Local survelance study on etiology of community-and hospital-acquired urinary tract infections (UTI) and antimicrobial susceptibility of uropathogens

This study was conduced during October 2010-March 2011 with the collaboration of the microbiology laboratory of International Evangelical Hospital (Voltri division) to identify the most frequent pathogens isolates from Urinary Tract Infections (UTI) and to evaluate their antibiotics susceptibility patterns. Overall, 780 consecutive, non duplicate strains were collected and sent to the coordinating laboratory. 143 strains were from Healthcare settings and 637 from comunity acqueired infections.The most rappresented pathogens was E. coli. In our region the epidemiological community landscape in terms of resistance, is getting closer to the nosocomial setting

Epidemiology of skin and soft tissue pathogens circulating in Liguria in 2011

This study was conduced during March-May 2011 with the collaboration of 4 clinical microbiology laboratories evenly distibuited across the Ligurian area to identify the most frequent pahogens isolates from skin and soft tissue infections and to evaluate their antibiotic susceptibility patterns. Overall, 213 consecutive, non duplicate strains were collected and sent to the coordinating laboratory.The most rappresented pathogens were: S. aureus (35.7%), P. aeruginosa (14%), E. coli (12.7%), Staphylococcus coaugulase negative (6.6%) and Enterococcus spp. (4.7%). The data indicate an increase of Gram negative compared to previous years, S. aureus remains the most common pathogen.The methicillin resistance in S. aureus was 43.4% and no one Enterococcus spp. resistant to vancomicin was found

Epidemiological study of pathogens isolated from blood in Liguria during 2011

Objectives. An epidemiological study addressed to identify the most represented pathogens isolated from blood and to evaluate their antibiotic susceptibility patterns, was conducted. Methods. Five clinical microbiology laboratories, homogenously distributed in Liguria, were required to collected all consecutive non-duplicates strains isolated from blood cultures during March 2011 to May 2011. the strains were sent to the reference laboratory (Section of Microbiology, DISC, University of Genoa, Italy). Results. A total of 159 microorganisms were enrolled, including 81 Gram positive, 69 Gram negative and 9 fungi.The most represented pathogens were: Escherichia coli (35), Staphylococcus aureus (26), S. epidermidis (20), S. hominis (10). Samples were collected mainly from medicine (59 isolates).Among the staphylococci, the most active molecules were: vancomycin (100% of susceptible strains), teicoplanin (93.4%), trimethoprim-sulfamethoxazole (83.8%) and tobramycin (61.6%). Enterococci showed rates of resistance to vancomycin of 25%. Enterobacteriaceae exhibited resistance to ampicillin (76.9%), ceftriaxone (44.4%), ciprofloxacin (43.3%), trimethoprim-sulfamethoxazole (36.6%) and ceftazidime (32.2%). Conclusions. The data show a higher incidence of Gram positive (51%) in comparison to Gram negative (43.4%). Gram-positive strains showed a high resistance level to fluoroquinolones (92.3%) while Gram-negative resulted resistant to ceftriaxone (44.4%) and fluoroquinolone (43.3%)

Epidemiological study of pathogens isolated from blood in Liguria (January-April 2010)

Objectives. An epidemiological study to identify the most represented pathogens isolated from blood and to evaluate their antibiotic susceptibility patterns, was conducted. Methods. Seven clinical microbiology laboratories, homogeneously distributed in the Ligurian area,were required to collected all consecutive non-duplicates strains isolated froom blood cultures during January 2010 to April 2010. The strains were sent to the reference laboratory (Sezione di Microbiologia del DISC, University of Genoa, Italy). Results. A total of 277 microorganisms were enrolled, including 155 Gram positive and 122 Gram negative.The most represented pathogens were: Escherichia coli (68), Staphylococcus aureus (57), Staphylococcus epidermidis (32), Staphylococcus hominis (17), Pseudomonas aeruginosa (15), Klebsiella pneumoniae (15), Enterococcus faecalis (11). Samples were collected mainly from medicine (66, 33.3%, of this number was determined by E. coli), intensive care units (33, 18.2% of this number consisted of S. epidermidis), surgery (24, 33.3% consisted of E. coli) and infectious diseases (20, of which S. aureus, E. coli and S. epidermidis equally represented 20.0%).Among the Staphylococci the most active molecules were: vancomycin and teicoplanin (100% of susceptible strains), chloramphenicol (92.3%) and trimethoprim-sulfamethoxazole (89.8%). Among the OXA-R Staphylococci (81/123, 65.9%) the most active molecules were: vancomycin and teicoplanin (100% of susceptible strains), chloramphenicol (93.8%) and trimethoprim-sulfamethoxazole (84.8%). Enterococci showed rates of resistance to vancomycin of 5.9%. Enterobacteriaceae exhibited resistance to ampicillin (77.5%), trimethoprim-sulfamethoxazole (42.6%), ciprofloxacin (41.2%), ceftriaxone (37.5%), ceftazidime (28.2%), cefepime (26.7%), cefoxitin (22.1%), piperacillintazobactam (20.4%), imipenem (4.7%) and amikacin (2.9%). The Gram negative non-Enterobacteriaceae showed rates of resistance of 100% to ceftriaxone, 81.3% to trimethoprim-sulfamethoxazole, 42.1% to ciprofloxacin and piperacillin-tazobactam, 33.3% to ceftazidime, 31.6% to cefepime, 27.8% to imipenem, 26.3 % to amikacin. Conclusions. The data show a higher incidence of Gram positive (56%) in comparison to Gram negative (44%).This confirms the high incidence of oxacillino-resistance in Staphylococci in our geographic area.Against Enterobacteriaceae rates of resistance were observed in excess of 20% for all drugs tested except imipenem (4.7%) and amikacin (2.9%). The proportion of imipenem-resistant isolates was constituted of strains of K. pneumoniae carbapenemase producers

Etiology and antibiotic susceptibility patterns of bacteria collected from urinary tract infections in the ASL3 in Genoa

An epidemiological study addressed to identify the pathogens collected from urine samples and their antibiotic susceptibility patterns was conducted. From January 2008 to May 2009 56,435 urine samples were processed in the Clinical Microbiological Laboratory of the ASL3 in Genoa. Materials and methods. Urine samples were firstly screened by automated equipment Uroquik (ALIFAX).All urine cultures with microbial ≥105 CFU / ml were seeded on Chromagar Orientation (BD) and incubated at 37 ° C °.The identification of the isolates and the evaluation of their susceptibility to antibiotics were determined by the automated system Vitek 2 (bioMérieux). Results. About 33% (18,543) of the urine samples gave positive results.The number and frequency of the microorganisms collected was: 13,379 (72%) Gram-negative including 9179 (69%) E.coli, 1382 (10%) Klebsiella spp, 1209 (9%) Proteus spp, 445 (3%) Pseudomonas spp, and other species 1164 (9%), 4942 (27%) Gram positive which included 3615 (73%) Enterococcus spp, 821 (17%) Staphylococcus spp, 506 (10% ) Streptococcus spp and 222 (1%) fungi. In E. coli the incidence of susceptible strains ranged between 90-96% for gentamicin, fosfomycin, nitrofurantoin, piperacillin-tazobactam, between 87-89% for the cefepime, cefotaxime, ceftazidime, about 70% for quinolones ciprofloxacin, norfloxacin, and trimethoprim-sulfamethoxazole, 62% for piperacillin, about 50% to ampicillin. For Klebsiella spp and Proteus spp the percentage of susceptible strains ranged from 95-99% to piperacillin-tazobactam, gentamicin, and respectively 93% and between 68-52% for third-generation cephalosporins cefotaxime and ceftazidime and fluoroquinolones ciprofloxacin and norfloxacin. Conclusions. Present findings indicate that among the Enterobacteriaceae, E. coli, cause most of UTI and in vitro resulted susceptible various antibiotics.There was an increased resistance to fluoroquinolones among community-acquired E. coli and Proteus spp.A periodical epidemiological study will be necessary to monitor the evolution toward resistance to antibiotics of the strains collected from urinary tract infections

Evaluation of a new automated cell analyzer (Sysmex UF-1000i) for bacteriological screening of urine

Introduction. Sysmex UF-1000 is a new flow cytometry for the analysis of urine based on a laser diode technology using specific compounds for the staining nucleic acids, characterized by a threshold of detection of bacteria equal to 1000 CFU/ml.The purpose of this study was to compare the positivity or negativity of the urine samples using standard procedures and with the response obtained from the instrument UF-1000i. Methods. During the period May and July 2011, 1024 urine samples obtained from the laboratory of the hospital in Genoa-Voltri were analyzed with the instrument Sysmex UF-1000i.The samples were stored at a temperature of 5°C during transport.The instrument after loading of the sample is able to assess the bacterial load in about 1 minute per sample. Results. 1024 samples were analyzed with Sysmex UF-1000 analyzed in parallel by the hospital laboratory in Genoa Voltri. 228 are positive results for Sysmex UF-1000 (bacterial loads in excess of 1000 CFU/ml).The data obtained were consistent with those recorded with traditional analysis. 18 samples were positive only for our instrument, but not with the traditional system used in the laboratory for comparison. Conclusion. The advantage of Sysmex UF-1000 is certainly due to obtain immediate results after the reading of each individual sample that is higher than any other instrument or method of analysis used. The slight discrepancy of the results obtained may be due to the extremely low calibration of UF-1000. This allows in a very short time to discard all negative samples with enormous saving of time and material. For positive samples and applies the criterion of the routine ie, the bacterial load has a meaning according to the type of patient considered, as in the case of pediatric or catheterized patient

Epidemiology of skin and soft tissue pathogens circulating in Liguria in 2011

This study was conduced during March-May 2011 with the collaboration of 4 clinical microbiology laboratories evenly distibuited across the Ligurian area to identify the most frequent pahogens isolates from skin and soft tissue infections and to evaluate their antibiotic susceptibility patterns. Overall, 213 consecutive, non duplicate strains were collected and sent to the coordinating laboratory.The most rappresented pathogens were: S. aureus (35.7%), P. aeruginosa (14%), E. coli (12.7%), Staphylococcus coaugulase negative (6.6%) and Enterococcus spp. (4.7%). The data indicate an increase of Gram negative compared to previous years, S. aureus remains the most common pathogen.The methicillin resistance in S. aureus was 43.4% and no one Enterococcus spp. resistant to vancomicin was found

Epidemiology of multi-resistance Gram negative pathogen circulating in Liguria and molecular characterization of different carbapenemases

This study was conducted during January-April 2010 with the collaboration of 7 clinical microbiology laboratories evenly distributed across the Ligurian area to identify the most frequent Gram negative species and to evaluate their antibiotic susceptibility patterns Overall, 110 consecutive multi-resistant non duplicate Gram negative isolates,were collected and sent to the coordinating laboratory (Sezione di Microbiologia del DISC, University of Genoa, Italy) together with susceptibility data obtained by routine methods. In addition, strains resistant to carbapenems were characterized by PCR. A total of 110 Gram negative multi-resistance strains were found, including 74 and 36 isolated from healthcare or nosocomial settings and community acquired infections, respectively. The most represented pathogens were: A. baumannii (38, 34.5%), E. coli (30, 27.2%), P. aeruginosa (29, 26.3%), K. pneumoniae (9, 8.2%) and P. mirabilis (4, 3.6%). A. baumannii were more frequently collected from healthcare settings or nosocomial samples, while the other strains were generally equally isolated from in- and out-patients. Amikacin was the most active molecule against E. coli and P. mirabilis (96,7% and 100% of susceptible stains respectively). Colistin was the only active molecule agains A. baumanii and P. aeruginosa (100% of susceptible strains). Against K. pneumoniae tigecycline and colistin were the most active molecules (100% of susceptible strains). Imipenem was the most active compound against E. coli and P. mirabilis (100% of susceptible strains). A large number (97.4%) of A. baumannii was resistant to imipenem. K. pneumoniae and P. aeruginosa showed rates of resistance of 88% and 34.4% respectively. A. baumannii, K. pneumoniae and P. aeruginosa isolates resistant to Imipenem, carried OXA-23, KPC and VIM carbapenemases.These data shown a significant spread of multidrug-resistant Gram negative bacteria in hospitals and in communities.The production of carbapenemase in A. baumannii, K. pneumoniae and P. aeruginosa is now an important phenomenon in our region

Peripheral arterial disease has a strong impact on cardiovascular outcome in patients with acute coronary syndromes: from the START Antiplatelet registry

Background: Peripheral arterial disease (PAD) was reported to increase the risk of new cardiovascular events in patients with acute coronary syndromes (ACS). However, most of the evidence comes from randomized clinical trials. We aimed to assess the impact of PAD on cardiovascular outcome and treatment decisions in ACS patients in a current real-life setting. Methods: START-ANTIPLATELET is a multicenter registry enrolling ACS patient. Baseline clinical characteristics and treatment at discharge were recorded and follow-up was repeated at 6-months and 1-year. PAD was defined as intermittent claudication and/or previous revascularization. Results: Among 1442 patients enrolled, 103 (7.1%) had PAD. PAD patients were older (71.8 ± 10.6vs66.2 ± 12.6 yrs., p < 0.0001), more frequently hypertensive (90.3vs68.6%, p< 0.0001), hypercholesterolemic (66vs52%, p= 0.037), diabetic (51.5vs24%, p= 0.0001), obese (28.2vs19.3%, p= 0.029) and with previous TIA (7.8vs2.8%, p= 0.005) or stroke (11.7vs3.1%, p< 0.0001). Clinical presentation and acute treatment were similar in non-PAD and PAD patients, but the latter were discharged significantly less frequently on dual antiplatelet therapy (DAPT) (68.9vs85%, p= 0.005). After a median follow-up time of 11.1 months, major cardio/cerebrovascular event-free survival [MACCE, including cardiovascular death, MI, TIA and stroke, target-vessel revascularization (TVR) and major arterial ischemic events] was significantly shorter (9.0vs11.2 months, p= 0.02; HR 3.2, 2.4–8.4) in PAD patients and net adverse cardiovascular events (NACE = MACCE plus major hemorrhages) were significantly more frequent (19.1%vs10.5%, p = 0.049). Conclusions: PAD identifies a subgroup of ACS patients at significantly increased cardiovascular risk, but these patients tend to be undertreated. Patients admitted for ACS should be screened for PAD and optimal medical therapy at discharge should be implemented