Browsing by Author "Boattini, M"
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- Accuracy of the ELITe MGB Assays for the Detection of Carbapenemases, CTX-M, Staphylococcus Aureus and MecA/C Genes Directly From Respiratory SamplesPublication . Boattini, M; Bianco, G; Iannaccone, M; Charrier, L; Almeida, A; De Intinis, G; Cavallo, R; Costa, CIntroduction: Bacterial lower respiratory tract infections (BLRTI) may represent serious clinical conditions which can lead to respiratory failure, intensive care unit admission and high hospital costs. The detection of carbapenemase- and extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, as well as meticillin-resistant Staphylococcus aureus (MRSA), has become a major issue, especially in healthcare-associated infections. This study aimed to determine whether molecular assays could detect genes encoding carbapenemases, ESBL and MRSA directly from respiratory samples in order to expedite appropriate therapy and infection control for patients with BLRTI. Methods: The carbapenem-resistant enterobacterales (CRE), ESBL and MRSA/SA ELITe MGB assays were performed directly on 354 respiratory specimens sampled from 318 patients admitted with BLRTI. Molecular results were compared with routine culture-based diagnostics results. Results: Positive (PPV) and negative (NPV) predictive values of the CRE ELITe MGB kit were 75.9% [95% confidence interval (CI) 60.3-86.7] and 100%, respectively. PPV and NPV of the ESBL ELITe MGB kit were 80.8% (95% CI 63.6-91.0) and 99.1% (95% CI 96.6-99.8), respectively. PPV and NPV of the MRSA/SA ELITe MGB kit were 91.7% (95% CI 73.7-97.7)/100% and 98.3% (95% CI 89.8-99.3)/96.8% (95% CI 81.6-99.5), respectively. Discussion: Validity assessment of molecular assays detecting the main antibiotic resistance genes directly from respiratory samples showed high accuracy compared with culture-based results. Molecular assays detecting the main carbapenemase, ESBL, S. aureus and meticillin resistance encoding genes provide an interesting tool with potential to expedite optimization of antibiotic therapy and infection control practices in patients with BLRTI.
- Hemopneumotórax Espontâneo InterlobarPublication . Boattini, M; Castelo Branco, S; Toscano Rico, M
- Neglected Obstructive PneumoniaPublication . Boattini, M; Costa, N; Murinello, N; Matos, R
- Pasteurella Infections in a Tertiary Centre - from Cellulitis to Multiple-Organ Failure: Retrospective Case SeriesPublication . Vesza, Z; Boattini, M; Pinto, M; Marques da Silva, PThe purpose of this article is to review the clinical features of pasteurellosis in a tertiary centre over a period of 4½ years. We have identified eight cases of Pasteurella multocida and one case of Pasteurella canis infection, with a large diversity of clinical pictures and outcomes. All patients were elderly and/or immunocompromised and 55.6% reported animal exposure. Soft tissue infections were the most prevalent (55.6%), followed by pneumonia (22.2%) and sepsis (22.2 %). All isolates were susceptible to beta-lactam antibiotics using in vitro sensitivity testing. The overall mortality was 33.3%, which occurred in patients with no evidence of animal contact.
- Propylthiouracil Induced Pulmonary-Renal Syndrome: a Case Report.Publication . Boattini, M; Rodrigues, A; Nascimento, P; Luz, KC; Castelo Branco, S; Rodrigues, N; Cachado, P; Garcia, TPropylthiouracil (PTU) is known to induce antineutrophil cytoplasmatic antibody (ANCA) seropositivity; however, small vessel vasculitis (SVV) with pulmonary and renal involvement is rare. We present the case of an 81-year-old woman on PTU treatment due to toxic nodular goitre who developed alveolar hemorrhage and rapidly progressive glomerulonephritis. The authors highlight the importance of early recognising drug-induced pulmonary-renal syndrome (PRS) in order to avoid unnecessary tests, a delay in the diagnosis and evolution to end-stage kidney disease or life-threatening conditions.
- Recurrent Klebsiella Pneumoniae Infection Causing Transcatheter Aortic Valve Implantation (TAVI)-Related EndocarditisPublication . Tosatto, V; Cruz, C; Ferreira, T; Moreira Marques, T; Boattini, M; Almeida, A; Barata Moura, RThe authors report the case of an 86-year-old woman presenting with recurrent Klebsiella pneumoniae bacteraemia. She had severe aortic stenosis submitted to a recent transcatheter aortic valve implantation (TAVI). Initially, Klebsiella pneumoniae bacteraemia from a urinary source was diagnosed. Following another 4 episodes of bacteraemia with the same agent, the source was ultimately found to be a periprosthetic abscess. Considering the patient's unsuitability for surgery, a decision was made for life-long antimicrobial therapy. This approach has been successful in preventing recurrences or complications. Endocarditis is one of the most severe complications seen following TAVI, often carrying a poor prognosis. Even though Klebsiella spp. are common pathogens for healthcare-associated infections among the elderly, they are seldom the causative agent for endocarditis. Being the first reported case of TAVI-related Klebsiella endocarditis, it was successfully managed using a medical approach.
- Shock Following Subcutaneous Injections of PolymethylmethacrylatePublication . Boattini, M; Francisco, AR; Cavaco, R; Rodrigues, J; Bento, L
- The Impact of the Lisbon Football Derby on the Profile of Emergency Department AdmissionsPublication . Almeida, A; Eusébio, M; Almeida, J; Boattini, MBACKGROUND: Variations in emergency department admissions have been reported to happen as a result of major sports events. The work presented assessed changes in volume and urgency level of visits to a major Emergency Department in Lisbon during and after the city's football derby. MATERIAL AND METHODS: Volume of attendances and patient urgency level, according to the Manchester Triage System, were retrospectively analyzed for the 2008-2011 period. Data regarding 24-hour periods starting 45 minutes before kick-off was collected, along with data from similar periods on the corresponding weekdays in the previous years, to be used as controls. Data samples were organized according to time frame (during and after the match), urgency level, and paired accordingly. RESULTS: A total of 14 relevant periods (7 match and 7 non-match) were analyzed, corresponding to a total of 5861 admissions. During the match time frame, a 20.6% reduction (p = 0.06) in the total number of attendances was found when compared to non-match days. MTS urgency level sub-analysis only showed a statistically significant reduction (26.5%; p = 0.05) in less urgent admissions (triage levels green-blue). Compared to controls, post-match time frames showed a global increase in admissions (5.6%; p = 0.45), significant only when considering less urgent ones (18.9%; p = 0.05). DISCUSSION: A decrease in the total number of emergency department attendances occurred during the matches, followed by a subsequent increase in the following hours. These variations only reached significance among visits triaged green-blue. CONCLUSION: During major sports events an overall decrease in emergency department admissions seems to take place, especially due to a drop in visits associated with less severe conditions.