Italian Tertiary Care Hospital Research Articles

Epidemiology of candidaemia and antifungal susceptibility patterns in an Italian tertiary-care hospital

The epidemiological and antifungal susceptibility data for 94 episodes of candidaemia in an Italian tertiary-care hospital between January 2000 and August 2003 were evaluated by prospective laboratory-based surveillance. The incidence of fungaemia was 0.90 episodes/10 000 patient-days, and the most common species isolated were Candida albicans (40.4%), Candida parapsilosis (22.3%), Candida tropicalis (16.0%) and Candida glabrata (12.8%). Among 24 patients who received antifungal prophylaxis, non-albicans Candida spp. were more prevalent than C. albicans (p 0.012). The 30-day mortality rate was high (38.2%), particularly for haematological (71.4%) and solid-organ transplant patients (50.0%), and in individuals with C. tropicalis and C. glabrata bloodstream infections (60.0% and 50.0%, respectively). In-vitro susceptibility tests demonstrated that 95% of the isolates were susceptible to amphotericin B (MIC < 2 mg/L), 98.1% to posaconazole (MIC < 1 mg/L), 95.8% to flucytosine (MIC < 32 mg/L) and fluconazole (MIC < 64 mg/L), and 94.7% to itraconazole (MIC < 1 mg/L). Posaconazole was active (MIC 0.5 mg/L) against all three isolates of Candida krusei, which had reduced susceptibility to both fluconazole and itraconazole. Overall, non-albicans Candida spp. accounted for 60% of the episodes of candidaemia, which could be related to the use of antifungal prophylaxis. Resistance is still uncommon in Candida spp. recovered from blood cultures. The in-vitro activity of posaconazole is encouraging, and this agent could play an important role in the management of invasive candidiasis, including episodes caused by inherently less susceptible species such as C. krusei.

Erysipelas and cellulitis: clinical and microbiological spectrum in an Italian tertiary care hospital

Patients hospitalized in the authors' institution for erysipelas or cellulitis between January 1995 and December 2002 were included in this retrospective review. Two hundred cases of soft tissue infections were hospitalized during the study period. The mean age of the patients was 58 years. The most commonly involved site was the leg (66%), followed by the arm (24%) and face (6%). Most patients (71%) had a recognized risk factor for soft tissue infection. Fever was present in 71% of cases, with a mean duration of 3 days. Blood cultures were positive in 3 out of 141 (2%) cases, whereas cutaneous swabs were positive in 73 out of 92 (79%) cases. On admission, white blood cells counts (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were elevated above normal levels in 100 out of 191 (50%) cases, 151 out of 176 (85%) cases, and 150 out of 154 (97%) cases, respectively. Patients with a hospital stay of more than 10 days had significantly higher CRP and ESR values than patients hospitalized for 10 days or less ( P<0.01). A single antibiotic was used as treatment in 115 cases, whereas in the remaining 85 cases a combination of two antibiotics was administered. The most commonly used antibiotics were amoxicillin-clavulanic acid as single agent and penicillin with clindamycin as combination therapy. The mean duration of hospitalization was 7 days for patients treated with a single antibiotic and 11 days for patients treated with an antibiotic combination. A recurrence of infection occurred in 34 (17%) patients. Soft tissue infections are common and have a high degree of morbidity and require prolonged hospitalization and antibiotic treatment. Microbiological diagnosis is difficult and treatment is based on empiric evidence. ESR and CPR levels on admission may predict the severity of the disease and duration of hospitalization.

Overwork weakness in Charcot-Marie-Tooth disease

Vinci P, Esposito C, Perelli SL, Antenor JV, Thomas FP. Overwork weakness in Charcot-Marie-Tooth disease. Objective: To determine the incidence of overwork weakness in Charcot-Marie-Tooth disease (CMT). Design: Prospective survey. Setting: Rehabilitation department for CMT in an Italian tertiary care hospital. Participants: A total of 106 outpatients with CMT, selected for absence of other causes of weakness (age range, 11–69y), and 48 healthy volunteers (controls). Interventions: The strength of 2 intrinsic hand muscles (abductor pollicis brevis [APB], first dorsal interosseous) in the dominant and nondominant hands was graded by using manual muscle testing and a modified Medical Research Council (MRC) Scale. Main Outcome Measures: The side of the stronger muscle and the difference in strength between the nondominant and dominant muscles. Results: Muscles were stronger on the nondominant side in 65.57% of patients versus 1.04% of controls, and on the dominant side in .94% of patients versus 84.38% controls. The difference in strength for first dorsal interosseous was .51 in patients and −.32 in controls ( P>.01). The difference in strength for APB was .65 in patients and −.35 in controls ( P>.01). Conclusions: CMT muscles in the dominant hand are weaker than in the nondominant hand. This may be the result of overwork weakness.

Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital.

In a retrospective study conducted in an Italian tertiary care hospital, the incidence of nosocomial candidemia was evaluated together with causative pathogens, treatment, and risk factors for death. Over a 6-year period (1992-1997), a total of 189 episodes of candidemia occurred in 189 patients (mean age 58+/-19 years), accounting for an average incidence of 1.14 episodes per 10,000 patient-days per year. The most common reasons for hospitalization were solid neoplasia (21%), trauma (17%), abdominal diseases requiring surgery (13%), and cardiovascular diseases (13%). No patient was neutropenic within 3 weeks prior to the onset of candidemia. One hundred thirty patients were hospitalized in intensive care units, 47 patients in surgical wards, and 12 patients in medical wards. Candida albicans was the most frequently isolated pathogen, accounting for 54% of fungal isolates, followed by Candida parapsilosis (23%), Candida glabrata (7%), Candida tropicalis (5%), Candida pelliculosa (4%), Candida lusitaniae (1%), Candida humicula (1%), and other non-albicans Candida spp. (5%). Seventy-six (41%) patients received adequate antifungal therapy. Seventy-one (58%) of the 123 evaluable patients with central venous catheters underwent line removal; 51 of them had catheter-related candidemia. The 30-day crude mortality rate was 45%. Older age, hospitalization in an intensive care unit, a longer duration of candidemia, retention of central lines, and inadequate antifungal therapy were significantly associated with poor outcome. In the present study, nosocomial candidemia was a frequent and relatively underestimated illness. Adequate antifungal therapy and central line removal independently reduced the high mortality of the disease.

Nosocomial candidemia in an Italian tertiary care hospital

In a retrospective ongoing study, the incidence of nosocomial candidemia among patients (pts) admitted to a tertiary-care teaching hospital (bed capacity 2400; 78 beds for intensive care units, ICUs) was evaluated together with causative pathogens, potential risk factors, antifungal treatment, and crude mortality. During the primary study period (November 1991—October 1994) there were 136 episodes of candidemia occurring in 136 pts (median age 62 years, range 4–96). The overall incidence of candidemia was 11.3 episodes per 10 000 hospital admissions. The underlying diseases were the following: solid or hematological malignancies (43 pts), major abdominal surgery (30 pts), cardiovascular diseases (18 pts), trauma (17 pts), other diseases (28 pts). At the onset of candidemia 67 pts (49%) were located in ICUs, 48 and 21 pts respectively in surgical and medical wards. C. albicans (83 strains) accounted for 53% of all blood culture Candida isolates. Fifty-three pts (39%) received adequate antifungal treatment: 16 pts amphotericin-B and 37 pts fluconazole. The overall crude mortality was 54%. The number of positive fungal blood cultures (1 culture versus >1 culture) did not influence crude mortality (54% versus 63%). In addition, the mortality of pts infected by C. albicans (55%) was similar to that of pts infected by C. non-albicans species (45%). The mortality of pts located in ICUs (79%) was significantly higher (P < 0.001) than that of pts in surgical (29%) and medical wards (33%). Finally, the mortality of pts who did not receive adequate antifungal therapy (70%) was significantly higher (P < 0.001) than that of treated pts (30%). In conclusion, the incidence of nosocomial candidemia was high during the primary phase of the study; most of our pts with candidemia had severe underlying diseases and were hospitalized in ICUs. The number of fungal positive blood cultures did not influence the crude mortality, confirming that a single bood culture shuld not be dismissed as benign transient candidemia. On the contrary, about two-third of our pts did not receive an adequate antifungal treatment and the majority of them died.