. Crude mortality was 15.9%. Results showed a total of 37 infection episodes (20 PNE , 7 BSI, 8 UTI and 2 SSI) in 33 patients (10.9%). Infection and mortality rates were among the lowest registered in other italian ICU's. Standardized infection rates associated to invasive procedures were: Ventilator-associated PNE rate (7.8/1000), central venous catheter-associated BSI rate (2.2/1000), urinary catheter-associated UTI rate (2.1/1000). The first (PNE) was higher than the NNIS mean rate, whwreas BSI and urinary catheter associated rates were minor than the mean rates reported by NNIS. Gram-negatives were 61.7%, gram-positives 27.6% and Candida spp. 10.6%. The results confirm the ICU successful preventive strategy.

Cross Infection↗
PubMedDate not supplied

[Infective endocarditis: a changing disease].

Infective endocarditis is best characterized as a disease in evolution. The list of patients at risk, which formerly included almost exclusively patients with rheumatic heart disease, is being continuously modified and expanded. Nowadays, patients with prosthetic heart valves, users of illicit intravenous drugs, and patients with mitral valve prolapse rather than patients with rheumatic heart disease account for the majority of cases of infective endocarditis. Moreover, due to the widespread use of indwelling atrial catheters for parenteral nutrition as well as for intensive cytotoxic therapy, catheter-related right-sided endocarditis is emerging among nosocomial infections. With the advent of successful antimicrobial therapy, complications rather than endocardial infection pose the major therapeutic problems. In addition to progressive heart failure, myocardial abscesses, fungal endocarditis, relapsing infection, and major systemic emboli in the presence of large protuberant vegetations constitute indications for replacement of the valve. Despite progresses in diagnosis and therapy, infective endocarditis will most likely continue to challenge physicians even in the next future.

Adult↗
PubMedDate not supplied

Aspergillus colonization of the nose and pulmonary aspergillosis in neutropenic patients: a retrospective study.

Fungal infections are definitely increasing in neutropenic patients with hematologic malignancies. In view of a previous report on a likely correlation between nose cultures positive for Aspergillus spp. and pulmonary aspergillosis, a retrospective study on 306 consecutive neutropenic patients was performed. Twenty-six patients had one or more nose cultures positive for Aspergillus: thirteen of them developed pulmonary aspergillosis. On the other hand, only twenty out of the remaining 280 patients with negative nose cultures developed this fungal pneumonia (p less than 0.00001). Even if negative results do not obviously exclude the possibility of invasive aspergillosis, nose cultures positive for Aspergillus might prove helpful in predicting this fungal infection in febrile neutropenic patients.

Agranulocytosis↗