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Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review

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World Journal of Gastroenterology 2017年第25期23卷 4654-4660页

作者： Marco Fiore Alberto Enrico Maraolo Ivan Gentile Guglielmo Borgia Sebastiano Leone Pasquale Sansone maria Beatrice Passavanti caterina Aurilio maria caterina pace Department of Anaesthesiological Surgical and Emergency SciencesUniversity of Campania“Luigi Vanvitelli” Department of Clinical Medicine and Surgery Section of Infectious DiseasesUniversity of Naples Federico II Division of Infectious Diseases “San Giuseppe Moscati”Hospital

To systematically review literature upon aetiology of nosocomial spontaneous bacterial peritonitis (N-SBP) given the rising importance of multidrug-resistant (MDR) bacteria. METHODSA literature search was performed on MEDLINE and Google Scholar databases from 2000 to 15th of November 2016, using the following search strategy: “spontaneous” AND “peritonitis”. RESULTSThe initial search through electronic databases retrieved 2556 records. After removing duplicates, 1958 records remained. One thousand seven hundred and thirty-five of them were excluded on the basis of the screening of titles and abstract, and the ensuing number of remaining articles was 223. Of these records, after careful evaluation, only 9 were included in the qualitative analysis. The overall proportion of MDR bacteria turned out to be from 22% to 73% of cases across the studies. CONCLUSIONN-SBP is caused, in a remarkable proportion, by MDR pathogens. This should prompt a careful re-assessment of guidelines addressing the treatment of this clinical entity.

关键词： Hospital-acquired infections Nosocomial spontaneous bacterial peritonitis Multidrug resistant bacteria Cirrhosis Critically ill patient

Burden of severe infections due to carbapenem-resistant pathogens in intensive care unit

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World Journal of Clinical Cases 2023年第13期11卷 2874-2889页

作者： maria caterina pace Antonio Corrente maria Beatrice Passavanti Pasquale Sansone Stephen Petrou Sebastiano Leone Marco Fiore Department of Women Child and General and Specialized SurgeryUniversity of Campania"Luigi Vanvitelli"Naples 80138Italy Department of Emergency Medicine University of California San FranciscoSan FranciscoCA 94143United States Division of Infectious Diseases “San Giuseppe Moscati”HospitalAvellino 83100Italy

Intensive care units(ICU)for various reasons,including the increasing age of admitted patients,comorbidities,and increasingly complex surgical procedures(e.g.,transplants),have become"the epicenter"of nosocomial infections,these are characterized by the presence of multidrug-resistant organisms(MDROs)as the cause of ***,the perfect match of fragile patients and MDROs,as the cause of infection,makes ICU mortality very ***,carbapenems were considered for years as last-resort antibiotics for the treatment of infections caused by MDROs;unfortunately,nowadays carbapenem resistance,mainly among Gram-negative pathogens,is a matter of the highest concern for worldwide public *** comprehensive review aims to outline the problem from the intensivist's perspective,focusing on the new definition and epidemiology of the most common carbapenem-resistant MDROs(Acinetobacter baumannii,Pseudomonas aeruginosa and Enterobacterales)to emphasize the importance of the problem that must be permeating clinicians dealing with these diseases.

关键词： Antimicrobial resistance Multidrug-resistant PDR Carbapenem-resistance Multidisciplinary critical care Intensive care unit

Medicinal cannabis products for the treatment of acute pain

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World Journal of Clinical Cases 2023年第12期11卷 2670-2676页

作者： Marco Fiore Aniello Alfieri Sveva Di Franco Stephen Petrou Giovanni Damiani maria caterina pace Department of Women Child and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Emergency Medicine University of California San FranciscoSan FranciscoCA 94143United States Department of Biomedical Surgicaland Dental SciencesUniversity of MilanMilan 20122Italy

For thousands of years,medicinal cannabis has been used for pain treatment,but its use for pain management is still ***-analysis of the literature has shown contrasting results on the addition of cannabinoids to opioids compared with placebo/other active agents to reduce *** studies are mainly focused on medicinal cannabis use in chronic pain management,for which the analgesic effect has been proven in many *** review focuses on the potential use of medical cannabis for acute pain management in preclinical studies,studies on healthy subjects and the few pioneering studies in the clinical setting.

关键词： Cannabis Cannabinoids Endocannabinoid system 2-arachidonoylglycerol Anandamide Analgesia Acute pain

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

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World Journal of Hepatology 2017年第30期9卷 1166-1175页

作者： Marco Fiore Alberto Enrico Maraolo Ivan Gentile Guglielmo Borgia Sebastiano Leone Pasquale Sansone maria Beatrice Passavanti caterina Aurilio maria caterina pace Department of Anesth-esiological Surgical and Emergency SciencesUniversity of Campania 'Luigi Vanvitelli' Department of Clinical Medicine and Surgery Section of Infectious DiseasesUniversity of Naples Federico Ⅱ Division of Infectious Diseases 'San Giuseppe Moscati' Hospital

Spontaneous bacterial peritonitis(SBP) is the most common infection in end-stage liver disease *** is defined as an ascitic fluid infection with a polymorphonuclear leucocyte count ≥ 250/mm^3 without an evident intra-abdominal surgically treatable *** mechanisms contribute to SBP occurrence,including translocation of gut bacteria and their products,reduced intestinal motility provoking bacterial overgrowth,alteration of the gut's barrier function and local immune ***,Gram-negative enteric bacteria have been the main causative agents of SBP,thereby guiding the empirical therapeutic ***,over the last decade,a worryingly increasing prevalence of Gram-positive and multi-drug resistant(MDR) SBP has been ***,the microbiological spectrum of SBP seems to have changed in Europe due to a high prevalence of Gram-positive bacteria(48%-62%).The overall proportion of MDR bacteria is up to 22%-73% of ***,empirical therapy based on thirdgeneration cephalosporins or amoxicillin/clavulanic acid,can no longer be considered the standard of care,as these drugs are associated with poor *** of this review is to describe,with an epidemiological focus,the evidence behind this rise in Gram-positive and MDR SBP from 2000 to present,and illustrate potential targeted therapeutic *** appropriate treatment protocol should include daptomycin plus ceftaroline and meropenem,with prompt stepdown to a narrower spectrum when cultures and sensitivity data are available in order to reduce both cost and potential antibiotic resistance development.

关键词： Spontaneous bacterial peritonitis Multi-drug resistant bacteria End-stage liver disease Cirrhosis Critically ill patient

First Italian outbreak of VIM-producing Serratia marcescens in an adult polyvalent intensive care unit, August-October 2018: A case report and literature review

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World Journal of Clinical Cases 2019年第21期7卷 3535-3548页

作者： maria Rosaria Iovene Vincenzo Pota Massimiliano Galdiero Giusy Corvino Federica maria Di Lella Debora Stelitano maria Beatrice Passavanti maria caterina pace Aniello Alfieri Sveva Di Franco caterina Aurilio Pasquale Sansone Vettakkara Kandy Muhammed Niyas Marco Fiore Department of Experimental Medicine University of Campania"Luigi Vanvitelli"Naples 80138Italy Department of Women Child and General and Specialized SurgeryUniversity of Campania"Luigi Vanvitelli"Naples 80138Italy Department of Medicine All India Institute of Medical SciencesNew Delhi 110029India

BACKGROUND Carbapenem-resistant Enterobacteriaceae has become a significant public health concern as hospital outbreaks are now being frequently reported and these organisms are becoming difficult to treat with the available *** SUMMARY An outbreak of VIM-producing Serratia marcescens occurred over a period of 11 wk(August,1 to October,18)in patients admitted to the adult polyvalent intensive care unit of the University of Campania“Luigi Vanvitelli”located in *** episodes occurred in three patients(two patients infected,and one patient colonized).All the strains revealed the production of *** After three decades of carbapenem antibiotics use,the emergence of carbapenemresistance in Enterobacteriaceae has become a significant concern and a stricter control to preserve its clinical application is *** is,to our knowledge,the first outbreak of VIM-producing Serratia marcescens in *** policies must be implemented to avoid future outbreaks.

关键词： Serratia marcescens Carbapenamase VIM Intensive care unit Outbreak Case report

Spontaneous bacterial peritonitis due to carbapenemase-producing Enterobacteriaceae:Etiology and antibiotic treatment

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World Journal of Hepatology 2020年第12期12卷 1136-1147页

作者： Marco Fiore Sveva Di Franco Aniello Alfieri maria Beatrice Passavanti maria caterina pace Stephen Petrou Francesca Martora Sebastiano Leone Department of Women Child and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Emergency Medicine Good Samaritan Hospital Medical CenterNY 11795United States Department of Experimental Medicine University of Campania“Luigi Vanvitelli”Naples 80138Italy Division of Infectious Diseases “San Giuseppe Moscati”HospitalAvellino 83100Italy

Carbapenem antibiotics were first introduced in the 1980s and have long been considered the most active agents for the treatment of multidrug-resistant gramnegative *** the last decade,carbapenem-resistant Enterobacteriaceae(CRE)have emerged as organisms causing spontaneous bacterial *** caused by CRE have shown a higher mortality rate than those caused by bacteria sensitive to carbapenem *** antibiotic guidelines for the treatment of spontaneous bacterial peritonitis are insufficient,and rapid deescalation of empiric antibiotic treatment is not widely *** review summarizes the molecular characteristics,epidemiology and possible treatment of spontaneous bacterial peritonitis caused by CRE.

关键词： Spontaneous bacterial peritonitis Carbapenem-resistant Enterobacteriaceae Carbapenem-resistant Klebsiella pneumoniae Cirrhosis

Antimicrobial approach of abdominal post-surgical infections

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2674-2692页

作者： Marco Fiore Antonio Corrente Sveva Di Franco Aniello Alfieri maria caterina pace Francesca Martora Stephen Petrou Claudio Mauriello Sebastiano Leone Department of Women Child and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy Unit of Virology and Microbiology “Umberto I”HospitalNocera Inferiore 84018Italy Department of Emergency Medicine University of California San FranciscoSan FranciscoCA 94143United States Department of General Surgery “Santa Maria delle Grazie”HospitalPozzuoli 80078Italy Division of Infectious Diseases “San Giuseppe Moscati”HospitalAvellino 83100Italy

Abdominal surgical site infections(SSIs)are infections that occur after abdominal *** can be superficial,involving the skin tissue only,or more profound,involving deeper skin tissues including organs and implanted ***,SSIs are large global health problem with an incidence that varies significantly depending on the United Nations’Human Development *** purpose of this review is to provide a practical update on the latest available literature on SSIs,focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.

关键词： Surgical site infections Multidrug resistance Carbapenem-resistant Enterobacterales Carbapenem-resistant Klebsiella Abdominal post-operative complications Post-surgical infections

Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications

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World Journal of Orthopedics 2024年第9期15卷 882-890页

作者： Marco Fiore Luigi Aurelio Nasto Eleni McCaffery Fannia Barletta Angela Visconti Francesca Gargano Enrico Pola maria caterina pace Department of Women Child and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Orthopaedics University of Campania“Luigi Vanvitelli”Naples 80138Italy Department of Emergency Medicine New York Presbyterian-Brooklyn Methodist HospitalNew YorkNY 11215United States Department of Anesthesia and Intensive Care “San Carlo”HospitalPotenza 85100Italy Department of Anaesthesia “San Giuliano”HospitalGiugliano 80014Italy Unit of Anesthesia and Intensive Care The Fondazione Policlinico Universitario Campus Bio-MedicoRome 00128Italy

BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few *** The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:*** and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in *** After full-text screening,we included 14 studies in the qualitative *** these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients *** was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome *** MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an *** 11 cases,the setting of care was the Emergency Department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not *** included studies were found to have a low-moderate risk of *** Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal *** ketamine may cause more adverse events than other routes of administration.

关键词： Acute musculoskeletal injury Acute traumatic pain Non-opioid analgesia Non-opioid pain control Opioid-sparing analgesia Opioid crisis Opioid disorder Systematic review

Outcomes assessment of hepatitis C virus-positive psoriatic patients treated using pegylated interferon in combination with ribavirin compared to new Direct-Acting Antiviral agents

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World Journal of Hepatology 2018年第2期10卷 329-336页

作者： Giovanni Damiani Chiara Franchi Paolo Pigatto Andrea Altomare Alessia Pacifico Stephen Petrou Sebastiano Leone maria caterina pace Marco Fiore Study Center of Young Dermatologists Italian Network (YDIN) Gised Bergamo Italy and Clinical Dermatology IRCCS Galeazzi Orthopaedic Institute Department of Biomedical Surgical and Dental Sciences University of Milan Clinical Dermatology IRCCS Galeazzi Orthopaedic Institute San Gallicano Dermatological Institute IRCCS Department of Emergency Medicine St. George’s University Medical School Division of Infectious Diseases "San Giuseppe Moscati" Hospital Department of Anesthe-siological Surgical and Emergency Sciences University of Campania "Luigi Vanvitelli"

AIM To evaluate the outcomes in biological treatment and quality of life of psoriatic patients with chronic hepatitis C(CHC) treated with new Direct-Acting Antiviral agents(DAAs) compared to pegylated interferon-2α plus ribavirin(P/R) *** This is a retrospective study involving psoriatic patients in biological therapy who underwent anti-hepatitis C virus(HCV) treatment at the Department of Dermatology Galeazzi Orthopaedic Institute Milan, Italy from January 2010 to November 2017. The patients were divided into two groups: patients that underwent therapy with DAAs and patients that underwent HCV treatment with P/R. Patients were assessed by a dermatologist for psoriasis symptoms, collecting Psoriasis Area Severity Index(PASI) scores and the Dermatology Quality of Life Index(DLQI). PASI and DLQI scores were evaluated 24 wk after the end of HCV treatment and were assumed as an outcome of the progression of psoriasis. Switching to a different b DMARD was considered as an inadequate response to biological therapy. The dropout of HCV therapy and sustained virological response(SVR) were considered as outcomes of HCV *** Fifty-nine psoriatic patients in biological therapy underwent antiviral therapy for CHC. Of this, 27 patients were treated with DAAs and 32 with P/R. After 24 wk post treatment, the DLQI and the PASI scores were significantly lower(P < 0.001 and P < 0.005, respectively) in the DAAs group compared with P/R group. None of the patients in the DAAs group(0/27) compared to 8 patients of the P/R group(8/32) needed a shift in biological *** DAAs seem to be more effective and safe than P/R in HCV-positive psoriatic patients on biological treatment. Fewer dermatological adverse events may be due to interferon-free therapy.

关键词： Hepatitis C virus New Direct-Acting Antiviral agents Psoriasis Biological disease modifying drugs