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Antibiotic Prophylaxis and Ventilator-Associated Pneumonia in Traumatic Brain Injury Patients: Insights from The CREACTIVE Study
No full textINTRODUCTIONTraumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide [1, 2]. It is now recognized as a condition involving multiorgan dysfunction, characterized by non-neurological complications, particularly respiratory ones such as ventilator-associated pneumonia (VAP), being common and associated with worse outcomes. VAP occurs frequently in intensive care unit (ICU) patients, and the incidence among those with TBI ranges from 21% to 60% and an average of 36% [3]. Prevention strategies for VAP include daily sedation interruption, spontaneous breathing trials, oral decontamination, continuous monitoring of endotracheal tube cuff pressure, the use of an endotracheal tube with subglottic drainage ports, and, most importantly, antibiotic prophylaxis (AP) [4, 5]. However, the role of AP in preventing VAP remains unclear. While some studies suggested that AP has a protective effect, particularly against early-onset VAP [6-9], others found no association between AP and VAP occurrence, length of hospital stay, or mortality [9-12]. Moreover, prolonged AP use has been associated with an increased incidence of antibiotic-resistant Gram-negative pathogens and other complications [13].
OBJECTIVESTo investigate the effect of AP on the incidence of VAP in patients with TBI admitted to ICU. We also assessed the role of AP on secondary outcomes, including the duration of mechanical ventilation, ICU and hospital length of stay, ICU and hospital mortality, and the six-month Glasgow Outcome Scale-Extended (GOS-E), using data from the large, multicenter, prospective CREACTIVE cohort [14].
METHODSWe included adult TBI patients requiring mechanical ventilation for more than 48 hours. AP was defined as administration of antibiotics in the absence of documented infection within the first 7 days of ICU stay. The primary outcome was the incidence of VAP, defined according to international criteria.
To create well-balanced AP and no-AP groups for all relevant confounding factors, we used a propensity score-matched design, a robust methodology for estimating causal effects in observational studies [15]. Propensity scores were estimated for each patient using a logistic regression model based on 22 covariates, including variables that were identified to impact both the decision to administer AP and the patient outcome (i.e., demographics, TBI severity, extracranial injuries, and ICU characteristics). We used the full matching algorithm [16], which requires weighted post-matching analyses, in which the weights depend on the size and composition of the matched sets [17]. Differences between no AP and AP groups for the primary and secondary outcomes were investigated using opportune weighted tests. The probability of experiencing VAP was assessed using the weighted Kaplan-Meier analysis, and a time-to-event comparison was conducted using the log-rank test.
RESULTSA total of 2,518 patients from 70 European ICUs were included, of whom 1,392 (54%) received AP, while 1,183 (46%) did not. Compared to patients in the no-AP group, those with AP at ICU admission were younger, had fewer comorbidities, presented lower Glasgow Coma Scale scores, higher Marshall scores, more injuries in body areas other than TBI, and were more frequently involved in high-impact or traffic-related trauma. After weighting, the groups were well balanced, with weighted standardized mean differences below 10% for all variables used in model to estimate the propensity score, except for country (11.8%) and penetrating trauma (10.4%).
After weighting, patients in the no-AP group had higher probability of experiencing early VAP than those in the AP group (18.9% vs. 14.7%, p-value<0.01), although there was no significant difference in the overall occurrence of VAP (Table 1). Time-to-event analysis confirmed a reduced risk of early VAP in the AP group, particularly during the first days of mechanical ventilation (Log-rank p-value<0.05). Compared to AP patients, those without AP had higher ICU mortality (35.0% vs. 27.1%, p-value<0.01) and higher hospital mortality (43.5% vs. 37.1%, p-value<0.01). ICU and hospital stays were significantly longer for AP patients, while no difference was detected in the duration of mechanical ventilation. There were no differences between groups in the 6-month GOS-E.
Among patients who developed VAP and had available microbiological data, those in the AP group reported a lower proportion of Gram-positive bacteria compared to the no-AP group (29.3% vs. 47.2%), and a higher proportion of Gram-negative bacteria (80.9% vs. 71.4%). Moreover, AP patients showed higher rates of MDR bacteria, both Gram-positive (17.4% vs. 11.9%) and Gram-negative (32.3% vs. 15.8%).
CONCLUSIONSOur findings suggest that AP is effective in reducing early-onset VAP among TBI patients, consistent with previous studies [6, 8, 12, 18, 19]. The benefit is pronounced during the early phase of mechanical ventilation, when patients are especially vulnerable. Patients who received AP had more Gram-negative infections and fewer Gram-positive ones but also showed higher rates of MDR in both types. The higher MDR rates in the AP group may be attributable to longer antibiotic courses, which was also evident in our results. This finding aligns with existing literature, which indicates that greater antibiotic exposure may promote the selection of resistant strains, complicating future treatment [20-23].
These results underscore the need to balance the benefits of VAP prevention with the risks of antimicrobial resistance. In conclusion, AP appears effective in reducing the incidence of VAP in TBI patients, but its use should be carefully considered. Clinicians are encouraged to apply AP selectively in high-risk cases, aiming to prevent infection while preserving antibiotic efficacy.
 
Vittorio Sereni and Memory in Motion. From Frontiera to Stella variabile: The Turning Point of Car Travel
No full textIl saggio esplora l’evoluzione del tema del movimento nella poesia di Vittorio Sereni, tracciando il passaggio dal treno all’automobile come paradigma di una trasformazione percettiva più ampia. Dall’esperienza del camminare in Frontiera ai viaggi ferroviari del Diario d’Algeria, fino all’irruzione dell’automobile negli Strumenti umani e in Stella variabile, il movimento si configura come dispositivo che riorganizza il rapporto tra soggetto, paesaggio e memoria. L’automobile, inizialmente portatrice del «privilegio del moto», rivela nelle ultime raccolte i suoi limiti, segnalando l’impossibilità di raggiungere attraverso la velocità un autentico recupero memoriale.This essay explores the evolution of movement as a theme in Vittorio Sereni’s poetry, tracing the shift from train to automobile as a paradigm of a broader perceptual transformation. From the walking experience in Frontiera to the railway journeys in Diario d’Algeria, to the emergence of the automobile in Gli strumenti umani and Stella variabile, movement functions as a device that reorganizes the relationship between subject, landscape, and memory. The automobile, initially bearer of the «privilege of motion», reveals its limitations in the later collections, signaling the impossibility of achieving authentic memory recovery through speed
The Mirror and the Double: Analysis of two Mirror texts by Vittorio Sereni on a petrarchan Track (Il sabato tedesco e Un posto di vacanza)
No full textIn Sereni’s poetic and prose corpus, the topos of the mirror is recurrent. In light of this constant theme, literature is conceived as a form of mirroring of interior and exterior reality. The idea of art as a specular/speculative process, however, goes beyond the notion of pure mimesis of the self and the world, since the image that returns to the subject from a reflecting surface is never fixed but changeable and, at most, elusive. The use of this emblem is charged with a strong semantic significance in the production between the end of the Seventies and the beginning of the Eighties. In this essay, the detailed investigation focuses precisely on two key texts from Sereni’s late period: Il sabato tedesco and Un posto di vacanza.Nel corpus poetico e prosastico sereniano ricorrente è il topos dello specchio. Alla luce di questa costante stilistico-tematica la letteratura è concepita come una forma di rispecchiamento della realtà interiore ed esteriore. L’idea dell’arte quale procedimento speculare/speculativo esula tuttavia dalla nozione di pura mimesi dell’io e del mondo in quanto l’immagine che ritorna al soggetto da una superficie riflettente non è mai fissa ma mutevole e, al limite, inafferrabile. L’impiego di siffatto emblema si carica di una forte pregnanza semantica nella produzione a cavallo tra la fine degli anni Settanta e gli inizi degli Ottanta. In questo saggio l’indagine puntuale si concentra proprio su due testi chiave del periodo tardo di Sereni: Il sabato tedesco e Un posto di vacanza
The enigmas of the Madrigale a Nefertiti
No full textIl Madrigale a Nefertiti, per il rapporto con la forma del madrigale, può essere considerato un outlier nelle manifestazioni dello stile di Sereni, e in particolare di quello tardo. Ma in cosa consiste davvero la peculiarità di questo testo? E in cosa l’oscurità che caratterizza MN? L’articolo sviluppa prima un’analisi delle strutture metriche, sintattiche, e infine poetiche, di MN. Di qui, identifica alcune ambiguità formali nella poesia, che successivamente tenta di spiegare attraverso una possibile eco dell’Ulisse di Saba e una lettera dello stesso Sereni. Infine, connette queste ipotesi all’interpretazione di Ulisse data da Horkheimer e Adorno. Il risultato di questa analisi combinata è tentare una visione complessiva dell’immaginario grammaticale dell’autore come dell’oggetto estetico rappresentato questo enigmatico testo.The Madrigal to Nefertiti, because of its relation to the form of madrigal, can be seen as an outlier in the context of Sereni’s style, even more so if we consider his later poetry. Why exactly is this text peculiar? And why can it be described as obscure? This paper first analyses its metrical, syntactic and poetic structures; then it identifies some specific formal ambiguities, which then the article tries to explain by a possible echo from a poem by Saba, Ulysses, as well as a letter written by Sereni himself. Finally, the article connects these hypotheses to Horkheimer’s and Adorno’s interpretation of the myth of Ulysses. This combined analysis results in the possibility to gain a holistic account of both the author’s grammatical imagery, as well as the aesthetic object this text represents
Vittorio Sereni, the «Libera Stampa» Prize, and the Collection Un lungo sonno
No full textThe essay offers a study of Sereni’s participation in the «Libera Stampa» prize and aims firstly to contribute to the analysis of the process that led to Sereni’s establishment in the Italian and international literary field in the 1940s and 1950s. Secondly, the focus is placed on the collection Un lungo sonno, which remained unpublished in the configuration presented by Sereni to the jury of the Swiss prize in 1956. Un lungo sonno is analysed in its macro-textual structure and in its connections with other books by Sereni (among them Diario d’Algeria, Gli strumenti umani, Gli immediati dintorni).Il saggio offre uno studio della partecipazione di Sereni al premio «Libera stampa» e si propone di contribuire all’esame del processo che ha portato all’affermazione di Sereni nel campo letterario italiano e internazionale negli anni Quaranta e Cinquanta. In secondo luogo, il focus è posto sulla silloge Un lungo sonno, rimasta inedita nella configurazione presentata da Sereni alla giuria del premio svizzero nel 1956. La silloge è analizzata nella sua struttura macrotestuale e nelle sue connessioni con altri libri di Sereni (tra questi Diario d’Algeria, Gli strumenti umani, Gli immediati dintorni)
Digital citizenship and minors
No full textDopo aver definito le nozioni di (i) cittadinanza digitale, (ii) spazio digitale, (iii) divario digitale e (iv) competenze digitali, il saggio si propone di individuare i problemi giuridici posti dall\u27uso delle tecnologie digitali da parte dei minori. In particolare, viene esposto un piccolo inventario dei principali diritti e doveri che sorgono in conseguenza dell\u27esercizio della cittadinanza digitale da parte dei minori focalizzando infine l\u27attenzione sulla necessità, per i minori, di saper essere cittadini digitali.After defining the concepts of (i) digital citizenship, (ii) digital space, (iii) digital divide, and (iv) digital skills, this essay aims to identify the legal challenges posed by minors’ use of digital technologies. Specifically, it presents a concise inventory of the main rights and duties that emerge as a result of minors exercising digital citizenship, ultimately focusing on the need for minors to develope the ability of being digital citizens
Botanical Objects and Risorgimento. The Politicisation of Nature in 19th Century Italy
No full textIl saggio esamina il ruolo degli oggetti botanici nella costruzione dell’identità nazionale italiana nel XIX secolo. In particolare, l’analisi si concentra sulla funzione dei naturalia e sulla loro rappresentazione visiva e letteraria come strumenti di mobilitazione politica e culturale. Attraverso la diffusione delle pratiche di erborizzazione amatoriale, le piante e i loro oggetti associati divennero veicoli di partecipazione e forme di dissenso rispetto ai modelli dominanti di appartenenza e cittadinanza. Dal punto di vista metodologico, il contributo si colloca all’intersezione tra il material turn e l’eco-plant turn, integrando prospettive recenti della storiografia culturale e ambientale per esplorare la dimensione politica della cultura botanica ottocentesca.This article examines the role of botanical objects in the construction of Italian national identity during the nineteenth century. It particularly explores how naturalia – through their visual and literary representations – functioned as instruments of political and cultural mobilization. The dissemination of amateur practices of botanical collecting and herbarium-making fostered new forms of civic participation and subtle modes of dissent against prevailing models of belonging and citizenship. From a methodological standpoint, the study positions itself at the intersection of the material turn and the more recent eco-plant turn, integrating insights from cultural and environmental historiography to illuminate the political dimensions of nineteenth-century botanical culture
A Critical Examination of the Current Paradigms on the Origin of Writing in Mesopotamia
No full textThis article explores the methodological and historiographical challenges that persist in examining the complex topic of the origins of writing in antiquity, with focus on the earliest writing systems from Southwestern Asia and Northern Africa (proto-cuneiform, proto-hieroglyphic, and proto-Elamite). A review of scholarly literature reveals a lack of consensus regarding who invented writing first and when. This disagreement seems to stem from ideological factors, as scholars in different fields often advocate for the region they specialize in as the birthplace of writing. This situation is ultimately rooted in the prestige associated with writing in modern societies, which has led to historical narratives that overemphasize the role of this technology as a marker of civilization in antiquity. This study aims to highlight this phenomenon and lay the groundwork for a more nuanced paradigm that fully considers the interconnected cultural, technological, and social factors of the late 4th millennium BCE
