Ceftazidime-Avibactam as Osteomyelitis Therapy: A Miniseries and Review of the Literature

Bone and joint infections (BJIs) caused by multidrug-resistant gram-negative bacteria are becoming a concern due to limited therapeutic options. Although not approved for these indications, an ever-growing amount of evidence supports the efficacy and safety of ceftazidime–avibactam as a therapy for osteomyelitis and prosthetic joint infections. Here, we present three cases of difficult-to-treat resistant Pseudomonas aeruginosa osteomyelitis that were successfully treated with ceftazidime–avibactam alone or in combination therapy with fosfomycin and amikacin. Ceftazidime–avibactam was prescribed at a daily dose of 2.5 g every 8 h for 42 days in all cases. One potential drug-related adverse effect was observed, i.e., Clostridioides difficile infection, which occurred after fourteen days of treatment with ceftazidime–avibactam

Cluster of Legionnaires’ Disease in an Italian Prison

Background: Legionella pneumophila (Lp) is the most common etiologic agent causing Legionnaires’ Disease (LD). Water systems offer the best growth conditions for Lp and support its spread by producing aerosols. From 2015 to 2017, the Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis of Palermo monitored the presence of Lp in nine prisons in Western Sicily. During this investigation, we compared Lp isolates from environmental samples in a prison located in Palermo with isolates from two prisoners in the same prison. Methods: We collected 93 water samples from nine Sicilian prisons and the bronchoalveolar lavages (BALs) of two prisoners considered cases of LD. These samples were processed following the procedures described in the Italian Guidelines for the Prevention and Control of Legionellosis of 2015. Then, genotyping was performed on 19 Lp colonies (17 from water samples and 2 from clinical samples) using the Sequence-Based Typing (SBT) method, according to European Study Group for Legionella Infections (ESGLI) protocols. Results: Lp serogroup (sg) 6 was the most prevalent serogroup isolated from the prisons analyzed (40%), followed by Lp sg 1 (16%). Most of all, in four penitentiary institutions, we detected a high concentration of Lp >104 Colony Forming Unit/Liter (CFU/L). The environmental molecular investigation found the following Sequence Types (STs) in Lp sg 6: ST 93, ST 292, ST 461, ST 728, ST 1317 and ST 1362, while most of the isolates in sg 1 belonged to ST 1. We also found a new ST that has since been assigned the number 2451 in the ESGLI-SBT database. From the several Lp sg 1 colonies isolated from the two BALs, we identified ST 2451. Conclusions: In this article, we described the results obtained from environmental and epidemiological investigations of Lp isolated from prisons in Western Sicily. Furthermore, we reported the first cluster of Legionnaires’ in an Italian prison and the molecular typing of Lp sg 1 from one prison’s water system and two BALs, identified the source of the contamination, and discovered a new ST

The Porosity in Heterogeneous Carbonate Reservoir Rocks: Tectonic versus Diagenetic Imprint—A Multi-Scale Study from the Hyblean Plateau (SE Sicily, Italy)

The petroleum industry has always been pursuing highly exploitable gas fields, which are often hosted in carbonate rocks. However, carbonates are highly heterogeneous and show different fabrics and structures as the result of sedimentation in various environments, and subsequent diagenesis and deformation. In this study, a multi-scale and multidisciplinary approach has been performed on classical reservoir rocks from the subsurface of the Hyblean Plateau (Sicily, Italy). We aim at unravelling the important and debated role of tectonic and diagenetic structures (mainly fractures as well as stylolites) in enhancing or reducing the porosity. Black shales, limestones, and laminites of intertidal environment represent the main lithologies. Structure cross-cutting relationships record different stages of the basin geological history, which are related to the tectonic evolution of the area. Our results show that porosity is uncommonly lightly affected by fractures and faults, because of their mineralization, whereas stylolites, which are often considered as barriers to fluid flow, show a certain porosity. Therefore, we want to highlight the importance of a multi-scale and multidisciplinary approach in the analysis of heterogeneously porous, fractured- and stylolite-rich carbonate rocks, and our study aspires to boost other similar gas reservoir studies in energy transition times

The Porosity in Heterogeneous Carbonate Reservoir Rocks: Tectonic versus Diagenetic Imprint—A Multi-Scale Study from the Hyblean Plateau (SE Sicily, Italy)

The petroleum industry has always been pursuing highly exploitable gas fields, which are often hosted in carbonate rocks. However, carbonates are highly heterogeneous and show different fabrics and structures as the result of sedimentation in various environments, and subsequent diagenesis and deformation. In this study, a multi-scale and multidisciplinary approach has been performed on classical reservoir rocks from the subsurface of the Hyblean Plateau (Sicily, Italy). We aim at unravelling the important and debated role of tectonic and diagenetic structures (mainly fractures as well as stylolites) in enhancing or reducing the porosity. Black shales, limestones, and laminites of intertidal environment represent the main lithologies. Structure cross-cutting relationships record different stages of the basin geological history, which are related to the tectonic evolution of the area. Our results show that porosity is uncommonly lightly affected by fractures and faults, because of their mineralization, whereas stylolites, which are often considered as barriers to fluid flow, show a certain porosity. Therefore, we want to highlight the importance of a multi-scale and multidisciplinary approach in the analysis of heterogeneously porous, fractured- and stylolite-rich carbonate rocks, and our study aspires to boost other similar gas reservoir studies in energy transition times

Ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin for patients with hepatitis C virus genotype 1 or 4 infection with cirrhosis (ABACUS): a prospective observational study

Background We ran a compassionate use nationwide programme (ABACUS) to provide access to ombitasvir, paritaprevir, and ritonavir, with dasabuvir, plus ribavirin for hepatitis C virus (HCV) genotype 1 infection and ombitasvir, paritaprevir, and ritonavir, plus ribavirin for HCV genotype 4 infection in patients with cirrhosis at high risk of decompensation while approval of these regimens was pending in Italy. Methods In this prospective observational study, we collected data from a compassionate use nationwide programme from March 17, 2014, to May 28, 2015. Patients with HCV genotype 1 infection and cirrhosis at high risk of decompensation were given coformulated ombitasvir (25 mg), paritaprevir (150 mg), and ritonavir (100 mg) once daily and dasabuvir (250 mg) twice daily for 12 weeks (patients with HCV genotype 1b infection) or 24 weeks (patients with HCV genotype 1a infection). Patients with HCV genotype 4 infection were given coformulated ombitasvir (25 mg), paritaprevir (150 mg), and ritonavir (100 mg) once per day for 24 weeks. All patients were given weight-based ribavirin. The primary efficacy endpoint was sustained virological response at week 12 after the end of treatment (SVR12), analysed by intention-to-treat. Univariate and multivariate logistic regression analyses were used to identify baseline characteristics associated with SVR12. Adverse events were recorded throughout the study. Findings 728 (96%) of 762 patients with cirrhosis who were given ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin therapy for 12 or 24 weeks achieved SVR12. Logistic regression analyses identified that bilirubin concentrations of less than 2 mg/dL were associated with SVR12 (odds ratio [OR] 4·76 [95% CI 1·83–12·3]; p=0·001). 166 (23%) of 734 patients included in safety analyses had an adverse event. 25 (3%) patients discontinued treatment because of adverse events. Asthenia was the most commonly reported adverse event, occurring in 36 (5%) patients. Interpretation Our findings suggest that the safety and effectiveness of ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir, plus ribavirin in patients with HCV genotype 1 or 4 infection and cirrhosis at high risk of decompensation in a real-life setting are similar to those reported in clinical trials. The concordance with clinical trials provides reassurance that the reported efficacy of this treatment in clinical trials will translate to its use in routine clinical practice. Funding Dipartimento Biomedico di Medicina Interna e Specialistica dell'Universita di Palermo