Infections and colonizations on admission to a rehabilitation hospital: involved microorganisms and resistance to carbapenems of Klebsiella pneumoniae according to the hospital ward of origin

Introduction Infections, in particular from multiresistant germs, represent a problem of great importance in the rehabilitative setting that gathers patients from areas that differ in complexity and intensity of care. The aim of the study is to describe infections and colonizations on admission to a rehabilitation hospital, assessing any possible difference between the wards of origin regarding the involved microorganisms and in particular Klebsiella pneumoniae resistant to carbapenems. Materials and methods During the period November 2015 - July 2018 surveys were conducted through a specific form designed for detecting healthcare-associated infections in the rehabilitative setting. For each infection or colonization on admission to the hospital, the antibiogram was collected, a database was set up with Redcap platform and data have been analyzed with Epi-info7 (CDC Atlanta). Results Seven hundred and ninety-nine patients were included, 405 (50.7%) of these were transferred from another hospital. Most of them were admitted from medical (251/405, 62.0%) or surgical (86/405, 21.2%) wards, while a minority of patients came from intensive and emergency care units (31/405, 7.7%), rehabilitation units (18/405, 4.4%) or other types of setting (9/405, 2.2%). The largest rate of infections/colonizations on admission was identified in patients coming from intensive and emergency care units (16/31, 51.6%), while a lower one from medical (87/251, 34, 6%), surgical (28/86, 32.5%) and rehabilitation units (4/18, 22.2%). Surveillance procedures with rectal swabs also identified a higher percentage of positive samples in patients admitted from intensive and emergency units (6/31, 19.4%) compared to those coming from the medical (18/251, 7.17%), surgical (8/86, 9.3%) and rehabilitative wards (0/18, 0.0%). The colonizing or infecting microorganisms were different according to the ward of origin. In particular Klebsiella pneumoniae was isolated in a high percentage of patients coming from a medical (13/116 isolates, 11.2%), surgical (8/46, 17.4%) and rehabilitation unit (4/7, 57.1%), together with Pseudomonas aeruginosa, Escherichia coli and, in the rectal swabs, Acinetobacter baumannii. On the other hand, in patients admitted from intensive and emergency care units Klebsiella pneumoniae was a minority of isolates (1/32, 3.1%), compared to other microorganisms such as Pseudomonas aeruginosa (4/32, 12.5%), Candida (4/32, 12.5%) and, in the rectal swab, Acinetobacter baumannii (5/32, 15.6%). Finally, from the analysis of the collected antibiograms, the resistance to carbapenems was related to 5/25 Klebsiellae (20.0%), isolated exclusively from rectal swabs. Patients came from medical (3/5) and surgical (2/5) wards. Conclusions Data confirm the importance of rigorous implementation of the surveillance/control measures of all the patients, even though admitted from units that differ in the level of care. Moreover, the rectal swab emerges as a fundamental tool for the active surveillance of multiresistant germs

Relationship of Epstein-Barr Virus and Interleukin 10 Promoter Polymorphisms with the Risk and Clinical Outcome of Childhood Burkitt Lymphoma

<div><p>Epstein-Barr virus (EBV) is an important environmental factor associated to the development of Burkitt lymphoma (BL) in endemic and intermediate risk regions. However, little is known about the contribution of genetic constitution to the development and clinical response of the disease. The aim of this work was to investigate the role of EBV and Interleukin 10 (<em>IL10</em>) single nucleotide polymorphisms (−1082A/G, −819C/T, −592C/A) and microsatellites (IL10.R and IL10.G) in susceptibility and clinical outcome in pediatric BL patients, in a region with intermediate EBV association frequency. The frequencies of <em>IL10</em> promoter Single nucleotide polymorphisms −1082A/G, −819C/T, −592C/A, and IL10.R and IL10.G microsatellites were compared in 62 pediatric patients and 216 healthy donors. <em>IL10</em> −1082GG and GCC/GCC genotypes were more frequent in patients than in controls, and associated to a higher risk of BL development (GG genotype OR 2.62, 95% CI, 1.25–5.51; <em>P</em> = 0.008; <em>Pc</em> = 0.024). EBV was detected in tumor samples by EBER-ISH in 54.1% of cases. EBV+ patients exhibited a better event free survival (EFS) (<em>P</em> = 0.019) than EBV− patients. Carriers of <em>IL10</em> R3-GCC had worse EFS (<em>P</em> = 0.028). Our results suggest a risk effect and an independent prognostic value of <em>IL10</em> polymorphisms and EBV in childhood BL patients.</p> </div

Case-control comparisons of genotypic and allelic frequencies of SNPs −1082 e −592 and genetic models of disease risk.

1<p>Numbers represent the number of individuals carrying each IL10 proximal genotype;</p>2<p><i>P</i> values column: for genotype comparisons, the first p value (italics) represents the comparison of BL cases vs. controls, by Chi square test; and the following represent the significance of the odds ratio (OR), as calculated by logistic regression, having case vs. control as dependent variable and each IL10 genotype as a covariate.</p

Comparisons of haplotypes and combinations between BL patients and controls.

1<p>N represent the number of individuals and 2N the number of chromosomes carrying each IL10 proximal haplotype or combination;</p>2<p>P values column: for each category, the first p value (italics) represents the comparison of cases vs. controls, by Chi-square Test; and the following represent the significance of the odds ratio (OR), as calculated by logistic regression, having case vs. control as dependent variable and each IL10 haplotype, combination or family as a covariate.</p

Clinical and demographic characteristics of Burkitt lymphoma patients.

<p>N: number of cases with available data.</p>1<p>St. Jude's staging according to Murphy (ref. 23).</p>2<p>Risk group as classified in the Berlin-Frankfurt-Munster (BFM) 90 protocol, adopted by the Instituto Nacional de Câncer – INCA LNH-98 (Brazil) protocol for the treatment of childhood Non Hodgkin lymphoma (ref. 24).</p

Multivariate Cox's proportional hazards regression model showing significant independent predictors of event free survival in Burkitt lymphoma.

<p>Multivariate Cox's proportional hazards regression model showing significant independent predictors of event free survival in Burkitt lymphoma.</p

Genotypic frequencies of SNP-1082G/A in EBV+ and EBV− Burkitt lymphoma cases.

<p>Genotypic frequencies of SNP-1082G/A in EBV+ and EBV− Burkitt lymphoma cases.</p

Distributions of Event free survival (EFS) probabilities according to (A) EBV status; (B) presence of IL10.01 family; (C) presence of IL10.G12 microsatellite allele at RG3; ■ positive; • negative; (D) IL10/EBV combination of risks; ▲EBV−/IL10.01−; ✱EBV+/IL10.01+; EBV−/IL10.01+; ♦ EBV+/IL10.01−.

<p>Distributions of Event free survival (EFS) probabilities according to (A) EBV status; (B) presence of IL10.01 family; (C) presence of IL10.G12 microsatellite allele at RG3; ■ positive; • negative; (D) IL10/EBV combination of risks; ▲EBV−/IL10.01−; ✱EBV+/IL10.01+; EBV−/IL10.01+; ♦ EBV+/IL10.01−.</p