Does it still make sense to talk about carbapenem-sparing? Rita Murri, Pierluigi Del Vecchio, Francesca Giovannenze, Federico Frondizi, Gabriele Maria Leanza, Eleonora Taddei, Giulia De Angelis, Maurizio Sanguinetti, Carlo Torti Clinical Microbiology and Infection, 2026
Impact of a post-prescription audit and feedback antimicrobial stewardship intervention on inappropriate carbapenem prescribing: An interrupted time series analysis Flavio Sangiorgi, Pierluigi Del Vecchio, Eugenia Magrini, Emanuele Rando, Beatrice Liguoro, Alessia Frater, Francesca Giovannenze, Massimo Fantoni, Carlo Torti, Rita Murri Jac Antimicrobial Resistance, 2025 Background Antimicrobial stewardship programs (ASPs) are essential to improve antibiotic prescribing. This study evaluated the impact of a post-prescription audit and feedback intervention on carbapenem prescribing appropriateness in a large university hospital. Methods This retrospective observational study utilized interrupted time series (ITS) analysis, employing an Autoregressive Integrated Moving Average (ARIMA) model, to assess carbapenem prescribing across three consecutive phases: a 12-month pre-intervention, a 6-month intervention, and a 6-month post-intervention follow-up. Carbapenem prescribing appropriateness was retrospectively evaluated using an in-house developed algorithm, based on international and national guidelines and institutional protocols. The intervention involved bedside consultations by infectious diseases specialists employing a post-prescription audit with face-to-face feedback. Results We evaluated 1825 carbapenem therapies, primarily prescribed for suspected/confirmed bloodstream infections (46%, 843/1825). Among these, 458 (25%) were deemed inappropriate, mainly due to unnecessarily broad-spectrum use (72%, 331/458). The ITS-ARIMA model showed an immediate 11% reduction in the rate of inappropriate prescriptions during the first month of intervention phase (P = 0.001), followed by a non-significant downward trend during the remaining intervention period. However, an immediate 14.9% increase in inappropriate prescriptions was observed at the onset of the post-intervention phase (P = 0.001), indicating a rebound effect after the withdrawal of the active stewardship intervention. Conclusions Implementing a post-prescription audit and face-to-face feedback intervention was associated with a short-term improvement in carbapenem prescribing appropriateness. We observed a reduction in the trend of inappropriateness, although this change was not statistically significant. Future studies should investigate strategies for implementing sustainable ASPs optimizing human resources and time investment.
Risk factors for 30-Day mortality and the role of empirical therapy in Pseudomonas aeruginosa bloodstream infections Nicholas Geremia, Federico Giovagnorio, Antonio Vena, Silvia Corcione, Maddalena Giannella, Simone Mornese Pinna, Francesca Giovannenze, Renato Pascale, Davide Fiore Bavaro, Beatrice Brusasco, Vincenzo Scaglione, Malgorzata Mikulska, Veronica Vassia, Marco Merli, Daniele Roberto Giacobbe, Andrea Marino, Giuseppe Accurso, Gabriele Pagani, Domenico Faliero, Benedetta Fumarola, Michele Bartoletti, Pierluigi Viale, Francesco Giuseppe De Rosa, Matteo Bassetti, and Infection, 2025
The Use of Oritavancin as Consolidation Therapy for Infective Endocarditis Caused by Enterococcus spp. Federico Frondizi, Gabriele Maria Leanza, Marta Chiuchiarelli, Francesca Catania, Flavio Sangiorgi, Francesca Giovannenze, Eleonora Taddei, Enrica Tamburrini, Carlo Torti, Giancarlo Scoppettuolo Open Forum Infectious Diseases, 2025 Oritavancin is emerging as a potential alternative to standard antibiotic regimens in the treatment of infective endocarditis caused by gram-positive bacteria, though evidence remains limited. We hereby report 7 cases of enterococcal endocarditis treated with oritavancin as consolidation therapy, resulting in 6 cures and 1 relapse.
Effect of an educational antimicrobial stewardship programme on antibiotic prescriptions' appropriateness in three medical units of a large university hospital: an interrupted time series analysis F. Giovannenze, P. Del Vecchio, F. Frondizi, E. Rando, G.M. Leanza, M.M. Gross, A. Frater, E. Magrini, B. Liguoro, F. Sangiorgi, M. Fantoni, C. Torti, R. Murri Journal of Hospital Infection, 2025 BACKGROUND: Antimicrobial stewardship (AMS) programmes aim to enhance antibiotic prescription quality, reduce antibiotic use, and combat multi-drug-resistant pathogens. However, the optimal AMS intervention for different clinical settings remains unclear, with previous studies predominantly focusing on antibiotic consumption rather than prescription appropriateness. AIM: This study aimed to evaluate the impact of an education-based AMS intervention on antibiotic prescription appropriateness in three medical units of a 1500-bed university hospital. METHODS: We conducted a retrospective interventional, interrupted time series study, to test the effect of an educational programme in three medical units of our 1500-bed university hospital in Rome, from June 2018 to October 2019. The intervention comprised six educational meetings held over 3 months (December 2018 to February 2019). The primary outcome was the appropriateness of antibiotic prescriptions, with in-hospital survival as a secondary outcome. FINDINGS: Of 609 antibiotic prescriptions evaluated, the programme led to a significant and sustained reduction in inappropriate prescriptions in one unit (change in level: -18.15%, P<0.01; change in trend: -3.21%, P=0.01), while it failed to demonstrate a significant reduction in the other two units and globally in the three units. CONCLUSION: The same educational AMS programme led to variable results in terms of antibiotic appropriateness in three medical units with similar structural and organizational features. Larger and more tailored high-quality AMS interventional studies are needed to better understand the impact of educational programmes on the appropriateness of antibiotic prescriptions.
Antipseudomonal cephalosporins versus piperacillin/tazobactam or carbapenems for the definitive antibiotic treatment of Pseudomonas aeruginosa bacteraemia: new kids on the ICU block? Davide Fiore Bavaro, Giuseppe Accurso, Silvia Corcione, Antonio Vena, Michela Schenone, Lucia Diella, Teresa Fasciana, Maddalena Giannella, Daniele Roberto Giacobbe, Simone Mornese Pinna, Renato Pascale, Francesca Giovannenze, Nicholas Geremia, Andrea Marino, Pierluigi Viale, Francesco Giuseppe De Rosa, Matteo Bassetti, Michele Bartoletti Journal of Antimicrobial Chemotherapy, 2025 Background Pseudomonas aeruginosa bloodstream infections (Pa-BSIs) are still a major cause of mortality in ICUs, posing many treatment uncertainties. Methods This multicentre, retrospective study analysed data from 14 Italian hospitals, including all consecutive adults developing Pa-BSI in ICU during 2021–22 and treated with antibiotics for at least 48 h. The primary aim was to identify predictors of 30 day mortality using Cox regression. Results were adjusted with inverse probability of treatment weighting (IPTW) and for immortal time bias. Results Overall, 170 patients were included. High-risk BSI (source: lung, intra-abdominal, CNS) occurred in 118 (69%) patients, and 54 (32%) had septic shock. In 37 (22%), 73 (43%), 12 (7%) and 48 (28%) the definitive backbone therapy was piperacillin/tazobactam, carbapenems, colistin or new antipseudomonal cephalosporins (ceftolozane/tazobactam, n = 20; ceftazidime/avibactam, n = 22; cefiderocol, n = 6), respectively. Moreover, 58 (34%) received a second drug as combination therapy. The incidence of 30 day all-cause mortality was 27.6% (47 patients). By Cox regression, Charlson comorbidity index, neutropenia, septic shock and high-risk BSI were independent predictors of 30 day mortality, while previous colonization by P. aeruginosa, use of antipseudomonal cephalosporins as definitive treatment, and combination therapy were shown to be protective. However, after IPTW adjustment, only the protective effect of antipseudomonal cephalosporins was confirmed (adjusted HR = 0.27, 95% CI = 0.10–0.69), but not for combination therapy. Hence, the treatment effect was calculated: antipseudomonal cephalosporins significantly reduced mortality risk [−17% (95% CI = −4% to −30%)], while combination therapy was beneficial only in the case of septic shock [−66% (95% CI = −44% to −88%]. Conclusions In ICU, antipseudomonal cephalosporins may be the preferred target therapy for the treatment of Pa-BSI; in addition, initial combination therapy may be protective in the case of septic shock.
Pseudomonas aeruginosa bloodstream infections in internal medicine wards: A large Italian multicenter retrospective study Silvia Corcione, Simone Mornese Pinna, Antonio Vena, Michela Schenone, Maura Sanino, Renato Pascale, Emanuele Pivetta, Daniele Roberto Giacobbe, Maddalena Giannella, Nour Shbaklo, Francesca Giovannenze, Nicholas Geremia, Malgorzata Mikulska, Davide Bavaro, Eleonora Taddei, Vincenzo Scaglione, Veronica Vassia, Benedetta Fumarola, Michele Bartoletti, Pierluigi Viale, Matteo Bassetti, Francesco Giuseppe De Rosa, and Plos One, 2025 Introduction This large, multicenter, Italian retrospective study aimed to describe clinical characteristics and risk factors associated with 30-day mortality in patients with Pseudomonas aeruginosa bloodstream infections (PA-BSI) admitted to internal medicine wards (IMW). To enhance clinical decision-making, we also developed and internally validated a bedside prognostic model to predict the 30-day mortality risk. Methods We conducted a retrospective, multicenter cohort study across 14 public hospitals in Italy, analyzing all adult patients admitted to IMW with PA-BSI between 2021 and 2022. Results Out of 285 eligible patients with PA-BSI, the median age was 73 years, and septic shock occurred in 13.3% of cases. Less than 5% of PA-BSI were caused by difficult-to-treat resistant P. aeruginosa (DTR-PA). Encouragingly, appropriate empiric therapy was administered in 69.8% of patients, yet the overall 30-day mortality remained 22.5%. Cox regression analysis identified age, and urinary catheter use as significant risk factors for mortality. Conversely, adequate source control and targeted therapy emerged as protective factors. Multivariate analysis confirmed septic shock at bloodstream infection onset (HR 6.96; 95% CI, 1.72–28.12) as a strong independent predictor of mortality, whereas effective source control (HR 0.152; 95% CI, 0.039–0.59) significantly improved survival odds. Using these insights, we developed a practical prognostic model capable of estimating the 30-day mortality risk, providing clinicians with a valuable predictive tool at the bedside. Conclusions PA-BSI in IMWs is characterized by a relatively low incidence of septic shock and rate of resistance, alongside high rates of appropriate empiric therapy. Despite these favorable factors, meropenem may represent a valuable therapeutic option for PA-BSI with severe presentations in this setting since mortality remains substantial (22.5%). Our findings underscore the critical importance of early source control and identify septic shock as a key predictor of mortality even in the setting of IMW. The proposed bedside nomogram model could empower clinicians to identify high-risk patients early, facilitating timely interventions and improving outcomes in this vulnerable population.
Cefiderocol for the Treatment of Nosocomial Bloodstream Infections Caused by Stenotrophomonas maltophilia: A Case Series and Literature Review Antonio Vena, Laura Mezzogori, Nadia Castaldo, Silvia Corcione, Renato Pascale, Maddalena Giannella, Simone Mornese Pinna, Daniele Roberto Giacobbe, Davide Fiore Bavaro, Vincenzo Scaglione, Benedetta Fumarola, Gabriele Pagani, Francesco Giuseppe De Rosa, Michele Bartoletti, Matteo Bassetti, , Giuseppe Accurso, Davide Fiore Bavaro, Stefania Chiappetta, Domenico Faliero, Benedetta Fumarola, Nicholas Geremia, Francesca Giovannenze, Angelo Maccaro, Andrea Marino, Marco Merli, Gabriele Pagani, Alessia Sardanelli, Vincenzo Scaglione, Monica Tontodonati, Veronica Vassia Infectious Diseases and Therapy, 2025 INTRODUCTION: The treatment of Stenotrophomonas maltophilia bloodstream infections (BSI) remains challenging due to the organism's intrinsic multidrug resistance and the potential side effects of commonly used first-line antibiotics. METHODS: Here, we describe four cases of S. maltophilia BSI treated with cefiderocol (≥ 72 h) in different Italian hospitals. Additionally, we conducted a PubMed search to identify other studies reporting cases of S. maltophilia BSI managed with cefiderocol. RESULTS: We reviewed a total of 8 cases of S. maltophilia BSI [median age 52.5 years (Q1-Q3 27.5-61.0), 50% males] treated with cefiderocol, including ours. BSI sources were mainly central venous catheters (62.5%) and the lower respiratory tract (25.0%). Cefiderocol was used as first-line therapy in 87.5% of patients (7/8), with a median treatment duration of 14 days (IQR 6.2-16.0). Combination therapy was administered in 62.5% of cases. Infection source control was required in 75.0% and achieved in 40.0%. Clinical success was observed in 62.5% of patients, with microbiological eradication in 87.5%. In-hospital mortality occurred in 37.5% of cases, with one death directly attributable to S. maltophilia. No significant differences were observed in terms of outcomes between cefiderocol monotherapy and combination therapy. CONCLUSIONS: Based on our findings and a review of the literature, cefiderocol-based regimens show promise as an effective treatment option for S. maltophilia BSI, warranting further investigation in larger studies.
A systematic review of dalbavancin efficacy as a sequential therapy for infective endocarditis Gabriele Maria Leanza, Emanuele Rando, Federico Frondizi, Eleonora Taddei, Francesca Giovannenze, Juan P. Horcajada, Giancarlo Scoppettuolo, Carlo Torti Infection, 2025 Introduction Dalbavancin is an antibiotic characterized by an extended half-life and efficacy against methicillin-resistant Staphylococci. Currently, there are only narrative reviews summarizing the evidence about the use of dalbavancin for infective endocarditis (IE), many of which are focused primarily on its use as consolidation therapy. For this reason, we conducted a systematic review to describe the clinical efficacy and the safety of dalbavancin in IE treatment. Methods We searched for available evidence using the MEDLINE (PubMed), Embase, Scopus, Cochrane Library and Web of Science libraries, with no restrictions regarding the publication year. The risk of bias was performed using the Cochrane ROBINS-I tool for the comparative studies and the Newcastle-Ottawa Scale for descriptive studies. Results Nine studies were included. All of them were observational. Native valve endocarditis was the most common kind of IE found in the studies’ populations (128/263, 48.7%), followed by prosthetic valve endocarditis, and cardiovascular implantable electronic device-related endocarditis. Coagulase-negative Staphylococci were the most common pathogens isolated (83/269, 30.1%), followed by S. aureus, Enterococci spp and Streptococci spp. Five out of nine studies documented a clinical failure rate of less than 10%. Dalbavancin showed a favourable safety profile. Dalbavancin appears to be a promising option for the consolidation therapy of IE. However, further studies comparing dalbavancin with standard of care are needed. PROSPERO registration number CRD42023430032.
Outbreaks of autochthonous Dengue in Lazio region, Italy, August to September 2023: preliminary investigation Gabriella De Carli, Fabrizio Carletti, Martina Spaziante, Cesare Ernesto Maria Gruber, Martina Rueca, Pietro Giorgio Spezia, Valentina Vantaggio, Alessandra Barca, Claudio De Liberato, Federico Romiti, Maria Teresa Scicluna, Stefania Vaglio, Mariano Feccia, Enrico Di Rosa, Francesco Paolo Gianzi, Cristina Giambi, Paola Scognamiglio, Emanuele Nicastri, Enrico Girardi, Fabrizio Maggi, Francesco Vairo, and Eurosurveillance, 2023
Cutaneous diphtheria most likely due to exposure in a detention camp in Libya Francesco Taccari, Federico Frondizi, Federica Salvati, Francesca Giovannenze, Paola Del Giacomo, Fernando Damiano, Teresa Spanu, Rosalia Graffeo, Giulia Menchinelli, Melinda Mariotti, Maurizio Sanguinetti, Federica Castri, Andreas Neumayr, Enrico Brunetti, Giulia Errico, Rita Murri, Roberto Cauda, Giancarlo Scoppettuolo Journal of Travel Medicine, 2023
Procalcitonin is useful in driving the choice of early antibiotic treatment in patients with bloodstream infections European Review for Medical and Pharmacological Sciences, 2018
Impact of antibiotic stewardship on perioperative antimicrobial prophylaxis Rita Murri, Antonio Giulio de Belvis, Massimo Fantoni, Maria Tanzariello, Paolo Parente, Stefano Marventano, Sabina Bucci, Francesca Giovannenze, Walter Ricciardi, Roberto Cauda, Gabriele Sganga International Journal for Quality in Health Care, 2016