Procalcitonin: a possible marker of invasive fungal infection in high risk patients?

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Pilot study on the antibacterial activity of hydrogen peroxide and silver ions in the hospital environment

BACKGROUND: Nosocomial environmental contamination plays an important role in the transmission of several health care-associated pathogens. Control of surfaces contamination can reduce the risk of cross-infection in hospitals. The aim of our study is to evaluate the disinfectant effectiveness of hydrogen peroxide and silver ions, against nosocomial multidrug-resistant strains, when it's used directly on surfaces. METHODS: Staphylococcus aureus ATCC 6538, Pseudomonas aeruginosa ATCC 15442 and the same multidrug-resistant clinical isolates were selected to study the effectiveness of the disinfectant used in suspension or on the clean and dirty surface. RESULTS: Regarding the suspension activity test, the hydrogen peroxide and silver ions resulted effective after 5 min for ATCC strains and after 10 min for multidrug-resistant isolates; about the surface activity test, its action resulted after 10 min for ATCC strains and after 15 min for multidrug-resistant isolates. Moreover, it was more effective when used in the absence or in presence of a low concentration of biological materials. CONCLUSIONS: In a complex environment such as hospital wards, to have a disinfectant notoriously effective but more easy and quick to use would be an useful solution to treat small surfaces occasionally contaminated by biological materials

The Role of Urban Wastewater in the Environmental Transmission of Antimicrobial Resistance: The Current Situation in Italy (2010-2019)

Scientific studies show that urban wastewater treatment plants (UWWTP) are among the main sources of release of antibiotics, antibiotic resistance genes (ARG) and antibiotic-resistant bacteria (ARB) into the environment, representing a risk to human health. This review summarizes selected publications from 1 January 2010 to 31 December 2019, with particular attention to the presence and treatment of ARG and ARB in UWWTPs in Italy. Following a brief introduction, the review is divided into three sections: (i) phenotypic assessment (ARB) and (ii) genotypic assessment (ARG) of resistant microorganisms, and (iii) wastewater treatment processes. Each article was read entirely to extract the year of publication, the geographical area of the UWWTP, the ARB and ARG found, and the type of disinfection treatment used. Among the ARB, we focused on the antibiotic resistance of Escherichia coli, Klebsiella pneumoniae, and Enterococci in UWWTP. The results show that the information presented in the literature to date is not exhaustive; therefore, future scientific studies at the national level are needed to better understand the spread of ARB and ARG, and also to develop new treatment methods to reduce this spread

Antibiotic susceptibility of Legionella pneumophila strains isolated from hospital water systems in Southern Italy

The purpose of this study was to describe the susceptibility of environmental strains of Legionella spp. to 10 antimicrobials commonly used for legionellosis therapy. A study of environmental strains could be useful to timely predict the onset of antibiotic resistance in the environment before it is evidenced in clinical specimens

Invasive fungal infections in Neonatal Intensive Care Units of Southern Italy: a multicentre regional active surveillance (AURORA Project)

Introduction. During the past years invasive fungal infections (IFIs) have become an increasingly important problem in infants hospitalized in the Neonatal Intensive Care Unit (NICU). Candida species is the third most-common agent of late-onset infections in critically ill neonates, with an estimated incidence of 2.6-10% in very low birth weight and 5.5-20% in extremely low birth weight infants. The aim of this observational study is to evaluate the epidemiology of IFIs among infants admitted to NICUs of one Italian region by a multicenter surveillance (Aurora Project). Methods. The IFIs surveillance was carried out prospectively in Apulia (Southern Italy) between February 2007 and August 2008. This report focuses on the results from 6 enrolled NICUs. Results. Twenty-one neonates developed IFIs: the overall incidence was 1.3% and crude mortality was 23.8%. Infants weighing ? 1500g (4.3%) showed a significantly higher incidence than those ? 2500g (0.2%). C.parapsilosis (61.9%) was the most frequent isolated species. The main potential risk factors were having a central venous catheter placed, length of stay in NICU > 7 days and total parenteral nutrition for > 5 days. The (1,3)-Ã-D glucan (BDG), mannan antigens and anti-Candida antibodies? evaluation was performed in 7 neonates. All neonates were positive to the BDG; the mannan antigen result was positive in 5 newborns, the anti-mannan antibodies were always negative. All isolates were amphotericin B and fluconazole-susceptible. Discussion. This first prospective study on neonatal fungal infection in one Italian region gives evidence of a preponderance of non-albicans Candida spp and indicates potential utility of BDG as an adjunct diagnostic test

Legionella and legionellosis in touristic-recreational facilities. Influence of climate factors and geostatistical analysis in Southern Italy (2001-2017)

Legionella is the causative agent of Legionnaires' disease, a flu-like illness normally acquired following inhalation or aspiration of contaminated water aerosols. Our recent studies revealed that climatic parameters can increase the number of reported cases of community-acquired Legionnaires' disease. Here, we evaluated the presence of Legionella in water networks and the distribution of Legionnaires' disease cases associated with touristic-recreational facilities in the Apulia region (southern Italy) during the period 2001-2017 using geostatistical and climatic analyses. Geostatistical analysis data revealed that the area with the highest concentration of Legionella in water systems also had the greatest number of cases of Legionnaires' disease associated with touristic-recreational facilities. Climatic analysis showed that higher daily temperature excursion (difference between maximum and minimum temperature) on the day of sampling was more often associated with Legionella-positive samples than Legionella-negative samples. In addition, our data highlighted an increased risk of Legionnaires' disease with increases in precipitation and average temperature and with decreases in daily temperature excursion (difference between maximum and minimum temperature over the course of 24 h in the days of incubation period of disease) and minimum temperature. Healthcare professionals should be aware of this phenomenon and be particularly vigilant for cases of community-acquired pneumonia during such climatic conditions and among the tourist population. The innovative geo-statistical approach used in this study could be applied in other contexts when evaluating the effects of climatic conditions on the incidence of Legionella infections

Molecular Identification and Echinocandin Susceptibility of Candida parapsilosis Complex Bloodstream Isolates in Italy, 2007–2014

The Candida parapsilosis group encompasses three species: C. parapsilosis, C. orthopsilosis, and C. metapsilosis. Here, we describe the incidence and echinocandin susceptibility profile of bloodstream isolates of these three species collected from patients admitted to an Italian university hospital from 2007 to 2014. Molecular identification of cryptic species of the C. parapsilosis complex was performed using polymerase chain reaction amplification of the gene encoding secondary alcohol dehydrogenase, followed by digestion with the restriction enzyme BanI. Minimum inhibitory concentrations were determined using the broth microdilution method according to European Committee for Antimicrobial Susceptibility Testing (EUCAST EDef 7.2) and Clinical Laboratory Standards Institute (CLSI M27-A3) guidelines, and the results were compared with those obtained using the E-test and Sensititre methods. Of the 163 C. parapsilosis complex isolates, 136 (83.4%) were identified as C. parapsilosis, and 27 (16.6%) as C. orthopsilosis. The species-specific incidences were 2.9/10,000 admissions for C. parapsilosis and 0.6/10,000 admissions for C. orthopsilosis. No resistance to echinocandins was detected with any of the methods. The percent essential agreement (EA) between the EUCAST and E-test/Sensititre methods for anidulafungin, caspofungin, and micafungin susceptibility was, respectively, as follows: C. parapsilosis, 95.6/97.8, 98.5/88.2, and 93.4/96.3; C. orthopsilosis, 92.6/92.6, 96.3/77.8, and 63.0/66.7. The EA between the CLSI and E-test/Sensititre methods was, respectively, as follows: C. parapsilosis, 99.3/100, 98.5/89.0, and 96.3/98.5; C. orthopsilosis, 96.3/92.6, 100/81.5, and 92.6/88.9. Only minor discrepancies, ranging from 16.9% (C. parapsilosis) to 11.1% (C. orthopsilosis), were observed between the CLSI and E-test/Sensititre methods. In conclusion, this epidemiologic study shows a typical C. parapsilosis complex species distribution, no echinocandin resistance, and it reinforces the relevance of using commercially available microbiological methods to assess antifungal susceptibility. These data improve our knowledge of the national distribution of species of the psilosis group, as there are very few studies of these species in Ital

Integrated approach for legionellosis risk analysis in touristic-recreational facilities

Legionellosis is a severe pneumonia caused by the inhalation of aerosols containing Legionella, Gram-negative bacteria present in the water systems of touristic-recreational facilities. The purpose of this study was to develop a scoring tool to predict the risk of both environmental contamination and Legionnaires' disease cases in such facilities in the Apulia region of southern Italy. We analyzed 47 structural and management parameters/risk factors related to the buildings, water systems, and air conditioning at the facilities. A Poisson regression model was used to compute an overall risk score for each facility with respect to three outcomes: water samples positive for Legionella (risk score range: 7-54), water samples positive for Legionella with an average load exceeding 1000 colony-forming units per liter (CFU/L) (risk score range: 22-179,871), and clinical cases of Legionnaire's disease (risk score range: 6-31). The cut-off values for three outcomes were determined by receiver operating characteristic curves (first outcome, samples positive for Legionella in a touristic-recreational facility: 19; second outcome, samples positive for Legionella in a touristic-recreational facility with an average load exceeding 1000 CFU/L: 2062; third outcome, clinical cases of Legionnaire's disease in a touristic-recreational facility: 22). Above these values, there was a significant probability of observing the outcome. We constructed this predictive model using 70% of a large dataset (18 years of clinical and environmental surveillance) and tested the model on the remaining 30% of the dataset to demonstrate its reliability. Our model enables the assessment of risk for a touristic facility and the creation of a conceptual framework to link the risk analysis with prevention measures

Understanding Knowledge and Behaviors Related to CoViD−19 Epidemic in Italian Undergraduate Students: The EPICO Study

Background: On February 2020, the novel coronavirus (2019nCoV) epidemic began in Italy. In order to contain the spread of the virus, the Italian government adopted emergency measures nationwide, including closure of schools and universities, workplaces and subsequently lockdown. This survey was carried out among Italian undergraduates to explore their level of knowledge about the epidemic and the behaviors they adopted during the lockdown. Methods: An electronic questionnaire was administered to the students attending three Italian universities. Results: A good level of knowledge about the epidemic and its control was registered in the sample, mainly among students attending life sciences degree courses. The majority of the students did not modify their diet and smoking habits, while a great part of the sample reported a decrease in physical activity (PA). Conclusions: Students from life sciences courses showed a higher awareness regarding the infection and the control measures. The lockdown caused an important reduction of PA. Preventive interventions should transform the restrictive measures also as an opportunity to improve lifestyle