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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

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

Spontaneous fungal peritonitis: Epidemiology, current evidence and future prospective

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World Journal of Gastroenterology 2016年第34期22卷 7742-7747页

作者： Marco Fiore sebastiano leone Department of Anesthesiological Surgical and Emergency SciencesSecond University of Naples Division of Infectious Diseases "San Giuseppe Moscati" Hospital

Spontaneous bacterial peritonitis is a complication of ascitic patients with end-stage liver disease(ESLD); spontaneous fungal peritonitis(SFP) is a complication of ESLD less known and described. ESLD is associated to immunodepression and the resulting increased susceptibility to infections. Recent perspectives of the management of the critically ill patient with ESLD do not specify the rate of isolation of fungi in critically ill patients,not even the antifungals used for the prophylaxis,neither optimal treatment. We reviewed,in order to focus the epidemiology,characteristics,and,considering the high mortality rate of SFP,the use of optimal empirical antifungal therapy the current literature.

关键词： Cirrhosis Critically ill patient Spontaneous fungal peritonitis Life-threatening infections Fungal ascitis Nosocomial spontaneous peritonitis

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

AIM To systematically review literature upon aetiology of nosocomial spontaneous bacterial peritonitis(N-SBP) given the rising importance of multidrug-resistant(MDR) *** A literature search was performed on MEDLINE and Google Scholar databases from 2000 to 15 th of November 2016, using the following search strategy: "spontaneous" AND "peritonitis".RESULTS The 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 *** N-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：获得医院的感染医院的自发的细菌的腹膜炎 Multidrug 抵抗细菌肝硬化极其有病的病人

Gut microbiota and nutrient interactions with skin in psoriasis:A comprehensive review of animal and human studies

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World Journal of Clinical Cases 2020年第6期8卷 1002-1012页

作者： Giovanni Damiani Nicola Luigi Bragazzi Thomas S McCormick Paolo Daniele Maria Pigatto sebastiano leone Alessia Pacifico Danica Tiodorovic Sveva Di Franco Aniello Alfieri Marco Fiore Department of Dermatology Case Western Reserve UniversityClevelandOH 44106United States Clinical Dermatology IRCCS Istituto Ortopedico GaleazziMilan 20122Italy Department of Biomedical Surgical and Dental SciencesUniversity of MilanMilan 20122Italy Postgraduate School of Public Health Department of Health SciencesUniversity of GenoaGenoa 16132Italy Department of Medicine Division of Infectious diseases“San Giuseppe Moscati”HospitalAvellino 83100Italy San Gallicano Dermatological Institute IRCCSRome 00144Italy Dermatology Clinic Medical FacultyNis UniversityNis 18000Serbia Department of Women Child and General and Specialized SurgeryUniversity of Campania"Luigi Vanvitelli"Naples 80138Italy

The intestinal tract(i.e.,the gut),is where the body’s nutrients are absorbed,and is simultaneously inhabited by numerous *** increasing body of literature suggests a crucial role for the gut microbiome in modulating systemic inflammatory *** is a chronic systemic inflammatory disease and its pathogenesis is related to the interaction between genetic susceptibility,immune response and environmental *** omics era has allowed physicians to assess different aspects of psoriasis pathogenesis such as the microbiome,infectome,and ***,diet appears to play an important role in modulating disease activity,perhaps by influencing gut *** these observations,we aimed to summarize the current knowledge regarding skin-microbiome-gut-nutrients and psoriasis.

关键词： Gut Microbiota Nutrients Endotypes Exposome Psoriasis

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

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

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

Current controversies and future perspectives on treatment of intensive care unit delirium in adults

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World Journal of Critical Care Medicine 2019年第3期8卷 18-27页

作者： Marco Cascella Marco Fiore sebastiano leone Domenico Carbone Raffaela Di Napoli Division of Anesthesia and Pain Medicine Istituto Nazionale TumoriIRCCS Fondazione G.PascaleNaples 80049Italy Department of Women Child and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy Division of Infectious Diseases “San Giuseppe Moscati”HospitalAvellino 83100Italy Department of Emergency Medicine Umberto I HospitalNocera InferioreSalerno 84014Italy Department of Anesthesiology Institut Jules BordetUniversitéLibre de BruxellesBruxelles 1000Belgium

Delirium is the most frequent manifestation of acute brain dysfunction in intensive care unit(ICU).Although antipsychotics are widely used to treat this serious complication,recent evidence has emphasized that these agents did not reduce ICU delirium(ICU-D)prevalence and did not improve survival,length of ICU or hospital stay after its *** note,no pharmacological strategy to prevent or treat delirium has been identified,so *** this scenario,new scientific evidences are urgently *** on specific ICU-D subgroups,or focused on different clinical settings,and studies on medications other than antipsychotics,such as dexmedetomidine or melatonin,may represent interesting fields of *** the meantime,because there is some evidence that ICU-D can be effectively prevented,the literature suggests strengthening all the strategies aimed at prevention through no-pharmacological approaches mostly focused on the correction of risk *** more appropriate strategy useful to treat established delirium remains the use of antipsychotics managed by choosing the right doses after a careful case-by-case *** the evidence regarding the use of dexmedetomidine is still conflicting and sparse,this drug offers interesting perspectives for both ICU-D prevention and *** paper aims to provide an overview of current pharmacological approaches of evidence-based medicine *** state of the art of the on-going clinical research on the topic and perspectives for future research are also addressed.

关键词： Delirium Intensive care Haloperidol Antipsychotic agents Major tranquilizers Cognitive decline Dexmedetomidine