Candida SPP. Colonization in NICU: A 2-Year Surveillance Study

Introduction: Fungal infections are an important cause of increased morbidity and mortality in infants admitted to neonatal intensive care units (NICUs). In VLBW infants, Candida (C.) albicans is the third most common cause of neonatal late onset sepsis (LOS). The overall incidence of candidemia in NICU is increasing because of the longer survival and the invasive procedures related with the intensive care of extremely preterm infants. Prevention of candidemia in neonates is supported by the identification and adequate management of specific risk factors, including low birth weight, use of invasive devices, prolonged hospitalization and use of broad-spectrum antimicrobial agents. Effective prophylactic strategies have recently become available, but the identification of the best possible strategies to manage high-risk infants is still a priority. Prior colonization is a key risk factor for candidemia. For this reason, surveillance studies to monitor incidence, species distribution, and antifungal susceptibility profiles are mandatory. Materials and Methods: In 2013 and 2014, we performed a cohort, prospective surveillance study in our NICU, collecting weekly nasal and rectal swabs. For each patient, clinical and demographic data expected to affect Candida colonization were recorded. We evaluated Candida spp. colonization rate and assessed the related risk factors. Swabs were placed on Sabouraud agar and incubated at 30°C for 4 days. Candida growth on agar was confirmed by microscopic observation. Moreover, Candida spp. were identified through Candida chromogenic agar (ChromAgar Candida, Laboratorios Conda) and API® 20C AUX (Biomérieux). Statistical analysis was performed by EpiInfo (CDC software) using the chi square or the Fisher’s exact method, when indicated. We assumed as statistically significant a p-value < 0.05. Results: In this 2-year study, we enrolled 520 patients and we analyzed 1,259 nasal and 1,255 rectal swabs. From 472 out of 520 patients we collected complete microbiological, clinical and demographic data. 48 out of 472 (10.17%) patients tested positive for Candida spp. at least once. In particular, 26 patients tested positive for C. albicans, 16 for C. parapsilosis, 6 for C. glabrata and 1 each for C. guilliermondii and an environmental mold. All the colonized patients had their rectal samples positive, and 7 their nasal samples as well. 15 patients out of 472 (3.18%) had more than one rectal or nasal swab positive during their NICU stay. Importantly, 9 patients out of 15 tested negative at the first sampling, suggesting that they have acquired Candida spp. colonization during their stay. Table 1 summarizes data about risk factors for Candida colonization in the patients under study. No systemic infection by Candida spp. was reported during the study. Conclusion: Our experience suggest that an effective microbiological surveillance can allow for implementing proper, effective and timely control measures in a high-risk setting

Burden of disease of human papillomavirus (HPV) : hospitalizations in the Marche and Veneto regions. An observational study

Background and Objectives HPV (human papillomavirus) is the virus most often responsible for sexually transmitted infections. The burden of HPV-related diseases on hospital resources represents a major public health problem. The aim of this study was to assess the economic burden of HPV-related diseases (anal cancer, genital cancer, genital warts, oropharyngeal cancer) on hospital resources in two Italian regions.Methods A retrospective, non-randomized, observational study was developed in the Marche and Veneto Regions, based on patients receiving hospitalization between 2008 and 2011. All hospitalizations were identified through administrative archives, according to the International Classification of Diseases (ICD-9 CM) to which a defined tariff was assigned.Results We identified 5299 hospitalized patients in Veneto and 1735 in the Marche Region. The mean annual hospitalization rate was 49.44 per 100,000 individuals in Veneto and 48.41 in Marche. The total mean annual cost attributable to HPV-related diseases was (sic)5.78 (SD 0.80) million in Veneto and (sic)2.24 (SD 0.17) million in Marche. Costs associated with genital cancer amounted to (sic)1.61 million in Veneto and (sic)1.06 million in Marche (28% and 47% of the total mean annual cost, respectively). Oropharyngeal cancer accounted for 36% in Veneto ((sic)2.08 million) and 28% in Marche ((sic)632,645). Hospitalization costs related to anal cancer were (sic)882,567 in Veneto and (sic) 377,719 in Marche; genital warts accounted for (sic)1.19 million in Veneto and (sic)171,406 in Marche. Finally, the mean cost per patient was (sic)4364 in Veneto and (sic)5176 in Marche.Conclusions The present work estimated the cost of HPV-related diseases for hospitalized patients in two Italian regions. The considerable estimated annual economic burden is a powerful driver for the governance of the public health sector

Compliance with herpes zoster vaccination in young and adult individuals in two regions of Italy

Background: The purpose of this work was to explore the knowledge and acceptance of Varicella Zoster Virus (VZV)- Herpes Zoster (HZ) vaccination in the general Italian population, where the HZ vaccine has not yet been distributed, using a prevalence study of subjects from two regions in Italy. Methods: A group of 3,173 individuals were interviewed using a questionnaire. The youngest age group (≤ 20 year) was composed of students interviewed at university. The middle age group (21-40 years) and the older age group (≥ 41 years) were interviewed by general practitioners in their office. Results: In both regions, the majority of subjects had been infected with varicella, and only 165 (5.2%) subjects reported receiving the VZV vaccination. Regarding HZ, 2,749 (86.6%) individuals stated that they knew of the virus and 2,233 (70%) were willing to be vaccinated against HZ. The majority of people willing to be vaccinated were in the middle and older age groups (36.6% and 44.7%, respectively). Conclusion: Compliance versus vaccination results were satisfactory and probably, with the upcoming availability of the HZ vaccine in Italy, adults will be favourably disposed towards vaccination

Indagine sulla formazione in pneumologia pediatrica nelle scuole di specializzazione in pediatria

Riassunto Background Sebbene le malattie respiratorie rappresentino uno dei principali motivi di visita pediatrica, nel nostro paese la formazione in quest’ ambito è attuata in maniera disomogenea. Scopo dell’indagine è stato descrivere lo stato dell’arte della formazione in pneumologia pediatrica nelle scuole di specializzazione in pediatria. Materiali e Metodi: Abbiamo realizzato una survey composta di 25 item e l’abbiamo resa accessibile online per 2 mesi, comunicandone le modalità di accesso a tutti gli specializzandi in pediatria mediante mailing list e newsletter di SIMRI, ONSP (Osservatorio Nazionale Specializzandi Pediatria) e Forum Junior Members SIMRI. Risultati: Hanno partecipato all’indagine 182 specializzandi da 16 regioni. Nessuno riteneva la propria preparazione in ambito pneumologico ottima. Lezioni e tirocini sono diffusi nelle scuole, a differenza di journal club e discussione di casi clinici. Spesso non è disponibile alcuna attività formativa relativa a radioprotezione (85.2%) e fisioterapia respiratoria (71.4%). Uno pneumologo pediatra è presente nell’83% dei casi. I test più diffusi sono: spirometria (97.8%), test del sudore (94%) e pH-metria (78.6%), ma la relativa formazione è attuata capillarmente solo per la spirometria (87.9%). Solo il 7.7% del campione è molto soddisfatto del piano formativo della propria scuola, mentre il 45.6% lo è abbastanza, il 40.1% poco ed il 6.6% per niente. L’84% ritiene fondamentali gli anni della specializzazione per la formazione sub-specialistica. Conclusioni: La nostra indagine suggerisce che nelle scuole di specializzazione in pediatria la formazione pneumologica deve essere incrementata