Skip to main content

Mario Venditti

Followers

73

Following

36

Co-authors

36

Public Views

Peter Van Der Voort

Tilburg University

Namkje Vellinga

University of Pittsburgh

Rinaldo Bellomo

University of Melbourne

Katia Donadello

GRACIELA VELASCO HERNÁNDEZ

Interests

Uploads

Papers by Mario Venditti

Microvascular Effects of Heart Rate Control With Esmolol in Patients With Septic Shock

by Christian Ertmer, Andrea Morelli, P. Pietropaoli, and Mario Venditti

Critical Care Medicine, 2013

Objective: β-blocker therapy may control heart rate and attenuate the deleterious effects of β-st... more Objective: β-blocker therapy may control heart rate and attenuate the deleterious effects of β-stimulating catecholamines in septic shock. However, their negative chronotropy and inotropy may potentially lead to an inappropriately low cardiac output, with a subsequent compromise of microvascular blood flow. The purpose of the present pilot study was to investigate the effects of reducing heart rate to less than 95 beats per minute in patients with septic shock using the β-1 adrenoceptor blocker, esmolol, with specific focus on systemic hemodynamics and the microcirculation. Design: Prospective, observational clinical study. Setting: Multidisciplinary ICU at a university hospital. Measurements and Main Results: After 24 hours of initial hemodynamic optimization, 25 septic shock patients with a heart rate greater than or equal to 95 beats per minute and requiring norepinephrine to maintain mean arterial pressure greater than or equal to 65 mm Hg received a titrated esmolol infusion to maintain heart rate less than 95 beats per minute. Sublingual microcirculatory blood flow was assessed by sidestream dark-field imaging. All measurements, including data from right heart catheterization and norepinephrine requirements, were obtained at baseline and 24 hours after esmolol administration. Heart rates targeted between 80 and 94 beats per minute were achieved in all patients. Whereas cardiac index decreased (4.0 [3.5; 5.3] vs 3.1 [2.6; 3.9] L/min/m 2 ; p < 0.001), stroke volume remained unchanged (34 [37; 47] vs 40 [31; 46] mL/beat/m 2 ; p = 0.32). Microcirculatory blood flow in small vessels increased (2.8 [2.6; 3.0] vs 3.0 [3.0; 3.0]; p = 0.002), while the heterogeneity index decreased (median 0.06 [interquartile range 0; 0.21] vs 0 [0; 0]; p = 0.002). Pao 2 and pH increased while Paco 2 decreased (all p < 0.05). Of note, norepinephrine requirements were significantly reduced by selective β-1 blocker therapy (0.53 [0.29; 0.96] vs 0.41 [0.22; 0.79] µg/kg/min; p = 0.03).

The chronic use of beta-blockers and proton pump inhibitors may affect the rate of bacterial infections in cirrhosis

by Manuela Merli, Giancarlo Ceccarelli, Cristina Lucidi, and Mario Venditti

Liver International, 2014

Bacterial infections are among the most common and life-threatening complications in cirrhosis. Q... more Bacterial infections are among the most common and life-threatening complications in cirrhosis. Qualitative and quantitative modifications of the gut microbiota, dysfunction of the intestinal barrier and multiple immune defects are factors that contribute to a pathological &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;bacterial translocation&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (BT), leading to a higher susceptibility to infections in cirrhotic patients. Long-term therapies, commonly adopted in cirrhotic patients, may influence BT and modify the risk of infection in these patients. To investigate the influence of chronic therapies on the prevalence and microbiological characteristics of infections in cirrhosis. Consecutive cirrhotic patients hospitalised from 2008 to 2013 were enrolled. All previous treatments were carefully recorded. Infections were actively sought out, patients were actively monitored for infection, and possible risk factors were evaluated. Four hundred cirrhotic patients were included. The most frequent therapies were proton pump inhibitors (PPIs) (67%), non-absorbable-disaccharides (44%), beta-blockers (BBs) (39%) and non-absorbable-antibiotics (10%). Child-Pugh C (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; OR 5; 95%CI: 2.6-9.9) and PPI therapy (P = 0.008; OR 2; 95% CI: 1.2-3.2) were found to be independent predictors of infection, and the use of BBs was a protective factor (P = 0.001; OR 0.46; 95%CI: 0.3-0.7). Cirrhotic patients with bacterial infection showed lower morbidity and mortality when taking BBs. Proton pump inhibitors increase the risk of infection in cirrhosis and should not be prescribed in these patients without specific indications. In contrast, the use of BBs is associated with a lower rate of infection and attenuates the consequences of infections in cirrhotic patients.

The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey

by Mario Venditti, Giancarlo Ceccarelli, Cristina Lucidi, and Manuela Merli

PLOS ONE, 2015

The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, ... more

Optimizing antibiotic therapy of bacteremia and endocarditis due to staphylococci and enterococci: New insights and evidence from the literature

by Mario Venditti and Alessandro Russo

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, Jan 6, 2015

Gram-positive cocci are a well-recognised major cause of nosocomial infection worldwide. Bloodstr... more Gram-positive cocci are a well-recognised major cause of nosocomial infection worldwide. Bloodstream infections due to methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative staphylococci, and multi-drug resistant enterococci are a cause of concern for physicians due to their related morbidity and mortality rates. Aim of this article is to review the current state of knowledge regarding the management of BSI caused by staphylococci and enterococci, including infective endocarditis, and to identify those factors that may help physicians to manage these infections appropriately. Moreover, we discuss the importance of an appropriate use of antimicrobial drugs, taking in consideration the in vitro activity, clinical efficacy data, pharmacokinetic/pharmacodynamic parameters, and potential side effects.

Beta-blockers in patients with cirrhosis and infections: don't blame too soon!

by Mario Venditti and Cristina Lucidi

Liver international : official journal of the International Association for the Study of the Liver, Jan 18, 2015

[Piperacillin-tazobactam in the treatment of severe nosocomial infections]

Recenti progressi in medicina, 2002

Epidemiology and clinical manifestations of nosocomial infections have been progressively evolvin... more Epidemiology and clinical manifestations of nosocomial infections have been progressively evolving through last three decades. New pathogens, often associated to multiple antibiotic-resistances, are now among the leading etiologies in a patient population mainly represented by individuals debilitated by serious underlying diseases, immunosuppressive treatments and multiple diagnostic and therapeutic invasive procedures. Under these circumstances, when an infectious complication develops, prompt initiation of empiric antibiotic therapy, based on general and/or local epidemiology of nosocomial infections, may be crucial for survival of more critically ill patients. Based on recent data, the antibiotics of choice for treatment of nosocomial infections should have not only a bactericidal activity and a broad antibacterial spectrum, but also poor propensity to induce antibiotic-resistance and a satisfactory pharmacoeconomy profile. After a detailed description of the above mentioned cont...

Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves

Some studies describe an increased risk for emboli in infective endocarditis patients with large ... more Some studies describe an increased risk for emboli in infective endocarditis patients with large (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10 mm) and mobile vegetations. Other studies fail to demonstrate the above relation. Most studies have been performed using transthoracic echocardiography or with a monoplane transesophageal approach. The present study examines whether distinctive characteristics of vegetative lesions detected by transthoracic and multiplane transesophageal echocardiography are predictive of embolic risk. We reviewed both transthoracic and transesophageal echocardiograms of 57 patients with diagnosis of acute infective endocarditis and no documented or suspected previous embolic events. We evaluated site, length, width, mobility, and echodensity of vegetations. Twenty-five patients (44%) had embolic events. No statistical differences in age, sex distribution, location of endocarditis, or offending pathogens between embolic (n = 25) and nonembolic (n = 32) patients were found. There were no differences in any of the echo characteristics of vegetations detected by transthoracic and transesophageal approach in embolic and nonembolic groups. Thus, transthoracic and transesophageal characteristics of vegetations are not helpful in defining embolic risk in patients with infective endocarditis.

Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part I. Epidemiology and diagnosis

Background: Invasive candidiasis and candidemia are frequently encountered in the nosocomial sett... more Background: Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting, particularly in the intensive care unit (ICU). Objectives and methods: To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review of the literature and a European expert panel discussion. Results and conclusions: Candida albicans remains the most frequently isolated fungal species followed by C. glabrata. The diagnosis of invasive candidiasis involves both clinical and laboratory parameters, but neither of these are specific. One of the main features in diagnosis is the evaluation of risk factor for infection which will identify patients in need of pre-emptive or empiric treatment. Clinical scores were built from those risk Intensive Care Med (2009) 35:55-62

Streptococcus anginosus group disseminated infection: case report and review of literature

by Paola Goldoni and Mario Venditti

Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2012

Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infectio... more Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infections. There are very few reports of disseminated infections sustained by members of this streptococcal group. We report a case of a highly disseminated infection and analyse previous literature reports. Disseminated pyogenic infection has been defined as an infection affecting two or more of the following organs/systems: central nervous system, lung, liver and spleen. We performed a PubMed search using the terms: S. milleri, S. anginosus, brain abscess, pulmonary abscess, hepatic abscess, spleen abscess. We reviewed 12 case reports including the one presented in this paper. Underlying conditions such as dental infections, malignancy, gastrointestinal and respiratory tract disease accounted for 42% of cases. No definite endocarditis was encountered, even though positive blood cultures were found in 67% of patients. Concomitant brain-liver, brain-lung and brain-spleen involvement occurred in...

Linezolid-resistant staphylococcal bacteraemia: A multicentre case–case–control study in Italy

by Floriana Campanile, Paola Goldoni, Mario Venditti, and Maria Trancassini

International Journal of Antimicrobial Agents, 2014

The aim of this multicentre study was to analyse the characteristics of patients with bloodstream... more The aim of this multicentre study was to analyse the characteristics of patients with bloodstream infections due to staphylococcal strains resistant to linezolid. This was a retrospective case-case-control study of patients hospitalised in three large teaching hospitals in Italy. A linezolid-resistant (LIN-R) Staphylococcus spp. group and a linezolid-susceptible (LIN-S) Staphylococcus spp. group were compared with control patients to determine the clinical features and factors associated with isolation of LIN-R strains. All LIN-R Staphylococcus spp. strains underwent molecular typing. Compared with the LIN-S group, central venous catheters were the main source of infection in the LIN-R group. The LIN-R and LIN-S groups showed a similar incidence of severe sepsis or septic shock, and both showed a higher incidence of these compared with the control group. Overall, patients in the LIN-R group had a higher 30-day mortality rate. Multivariate analysis found previous linezolid therapy, linezolid therapy >14 days, antibiotic therapy in the previous 30 days, antibiotic therapy >14 days, previous use of at least two antibiotics and hospitalisation in the previous 90 days as independent risk factors associated with isolation of a LIN-R strain. The G2576T mutation in domain V of 23S rRNA was the principal mechanism of resistance; only one strain of Staphylococcus epidermidis carried the cfr methylase gene (A2503), together with L4 insertion ( 71 GGR 72 ) and L3 substitution (H146Q). LIN-R strains are associated with severe impairment of clinical conditions and unfavourable patient outcomes. Reinforcement of infection control measures may have an important role in preventing these infections.

Healthcare-associated pneumonia: a never-ending story

by Mario Venditti, Simone Giuliano, Maurizio Guastalegname, and Alessandro Russo

Infectious Disease Reports, 2014

Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia

Internal and Emergency Medicine, 2011

The objective was to compare three score systems, pneumonia severity index (PSI), the Confusion-U... more The objective was to compare three score systems, pneumonia severity index (PSI), the Confusion-Urea-Respiratory Rate-Blood pressure-65 (CURB-65), and severe community-acquired pneumonia (SCAP), for prediction of the outcomes in a cohort of patients with community-acquired (CAP) and healthcare-associated pneumonia (HCAP). Large multi-center, prospective, observational study was conducted in 55 hospitals. HCAP patients were included in the high classes of CURB-65, PSI and SCAP scores have a mortality rate higher than that of CAP patients. HCAP patients included in the low class of the three severity rules have a significantly higher incidence of adverse events, including development of septic shock, transfer into an ICU, and death (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). At multivariate Cox regression analysis, inclusion in the severe classes of PSI, CURB-65, or SCAP scores and receipt of an empirical therapy not adherent to international guidelines prove to be risk factors independently associated with poor outcome. PSI, CURB-65, and SCAP score have a good performance in patients with CAP but are less useful in patients with HCAP, especially in patients classified in the low-risk classes.

Lower mortality rate in elderly patients with community-onset pneumonia on treatment with aspirin

by Giuliano Bertazzoni and Mario Venditti

Journal of the American Heart Association, 2015

Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potentia... more Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. Consecutive patients admitted to the University-Hospital Policlinico Umberto I (Rome, Italy) with community-onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow-up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%;...

Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

World Journal of Gastroenterology, 2008

CAP and HCAP are different? An unresolved question

by Mario Venditti and Alessandro Russo

Thorax, 2014

Identification of a Variant "Rome Clone" of Methicillin-Resistant Staphylococcus aureus with Decreased Susceptibility to Vancomycin, Responsible for an Outbreak in an Intensive Care Unit

by Floriana Campanile and Mario Venditti

Microbial Drug Resistance, 2004

We describe the identification of a variant of the "Rome clone" of methicillin-resistant Staphylo... more We describe the identification of a variant of the "Rome clone" of methicillin-resistant Staphylococcus aureus (MRSA), responsible for an outbreak involving 5 patients in a Cardiac Surgery Intensive Care Unit (CS-ICU) of a tertiary-care University Hospital in Rome. All strains isolated from patients and from nasal swabs obtained from four members of the CS-ICU personnel, belonged to the same identified clone. The characteristics of this clone were: (1) resistance to ampicillin, oxacillin, gentamicin, ciprofloxacin, erythromycin, clindamycin, rifampin, spectinomycin, and tetracycline; (2) vancomycin and teicoplanin MICs respectively of 2 and 4 mg/L; (3) heteroresistant subpopulations in the presence of 4 and 6 mg/L of vancomycin (10 23 and 10 25 , respectively); (4) clonal type I::J::C determined following an established protocol (mecA::Tn554::PFGE); (5) sequence type ST247 , obtained by multilocus sequence typing (MLST); and (6) the staphylococcal cassette chromosome mec (SCC) IA, obtained by multiplex PCR method. This new strain had different characteristics from the epidemic clone circulating in the same hospital from 1997 and designed "Rome clone," which was susceptible to erythromycin, clindamycin, and spectinomycin and belonged to the II::NH::C genetic background. A high genetic similarity between this Rome clone and the previously classified Archaic and Iberian clones was found, because they shared the same allelic profile (ST247), probably originating from the same S. aureus ancestor of the Iberian MRSA strains. Therefore, the strains responsible for the outbreak, with vancomycin MICs 2-4 mg/L, are variant clones, showing the genotype of the "Rome clone," the ST247 in association with SCCmec type IA (ST247-MRSA-IA), and are characterized by a uniform susceptibility to fosfomycin.

Characterization of a Variant of the SCC mec Element in a Bloodstream Isolate of Staphylococcus intermedius

by Floriana Campanile and Mario Venditti

Microbial Drug Resistance, 2007

S. intermedius is a coagulase-positive zoonotic microrganism, recently classified as a separate s... more S. intermedius is a coagulase-positive zoonotic microrganism, recently classified as a separate species. In routine clinical laboratory practice, the coagulase production is used as criterion of pathogenicity related to S. aureus, but S. intermedius is frequently misidentified-being mistaken for S. aureus-and consequently its real incidence underestimated. S. intermedius have been found only occasionally in human beings, and methicillin-resistance is very rare for this organism. Even if the genetic element responsible for methicillinresistance-the mecA gene carried by diverse staphylococcal chromosomal cassettes-has been described in various staphylococcal species, the current literature doesn't report any case of S. intermedius isolate carrying SCCmec-like elements. Our study could be useful to explain the mechanism and routes of transfer of the chromosomal cassette carrying the mec complex, among staphylococci.

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae in Italy by Agar Dilution Method and E Test

by A. Tarasi, Mario Venditti, and F. D'Ambrosio

Microbial Drug Resistance, 1999

Few data on antimicrobial susceptibility of invasive Streptococcus pneumoniae isolated in Italy a... more Few data on antimicrobial susceptibility of invasive Streptococcus pneumoniae isolated in Italy are available. Ninety-two invasive isolates from all over the country collected from January 1997 to April 1998 were tested for sensitivity to penicillin, erythromycin, ceftriaxone, chloramphenicol, tetracycline, and trimethoprim/sulfamethoxazole by the agar dilution method. Five (5.4%) strains were resistant to penicillin (one highly, four intermediately resistant), 8 (8.7%) to chloramphenicol, 27 (29.3%) to erythromycin, 17 (18.5%) to tetracycline (16 highly, one intermediately), and 21 (22.8%) to trimethoprim/sulfamethoxazole (14 highly, 7 intermediately). All strains were susceptible to ceftriaxone, although the penicillin-resistant strain had the highest minimal inhibitory concentration. (MIC) value (0.5 microg/ml); three penicillin-resistant strains were also resistant to erythromycin. Eight strains were multi-drug resistant, being also resistant to at least three antibiotics. The commercially available E test was compared with the standard agar dilution method for the determination of MIC of penicillin, erythromycin, ceftriaxone, chloramphenicol, and trimethoprim/sulfamethoxazole. E test established the same susceptibility categories for 100% of the strains tested for penicillin and ceftriaxone, 99% for chloramphenicol, 97% for erythromycin, and 74% for trimethoprim/sulfamethoxazole. According to our results, E test was simple to perform, easy to interpret, and a valid method for susceptibility testing of S. pneumoniae. Our study shows that in Italy the rate of penicillin resistance in invasive isolates of S. pneumoniae is one of the lowest in Europe (5.4%), while the rate of erythromycin is very high (29.3%) and is reaching the highest rates of other Southern European countries.

Class I Integron-Borne bla VIM-1 Carbapenemase in a Strain of Enterobacter cloacae Responsible for a Case of Fatal Pneumonia

Microbial Drug Resistance, 2008

We report here a fatal case of nosocomial pneumonia due to a multidrug-resistant (MDR) strain of ... more We report here a fatal case of nosocomial pneumonia due to a multidrug-resistant (MDR) strain of Enterobacter cloacae, which was also resistant to carbapenems, in a patient with a diagnosis of Churg-Strauss syndrome. The microorganism was investigated for the presence of metallo-and extended-spectrum b-lactamases. The strain produced two class 1 integrons carrying bla VIM-1 and aadA2 gene cassettes located on chromosomal and plasmidic DNA, respectively, and a plasmid-encoded SHV-12 extended-spectrum b-lactamase. Our results clearly demonstrate the transfer of this kind of resistance in E. cloacae with potentially serious clinical implications.

Candida Infective Endocarditis

Medicine, 2009

Candida species are an uncommon cause of infective endocarditis (IE). Given the rarity of this in... more Candida species are an uncommon cause of infective endocarditis (IE). Given the rarity of this infection, the epidemiology, prognosis, and optimal therapy of Candida IE are poorly defined. We conducted a prospective, observational study at 18 medical centers in Italy, including all consecutive patients with a definite diagnosis of IE admitted from January 2004 through December 2007.

Microvascular Effects of Heart Rate Control With Esmolol in Patients With Septic Shock

by Christian Ertmer, Andrea Morelli, P. Pietropaoli, and Mario Venditti

Critical Care Medicine, 2013

Objective: β-blocker therapy may control heart rate and attenuate the deleterious effects of β-st... more Objective: β-blocker therapy may control heart rate and attenuate the deleterious effects of β-stimulating catecholamines in septic shock. However, their negative chronotropy and inotropy may potentially lead to an inappropriately low cardiac output, with a subsequent compromise of microvascular blood flow. The purpose of the present pilot study was to investigate the effects of reducing heart rate to less than 95 beats per minute in patients with septic shock using the β-1 adrenoceptor blocker, esmolol, with specific focus on systemic hemodynamics and the microcirculation. Design: Prospective, observational clinical study. Setting: Multidisciplinary ICU at a university hospital. Measurements and Main Results: After 24 hours of initial hemodynamic optimization, 25 septic shock patients with a heart rate greater than or equal to 95 beats per minute and requiring norepinephrine to maintain mean arterial pressure greater than or equal to 65 mm Hg received a titrated esmolol infusion to maintain heart rate less than 95 beats per minute. Sublingual microcirculatory blood flow was assessed by sidestream dark-field imaging. All measurements, including data from right heart catheterization and norepinephrine requirements, were obtained at baseline and 24 hours after esmolol administration. Heart rates targeted between 80 and 94 beats per minute were achieved in all patients. Whereas cardiac index decreased (4.0 [3.5; 5.3] vs 3.1 [2.6; 3.9] L/min/m 2 ; p < 0.001), stroke volume remained unchanged (34 [37; 47] vs 40 [31; 46] mL/beat/m 2 ; p = 0.32). Microcirculatory blood flow in small vessels increased (2.8 [2.6; 3.0] vs 3.0 [3.0; 3.0]; p = 0.002), while the heterogeneity index decreased (median 0.06 [interquartile range 0; 0.21] vs 0 [0; 0]; p = 0.002). Pao 2 and pH increased while Paco 2 decreased (all p < 0.05). Of note, norepinephrine requirements were significantly reduced by selective β-1 blocker therapy (0.53 [0.29; 0.96] vs 0.41 [0.22; 0.79] µg/kg/min; p = 0.03).

The chronic use of beta-blockers and proton pump inhibitors may affect the rate of bacterial infections in cirrhosis

by Manuela Merli, Giancarlo Ceccarelli, Cristina Lucidi, and Mario Venditti

Liver International, 2014

Bacterial infections are among the most common and life-threatening complications in cirrhosis. Q... more Bacterial infections are among the most common and life-threatening complications in cirrhosis. Qualitative and quantitative modifications of the gut microbiota, dysfunction of the intestinal barrier and multiple immune defects are factors that contribute to a pathological &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;bacterial translocation&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (BT), leading to a higher susceptibility to infections in cirrhotic patients. Long-term therapies, commonly adopted in cirrhotic patients, may influence BT and modify the risk of infection in these patients. To investigate the influence of chronic therapies on the prevalence and microbiological characteristics of infections in cirrhosis. Consecutive cirrhotic patients hospitalised from 2008 to 2013 were enrolled. All previous treatments were carefully recorded. Infections were actively sought out, patients were actively monitored for infection, and possible risk factors were evaluated. Four hundred cirrhotic patients were included. The most frequent therapies were proton pump inhibitors (PPIs) (67%), non-absorbable-disaccharides (44%), beta-blockers (BBs) (39%) and non-absorbable-antibiotics (10%). Child-Pugh C (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; OR 5; 95%CI: 2.6-9.9) and PPI therapy (P = 0.008; OR 2; 95% CI: 1.2-3.2) were found to be independent predictors of infection, and the use of BBs was a protective factor (P = 0.001; OR 0.46; 95%CI: 0.3-0.7). Cirrhotic patients with bacterial infection showed lower morbidity and mortality when taking BBs. Proton pump inhibitors increase the risk of infection in cirrhosis and should not be prescribed in these patients without specific indications. In contrast, the use of BBs is associated with a lower rate of infection and attenuates the consequences of infections in cirrhotic patients.

The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey

by Mario Venditti, Giancarlo Ceccarelli, Cristina Lucidi, and Manuela Merli

PLOS ONE, 2015

The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, ... more

Optimizing antibiotic therapy of bacteremia and endocarditis due to staphylococci and enterococci: New insights and evidence from the literature

by Mario Venditti and Alessandro Russo

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, Jan 6, 2015

Gram-positive cocci are a well-recognised major cause of nosocomial infection worldwide. Bloodstr... more Gram-positive cocci are a well-recognised major cause of nosocomial infection worldwide. Bloodstream infections due to methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative staphylococci, and multi-drug resistant enterococci are a cause of concern for physicians due to their related morbidity and mortality rates. Aim of this article is to review the current state of knowledge regarding the management of BSI caused by staphylococci and enterococci, including infective endocarditis, and to identify those factors that may help physicians to manage these infections appropriately. Moreover, we discuss the importance of an appropriate use of antimicrobial drugs, taking in consideration the in vitro activity, clinical efficacy data, pharmacokinetic/pharmacodynamic parameters, and potential side effects.

Beta-blockers in patients with cirrhosis and infections: don't blame too soon!

by Mario Venditti and Cristina Lucidi

Liver international : official journal of the International Association for the Study of the Liver, Jan 18, 2015

[Piperacillin-tazobactam in the treatment of severe nosocomial infections]

Recenti progressi in medicina, 2002

Epidemiology and clinical manifestations of nosocomial infections have been progressively evolvin... more Epidemiology and clinical manifestations of nosocomial infections have been progressively evolving through last three decades. New pathogens, often associated to multiple antibiotic-resistances, are now among the leading etiologies in a patient population mainly represented by individuals debilitated by serious underlying diseases, immunosuppressive treatments and multiple diagnostic and therapeutic invasive procedures. Under these circumstances, when an infectious complication develops, prompt initiation of empiric antibiotic therapy, based on general and/or local epidemiology of nosocomial infections, may be crucial for survival of more critically ill patients. Based on recent data, the antibiotics of choice for treatment of nosocomial infections should have not only a bactericidal activity and a broad antibacterial spectrum, but also poor propensity to induce antibiotic-resistance and a satisfactory pharmacoeconomy profile. After a detailed description of the above mentioned cont...

Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native cardiac valves

Some studies describe an increased risk for emboli in infective endocarditis patients with large ... more Some studies describe an increased risk for emboli in infective endocarditis patients with large (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10 mm) and mobile vegetations. Other studies fail to demonstrate the above relation. Most studies have been performed using transthoracic echocardiography or with a monoplane transesophageal approach. The present study examines whether distinctive characteristics of vegetative lesions detected by transthoracic and multiplane transesophageal echocardiography are predictive of embolic risk. We reviewed both transthoracic and transesophageal echocardiograms of 57 patients with diagnosis of acute infective endocarditis and no documented or suspected previous embolic events. We evaluated site, length, width, mobility, and echodensity of vegetations. Twenty-five patients (44%) had embolic events. No statistical differences in age, sex distribution, location of endocarditis, or offending pathogens between embolic (n = 25) and nonembolic (n = 32) patients were found. There were no differences in any of the echo characteristics of vegetations detected by transthoracic and transesophageal approach in embolic and nonembolic groups. Thus, transthoracic and transesophageal characteristics of vegetations are not helpful in defining embolic risk in patients with infective endocarditis.

Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part I. Epidemiology and diagnosis

Background: Invasive candidiasis and candidemia are frequently encountered in the nosocomial sett... more Background: Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting, particularly in the intensive care unit (ICU). Objectives and methods: To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review of the literature and a European expert panel discussion. Results and conclusions: Candida albicans remains the most frequently isolated fungal species followed by C. glabrata. The diagnosis of invasive candidiasis involves both clinical and laboratory parameters, but neither of these are specific. One of the main features in diagnosis is the evaluation of risk factor for infection which will identify patients in need of pre-emptive or empiric treatment. Clinical scores were built from those risk Intensive Care Med (2009) 35:55-62

Streptococcus anginosus group disseminated infection: case report and review of literature

by Paola Goldoni and Mario Venditti

Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive, 2012

Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infectio... more Streptococcus anginosus group is widely known for its ability to cause invasive pyogenic infections. There are very few reports of disseminated infections sustained by members of this streptococcal group. We report a case of a highly disseminated infection and analyse previous literature reports. Disseminated pyogenic infection has been defined as an infection affecting two or more of the following organs/systems: central nervous system, lung, liver and spleen. We performed a PubMed search using the terms: S. milleri, S. anginosus, brain abscess, pulmonary abscess, hepatic abscess, spleen abscess. We reviewed 12 case reports including the one presented in this paper. Underlying conditions such as dental infections, malignancy, gastrointestinal and respiratory tract disease accounted for 42% of cases. No definite endocarditis was encountered, even though positive blood cultures were found in 67% of patients. Concomitant brain-liver, brain-lung and brain-spleen involvement occurred in...

Linezolid-resistant staphylococcal bacteraemia: A multicentre case–case–control study in Italy

by Floriana Campanile, Paola Goldoni, Mario Venditti, and Maria Trancassini

International Journal of Antimicrobial Agents, 2014

The aim of this multicentre study was to analyse the characteristics of patients with bloodstream... more The aim of this multicentre study was to analyse the characteristics of patients with bloodstream infections due to staphylococcal strains resistant to linezolid. This was a retrospective case-case-control study of patients hospitalised in three large teaching hospitals in Italy. A linezolid-resistant (LIN-R) Staphylococcus spp. group and a linezolid-susceptible (LIN-S) Staphylococcus spp. group were compared with control patients to determine the clinical features and factors associated with isolation of LIN-R strains. All LIN-R Staphylococcus spp. strains underwent molecular typing. Compared with the LIN-S group, central venous catheters were the main source of infection in the LIN-R group. The LIN-R and LIN-S groups showed a similar incidence of severe sepsis or septic shock, and both showed a higher incidence of these compared with the control group. Overall, patients in the LIN-R group had a higher 30-day mortality rate. Multivariate analysis found previous linezolid therapy, linezolid therapy >14 days, antibiotic therapy in the previous 30 days, antibiotic therapy >14 days, previous use of at least two antibiotics and hospitalisation in the previous 90 days as independent risk factors associated with isolation of a LIN-R strain. The G2576T mutation in domain V of 23S rRNA was the principal mechanism of resistance; only one strain of Staphylococcus epidermidis carried the cfr methylase gene (A2503), together with L4 insertion ( 71 GGR 72 ) and L3 substitution (H146Q). LIN-R strains are associated with severe impairment of clinical conditions and unfavourable patient outcomes. Reinforcement of infection control measures may have an important role in preventing these infections.

Healthcare-associated pneumonia: a never-ending story

by Mario Venditti, Simone Giuliano, Maurizio Guastalegname, and Alessandro Russo

Infectious Disease Reports, 2014

Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia

Internal and Emergency Medicine, 2011

The objective was to compare three score systems, pneumonia severity index (PSI), the Confusion-U... more The objective was to compare three score systems, pneumonia severity index (PSI), the Confusion-Urea-Respiratory Rate-Blood pressure-65 (CURB-65), and severe community-acquired pneumonia (SCAP), for prediction of the outcomes in a cohort of patients with community-acquired (CAP) and healthcare-associated pneumonia (HCAP). Large multi-center, prospective, observational study was conducted in 55 hospitals. HCAP patients were included in the high classes of CURB-65, PSI and SCAP scores have a mortality rate higher than that of CAP patients. HCAP patients included in the low class of the three severity rules have a significantly higher incidence of adverse events, including development of septic shock, transfer into an ICU, and death (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). At multivariate Cox regression analysis, inclusion in the severe classes of PSI, CURB-65, or SCAP scores and receipt of an empirical therapy not adherent to international guidelines prove to be risk factors independently associated with poor outcome. PSI, CURB-65, and SCAP score have a good performance in patients with CAP but are less useful in patients with HCAP, especially in patients classified in the low-risk classes.

Lower mortality rate in elderly patients with community-onset pneumonia on treatment with aspirin

by Giuliano Bertazzoni and Mario Venditti

Journal of the American Heart Association, 2015

Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potentia... more Pneumonia is complicated by high rate of mortality and cardiovascular events (CVEs). The potential benefit of aspirin, which lowers platelet aggregation by inhibition of thromboxane A2 production, is still unclear. The aim of the study was to assess the impact of aspirin on mortality in patients with pneumonia. Consecutive patients admitted to the University-Hospital Policlinico Umberto I (Rome, Italy) with community-onset pneumonia were recruited and prospectively followed up until discharge or death. The primary end point was the occurrence of death up to 30 days after admission; the secondary end point was the intrahospital incidence of nonfatal myocardial infarction and ischemic stroke. One thousand and five patients (age, 74.7±15.1 years) were included in the study: 390 were receiving aspirin (100 mg/day) at the time of hospitalization, whereas 615 patients were aspirin free. During the follow-up, 16.2% of patients died; among these, 19 (4.9%) were aspirin users and 144 (23.4%;...

Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

World Journal of Gastroenterology, 2008

CAP and HCAP are different? An unresolved question

by Mario Venditti and Alessandro Russo

Thorax, 2014

Identification of a Variant "Rome Clone" of Methicillin-Resistant Staphylococcus aureus with Decreased Susceptibility to Vancomycin, Responsible for an Outbreak in an Intensive Care Unit

by Floriana Campanile and Mario Venditti

Microbial Drug Resistance, 2004

We describe the identification of a variant of the "Rome clone" of methicillin-resistant Staphylo... more We describe the identification of a variant of the "Rome clone" of methicillin-resistant Staphylococcus aureus (MRSA), responsible for an outbreak involving 5 patients in a Cardiac Surgery Intensive Care Unit (CS-ICU) of a tertiary-care University Hospital in Rome. All strains isolated from patients and from nasal swabs obtained from four members of the CS-ICU personnel, belonged to the same identified clone. The characteristics of this clone were: (1) resistance to ampicillin, oxacillin, gentamicin, ciprofloxacin, erythromycin, clindamycin, rifampin, spectinomycin, and tetracycline; (2) vancomycin and teicoplanin MICs respectively of 2 and 4 mg/L; (3) heteroresistant subpopulations in the presence of 4 and 6 mg/L of vancomycin (10 23 and 10 25 , respectively); (4) clonal type I::J::C determined following an established protocol (mecA::Tn554::PFGE); (5) sequence type ST247 , obtained by multilocus sequence typing (MLST); and (6) the staphylococcal cassette chromosome mec (SCC) IA, obtained by multiplex PCR method. This new strain had different characteristics from the epidemic clone circulating in the same hospital from 1997 and designed "Rome clone," which was susceptible to erythromycin, clindamycin, and spectinomycin and belonged to the II::NH::C genetic background. A high genetic similarity between this Rome clone and the previously classified Archaic and Iberian clones was found, because they shared the same allelic profile (ST247), probably originating from the same S. aureus ancestor of the Iberian MRSA strains. Therefore, the strains responsible for the outbreak, with vancomycin MICs 2-4 mg/L, are variant clones, showing the genotype of the "Rome clone," the ST247 in association with SCCmec type IA (ST247-MRSA-IA), and are characterized by a uniform susceptibility to fosfomycin.

Characterization of a Variant of the SCC mec Element in a Bloodstream Isolate of Staphylococcus intermedius

by Floriana Campanile and Mario Venditti

Microbial Drug Resistance, 2007

S. intermedius is a coagulase-positive zoonotic microrganism, recently classified as a separate s... more S. intermedius is a coagulase-positive zoonotic microrganism, recently classified as a separate species. In routine clinical laboratory practice, the coagulase production is used as criterion of pathogenicity related to S. aureus, but S. intermedius is frequently misidentified-being mistaken for S. aureus-and consequently its real incidence underestimated. S. intermedius have been found only occasionally in human beings, and methicillin-resistance is very rare for this organism. Even if the genetic element responsible for methicillinresistance-the mecA gene carried by diverse staphylococcal chromosomal cassettes-has been described in various staphylococcal species, the current literature doesn't report any case of S. intermedius isolate carrying SCCmec-like elements. Our study could be useful to explain the mechanism and routes of transfer of the chromosomal cassette carrying the mec complex, among staphylococci.

Antimicrobial Susceptibility of Invasive Streptococcus pneumoniae in Italy by Agar Dilution Method and E Test

by A. Tarasi, Mario Venditti, and F. D'Ambrosio

Microbial Drug Resistance, 1999

Few data on antimicrobial susceptibility of invasive Streptococcus pneumoniae isolated in Italy a... more Few data on antimicrobial susceptibility of invasive Streptococcus pneumoniae isolated in Italy are available. Ninety-two invasive isolates from all over the country collected from January 1997 to April 1998 were tested for sensitivity to penicillin, erythromycin, ceftriaxone, chloramphenicol, tetracycline, and trimethoprim/sulfamethoxazole by the agar dilution method. Five (5.4%) strains were resistant to penicillin (one highly, four intermediately resistant), 8 (8.7%) to chloramphenicol, 27 (29.3%) to erythromycin, 17 (18.5%) to tetracycline (16 highly, one intermediately), and 21 (22.8%) to trimethoprim/sulfamethoxazole (14 highly, 7 intermediately). All strains were susceptible to ceftriaxone, although the penicillin-resistant strain had the highest minimal inhibitory concentration. (MIC) value (0.5 microg/ml); three penicillin-resistant strains were also resistant to erythromycin. Eight strains were multi-drug resistant, being also resistant to at least three antibiotics. The commercially available E test was compared with the standard agar dilution method for the determination of MIC of penicillin, erythromycin, ceftriaxone, chloramphenicol, and trimethoprim/sulfamethoxazole. E test established the same susceptibility categories for 100% of the strains tested for penicillin and ceftriaxone, 99% for chloramphenicol, 97% for erythromycin, and 74% for trimethoprim/sulfamethoxazole. According to our results, E test was simple to perform, easy to interpret, and a valid method for susceptibility testing of S. pneumoniae. Our study shows that in Italy the rate of penicillin resistance in invasive isolates of S. pneumoniae is one of the lowest in Europe (5.4%), while the rate of erythromycin is very high (29.3%) and is reaching the highest rates of other Southern European countries.

Class I Integron-Borne bla VIM-1 Carbapenemase in a Strain of Enterobacter cloacae Responsible for a Case of Fatal Pneumonia

Microbial Drug Resistance, 2008

We report here a fatal case of nosocomial pneumonia due to a multidrug-resistant (MDR) strain of ... more We report here a fatal case of nosocomial pneumonia due to a multidrug-resistant (MDR) strain of Enterobacter cloacae, which was also resistant to carbapenems, in a patient with a diagnosis of Churg-Strauss syndrome. The microorganism was investigated for the presence of metallo-and extended-spectrum b-lactamases. The strain produced two class 1 integrons carrying bla VIM-1 and aadA2 gene cassettes located on chromosomal and plasmidic DNA, respectively, and a plasmid-encoded SHV-12 extended-spectrum b-lactamase. Our results clearly demonstrate the transfer of this kind of resistance in E. cloacae with potentially serious clinical implications.

Candida Infective Endocarditis

Medicine, 2009

Candida species are an uncommon cause of infective endocarditis (IE). Given the rarity of this in... more Candida species are an uncommon cause of infective endocarditis (IE). Given the rarity of this infection, the epidemiology, prognosis, and optimal therapy of Candida IE are poorly defined. We conducted a prospective, observational study at 18 medical centers in Italy, including all consecutive patients with a definite diagnosis of IE admitted from January 2004 through December 2007.