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1.
J Endocrinol Invest ; 44(12): 2735-2739, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34101132

ABSTRACT

PURPOSE: "Non thyroidal illness syndrome" (NTIS) or "euthyroid sick syndrome" (ESS) is a possible biochemical finding in euthyroid patients with severe diseases. It is characterized by a reduction of serum T3 (fT3), sometimes followed by reduction of serum T4 (fT4). The relationship between thyroid hormones levels and mortality is well known and different studies showed a direct association between NTIS and mortality. The sudden spread of the 2019 novel coronavirus (SARS-CoV 2) infection (COVID-19) and its high mortality become a world healthcare problem. Our aim in this paper was to investigate if patients affected by COVID-19 presented NTIS and the relationship between thyroid function and severity of this infection. METHODS: We evaluated the thyroid function in two different groups of consecutive patients affected by COVID-19 with respect to a control group of euthyroid patients. Group A included patients hospitalized for COVID-19 pneumonia while patients requiring intensive care unit (ICU) for acute respiratory syndrome formed the group B. Group C identified the control group of euthyroid patients. RESULTS: Patients from group A and group B showed a statistically significant reduction in fT3 and TSH compared to group C. In group B, compared to group A, a further statistically significant reduction of fT3 and TSH was found. CONCLUSIONS: COVID-19 in-patients can present NTIS. FT3 and TSH serum levels are lower in patients with more severe symptoms.


Subject(s)
COVID-19/complications , Euthyroid Sick Syndromes/complications , Thyroid Diseases/complications , Adult , Aged , Aged, 80 and over , Critical Care , Euthyroid Sick Syndromes/blood , Female , Hospitalization , Humans , Male , Middle Aged , Respiratory Distress Syndrome/complications , Retrospective Studies , Thyroid Diseases/blood , Thyroid Function Tests , Thyroid Gland/physiopathology , Thyroxine/blood , Triiodothyronine/blood
3.
J Hosp Infect ; 108: 158-167, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33290816

ABSTRACT

BACKGROUND: Carbapenem resistance in Gram-negative bacteria is associated with severe infections in the hospital setting. No uniform screening policy or agreed set of criteria exists within the EU to inform treatment decisions for infections caused by carbapenem-resistant Gram-negative bacteria. AIM: To develop a range of consensus statements to survey experts in carbapenem resistance, to identify potential similarities and differences across the EU and across specialties. METHODS: The survey contained 43 statements, covering six key topics relating to carbapenem-resistant organisms: microbiological screening; diagnosis; infection control implementation; antibiotic stewardship; use of resources; and influencing policy. FINDINGS: In total, 136 survey responses were received (66% infectious disease specialists, 18% microbiologists, 11% intensive care specialists, 4% other/unknown) from France, Germany, Greece, Italy, Spain, and the UK. High, or very high, levels of agreement were seen for all 43 consensus statements, indicating good alignment concerning early identification and optimal management of infection due to carbapenem-resistant organisms. CONCLUSION: We offer the following recommendations: (1) screening is required when a patient may have been exposed to the healthcare system in countries/hospitals where carbapenem-resistant organisms are endemic; (2) rapid diagnostic tools should be available in every institution; (3) all institutions should have a specific policy for the control of carbapenem-resistant organisms, which is routinely audited; (4) clear strategies are required to define both appropriate and inappropriate use of carbapenems; (5) priority funding should be allocated to the management of infections due to carbapenem-resistant organisms; and (6) international co-operation is required to reduce country-to-country transmission of carbapenem-resistant organisms.


Subject(s)
Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Drug Resistance, Bacterial , Gram-Negative Bacterial Infections , Antimicrobial Stewardship , Consensus , France , Germany , Gram-Negative Bacteria , Gram-Negative Bacterial Infections/drug therapy , Greece , Humans , Infection Control , Italy , Spain , United Kingdom
4.
Vacunas ; 22(2): 129-130, 2021.
Article in English | MEDLINE | ID: mdl-32904361
5.
Clin Microbiol Infect ; 26(7): 880-894, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32360444

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19), which has rapidly become epidemic in Italy and other European countries. The disease spectrum ranges from asymptomatic/mildly symptomatic presentations to acute respiratory failure. At the present time the absolute number of severe cases requiring ventilator support is reaching or even surpassing the intensive care unit bed capacity in the most affected regions and countries. OBJECTIVES: To narratively summarize the available literature on the management of COVID-19 in order to combine current evidence and frontline opinions and to provide balanced answers to pressing clinical questions. SOURCES: Inductive PubMed search for publications relevant to the topic. CONTENT: The available literature and the authors' frontline-based opinion are summarized in brief narrative answers to selected clinical questions, with a conclusive statement provided for each answer. IMPLICATIONS: Many off-label antiviral and anti-inflammatory drugs are currently being administered to patients with COVID-19. Physicians must be aware that, as they are not supported by high-level evidence, these treatments may often be ethically justifiable only in those worsening patients unlikely to improve only with supportive care, and who cannot be enrolled onto randomized clinical trials. Access to well-designed randomized controlled trials should be expanded as much as possible because it is the most secure way to change for the better our approach to COVID-19 patients.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , Betacoronavirus/drug effects , Coronavirus Infections/drug therapy , Off-Label Use/ethics , Pneumonia, Viral/drug therapy , COVID-19 , Coronavirus Infections/epidemiology , Humans , Intensive Care Units/statistics & numerical data , Italy/epidemiology , Lung Diseases/drug therapy , Lung Diseases/pathology , Lung Diseases/virology , Pandemics , Pneumonia, Viral/epidemiology , Respiration, Artificial/methods , SARS-CoV-2
6.
Clin Microbiol Infect ; 26(6): 729-734, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32234451

ABSTRACT

BACKGROUND: The 2019 novel coronavirus (SARS-CoV-2) is a new human coronavirus which is spreading with epidemic features in China and other Asian countries; cases have also been reported worldwide. This novel coronavirus disease (COVID-19) is associated with a respiratory illness that may lead to severe pneumonia and acute respiratory distress syndrome (ARDS). Although related to the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS), COVID-19 shows some peculiar pathogenetic, epidemiological and clinical features which to date are not completely understood. AIMS: To provide a review of the differences in pathogenesis, epidemiology and clinical features of COVID-19, SARS and MERS. SOURCES: The most recent literature in the English language regarding COVID-19 has been reviewed, and extracted data have been compared with the current scientific evidence about SARS and MERS epidemics. CONTENT: COVID-19 seems not to be very different from SARS regarding its clinical features. However, it has a fatality rate of 2.3%, lower than that of SARS (9.5%) and much lower than that of MERS (34.4%). The possibility cannot be excluded that because of the less severe clinical picture of COVID-19 it can spread in the community more easily than MERS and SARS. The actual basic reproductive number (R0) of COVID-19 (2.0-2.5) is still controversial. It is probably slightly higher than the R0 of SARS (1.7-1.9) and higher than that of MERS (<1). A gastrointestinal route of transmission for SARS-CoV-2, which has been assumed for SARS-CoV and MERS-CoV, cannot be ruled out and needs further investigation. IMPLICATIONS: There is still much more to know about COVID-19, especially as concerns mortality and its capacity to spread on a pandemic level. Nonetheless, all of the lessons we learned in the past from the SARS and MERS epidemics are the best cultural weapons with which to face this new global threat.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Basic Reproduction Number , COVID-19 , Coronavirus Infections/mortality , Coronavirus Infections/transmission , Humans , Pandemics , Phylogeny , Pneumonia, Viral/mortality , Pneumonia, Viral/transmission , SARS-CoV-2 , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/mortality , Severe Acute Respiratory Syndrome/transmission , Virus Attachment
7.
Clin. Microbiol. Infect ; 20(Suppl 1): 1-55, jan. 2014.
Article in English | BIGG | ID: biblio-965308

ABSTRACT

Healthcare-associated infections due to multidrug-resistant Gram-negative bacteria (MDR-GNB) are a leading cause of morbidity and mortality worldwide. These evidence-based guidelines have been produced after a systematic review of published studies on infection prevention and control interventions aimed at reducing the transmission of MDR-GNB. The recommendations are stratified by type of infection prevention and control intervention and species of MDR-GNB and are presented in the form of 'basic' practices, recommended for all acute care facilities, and 'additional special approaches' to be considered when there is still clinical and/or epidemiological and/or molecular evidence of ongoing transmission, despite the application of the basic measures. The level of evidence for and strength of each recommendation, were defined according to the GRADE approach.


Subject(s)
Humans , Cross Infection , Cross Infection/prevention & control , Cross Infection/transmission , Chlorhexidine , Health Knowledge, Attitudes, Practice , Disease Outbreaks/prevention & control , Risk Factors , Bacterial Typing Techniques , Infection Control , Gram-Negative Bacterial Infections/prevention & control , Gram-Negative Bacterial Infections/transmission , Drug Resistance, Multiple, Bacterial , Hand Hygiene , Gram-Negative Bacteria/isolation & purification , Anti-Infective Agents, Local
8.
Clin Microbiol Infect ; 25(4): 474-480, 2019 Apr.
Article in English | MEDLINE | ID: mdl-29964230

ABSTRACT

OBJECTIVES: Our objective was to evaluate factors associated with recurrence in patients with 027+ and 027- Clostridium difficile infection (CDI). METHODS: Patients with CDI observed between January and December 2014 in six hospitals were consecutively included in the study. The 027 ribotype was deduced by the presence of tcdB, tcdB, cdt genes and the deletion Δ117 in tcdC (Xpert® C. difficile/Epi). Recurrence was defined as a positive laboratory test result for C. difficile more than 14 days but within 8 weeks after the initial diagnosis date with reappearance of symptoms. To identify factors associated with recurrence in 027+ and 027- CDI, a multivariate analysis was performed in each patient group. Subdistributional hazard ratios (sHRs) and 95% confidence intervals (95%CIs) were calculated. RESULTS: Overall, 238 patients with 027+ CDI and 267 with 027- CDI were analysed. On multivariate analysis metronidazole monotherapy (sHR 2.380, 95%CI 1.549-3.60, p <0.001) and immunosuppressive treatment (sHR 3.116, 95%CI 1.906-5.090, p <0.001) were factors associated with recurrence in patients with 027+ CDI. In this patient group, metronidazole monotherapy was independently associated with recurrence in both mild/moderate (sHR 1.894, 95%CI 1.051-3.410, p 0.033) and severe CDI (sHR 2.476, 95%CI 1.281-4.790, p 0.007). Conversely, non-severe disease (sHR 3.704, 95%CI 1.437-9.524, p 0.007) and absence of chronic renal failure (sHR 16.129, 95%CI 2.155-125.000, p 0.007) were associated with recurrence in 027- CDI. CONCLUSIONS: Compared to vancomycin, metronidazole monotherapy appears less effective in curing CDI without relapse in the 027+ patient group, independently of disease severity.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Clostridioides difficile/genetics , Clostridium Infections/epidemiology , Metronidazole/therapeutic use , Bacterial Proteins/genetics , Bacterial Toxins/genetics , Clostridioides difficile/classification , Clostridioides difficile/drug effects , Clostridium Infections/microbiology , Clostridium Infections/pathology , Humans , Recurrence , Repressor Proteins/genetics
9.
Med Mal Infect ; 48(1): 18-22, 2018 Feb.
Article in English | MEDLINE | ID: mdl-29336928

ABSTRACT

The pathogenesis of recurrent Clostridium difficile infection (CDI) is still poorly understood. The risk of recurrence is approximately 20% after an initial CDI episode and dramatically increases with subsequent CDI recurrences. Several factors may play a role in recurrent CDI (rCDI), including conditions influencing germination, metabolic pathways that influence toxin production of C. difficile, and the microbiota composition offering protection against colonization and disease caused by C. difficile. Paradoxically, the currently recommended treatment for acute symptomatic CDI, i.e. metronidazole or vancomycin, can cause modification of the intestinal flora. Indeed, administration of anti-CDI antibiotics leads to suppression of C. difficile, along with collateral damage of the protective intestinal microbiota and opening of a "window of vulnerability" for recurrence. Host factors also have a prominent role, including innate and acquired humoral immunity, i.e. passive antibodies administration or active vaccination as a prevention strategy. They play a crucial role in the protection against severe and recurrent CDI. The assessment of risk factors of recurrence and modeling prediction scores could help in preventing the troublesome experience of CDI recurrence. Six studies have methodologically assessed prediction scores for rCDI. However, the definition of recurrence was heterogeneous, external validation was often not performed, and immunological factors were often not considered. There is a need for further studies on the pathophysiology of recurrence to design models for prediction that are sound and applicable in clinical practice.


Subject(s)
Clostridium Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Bacterial Vaccines , Clostridium Infections/immunology , Clostridium Infections/prevention & control , Clostridium Infections/therapy , Cross Infection/drug therapy , Cross Infection/prevention & control , Cytokines/physiology , Exotoxins/physiology , Gastrointestinal Microbiome , Host-Pathogen Interactions , Humans , Immunization, Passive , Multicenter Studies as Topic , Randomized Controlled Trials as Topic , Recurrence , Risk Factors , Vaccination
10.
Euro Surveill ; 10(3): 1-2, 2005 Mar.
Article in English | MEDLINE | ID: mdl-29183559

ABSTRACT

The US cases of anthrax in 2001 and the recent severe acute respiratory syndrome outbreak have heightened the need for preparedness and response to naturally emerging and re-emerging infections or deliberately released biological agents. This report describes the response model of the Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (INMI), Rome, Italy for managing patients suspected of or affected by smallpox or viral haemorrhagic fever (VHF) either in the context of an intentional release or natural occurrence. The INMI is Italy's leading hospital in its preparedness and response plan to bioterrorism-related infectious agents. All single and double rooms of INMI are equipped with negative air pressure, sealed doors, high efficiency particulate air (HEPA) filters and a fully-equipped anteroom; moreover, a dedicated high isolation unit with a laboratory next door for the initial diagnostic assays is available for admission of sporadic patients requiring high isolation. For patient transportation, two fully equipped ambulances and two stretcher isolators with a negative pressure section are available. Biomolecular and traditional diagnostic assays are currently performed in the biosafety level 3/4 (BSL 3/4) laboratories. Continuing education and training of hospital staff, consistent application of infection control practices, and availability of adequate personnel protective equipment are additional resources implemented for the care of highly infectious patients and to maintain the readiness of an appropriately trained workforce to handle large scale outbreaks.

11.
Clin Microbiol Infect ; 24(4): 369-375, 2018 Apr.
Article in English | MEDLINE | ID: mdl-29155018

ABSTRACT

OBJECTIVES: This paper review trends in emerging infections and the need for increased clinical and laboratory surveillance. METHODS: Factors that contributed to the emergence of recent outbreaks have been reviewed. Known, major outbreaks over the past two decades were reviewed. RESULTS: We identified at least four major drivers of emergent infections: (i) increasing density of the human population; (ii) stress from farmland expansion on the environment; (iii) globalization of the food market and manufacturing; (iv) environmental contamination. The factors creating new opportunities for emerging infections include: (i) population growth; (ii) spread in health care facilities; (iii) an ageing population; (iv) international travel; (v) changing and expanding vector habitats. CONCLUSIONS: Emerging infections are unpredictable. In this review we argue that to discover new trends in infectious diseases, the clinicians have to look for the unusual and unexpected and ensure proper diagnostics and that syndromic surveillance must be supported by highly specialized laboratory services. Mathematical modeling has not been able to predict outbreaks More emphasis on the biology of evolution is needed. EID rarely stands out as unusual, and the continuous pressure on health care budgets forces clinicians and laboratories to prioritize their diagnostic work-up to common and treatable conditions. The European Society for Infectious Diseases and Clinical Microbiology, ESCMID, has established an Emerging Infections Task Force, EITaF, to strengthen the activities of the society on emerging infections and ensure that emerging infections is included in differential diagnostic considerations in everyday clinical practice.


Subject(s)
Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/prevention & control , Disease Outbreaks , Advisory Committees , Communicable Diseases, Emerging/diagnosis , Global Health , Humans , Microbiological Techniques/methods , Microbiological Techniques/trends
12.
Clin Microbiol Infect ; 24(5): 546.e1-546.e8, 2018 May.
Article in English | MEDLINE | ID: mdl-28818628

ABSTRACT

OBJECTIVES: To describe the current epidemiology of bloodstream infection (BSI) in patients with cirrhosis; and to analyse predictors of 30-day mortality and risk factors for antibiotic resistance. METHODS: Cirrhotic patients developing a BSI episode were prospectively included at 19 centres in five countries from September 2014 to December 2015. The discrimination of mortality risk scores for 30-day mortality were compared by area under the receiver operator risk and Cox regression models. Risk factors for multidrug-resistant organisms (MDRO) were assessed with a logistic regression model. RESULTS: We enrolled 312 patients. Gram-negative bacteria, Gram-positive bacteria and Candida spp. were the cause of BSI episodes in 53%, 47% and 7% of cases, respectively. The 30-day mortality rate was 25% and was best predicted by the Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure-SOFA (CLIF-SOFA) score. In a Cox regression model, delayed (>24 hours) antibiotic treatment (hazard ratio (HR) 7.58; 95% confidence interval (CI) 3.29-18.67; p < 0.001), inadequate empirical therapy (HR 3.14; 95% CI 1.93-5.12; p < 0.001) and CLIF-SOFA score (HR 1.35; 95% CI 1.28-1.43; p < 0.001) were independently associated with 30-day mortality. Independent risk factors for MDRO (31% of BSIs) were previous antimicrobial exposure (odds ratio (OR) 2.91; 95% CI 1.73-4.88; p < 0.001) and previous invasive procedures (OR 2.51; 95% CI 1.48-4.24; p 0.001), whereas spontaneous bacterial peritonitis as BSI source was associated with a lower odds of MDRO (OR 0.30; 95% CI 0.12-0.73; p 0.008). CONCLUSIONS: MDRO account for nearly one-third of BSI in cirrhotic patients, often resulting in delayed or inadequate empirical antimicrobial therapy and increased mortality rates. Our data suggest that improved prevention and treatment strategies for MDRO are urgently needed in the liver cirrhosis patients.


Subject(s)
Liver Cirrhosis/complications , Liver Cirrhosis/epidemiology , Sepsis/drug therapy , Sepsis/etiology , Aged , Comorbidity , Disease Management , Drug Resistance, Microbial , Female , Humans , Liver Cirrhosis/etiology , Male , Middle Aged , Mortality , Patient Outcome Assessment , Population Surveillance , Prognosis , Prospective Studies , Risk Factors , Sepsis/mortality
13.
J Hosp Infect ; 96(1): 1-15, 2017 May.
Article in English | MEDLINE | ID: mdl-28410761

ABSTRACT

BACKGROUND: Surgical site infections (SSIs) are associated with increased morbidity and mortality. Furthermore, SSIs constitute a financial burden and negatively impact on patient quality of life (QoL). AIM: To assess, and evaluate the evidence for, the cost and health-related QoL (HRQoL) burden of SSIs across various surgical specialties in six European countries. METHODS: Electronic databases and conference proceedings were systematically searched to identify studies reporting the cost and HRQoL burden of SSIs. Studies published post 2005 in France, Germany, the Netherlands, Italy, Spain, and the UK were eligible for data extraction. Studies were categorized by surgical specialty, and the primary outcomes were the cost of infection, economic evaluations, and HRQoL. FINDINGS: Twenty-six studies met the eligibility criteria and were included for analysis. There was a paucity of evidence in the countries of interest; however, SSIs were consistently associated with elevated costs, relative to uninfected patients. Several studies reported that SSI patients required prolonged hospitalization, reoperation, readmission, and that SSIs increased mortality rates. Only one study reported QoL evidence, the results of which demonstrated that SSIs reduced HRQoL scores (EQ-5D). Hospitalization reportedly constituted a substantial cost burden, with additional costs arising from medical staff, investigation, and treatment costs. CONCLUSION: Disparate reporting of SSIs makes direct cost comparisons difficult, but this review indicated that SSIs are extremely costly. Thus, rigorous procedures must be implemented to minimize SSIs. More economic and QoL studies are required to make accurate cost estimates and to understand the true burden of SSIs.


Subject(s)
Health Care Costs/statistics & numerical data , Infections/economics , Patient Outcome Assessment , Quality of Life/psychology , Surgical Wound Infection/economics , Cost of Illness , Cost-Benefit Analysis/methods , Europe/epidemiology , France , Germany , Humans , Infections/epidemiology , Infections/mortality , Italy , Length of Stay/economics , Mortality , Netherlands , Spain , Surgical Wound Infection/epidemiology , Surgical Wound Infection/mortality , Surgical Wound Infection/psychology , United Kingdom
14.
Clin Microbiol Infect ; 23(5): 335.e1-335.e5, 2017 May.
Article in English | MEDLINE | ID: mdl-28259548

ABSTRACT

OBJECTIVE: This multicentre cross-sectional study aims to estimate the prevalence of five neglected tropical diseases (Chagas disease, filariasis, schistosomiasis, strongyloidiasis and toxocariasis) among immigrants accessing health care facilities in five Italian cities (Bologna, Brescia, Florence, Rome, Verona). METHODS: Individuals underwent a different set of serological tests, according to country of origin and presence of eosinophilia. Seropositive patients were treated and further followed up. RESULTS: A total of 930 adult immigrants were enrolled: 477 men (51.3%), 445 women (47.9%), eight transgender (0.8%); median age was 37.81 years (range 18-80 years). Most of them had come from the African continent (405/930, 43.5%), the rest from East Europe, South America and Asia, and 9.6% (89/930) were diagnosed with at least one of the infections under study. Seroprevalence of each specific infection varied from 3.9% (7/180) for Chagas disease to 9.7% (11/113) for toxocariasis. Seropositive people were more likely to be 35-40 years old and male, and to come from South East Asia, sub-Saharan Africa or South America. CONCLUSIONS: The results of our study confirm that neglected tropical diseases represent a substantial health problem among immigrants and highlight the need to address this emerging public health issue.


Subject(s)
Emigrants and Immigrants , Neglected Diseases/epidemiology , Parasitic Diseases/epidemiology , Adolescent , Adult , Africa South of the Sahara/epidemiology , Aged , Aged, 80 and over , Asia/epidemiology , Cross-Sectional Studies , Europe/epidemiology , Female , Follow-Up Studies , Humans , Italy/epidemiology , Male , Middle Aged , Neglected Diseases/diagnosis , Neglected Diseases/parasitology , Parasitic Diseases/diagnosis , Public Health , Seroepidemiologic Studies , Socioeconomic Factors , South America/epidemiology , Young Adult
15.
Bull Soc Pathol Exot ; 109(4): 244-247, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27714628

ABSTRACT

Ebola virus is a pathogen responsible for a severe disease that affects humans and several animal species. To date, the natural reservoir of this virus is not known with certainty, although it is believed that fruit bats (Chiroptera: Pteropodidae) play an important role in maintaining the virus in nature. Although information on viral transmission from animals to humans is not clear, the role of arthropods has come under suspicion. In this article, we review the potential role of arthropods in spreading Ebola virus, acting as mechanical or biological vectors.


Subject(s)
Arthropod Vectors/physiology , Arthropods/virology , Disease Reservoirs , Ebolavirus/physiology , Hemorrhagic Fever, Ebola/transmission , Hemorrhagic Fever, Ebola/virology , Animals , Arthropod Vectors/classification , Arthropod Vectors/virology , Chiroptera/physiology , Chiroptera/virology , Disease Reservoirs/virology , Hemorrhagic Fever, Ebola/epidemiology , Humans , Zoonoses/epidemiology , Zoonoses/virology
16.
Eur J Clin Microbiol Infect Dis ; 35(12): 1949-1956, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27590621

ABSTRACT

Lack of standardised Clostridium difficile testing is a potential confounder when comparing infection rates. We used an observational, systematic, prospective large-scale sampling approach to investigate variability in C. difficile sampling to understand C. difficile infection (CDI) incidence rates. In-patient and institutional data were gathered from 60 European hospitals (across three countries). Testing methodology, testing/CDI rates and case profiles were compared between countries and institution types. The mean annual CDI rate per hospital was lowest in the UK and highest in Italy (1.5 vs. 4.7 cases/10,000 patient bed days [pbds], p < 0.001). The testing rate was highest in the UK compared with Italy and France (50.7/10,000 pbds vs. 31.5 and 30.3, respectively, p < 0.001). Only 58.4 % of diarrhoeal samples were tested for CDI across all countries. Overall, only 64 % of hospitals used recommended testing algorithms for laboratory testing. Small hospitals were significantly more likely to use standalone toxin tests (SATTs). There was an inverse correlation between hospital size and CDI testing rate. Hospitals using SATT or assays not detecting toxin reported significantly higher CDI rates than those using recommended methods, despite testing similar testing frequencies. These data are consistent with higher false-positive rates in such (non-recommended) testing scenarios. Cases in Italy and those diagnosed by SATT or methods NOT detecting toxin were significantly older. Testing occurred significantly earlier in the UK. Assessment of testing practice is paramount to the accurate interpretation and comparison of CDI rates.


Subject(s)
Clostridioides difficile/isolation & purification , Clostridium Infections/diagnosis , Clostridium Infections/epidemiology , Diagnostic Tests, Routine/methods , Diarrhea/diagnosis , Diarrhea/epidemiology , Microbiological Techniques/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Clostridium Infections/microbiology , Diagnostic Errors , Diagnostic Tests, Routine/standards , Diarrhea/microbiology , Epidemiological Monitoring , Female , France/epidemiology , Hospitals , Humans , Incidence , Infant , Infant, Newborn , Italy/epidemiology , Male , Microbiological Techniques/standards , Middle Aged , Organizational Policy , Pilot Projects , United Kingdom/epidemiology , Young Adult
17.
Clin Microbiol Infect ; 22(12): 984-989, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27545697

ABSTRACT

The study aimed to prospectively assess incidence and risk factors for colistin-associated nephrotoxicity. This is a secondary analysis of a multicentre, randomized clinical trial, comparing efficacy and safety of colistin versus the combination of colistin plus rifampicin in severe infections due to extensively drug-resistant (XDR) Acinetobacter baumannii. The primary end point was acute kidney injury (AKI) during colistin treatment, assessed using the AKI Network Criteria, and considering death as a competing risk. A total of 166 adult patients without baseline kidney disease on renal replacement therapy were studied. All had life-threatening infections due to colistin-susceptible XDR A. baumannii. Patients received colistin intravenously at the same initial dose (2 million international units (MIU) every 8 h) with predefined dose adjustments according to the actual renal function. Serum creatinine was measured at baseline and at days 4, 7, 11, 14 and 21 (or last day of therapy when discontinued earlier). Outcomes assessed were 'time to any kidney injury' (AKI stages 1-3) and 'time to severe kidney injury' (considering only AKI stages 2-3 as events). When evaluating overall mortality, AKI occurrence was modelled as a time-dependent variable. AKI was observed in 84 patients (50.6%, stage 1 in 40.4%), with an incidence rate of 5/100 person-days (95% CI 4-6.2). Risk estimates of AKI at 7 and 14 days were 30.6% and 58.8%. Age and previous chronic kidney disease were significantly associated with any AKI in multivariable analysis. Neither 'any' nor 'severe AKI' were associated with on-treatment mortality (p 0.32 and p 0.54, respectively). AKI occurs in one-third to one-half of colistin-treated patients and is more likely in elderly patients and in patients with kidney disease. As no impact of colistin-associated AKI on mortality was found, this adverse event should not represent a reason for withholding colistin therapy, whenever indicated.


Subject(s)
Acinetobacter Infections/drug therapy , Acute Kidney Injury/chemically induced , Acute Kidney Injury/epidemiology , Anti-Bacterial Agents/adverse effects , Colistin/adverse effects , Drug Resistance, Multiple, Bacterial , Acinetobacter baumannii/drug effects , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Colistin/administration & dosage , Creatinine/blood , Dose-Response Relationship, Drug , Endpoint Determination , Female , Humans , Incidence , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Rifampin/administration & dosage , Rifampin/adverse effects , Risk Assessment
18.
J Glob Antimicrob Resist ; 4: 44-48, 2016 03.
Article in English | MEDLINE | ID: mdl-27436392

ABSTRACT

The objective of this study was to describe a hospital cluster of NDM-1-producing Enterobacter cloacae infections observed in the surgical intensive care unit (ICU) of a tertiary-care hospital at Pula, Croatia. NDM-1-producing E. cloacae strains isolated from clinical samples were screened by PCR for the presence of carbapenemases. Genetic relatedness of NDM-1-producing E. cloacae strains was determined by multilocus sequence typing (MLST). During the period October 2013 to April 2014, four patients, with overlapping hospital stay in the surgical ICU, developed severe infections caused by E. cloacae demonstrated to produce carbapenemases. According to MLST, all strains belonged to ST133 and were positive by PCR for the blaNDM-1 carbapenemase gene, for blaCTX-M-15 and blaSHV-12 extended-spectrum ß-lactamase (ESBL) genes, and for blaTEM-1 and blaOXA-1 narrow-spectrum ß-lactamase genes. They were negative for other carbapenemases genes including blaOXA-48, blaVIM and blaKPC as well as for AmpC and the armA and rmtB aminoglycoside resistance genes. All strains were positive for the HI2 replicon, suggesting that an IncHI2 plasmid is likely the plasmid carrying the blaNDM-1 gene. Infection control measures were implemented after the first case although they were not effective in avoiding spread of this organism to other patients in the surgical ICU. In conclusion, the evolving epidemiology of NDM-producing micro-organisms and the interspecies diffusion of this resistance mechanism to emerging pathogens such as E. cloacae necessitate the setting up of strong and urgent joint measures to control the spread of NDM carbapenemase especially in the ICU setting.


Subject(s)
Drug Resistance, Multiple, Bacterial , Enterobacter cloacae/drug effects , Intensive Care Units , Plasmids/genetics , Quinolones , beta-Lactamases/genetics , Anti-Bacterial Agents , Bacterial Proteins , Croatia , Enterobacter cloacae/genetics , Humans , Microbial Sensitivity Tests , Multilocus Sequence Typing
19.
J Hosp Infect ; 94(3): 295-304, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27424948

ABSTRACT

Surgical site infections (SSIs) are among the most common healthcare-associated infections, and contribute significantly to patient morbidity and healthcare costs. Staphylococcus aureus is the most common microbial cause. The epidemiology of S. aureus is changing with the dissemination of newer clones and the emergence of mupirocin resistance. The prevention and control of SSIs is multi-modal, and this article reviews the evidence on the value of screening for nasal carriage of S. aureus and subsequent decolonization of positive patients pre-operatively. Pre-operative screening, using culture- or molecular-based methods, and subsequent decolonization of patients who are positive for meticillin-susceptible S. aureus and meticillin-resistant S. aureus (MRSA) reduces SSIs and hospital stay. This applies especially to major clean surgery, such as cardiothoracic and orthopaedic, involving the insertion of implanted devices. However, it requires a multi-disciplinary approach coupled with patient education. Universal decolonization pre-operatively without screening for S. aureus may compromise the capacity to monitor for the emergence of new clones of S. aureus, contribute to mupirocin resistance, and prevent the adjustment of surgical prophylaxis for MRSA (i.e. replacement of a beta-lactam agent with a glycopeptide or alternative).


Subject(s)
Anti-Bacterial Agents/therapeutic use , Carrier State/diagnosis , Mass Screening/methods , Staphylococcal Infections/diagnosis , Staphylococcus aureus/isolation & purification , Surgical Wound Infection/prevention & control , Carrier State/drug therapy , Humans , Staphylococcal Infections/drug therapy , Surgical Wound Infection/epidemiology , Surgical Wound Infection/microbiology
20.
Clin Microbiol Infect ; 22 Suppl 2: S27-36, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27125562

ABSTRACT

In 2013 the US Food and Drug Administration (FDA) issued recommendations and guidance on developing drugs for treatment of skin infection using a new definition of acute bacterial skin and skin-structure infection (ABSSSI). The new classification includes cellulitis, erysipelas, major skin abscesses and wound infection with a considerable extension of skin involvement, clearly referring to a severe subset of skin infections. The main goal of the FDA was to better identify specific infections where the advantages of a new antibiotic could be precisely estimated through quantifiable parameters, such as improvement of the lesion size and of systemic signs of infection. Before the spread and diffusion of methicillin-resistant Staphylococcus aureus (MRSA) in skin infections, antibiotic therapy was relatively straightforward. Using an empiric approach, a ß-lactam was the preferred therapy and cultures from patients were rarely obtained. With the emergence of MRSA in the community setting, initial ABSSSI management has been changed and readdressed. Dalbavancin, oritavancin and tedizolid are new drugs, approved or in development for ABSSSI treatment, that also proved to be efficient against MRSA. Dalbavancin and oritavancin have a long half-life and can be dosed less frequently. This in turn makes it possible to treat patients with ABSSSI in an outpatient setting, avoiding hospitalization or potentially allowing earlier discharge, without compromising efficacy. In conclusion, characteristics of long-acting antibiotics could represent an opportunity for the management of ABSSSI and could profoundly modify the management of these infections by reducing or in some cases eliminating both costs and risks of hospitalization.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Skin Diseases, Bacterial/drug therapy , Staphylococcal Skin Infections/drug therapy , Ambulatory Care , Drug Resistance, Multiple, Bacterial , Glycopeptides/therapeutic use , Humans , Lipoglycopeptides , Organophosphates/therapeutic use , Oxazoles/therapeutic use , Skin Diseases, Bacterial/microbiology , Teicoplanin/analogs & derivatives , Teicoplanin/therapeutic use , United States , United States Food and Drug Administration
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