Francesco Sbrana - Academia.edu (original) (raw)

Papers by Francesco Sbrana

Internal and Emergency Medicine

Journal of Investigational Allergy and Clinical Immunology

This article has been accepted for publication and undergone full peer review but has not been th... more This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

The new microbiologica, 2020

Coronavirus disease 2019 poses a serious threat to public health. The protocol developed at the A... more Coronavirus disease 2019 poses a serious threat to public health. The protocol developed at the Azienda Sanitaria Universitaria Friuli Centrale (Italy) is based on clinical data, laboratory tests, chest echography and HRCT. Several therapeutic options are considered, since patients vary in disease severity, evolution and co-morbidities and because so far there are no clear indications about therapeutic strategy based on randomized clinical trial. In this protocol chest echography has a central role in categorizing patient status, follow-up and decision-making.

The new microbiologica, 2019

Pertussis is quite frequent and severe among infants; therefore, rapid diagnosis and timely targe... more Pertussis is quite frequent and severe among infants; therefore, rapid diagnosis and timely targeted therapy are essential. Although a molecular test for etiological diagnosis is now available, it may not be available everywhere, and therefore adjunctive diagnostic tests are still useful for presumptive diagnosis. We describe the use of procalcitonin (PCT) and lymphocyte count to discriminate among pertussis, bacterial and viral infections. Fourteen infants per group were studied. The decision tree, built considering all available variables, showed a major role of PCT in predicting the different groups. A PCT value equal to or greater than 0.75 ng/ml selected for bacterial infections. A PCT value lower than 0.75 ng/ml and a lymphocyte count equal to or greater than 10,400/mm3 selected the subjects with pertussis, while a lymphocyte count lower than 10,400/mm3 selected for viral etiology. PCT should be used in the diagnosis of infants suspected of having pertussis.

Internal and Emergency Medicine, 2021

Scientific Reports, 2021

Mid Regional pro-ADM (MR-proADM) is a promising novel biomarker in the evaluation of deterioratin... more Mid Regional pro-ADM (MR-proADM) is a promising novel biomarker in the evaluation of deteriorating patients and an emergent prognosis factor in patients with sepsis, septic shock and organ failure. It can be induced by bacteria, fungi or viruses. We hypothesized that the assessment of MR-proADM, with or without other inflammatory cytokines, as part of a clinical assessment of COVID-19 patients at hospital admission, may assist in identifying those likely to develop severe disease. A pragmatic retrospective analysis was performed on a complete data set from 111 patients admitted to Udine University Hospital, in northern Italy, from 25th March to 15th May 2020, affected by SARS-CoV-2 pneumonia. Clinical scoring systems (SOFA score, WHO disease severity class, SIMEU clinical phenotype), cytokines (IL-6, IL-1b, IL-8, TNF-α), and MR-proADM were measured. Demographic, clinical and outcome data were collected for analysis. At multivariate analysis, high MR-proADM levels were significantly ...

International Immunopharmacology, 2021

Background: Following positive experience on the use of blood ozonation in SARS-CoV-2, the CORMOR... more Background: Following positive experience on the use of blood ozonation in SARS-CoV-2, the CORMOR randomized trial was designed to evaluate the adjuvant role of oxygen/ozone therapy in mild to moderate SARS-CoV-2 pneumonia. Methods: The trial (ClinicalTrial.gov NCT04388514) was conducted in four different Italian centers (April-October 2020). Patients were treated according to best available standard of care (SoC) therapy, with or without O3-autohemotherapy (O3-AHT). Results: A total of 92 patients were enrolled: SoC + O3-AHT (48 patients) were compared to the SoC treatment (44 patients). The two groups differed in steroids therapy administration (72.7% in SoC arm vs. 50.0% in O3-AHT arm; p = 0.044). Steroid therapy was routinely started when it was subsequently deemed as effective for the treatment of COVID-19 disease. No significant differences in mortality rates, length of hospital stay, mechanical ventilation requirement and ICU admission were observed. Clinical improvement in patients with pneumonia was assessed according to a specifically designed score (decrease in SIMEU class, improvement in radiology imaging, improvement in PaO2/ FiO2, reduction in LDH and requirement of oxygen therapy ≤ 5 days). Score assessment was performed on day-3 (T3) and day-7 (TEnd) of O3-AHT treatment. A significant increase in the score was reported at TEnd, in the O3-AHT treatment arm (0 [0-1] in the SoC arm vs. 2 [1-3] the O3-AHT arm; p = 0.018). No adverse events related O3-AHT treatment was observed. Conclusion: In mild-to-moderate pneumonia due to SARS-CoV-2, adjuvant oxygen/ozone therapy did not show any effect on mortality, or mechanical intubation but show a clinical improvement a day 7 from randomization in

Medicina, 2021

Background and Objectives: Chances of surviving sepsis increase markedly upon prompt diagnosis an... more Background and Objectives: Chances of surviving sepsis increase markedly upon prompt diagnosis and treatment. As most sepsis cases initially show-up in the Emergency Department (ED), early recognition of a septic patient has a pivotal role in sepsis management, despite the lack of precise guidelines. The aim of this study was to identify the most accurate predictors of in-hospital mortality outcome in septic patients admitted to the ED. Materials and Methods: We compared 651 patients admitted to ED for sepsis (cases) with 363 controls (non-septic patients). A Bayesian mean multivariate logistic regression model was performed in order to identify the most accurate predictors of in-hospital mortality outcomes in septic patients. Results: Septic shock and positive qSOFA were identified as risk factors for in-hospital mortality among septic patients admitted to the ED. Hyperthermia was a protective factor for in-hospital mortality. Conclusions: Physicians should bear in mind that fever ...

Journal of Chemotherapy, 2020

Streptococci still represent common etiologic agents of infective endocarditis (IE). Although ren... more Streptococci still represent common etiologic agents of infective endocarditis (IE). Although renal failure is frequently reported as an aminoglycoside-associated adverse event, last international guidelines recommend a beta-lactam/gentamicin combination therapy. We retrospectively evaluated the use of daptomycin-based aminoglycoside-sparing combination therapy for the treatment of streptococcal IE in seven referral hospitals in Italy. Retrospective, multicenter, observational study. All patients with streptococcal IE admitted from 2016 to 2018 were enrolled. Mortality and incidence of acute kidney injury (AKI) were compared between Group A (standard of care, SoC) and Group B (daptomycin-based aminoglycoside-sparing combination therapy). Fiftyfour patients were enrolled, 33 in Group A and 21 in Group B. Mortality was 2/33 (6%) in Group A and 0 in Group B (p ¼ 0.681); AKI incidence was 8/33 (24%) in Group A and 0 in Group B (p ¼ 0.04). Daptomycinbased aminoglycoside-sparing combination therapy appears to be promising for the treatment of streptococcal endocarditis because of similar efficacy compared with SoC and significantly reduced incidence of AKI.

Minerva Anestesiologica, 2019

American Journal of Infection Control, 2019

We read with interest the article by Marotta et al 1 titled, "Management of a family outbreak of ... more We read with interest the article by Marotta et al 1 titled, "Management of a family outbreak of scabies with high risk of spread to other community and hospital facilities" and support their conclusion. Here, we report the case of a 5-year-old white child presented with nocturnal itching. In this case, atopic dermatitis was treated with topical emollients and oral antihistamines (cetirizine 5 mg twice daily). No other comorbidity was present, and an improvement of the symptoms was obtained within 1 week of therapy. After discontinuation of oral antihistamines, the patient developed an intensely pruritic rash involving the chest, abdomen (Fig 1A), and trunk (Fig 1B). The therapy was started again, with partial clinical benefit. After a few days, on the left hand, a nodular lesion (Fig 1C, yellow arrow), an ulcer on the webbing of the fingers (Fig 1C, blue arrow), and a subtle linear burrow (Fig 1D, white arrow) appeared. Based on these findings, the clinical diagnosis of nodular scabies was made. Treatment with topical acaricides and supportive care permitted the resolution of itching and cutaneous manifestations.

Infection, Jan 9, 2018

Increasing prevalence of candidemia in Internal Medicine wards (IMWs) has been reported in recent... more Increasing prevalence of candidemia in Internal Medicine wards (IMWs) has been reported in recent years, but risk factors for candida bloodstream infection in patients admitted to IMW may differ from those known in other settings. The aim of this study was to identify risk factors and define a prediction rule for the early recognition of the risk of candidemia in IMW inpatients. This was a multicentric, retrospective, observational case-control study on non-neutropenic patients with candidemia admitted to IMWs of four large Italian Hospitals. Each eligible patient with candidemia (case) was matched to a control with bacteremia. Stepwise logistic regression analyses were performed. Overall, 300 patients (150 cases and 150 controls) were enrolled. The following factors were associated with an increased risk of candidemia and weighted to build a score: total parenteral nutrition (OR 2.45, p = 0.008; 1 point); central venous catheter (OR 2.19, p = 0.031; 1 point); peripherally inserted ...

Infectious diseases (London, England), Mar 1, 2018

Evaluation of the role on patient mortality exerted by biofilm forming (BF) Candida strains, by u... more Evaluation of the role on patient mortality exerted by biofilm forming (BF) Candida strains, by using predictive clinical data. Eighty-nine strains isolated from Candida bloodstream infection, occurring in two Italian University Hospitals, were employed in this study. A random forest (RF) model was built with a procedure of iterative selection of the risk factors potentially able to predict the probability of death. The similarity between patient conditions and Bayesian clustering was calculated in order to evaluate the role of predictors in the stratification of the death risk. Three different groups of patients with different probability of death were obtained with a RF approach: Group 1 (mortality in 33.3% of cases), Group 2 (death in 50% of cases), and Group 3 (mortality in 76.9% of cases). The comparison between these three groups showed that BF correlated well with increased mortality in patients, admitted for medical diagnosis, with high APACHE II score and treated with azole...

Intensive care medicine, Feb 9, 2017

European journal of internal medicine, Feb 28, 2017

Infections caused by ESBL-producing Enterobacteriaceae (ESBL-EB) are a major health problem, but ... more Infections caused by ESBL-producing Enterobacteriaceae (ESBL-EB) are a major health problem, but data regarding elderly patients is lacking. We performed a retrospective observational study quantifying the effects of antimicrobial treatment and primary infection site on clinical outcomes in an historical case series of 42 patients aged 80.7±10years admitted to an Internal Medicine ward in Italy for ESBL-EB bloodstream infections (BSI). At multivariate risk analysis, we found that urinary tract as primary infection site (RR=0.181 [0.037-0.886], p=0.035) and definitive antibiotic therapy (RR=0.517 [0.147-0.799], p=0.038) decreased the relative risk of a negative clinical response, while the respiratory tract origin increased the relative risk (RR=2.788 [1.407-9.228], p=0.025). Also regarding 30days mortality, multivariate risk analysis identified that urinary tract as primary infection site (RR=0.098 [0.011-0.743], p=0.025) and definitive antibiotic therapy (RR=0.236 [0.058-0.961], p=...

The new microbiologica, 2017

Most clinicians in developed countries have limited experience in making clinical assessments of ... more Most clinicians in developed countries have limited experience in making clinical assessments of malaria disease severity and/or monitoring high-level parasitemia in febrile patients with imported malaria. Hyperparasitemia is a risk factor for severe P. falciparum malaria, and procalcitonin (PCT) has recently been related to the severity of malaria. In developed countries, where not all hospital have skilled personnel to count parasitemia, a rapid test might be useful for the prompt diagnosis of malaria but unfortunately these tests are not able to count the number of parasites. In this context, PCT might have a prognostic value for the assessment of severe malaria, especially in children with cerebral malaria. We describe two children with severe cerebral malaria, who were directly admitted to the ICU with a high level of PCT and extremely high (>25%) parasitemia. Our conclusion is that PCT may also be a measure of severity of P. falciparum malaria in children.

The American Journal of Medicine, 2016

Background: An increasing number of candidemia has been reported in patients cared for in Interna... more Background: An increasing number of candidemia has been reported in patients cared for in Internal Medicine Wards. These usually older and frail patients may not be suspected as having candidemia because they lack fever at the onset of the episode. To identify the risk factors associated with the lack of fever at the onset of candidemia (i.e. the collection of the first positive blood culture for Candida spp.) in patients cared for in internal medicine wards, we compared two group of patients with or without fever. Methods: We retrospectively review data charts from three tertiary care, University Hospitals in Italy, comparing patients with or without fever at onset of candidemia. Consecutive candidemic episodes in afebrile patients and matched febrile controls were enrolled during the three years study period. Patient baseline characteristics and several infection-related variables were examined. Random Forest analysis was used given the number of predictors to be considered and the potential complexity of their relations with the onset of fever. Results: We identified 147 candidemic episodes without fever at onset and 147 febrile candidemia. Factors associated with the lack of fever at onset of candidemia were: diabetes, C. difficile infection and a shorter delta time from internal medicine wards admission to the onset of candidemia. The only variable associated with fever was the use of intravascular devices. Quite unexpectedly, antifungal therapy was administered more frequently to patients without fever and no differences on 30-day mortality rate were documented in the two study group. Conclusions: Clinicians should be aware that an increasing number of patients with invasive candidiasis cared for in internal medicine wards may lack fever at onset, especially those with diabetes and C. difficile infection. Candidemia should be suspected in patients with afebrile systemic inflammatory response syndrome or in worsening clinical condition: blood cultures should be taken and a timely and appropriate antifungal therapy should be considered.

Infectious Diseases, 2016

Intensive Care Medicine, 2015