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Eur J Clin Microbiol Infect Dis ; 41(3): 495-500, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1603573


The objective was to study ceftazidime-avibactam resistant and susceptible Klebsiella pneumoniae isolated from a patient admitted to the Policlinico Umberto I of Rome for SARS-CoV2. Data on the evolution of patient's conditions, antimicrobial therapies, and microbiological data were collected. Whole-genome sequencing performed by Illumina and Nanopore sequencing methods were used to type the strains. During the hospitalization, a SARS-CoV2-infected patient was colonized by a KPC-producing K. pneumoniae strain and empirically treated with ceftazidime-avibactam (CZA) when presenting spiking fever symptoms. Successively, ST2502 CZA-resistant strain producing the KPC-31 variant gave a pulmonary infection to the patient. The infection was treated with high doses of meropenem. The KPC-31-producing strain disappeared but the patient remained colonized by a KPC-3-producing K. pneumoniae strain. An interplay between highly conserved KPC-31- and KPC-3-producing ST2502 strains occurred in the SARS-CoV2 patient during the hospitalization, selected by CZA and carbapenem treatments, respectively.

Anti-Bacterial Agents , COVID-19 , Klebsiella Infections , Meropenem , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/genetics , COVID-19/complications , Ceftazidime/therapeutic use , Drug Combinations , Humans , Klebsiella Infections/drug therapy , Klebsiella pneumoniae/genetics , Meropenem/therapeutic use , Microbial Sensitivity Tests , beta-Lactamases/genetics
Diagn Microbiol Infect Dis ; 100(4): 115399, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1315428


Between November 2018 and October 2019, carbapenem-resistant Enterobacterales carrying New Delhi Metallo-ß-lactamase (NDM) caused one of the largest and persistent outbreaks occurred in Italy and intensified surveillance measures have been taken in all Italian hospitals. In this study we analyzed NDM-5- producing Escherichia coli identified in 2 hospitals of the Lazio region in Italy. Epidemiological and microbiological data demonstrated that in 2018-2019 the NDM-5-producing high-risk E. coli ST167 clone circulated in patients from both hospitals. In 2019, another NDM-5-producing E. coli clone, identified by MLST as ST617 was introduced in one of the 2 hospitals and caused an outbreak. This study describes an application of genomics as a useful method to discern endemic and outbreak clones when applied to strains of the same species (E. coli) with the same resistance determinant (NDM-5) and the relevance of screening patients admitted in critical units for carbapenemase producers to prevent outbreaks.

Escherichia coli Infections/epidemiology , Escherichia coli/genetics , beta-Lactamases/genetics , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , DNA, Bacterial/genetics , Disease Outbreaks/prevention & control , Disease Outbreaks/statistics & numerical data , Drug Resistance, Multiple, Bacterial , Escherichia coli/drug effects , Escherichia coli/enzymology , Female , Genome, Bacterial , Hospitals/statistics & numerical data , Humans , Italy/epidemiology , Male , Microbial Sensitivity Tests , Middle Aged , Retrospective Studies , Whole Genome Sequencing , beta-Lactamases/biosynthesis
J Med Virol ; 93(7): 4319-4325, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1118173


Teicoplanin has a potential antiviral activity expressed against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was suggested as a complementary option to treat coronavirus disease 2019 (COVID-19) patients. In this multicentric, retrospective, observational research the aim was to evaluate the impact of teicoplanin on the course of COVID-19 in critically ill patients. Fifty-five patients with severe COVID-19, hospitalized in the intensive care units (ICUs) and treated with best available therapy were retrospectively analysed. Among them 34 patients were also treated with teicoplanin (Tei-COVID group), while 21 without teicoplanin (control group). Crude in-hospital Day-30 mortality was lower in Tei-COVID group (35.2%) than in control group (42.8%), however not reaching statistical significance (p = .654). No statistically significant differences in length of stay in the ICU were observed between Tei-COVID group and control group (p = .248). On Day 14 from the ICU hospitalization, viral clearance was achieved in 64.7% patients of Tei-COVID group and 57.1% of control group, without statistical difference. Serum C-reactive protein level was significantly reduced in Tei-COVID group compared to control group, but not other biochemical parameters. Finally, Gram-positive were the causative pathogens for 25% of BSIs in Tei-COVID group and for 70.6% in controls. No side effects related to teicoplanin use were observed. Despite several limitations require further research, in this study the use of teicoplanin is not associated with a significant improvement in outcomes analysed. The antiviral activity of teicoplanin against SARS-CoV-2, previously documented, is probably more effective at early clinical stages.

Antiviral Agents/therapeutic use , COVID-19/drug therapy , Hospital Mortality , SARS-CoV-2/drug effects , Teicoplanin/therapeutic use , Aged , C-Reactive Protein/analysis , Critical Care/statistics & numerical data , Critical Illness/therapy , Female , Humans , Intensive Care Units , Length of Stay/statistics & numerical data , Male , Middle Aged , Retrospective Studies