Santa Chiara Regional Hospital

Trento, Italy

Santa Chiara Regional Hospital

Trento, Italy
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Cai T.,Santa Chiara Regional Hospital | Verze P.,University of Naples | Brugnolli A.,University of Verona | Tiscione D.,Santa Chiara Regional Hospital | And 9 more authors.
European Urology | Year: 2016

Background The evolution of resistant pathogens is a worldwide health crisis and adherence to European Association of Urology (EAU) guidelines on antibiotic prophylaxis may be an important way to improve antibiotic stewardship and reduce patient harm and costs. Objective To evaluate the prevalence of antibiotic-resistant bacterial strains and health care costs during a period of adherence to EAU guidelines in a tertiary referral urologic institution. Design, setting, and participants A protocol for adherence to EAU guidelines for antibiotic prophylaxis for all urologic procedures was introduced in January 2011. Data for 3529 urologic procedures performed between January 2011 and December 2013 after protocol introduction were compared with data for 2619 procedures performed between January 2008 and December 2010 before protocol implementation. The prevalence of bacterial resistance and health care costs were compared between the two periods. Outcome measurements and statistical analysis The outcome measures were the proportion of resistant uropathogens and costs related to antibiotic consumption and symptomatic postoperative infection. We used χ2 and Fisher's exact tests to test the significance of differences. Results and limitations The proportion of patients with symptomatic postoperative infection did not differ (180/3529 [5.1%] vs 117/2619 [4.5%]; p = 0.27). A total of 342 isolates from all patients with symptomatic postoperative infections were analysed. The rate of resistance of Escherichia coli to piperacillin/tazobactam (9.1% vs 5.4%; p = 0.03), gentamicin (18.3% vs 11.2%; p = 0.02), and ciprofloxacin (32.3% vs 19.1%; p = 0.03) decreased significantly after protocol introduction. The defined daily dose (DDD) use of ciprofloxacin fell from 4.2 to 0.2 DDD per 100 patient-days after implementation (p < 0.001). Antibiotic drug costs (€76 980 vs €36 700) and costs related to postoperative infections (€45 870 vs €29 560) decreased following introduction of the protocol (p < 0.001). Conclusions Adherence to EAU guidelines on antibiotic prophylaxis reduced antibiotic usage without increasing post-operative infection rate and lowered the prevalence of resistant uropathogens. Patient summary We analysed the impact of adherence to European Association of Urology guidelines on antibiotic prophylaxis for all surgical urologic procedures on the prevalence of infections and resistant bacterial strains and on costs. We found that adherence to the guidelines reduced the rate of bacterial resistance, in particular against piperacillin/tazobactam, gentamicin, and ciprofloxacin, and reduced costs without increasing the risk of postoperative infection after urologic procedures. We recommend adherence to the guidelines as an important part of antibiotic stewardship programmes. © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.


PubMed | TB Research Institute, University of Oslo, Santa Chiara Regional Hospital, Trakya Medical School and 8 more.
Type: Journal Article | Journal: Pathogens (Basel, Switzerland) | Year: 2016

The Global Prevalence of Infections in Urology (GPIU) study is a worldwide-performed point prevalence study intended to create surveillance data on antibiotic resistance, type of urogenital infections, risk factors and data on antibiotic consumption, specifically in patients at urological departments with healthcare-associated urogenital infections (HAUTI). Investigators registered data through a web-based application (http://gpiu.esiu.org/). Data collection includes the practice and characteristics of the hospital and urology ward. On a certain day in November, each year, all urological patients present in the urological department at 8:00 a.m. are screened for HAUTI encompassing their full hospital course from admission to discharge. Apart from the GPIU main study, several side studies are taking place, dealing with transurethral resection of the prostate, prostate biopsy, as well as urosepsis. The GPIU study has been annually performed since 2003. Eight-hundred fifty-six urology units from 70 countries have participated so far, including 27,542 patients. A proxy for antibiotic consumption is reflected by the application rates used for antibiotic prophylaxis for urological interventions. Resistance rates of most uropathogens against antibiotics were high, especially with a note of multidrug resistance. The severity of HAUTI is also increasing, 25% being urosepsis in recent years.


Bartoletti R.,University of Florence | Cai T.,Santa Chiara Regional Hospital | Nesi G.,University of Florence | Albanese S.,Santa Maria Annunziata Hospital | And 3 more authors.
World Journal of Urology | Year: 2014

Purpose: We aim to evaluate the role of biofilm-producing bacteria in the clinical response to antibiotic therapy among patients affected by chronic bacterial prostatitis (CBP). Methods: All patients attending our centre from January to December 2008 due to prostatitis-like symptoms with a positive Meares-Stamey test were enroled. The clinical symptoms were assessed according to the NIH-CPSI, and the bacterial strains isolated from the patients enroled were identified and tested for antibiotic sensitivity using cards of the Vitek II semi-automated System for Microbiology (BioMerieux). Quantitative bacterial slime production was assessed by the Christensen microwell assay. All patients were treated with fluoroquinolones for 4 weeks and reevaluated clinically and microbiologically after 3 months. Results: One hundred and sixteen patients were enroled, and 150 bacterial strains were isolated from all patients. About 85 % of these strains were strong or moderate biofilm producers. Patients with strong or moderate biofilm-producing bacteria had a higher NIH-CPSI symptom score than those without biofilm-producing bacteria (mean 17.6 ± 5.6 vs. 14.1 ± 3.3; p = 0.0009). At the follow-up, 68 patients (58.6 %) had negative microbiological tests, but only 11 (9.48 %) reported a reduction in NIH-CPSI score. Improvement of symptoms was found statistically significantly less frequent in patients with biofilm-producing bacteria than in those without (p = 0.03). Ultrastructural analysis showed cellular forms in active replication with aberrant morphology of unknown cause and confirmed strong slime production with consistent bacterial stratification. Conclusion: In our CBP population, biofilm-producing bacteria were commonly found and had a significant negative impact on the clinical response to antibiotic therapy. © 2013 Springer-Verlag Berlin Heidelberg.


The relationship between food and women's sexual health is very intriguing. Several authors stated that the daily use of some foods or beverages, such as chocolate or red wine, are associated with a better female sexual quality of life in terms of sexual desire or lubrication. Recently, a national multicenter cross-sectional study suggest a potential relationship between regular daily apple consumption and better sexuality in our young women population, highlighting the role of some phytoestrogen such as phloridzin, a dihydrochalcone glycoside, that is contained under the apple pee. Here, we evaluate the role of daily apple consumption in the female sexual quality of life, by using a narrative review of the current literature.


Bartoletti R.,University of Florence | Cai T.,Santa Chiara Regional Hospital
Clinical Uro-Andrology | Year: 2015

Human papillomavirus (HPV) is a very resistant, ubiquitous and sexually transmitted virus that can survive in the environment without a host. HPV is involved in the genesis of cervical cancer in women. Men are usually seen as potential vectors for infection through sexual intercourse but not as final targets of the disease with clinical manifestations that include genital condylomata and some cancers such as penile, oral/neck, anal and, more recently, bladder cancer. On the other hand, aside the evidence of genital condylomata, specific criteria for diagnosis in asymptomatic subjects are still missing to determine both the presence of viral DNA (infection) and the possible role of HPV in the cell transformation to cancer. The prevalence of HPV in males ranges from 7 to 45 %. The quadrivalent vaccine against HPV has proved to be effective in preventing external genital lesions in 90.4 % males aged 16–26 years (95 % CI 69.2–98.1). It has also proved to be effective in preventing precancerous anal lesions in 77.5 % (95 % CI 39.6–93.3) of cases in a per-protocol analysis and in 91.7 % (95 % CI: 44.6–99.8) of cases in a post hoc analysis. Another aspect to highlight is the association between HPV infection and male infertility, probably due to the viral adhesion on the spermatozoa wall. However, several studies on this topic are currently in process. Recently, for prevention purposes the vaccination of 12-year-old males against HPV was recommended. As it has done already for females, a facilitated access to vaccination for males (by price reductions) should be implemented as well. More campaigns to raise awareness through all institutional channels are needed, not only regarding anogenital warts but for HPV-related diseases in general, to achieve adequate vaccine coverage in female cohorts and to reduce HPV-related morbidity. © Springer-Verlag Berlin Heidelberg 2015.


Verze P.,University of Naples Federico II | Cai T.,Santa Chiara Regional Hospital | Lorenzetti S.,Instituto Superiore Of Sanit Iss
Nature Reviews Urology | Year: 2016

Ejaculation is a synchronized cascade of events that has the ultimate goal of activating sperm and enabling them to reach an egg for fertilization. The seminal plasma contains a complex mixture of fluids that is secreted from the testes, epididymis and male accessory glands. The prostate gland has a pivotal role in this process, as prostatic fluid enriched in Zn 2+, citrate and kallikreins is crucial for the molecular synchronization of the functional cascade triggered by ejaculatory stimuli. The prostate is the target of a number of common diseases that can affect male fertility at different ages. In both young and aged men, prostatic diseases or an unhealthy prostate can affect spermatozoa functioning and, therefore, male fertility. Consideration of prostate physiology emphasizes a number of points: the central role of Zn 2+ and citrate in the regulation of prostate epithelium homeostasis and in ejaculation; the influence of bacteria-related prostatic inflammation on male fertility; and the potential role of prostatic inflammation in promoting the development of prostatic hyperplastic growth and carcinogenesis. © 2016 Macmillan Publishers Limited.


The therapeutic efficacy of CP/CPPS is not very satisfactory and the impact on young male's quality of life is considerable. The aim of the present study is to evaluate the efficacy of pollen extract associated with vitamins (DEPROX 500®) in order to improve the quality of life of young patients affected by chronic prostatitis type IIIb (CP/CPPS) by pain relieving. All patients with clinical and instrumental diagnosis of CP/CPPS (class b) underwent DEPROX 500® 2 tablets in a single dose daily for 30 days. Clinical and microbiological analyses were carried out at the enrolment and after 1 month. NIH-CPSI and IPSS questionnaires have been used. The main outcome measure was the improvement of quality of life at the end of the whole study period, evaluated by questionnaires results. 20 men (mean age 32.8 ± 6.78) were enrolled in this pilot study. The baseline questionnaire mean scores were 25.90 ± 2.1 and 8.01 ± 3.64 for NIH-CPSI and IPSS, respectively. At the follow-up examination (1 month after treatment), 18 out of 20 patients (90.0%) reported an improvement of quality of life, in terms of pain reduction. The questionnaire results after 1 month from treatment were as follows: NIH-CPSI 12.8 ± 2.20, IPSS 7.6 ± 1.58. Statistically significant differences were then reported between the two visits, in terms of NIH-CPSI scores (p<0.001). No statistically significant differences have been reported in terms of IPSS between the two groups. All patients were negative at the Meares-Stamey test evaluation. The compliance to the study protocol was 100%. The pollen extract associated with vitamins (DEPROX 500®) significantly improved {line separator}total symptoms, pain, and QoL in patients with non-inflammatory CP/CPPS without severe side {line separator}effects.


Cai T.,Santa Chiara Regional Hospital | Wagenlehner F.M.E.,Justus Liebig University | Mondaini N.,University of Florence | D'Elia C.,Santa Chiara Regional Hospital | And 5 more authors.
BJU International | Year: 2014

Objective To investigate the effect of human papillomavirus (HPV) and Chlamydia trachomatis (Ct) co-infection on sperm concentration, motility and morphology, in a large cohort of young heterosexual male patients with chronic prostatitis-related symptoms. Patients and Methods Patients with chronic prostatitis-related symptoms, attending the same centre for sexually transmitted diseases from January 2005 and December 2010, were consecutively enrolled in this cross-sectional study. All patients underwent clinical and instrumental examination, microbiological cultures for common bacteria, DNA extraction, mucosal and serum antibodies evaluation for Ct, specific tests for HPV and semen analysis. The semen variables analysed were: volume; pH; sperm concentration; motility; and morphology. Subjects were subdivided in two groups: group A, patients with Ct infection alone and group B, patients with Ct and HPV co-infection. The main outcome measurement was the effect of Ct and HPV co-infection on the semen variables examined. Results Of 3050 screened patients, 1003 were enrolled (32.9%) in the study. A total of 716 (71.3%) patients were allocated to group A, and 287 (28.7%) to group B. Significant differences between the two groups were reported in terms of percentage of motile sperm (degrees of freedom [df] = 1001; t-test = 11.85; P < 0.001) and percentage of normal morphological forms (df = 1001; t-test = 7.18; P < 0.001), while no differences were reported in terms of semen volume or pH. According to World Health Organization thresholds for normal semen, 364 (50.8%) men in group A and 192 (66.8%) men in group B were subfertile (odds ratio = 1.95; 95% confidence interval 1.46-2.60; P < 0.001). No correlation between HPV genotype, mucosal IgA type and semen variables was found. Conclusion In a population of prostatitis-related symptoms attributable to Ct infection, co-infection with HPV has a significant role in decreasing male fertility, in particular with regard to sperm motility and morphology. © 2013 The Authors. BJU International © 2013 BJU International.


PubMed | University of Verona, University of Florence, Santa Maria Annunziata Hospital, Santa Chiara Regional Hospital and University of Catanzaro
Type: | Journal: Journal of pathogens | Year: 2016

We evaluated, in a preliminary study, the efficacy of umbelliferone, arbutin, and N-acetylcysteine to inhibit biofilm formation on urinary catheter. We used 20 urinary catheters: 5 catheters were incubated with Enterococcus faecalis (control group); 5 catheters were incubated with E. faecalis in presence of umbelliferone (150mg), arbutin (60mg), and N-acetylcysteine (150mg) (group 1); 5 catheters were incubated with E. faecalis in presence of umbelliferone (150mg), arbutin (60mg), and N-acetylcysteine (400mg) (group 2); and 5 catheters were incubated with E. faecalis in presence of umbelliferone (300mg), arbutin (60mg), and N-acetylcysteine (150mg) (group 3). After 72 hours, planktonic microbial growth and microorganisms on catheter surface were assessed. In the control group, we found a planktonic load of 10(5)CFU/mL in the inoculation medium and retrieved 3.69 10(6)CFU/cm from the sessile cells adherent to the catheter surface. A significantly lower amount in planktonic (p < 0.001) and sessile (p = 0.004) bacterial load was found in group 3, showing <100CFU/mL and 0.12 10(6)CFU/cm in the incubation medium and on the catheter surface, respectively. In groups 1 and 2, 1.67 10(6)CFU/cm and 1.77 10(6)CFU/cm were found on catheter surface. Our results document that umbelliferone, arbutin, and N-acetylcysteine are able to reduce E. faecalis biofilm development on the surface of urinary catheters.


PubMed | Santa Maria Annunziata Hospital, Santa Chiara Regional Hospital, University of Naples Federico II, Urology Clinic and 2 more.
Type: Journal Article | Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology | Year: 2016

In this study, we aimed to investigate the clearance of type-specific genital human papillomavirus (HPV) infection in heterosexual, non-HPV-vaccinated males whose female partners were positive to HPV DNA tests. All consecutive men attending the same sexually transmitted diseases (STD) centre between January 2005 and December 2006 were considered for this study. All subjects (n=1009) underwent a urologic visit and microbiological tests on first void, midstream urine and total ejaculate samples. One hundred and five patients were positive for HPV DNA (10.4%; mean age: 34.85.8 years) and consented to clinical examination and molecular diagnostic assays for HPV detection scheduled every 6 months (median surveillance period of 53.2months). HPV genotypes were classified as high risk, probable high risk and low risk. HPV-positive samples which did not hybridise with any of the type-specific probes were referred to as positive non-genotypeable. At enrollment, the distribution of HPV genotypes was as follows: high-risk HPV (n=37), probable high-risk HPV (n=6), low-risk HPV (n=23) and non-genotypeable HPV (n=39). A high HPV genotype concordance between stable sexual partners emerged (kappa=0.92; p<0.001). At the end of the study, 71/105 (67.6%) subjects were negative for HPV (mean virus clearance time: 24.3months). With regard to the HPV genotype, virus clearance was observed in 14/37 (37.8%) high-risk HPV cases, 6/6 (100%) probable high-risk HPV cases, 20/23 (86.9%) low-risk HPV cases and 31/39 (79.5%) non-genotypeable cases. The high-risk HPV genotypes showed the lowest rate and probability of viral clearance (p<0.001). In our series, high-risk HPV infections were more likely to persist over time when compared with other HPV genotypes.

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