Dimitrios Matthaiou - Academia.edu (original) (raw)

Papers by Dimitrios Matthaiou

Infectious Diseases and Clinical Microbiology

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Open Forum Infectious Diseases

statistically significant difference in both all-cause mortality (24% vs. 73%, P = 0.006) and inf... more statistically significant difference in both all-cause mortality (24% vs. 73%, P = 0.006) and infection related mortality (4% vs. 26%, P = 0.017) in the CAZ-AVI and BAT groups, respectively. There was a trend toward a lower overall length of stay favoring the CAZ-AVI cohort as opposed to the BAT cohort (16 days vs. 30 days, P = 0.082). Conclusion. CAZ-AVI therapy was associated with lower mortality rates for CRE infections and have a high attributable mortality, especially with concomitant bacteremia. Future studies are warranted to confirm these results. Disclosures. All authors: No reported disclosures.

Drugs

Positive experience with inhaled antibiotics in pulmonary infections of patients with cystic fibr... more Positive experience with inhaled antibiotics in pulmonary infections of patients with cystic fibrosis has paved the way for their utilization in mechanically ventilated, critically ill patients with lower respiratory tract infections. A successful antibiotic delivery depends upon the size of the generated particle and the elimination of drug impaction in the large airways and the ventilator circuit. Generated droplet size is mainly affected by the type of the nebulizer employed. Currently, jet, ultrasonic, and vibrating mesh nebulizers are marketed; the latter can deliver optimal antibiotic particle size. Promising novel drug-device combinations are able to release drug concentrations of 25-to 300-fold the minimum inhibitory concentration of the targeted pathogens into the pulmonary alveoli. The most important practical steps of nebulization include pre-assessment and preparation of the patient (suctioning, sedation, possible bronchodilation, adjustment of necessary ventilator settings); adherence to the procedure (drug preparation, avoidance of unnecessary tubing connections, interruption of heated humidification, removal of heat-moisture exchanger); inspection of the procedure (check for residual in drug chamber, change of expiratory filter, return sedation, and ventilator settings to previous status); and surveillance of the patient for adverse events (close monitoring of the patient and particularly of peak airway pressure and bronchoconstriction). Practical aspects of nebulization are very important to ensure optimal drug delivery and safe procedure for the patient. Therefore, the development of an operational checklist is a priority for every department adopting this modality. Key Points Delivery of inhaled antibiotics in mechanically ventilated patients is a modality with increasing interest and utilization among intensivists, without well-recognized standard procedures. The type of nebulizer used is the major determinant of all practical issues. The most important practical steps of nebulization include pre-assessment and preparation of the patient; adherence to the procedure (drug preparation, ventilator settings, and circuit adjustments); and monitoring of the procedure for completeness and safety.

Intensive care medicine, Aug 1, 2017

Minerva anestesiologica, Jan 11, 2017

Intra-abdominal candidiasis (IAC) has a considerable cost in terms of mortality and morbidity. We... more Intra-abdominal candidiasis (IAC) has a considerable cost in terms of mortality and morbidity. We sought to study the epidemiology, characteristics and outcome of elderly (>75 years old) versus non-elderly patients with IAC and risk factors for mortality in elderly patients. Post-hoc analysis of a retrospective multinational cohort study over a 3- year period (2011-2013). Of 482 patients, 124 (25.7%) were elderly and 358 (74.3%) were non- elderly. The mean age was 80.4±3.9 and 56.3±13.8 years, respectively. Fifty-four of 124 (43.5%) and 75/358 (20.9%) died until the end of observation. The majority of isolates were Candida albicans. Echinocandins were the most prescribed initial agent. Elderly patients were more likely to have a higher APACHE II score, and to suffer from COPD and heart disease. Non-elderly patients were more likely to be treated with immunosuppressants and steroids, and to have received a solid organ transplantation. Mortality was significantly higher in the elde...

Alimentary Pharmacology Therapeutics, 2007

Current Opinion in Infectious Diseases, 2016

Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in the critical... more Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in the critical care setting. It incurs great additional cost and the antibiotics prescribed for patients with VAP account for the majority of total antibiotic prescriptions. The increased cost of VAP as well as the emergence of antimicrobial resistance and the potential adverse events because of treatment indicate that the application of shorter antibiotic regimens for the treatment of VAP poses as a one-way choice. According to the findings of relevant randomized controlled trials, patients receiving short-course regimens for the treatment of VAP have significantly more antibiotic-free days without any negative impact on mortality. Additionally, no other differences were found regarding other secondary outcomes. However, there were higher relapse rates in patients with VAP because of nonfermenting Gram-negative bacilli and there was a lower emergence of multidrug-resistant pathogens. The shortening of the duration of treatment for VAP is promising, as long as a holistic approach that combines methods ensuring the adequate sterilization of septic foci, the optimization of antibiotic levels, the multifaceted delivery of antimicrobials in the lung and the usage of biomarkers that allow the monitoring of the disease course and the effectiveness of administered treatment are incorporated in clinical practice.

Background: The addition of an aminoglycoside to a b-lactam for the treatment of patients with in... more Background: The addition of an aminoglycoside to a b-lactam for the treatment of patients with infective endocarditis has been supported by data from laboratory and animal studies. Purpose: We sought to review the evidence from the available comparative clinical trials regarding the role of aminoglycosides in combination with a b-lactam for the treatment of bacterial endocarditis caused by Gram-positive cocci. Data sources: The studies for our meta-analysis were retrieved from searches of the PubMed and Cochrane Central Register of Controlled Trials databases, as well as from the references cited in relevant articles. No limits were set regarding the language and date of publication of the studies. Study selection: Included studies were prospective studies that provided comparative data regarding the effectiveness of the treatment and/or mortality in patients receiving monotherapy with a b-lactam or b-lactam/aminoglycoside combination therapy. Data extraction: Two independent reviewers performed the literature search, study selection and extraction of data from relevant studies. Data synthesis: No clinical trial comparing b-lactam monotherapy with b-lactam/aminoglycoside combination therapy for the treatment of enterococcal endocarditis was found. We performed a meta-analysis of five available comparative trials [four randomized controlled trials (RCTs) and one comparative prospective trial], which included 261 patients with bacterial endocarditis in native valves due to Staphylococcus aureus (four studies) or streptococci of the viridans group (one study). There was no statistically significant difference between b-lactam monotherapy and b-lactam/aminoglycoside combination therapy regarding mortality [odds ratio (OR) = 0.59, 95% confidence interval (95% CI) = 0.21-1.66], treatment success (OR = 1.25, 95% CI = 0.49-3.05), treatment success without surgery (OR = 1.66, 95% CI = 0.64-4.30) or relapse of endocarditis (OR = 0.79, 95% CI = 0.15-4.29). Nephrotoxicity was less common in the b-lactam monotherapy arm than in the b-lactam/aminoglycoside combination therapy arm (OR = 0.38, 95% CI = 0.16-0.88, P = 0.024). No difference between the two treatment arms was found in subanalyses of the four studies that included only patients with staphylococcal infections in terms of mortality (OR = 0.69, 95% CI = 0.26-1.86, fixed effects model), treatment success (OR = 1.27, 95% CI = 0.47-3.43, fixed effects model) or relapse (OR = 0.76, 95% CI = 0.12-4.92, fixed effects model). Limitations: The relatively small number of available comparative trials was the major limitation of this meta-analysis. Conclusions: The limited evidence from the available prospective comparative studies does not offer support for the addition of an aminoglycoside to b-lactam treatment of patients with endocarditis caused by Gram-positive cocci. A large multicentre RCT is necessary to reach a definitive conclusion on this issue.

European Journal of Clinical Pharmacology, Mar 5, 2008

Background The administration of angiotensin-converting enzyme (ACE) inhibitors has been suggeste... more Background The administration of angiotensin-converting enzyme (ACE) inhibitors has been suggested as an alternative strategy for lowering the risk of communityacquired pneumonia (CAP) in the elderly, especially in patients with neurological and cerebrovascular comorbidity. Methods We critically examined the relevant data from studies regarding the impact of ACE inhibitors in lowering the risk of CAP and/or mortality due to CAP in the elderly. We searched PubMed, Cochrane Database, and references of initially retrieved articles, and http://clinicaltrials.gov for ongoing trials. Results We identified 285 evaluable studies. Fourteen studies met the inclusion criteria and were evaluated further, of which seven were prospective studies, two randomized controlled trials, and five retrospective studies. Eight of ten studies including patients of Asian origin demonstrated a statistical significance in favor of ACE inhibitors. On the contrary, only one of five studies including patients of non-Asian origin demonstrated results in favor of ACE inhibitors. Conclusion The available data suggest that ACE inhibitors may contribute to the reduction of the risk of CAP. Nevertheless, clinical data are scarce and mainly comprise studies including patients of Asian origin. As there seem to be differences regarding the genetic polymorphism of ACE among patients of different origins, future studies are needed that incorporate relevant genetics data that may help clarify the role, if any, of ACE inhibitors in preventing CAP.

Emerging Infectious Diseases, Sep 1, 2008

Pneumon

The increasing rate of ventilator-associated pneumonia (VAP) caused by multidrug-resistant pathog... more The increasing rate of ventilator-associated pneumonia (VAP) caused by multidrug-resistant pathogens warrants the development of new treatment strategies. Carefully engineered delivery systems are undergoing evaluation to test the hypothesis that aerosolized administration of antibiotics will provide high local concentrations and fast clearance, which in turn may improve efficacy and decrease the risk of microbial resistance. Recent studies indicate that aerosolized delivery systems for specially formulated antibiotics yield high local concentrations with rapid clearance and low systemic exposure. Preliminary clinical studies reveal that aerosolized delivery of antibiotics is well tolerated and active, when combined with intravenous antibiotics. No single aerosolized antibiotic is likely to provide broad-spectrum activity against both Gram-negative and Gram-positive bacteria. Large multicenter trials are needed to determine whether preliminary findings will translate to improved clinical activity and decreased microbial resistance in VAP patients, and to optimize the use of aerosolized antibiotics.

The International Journal of Tuberculosis and Lung Disease

To investigate the clinical features and prognosis of patients with methicillin-resistant Staphyl... more To investigate the clinical features and prognosis of patients with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) community-acquired pneumonia (CAP) producing the Panton-Valentine leukocidin (PVL). PubMed and Scopus were searched. Inclusion was stratified according to S. aureus susceptibility and clinical, microbiological and outcome data of patients with S. aureus CAP; both primary and secondary cases of CAP (hematogenous spread from other sites of infection) were included. We identified 71 articles reporting data on patients with MRSA (n = 76) and MSSA (n = 31) PVL-positive CAP. There were no differences in demographics and history among patients with MRSA and MSSA CAP. Features associated with MRSA CAP were gastrointestinal tract symptoms (P = 0.016) and unilobar infiltrates (P = 0.043). Features associated with MSSA CAP were airway hemorrhage (P = 0.01), multilobar infiltrates (P = 0.043) and acute respiratory distress syndrome (...

Textbook of Respiratory and Critical Care Infections, 2015

ABSTRACT

Infectious diseases (London, England), Jan 19, 2015

BMC Infectious Diseases, 2015

Fungal infections represent a major burden in the critical care setting with increasing morbidity... more Fungal infections represent a major burden in the critical care setting with increasing morbidity and mortality. Candidiasis is the leading cause of such infections, with C. albicans being the most common causative agent, followed by Aspergillosis and Mucormycosis. The diagnosis of such infections is cumbersome requiring increased clinical vigilance and extensive laboratory testing, including radiology, cultures, biopsies and other indirect methods. However, it is not uncommon for definitive evidence to be unavailable. Risk and host factors indicating the probability of infections may greatly help in the diagnostic approach. Timely and adequate intervention is important for their successful treatment. The available therapeutic armamentarium, although not very extensive, is effective with low resistance rates for the newer antifungal agents. However, timely and prudent use is necessary to maximize favorable outcomes.

Minerva anestesiologica, 2014

Mayo Clinic proceedings, 2006

To compare the effectiveness and safety of fluoroquinolones with beta-lactams in the treatment of... more To compare the effectiveness and safety of fluoroquinolones with beta-lactams in the treatment of patients with skin and soft tissue infections (SSTIs). We searched the PubMed database, Cochrane Database of Controlled Trials, and references of relevant articles for study reports published between January 1980 and February 2006. Twenty randomized controlled trials that enrolled 4817 patients were included in the analysis. Fluoroquinolones as empirical treatment of patients with SSTIs were more effective than beta-lactams for the clinically evaluable patients (90.4% vs 88.2%; odds ratio [OR], 1.29; 95% confidence interval [CI], 1.00-1.66). This was also true in subset analyses of randomized controlled trials that studied ciprofloxacin (OR, 2.49; 95% CI, 1.45-4.26) and for patients with mild to moderate infections (OR, 1.83; 95% CI, 1.13-2.96). In contrast, no difference was found between the compared regimens for patients with moderate to severe infections (OR, 1.12; 95% CI, 0.80-1.55...