Treatment of wounds colonized by multidrug resistant organisms in immune-compromised patients: a retrospective case series.

Immune-compromised patients incur a high risk of surgical wound dehiscence and colonization by multidrug resistant organisms. Common treatment has been debridement and spontaneous secondary healing.All immune-compromised patients referred to our Institution between March 1, 2010 and November 30, 2011 for dehiscent abdominal wounds growing multidrug resistant organisms were treated by serial wound debridements and negative pressure dressing. They were primarily closed, despite positive microbiological cultures, when clinical appearance was satisfactory.Nine patients were treated by direct wound closure, five had been treated previously by secondary intention healing.According to our results, fast healing can be safely obtained by closure of a clinically healthy wound, despite growth of multidrug resistant organisms, even in immune-compromised patients

Retrospective 8-year study on the antibiotic resistance of uropathogens in children hospitalised for urinary tract infection in the emilia-romagna region, italy

The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospital-ised for UTI between January 1st, 2012, and June 30th, 2020, in Emilia-Romagna, Italy, were analysed. Escherichia coli was the most frequently detected pathogen (75.6%), followed by Klebsiella pneumoniae (6.9%) and Pseudomonas aeruginosa (2.5%). Overall, 840 cases (46.7%) were due to anti-microbial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and ration-alise antibiotic consumption must be implemented

Clinical Outcome of Discordant Empirical Therapy and Risk Factors Associated to Treatment Failure in Children Hospitalized for Urinary Tract Infections

With the spread of antibiotic resistance in pediatric urinary tract infections (UTIs), more patients are likely to be started empirically on antibiotics to which pathogens are later found to be resistant (discordant therapy). However, in-vivo effectiveness may be different from in-vitro susceptibility. Aims of this study were to describe clinical outcomes of discordant empirical treatments in pediatric UTIs and to investigate risk factors associated to treatment failure. This observational, retrospective study was conducted on children hospitalized for febrile UTIs with positive urine culture and started on discordant empirical therapy. Failure rates of discordant treatments and associated risk factors were investigated. A total of 142/1600 (8.9%) patients were treated with inadequate empirical antibiotics. Clinical failure was observed in 67/142 (47.2%) patients, with no fatal events. Higher failure rates were observed for combinations of penicillin and beta-lactamase inhibitors (57.1%). Significant risk factors for failure of discordant treatment were history of recurrent UTIs (95% CI: 1.13–9.98, OR: 3.23, p < 0.05), recent use of antibiotics (95% CI: 1.46–21.82, OR: 5.02, p < 0.01), infections caused by Pseudomonas aeruginosa (95% CI: 1.85–62.10, OR: 7.30, p < 0.05), and empirical treatment with combinations of penicillin and beta-lactamase inhibitors (95% CI: 0.94–4.03, OR: 1.94, p = 0.05). This study showed that discordant empirical treatments may still be effective in more than half of pediatric UTIs. Clinical effectiveness varies between different discordant antibiotics in pediatric UTIs, and patients presenting risk factors for treatment failure may need a differentiated empirical approach

Antibodies reacting with Simian virus 40 mimotopes in serum samples from patients with thalassaemia major

Background. Simian virus 40 (SV40) is a small DNA tumour virus. Footprints of the virus have been detected in different humam lymphoproliferative disorders and in blood specimens of blood from healthy blood donors. This study was carried out to verify whether SV40 antibodies can be detected in serum samples from multiply transfused patients with thalassaemia major.Materials and methods. An indirect enzyme-linked immunosorbent assay was employed, using SV40 specific synthetic peptides mimicking the antigens of the viral capsid proteins 1-2-3, to test for the presence of antibodies to SV40 in serum samples taken from patients affected by transfusiondependent thalassaemia major (n=190) and healthy blood donors (n=251).Results. The prevalence of antibodies against SV40 was higher in patients than in controls (24% vs 17%). The prevalence increased and was significantly higher in the older age group of patients affected by thalassemia major than in controls (38% vs 20%, p<0.04).Discussion. The higher prevalence of serum antibodies against simian virus 40 in older, multiply transfused patients with thalassamia major than in controls suggests that this virus, or a closely related yet unknown human polyomavirus, could have been transmitted in the past by transfusion with whole blood. At the same time, our data indicate no significant differences in prevalence of SV40 antibodies in patients and controls of younger age thus suggesting that current transfusion methods with leucodepletion and filtered red cells are safe

La fosfatasi alcalina elevata quasi per caso

E' descritto un caso di iperfosfasasemia alcalina transitoria dell'infanzi

Gambe gonfie in età pediatrica: un caso di “linfedema primario precoce”

Riportiamo il caso di un bambino di 3 anni giunto alla nostra osservazione per la comparsa di un “gonfiore” localizzato all’arto inferiore destro. L’anamnesi familiare e personale è risultata negativa per patologie di rilievo o episodi analoghi e non veniva riferito alcun trauma nei giorni precedenti. La monolateralità e le caratteristiche dell’edema con il supporto delle indagini di laboratorio e strumentali ci hanno fatto formulare la diagnosi di “linfedema primario precoce”, una patologia rara in età pediatrica di cui riportiamo una breve descrizione

Type 2 autoimmune hepatitis: long term follow.-up in a single center

Autoimmune hepatitis of type 2 is a distinct type of autoimmune hepatitis with typical onset in pediatric age and, if left untreated, evolves naturally towards cirrhosis and terminal liver failure. The aim of this study is to describe and analyze a pediatric population with type 2 autoimmune hepatitis. We reviewed the medical records (clinical, biochemical and histological characteristics at diagnosis, on initial therapy and follow-up) of patients diagnosed between 1999 and 2016 and followed by the same physician. The diagnosis was confirmed by the presence of anti-LKM1 and/or anti- LC1 autoantibodies serum and by compatible histological findings. Results: We studied 19 children (15 females), median age 6.43 years (4.5 yrs SD). The most common type of onset was an isolated hypertransaminasemia (68%). Severe hepatic damage at onset was rarely found and only a patient presented cirrhosis at diagnosis. This was the only case who needed liver transplant on followup. All patient were treated by immunosuppression (standard treatment with prednisone and azathioprine 9; cyclosporine 6; cyclosporine and prednisone 1; cyclosporine and azathioprine 2; only prednisone 1). Themeanduration of follow-up was 91 months, ranging between 9 and 206 months. Relapses occurred in ten patients during discontinuation of therapy. The degree of fibrosis on liver biopsy at diagnosis correlated significantly with the number of relapses. At the end of follow-up all patients were alive; 1 patient had been transplanted; 16 patients were still treated (5 azathioprine monotherapy; 5 prednisone and azathioprine; 4cyclosporine and azathioprine; 1 cyclosporine monotherapy; 1 cyclosporine, prednisone and mycophenolate mofetil); 2 patients were free of treatment from 41 and 6 months respectively. All patients presented minor side-effects during treatment: weight gain and hirsutism in 10 patients with prednisone therapy, gingival hypertrophy in 9 patients treated with cyclosporine. All of these regressed after lowering of the drug’s dosage. One patient treated with cyclosporine manifested nephrotoxicity: renal function normalized after drug suspension. A patient with azathioprine therapy in clinical remission completed a pregnancy without complications. Conclusion: Asymptomatic hypertransaminasemia as type of onset was higher in respect to all other series reported. This onset might explain the low incidence of severe hepatic damage at diagnosis and suggests the importance of an early diagnosis in asymptomatic children with AIH-2. Immunosuppressive therapy is safe and effective in the long term

Burden of hospitalizations due to Rotavirus infection in Emilia Romagna, Italy.

The aim of this study was to collect data on hospitalizations due to gastrointestinal diseases, in particular Rotavirus gastroenteritis (RVGE), in the Region of Emilia Romagna, Italy. The national hospital discharge database was used to evaluate the epidemiology of RV infections in the 2000-2003 period, analyzing only the principal diagnosis. The available age groups were 0-14 years, 15-64 years and, >64 years. Hospitalization related costs were estimated through Diagnosis Related Group (DRG) rates even though a specific DRG for RVGE does not exist. In the 0-14yr. old subjects, RV were responsible for an average of 310 GE-related hospitalizations per year and globally represented 17% of admissions for enteritis and 84% of hospitalized viral GE. Fifty-six percent of the enteritis was of undefined origin. Considering the three possible DRG codes to which the disease can be referred (184, 298, 422) and the classification of hospitals in two categories, the cost of each admission for RVGE ranged between 1,293.83 Euro and 2,263.79 Euro. RV seems to play an important role as a cause of severe viral gastroenteritis, although RV infections are certainly underestimated for several reasons, one of them being the low sensitivity of hospital discharge forms. Today we have safe and effective vaccines that can be used in order to protect from moderate/severe forms of RV-related diarrhea. The extensive use of these vaccines could reduce hospitalizations and related costs in industrialized countries

BODY MASS INDEX IN CELIAC CHILDREN BEFORE AND DURING GLUTEN FREE DIET

Gluten free diet (GFD) is hypothesized to be a predisposing factor for overweight and obesity in celiac children. The aim of this study is to evaluate the effects of GFD in celiac patients. BMI was calculated for each patient at diagnosis, after one year of GFD and at the last follow-up (median: 45 months after diagnosis) and compared to Italian percentiles. We evaluated current diet and physical activity by mean of a questionnaire. Results: We studied 64 children (42 females), median age 10 years, following a GFD since at least one year from diagnosis. At diagnosis of celiac disease: 55 children had normal BMI (86%) 3 (5%) were overweight and one (2%) was obese. After one year of GFD: 56 (87%) had normal BMI, 4 ( 6%) were overweight and one (2%) was obese. At the last follow-up examination: 55 (86%) had normal BMI and 3 (5%) were overweight. Eighty-one percent practiced physical activity regularly and 89% had breakfast. Fruits and vegetables were part of the everyday diet of respectively 66% and 58% of the subjects. Sodas were consumed by 41% of children at least once a week. Conclusions: All along during the follow up on GFD there was not any increase of BMI in the children studied. The prevalence of overweight and obesity was lower than in the general pediatric population in Italy. Our results suggest that GFD do not seem to increase the risk of overweight in celiac children in a median term follow-up

Body mass index in celiac children before and after gluten free diet

On gluten free diet there was not any increase of body mass index in the children studie