Monitoring the quality of laboraties and the prevalence of resistance to antituberculosis drugs: Italy, 1998-2000

In 1998 a network of 20 regional tuberculosis (TB) laboratories (the Italian Multicentre Study on Resistance to Antituberculosis drugs (SMIRA) network) was established in Italy to implement proficiency testing and to monitor the prevalence of drug resistance nationwide. The network managed 30% of all TB cases reported in Italy each year. The aim of the present report is to describe: 1) the accuracy of drug-susceptibility testing in the network; 2) the prevalence of drug resistance for the period 1998-2000. Data were collected from the network laboratories. Sensitivity to streptomycin and ethambutol increased from the first survey (1998-1999) to the second survey (2000) from 87.7 to 91.9%. Specificity, predictive values for resistance and susceptibility, efficiency and reproducibility were consistent in both surveys. In previously untreated cases, the prevalence of multidrug-resistance was the same in both surveys (1.2%), while a slight decrease from the first to the second survey was observed for monoresistance to rifampicin (from 0.8 to 0.4%) and isoniazid (from 2.9 to 2%,). The significant association found between isoniazid resistance and immigration is a useful indicator for both clinicians managing individual tuberculosis cases and public health services planning control strategies

Trends in candidaemia in one Italian region, Lombardia

Objectives: To perform a 1-year survey on candidaemia in one Italian region, Lombardia, to verify the epidemiological changes in comparison with the results of a previous survey conducted ten years ago (Tortorano et al. J. Hosp. Infect. 2002; 51: 297). Methods: The survey was carried out prospectively during 2009 involving 30 Microbiology Laboratories of Lombardia that notified candidaemia episodes defined by at least one blood culture positive for Candida. Results: A total of 354 episodes of candidaemia occurred in 344 patients accounting for an incidence of 1.19 per 1000 admissions (range 0.19\u20132.3) and 1.20 per 10000 patient days (range 0.2\u20132.2). These rates were higher compared to those obtained in the previous '90s survey (0.38 per 1000 admissions, range 0.03\u20131.45, and 0.44 per 10000 patient days, range 0.04\u20131.64). In the present survey, candidaemia occurred more frequently in patients aged ?80 years (15.4 vs 8.1% of the cases) and remained associated mainly, even if at a reduced rate, to surgery (45% of the cases vs 56% in the previous study) and intensive care treatments (35% vs 45%). A shift of the species causing fungaemia was demonstrated by the comparison of the two periods: while the proportion due to C. albicans decreased from 58 to 52%, an increase of C. glabrata (from 13 to 20%) and C. tropicalis (from 6 to 8%) was noted. The proportion of C. parapsilosis remained unchanged (14.5%). A decreased of the crude mortality at day 30 from 35 to 32% was observed. The highest mortality rate was detected in patients with C. tropicalis (41%) and C. albicans (33%) bloodstream infections. Conclusion: The present study revealed an increasing incidence of candidaemia, mainly in aged subjects, and an increasing proportion of isolates with decreased susceptibility to fluconazole. Powered b

European Confederation of Medical Mycology (ECMM) prospective survey of cryptococcosis : report from Italy

Italy is one of the countries participating in a prospective epidemiological survey of cryptococcosis set up in July 1997 by the European Confederation of Medical Mycology (ECMM). Over a 30-month period 156 cases, all caused by Cryptococcus neoformans var. neoformans, were reported by 29 hospitals in 9 regions. An ECMM questionnaire was used to report the clinical presentation and the diagnostic and treatment approach used. Cryptococcosis was associated with HIV infection in 147 cases and was considered indicative of AIDS in 65%. The estimated incidence in the Lombardy region was 0.85/100 in the AIDS population. One isolate from each of 129 patients was serotyped and genotyped. PCR fingerprinting using the primer (GACA)4 proved to be a more reproducible typing method than the slide agglutination test. Genotypes VN1 (serotype D), VN6 (serotype A) and VN3-VN4 (serotype AD hybrid strains) occurred in Italy at similar levels nationwide, but VN1 (D) was prevalent in the North. In vitro resistance to antifungals was uncommon