Evaluation of an MPN test for the rapid enumeration of Pseudomonas aeruginosa in hospital waters.

In this study, the performance of a new most probable number (MPN) test (Pseudalert®/Quanti-Tray®) for the enumeration of Pseudomonas aeruginosa from hospital waters was compared with both international and national membrane filtration-based culture methods for P. aeruginosa: ISO 16266:2006 and UK The Microbiology of Drinking Water – Part 8 (MoDW Part 8), which both use Pseudomonas CN agar. The comparison based on the calculation of mean relative differences between the two methods was conducted according to ISO 17994:2014. Using both routine hospital water samples (80 from six laboratories) and artificially contaminated samples (192 from five laboratories), paired counts from each sample and the enumeration method were analysed. For routine samples, there were insufficient data for a conclusive assessment, but the data do indicate at least equivalent performance of Pseudalert®/Quanti-Tray®. For the artificially contaminated samples, the data revealed higher counts of P. aeruginosa being recorded by Pseudalert®/Quanti-Tray®. The Pseudalert®/Quanti-Tray® method does not require confirmation testing for atypical strains of P. aeruginosa, saving up to 6 days of additional analysis, and has the added advantage of providing confirmed counts within 24–28 hours incubation compared to 40–48 hours or longer for the ISO 16266 and MoDW Part 8 methods

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Effect evaluation on a medical device for drinking water filtration designed for reduction of microbial density in areas at risk

In areas at risk (hospitals, nursing homes) but in also in community such as schools, swimming pools, gyms, drinking water plumbing system can harbor also pathogenic microrganisms, potential vehicles of diseases because of structural factors and phenomena of microbial regrowth. In a setting of prevention, for limiting the exposure to pathogens in the environment and for minimizing the risk, at the point of use, specific disposable filter units could be installed. Aims. The purpose of this study was to examine the effectiveness in retaining microrganisms of a medical devices installed at drinking water faucets. Materials and methods. One hundred and eighty samples of water were microbiologically analyzed. Natural heterotrophic microbial flora present in drinking water were analytically determined before and after the passage through the system. Contemporaneously, twenty four suspensions of Pseudomonas aeruginosa and Escherichia coli at known concentration were determined for the calculation of the limit of retention calculated taking into examination the worst cases associated with the highest microbial concentrations. Results. The investigation showed that the devices were both efficient at reducing the natural microbial load and at guaranteeing the removal of high concentration of microrganisms (till 5 log). Fifty-seven out of 90 samples analyzed for the heterotrophs did not show any growth after the drainage through the system. In the positive samples, 86% showed a microbial concentration ranging between 1 e 3 CFU/L. Progressive growing concentrations of P. aeruginosa and E. coli proved a high limit of retention: none growth was obtained till the concentrations of 1.3x1012 CFU/mL and 5.0x1013 CFU/mL, respectively. Conclusions. The data show that the filter units installed directly at the point of use can be helpful at guaranteeing reliable retention of microbes. Still, in order to obtain an appropriate operation of the device, in spite of both the ease of use and safety margin, it is necessary to implement an efficient and orderly activity of maintenance according to the manufacturer’s instructions

An Italian survey on the microbiological safety of toys containing aqueous media

Aims The purpose of the present investigation is to fill the current gap in information regarding the microbiological quality of toys containing aqueous media and the related risks for users. Methods Over 18 years, a total of 491 sealed toys containing aqueous media were analysed using conventional microbial culture methods. In addition, molecular methods (PCR/nested RT-PCR, followed by Sanger sequencing) were employed to test for enteric viruses (enteroviruses and adenoviruses) in a subset of toys; subsequently, the infectivity of the positive samples was tested on cell cultures. Results Of the examined toys, 23.8% were noncompliant with the limits of the European guideline. The most frequently exceeded limits were those for Aerobic bacteria (84.6%), and Pseudomonas aeruginosa (29.9%). Other opportunistic bacterial species that were frequently detected were Stenotrophomonas maltophilia, Pseudomonas fluorescens, Burkholderia cepacia, Sphingomonas paucimobilis and Comamonas acidovorans. In a subset of 28 samples, adenovirus (25%) and enterovirus (11%) genome was also found to be present, although the samples with viral positivity did not show infectivity after inoculation on appropriate cell monolayers. Conclusions The results indicate a condition of microbial exposure related to the use of toys containing aqueous media. Significance and Impact of Study The investigation highlights the need for more stringent monitoring during the production, packaging and storage of toys containing aqueous matrices in order to safeguard children's health

Microbiological evaluation of open and sealed tattoo inks

Background. Introduction of tattoo inks in the skin has been associated with a potential entry of a great number of microorganisms including bacteria, virus and fungi. Contaminated pigments, diluents and instruments represent primary infection risk factors as well as inadequacy of hygienic measures during this practice. However, the evaluation of the infectious risk for public health due to tattoo ink use is actually not feasible cause of the low efficiency of health surveillance and the lack of specific regulation in this area.Materials and Methods. A survey was carried out to test the microbial product safety of some tattoo inks available in Italian tattoo parlours. Physical packaging and labelling of the collected inks were also examined. Newly acquired sealed stock bottles, open ink bottles and tattoo-correlated instruments (needles, spikes and grips) were collected and tested for different microbiological parameters. Results. Both from opened and sealed inks a variety of potentially pathogenic organisms were isolated and identified including Gram positive rods and cocci, Gram negative bacteria and fungi. Different species of Bacillus and Staphylococcus genera were identified, among which S. haemolyticus; Cronobacter sakazaki, Enterobacter intermedius and Sphingomonas paucimobilis were also identified while no atypical mycobacteria were isolated. Needles, spikes and grips tested for sterility were aseptic.Conclusions. Microbial contamination of opened samples suggest inefficacy of preservatives and additives in maintaining inks hygienic quality, and inadequacy of hygienic procedures during the tattooing operations, while the occurrence of microorganisms in unopened samples put in doubt the effectiveness of the sterilization technology applied to this type of product.</p

Valutazione microbiologica di prodotti di compostaggio: aspetti normativi e igienico-sanitari Procedure operative per lo svolgimento di indagini microbiologiche

Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 , Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal