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N Petrosillo

Publications and source records attributed to N Petrosillo.

At least 19 recordsLinked to original sources
PubMed2004

Remission of Behçet's disease and keratoconjunctivitis sicca in an HIV-infected patient treated with HAART.

A 34-year-old woman presented with a 10-year history of recurrent oral and genital ulcerations and recurrent episodes of bilateral conjunctivitis associated with HIV infection. A diagnosis of Behçet's disease (BD) in association with keratoconjunctivitis sicca (KCS) was made after exclusion of other viral and autoimmune diseases according to the international criteria for BD. This is the first reported case of a combination of BD and KCS in a patient with HIV infection in which a complete resolution was observed as a result of successful highly active antiretroviral therapy. The likelihood that a direct viral effect or HIV-induced autoimmune mechanisms act in the pathogenesis of both BD and KCS in HIV-infected patients is discussed.

Adult↗
PubMed2004

[Guidelines for the management of HCV infection in HIV-infected patients. Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani].

It is crucial to ensure an optimal clinical management of HCV infection in HIV-co-infected persons. The reasons for the development of guidelines on HCV-infection treatment in HIV-infected persons arise from the need for a standardised management of HIV/HCV coinfection in our Institute. The aim of these guidelines are: to clarify principles of clinical management of HCV infection in HIV-infected patients to care-providers; to improve the awareness of HIV-infected patients cared for our Institute on current management of HCV infection; to improve the quality of care on this topic. These guidelines, based on Evidence based Medicine principles, have been developed by a panel of experts, who conducted a systematic review of the literature, mainly taking into account current international recommendations. In the present document, the most frequent clinical presentation occurring in the management of HIV/HCV co-infected patients at our Institution are discussed. The adherence to present guidelines and their effectiveness at our Institution, outcome indicators will be evaluated. The present guidelines cannot entirely substitute the judgement of an expert clinician. However, adherence to these guidelines will contribute to the improvement of the standard of care of HIV/HCV-co-infected persons.

Anti-HIV Agents↗
PubMed2003

Clinical stability in human immunodeficiency virus-infected patients with community-acquired pneumonia.

Clinical stability (CS), defined as normalization of vital signs, is often used to manage inpatients with community-acquired pneumonia (CAP). The main objective of our study was to identify a reliable definition of CS for human immunodeficiency virus (HIV)-positive patients with CAP. During an 18-month period, 437 HIV-positive Italian inpatients with CAP were enrolled in the study. We used 3 definitions of CS (from a less conservative [definition 1] to a more conservative [definition 3] definition) based on combinations of different thresholds for vital signs. Assessments were performed at admission and daily during the hospital stay. For the 3 definitions, 14.9%, 8.0%, and 4.8% of patients were stable at baseline, with deterioration after reaching CS in 7.16%, 4.76%, and 2.05%, respectively. The 8 patients whose conditions deteriorated after reaching CS definition 3 (systolic blood pressure, >90 mm Hg; pulse, <90 beats/min; respiratory rate, <20 breaths/min; oxygen saturation, >90%; temperature, <37 degrees C; ability to eat; and normal mental status) survived and were discharged from the hospital. The more conservative definition of CS appears to be reliable for the management of HIV-infected patients with CAP.

Adult↗
PubMed2003

Antibiotic policies in Italian hospitals: still a lot to achieve.

A national survey was conducted using a mailed questionnaire in 2000 to quantify the prevalence in Italian hospitals of policies aimed to reduce the emergence and dissemination of resistant strains. The study population consisted of all of the Italian teaching and research hospitals, as well as all public hospitals with 300 beds or more; a 50% random sample of public hospitals smaller than 300 beds was selected. The overall response rate was 80% (428/535). Of the respondents, 9.6% claimed to have implemented a surveillance system of antimicrobial resistance and to be able to identify repeated isolations; 90% had a hospital formulary in place, 50% had a pharmacy committee, and 18% had an antibiotic policy subcommittee that met at least once a year in 1999. Forty-one percent implemented restriction policies based on written justifications for antibiotics, and 8% provided susceptibility results for first line antibiotics only. Antibiotic consumption was monitored by using the Defined Daily Dose, as a unit of measure, in 11% of the cases. Of the respondent hospitals, 251 (58.6%) claimed to have defined clinical practice guidelines for handwashing, 156 (36.4%) for isolation procedures, and seven (1.6%) for the control of methicillin-resistant Staphylococcus aureus (MRSA) infections. Our data demonstrates that intensive efforts are necessary to understand barriers better to change and to identify solutions to adopt uniform, comprehensive policies for antimicrobial resistance in Italy.

Anti-Bacterial Agents↗
PubMed2003

Antibiotic lock-technique for the treatment of catheter-related bloodstream infections.

The management of central venous catheter-related bloodstream infections (CRBSI), though still debated, requires the removal of the line in most cases: we investigated the efficacy of an alternative approach, based on higher concentrations of antibiotics locked within the catheter lumen, in an open, pilot study aimed at preserving the line in place and at eradicating the infection. Thirty consecutive patients carrying a central line over 10 days and who fulfilled criteria for ascertained diagnosis of bacterial CRBSI, had the catheter "locked" with antimicrobials therein; all patients also received systemic antibiotic therapy within the first 48 hours. Subsequently, 15 patients underwent locks alone, and 15 locks plus systemic therapy. Twenty-eight out of 30 (93.3%) patients retained the catheter in place, appearing to be cleared of infection and no treatment-related untoward events were observed. Locks should be considered as effective as line removal in the management of bacterial CRBSI in unselected patients, and could thus provide advantages in terms of resource sparing and lowered antibiotic pressure in the hospital setting.

Adult↗
PubMed2003

Hospital infection control in Italy.

In 1998, the National Health Plan identified the reduction of hospital infection (HI) incidence as a priority. This article reviews the main activities set up in Italy on infection control in the hospital setting. In 1983, the first national prevalence survey reported 6.8% and 7.6% prevalence rates of patients with HI and of HIs, respectively. The high point prevalence found in the intensive care units (ICU) (12.5%), prompted a national incidence study in 1985. This study found an incidence of 29.5 HIs per 100 patients in the ICUs: lower respiratory tract infections (LRTI) were the most common HIs (47.8%), followed by urinary tract infections (UTI) (19.9%) and blood stream infections (BSI) (4.8%). A 1999 survey showed that in 463 Italian hospitals only 40.5% had protocols on the use of disinfectants, 32.3% on sterilization, 30.8% on occupational risk management, 18.3% on isolation measures, 17.7% on hand-washing, 14.3% on antibiotic prophylaxis in surgery, 9.4% on the prevention of surgical site infections and 8.5% on the management of CVC. A national forum to consider surveillance systems using standardized definitions and methodologies is urgently needed.

Bacteremia↗
PubMed2003

Prevalence of nosocomial infections in 15 Italian hospitals: first point prevalance study for the INF-NOS project.

BACKGROUND: The aim of our study was to assess the magnitude of nosocomial infections (NI) in 15 Italian hospitals. PATIENTS AND METHODS: A multicenter point prevalence study of NI was carried out in October 2001 among eight medical, surgical and intensive care units in hospitals with more than 400 beds, after a pilot phase performed in April 2001. RESULTS: Of the 2,165 surveyed patients, 163 had a total of 179 NIs. The global prevalence rate of patients with NI and of NI was respectively 7.5% (95% CI 6.4-8.6) and 8.3% (95% CI 7.1-9.4), ranging from 5.5% (95% CI 4.2-6.8) in medical wards to 34.2% (95% CI 25.7-42.7) in intensive care units (ICUs). The NI prevalence was higher in: hospitals that did not have an infection control committee (ICC) compared to hospitals with an ICC (10.3%, 95% CI 6.4-10.1 versus 7.2, 95% CI 6.0-8.3, p = 0.08); university hospitals compared with non-teaching hospitals (9.4%, 95% CI 4.5-14.2 versus 7.4%, 95% CI 6.3-8.5, p = 0.4) and; hospitals with 1,000 or more beds compared to lower volume hospitals (9.5%, 95% CI 7.3-11.7 versus 6.6%, 95% CI 5.3-7.8, p = 0.02). The most prevalent infections found were lower respiratory tract infections, urinary tract infections and surgical-site infections, representing 38.0%, 20.1% and 12.8%, respectively, of all NI. Among 1,674 patients without any infection, 575 (34.3%) of them had been undergoing antibiotic treatment at the time of the survey. CONCLUSION: The high rate of NI, particularly in ICUs, and the high number of improper procedures emphasize the need to develop clinically-oriented guidelines, tailor active infection control programs and implement an active ICU surveillance system.

Bacteremia↗
PubMed2003

Nosocomial infections in HIV-positive patients: an overview.

Nosocomial infections (NIs) constitute a significant public health problem and contribute to prolonged hospitalization, additional healthcare costs and excess morbidity and mortality. NIs appear to be more common in patients with acquired immunodeficiency syndrome (AIDS) as a result of some degree of immunosuppression, prior antiobiotics treatment and greater exposure to invasive devices such as indwelling intravenous catheters. The objective of this article is to give an insight into the main NIs occurring in HIV-infected patients. Literature pertaining to NIs in HIV-infected patients was reviewed. According to the leading studies in the literature, the incidence of NI ranges from 7.9 to 15 per 100 admissions. Bloodstream infections are the most frequent infections, mainly due to intravascular catheters, followed by urinary and respiratory tract infections. Colonization seems to have an important role in the development of NIs among this immunocompromised population. CLinicians need to be aware of the risk of NIs in HIV-infected patients, and must always take these infections into account in their overall management.

Bacteremia↗
PubMed2002

Prevalence, determinants, and molecular epidemiology of Streptococcus pneumoniae isolates colonizing the nasopharynx of healthy children in Rome.

The aim of this study was to determine the factors favouring Streptococcus pneumoniae nasopharyngeal colonization of healthy children attending daycare centres and to describe the circulation of penicillin-nonsusceptible strains using molecular techniques. A single nasopharyngeal swab was obtained from 610 children attending daycare centres in the southeast area of Rome. Streptococcus pneumoniae isolates were serotyped, and antibiotic susceptibility was assayed by the E test. The genetic determinants of erythromycin resistance were detected by a duplex polymerase chain reaction, and the penicillin-nonsusceptible isolates were typed by pulsed-field gel electrophoresis. The overall carriage rate of Streptococcus pneumoniae was 14.9%. Living with more than three persons in the same household was the only risk factor statistically associated with carriage. Sixteen of 85 (18.8%) strains were nonsusceptible to penicillin, and 44 (52%) were resistant to erythromycin. Of the erythromycin-resistant strains, the vast majority showed a high level of resistance and carried the erm(B) gene. The penicillin-nonsusceptible strains belonged to six different serotypes; molecular typing showed that in only one case (2 strains) was there a circulation of the same clone in the same daycare centre. In view of the high rate of resistant Streptococcus pneumoniae strains, risk factors for carriage of resistant strains were evaluated. Children who received macrolides in the previous month had a higher risk of being colonized by macrolide-resistant strains as well as by strains resistant to both penicillin and erythromycin. Limiting the use of antibiotics in children seems the most appropriate measure to control the spread of antibiotic-resistant strains.

Anti-Bacterial Agents↗
PubMed2002

Pulmonary tuberculosis in HIV-infected patients presenting with normal chest radiograph and negative sputum smear.

BACKGROUND: HIV-infected patients with pulmonary tuberculosis exhibit atypical radiological presentation and negative sputum smear more frequently than their HIV-negative counterparts. PATIENTS AND METHODS: We performed a retrospective study based on a chart review of 146 HIV-infected patients with pulmonary symptoms and culture-proven pulmonary tuberculosis. We compared clinical characteristics and the outcome in 71 patients (49%) with positive sputum smear (SS+), 62 patients (42%) with negative sputum smear/abnormal chest X-ray (SS-/CXR+) and 13 patients (9%) with negative sputum smear/normal chest X-ray (SS-/CXR-). Patients were enrolled from January 1987 to December 1998, and were followed up until December 1999. RESULTS: On hospital admission the three groups of patients examined did not differ significantly in demographic characteristics, degree of immunosuppression or Mycobacterium tuberculosis drug-susceptibility pattern. SS-/CXR- patients were significantly Less LikeLy to present with prolonged fever and dyspnea. Median survival was shorter for SS-/CXR- patients (6.4 months vs 20.2 and 18.8 months in the other two groups). In multivariate analysis, SS-/CXR-patients had a significantly increased risk of death (hazard ratio 3.0, 95% confidence interval, 1.4 to 6.4, p = 0.004) compared to SS+ patients. This increase in risk was no longer statistically significant when initiation of antituberculous therapy within 8 weeks from the collection date of the first specimen yielding M. tuberculosis was included in the multivariate model. CONCLUSION: Decreased survival was observed in HIV-infected patients with pulmonary tuberculosis and with both negative sputum smear and normaL chest X-ray presentation. This may primarily be a resuLt of delayed tuberculosis diagnosis and initiation of antituberculous therapy. The latter delay may also lead to a faster progression of HIV infection in SS-/CXR patients, in whom diagnostic oversight may be common.

AIDS-Related Opportunistic Infections↗
PubMed2002

Macrolide efflux genes mef(A) and mef(E) are carried by different genetic elements in Streptococcus pneumoniae.

Susceptibilities to macrolides were evaluated in 267 Streptococcus pneumoniae isolates, of which 182 were from patients with invasive diseases and 85 were from healthy carriers. Of the 98 resistant isolates, 20 strains showed an M phenotype and carried mef. Strains that carried both mef(A) and mef(E) were found: 17 strains carried mef(A) and 3 carried mef(E). The characteristics of the strains carrying the mef genes and the properties of the mef-containing elements were studied. Strains carrying mef(A) belonged to serotype 14, were susceptible to all the antibiotics tested except erythromycin, and appeared to be clonally related by pulsed-field gel electrophoresis (PFGE). The three mef(E) strains belonged to different serotypes, showed different susceptibility profiles, and did not appear to be related by PFGE. The sequences of a fragment of the mef-containing element, which encompassed mef and the msr(A) homolog, were identical among the three mef(E)-positive strains and among the three mef(A)-positive strains, although there were differences between the sequences for the two variants at 168 positions. In all mef(A)-positive strains, the mef element was inserted in celB, which led to impairment of the competence of the strains. In line with insertion of the mef(E) element at a different site, the competence of the mef(E)-positive strains was maintained. Transfer of erythromycin resistance by conjugation was obtained from two of three mef(A) strains but from none of three mef(E) strains. Due to the important different characteristics of the strains carrying mef(A) or mef(E), we suggest that the distinction between the two genes be maintained.

Bacterial Proteins↗
PubMed2001

Endocarditis caused by Aspergillus species in injection drug users.

Aspergillus endocarditis is a rare event; a very few cases have been reported in injection drug users (IDUs) and patients infected with human immunodeficiency virus (HIV). We report 2 proven cases and 1 highly suggestive case of Aspergillus endocarditis in IDUs, 2 of whom were infected with HIV, and discuss some related clinical and pathogenic aspects.

AIDS-Related Opportunistic Infections↗
PubMed2001

Changing clinical presentation and survival in HIV-associated tuberculosis after highly active antiretroviral therapy.

OBJECTIVE: To assess changes in clinical presentation and outcome of HIV-associated tuberculosis (TB) before and after widespread implementation of highly active antiretroviral therapy (HAART). METHODS: We reviewed clinical charts of HIV-infected patients with culture-confirmed pulmonary TB in two referral clinical centers in Rome, Italy. The 67 patients diagnosed in 1995 to 1996 were compared with 51 patients diagnosed in 1997 to 1998. To analyze factors associated with survival we used a Cox model including antiretroviral therapy as a time-dependent covariate. RESULTS: Patients diagnosed in 1997 to 1998 were more likely to have TB as the first AIDS-defining illness (78% versus 58%, p <.05), to have HIV diagnosed <2 months before TB (33% vs. 7%, p <.005) and to have typical chest radiograph pattern (45% vs. 25%, p <.05), and had a higher CD4(+) count (median 105 vs. 43, p <.005). Survival at 1 year was 80% for patients diagnosed in 1997 to 1998 vs. 65% for those diagnosed in 1995 to 1996 (p by log-rank =.02). After adjusting at multivariate analysis, time period of diagnosis was not confirmed as associated with survival (hazard ratio, 1.05; 95% confidence interval, 0.39--2.81). Age, CD4+ cell count <25/mm(3), and AIDS-defining illnesses before TB diagnosis were all associated with an higher risk of death, whereas a decreased risk of death was observed in patients starting a triple combination antiretroviral therapy after TB diagnosis (hazard ratio, 0.14; 95% confidence interval, 0.03--0.57). CONCLUSIONS: Cases of HIV-associated TB occurring in patients with advanced immunosuppression and presenting with atypical radiologic appearance tend to be relatively less common in the HAART era. HAART is a major factor in prolonging survival in these patients.

Adult↗
PubMed2001

Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis.

To assess hepatitis C virus (HCV) incidence rates and identify determinants of infection among hemodialysis patients, a multicenter study was conducted in 58 units in ITALY: An initial seroprevalence survey was conducted among 3,492 patients already on hemodialysis therapy as of January 1997 and among an additional 434 patients who began dialysis up to January 1998. HCV antibodies were assessed by third-generation enzyme immunoassays. Patients testing seronegative at baseline were enrolled into a 1-year incidence study with serological follow-up at 6 and 12 months. For patients who seroconverted, an HCV RNA assay was performed on stored baseline samples to confirm new infection. A nested case-control study was subsequently performed to investigate potential risk factors. For each incident case, three controls negative for both HCV antibodies and HCV RNA were randomly selected. At enrollment, HCV seroprevalence was 30.0%. During follow-up, 23 new HCV cases were documented, with a cumulative incidence of 9.5 cases/1,000 patient-years. By logistic regression analysis, an increased risk for HCV infection emerged for patients attending the dialysis units with a high prevalence of HCV-infected patients at baseline (odds ratio [OR], 4.6) and for those attending units with a low personnel-patient ratio (OR, 5.4). Among extradialysis factors, a history of surgical intervention in the previous 6 months (OR, 16.7) significantly increased HCV risk. These findings suggest that the combination of understaffing and a high level of infected patients in the dialysis setting increases the risk for HCV nosocomial transmission. This is likely related to an increased likelihood for breaks in infection control measures.

Aged↗
PubMed2001

Risk management of HBsAg or anti-HCV positive healthcare workers in hospital.

Recommendations are made for controlling the transmission of the hepatitis B and hepatitis C viruses from healthcare workers to patients. These recommendations were based both on the literature and on experts' opinions, obtained during a Consensus Conference. The quality of the published information and of the experts' opinions was classified into 6 levels, based on the source of the information. The recommendations can be summarised as follows: all healthcare workers must undergo hepatitis B virus vaccination and adopt the standard measures for infection control in hospitals; healthcare workers who directly perform invasive procedures must undergo serological testing and the evaluation of markers of viral infection. Those found to be positive for: 1) HBsAg and HBeAg, 2) HBsAg and hepatitis B virus DNA, or 3) anti-hepatitis C virus and hepatitis C virus RNA must abstain from directly performing invasive procedures; no other limitations in their activities are necessary. Infected healthcare workers are urged to inform their patients of their infectious status, although this is left to the discretion of the healthcare worker; whose privacy is guaranteed by law. If exposure to hepatitis B virus occurs, the healthcare worker must undergo prophylaxis with specific immunoglobulins, in addition to vaccination.

Algorithms↗