Guidelines for the use and interpretation of diagnostic methods in adult food allergy

Food allergy has an increasing prevalence in the general population and in Italy concerns 8 % of people with allergies. The spectrum of its clinical manifestations ranges from mild symptoms up to potentially fatal anaphylactic shock. A number of patients can be diagnosed easily by the use of first- and second-level procedures (history, skin tests and allergen specific IgE). Patients with complex presentation, such as multiple sensitizations and pollen-food syndromes, frequently require a third-level approach including molecular diagnostics, which enables the design of a component-resolved sensitization profile for each patient. The use of such techniques involves specialists' and experts' skills on the issue to appropriately meet the diagnostic and therapeutic needs of patients. Particularly, educational programs for allergists on the use and interpretation of molecular diagnostics are needed

Clinical outcomes of elderly patients with bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae in an Italian Internal Medicine ward

Purpose: Infections caused by ESBL-producing Enterobacteriaceae (ESBL-EB) are a major health problem, but data regarding elderly patients is lacking. Methods: We performed a retrospective observational study quantifying the effects of antimicrobial treatment and primary infection site on clinical outcomes in an historical case series of 42 patients aged 80.7 ± 10 years admitted to an Internal Medicine ward in Italy for ESBL-EB bloodstream infections (BSI). Results: At multivariate risk analysis, we found that urinary tract as primary infection site (RR=0.181 [0.037–0.886], p=0.035) and definitive antibiotic therapy (RR=0.517 [0.147–0.799], p= 0.038) decreased the relative risk of a negative clinical response, while the respiratory tract origin increased the relative risk (RR =2.788 [1.407–9.228], p=0.025). Also regarding 30 days mortality, multivariate risk analysis identified that urinary tract as primary infection site (RR=0.098 [0.011–0.743], p=0.025) and definitive antibiotic therapy (RR=0.236 [0.058–0.961], p =0.044) decreased the relative risk, while the respiratory origin increased the relative risk (RR=4.241 [1.040–17.295], p= 0.014). We observed similar outcomes in patients definitively treated with carbapenems or with carbapenem-free treatments. Additionally, an initially inappropriate therapy did not correlate with worse outcomes if a switch to an effective definitive treatment was performed promptly. Conclusions: Carbapenem-sparing regimens (e.g. piperacillin-tazobactam alone or with an aminoglycoside) could be empirically safely used in elderly patients at high risk of ESBL-EB BSI and for definitive treatment of ascertained cases if the primary site is the urinary tract, leaving early carbapenem use for cases at higher risk of death, such as those with pneumonia

Clinical outcomes of elderly patients with bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae in an Italian Internal Medicine ward

Purpose: Infections caused by ESBL-producing Enterobacteriaceae (ESBL-EB) are a major health problem, but data regarding elderly patients is lacking. Methods: We performed a retrospective observational study quantifying the effects of antimicrobial treatment and primary infection site on clinical outcomes in an historical case series of 42 patients aged 80.7 ± 10 years admitted to an Internal Medicine ward in Italy for ESBL-EB bloodstream infections (BSI). Results: At multivariate risk analysis, we found that urinary tract as primary infection site (RR=0.181 [0.037–0.886], p=0.035) and definitive antibiotic therapy (RR=0.517 [0.147–0.799], p= 0.038) decreased the relative risk of a negative clinical response, while the respiratory tract origin increased the relative risk (RR =2.788 [1.407–9.228], p=0.025). Also regarding 30 days mortality, multivariate risk analysis identified that urinary tract as primary infection site (RR=0.098 [0.011–0.743], p=0.025) and definitive antibiotic therapy (RR=0.236 [0.058–0.961], p =0.044) decreased the relative risk, while the respiratory origin increased the relative risk (RR=4.241 [1.040–17.295], p= 0.014). We observed similar outcomes in patients definitively treated with carbapenems or with carbapenem-free treatments. Additionally, an initially inappropriate therapy did not correlate with worse outcomes if a switch to an effective definitive treatment was performed promptly. Conclusions: Carbapenem-sparing regimens (e.g. piperacillin-tazobactam alone or with an aminoglycoside) could be empirically safely used in elderly patients at high risk of ESBL-EB BSI and for definitive treatment of ascertained cases if the primary site is the urinary tract, leaving early carbapenem use for cases at higher risk of death, such as those with pneumonia