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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
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
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
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
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...
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
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
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
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
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...