24 research outputs found
Healthcare associated pathogens in a changing world
In developed countries about 10% of the hospitalizations are complicated by a healthcare-associated infection [1]. Up to 75% of these infections are due to multidrug-resistant organisms (MDROs) [1]. Antimicrobial resistant bacterial infections are associated to higher morbidity, mortality and healthcare costs than those caused by susceptible organisms [1]. The findings of the point prevalence survey in European acute care hospitals published in 2013 by the European Centre for Disease Control and Prevention (ECDC) show large variations between countries and between different regions of the same country, with Italy being allocated within the high-endemic areas for both MRSA and MDROs [2].
Despite antimicrobial resistance affects most bacterial species, MDR Gram negatives represent the most serious threat. In a few years Enterobacteriaceae, mainly Escherichia coli and Klebsiella pneumoniae, have evolved from extended spectrum β-lactamase (ESBL) producing to carbapanem-resistant organisms [3]. Simultaneously, Acinetobacter baumannii has quickly become extremely or pan-drug resistant [4]. Carbapenem resistant Gram negatives heavily impact on clinical outcomes with mortality rates significantly higher than the susceptible strains of the same species [1]. Of further concern, very few antimicrobial agents are available for an effective treatment of these infections and new agents active against these organisms are not currently in development.
Many intertwining factors are driving these epidemiological changes, involving patients, healthcare delivery systems, infection control practices and, most important, misuse and inappropriate use of antibiotics in all healthcare facilities, in community and in animal husbandry. In particular, the transition of the healthcare delivery systems from a hospital-centered model to a healthcare facility network has gradually blurred the borders between hospital and community and the patients’ travel within this network has critically contributed to disseminate MDROs [5]. As a consequence, antimicrobial resistance is now as common, if not more so, in post-acute clinical facilities, such as long term care settings and nursing homes [5]. The “revolving door” is the very efficacious image used as the paradygm of the spreading routes of organisms with hospital and community reservoirs, as E. coli or MRSA. The revolving door, indeed, enlightens how the colonized patients entering back and forth several healthcare settings drive the amplification of the antibiotic resistance [6].
Stringent infection control and prevention practices and wise use of antibiotics are unanimously agreed as the key actions to fight MDROs. Of course, we need new antibiotics, but first we have to learn how to protect them from a precipitous erosion of their effectiveness
The burden of Candida species colonization in NICU patients: a colonization surveillance study
Fungal infections are an important cause
of morbidity and mortality in neonatal
intensive care units (NICUs). The identification
of specific risk factors supports prevention
of candidemia in neonates. Effective
prophylactic strategies have recently
become available, but the identification
and adequate management of high-risk infants
is still a priority. Prior colonization is
a key risk factor for candidemia. For this
reason, surveillance studies to monitor incidence,
species distribution, and antifungal
susceptibility profiles, are mandatory.
Among 520 infants admitted to our NICU
between January 2013 and December
2014, 472 (90.77%) were included in the
study. Forty-eight out of 472 (10.17%) patients
tested positive for Candida spp. (C.),
at least on one occasion. All the colonized
patients tested positive for the rectal swab,
whereas 7 patients also tested positive for
the nasal swab. Fifteen out of 472 patients
(3.18%) had more than one positive rectal
or nasal swab during their NICU stay.
Moreover, 9 out of 15 patients tested negative
at the first sampling, suggesting they
acquired Candida spp. during their stay.
Twenty-five of forty-eight (52.1%) colonized
patients carried C.albicans and 15/48
(31.25%) C.parapsilosis. We identified as
risk factors for Candida spp. colonization:
antibiotic therapy, parenteral nutrition,
the use of a central venous catheter, and
nasogastric tube. Our experience suggests
that effective microbiological surveillance
can allow for implementing proper, effective
and timely control measures in a highrisk
setting
An update of the evolving epidemic of blaKPC carrying Klebsiella pneumoniae in Sicily, Italy, 2014: Emergence of multiple Non-ST258 Clones
Background: In Italy, Klebsiella pneumoniae carbapenemase producing K. pneumoniae (KPC-Kp) strains are highly endemic and KPC producing CC258 is reported as the widely predominating clone. In Palermo, Italy, previous reports have confirmed this pattern. However, recent preliminary findings suggest that an epidemiological change is likely ongoing towards a polyclonal KPC-Kp spread. Here we present the results of molecular typing of 94 carbapenem non susceptible K. pneumoniae isolates detected during 2014 in the three different hospitals in Palermo, Italy. Methods and Results: Ninety-four consecutive, non replicate carbapenem non susceptible isolates were identified in the three largest acute general hospitals in Palermo, Italy, in the six-month period March-August 2014. They were characterized by PCR for β-lactam, aminoglycoside and plasmid mediated fluoroquinolone resistance genetic determinants. The mgrB gene of the colistin resistant isolates was amplified and sequenced. Clonality was assessed by pulsed field gel electrophoresis and multilocus sequence typing. Eight non-CC258 sequence types (STs) were identified accounting for 60% of isolates. In particular, ST307 and ST273 accounted for 29% and 18% of isolates. CC258 isolates were more frequently susceptible to gentamicin and non-CC258 isolates to amikacin. Colistin non susceptibility was found in 42% of isolates. Modifications of mgrB were found in 32 isolates. Conclusions: Concurrent clonal expansion of some STs and lateral transmission of genetic resistance determinants are likely producing a thorough change of the KPC-Kp epidemiology in Palermo, Italy. In our setting mgrB inactivation proved to substantially contribute to colistin resistance. Our findings suggest the need to continuously monitor the KPC-Kp epidemiology and to assess by a nationwide survey the possible shifting towards a polyclonal epidemic
A Snapshot on MRSA epidemiology in a neonatal intensive care unit network, Palermo, Italy
Objectives: We performed a 1-year prospective surveillance study on MRSA colonization within the five NICUs of the metropolitan area of Palermo, Italy. The purpose of the study was to assess epidemiology of MRSA in NICU from a network perspective. Methods: Transfer of patients between NICUs during 2014 was traced based on the annual hospital discharge records. In the period February 2014-January 2015, in the NICU B, at the University teaching hospital, nasal swabs from all infants were collected weekly, whereas in the other four NICUs (A, C, D, E) at 4 week-intervals of time. MRSA isolates were submitted to antibiotic susceptibility testing, SCCmec typing, PCR to detect lukS-PV and lukF-PV (lukS/F-PV) genes and the gene encoding the toxic shock syndrome toxin (TSST-1), multilocus variable number tandem repeat fingerprinting (MLVF), and multilocus sequence typing (MLST). Results: In the period under study, 587 nasal swabs were obtained from NICU B, whereas 218, 180, 157, and 95 from NICUs A, C, D, and E, respectively. Two groups of NICUs at high prevalence and low prevalence of MRSA colonization were recognized. Overall, 113 isolates of MRSA were identified from 102 infants. Six MLVF types (A-F) were detected, with type C being subdivided into five subtypes. Five sequence types (STs) were found with ST22-IVa being the most frequent type in all NICUs. All the MRSA molecular subtypes, except for ST1-IVa, were identified in NICU B. Conclusions: Our findings support the need to approach surveillance and infection control in NICU in a network perspective, prioritizing referral healthcare facilities
Cystic mucinous adenocarcinoma of the lung: a case report
Mucinous cystic tumors of the lung are uncommon, the preoperative pathologic diagnosis is difficult and their biological behavior is still controversial. We report the case of a patient with a clinically benign cystic lesion that post-operatively showed to be consistent with an invasive adenocarcinoma arising in a mucinous cystadenoma of the lung
A Snapshot on MRSA Epidemiology in a Neonatal Intensive Care Unit Network, Palermo, Italy
Objectives. We performed a one-year prospective surveillance study on MRSA colonization within the five NICUs of the metropolitan area of Palermo, Italy. The purpose of the study was to assess epidemiology of MRSA in NICU from a network perspective.Methods. Transfer of patients between NICUs during 2014 was traced based on the annual hospital discharge records. In the period February 2014 – January 2015, in the NICU B, at the University teaching hospital, nasal swabs from all infants were collected weekly, whereas in the other four NICUs (A, C, D, E) at four week-intervals of time. MRSA isolates were submitted to antibiotic susceptibility testing, SCCmec typing, PCR to detect lukS-PV and lukF-PV (lukS/F-PV) genes and the gene encoding the toxic shock syndrome toxin (TSST-1), multilocus variable number tandem repeat fingerprinting (MLVF) and multilocus sequence typing (MLST). Results. In the period under study, 587 nasal swabs were obtained from NICU B, whereas 218, 180, 157 and 95 from NICUs A, C, D and E, respectively. Two groups of NICUs at high prevalence and low prevalence of MRSA colonization were recognized. Overall, 113 isolates of MRSA were identified from 102 infants. Six MLVF types (A-F) were detected, with type C being subdivided into five subtypes. Five sequence types (STs) were found with ST22-IVa being the most frequent type in all NICUs. All the MRSA molecular subtypes, except for ST1-IVa, were identified in NICU B. Conclusions. Our findings support the need to approach surveillance and infection control in NICU in a network perspective, prioritizing referral healthcare facilities
Mesialização de molares com ancoragem em mini-implantes Mesial movement of molars with mini-implants anchorage
INTRODUÇÃO: é muito comum, na rotina do consultório odontológico, especialmente em Ortodontia, o paciente, após avaliar o plano de tratamento proposto, questionar sobre a possibilidade de fechamento de espaços presentes, ocasionados pela perda de dentes permanentes. O ortodontista, frente a essa questão, tem que avaliar diversos fatores, tais como a má oclusão presente, a integridade do osso e das raízes, o tempo de tratamento e a geometria do posicionamento dentário, que é o que permite avaliar se, com o fechamento dos espaços e, conseqüentemente, a perda de ancoragem dos segmentos anteriores, a finalização estará de acordo com os ideais que regem a especialidade. Com o advento dos mini-implantes, as possibilidades desta abordagem terapêutica aumentaram, pois o efeito adverso da perda de ancoragem pode ser eliminado e, com isso, o paciente pode ser beneficiado. No entanto, os outros fatores envolvidos, assim como a mecânica do movimento, requerem especial atenção. OBJETIVOS: no presente artigo serão abordados os fatores envolvidos neste tipo de tratamento, o raciocínio na tomada de decisões e os detalhes importantes que devem ser observados durante a condução da mecânica, ilustrados com casos clínicos.<br>INTRODUCTION: It's routine, especially at the orthodontic office, the patient, after the assessment of the proposed treatment plan, answer about the possibility of closing their edentulous spaces caused by missed permanent teeth. In these situations, several factors must be evaluated, like the present malocclusion, the bone and roots integrity, the treatment time and the geometry of teeth positioning, that is what permits to assess if the loss of anchorage from the anterior segments, during the space closure, would permit the occlusion to end within the orthodontic ideals. With the mini-implants, the possibilities of this therapeutic approach have been improved, since the adverse effects are eliminated with the skeletal anchorage. AIM: In the present paper will be analyzed the factors involved in this treatment type, the reasoning in the decisions making and the important details that should be observed during the mechanics conduction, illustrated by cases reports