Outpatient parenteral antibiotic therapy in the elderly: an Italian observational multicenter study.

Bacterial infections are the most frequent cause of hospitalization in elderly patients. In the early eighties, the advantages of Outpatient parenteral Antibiotic therapy (OPAT) were identified in the United States, and suitable therapeutic programs were established. In order to understand the different ways of managing OPAT, a National OPAT Registry was set up in 2003 in Italy. This study analyzes data concerning bacterial infections in 176 elderly patients including demographics, therapeutic management, clinical response, and side-effects. Bone and joint infections (48.9%) and skin and soft tissue infections (27.8%) were the most common infections treated with OPAT. Teicoplanin (28.9%) and ceftriaxone (22.1%) were the top two antibiotics chosen. OPAT was mainly performed at a hospital infusion center (52.8%). The clinical success rate was high and side-effects were low (12.6% of cases). Management of bacterial infections in the elderly with an outpatient program is effective and safe.

Outpatient parenteral antibiotic therapy for bone and joint infections: an italian multicenter study.

In the early eighties, the advantages of outpatient parenteral antibiotic therapy (OPAT) (reduced costs, no hospitalization trauma in children, no immobilization syndrome in elderly, reduction in nosocomial infections by multiresistant organisms) were identified in the United States, and suitable therapeutic programs were established. Currently, more than 250,000 patients per year are treated according to an OPAT program. In order to understand the different ways of managing OPAT and its results, a National OPAT Registry was set up in 2003 in Italy. Analysis of data concerning osteomyelitis, septic arthritis, prosthetic joint infection and spondylodiskitis, allowed information to be acquired about 239 cases of bone and joint infections, with particular concern to demographics, therapeutic management, clinical response, and possible side effects. Combination therapy was the first-line choice in 66.9% of cases and frequently intravenous antibiotics were combined with oral ones. Teicoplanin (38%) and ceftriaxone (14.7%), whose pharmacokinetic/pharmacodynamic properties permit once-a-day administration, were the two top antibiotics chosen; fluoroquinolones (ciprofloxacin and levofloxacin) were the most frequently utilized oral drugs. Clinical success, as well as patients' and doctors' satisfaction with the OPAT regimen was high. Side-effects were mild and occurred in 11% of cases. These data confirm that the management of bone and joint infections in an outpatient setting is suitable, effective and safe.

[Cytomegalovirus infection in the adult]. / Infezione da Cytomegalovirus nell'adulto.

Aim of this report is to review the epidemiological and clinical features of HCMV infection in the adult. In all geographical areas high diffusion of HCMV infection involving all socioeconomic groups is observed; significant most elevated seroprevalence in North African and Asian ethnic groups is compared to Western populations is pointed out; besides, HCMV is absolutely the virus most frequently transmitted in the perinatal period. In the immunocompetent host, the HCMV infection is symptomless in the great majority of cases; in the symptomatic cases it shows the clinical features of a self-limited mononucleosis-like syndrome. In the immunocompromised patients, either in subjects infected with HIV or in onco-hematologic patients or recipients of solid organ or bone marrow transplants patients, HCMV infection leads to serious illness. The most frequent clinical pictures are: pneumonia, retinitis, hepatitis, polyradiculopathy, encephalitis, gastrointestinal tract disease, adrenal involvement; cases of myocarditis, pancreatitis, genitourinary localizations are less frequent. The clinical pictures are different in the different clinical groups: retinitis, in subjects with HIV infection and pneumonia in recipients of transplants, are respectively the main clinical manifestations; the mechanisms of such differences are not clearly defined. A to the diagnosis, the serological tests (evidence of IgM activity, IgG avidity) are useful in the immunocompetent host; whereas, in the immunocompromised host cytological detection (demonstration of typical cytological aspects and positive immunohistology for HCMV antigens) and/or virological detection (isolation of virus or evidence of viral antigens or viral DNA) are needed. The most used therapeutical choices are ganciclovir, foscarnet and cidofovir; these three drugs have similar antiviral effectiveness, but they show different outlines of toxicity and praticality of use.