Legionella anisa or Legionella bozemanii? Traditional and molecular techniques as support in the environmental surveillance of a hospital water network.

Understanding the actual distribution of different Legionella species in water networks would help prevent outbreaks. Culture investigations followed by serological agglutination tests, with poly/monovalent antisera, still represent the gold standard for isolation and identification of Legionella strains. However, also MALDI-TOF and mip-gene sequencing are currently used. This study was conducted to genetically correlate strains of Legionella non pneumophila (L-np) isolated during environmental surveillance comparing different molecular techniques. Overall, 346 water samples were collected from the water system of four pavilions located in a hospital of the Apulia Region of Italy. Strains isolated from the samples were then identified by serological tests, MALDI-TOF, and mip-gene sequencing. Overall, 24.9% of water samples were positive for Legionella, among which the majority were Legionella pneumophila (Lpn) 1 (52.3%), followed by Lpn2-15 (20.9%), L-np (17.4%), Lpn1 + Lpn2-15 (7.1%), and L-np + Lpn1 (2.3%). Initially, L-np strains were identified as L. bozemanii by monovalent antiserum, while MALDI-TOF and mip-gene sequencing assigned them to L. anisa. More cold water than hot water samples were contaminated by L. anisa (p < 0.001). PFGE, RAPD, Rep-PCR, and SAU-PCR were performed to correlate L. anisa strains. Eleven out of 14 strains identified in all four pavilions showed 100% of similarity upon PFGE analysis. RAPD, Rep-PCR, and SAU-PCR showed greater discriminative power than PFGE.

[Healthcare-associated infections and antibiotic resistance: a global challenge for the 21st century]. / Le infezioni correlate all'assistenza e l'antibioticoresistenza: una sfida globale del XXI secolo.

Healthcare-associated infections (HAIs) are a significant cause of patient morbidity and mortality. They represent one of the biggest Public Health problems today as they prolong hospital stay, reduce quality of life and increase mortality. The frequency and severity of HAIs have increased due to increased severity of patients being admitted to hospitals, increased use of vascular catheterization and progressive spread of antibioticresistant strains. In Italy, there are wide regional variations in antibiotic consumption and in the incidence of infections by multiresistant germs. This suggests the need to not only limit consumption of antibiotics but also to improve their appropriate use. Unfortunately, not all HAIs are preventable: it is therefore advisable to selectively monitor those that are attributable to problems in the quality of care. Prevention of HAIs is obviously aimed at protecting the health of patients; however, occupational exposure of healthcare workers (HCW) has also been receiving increased attention. This has resulted in the dissemination of guidelines and operating instructions aimed at minimizing the risk of exposure to biological agents, through the implementation of general and specific infection control measures. The authors also highlight that litigation related to HAIs is a trend that should be kept in mind by every HCW, especially in light of the fact that the frequency of malpractice liability claims is increasing.