Epidemiology of intensive care unit-acquired sepsis in Italy: results of the SPIN-UTI network

none139BACKGROUND: Sepsis is the major cause of mortality from any infectious disease worldwide. Sepsis may be the result of a healthcare associated infection (HAI): the most frequent adverse events during care delivery especially in Intensive Care Units (ICUs). The main aim of the present study was to describe the epidemiology of ICU-acquired sepsis and related outcomes among patients enrolled in the framework of the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project. STUDY DESIGN: Prospective multicenter study. METHODS: The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance. RESULTS: During the five editions of the SPIN-UTI project, from 2008 to 2017, 47.0% of HAIs has led to sepsis in 832 patients. Overall, 57.0% episodes were classified as sepsis, 20.5% as severe sepsis and 22.5% as septic shock. The most common isolated microorganisms from sepsis episodes were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. The case fatality rate increased with the severity of sepsis and the mean length of ICU-stay was significantly higher in patients with ICU-acquired sepsis than in patients without. CONCLUSION: Our study provides evidence that ICU-acquired sepsis occurs frequently in Italian ICU patients and is associated with a high case fatality rate and increased length of stay. However, in order to explain these findings further analyses are needed in this population of ICU patients.noneAgodi A, Barchitta M, Auxilia F, Brusaferro S3, D'Errico MM, Montagna MT, Pasquarella C, Tardivo S, Arrigoni C, Fabiani L, Laurenti P, Mattaliano AR, Orsi GB, Squeri R, Torregrossa MV, Mura I, Aiello MR, Alliani C, Amatucci MR, Antoci M, Antonelli M, Astuto M, Arnoldo L, Arru B, Baccari G, Barbadoro P, Barbara A, Barilaro C, Battaglia P, Bellocchi P, Bernasconi MO, Bianco A, Bissolo E, Bocchi A, Bruno A, Brusaferro M, Buccheri M, Campanella F, Canino R, Cannistrà A, Carini SA, Catalano S, Castellani P, Castiglione G, Coniglio S, Consolante C, Conte C, Contrisciani R, Corallini R, Crollari P, Damiani G, Denaro C, De Remigis S, Diana F, Di Bartolo R, Di Benedetto A, Di Fabio G, Di Falco C, Digeronimo V, Di Gregorio P, Distefano R, Egitto G, Falciani E, Farruggia P, Fenaroli S, Ferlazzo G, Garofalo G, Girardis M, Giovanelli L, Giubbini G, Graceffa A, Guadagna A, Gregu G, Ingala F, Innocenzi L, La Camera G, La Rosa MC, Lesa L, Longhitano AM, Luppino G, Maida CM, Manta G, Marino G, Masia MD, Maviglia R, Mazzetti M, Maugeri A, Megna MT, Mella LM, Milazzo M, Milia M, Minari C, Minerva M, Mordacci M, Murgia P, Oliveri P, Olori MP, Pagliarulo R, Palermo R, Pandiani I, Pappalardo F, Papetti C, Partenza A, Pascu D, Pasculli M, Pavia M, Pavone ML, Pellegrino MG, Pelligra F, Pillon D, Pintaudi S, Pitzoi L, Pinto A, Piotti P, Pupo S, Quattrocchi R, Righi E, Rigo A, Rigo A, Romeo A, Rosa E, Rutigliano S, Sarchi P, Scimonello G, Seminerio A, Stefanini P, Sticca G, Taddei S, Tessari L, Tetamo R, Ticca M, Tribastoni S, Vallorani S, Venturoni F, Vitagliano E, Vitali P, Zappone A, Zei E, Zeoli MP.Agodi, A; Barchitta, M; Auxilia, F; Brusaferro, S3; D'Errico, Mm; Montagna, Mt; Pasquarella, C; Tardivo, S; Arrigoni, C; Fabiani, L; Laurenti, P; Mattaliano, Ar; Orsi, Gb; Squeri, R; Torregrossa, Mv; Mura, I; Aiello, Mr; Alliani, C; Amatucci, Mr; Antoci, M; Antonelli, M; Astuto, M; Arnoldo, L; Arru, B; Baccari, G; Barbadoro, P; Barbara, A; Barilaro, C; Battaglia, P; Bellocchi, P; Bernasconi, Mo; Bianco, A; Bissolo, E; Bocchi, A; Bruno, A; Brusaferro, M; Buccheri, M; Campanella, F; Canino, R; Cannistrà, A; Carini, Sa; Catalano, S; Castellani, P; Castiglione, G; Coniglio, S; Consolante, C; Conte, C; Contrisciani, R; Corallini, R; Crollari, P; Damiani, G; Denaro, C; De Remigis, S; Diana, F; Di Bartolo, R; Di Benedetto, A; Di Fabio, G; Di Falco, C; Digeronimo, V; Di Gregorio, P; Distefano, R; Egitto, G; Falciani, E; Farruggia, P; Fenaroli, S; Ferlazzo, G; Garofalo, G; Girardis, M; Giovanelli, L; Giubbini, G; Graceffa, A; Guadagna, A; Gregu, G; Ingala, F; Innocenzi, L; La Camera, G; La Rosa, Mc; Lesa, L; Longhitano, Am; Luppino, G; Maida, Cm; Manta, G; Marino, G; Masia, Md; Maviglia, R; Mazzetti, M; Maugeri, A; Megna, Mt; Mella, Lm; Milazzo, M; Milia, M; Minari, C; Minerva, M; Mordacci, M; Murgia, P; Oliveri, P; Olori, Mp; Pagliarulo, R; Palermo, R; Pandiani, I; Pappalardo, F; Papetti, C; Partenza, A; Pascu, D; Pasculli, M; Pavia, M; Pavone, Ml; Pellegrino, Mg; Pelligra, F; Pillon, D; Pintaudi, S; Pitzoi, L; Pinto, A; Piotti, P; Pupo, S; Quattrocchi, R; Righi, E; Rigo, A; Rigo, A; Romeo, A; Rosa, E; Rutigliano, S; Sarchi, P; Scimonello, G; Seminerio, A; Stefanini, P; Sticca, G; Taddei, S; Tessari, L; Tetamo, R; Ticca, M; Tribastoni, S; Vallorani, S; Venturoni, F; Vitagliano, E; Vitali, P; Zappone, A; Zei, E; Zeoli, Mp

Correction to: Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial (Journal of Translational Medicine, (2020), 18, 1, (405), 10.1186/s12967-020-02573-9)

Following publication of the original article [1] the authors identified that the collaborators of the TOCIVID-19 investigators, Italy were only available in the supplementary file. The original article has been updated so that the collaborators are correctly acknowledged. For clarity, all collaborators are listed in this correction article

Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.ResultsIn the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P=0.52) and 22.4% (97.5% CI: 17.2-28.3, P<0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.ConclusionsTocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline.Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092)