A cluster of fulminant Clostridium difficile colitis in an intensive care unit in Italy
被引:10
作者:
Guastalegname, M.
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Univ Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, ItalyUniv Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
Guastalegname, M.
[1
]
Grieco, S.
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Univ Roma La Sapienza, Policlin Umberto I, Dept Clin Med, I-00161 Rome, ItalyUniv Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
Grieco, S.
[2
]
Giuliano, S.
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Univ Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, ItalyUniv Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
Giuliano, S.
[1
]
Falcone, M.
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Univ Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, ItalyUniv Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
Falcone, M.
[1
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Caccese, R.
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San Giovanni Hosp, Intens Care Unit, Rome, ItalyUniv Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
Caccese, R.
[3
]
Carfagna, P.
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San Giovanni Hosp, Intens Care Unit, Rome, ItalyUniv Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
Carfagna, P.
[3
]
D'ambrosio, M.
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San Giovanni Hosp, Intens Care Unit, Rome, ItalyUniv Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
D'ambrosio, M.
[3
]
Taliani, G.
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Univ Roma La Sapienza, Policlin Umberto I, Dept Clin Med, I-00161 Rome, ItalyUniv Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
Taliani, G.
[2
]
Venditti, M.
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Univ Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, ItalyUniv Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
Venditti, M.
[1
]
机构:
[1] Univ Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
[2] Univ Roma La Sapienza, Policlin Umberto I, Dept Clin Med, I-00161 Rome, Italy
[3] San Giovanni Hosp, Intens Care Unit, Rome, Italy
We describe, for the first time, a cluster of lethal fulminant health-care associated Clostridium difficile (CD) colitis in Italy, observed in the intensive care unit (ICU) of an Italian tertiary care hospital in Rome. For all cases the cause of ICU admission was CD-related septic shock. Three out of seven patients were residents in a long-term care facility in Rome, and the others had been transferred to the ICU from different medical wards of the same hospital. Five patients died within 96 h of ICU admission. Because of a clinical deterioration after 4 days of adequate antibiotic therapy, two patients underwent subtotal colectomy: both of them died within 30 days of surgical intervention. In four cases, ribotyping assay was performed and ribotype 027 was recognized. This high mortality rate could be attributable to three findings: the extent of disease severity induced by the strain 027, the delay in antimicrobial therapy administration, and the lack of efficacy of the standard antibiotic treatment for fulminant CD colitis compared to an earlier surgical approach. In order to contain a CD infection epidemic, control and surveillance measures should be implemented, and empirical therapy should be administered. Because of potential 027 ribotype CD spread in Italy, CDI should be regarded with a high index of suspicion in all patients presenting with shock and signs or symptoms suggesting abdominal disease, and an early surgical approach should be considered.
机构:
Ist Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Baldan, Rossella
;
Cavallerio, Paolo
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Univ San Giovanni Battista, Azienda Osped, Microbiol Lab, Turin, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Cavallerio, Paolo
;
Tuscano, Antonella
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Ist Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Tuscano, Antonella
;
Parlato, Caterina
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机构:
Univ San Giovanni Battista, Azienda Osped, Microbiol Lab, Turin, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Parlato, Caterina
;
Fossati, Lucina
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Univ San Giovanni Battista, Azienda Osped, Microbiol Lab, Turin, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Fossati, Lucina
;
Moro, Matteo
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Ist Sci San Raffaele, Chief Med Off, I-20132 Milan, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Moro, Matteo
;
Serra, Roberto
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Univ San Giovanni Battista, Azienda Osped, Microbiol Lab, Turin, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Serra, Roberto
;
Cirillo, Daniela M.
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Ist Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
机构:
Leeds Gen Infirm, Old Med Sch, Dept Microbiol, Leeds, W Yorkshire, England
Univ Leeds, Leeds, W Yorkshire, EnglandLeiden Univ, Med Ctr, Ctr Infect Dis, NL-2300 RC Leiden, Netherlands
机构:
Ist Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Baldan, Rossella
;
Cavallerio, Paolo
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h-index: 0
机构:
Univ San Giovanni Battista, Azienda Osped, Microbiol Lab, Turin, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Cavallerio, Paolo
;
Tuscano, Antonella
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h-index: 0
机构:
Ist Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Tuscano, Antonella
;
Parlato, Caterina
论文数: 0引用数: 0
h-index: 0
机构:
Univ San Giovanni Battista, Azienda Osped, Microbiol Lab, Turin, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Parlato, Caterina
;
Fossati, Lucina
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机构:
Univ San Giovanni Battista, Azienda Osped, Microbiol Lab, Turin, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Fossati, Lucina
;
Moro, Matteo
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机构:
Ist Sci San Raffaele, Chief Med Off, I-20132 Milan, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Moro, Matteo
;
Serra, Roberto
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h-index: 0
机构:
Univ San Giovanni Battista, Azienda Osped, Microbiol Lab, Turin, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
Serra, Roberto
;
Cirillo, Daniela M.
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机构:
Ist Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, ItalyIst Sci San Raffaele, Emerging Bacterial Pathogens Unit, I-20132 Milan, Italy
机构:
Leeds Gen Infirm, Old Med Sch, Dept Microbiol, Leeds, W Yorkshire, England
Univ Leeds, Leeds, W Yorkshire, EnglandLeiden Univ, Med Ctr, Ctr Infect Dis, NL-2300 RC Leiden, Netherlands