Impact of Whole Genome Sequencing to investigate transmission of Serratia marcescens in Neonatal Intensive Care Unit.

Newborns admitted to neonatal intensive care units (NICU) are at increased risk of health care-associated infections. Serratia marcescens represent the third most common pathogen in NICU outbreaks. Here we present an outbreak investigation performed using Whole Genome Sequencing (WGS) analyses and the control measures implemented to limit the spread of S. marcescens in the NICU of an Italian hospital. In February 2023 S. marcescens was isolated from six newborns, when in 2022 this pathogen was isolated only from two samples in the same ward. Measures for infection prevention were adopted. Routinary surveillance screening, performed with rectal swabs collected at admission and weekly thereafter, was implemented to search for S. marcescens presence. Environmental samples were collected. All the isolates, obtained from the conjunctival swab of six newborns, from rectal swab of two newborns who did not develop infections, as well as from the aerators of two faucets, were sequenced. WGS analyses showed no correlation between the isolates from newborns and environmental isolates. The implementation of the measures for infection prevention and control had enabled us to successfully control the outbreak within a short period. WGS analyses proved to be crucial in outbreak investigation to limit the spreading of the pathogens.

Vaccination coverage and mortality after splenectomy: results from an Italian single-centre study.

Splenectomy is a well-recognised risk factor for life-threatening overwhelming post-splenectomy infection (OPSI). To prevent OPSI, immunisations against encapsulated bacteria (S. pneumoniae, N. meningitidis, H. influenzae) and influenza virus are recommended. However, there is still a lack of uniformity and poor compliance with these recommendations. Following a local physicians' awareness campaign regarding the importance of vaccine prophylaxis of splenectomised patients, we aimed to register vaccination coverage, mortality and infection rates in all patients who underwent splenectomy at our hospital, over a six-year time span. Reasons for splenectomy, patients' compliance with vaccinations, mortality and infectious events were recorded. The reasons for splenectomy in the 216 identified patients (mean age 58.2 ± 14; M:F ratio 1.4:1) were haematologic disorders (38.8%), solid tumours (28.7%), traumatic rupture (22.7%) and other causes (9.7%). A total of 146 patients (67.6%) received at least one of the four vaccines. Overall, the mortality rate was significantly greater in unvaccinated compared to vaccinated patients (p < 0.001), although after the adjustment for the cause of splenectomy the statistical significance was lost (p = 0.085) due to the burden of solid tumour-related mortality. Among the 21 reported cases of OPSI, eight were fatal and five were potentially vaccine-preventable. Our results show that two-thirds of splenectomised patients comply with vaccine prophylaxis. Future interventional studies or ad hoc registries might overcome barriers to vaccination or intentional non-compliance.

[Accidents with risk of blood-borne infections in obstetricians: analysis of a hospital case records]. / Infortuni a rischio di malattie a trasmissione ematica nel personale ostetrico: analisi di una casistica ospedaliera.

BACKGROUND: Health care workers (HCW) are at high risk of accidental contact with biological fluids. In spite of extensive recom mendations concerning HCW accidents continue to be frequent and seem to be related to specific factors. OBJECTIVES: To evaluate the factors influencing risk of blood-borne infections in a particular category of HCW--obstetricians, and obtain information useful for prevention guidelines. METHODS: Data were obtained from the exposure registers of nursing and of the Emergency Ward staff where HCWfirst report after accidental contact with biological fluids. RESULTS: Accidents with risk of blood-borne diseases were more frequent in obstetricians with lower job seniority. They usually occurred between 8 a.m. and 4p. m., in the patient's room. The hands and face (particularly the eyes) were the body parts more often involved In almost half of the accidents, the worker was not wearing any personal protective device. Although some contacts were with infected blood, no seroconversion occurred. CONCLUSIONS: Obstetricians are at high risk of contact with biologicalfluids. Prevention requires a global strategy including the availability of protective and safety devices, as well as worker education, especially concerning the use of such devices, the application of the universal rules of prevention and the improvement of risk awareness. An adequate post-exposure management of accidents in also required