Papers by Giacomo Castiglione
Antibiotics
Due to the COVID-19 pandemic, there has been a shift in focus towards controlling the spread of S... more Due to the COVID-19 pandemic, there has been a shift in focus towards controlling the spread of SARS-CoV-2, which has resulted in the neglect of traditional programs aimed at preventing healthcare-associated infections and combating antimicrobial resistance. The present work aims to characterize the colonization or infection with Acinetobacter baumannii of COVID-19 patients and to identify any clonality between different isolates. Specifically, data and resistance profiles of A. baumannii isolates were prospectively collected from patients recruited by the EPIRADIOCLINF project. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used for molecular typing. Overall, we analyzed 64 isolates of A. baumannii from 48 COVID-19 patients. According to our analysis, we have identified the spread of a clonally related isolate, referred to as B. The PFGE pattern B includes four subtypes: B1 (consisting of 37 strains), B2 (11), B3 (5), and B4 (2). Furthermore, in...
Journal of Emergency and Critical Care Medicine, 2020
We reported the case of a 75-year-old man, who undergone pulmonary lobectomy and on whom we perfo... more We reported the case of a 75-year-old man, who undergone pulmonary lobectomy and on whom we performed renal doppler ultrasound measuring renal doppler resistive index (RDRI) to detect renal and global hypoperfusion. RDRI turned out be earlier than any other hemodynamic and laboratory parameter routinely reported as marker of hypoperfusion. He developed septic shock and a myocardial infarction. His laboratory test and vital parameters suggested a critical condition, on the other hand the blood gas test showed a normal value of lactate and the central venous oxygen saturation (SvcO 2 ) wasn't altered. During an episode of hypotension, we performed a cardiopulmonary ultrasound that revealed a condition of fluid responsiveness. His renal (RDRI) was 0.75. After a fluid challenge both vital signs and ultrasound measurement improved as we expected. RDRI also decreased to normal values, suggesting an enhancement of kidney and global perfusion. We may point out that performing renal doppler ultrasound and measuring RDRI could allow to detect renal and global hypoperfusion evidently earlier than any other hemodynamic and laboratory parameter routinely reported as marker of hypoperfusion.
Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia, 2020
We report the case of a 37-year-old woman that developed severe hypercalcemia due to a parathyroi... more We report the case of a 37-year-old woman that developed severe hypercalcemia due to a parathyroid gland mass. After the initial medical treatment, only a minimal reduction of calcemia was observed and her clinical condition worsened; thus, she required continuous renal replacement therapy (CRRT) that resulted in the normalization of calcium serum level. She then underwent a left thyroid lobectomy with exeresis of the associated parathyroid glands; the histological diagnosis revealed a giant parathyroid adenoma (GPA). CRRT, initially recommended only in case of severe refractory hypercalcemia poorly responsive to pharmacological approaches, is now being evaluated in the first line treatment of life-threatening cases, with or without associated acute kidney injury (AKI).
Anesthesia & Analgesia, 2020
The Ultrasound Journal, 2019
Background We reported a case of early detection of peripheral hypoperfusion trough the evaluatio... more Background We reported a case of early detection of peripheral hypoperfusion trough the evaluation of a new index in intensive care: Renal Doppler Resistive Index (RRI). Case presentation We admitted a 76-year-old man who underwent ileostomy and hernioplasty because of an intestinal occlusion due to obstructive strangulated right inguinal hernia. The post-operative period was characterised by hemodynamic instability and he needed an invasive hemodynamic monitoring, administration of vasopressors and continuous renal replacement therapy (CRRT). Then, hemodynamic stability was obtained and vasopressors interrupted. RRI was lower than 0.7. In the eleventh post-operative day, despite stable macrocirculatory parameters, we found increased values of RRI. An abdomen ultrasound first and then a CT scan revealed the presence of bleeding from the previous ileostomy. Hence, the patient immediately underwent another surgical operation. Conclusions RRI modification appears to be more precocious ...
Journal of Microbiology, Immunology and Infection, 2019
Background: The diagnosis of Invasive Candidiasis (IC) presents serious problems, mainly associat... more Background: The diagnosis of Invasive Candidiasis (IC) presents serious problems, mainly associated with the absence of pathognomonic symptoms of the disease and the difficulty of isolating the fungus in blood culture. Candida albicans germ tube antibody (CAGTA) provides a rapid and simple test for diagnosis of IC. The aim of this study was to evaluate the diagnostic role of the CAGTA in the monitoring of critically-ill patients at risk of developing IC. Methods: During diagnostic surveillance in the intensive care units (ICU) CAGTA was performed twice a week if predetermined risk factors were present and a positive result was considered when a serum titer !1/160 was detected in at least one sample. Results: Seventy critically ill patients were included in the study. Twenty-three patients with proven/probable IC were identified. The sensitivity, specificity, PPV, and NPV of CAGTA for the diagnosis of proven/probable IC in all 70 patients were 91.3%, 68.1%, 58.3%, and 94.1%, respectively. Statistically significant highest titers were found in patients with proven/probable IC as well as increasing titers more than 1/160. Conclusions: Our results suggest that detection of CAGTA could be a useful biomarker for the diagnosis of proven and probable IC in critical patients during prolonged ICU stay. During the monitoring it is opportune to evaluate the titers kinetics since the clinical diagnosis of proven/probable IC coincided with increase titer from negative (<1/160) to more than 1/160.
Trends in Anaesthesia and Critical Care, 2018
Background and goal of the study: We report of a case of unexpected difficult intubation despite ... more Background and goal of the study: We report of a case of unexpected difficult intubation despite preoperative evaluation. Ă Methods: A 67 years male patient scheduled for laparoscopic prostatectomy went for preoperative evaluation with the following findings: moderate obesity (BMI32), adequate mouth opening and thyromental distance, Mallampati III, history of snoring. In perspective of difficult mask ventilation he was requested to remove beard. Results: After routine monitoring and anesthesia induction, with NMBA administration following ventilability check, a first laryngoscopy revealed a Cormack-Lehane grade 3 view with limited room for airway instrumentation. After one failed conventional laryngoscopy two attempts with Airtraq (Prodol, Spain) failed because of view of sole epiglottis. Ventilation remained satisfactory thorough attempts, and a #4 LMA-fastrach (Teleflex, Ireland) was positioned resulting in poor ventilation and no view of laryngeal inlet with fiberoptic bronchoscope. Patient was then reverted to spontaneous breathing (atropine+neostigmine) and a spontaneous breathing fiberoptic intubation with a reinforced 6.5 mm OD endotracheal tube was successful, using the spray-as-you-go technique for airway topicalization. Surgery was performed and the patient received a protected extubation over airway catheter Conclusions: Our case highlights importance of ventilation over intubation, importance of preoperative evaluation (the patient, deferred to pneumologist, was diagnosed severe OSAS), possibility of failure of videolaryngoscopy, importance of avoidance of fixation error and fundamental role of fiberoptic, with spontaneous breathing, for difficult airway management. References
Critical Ultrasound Journal, 2017
The quantification of B-lines at lung ultrasonography is a valid tool to estimate the extravascul... more The quantification of B-lines at lung ultrasonography is a valid tool to estimate the extravascular lung water (EVLW) in patients after major cardiac surgery. However, there is still uncertainty about the correlation between B-lines and EVLW in a general population of critically ill. Aim: To evaluate a simplified lung ultrasonographic assessment as a tool to estimate the EVLW in critically ill patients admitted to a polyvalent intensive care unit (ICU). Methods: Nineteen consecutive critically ill patients requiring mechanical ventilation and hemodynamic monitoring were enrolled. Lung ultrasonography and the thermodilution methodology (PiCCO system) were performed by two independent operators. The positive scan at lung ultrasound was defined by visualization of at least 3 B-lines. We then compared the number of chest areas positive for B-lines with the EVLW index obtained by the invasive procedure. Results: A significant correlation was found between the number of lung quadrants positive for B-lines and EVLW indexed using both actual body weight (rho = 0.612 p = 0.0053) and predicted body weight (rho = 0.493 p = 0.032). Presence of more than 3 positive lung quadrants showed a good performance in identifying an EVLW index value >10 ml/kg of actual body weight(area under the ROC 0.894; 95% CI 0.668-0.987 p < 0.0001). Presence of of more than 4 positive lung quadrants indentified an EVLW index value >10 ml/kg of predicted body weight (area under the ROC 0.8; 95% CI 0.556-0.945 p = 0.0048). A simplified lung ultrasound approach can by used as a reliable noninvasive bedside tool to predict EVLW in emergency and critically ill patients.
Journal of Hospital Infection, 2011
Quinolone resistance was considered to be mainly mediated by themutations of chromosomal genes, m... more Quinolone resistance was considered to be mainly mediated by themutations of chromosomal genes, mainly gyrA and parC, encoding DNA gyrase and/or topoisomerase IV. Acinetobacter spp. clinical isolates usually mutated from Ser-83 to Leu-83 in the quinolone resistance-determining region (QRDR) of gyrA gene, and this mutationwas themost common cause for the resistance to quinolones in Acinetobacter spp.5,6 In our study, mutations Ser-83/ Leu and Gly117/Asp together with three synonymous substitutions, GGG (Gly)/GGT(Gly) at codon 71, GGC(Gly)/GGT(Gly) at codon 104 and GCC(Gla)/GCT(Gla) at codon 107, were found in gyrA of NJAb006. The sequence of gyrA has been confirmed to be a novel variant (GenBank accession number GQ892873). The patient was treated with tigecycline. Blood cultures at day 5 and day 12 were sterile. In many regions, PDR A. baumannii has been resistant to almost all antibiotics, except colistin or tigecycline. Nevertheless, resistance to colistin or tigecycline has also been documented.7 The study of Tacconelli et al. showed that the presence of central venous catheters (CVCs) was one of the risk factors for multidrug-resistant A. baumannii infections.8 In view of the implantation of a CVC before the emergence of this PDR A. baumannii isolate, NJAb006 might be associated with this.
Journal of Hospital Infection, 2014
Background: Infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have become an... more Background: Infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have become an important healthcare-associated problem, particularly in intensive care units (ICUs). Aim: To investigate the emergence of carbapenem-and colistin-resistant A. baumannii infections in two Sicilian hospitals. Methods: From October 2008 to May 2011, a period which included two Italian Nosocomial Infections Surveillance in ICUs network (SPIN-UTI) project surveys, all carbapenemresistant A. baumannii isolates from the ICUs of two hospitals in Catania, Italy, were prospectively collected. Minimum inhibitory concentrations (MICs) were measured by agar dilution, and phenotypic testing for metallo-b-lactamase (MBL) production was performed. Carbapenem resistance genes and their genetic elements were identified by polymerase chain reaction and sequencing. Genotypic relatedness was assessed by pulsedfield gel electrophoresis (PFGE) and multi-locus sequence typing. Patient-based surveillance was conducted using the SPIN-UTI protocol and previous antibiotic consumption was recorded. Findings: Twenty-six carbapenem-resistant A. baumannii were identified. Imipenem and meropenem MICs ranged from 4 to >32 mg/L, and 15 isolates exhibited high-level colistin resistance (MICs >32 mg/L). PFGE demonstrated that all isolates belonged to a unique clonal type and were assigned to ST2 of the international clone II. They harboured an intrinsic bla OxA-51-like carbapenemase gene, bla OxA-82 , which was flanked upstream by ISAba1. Conclusions: The dissemination of clonally related isolates of carbapenem-resistant A. baumannii in two hospitals is described. Simultaneous resistance to colistin in more
BMJ Open, 2021
IntroductionIn patients with septic shock, low levels of circulating immunoglobulins are common a... more IntroductionIn patients with septic shock, low levels of circulating immunoglobulins are common and their kinetics appear to be related to clinical outcome. The pivotal role of immunoglobulins in the host immune response to infection suggests that additional therapy with polyclonal intravenous immunoglobulins may be a promising option in patients with septic shock. Immunoglobulin preparations enriched with the IgM component have largely been used in sepsis, mostly at standard dosages (250 mg/kg per day), regardless of clinical severity and without any dose adjustment based on immunoglobulin serum titres or other biomarkers. We hypothesised that a personalised dose of IgM enriched preparation based on patient IgM titres and aimed to achieve a specific threshold of IgM titre is more effective in decreasing mortality than a standard dose.Methods and analysisThe study is designed as a multicentre, interventional, randomised, single-blinded, prospective, investigator sponsored, two-armed...
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Papers by Giacomo Castiglione