AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242...AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria. RESULTS: VAP occurred in 18(7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation(MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae(79%). Univariate logistic analysis showed that model for end-stage liver disease(MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariateanalysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP. CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.展开更多
BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)is the pathogen responsible for pandemic coronavirus disease 2019(COVID-19).It is a highly contagious virus which primarily affects the respiratory...BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)is the pathogen responsible for pandemic coronavirus disease 2019(COVID-19).It is a highly contagious virus which primarily affects the respiratory tract,nevertheless,the lungs are not the only target organs of the virus.The intestinal tract could represent an additional tropism site for SARS-CoV-2.Several observations have collectively suggested that enteric infections can occur in COVID-19 patients.However,the detection of viral RNA in gastrointestinal(GI)tissue samples has not been adequately investigated and results are conflicting.AIM To detect the presence of SARS-CoV-2 RNA in intestinal mucosa samples and to evaluate histological features.METHODS The COVID-19 patients hospitalized at an Italian tertiary hospital from April 2020 to March 2021 were evaluated for enrollment in an observational,monocentric trial.The study population was composed of two groups of adult patients.In the first group(biopsy group,30 patients),patients were eligible for inclusion if they had mild to moderate disease and if they agreed to have a rectal biopsy;in the second group(surgical specimen group,6 patients),patients were eligible for inclusion if they underwent intestinal resection during index hospitalization.Fifty-nine intestinal mucosal samples were analyzed.RESULTS Viral RNA was not detectable in any of the rectal biopsies performed(0/53).Histological examination showed no enterocyte damage,but slight edema of the lamina propria with mild inflammatory lymphoplasmacytic infiltration.There was no difference in inflammatory infiltrates in patients with and without GI symptoms.SARS-CoV-2 RNA was detected in fecal samples in 6 cases out of 14 cases examined(42.9%).In the surgical specimen group,all patients underwent emergency intestinal resection.Viral RNA was detected in 2 surgical specimens of the 6 examined,both of which were from patients with active neoplastic disease.Histological examination also pointed out abundant macrophages,granulocytes and plasma cells infiltrating the muscular layer and adipose tissue,and focal vasculitis.CONCLUSION Mild-moderate COVID-19 may not be associated with rectal infection by the virus.More comprehensive autopsies or surgical specimens are needed to provide histological evidence of intestinal infection.展开更多
AIM To determine whether ribavirin(RBV) concentrations differ according to cirrhosis stage among cirrhotic patients treated with interferon-free regimens. METHODS We included patients with hepatitis C virus and cirrho...AIM To determine whether ribavirin(RBV) concentrations differ according to cirrhosis stage among cirrhotic patients treated with interferon-free regimens. METHODS We included patients with hepatitis C virus and cirrhosis [Child-Pugh(CP) A or B], Glomerular Filtration Rate ≥ 60 mL/min, who started therapy with DAAs and weightbased RBV between October 2014 and February 2016. RBV plasma levels were assessed during the treatment. We focused our analysis on the first 8 wk of therapy. RESULTS We studied 68 patients: 54 with compensated(CP-B) and 14 with decompensated(CP-A) cirrhosis. Patients withdecompensated cirrhosis displayed significantly higher RBV concentrations than those with compensated cirrhosis at week 1, 2, 4 and 8(P < 0.035). RBV levels were positively correlated with Hb loss over the treatment(P < 0.04). Majority(71%) of CP-B patients required a RBV dosage reduction during the treatment. After adjustment for confounders, Child-Pugh class remained significantly associated(95%CI: 35, 348, P = 0.017) to RBV levels, independently from baseline per-Kg RBV dosage. CONCLUSION Liver decompensation might affect RBV clearance leading to an overexposure and increased related toxicities in decompensated cirrhosis. Our findings underscore the importance of an early ribavirin therapeutic drug monitoring and suggest that an initial lower RBV dose, rather than weight-based, might be considered in those with advanced liver disease(CP-B) treated with directacting antivirals.展开更多
文摘AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria. RESULTS: VAP occurred in 18(7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation(MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae(79%). Univariate logistic analysis showed that model for end-stage liver disease(MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariateanalysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP. CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.
基金approved by the Institutional Review Board of the Azienda Ospedaliero-Universitaria di Bologna,Italy(Approval No.2257/2020).
文摘BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)is the pathogen responsible for pandemic coronavirus disease 2019(COVID-19).It is a highly contagious virus which primarily affects the respiratory tract,nevertheless,the lungs are not the only target organs of the virus.The intestinal tract could represent an additional tropism site for SARS-CoV-2.Several observations have collectively suggested that enteric infections can occur in COVID-19 patients.However,the detection of viral RNA in gastrointestinal(GI)tissue samples has not been adequately investigated and results are conflicting.AIM To detect the presence of SARS-CoV-2 RNA in intestinal mucosa samples and to evaluate histological features.METHODS The COVID-19 patients hospitalized at an Italian tertiary hospital from April 2020 to March 2021 were evaluated for enrollment in an observational,monocentric trial.The study population was composed of two groups of adult patients.In the first group(biopsy group,30 patients),patients were eligible for inclusion if they had mild to moderate disease and if they agreed to have a rectal biopsy;in the second group(surgical specimen group,6 patients),patients were eligible for inclusion if they underwent intestinal resection during index hospitalization.Fifty-nine intestinal mucosal samples were analyzed.RESULTS Viral RNA was not detectable in any of the rectal biopsies performed(0/53).Histological examination showed no enterocyte damage,but slight edema of the lamina propria with mild inflammatory lymphoplasmacytic infiltration.There was no difference in inflammatory infiltrates in patients with and without GI symptoms.SARS-CoV-2 RNA was detected in fecal samples in 6 cases out of 14 cases examined(42.9%).In the surgical specimen group,all patients underwent emergency intestinal resection.Viral RNA was detected in 2 surgical specimens of the 6 examined,both of which were from patients with active neoplastic disease.Histological examination also pointed out abundant macrophages,granulocytes and plasma cells infiltrating the muscular layer and adipose tissue,and focal vasculitis.CONCLUSION Mild-moderate COVID-19 may not be associated with rectal infection by the virus.More comprehensive autopsies or surgical specimens are needed to provide histological evidence of intestinal infection.
文摘AIM To determine whether ribavirin(RBV) concentrations differ according to cirrhosis stage among cirrhotic patients treated with interferon-free regimens. METHODS We included patients with hepatitis C virus and cirrhosis [Child-Pugh(CP) A or B], Glomerular Filtration Rate ≥ 60 mL/min, who started therapy with DAAs and weightbased RBV between October 2014 and February 2016. RBV plasma levels were assessed during the treatment. We focused our analysis on the first 8 wk of therapy. RESULTS We studied 68 patients: 54 with compensated(CP-B) and 14 with decompensated(CP-A) cirrhosis. Patients withdecompensated cirrhosis displayed significantly higher RBV concentrations than those with compensated cirrhosis at week 1, 2, 4 and 8(P < 0.035). RBV levels were positively correlated with Hb loss over the treatment(P < 0.04). Majority(71%) of CP-B patients required a RBV dosage reduction during the treatment. After adjustment for confounders, Child-Pugh class remained significantly associated(95%CI: 35, 348, P = 0.017) to RBV levels, independently from baseline per-Kg RBV dosage. CONCLUSION Liver decompensation might affect RBV clearance leading to an overexposure and increased related toxicities in decompensated cirrhosis. Our findings underscore the importance of an early ribavirin therapeutic drug monitoring and suggest that an initial lower RBV dose, rather than weight-based, might be considered in those with advanced liver disease(CP-B) treated with directacting antivirals.
