A 1-year prospective case-control study (ratio of control patients to case patients, 3:1) was performed to assess the incidence, risk factors, and genotypic patterns of bacteremia caused by glycopeptide-resistant coagulase-negative staphylococci (CoNS) and their correlation with hospital glycopeptide use. Among 535 subjects with CoNS bacteremia, 20 subjects had a glycopeptide-resistant strain (19 strains were resistant to teicoplanin and 1 was resistant to both teicoplanin and vancomycin). The percentage of resistant isolates recovered in 1 year was 8% in intensive care units and 3% and 2% in medical and surgical wards, respectively. Genotypic analysis of resistant strains showed different patterns with a high degree of polymorphism. Use of glycopeptides in individual wards was not statistically associated with the percentage of resistance. Previous exposure to beta-lactams and glycopeptides, multiple hospitalization in the previous year, and concomitant pneumonia were significantly associated with the onset of glycopeptide-resistant CoNS bacteremia. Mortality rates were 25% among case patients and 18% among control patients, and they were significantly higher among patients who presented with concomitant pneumonia and a high Acute Physiology and Chronic Health Evaluation III score.
BackgroundNephrotic syndrome is a disorder characterized by proteinuria, hypoalbuminemia and dyslipidemia. Low-dose alternate-day steroid regimen is the standard of care. In case of relapse or significant adverse events, steroid-sparing agents may be used. This analysis was aimed at assessing the efficacy and safety of rituximab for the treatment of children with nephrotic syndrome.ResultsFour studies were included in the final meta-analysis. The end-point of our analysis was the percentage of patients in remission at 6 months. Pooled data from the four studies favours the use of rituximab (RR 5.25, 95 % CI: 3.05–9.06; p < 0.0001). As regards the safety data, rituximab has a limited number of adverse effects, the most common of which occur during the infusions.ConclusionsIn Italy, the off-label use of drugs is regulated by Law 648/96. In our opinion, there are three scientific requirements to merit a conditional national reimbursement for rituximab in nephrotic syndrome: 1. favourable clinical efficacy and safety data; 2. no available alternatives; 3. outcome data collecting by AIFA through prescribers. In conclusion, our results report a significant incremental benefit of adding rituximab to corticosteroid and/or calcineurin inhibitors for the treatment of nephrotic syndrome.
Since the beginning of coronavirus disease 2019 (COVID-19), several therapies have been purposed. Remdesivir has emerged as an encouraging antiviral drug with for the treatment of severe patients with documented COVID-19-related pneumonia. Although several studies about remdesivir effectiveness exist, no study investigated the combination of remdesivir with the vaccination status. The aim of this study was to assess if the administration of remdesivir could show some differences in outcomes on the basis of the vaccination status. The primary outcome was the mortality at hospital. The secondary outcomes of interest were the necessity of transfer to ICU and the need for oxygen supplementation. This is a retrospective longitudinal cohort study including all adult patients hospitalized for severe COVID-19 at the Padua University Hospital (Italy), between September 1, 2020, and January 31, 2022, and who received remdesivir. Baseline characteristics of the population according to vaccination status were given. To have a better estimate of the outcomes of interest, a propensity score of being vaccinated was performed. A total of 708 patients were included. A total of 605/708 patients (85.4%) completed the vaccination schedule. Overall, in-hospital mortality was 5.1% (n = 36), while 30-day mortality was 2.4% (n = 17). After propensity score matching, mortality between the two groups remained similar. The need for ICU and oxygen supplementation was lower in the vaccinated group. Our finding suggests that a complete vaccination course could have an impact in reducing the need for transfer in ICU and for high-flow therapy in moderate-to-severe COVID-19 patients treated with remdesivir.
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