Analisi differenziale sulla diagnostica e il trattamento delle infezioni nosocomiali in ambito postoperatorio cardiochirurgico. Studio retrospettivo effettuato presso Cardiochirurgia ospedale San Martino di Genova

The mortality rate of infections following cardiac surgery has always been very high due to the special conditions of the cardiac surgical patient and the risk of infection with bacteria characterised by an extended spectrum of resistance. The aim of our study was to evaluate which patients were at increased risk of infection with multi-resistant bacteria in a cardiac surgery setting and which patients could benefit from treatment with drugs with a less extensive spectrum of action, in order to save certain types of antibiotic and to generate a lower risk of infection with multi-resistant bacteria. A retrospective case-control analysis was therefore performed on cardiac surgical patients in the time period 2017-2019 analysing the variables classically correlated with increased risk of infection by multi-resistant bacteria. A total of 206 infections were considered by comparing cases (patients infected with multi-resistant bacteria) and controls (patient infected with susceptible bacteria). The results show that the risk of infection with multi-resistant bacteria is most strongly correlated with the presence of a higher Charlson score and a longer duration of previous antibiotic treatment in relation to hospital days. The conclusion of the study, which is limited by its observational nature and the presence of only one study centre, is that a shorter duration of antibiotic treatment in appropriately selected patients could have a positive impact on infections following cardiac surgery

Culture-negative infective endocarditis (CNIE): impact on postoperative mortality

AbstractIntroductionPoor postoperative outcomes have been reported after surgery for infective endocarditis (IE). Whether the absence of positive cultures impacts the prognosis remains a matter of discussion. The aim of this study was to evaluate the impact of negative cultures on the prognosis of surgically treated IE.MethodsThis was a single-center, retrospective study. From January 2000 to June 2019, all patients who underwent valvular surgery for IE were included in the study. The primary endpoint was early postoperative mortality. A covariate balancing propensity score was developed to minimize the differences between the culture-positive IE (CPIE) and culture-negative IE (CNIE) cohorts. Using the estimated propensity scores as weights, an inverse probability treatment weighting (IPTW) model was built to generate a weighted cohort. Then, to adjust for confounding related to CPIE and CNIE, a doubly robust method that combines regression model with IPTW by propensity score was adopted to estimate the causal effect of the exposure on the outcome.ResultsDuring the study period, 327 consecutive patients underwent valvular repair/replacement with the use of cardiopulmonary bypass and cardioplegic cardiac arrest for IE. Their mean age was 61.4 ± 15.4 years, and 246 were males (75.2%). Native valve IE and prosthetic valve IE accounted for 87.5% and 12.5% of cases, respectively. Aortic (182/327, 55.7%) and mitral valves (166/327, 50.8%) were mostly involved; 20.5% of isolated mitral valve diseases were repaired (22/107 patients). The tricuspid valve was involved in 10 patients (3.3%), and the pulmonary valve in 1 patient (<1%). Fifty-nine patients had multiple-valve disease (18.0%). Blood cultures were negative in 136/327 (41.6 %). A higher postoperative mortality was registered in CNIE than in CPIE patients (19% vs 9%, respectively, p = 0.01). The doubly robust analysis after IPTW by propensity score showed CNIE to be associated with early postoperative mortality (odds ratio 2.10; 95% CI, 1.04–4.26, p = 0.04).ConclusionsIn our cohort, CNIE was associated with a higher early postoperative mortality in surgically treated IE patients after dedicated adjustment for confounding. In this perspective, any effort to improve preoperative microbiological diagnosis, thus allowing targeted therapeutic initiatives, might lead to overall better postoperative outcomes in surgically treated IE

Surveillance of surgical site infections in orthopedic prosthetic surgery: a tool for identifying risk factors and improving clinical practice

Introduction Surgical site infections (SSIs) are one of the most frequently encountered complications associated with increased length of hospital stay, costs, and hospital mortality. There is no national system for the comprehensive monitoring of the incidence of SSIs. Methods All patients undergoing orthopedic prosthetic surgery from April 1 to June 30, 2023, were enrolled. Clinical evaluation of the surgical site was conducted at 30 days, and a telephone follow-up at 90 days was performed using a specially designed questionnaire. Results A total of 59 patients were included. Surgery was performed on the knee in 71.19% and on the hip in 28.81%. The mean BMI observed was 28.25±2.97, and the mean ASA score was 2.67±0.58. Among comorbidities, 6 patients had diabetes mellitus. The incidence of SSIs was 5,08%, two infections occurred in knee prosthesis surgery and one in hip surgery. The data were analysed and diabetes was found as the main risk factor for the development of infection. Conclusions Although based on a small number of patients, the results are encouraging, especially considering that the patients had an average ASA score of more than 2 and a high BMI. However, to further reduce the risk of infection, improved hygiene measures have been implemented in the operating room and antibiotic prophylaxis protocol has been updated to take into account the potential for MRSA colonization

Olfactory bulb astrocytes link social transmission of stress to cognitive adaptation in male mice

Emotions and behavior can be affected by social chemosignals from conspecifics. For instance, olfactory signals from stressed individuals induce stress-like physiological and synaptic changes in naïve partners. Direct stress also alters cognition, but the impact of socially transmitted stress on memory processes is currently unknown. Here we show that exposure to chemosignals produced by stressed individuals is sufficient to impair memory retrieval in unstressed male mice. This requires astrocyte control of information in the olfactory bulb mediated by mitochondria-associated CB1 receptors (mtCB1). Targeted genetic manipulations, in vivo Ca2+ imaging and behavioral analyses reveal that mtCB1-dependent control of mitochondrial Ca2+ dynamics is necessary to process olfactory information from stressed partners and to define their cognitive consequences. Thus, olfactory bulb astrocytes provide a link between social odors and their behavioral meaning.We would like to thank Delphine Gonzales, Nathalie Aubailly, Ruby Racunica, Jean-Baptiste Bernard and all the personnel of the Animal Facilities of the NeuroCentre Magendie for mouse care. We also thank the genotyping platform of the Neurocentre Magendie for the help in the experiments. The microscopy was done in the Bordeaux Imaging Center a service unit of the CNRS-INSERM and Bordeaux University, member of the national infrastructure France BioImaging supported by the French National Research Agency (ANR-10-INBS-04). We thank all the members of Marsicano’s lab for useful discussions and for their invaluable support. We thank Toni-Lee Sterley and Tamas Fuzesi for providing the software to analyze social behaviors and their valuable input in the analysis. This study was funded by Inserm (to G.M); the European Research Council (Micabra, ERC-2017-AdG-786467, to G.M); Fondation pour la Recherche Medicale (DRM20101220445, to G.M; SPF201809006908 to U.S); the Human Frontiers Science Program (to G.M); Region Aquitaine (CanBrain, AAP2022A-2021-16763610 and −17219710 to G.M); French State/Agence Nationale de la Recherche (ERA-Net Neuron CanShank, ANR-21-NEU2-0001-04, to G.M), (CaMeLS, ANR-23-CE16-0022-01, to G.M), (Hippobese, ANR-23-CE14-0004-03, to G.M); the French government in the framework of the University of Bordeaux IdEx “Investments for the Future” program / GPR BRAIN_2030 (to P.G-S and G.M) and Bordeaux Collaboration Scheme (to P.G-S); La Caixa Research Health grant HR23-00793 (to G.M. and A. B-G); the Canadian Institutes for Health and Research (FDN-148440 to J.S.B); The Basque Government (IT1620-22 to P.G); Atención Primaria, Cronicidad y Promoción de la Salud, Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III (RD21/0009/0006 to P.G

Reversibility of Central Nervous System Adverse Events in Course of Art

The purpose of this study is to evaluate the frequency of central nervous system adverse events (CNS-AE) on dolutegravir (DTG) and non-DTG containing ART, and their reversibility, in the observational prospective SCOLTA cohort. Factors associated with CNS-AE were estimated using a Cox proportional-hazards model. 4939 people living with HIV (PLWH) were enrolled in DTG (n = 1179) and non-DTG (n = 3760) cohorts. Sixty-six SNC-AE leading to ART discontinuation were reported, 39/1179 (3.3%) in DTG and 27/3760 (0.7%) in non-DTG cohort. PLWH naive to ART, with higher CD4 + T count and with psychiatric disorders were more likely to develop a CNS-AE. The risk was lower in non-DTG than DTG-cohort (aHR 0.33, 95% CI 0.19-0.55, p &lt; 0.0001). One-year follow-up was available for 63/66 PLWH with CNS-AE. AE resolution was reported in 35/39 and 23/24 cases in DTG and non-DTG cohorts, respectively. The probability of AE reversibility was not different based on ART class, sex, ethnicity, CDC stage, or baseline psychiatric disorder. At the same time, a lower rate of event resolution was found in PLWH older than 50 years (p = 0.017). In conclusion, CNS-AE leading to ART discontinuation was more frequent in DTG than non-DTG treated PLWH. Most CNS-AE resolved after ART switch, similarly in both DTG and non-DTG cohorts

Innovative therapies for acute bacterial skin and skin-structure infections (ABSSSI) caused by methicillin-resistant Staphylococcus aureus: advances in phase I and II trials

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is among the most frequent causative agents of acute bacterial skin and skin-structure infections (ABSSSI) and has been associated with increased risks of invasive disease and of treatment failure. Areas covered: In this review, we focus on those novel anti-MRSA agents currently in phase I or II of clinical development that may enrich the armamentarium against ABSSSI caused by MRSA in the future. Expert opinion: Promising agents belonging to either old or novel antibiotic classes are currently in early phases of clinical development and may become available in the future for the effective treatment of ABSSSI caused by MRSA. In particular, the future availability of agents belonging to novel classes will be important for guaranteeing an effective treatment and for allowing outpatient treatment/early discharge, with a consequent reduced impact on healthcare resources. However, this does not mean that we can relax our efforts directed toward improving the responsible use of already available agents. Indeed, preserving their activity in the long term is crucial for optimizing the use of healthcare resources

Role of new antibiotics in the treatment of acute bacterial skin and skin-structure infections

Purpose of review To summarize the available efficacy and safety data of novel agents for treating acute bacterial skin and skin-structure infections (ABSSSI), focusing on those active against methicillin-resistant Staphylococcus aureus (MRSA). Recent findings There are now several agents active against MRSA that are approved for the treatment of ABSSSI, including tedizolid, ceftaroline, dalbavancin, telavancin, oritavancin, delafloxacin, and omadacycline. In addition, iclaprim has completed phase-3 randomized clinical trials (RCTs). Considering the similar efficacy that arose from direct comparisons in phase-3 RCTs, in order to adopt the best approach for treating ABSSSI on patient-tailored basis, the different safety profiles and formulations of the different available agents should be balanced by taking into account the specific features of each treated patient in terms of baseline comorbidities, related risk of toxicity, need for hospitalization, possibility of early discharge, and expected adherence to outpatient oral therapy

Respiratory Fungal Diseases in Adult Patients With Cystic Fibrosis

Clinical manifestations of respiratory fungal diseases in adult cystic fibrosis (CF) patients are very heterogeneous, ranging from asymptomatic colonization to chronic infections, allergic disorders, or invasive diseases in immunosuppressed CF patients after lung transplantation. In this narrative review, mainly addressed to clinicians without expertise in CF who may nonetheless encounter adult CF patients presenting with acute and chronic respiratory syndromes, we briefly summarize the most representative clinical aspects of respiratory fungal diseases in adult CF patients