Gaetano Pierpaolo Privitera

Penicillin resistance among Streptococcus pneumoniae in Europe

Penicillin resistance in Streptococcus pneumoniae, which has been occasionally described in European isolates since the early 1970s, presently constitutes a general problem, although its rate may vary largely between countries and areas. Spain and Hungary show the highest rates of resistance and were probably the starting point for further dissemination to adjacent and distant countries. In Europe, resistant strains belong predominantly to serotypes 6, 9, 14, 19, and 23, and are isolated more frequently from pediatric than from adult patients, and from respiratory and CSF samples rather than blood. Although penicillin resistance in pneumococci is usually a well-recognized problem, some difficulties, mainly related to methodologic aspects of in vitro susceptibility testing, still subsist for its proper surveillance, but may be overcome through the adoption of adequate diagnostic protocols and tools.

Small bowel transplantation under oral immunosuppression: experimental study in the pig.

Abstract Despite recent improvements, clinical intestinal transplantation remains an experimental procedure for the treatment of irreversible failure of the intestine. Depending on the extent of additional failures, the transplant of the bowel can also be performed as a part of a multivisceral graft. Although these procedures have been performed preclinically for many years and have also been reported to have a successful outcome in the clinical setting, they have not yet become routine, unlike the transplant of other organs. With the aim of improving clinical results, many groups are studying on experimental models. Experimental studies are predominantly performed in rats, with fewer studies conducted in large animals. In 1992, the authors began an experimental program of orthotopic liver-small bowel transplantation (OLSBTx) and surgical technique. Results in the pig have been described for the first time by our group. Despite an acceptable control of rejection, results of intestinal function were poor. The OLSBTx is a high-risk procedure, and in animals an aggressive postoperative treatment is impossible. We therefore decided to continue with the transplant of the small bowel alone (SBTx) because it is a less demanding procedure.

Influence of different protocols of antibiotic prophylaxis on endoluminal bacterial overgrowth and translocation following small-bowel or combined liver-small-bowel transplantation in a large-animal model

Abstract Bacterial translocation from the intestinal tract can cause systemic sepsis and multiple-organ failure in traumatized and immunocompromised patients. Compared to transplantation of other organs, small-bowel transplantation (SBT) is at higher risk of bacterial sepsis. Septic episodes are probably related to the overgrowth of endoluminal microflora and bacterial translocation. Translocation may be secondary to mucosal damage, immunologic impairment, and changes in microflora; in animal models it appeared also to be influenced by dietary factors. Different animal models have been developed, mainly in the mouse or in the rat, to study bacterial translocation, including models of SBT. The participation in a multidisciplinary project on experimental SBT and combined orthotopic liver small-bowel transplantation (OLSBT) offered us the opportunity to assess in a large-animal model like Large White pigs the changes induced in the small-bowel flora and translocation by the graft and the influence of surgical procedure, antibiotic administration, and immunosuppression. Some of our most relevant recent results will be summarized in this paper.