Prevalence of urinary colonization by extended spectrum-beta-lactamase Enterobacteriaceae among catheterised inpatients in Italian long term care facilities.

Abstract Background: Long Term Care Facilities (LTCFs) play a key role in guaranteeing care to patients in developed countries. Many patients, mostly elderly, access LTCFs at some time in their lives, and their healthcare pathways often require them to move back and forth between hospital and outpatient settings. These patterns bring about new challenges regarding infection control, especially healthcare associated infections. Methods: A point prevalence study was conducted in 23 Italian LTCFs, to identify colonization in patients with urinary catheter (>24 hours). Species identification, susceptibility tests and extended spectrum beta lactamase (ESBL) production screenings were performed using Vitek 2 System. Enterobacteria identified by Vitek 2 System as ESBL-producers or suspected AmpC hyperproducers on the basis of cephamycin resistance, were sent to a research laboratory where they underwent a double-disk synergy test. Finally, ESBL-producers were screened for bla resistance genes by PCR assay. Results: 211 patients with catheter were screened, 185 out of 211 patients showed positive samples for the presence of Enterobacteriaceae, 114 of these 185 patients were colonized by extended spectrum cephalosporins resistant microorganisms. We identified a total of 257 Gram negative pathogens, of which 51.8% (133/257) were extended spectrum cephalosporins resistant. 7 out of 133 cephamycin not susceptible strains proved to be AmpC-type beta-lactamases and 125/133 ESBL-producers; 1 was not further characterized. 43 out of 257 (16.7%) E. coli, 37/257 (14.4%) P. mirabilis, 20/257 (7.8%), P. stuartii, 14/257 (5.4%) M. morganii, 7/257 (2.7%), K. pneumoniae, 4/257 (1.6%) C. koseri proved to be overall ESBL-producers by double-disk synergy test. Third and fourth generation cephalosporin resistant P. mirabilis, P. stuartii and M. morganii strains mainly harboured a blaTEM gene (95.9%), while 89.1% of E. coli were positive for the blaCTX-M determinant by PCR and sequencing. Patients with decubitus had a higher risk of colonization by at least one resistant isolate (p < 0.01). Samples of patients undergoing antibiotic therapy and patients with decubitus showed a higher risk (p < 0.05) of colonization by beta-lactam resistant microorganisms. Conclusions: These data confirm the presence of high percentages of ESBL-positive Enterobacteria in Italian LTCFs and the predominance of CTX-M type ESBL in E. coli. The alarming presence of ESBL-producing Enterobacteriaceae in Italian LTCFs can seriously compromise the effectiveness of antibiotic therapy.acilities (LTCFs), Antimicrobial resistance

Prevalence of urinary colonization by extended spectrum-beta-lactamase Enterobacteriaceae among catheterised inpatients in Italian long term care facilities.

Abstract Background: Long Term Care Facilities (LTCFs) play a key role in guaranteeing care to patients in developed countries. Many patients, mostly elderly, access LTCFs at some time in their lives, and their healthcare pathways often require them to move back and forth between hospital and outpatient settings. These patterns bring about new challenges regarding infection control, especially healthcare associated infections. Methods: A point prevalence study was conducted in 23 Italian LTCFs, to identify colonization in patients with urinary catheter (>24 hours). Species identification, susceptibility tests and extended spectrum beta lactamase (ESBL) production screenings were performed using Vitek 2 System. Enterobacteria identified by Vitek 2 System as ESBL-producers or suspected AmpC hyperproducers on the basis of cephamycin resistance, were sent to a research laboratory where they underwent a double-disk synergy test. Finally, ESBL-producers were screened for bla resistance genes by PCR assay. Results: 211 patients with catheter were screened, 185 out of 211 patients showed positive samples for the presence of Enterobacteriaceae, 114 of these 185 patients were colonized by extended spectrum cephalosporins resistant microorganisms. We identified a total of 257 Gram negative pathogens, of which 51.8% (133/257) were extended spectrum cephalosporins resistant. 7 out of 133 cephamycin not susceptible strains proved to be AmpC-type beta-lactamases and 125/133 ESBL-producers; 1 was not further characterized. 43 out of 257 (16.7%) E. coli, 37/257 (14.4%) P. mirabilis, 20/257 (7.8%), P. stuartii, 14/257 (5.4%) M. morganii, 7/257 (2.7%), K. pneumoniae, 4/257 (1.6%) C. koseri proved to be overall ESBL-producers by double-disk synergy test. Third and fourth generation cephalosporin resistant P. mirabilis, P. stuartii and M. morganii strains mainly harboured a blaTEM gene (95.9%), while 89.1% of E. coli were positive for the blaCTX-M determinant by PCR and sequencing. Patients with decubitus had a higher risk of colonization by at least one resistant isolate (p < 0.01). Samples of patients undergoing antibiotic therapy and patients with decubitus showed a higher risk (p < 0.05) of colonization by beta-lactam resistant microorganisms. Conclusions: These data confirm the presence of high percentages of ESBL-positive Enterobacteria in Italian LTCFs and the predominance of CTX-M type ESBL in E. coli. The alarming presence of ESBL-producing Enterobacteriaceae in Italian LTCFs can seriously compromise the effectiveness of antibiotic therapy.acilities (LTCFs), Antimicrobial resistance

Proposta di uno studio multicentrico per la valutazione del fenomeno delle Infezioni correlate a pratiche assistenziali in residenze socioassistenziali in Italia

&lt;p&gt;Razionale dello studio proposto In contesti come le Residenze Sanitarie Assistenziali (RSA), le Residenze Protette (RP), l’Assistenza Domiciliare Integrata (ADI) la letteratura e le prime esperirne italiane evidenziano come il problema ICPA sia importante e, pur variando le tipologie di infezione prevalenti, i costi individuali, sociali ed economici ad esse collegati rimangono molto elevati.&lt;/p&gt;&lt;p&gt;In questo scenario diventa importante che i Comitati per il Controllo delle Infezioni Ospedaliere (CIO) aziendali affrontino il problema del controllo delle infezioni in ambito extraospedaliero e comincino a strutturare modelli organizzativi in grado di operare efficacemente. Il dimensionamento del problema, ovvero l’attività di sorveglianza epidemiologica, anche in questo caso è tra le prime attività necessarie di provata efficacia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Obiettivo dello studio&lt;/strong&gt;: una prima valutazione della dimensione del problema ICPA nelle strutture RSA presenti nelle diverse regioni italiane attraverso uno studio di prevalenza nazionale. Materiali e metodi: l progetto prevede una prima fase con l’individuazione dei centri partecipanti e dei rispettivi referenti medici ed infermieristici. Successivamente si procederà, utilizzando la metodologia già testata in uno studio pilota, alla formazione del personale sull’uso degli strumenti. Saranno arruolati tutti i pazienti degenti da oltre 48 ore nelle RSA partecipanti, escludendo quelli in dimissione o in trasferimento nel giorno di rilevazione. I rilevatori, esterni alla struttura, raccoglieranno i dati consultando il quaderno infermieristico, il quaderno terapia, il diario clinico, la cartella clinica ed esaminando ciascun paziente per validare la eventuale presenza di “devices” e confermare sintomi e segni rientranti nelle definizioni di caso. Laddove necessario verrà consultato il personale medico ed infermieristico della struttura. Le variabili raccolte saranno centrate su dati anagrafici, fattori di rischio (es. punteggio Norton, allettamento, ecc.), presenza e tipologia di terapie in atto, presenza e tipologia di infezioni. Per le definizioni di caso verranno usati i criteri proposti dall’American Practioner Infection Control (APIC). Verranno sorvegliate le infezioni ematiche, le infezioni delle vie urinarie (IVU), con esclusione delle batteriurie asintomatiche, le infezioni cutanee (infezioni del sito chirurgico, infezioni dei tessuti molli, infezioni di lesioni da decubito), le infezioni del tratto gastrointestinale, le polmoniti e le infezioni delle basse vie respiratorie (LRTI), l’influenza e sindromi simil influenzali, le congiuntiviti, le micosi cutanee, le infezioni del cavo orale e le infezioni erpetiche.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risultati attesi:&lt;/strong&gt; risultato primario dello studio sarà il disporre di un dato nazionale di prevalenza del fenomeno ICPA in un contesto assistenziale in rapida crescita. Questo permetterà tra l’altro a livello locale di poter disporre di un dato di confronto significativo. In particolare sarà possibile definire la prevalenza di infezioni, quella di pazienti infetti, la tipologia di infezioni prevalenti e la distribuzione dei fattori di rischio. Secondariamente si potranno evincere dati sull’uso dell’antibiotico terapia e su eventuali correlazioni con fattori di rischio.&lt;/p&gt