Factors influencing persistence of Legionella pneumophila serogroup 1 in laboratory cocultures

Background: Risk for infections from Legionella pneumophila for immunocompromised individuals increases greatly when this species is present within the biofilm of the water distribution systems of hospitals or other health facilities. Multiplication and persistence of Legionella may dependent also upon planktonic growth in alternative to sessile growth. Here we compared the persistence of L. pneumophila serogroup 1 in experimental planktonic co-cultures subsided with iron, Pseudomonas aeruginosa and other non Legionella bacteria (quantified as Heterotrophic Plate Count, HPC at 37°C), isolated from drinking water sources of a large hospital. Results: Concentrations of L. pneumophila showed a decreasing pattern with incubation time in all co-cultures, the degree of reduction depending on the experimental treatment. In co-cultures with added P. aeruginosa, no L. pneumophila was detectable already after 4 days of incubation. In contrast in co-cultures without P. aeruginosa, HPC but not iron were significant factors in explaining the pattern of L. pneumophila, although the HPC effect was different according to the incubation time (HPC x time interaction, p < 0.01). Conclusions: Our results highlight the need of controlling for both HPC and metal constituents of the water systems of buildings used by individuals at particular risk to the effects of Legionella exposure

Pseudo-outbreak of Mycobacterium gordonae in a teaching hospital: importance of strictly following decontamination procedures and emerging issues concerning sterilization

Aim of this study was to investigate a pseudo-outbreak of Mycobacterium gordonae analyzing isolates detected from clinical and environmental samples. Mycobacterium gordonae was detected in 7 out of 497 broncho-alveolar lavage (BAL) samples after bronchoscopy procedure in patients admitted to a teaching hospital between January and April 2013. During this pseudo-outbreak clinical, epidemiological, environmental and molecular investigations were performed. None of the patients met the criteria for non-tuberculous mycobacterial (NTM) lung disease and were treated for M. gordonae lung disease. Environmental investigation revealed M. gordonae in 3 samples: in tap water and in the water supply channel of the washer disinfector. All the isolates were subjected to genotyping by pulsed-field gel electrophoresis (PFGE). The PFGE revealed that only patients' isolates presented the same band pattern but no correlation with the environmental strain was detected. Surveillance of the outbreak and the strict adherence to the reprocessing procedure and its supplies resulted afterwards in no detection of M. gordonae in clinical respiratory samples. Clinical surveillance of patients was crucial to establish the start of NTM treatment. Regular screening of tap water and endoscopic equipment should be adopted to compare the clinical strains with the environmental ones when an outbreak occurs

Preventive medicine center and health care for students of medicine and health professions at the Sapienza University of Rome: a research protocol

This project aims to develop a Center of Preventive Medicine and Health Care for the students of Medicine and Health profession at Sapienza University of Rome. At the beginning of the university career students, both residents and nonresident s, have to face several difficulties such as: starting smoking or the increase in cigarette consumption ; the independent management of their own health (especially for non residents consequently to the distance of the family doctor) ; unhealthy diet; tuberculosis (TB) biological risk during their university training. These aspects , especially if present at the same time, act as a source stress and adversely affect the quality of life and the academic performance. Specific aims of the project will be: implementing an ambulatory of Preventive Medicine; implementing a virtual ambulatory of general medicine; creating a website on the problems mentioned above. Data collected will be computerized to keep an electronic health record (HER) and to use the information for the purposes of scientific research. The Centre will act in close relationship with the Central Administration, with the Headmasters of the Medical Faculties, and in close collaboration with the Center of Occupational Medicine of Sapienza University

Temporal pattern of Klebsiella pneumoniae carbapenemase (KPC) on surfaces of an intensive care unit of a large hospital

Background:Carbapenem-resistant Enterobacteriaceae are an increasing cause of healthcare-associated infections worldwide. Patients with infections caused by Klebsiella pneumoniae resistant to carbapenems (KPC) have significant increases in both all-cause mortality and 30-day mortality. The aims of this study was to investigate the prevalence of KPC on environmental samples collected during and after an outbreak caused by KPC in an intensive care unit (ICU) of a teaching hospital. Methods:Between 2010 and 2014 we conducted a total of 132 environmental monitoring campaigns from different critical surface of ICU ward in a Teaching Hospital Policlinico Umberto I. Samples were collected on surfaces in patient rooms and health care area. All samples were cultured and K. pneumoniae isolates were identified by standard microbiological techniques. The presumptive colonies were confirmed and tested for antibiotic resistance by an automated system. K. pneumoniae resitant to carbapenems were tested for carbapenemase production by modified Hodge test. Results:A total of 2526 environmental samples were collected from November 2010 to July 2014. Of those, 111 resulted positive for K. pneumoniae while KPC were 95 (85.6% of all K. pneumoniae, 3.8% of total samples). KPC was recovered in all patient rooms with similar proportion (5.1-5.6%) with the exception of patient 6 bed room where it was lower (2.4%). The pathogen was not recovered in rooms dedicated to healthcare personnel and doctors. Among surfaces, the highest proportion of KPC resulted onbedrail (6.8%), more than double than other surfaces. Washbasins had nearly half of samples KPC positive (1.2%). Conclusions:Despite previous studies suggested that environment plays a minor role in the transmission of carbapenem-resistant enterobacteriaceae, our data highlighted that surfaces represents a significant reservoir for KPC possibly supporting transiently contamination of hands of healthcare workers in our ICU. Our results confirm that KPC are more likely found on surfaces closer to the patient than on those situated further away

Temporal pattern of microbial indicators of ready-to-eat rocket salads during shelf life

 Introduction. From 2001-2009 there have been numerous community alerts and notifications about the rocket salad produced in Italy and distributed in Europe. Our study describes the evolution of the microbial quality of ready to eat rocket salad during shelf life among three different Italian producers.Material and methods. Total Mesophilic Count (TMC) and Escherichia coli (EC) count were measured in 248 samples. We used Wilcoxon test to compare the median values of TMC and EC counts and Kruskal Wallis test to compare the producers. Results. The TMC and EC values differed among producers at the stages of raw material and in the finished product (Kruskall Wallis test, p < 0.05). The evolution of bacterial charges had significant differences among producers at expiration date (Wilcoxon test, p < 0.05). More than half of the samples (54.8%) exceed reference standard for TMC after 48 h from packaging.Conclusion. Differences among producers may linked to the different minimal processing technologies adopted after harvesting. 

How do patients experience genetic testing? Survey on patients tested for cancers and thrombophilia

Background Variation in patients’ experience of genetic services may affect their willingness to undergo testing and to participate in posttest disease prevention. The aim of this study was to investigate the main factors that may influence how patients experience genetic testing and post-testing care pathways. Methods Telephone surveys were administered to 370 individuals who underwent testing for APC, BRCA1/2, or inherited thrombophilia (FV Leiden and/or FIIG20210A). Outcomes (selfreported) were patient satisfaction with genetic counselling, patient perception of collaboration between actors in and out of the genetic service, and the impact of genetic testing on patient quality of life. Logistic regression analyses were used to assess determinants that could affect these outcomes. Results The response rate was 64% (237/370). Respondents included 33 tested for APC, 104 for BRCA1/2, and 100 for inherited thrombophilia. The majority of patients receiving counselling were satisfied with both pre-test (100% APC; 98% BRCA; 86% FVL/FII) and post-test (97% APC; 98% BRCA; 60% FVL/FII) sessions. Patients tested for cancer susceptibility reported significantly higher levels of satisfaction than those tested for thrombophilia in both pre-test (98 vs 86%; p<.001) and posttest counselling (98 vs 60%; p<.001). Face-to-face counselling was associated with more satisfaction than other counselling options. Patients tested for cancer susceptibility reported more perceived collaboration between health providers than those tested for thrombophilia (OR = 2.53; 95% CI = 1.23-5.23), and were also more likely to report improvement in life quality after testing (OR = 2.58; 95% CI = 1.22-5.47). Conclusions Patients show high satisfaction with genetic testing and tend to perceive their care pathways as integrated. The perceived quality of testing is significantly associated with the type of genetic disease. Key messages: Genetic counseling, management of genetic care paths and overall experience of undergoing genetic testing were judged more positively by patients tested for cancer than those tested for thrombophilia Patients’ perceptions may be influenced by the appropriateness and clarity of guidelines for different types of genetic tests

Microbiological safety of glasses dispensed at 3D movie theatres

Recent popularity of three-dimensional movies raised some concern about microbiological safety of glasses dispensed into movie theatres. In this study, we analysed the level of microbiological contamination on them before and after use and between theatres adopting manual and automatic sanitation systems. The manual sanitation system was more effective in reducing the total mesophilic count levels compared with the automatic system (P< 0.05), but no differences were found for coagulase-positive staphylococci levels (P= 0.22). No differences were found for mould and yeast between before and after levels (P= 0.21) and between sanitation systems (P= 0.44). We conclude that more evidences are needed to support microbiological risk evaluation

Temporal pattern of microbial indicators of ready-to-eat rocket salads during shelf life

Introduction. From 2001-2009 there have been numerous community alerts and notifications about the rocket salad produced in Italy and distributed in Europe. Our study describes the evolution of the microbial quality of ready to eat rocket salad during shelf life among three different Italian producers. Material and methods. Total Mesophilic Count (TMC) and Escherichia coli (EC) count were measured in 248 samples. We used Wilcoxon test to compare the median values of TMC and EC counts and Kruskal Wallis test to compare the producers. Results. The TMC and EC values differed among producers at the stages of raw material and in the finished product (Kruskall Wallis test, p < 0.05). The evolution of bacterial charges had significant differences among producers at expiration date (Wilcoxon test, p < 0.05). More than half of the samples (54.8%) exceed reference standard for TMC after 48 h from packaging. Conclusion. Differences among producers may linked to the different minimal processing technologies adopted after harvesting