Volume 11, Issue 3, 2003
Review
Pathways for surgical antibiotic prophylaxis
Maio Patrizia
Surgical site infections (SSIs) are a notable cause of hospital morbidity and mortality. Antibiotic prophylaxis has demonstrated a significant reduction in infection rate in clean-contaminated surgery and in clean surgery to a limited extent. To make antibiotic prophylaxis effective it is necessary to choose the right antibiotic, to administer it preoperatively and maintain sufficient serum and tissue levels through the operation. Open issues remain: antibiotic prophylaxis duration in prosthetic surgery , its use in hernia repair, breast surgery and mini-invasive surgery.
Epidemiology of paediatric tuberculosis today
Titone Lucina,
Romano Amelia,
Abbagnato Luisa,
Mazzola Angela,
Di Carlo Paola
Tuberculosis (TB) kills 2 million people each year in the world, of which 250,000 are children. In Italy, paediatric TB is 3.5% of total cases with a steady trend in the last ten years. Childhood tuberculosis remains a disease of great concern because its occurrence always indicates recent transmission and is a pivotal indicator of effectiveness of TB control efforts.
The epidemiological study, including DNA fingerprinting, of 71 children affected by TB - 62 pulmonary, 9 meningitis, 2 renal- shows that the source case is frequently a parent or household member. Sensitivity to anti-tubercular drugs was tested for 18/20 isolates obtained from the children and 21/44 isolates obtained from infection sources with 5 resistant strains in each group.
One child was resistant to isoniazid, and one adult source to rifampin. Multi-drug resistance was observed in 8 cases: 4 children and 4 sources.
In the children’s case, we may use the term primary resistance as the patients have not been previously treated with the drugs. These children’s treatment lasted longer, not only because their regimen had been changed, but also because of their delayed clinical-radiological response to the treatment. These data suggest that it would be opportune to re-evaluate current treatment of childhood tuberculosis, encouraging active and integrated cooperation between epidemiologists, infectious disease specialists and paediatricians.
Original article
Non-tubercular vertebral osteomyelitis: diagnosis and therapy of 45 patients from a single Italian centre
Carrega Giuliana,
Arena Sergio,
Bartolacci Valentina,
Gavino Dario,
Mecca Domenico,
Sandrone Clemente,
Santoriello Luisa,
Tabasso Giuseppe,
Riccio Giovanni
Aim of the study: to evaluate the episodes of non-tubercular spondylodiskitis diagnosed between 1998 and 2002 at Ospedale S. Corona, Pietra Ligure (SV). Methods: prospective evaluation of vertebral osteomyelitis classified as spontaneous or iatrogenic if associated with procedures on the spinal cord, with detection of associated risk factors, localization, etiology and treatment.
Results: 45 episodes, 71% spontaneous and 29% iatrogenic were observed. Associated risk factors were present in 47% of spontaneous spondylodiskitis. Lumbosacral localization was detected in 68% of spontaneous and 100% of iatrogenic episodes. Other localizations in spontaneous spondylodiskitis were dorsal (25%) or cervical (7%). Methicillin-sensitive staphylococci caused the majority of spontaneous spondylodiskitis, while methicillin-resistant strains were more frequently involved in iatrogenic episodes. Among spontaneous spondylodiskitis, 63% healed with antibiotics for 8 weeks, but surgery was often needed in dorsal localizations. In iatrogenic forms antibacterial therapy for 8 weeks-6 months was effective in cases not associated with foreign bodies but their presence always required surgery for healing. Conclusions: spondylodiskitis is more frequently localized at the lumbosacral level. Beta-lactams are generally effective in spontaneous episodes, while iatrogenic episodes often require associations of drugs. Surgery may be required in the case of dorsal localization or in the presence of foreign bodies.
Hepatitis viruses and HIV infection in the Naples area
Filippini Pietro,
Coppola Nicola,
Scolastico Carlo,
Rossi Giovanni,
Battaglia Martina,
Onofrio Mirella,
Pisapia Raffaella,
Marrocco Cecilia,
Sagnelli Caterina,
Piccinino Felice,
Sagnelli Evangelista
In 189 anti-HIV positive subjects (130 males and 59 females; median age 32 years, range 17-57) we evaluated the prevalence of patients with hepatitis infections, the role of parenteral and sexual risk factors on the acquisition of these infections and the reciprocal influence between HIV and HCV infections. HCV infection was detected in 53.9% of cases and HBV infection in 8.4%. In only 32% of our patients no marker of hepatitis virus infection was detected. The presence of a hepatitis virus infection was associated to drug addiction; indeed in 91 drug abusers HIV/HCV co-infection was present in 80% of cases and HIV infection alone in 7.7%, p<0.0001. On the other hand, the association between unsafe sexual activity, whether homosexual or heterosexual, and sexual activity with a steady anti-HIV positive partner with HCV infection was less evident, although the high prevalence of anti-HCV in these cases (10.4%, 15.4% and 26.4% respectively) clearly suggests that HIV infection may improve the sexual transmission of HCV. No substantial differences in the level of immunodeficiency, nor in the HIV viral load nor in the frequency of AIDS cases were observed between patients with HIV infection alone and those with HIV/HCV co-infection. In fact, the percentage of patients with AIDS was similar in these two groups. However, we observed a statistically significant association between an advanced HIV clinical stage and the presence of HIV/HCV co-infection (p<0.005), since subjects with co-infection more frequently than with HIV infection alone were in the CDC-B clinical stage. The presence of a more severe liver disease was linked to a multiple hepatitis virus infection, regardless of the degree of immunodeficiency.
Multicentre survey of post-surgical infections in Campania (Italy)
Esposito Silvano,
Ianniello Filomena,
Leone Sebastiano,
Noviello Silvana,
Marvaso Alberto,
Iannantuoni Nicola,
Esposito Eulalia,
Imperato Luigi,
Aiello Domenico,
Coppola Carmine,
Aloisio Teresa,
Maio Patrizia,
Acierno Domenico,
Romano Giovanni,
Patrelli Germanico
The aim of the study was to evaluate the incidence of post-surgical infections and to assess the way of managing antibiotic surgical prophylaxis. The survey was carried out by means of a questionnaire in order to obtain diverse information such as demographics, length of pre- and post-operative hospitalization, type of surgery, intervention duration, possible antibiotic prophylaxis and onset of post-surgical infections also monitored by post-discharge ambulatory controls. Four General Surgery and five Obstetrics and Gynaecology Departments in Campania (southern Italy) participated in the study, which was carried out in the period December 2001-January 2002. Overall, 410 questionnaires were collected referring to as many patients; antibiotic prophylaxis was performed in 385 (93.9%) patients. Antibiotic prophylaxis was generally managed not according to the general principles suggested by the international guidelines either for timing or for its duration or for the route of administration. Substantial differences were also noted in patient selection and antibiotic choice.
Surgical site infections were recorded in 0.6% of patients undergoing clean surgery, in 5.3% of patients undergoing clean-contaminated surgery and in 3.2% of those undergoing contaminated surgery. Distant infections occurred in 1.8% and 6.5% in clean-contaminated and contaminated surgery, respectively. The results of the present study suggest the need of a continuous and accurate monitoring of post-surgical infections and the need to adopt appropriate guidelines to improve the management of surgical prophylaxis.
Case report
Multiple AIDS-related malignancies just in the era of potent antiretroviral therapy. A rare but intriguing finding
Manfredi Roberto,
Calza Leonardo,
Chiodo Francesco
Two exceedingly rare cases of dual AIDS-associated neoplasms (Kaposi’s sarcoma and non-Hodgkin’s lymphoma), occurring in a short time as AIDS-defining diseases of two HIV-infected patients treated with highly active antiretroviral therapy (HAART) are reported and discussed in light of evidence from the available literature. A slowly progressive increase in neoplastic complications following the introduction of HAART and the consequent decline of opportunistic infections such as the main AIDS-related disorders has been observed, and combined cancer diseases may be expected in the next few years, due to the persistent dysregulation of the immune system, or a possible involvement of oncoviruses and HIV itself in the pathogenesis of HIV-associated cancer.
Outbreak and persistence of Chlamydia pneumoniae infection in an Italian family
Migliorini Lucia,
Canocchi Valentina,
Zanelli Giacomo,
Valassina Marcello,
Cellesi Carla
We describe an outbreak of familial infection of Chlamydia pneumoniae, an etiological agent for respiratory tract infections. In a family member detection of C. pneumoniae on a pharyngeal swab by polymerase chain reaction was positive until four months after the onset of symptoms, despite a course of antibiotics known to be effective against Chlamydia species.
The Infections in the History of Medicine
Health service organization during the age of pestilence. I half
Sabbatani Sergio
The author outlines the history of the places where the patients with epidemic pathologies were isolated. Since the study of medicine began, they have been called asclepiei, xenodochi, hospices, lazarettos, sanitary cordons, and quarantine stations and they contribute to controlling epidemics in Europe. These structures, important not only in the situation in which they were created, expressed the medical culture and point of view of that age. Although very far from discovering the cause of the pathology due to their lack of scientific knowledge, the medical class sometimes knew effectively how to organize the isolation of patients. The history of these isolation sites interweaves with the church’s life through the ages and with the reality of European states and of the city-states during the Italian renaissance. In classical Greece and in Imperial Rome there were also “homes for the sick” to isolate the patients. Today the world is periodically hit by epidemics. In these moments the medical class uses its research ability and exploits its organizational potential but it also uses historical memory to reduce contagion from the epidemic.
