Point prevalence data on antimicrobial usage in Italian acute-care hospitals: Evaluation and comparison of results from two national surveys (2011-2016).

AbstractObjectives and design:Data from the Italian national point-prevalence survey (PPS) of healthcare-associated infections (HAIs) were used to evaluate antimicrobial usage (AMU) in Italy and to identify targets for future interventions.Methods:The second Italian PPS was conducted in 2016 as part of the European PPS initiated by the ECDC. We compared these results with those of the first national survey, conducted in 2011.Results:An overall AMU prevalence of 44.5% (95% CI, 43.7–45.3) was estimated in 2016. No significant change in AMU prevalence was detected when comparing data with the first survey. In both surveys, the most prevalent indication for AMU was the treatment of infections. Considering all indications, penicillins plus β-lactamase inhibitors (BLIs) were the most commonly prescribed antimicrobial group in 2016; they were used significantly more than in 2011, and piperacillin plus BLI was the most frequently used agent. Broad-spectrum agents accounted for >60% of all antimicrobials for systemic use. No significant increase in the use of carbapenems occurred in 2016. Stable or decreasing carbapenem-resistance levels were identified in this study, although these levels remain alarmingly high for both Klebsiella pneumoniae (50%) and Acinetobacter baumannii (>75%).Conclusions:These results can be used to identify priorities and targets for interventions that promote more prudent use of antimicrobials, improve healthcare quality and patient safety, and combat the emergence and spread of antimicrobial-resistant pathogens

Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017

Point prevalence surveys of healthcare-associated infections (HAI) and antimicrobial use in the European Union and European Economic Area (EU/EEA) from 2016 to 2017 included 310,755 patients from 1,209 acute care hospitals (ACH) in 28 countries and 117,138 residents from 2,221 long-term care facilities (LTCF) in 23 countries. After national validation, we estimated that 6.5% (cumulative 95% confidence interval (cCI): 5.4-7.8%) patients in ACH and 3.9% (95% cCI: 2.4-6.0%) residents in LTCF had at least one HAI (country-weighted prevalence). On any given day, 98,166 patients (95% cCI: 81,022-117,484) in ACH and 129,940 (95% cCI: 79,570-197,625) residents in LTCF had an HAI. HAI episodes per year were estimated at 8.9 million (95% cCI: 4.6-15.6 million), including 4.5 million (95% cCI: 2.6-7.6 million) in ACH and 4.4 million (95% cCI: 2.0-8.0 million) in LTCF; 3.8 million (95% cCI: 3.1-4.5 million) patients acquired an HAI each year in ACH. Antimicrobial resistance (AMR) to selected AMR markers was 31.6% in ACH and 28.0% in LTCF. Our study confirmed a high annual number of HAI in healthcare facilities in the EU/EEA and indicated that AMR in HAI in LTCF may have reached the same level as in ACH

Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study

BackgroundVancomycin-resistant enterococcus (VRE) was the fastest growing pathogen in Europe in 2022 (+ 21%) but its clinical relevance is still unclear. We aim to identify risk factors for acquired VRE rectal colonization in hematological patients and evaluate the clinical impact of VRE colonization on subsequent infection, and 30- and 90-day overall mortality rates, compared to a matched control group.MethodsA retrospective, single center, case-control matched study (ratio 1:1) was conducted in a hematological department from January 2017 to December 2020. Case patients with nosocomial isolation of VRE from rectal swab screening (>= 48 h) were matched to controls by age, sex, ethnicity, and hematologic disease. Univariate and multivariate logistic regression compared risk factors for colonization.ResultsA total of 83 cases were matched with 83 controls. Risk factors for VRE colonization were febrile neutropenia, bone marrow transplant, central venous catheter, bedsores, reduced mobility, altered bowel habits, cachexia, previous hospitalization and antibiotic treatments before and during hospitalization. VRE bacteraemia and Clostridioides difficile infection (CDI) occurred more frequently among cases without any impact on 30 and 90-days overall mortality. Vancomycin administration and altered bowel habits were the only independent risk factors for VRE colonization at multivariate analysis (OR: 3.53 and 3.1; respectively).ConclusionsAntimicrobial stewardship strategies to reduce inappropriate Gram-positive coverage in hematological patients is urgently required, as independent risk factors for VRE nosocomial colonization identified in this study include any use of vancomycin and altered bowel habits. VRE colonization and infection did not influence 30- and 90-day mortality. There was a strong correlation between CDI and VRE, which deserves further investigation to target new therapeutic approaches

A turkey rhinotracheitis outbreak caused by the environmental spread of a vaccine-derived avian metapneumovirus

Avian metapneumovirus (aMPV) subtype A was isolated from 7-week-old turkeys showing respiratory disease typical of turkey rhinotracheitis. Comparison of the virus sequence with previously determined vaccine marker sequences showed that the virulent virus had originated from a licensed live subtype A aMPV vaccine. The vaccine had neither been in use on the farm within a period of at least 6 months nor had it been used on farms within a distance of approximately 5 km. Isolation of the virus and exposure to naive turkeys caused disease typical of a virulent aMPV field strain. The study shows that disease was caused by exposure to aMPV vaccine-derived virus that was present in the environment, and indicates that such virus is able to circulate for longer than was previously envisaged

Associazione fra vaccini vivi attenuati nella profilassi della Malattia di Newcastle e dell’infezione da Metapneumovirus aviare nel pollo.

La Malattia di Newcastle (ND), sostenuta dai ceppi patogeni di Paramyxovirus 1, è ritenuta una delle più temibili forme infettive dei volatili per la sua gravità e trasmissibilità; in specie quali il pollo può causare mortalità fino al 100%. Assieme alle norme di profilassi diretta, la vaccinazione è punto cardine del controllo della malattia. L’infezione da Metapneumovirus aviare (AMPV) causa la Rinotracheite infettiva del tacchino ed è fra le cause, assieme ad Escherichia coli, della Sindrome della testa gonfia nel pollo. Per la profilassi di quest’infezione, ampiamente diffusa nel nostro Paese, la vaccinazione è strumento imprescindibile che, anche nel pollo, sta assumendo grande rilevanza. Poiché, per entrambi i virus, la vaccinazione viene consigliata nelle prime settimane di vita mediante vaccino vivo, di particolare interesse pratico risulta poter associare questi interventi. In tale evenienza risultano necessarie informazioni sulla compatibilità fra i virus vaccinali. Infatti, quando si associano vaccini vivi diversi è fondamentale assicurarsi che non vi siano interferenze negative fra essi, tali da compromettere l’efficacia delle vaccinazioni o addirittura causare effetti patologici indesiderati. L’obiettivo del presente lavoro è stato appunto quello di valutare l'interferenza fra ceppi vaccinali di NDV e AMPV somministrati in polli Specific Pathogen Free (SPF) singolarmente o in associazione. La ricerca è stata svolta mediante prove sperimentali condotte in condizioni di isolamento biologico e sono stati usati come indicatori la persistenza dei virus vaccinali nell'ospite, la risposta immunitaria e la protezione dalla forma clinica e dalla replicazione virale dopo infezione di prova

Cosa c’è di nuovo sulle infezioni correlate all’assistenza nelle strutture residenziali per anziani in Italia? I risultati del progetto europeo HALT2

In the period April May 2013, the European Centre for disease Prevention and Control funded the HALT 2 project to promote the awareness on the healthcare acquired infection (HAI) and antimicrobial use in long term care facilities. During a point prevalence survey a set of indicators were collected in order to describe infection control resources and antimicrobial policy, population care load and risk factors, sites of infections and antimicrobial prescriptions. In Italy participated 235 voluntary facilities in 11 regions including 18418 residents. Most of them were older than 85 years and exposed at various risk factors as catheters or wounds. The observed prevalence of HAI was 3,3%, respiratory, urinary and skin infections were the most reported. Prevalence of antimicrobials was 4%, most of them were third generation cephalosporins, fluoroquinolones or penicillins and inhibitors given for therapy. Although written protocols are widely diffused, a lack of surveillance of infections and best practices was observed. Training of staff was heterogeneous among facilities and usually dedicated to the nursing staff only. Despite the problem is well known, actions are still required to introduce effective tools for the prevention and control in this critical setting in the healthcare net