Browsing by Author "Gori, Andrea"

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Open Access
Autochthonous ST405 NDM-5 producing Escherichia coli causing fatal sepsis in Northern Italy.
(International journal of antimicrobial agents, 2020-05) Peri, Anna Maria; Piazza, Aurora; De Zan, Valentina; Carugati, Manuela; Muscatello, Antonio; Comandatore, Francesco; De Lorenzis, Elisa; Pluderi, Mauro; Arghittu, Milena; Cariani, Lisa; Cantù, Anna Paola; Bandi, Claudio; Cugno, Massimo; Gori, Andrea; Bandera, Alessandra
Open Access
Challenges in the Diagnosis and Management of Bacterial Lung Infections in Solid Organ Recipients: A Narrative Review.
(International journal of molecular sciences, 2020-02) Carugati, Manuela; Morlacchi, Letizia Corinna; Peri, Anna Maria; Alagna, Laura; Rossetti, Valeria; Bandera, Alessandra; Gori, Andrea; Blasi, Francesco; Working Group, Ifalt
Respiratory infections pose a significant threat to the success of solid organ transplantation, and the diagnosis and management of these infections are challenging. The current narrative review addressed some of these challenges, based on evidence from the literature published in the last 20 years. Specifically, we focused our attention on (i) the obstacles to an etiologic diagnosis of respiratory infections among solid organ transplant recipients, (ii) the management of bacterial respiratory infections in an era characterized by increased antimicrobial resistance, and (iii) the development of antimicrobial stewardship programs dedicated to solid organ transplant recipients.
Open Access
Exogenous reinfection of tuberculosis in a low-burden area.
(Infection, 2015-12) Schiroli, Consuelo; Carugati, Manuela; Zanini, Fabio; Bandera, Alessandra; Bandera, Alessandra; Di Nardo Stuppino, Silvia; Monge, Elisa; Morosi, Manuela; Gori, Andrea; Matteelli, Alberto; Codecasa, Luigi; Franzetti, Fabio
Purpose
Recurrence of tuberculosis (TB) can be the consequence of relapse or exogenous reinfection. The study aimed to assess the factors associated with exogenous TB reinfection.
Methods
Prospective cohort study based on the TB database, maintained at the Division of Infectious Diseases, Luigi Sacco Hospital (Milan, Italy). Time period: 1995-2010.
Inclusion criteria
(1) ≥2 episodes of culture-confirmed TB; (2) cure of the first episode of TB; (3) availability of one Mycobacterium tuberculosis isolate for each episode. Genotyping of the M. tuberculosis strains to differentiate relapse and exogenous reinfection. Logistic regression analysis was used to assess the influence of risk factors on exogenous reinfections.
Result
Of the 4682 patients with TB, 83 were included. Of these, exogenous reinfection was diagnosed in 19 (23 %). It was independently associated with absence of multidrug resistance at the first episode [0, 10 (0.01-0.95), p = 0.045] and with prolonged interval between the first TB episode and its recurrence [7.38 (1.92-28.32) p = 0.004]. However, TB relapses occurred until 4 years after the first episode. The risk associated with being foreign born, extrapulmonary site of TB, and HIV infection was not statistically significant. In the relapse and re-infection cohort, one-third of the patients showed a worsened drug resistance profile during the recurrent TB episode.
Conclusions
Exogenous TB reinfections have been documented in low endemic areas, such as Italy. A causal association with HIV infection could not be confirmed. Relapses and exogenous reinfections shared an augmented risk of multidrug resistance development, frequently requiring the use of second-line anti-TB regimens.
Open Access
Influence of Hospitalization upon Diagnosis on the Risk of Tuberculosis Clustering.
(Mediterranean journal of hematology and infectious diseases, 2013-01) Lapadula, Giuseppe; Zanini, Fabio; Codecasa, Luigi; Franzetti, Fabio; Ferrarese, Maurizio; Carugati, Manuela; Mazzola, Ester; Schiroli, Consuelo; Motta, Davide; Iemmi, Diego; Gori, Andrea
Setting
Culture-positive tuberculosis (TB) diagnosed in the metropolitan area of Milan (Italy) over a 5-year period (1995-1999).
Objective
To assess the impact of short-course hospitalization upon diagnosis on the overall risk of TB clustering.
Design
Restriction fragment length polymorphism profiles with a similarity of 100% defined a cluster. Uni- and multivariable logistic regression models were performed to assess factors associated with clustering.
Results
Among 1139 patients, 392 (34.4%) were hospitalized before or soon after diagnosis, 405 (35.6%) received domiciliary treatment since the diagnosis and 392 (30%) had no information about initial clinical management. One hundred fifteen molecular clusters involving 363 patients were identified. Using multivariable analysis, hospitalization was not significantly associated with clustering (OR 1.06, 95%CI 0.75-1.50, p=0.575). Subjects aged >65 years old (OR 0.60; 95CI%:0.37-0.95; p=0.016) and non-Italian born patients (OR 0.56; 95%CI:0.41-0.76; p<0.001) were running a lower risk of clustering. Conversely, HIV co-infected patients (OR 1.88, 95%CI:1.20-2.95, p=0.006) and those with MDR TB (OR 2.50, 95%CI:1.46-4.25, p=0.001) were significantly more likely to be involved in clusters.
Conclusion
In our cohort, domiciliary treatment was not associated with TB clustering. Expanding domiciliary treatment upon diagnosis appears as an advisable measure to reduce unnecessary costs for the health care system.
Open Access
Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review.
(Medical sciences (Basel, Switzerland), 2019-01) Vanoni, Nicolò Maria; Carugati, Manuela; Borsa, Noemi; Sotgiu, Giovanni; Saderi, Laura; Gori, Andrea; Mantero, Marco; Aliberti, Stefano; Blasi, Francesco
Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide. CAP mortality is driven by the development of sepsis and acute respiratory failure (ARF). We performed a systematic review of the available English literature published in the period 1 January 1997 to 31 August 2017 and focused on ARF in CAP. The database searches identified 189 articles-of these, only 29 were retained for data extraction. Of these 29 articles, 12 addressed ARF in CAP without discussing its ventilatory management, while 17 evaluated the ventilatory management of ARF in CAP. In the studies assessing the ventilatory management, the specific treatments addressed were: high-flow nasal cannula (HFNC) (n = 1), continuous positive airway pressure (n = 2), non-invasive ventilation (n = 9), and invasive mechanical ventilation (n = 5). When analyzed, non-invasive ventilation (NIV) success rates ranged from 20% to 76% and they strongly predicted survival, while NIV failure led to an increased risk of adverse outcome. In conclusion, ARF in CAP patients may require both ventilatory and non-ventilatory management. Further research is needed to better evaluate the use of NIV and HFNC in those patients. Alongside the prompt administration of antimicrobials, the potential use of steroids and the implementation of severity scores should also be considered.
Open Access
Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study.
(ERJ open research, 2018-10) Carugati, Manuela; Aliberti, Stefano; Reyes, Luis Felipe; Franco Sadud, Ricardo; Irfan, Muhammad; Prat, Cristina; Soni, Nilam J; Faverio, Paola; Gori, Andrea; Blasi, Francesco; Restrepo, Marcos I
This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p<0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations.
Open Access
Mycobacterial interspersed repetitive-unit-variable-number tandem-repeat analysis and Beijing/W family of Mycobacterium tuberculosis.
(Journal of clinical microbiology, 2011-07) Carugati, Manuela; Zanini, Fabio; Schiroli, Consuelo; Gori, Andrea; Franzetti, Fabio; Hanekom, M; van der Spuy, GD; Gey van Pittius, NC; McEvoy, CRE; Ndabambi, SL; Victor, TC; Hoal, EG; van Helden, PD; Warren, RM
Open Access
Mycobacterium tuberculosis Beijing family: analysis of the epidemiological and clinical factors associated with an emerging lineage in the urban area of Milan.
(Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases, 2014-07) Zanini, Fabio; Carugati, Manuela; Schiroli, Consuelo; Lapadula, Giuseppe; Lombardi, Alessandra; Codecasa, Luigi; Gori, Andrea; Franzetti, Fabio
The Mycobacterium tuberculosis Beijing genotype raises major concern because of global spreading, hyper-virulence and association with multi-drug resistance (MDR). The aims of the study were to evaluate role of Beijing family in the epidemiological setting of Milan and to identify predictors associated with the spreading of this lineage. Overall 3830TB cases were included. Beijing family accounted for 100 isolates (2.6%). Prevalence grew from 1.7% to 5.4% in the period 1996-2009. Foreign origin increased significantly the risk of having a Beijing strain: the greatest risk was observed among patients coming either from China [AOR=57.7, 95%CI (26.3-126.8)] or from Former Soviet countries [AOR=33.9, 95%CI (12.8-99.6)]. Also MDR was independently associated with Beijing family [AOR=2.7, 95%CI (1.3-5.8)], whereas male gender and younger age only approximated the statistical significance [p 0.051 and p 0.099, respectively]. However, the percentage of cases attributable to MDR strains decreased over time, both in the Beijing group and in the non-Beijing group. 97 isolates were grouped in 37 sub-lineages: MT11, MT33 were predominant. Beijing family is an emerging lineage in Milan. Origin from countries like China and Ukraine and MDR are significantly associated with Beijing. The broad range of the sub-lineages reflects the recent dynamics of the migration flows to our area. This scenario can prelude to a constant increase in the spreading of Beijing strains in the near future.
Open Access
The hidden hypothesis: A disseminated tuberculosis case.
(International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2019-08) Foresti, Sergio; Perego, Maria Rita; Carugati, Manuela; Casati, Anna; Malafronte, Cristina; Manzoni, Marco; Badolato, Raffaele; Gori, Andrea; Achilli, Felice
Case presentation
77-year-old former smoker admitted because of fatigue and abdominal distention. Past medical history positive for two previous hospitalizations for pericardial and pleural effusions (no diagnosis achieved). At admission erythrocyte sedimentation rate was 122mm per hour. Baseline investigations revealed ascitic, pleural and pericardial effusion. Effusions were tapped: neoplastic cells and acid-fast bacilli (AFB) were not identified, aerobic and mycobacterial culture resulted negative. QuantiFERON TB-Gold test was negative. Total body PET-CT and autoimmunity panel were negative. A neoplastic process was considered the most likely explanation. Before signing off the patient to comfort care, a reassessment was performed and an exposure to tuberculosis during childhood was documented. Because of constrictive pericarditis, pericardiectomy was performed: histologic examination showed chronic pericardial inflammation without granulomas, but Ziehl-Neelsen stain identified AFB and PCR was positive for Mycobacterium tuberculosis complex. Patient was started on anti-TB therapy with resolution of the effusions in the following months. Genes associated with defects in innate immunity were sequences and dentritic cells were studied, but no alterations were identified.
Discussion
A Bayesian approach to clinical decision making should be recommended. Interpretation of diagnostic tests should take into account the imperfect diagnostic performance of the majority of these tests. Further studies to investigate genetic susceptibility to tuberculosis are needed.

Browsing by Author "Gori, Andrea"

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