Spread of Carbapenem-Resistant Klebsiella pneumoniae in Hub and Spoke Connected Health-Care Networks: A Case Study from Italy

The study describes the spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) in a regional healthcare network in Italy. The project included several stages: (1) Establishment of a laboratory-based regional surveillance network, including all the acute care hospitals of the Marches Region (n = 20). (2) Adoption of a shared protocol for the surveillance of Multi-Drug Resistant Organisms (MDROs). Only the first CRKP isolate for each patient has been included in the surveillance in each hospital. The anonymous tracking of patients, and their subsequent microbial records within the hospital network, allowed detection of networks of inter-hospital exchange of CRKP and its comparison with transfer of patients within the hospital network. Pulsed-Field Gel Electrophoresis (PFGE) analysis has been used to study selected isolates belonging to different hospitals. 371,037 admitted patients have been included in the surveillance system. CRKP has shown an overall incidence rate of 41.0 per 100,000 days of stay (95% confidence interval, CI 38.5–43.5/100,000 DOS), a CRKP incidence rate of isolation in blood of 2.46/100,000 days of stay (95% CI 1.89–3.17/100,000 days of stay (DOS) has been registered; significant variability has been registered in facilities providing different levels of care. The network of CRKP patients’ exchange was correlated to that of the healthcare organization, with some inequalities and the identification of bridges in CRKP transfers. More than 73% of isolates were closely related. Patients’ exchange was an important route of spread of antimicrobial resistance, highlighting the pivotal role played by the hub, and selected institution to be used in prioritizing infection control efforts

Cosa c’è di nuovo sulle infezioni correlate all’assistenza nelle strutture residenziali per anziani in Italia? I risultati del progetto europeo HALT2

In the period April May 2013, the European Centre for disease Prevention and Control funded the HALT 2 project to promote the awareness on the healthcare acquired infection (HAI) and antimicrobial use in long term care facilities. During a point prevalence survey a set of indicators were collected in order to describe infection control resources and antimicrobial policy, population care load and risk factors, sites of infections and antimicrobial prescriptions. In Italy participated 235 voluntary facilities in 11 regions including 18418 residents. Most of them were older than 85 years and exposed at various risk factors as catheters or wounds. The observed prevalence of HAI was 3,3%, respiratory, urinary and skin infections were the most reported. Prevalence of antimicrobials was 4%, most of them were third generation cephalosporins, fluoroquinolones or penicillins and inhibitors given for therapy. Although written protocols are widely diffused, a lack of surveillance of infections and best practices was observed. Training of staff was heterogeneous among facilities and usually dedicated to the nursing staff only. Despite the problem is well known, actions are still required to introduce effective tools for the prevention and control in this critical setting in the healthcare net

Comparison if the cortisol response to mental stress in responders.

<p>Comparison between the cortisol reactivity to mental stress in responders from the high-fit (HF, <i>n</i> = 8) and low-fit (LF, <i>n</i> = 5) groups. Between-group differences in the cortisol response indices were assessed by ANCOVA testing, adjusting for age, BMI, and pre-stress (baseline) cortisol levels as covariates. Data are reported as mean values (±SEM).</p><p>*ANCOVA testing, adjusted for age, BMI, and pre-stress (baseline) cortisol.</p><p>Comparison if the cortisol response to mental stress in responders.</p

Flowchart of the study participants.

<p>Age-specific percentiles for cardiorespiratory fitness were retrieved from [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141970#pone.0141970.ref036" target="_blank">36</a>].</p

Knowledge and beliefs on vaccines among a sample of Italian pregnant women. Results from the NAVIDAD study

BACKGROUND: Vaccine hesitancy is an emerging phenomenon in European countries and leads to decreasing trends in infant vaccine coverage. The aim of this study was to analyze the level of confidence and correct awareness about immunizations, which are crucial for the success of vaccination programmes. METHODS: As part of the NAVIDAD multicentre study, we examined vaccination confidence and complacency among a sample of 1820 pregnant women from 14 Italian cities. The questionnaire assessed the interviewee's knowledge, beliefs and misconceptions, as well as their socioeconomic status, information sources about vaccines and confidence in the Italian National Healthcare Service. RESULTS: Only 9% of women completely believed to the efficacy, necessity and safety of vaccinations. Almost 20% of them had misconceptions on most of the themes. There was a significant difference in the level of knowledge considering educational level: women with a high educational level have less probability of obtaining a low knowledge score (odds ratio (OR) 0.43 [95% confidence interval (CI) 0.34-0.54]). The level of knowledge was also influenced by the sources of information: women who received information from their general practitioner (GP) and from institutional websites had a significantly lower chance of having misconceptions (OR 0.74 [95% CI 0.58-0.96]; OR 0.59 [95% CI 0.46-0.74]). Finally, the results underlined the influence of trust in healthcare professional information on the likelihood of having misconceptions (OR 0.49 [95% CI 0.27-0.89]). CONCLUSIONS: The data suggest the efficacy of GPs and institutional websites as a source of information to contrast misconceptions and underline the importance of confidence in the healthcare system to increase complacency and confidence in vaccines

Circadian pattern of salivary cortisol concentration.

<p>Salivary cortisol concentrations (nmol/L) measured at different sampling times in participants from the high-fit (HF, <i>n</i> = 10) and low-fit (LF, <i>n</i> = 12) groups. Between-group differences reach the threshold for significance at 18.00 h, and are close to significance at 30 min post-awakening and midnight. Data are expressed as mean (±SEM).</p><p>* Student's t-test.</p><p>Circadian pattern of salivary cortisol concentration.</p