Vaccination coverage in healthcare workers: a multicenter cross-sectional study in Italy.

INTRODUCTION: In recent years, a phenomenon known as "vaccine hesitancy" has spread throughout the world, even among health workers, determining a reduction in vaccination coverage (VC).A study aimed at evaluating VC among healthcare workers (HCWs) in 10 Italian cities (L'Aquila, Genoa, Milan, Palermo, Sassari, Catanzaro, Ferrara, Catania, Naples, Messina) was performed. MATERIALS AND METHODS: Annex 3 of the Presidential Decree n. 445 of 28 December 2000 was used to collect information on the vaccination status of HCWs. The mean and standard deviation (SD) were calculated with regard to the quantitative variable (age), while absolute and relative frequencies were obtained for categorical data (sex, professional profile, working sector, vaccination status). The connection between VC and the categorical variables was evaluated by chi-square method (statistical significance at p < 0.05). The statistical analyses were performed by SPSS and Stata software. RESULTS: A total of 3,454 HCWs participated in the project: 1,236 males and 2,218 females.The sample comprised: physicians (26.9%), trainee physicians (16.1%), nurses (17.2%) and other professional categories (9.8%). Low VC was generally recorded. Higher VC was found with regard to polio, hepatitis B, tetanus and diphtheria, while coverage was very low for measles, mumps, rubella, pertussis, chickenpox and influenza (20-30%). CONCLUSIONS: This study revealed low VC rates among HCWs for all the vaccinations. Measures to increase VC are therefore necessary in order to prevent HCWs from becoming a source of transmission of infections with high morbidity and/or mortality both within hospitals and outside.

Healthcare-associated Clostridium difficile infection: role of correct hand hygiene in cross-infection control.

INTRODUCTION: Clostridium difficile (CD) is the most common cause of health-care-associated infectious diarrhea with increasing incidence and severity in recent years. The main cause of hospital's acquired cross infections can be attributed to incorrect hand hygiene. We described the epidemiology of CD infection (CDI) in a teaching hospital in Southern Italy during a two years surveillance period and evaluated the health-care workers compliance to hand hygiene. METHODS: CDI Incidence rates were calculated as the number of patients with positive C. difficile toxin assay per 10,000 patient-days. Compliance with hand hygiene was the ratio of the number of performed actions to the number of opportunities observed. Approximately 400 Hand Hygiene (HH) opportunities/year /ward were observed. We finally checked out if any correlation could be found. RESULTS: From January 2015 to December 2016 a total number of 854 CD determinations were performed in patients with clinical symptoms of diarrhea. The search for toxins A and B was positive in 175 cases (21,2%), confirming the diagnosis of CDI. Compliance to hand hygiene was significantly inversely associated with the number of CDIs: the lower the compliance of health-care workers with hand hygiene the higher was the number of cases of CDIs (p = 0.003). CONCLUSIONS: According to our results proper handwashing of health-care workers appears to be a key intervention in interrupting CD cross infections regardless of age and type of department in which the patient is admitted.

Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study.

BACKGROUND: Vaccine hesitancy is a considerable issue in European countries and leads to low coverage rates. After a long debate, Italy has made vaccination mandatory for admission to its schools. METHODS: In the NAVIDAD study (a cross-sectional multicentre study), a 63-item questionnaire was administered to 1820 pregnant women from 15 Italian cities. The questionnaire assessed the interviewee's opinion on mandatory vaccines, as well as their socioeconomic status, sources of information about vaccines, confidence in the Italian National Healthcare Service (NHS), and intention to vaccinate their newborn. RESULTS: Information sources play a key role in determining the opinion on restoration of mandatory vaccines; in particular, women who obtained information from anti-vaccination movements are less likely to accept the vaccines (OR: 0.35, 95% CI: 0.21-0.58, p < 0.001). Women who had confidence in healthcare professional information agreed more on mandatory vaccination than did the other women (OR: 2.66, 95% CI: 1.62-4.36, p < 0.001); those who perceived that healthcare professionals have economic interest in child immunization and who declared that healthcare providers inform only on vaccinations benefits not on risks were less likely to agree on compulsory vaccination (OR: 0.66, CI 95%: 0.46-0.96, p = 0.03; OR: 0.66, CI 95%: 0.46-0.95, p = 0.03, respectively). CONCLUSION: Information sources and confidence towards health professionals are the main determinants of acceptance of mandatory vaccine restoration. To increase the acceptability of the restoration and reduce vaccine hesitancy, these aspects need to be strengthened.

Antimicrobial potential of Sicilian honeys against commensal Escherichia coli and pathogenic Salmonella serovar infantis.

INTRODUCTION: The purpose of this study was to investigate the antibacterial effect of 71 locally produced honeys from different botanical sources collected from apiarist's open markets in Sicily. METHODS: Antimicrobial activity was determined against Escherichia coli (ATCC 25922) and Salmonella serovar Infantis (ATCC 1523) by an agar-diffusion assay from the estimation of the diameter of the inhibition zone produced by the honeys. Statistically) significant differences (P < .000) regarding inhibition were observed for the honeys tested. RESULTS: The chestnut and polyfloral honey samples exhibited the largest and highest inhibition (diameter of the inhibition zone > 25 mm) against both E. coli and S. Infantis. The honey of oregano origin showed intermediate or low activity against E. coli and S. Infantis, respectively. Prickly pear and erica honeys showed no antimicrobial activity against the two reference strains. DISCUSSION: The results may partially suggest the usefulness of the Sicilian honeys on treating multi-resistant enterobacteria. In light of the enormous potential for application of honey in the clinical practice, it is important that research continues not only into those honeys well recognized as antimicrobial, but also into other locally produced and yet untested honeys.

Persistent oral and urinary Candida spp. carriage in Italian HIV-seropositive asymptomatic subjects.

The aim of the present study was to ascertain frequency and persistence of Candida spp. oral and urinary carriage in asymptomatic, HAART-naive HIV-seropositive subjects who had not undergone therapy with antimycotic drugs, and whose CD4+ lymphocyte count was greater than 200/microl. Oral carriage was the most common Candida spp. carriage (63.0% of the subjects), while candiduria was more rarely observed (6.5%). C. albicans was recovered from the majority of the subjects examined (56.5%), followed by C. krusey (4.3%), C. tropicalis (2.2%) and C. dubliniensis (2.2%). C. albicans was also isolated from two urinary carriers (4.3%) and C. glabrata from another one (2.2%). The same C. albicans clone was repeatedly isolated from 14 out of 15 oral carriers while the same clone of C. dubliniensis was repeatedly isolated from one carrier, as shown by the persistence of RAPD fingerprint of serial isolates during one year of follow-up. Since persistence of Candida spp. carriage may influence the development of clinical candidiasis in immunocompromised hosts, monitoring of the carrier status could be useful for preventing clinical thrush in HIV-seropositive subjects.

[Microbiological quality of the Catania coastal sea water]. / La qualità microbiologica delle acque marine del litorale di Catania.

This study was carried out from 1997 to 1998 along a selected coastal area near Catania to ascertain bacteriological and virological quality of marine waters. 44 seawater samples, collected from 4 stations, were assayed for the presence of total and fecal coliforms, fecal streptococci, coliphages, Salmonellae and enteric viruses. Two stations localized at canal outfalls showed high levels of fecal pollution. The other stations were of good microbiological quality and showed a limited number of samples exceeding the standards laid down as guide values for bathing waters by Italian normative during the bathing period. Salmonellae were isolated in 8 out of 44 sea water samples (18%). Their presence was ascertained mainly in samples of the two polluted stations. Enteroviruses were not isolated. Enteric viruses such as Reoviruses were isolated from all stations, in 12 out of 44 samples (27%). The presence of these viruses was ascertained only during autumnal and winter seasons. The results of this study showed that, notwithstanding some stations showed high levels of bacteriological indicators of fecal pollution and presence of Salmonellae, enteroviruses growing on cell cultures were not isolated. Reoviruses confirmed their high diffusion in marine waters.

Use of hybridization assay and direct immuno assay for detection of Salmonella spp. in surface waters and a comparison with conventional culture procedure.

Hybridization assay and direct immunoassay for detecting Salmonella in contaminated surface waters have been compared with the conventional culture procedure. The 67 samples examined were taken from different rivers in the provinces of Catania and Ragusa. By culture method, Salmonella was isolated in 23 samples (34%), while direct immunoassay revealed the presence of Salmonella in 58 samples (87%) and the hybridization method identified Salmonella in 20 samples (30%). On the basis of the results obtained, the direct immunoassay method proved to be inaccurate for the high number of false positives revealed. The DNA probe test gave almost identical results to those obtained with the culture method, with notably shorter execution times than the latter. This test proved to be both sensitive and specific and could be used for the direct demonstration of Salmonella in surface waters where it is easier to find bacteria under stress from the environmental conditions, in waters where isolation is difficult, and in all those environmental control conditions which do not require isolation and the serological typing of the strains of Salmonella.

Molecular typing of Klebsiella pneumoniae isolates from a neonatal intensive care unit.

The epidemiological features of 60 multiresistant K. pneumoniae strains isolated from 1991 to 1995 in a neonatal ward are described. Antibiotic. Susceptibility testing and plasmid profile analysis were used as subtyping procedures. Antibiotic susceptibility typing was not informative enough since discrimination among isolates was typically poor. Plasmid profile analysis demonstrated that 58 out of 60 strains harboured one or more plasmid DNA bands, of different molecular weights ranging between 1.8 and 150 Mda. Small plasmids were best visualized after the alkaline lysis procedure, while large plasmids by the Kado and Liu method. A combination of plasmid patterns obtained by the two extraction procedures was used to define the final plasmid profile for each strain. Thirteen different plasmid profiles were identified among the collection of K. pneumoniae isolates from newborn patients of the same intensive care unit. The investigation showed that the strains were not responsible for a single outbreak.

Molecular characterization of trimethoprim resistance in salmonellas isolated in Sicily, 1985-1988.

The occurrence of trimethoprim (Tp) resistance in salmonellas isolated from humans and water samples in Sicily between 1985 and 1988 has been investigated and the Tp resistance mechanisms have been further characterized on the basis of hybridization with probes for the dihydrofolate reductase (DHFR) genes types I, II, IV and V. Of 765 strains examined, high level (> 1000 mg/l) resistance to Tp was identified in 23 strains (3%). In 22 of these strains, such resistance was associated with resistance to sulphonamides. Six serovars with Tp-resistant strains were identified, Salmonella typhimurium (14 strains), S. enteridis (2), S. agona (2), S. mbandaka (2), S. virchow (2), S. indiana (1). In all strains with high level Tp resistance, resistance to this antimicrobial was plasmid-encoded, in most strains by plasmids with MWs ranging from 70-100 MDa. On the basis of restriction endonuclease analysis, four different categories of Tp resistance plasmids were identified in Tp-resistant strains of S. typhimurium. Hybridization with the DHFR I probe was observed in three strains of Tp-resistant S. typhimurium and two strains of Tp-resistant S. enteritidis; in contrast, in none of the strains tested was there any detectable hybridization with the probes for DHFR types II, IV and V. It is concluded that the DHFR type I resistance mechanism, common in Tp-resistant enterobacteria in many European countries, is relatively uncommon in Tp-resistant salmonellas isolated in Sicily. Furthermore, the DHFR V resistance mechanism, previously identified in strains of Shigella sonnei isolated in Sicily and associated with travellers from Sri Lanka, has not yet appeared in salmonellas in Sicily.

Plasmid content in different serovars of Salmonella isolated in Sicily: an ecology study.

This study determined plasmid relative abundance and distribution among a representative collection of Sicilian strains of Salmonella, with the purpose of gaining more insight into bacterial and plasmid ecology. 161 Salmonella strains of different serovars, isolated in Sicily from human and environmental sources between 1981 and 1985 were characterized by plasmid profile typing. Two main sets of Salmonella serovars were identified, one composed by plasmid-free serovars, rarely associated with clinical salmonellosis but typical of environmental niches; the other comprising the serovars usually encountered as major agents of human and animal salmonellosis. The biological relevance of the baseline information so provided on the genetic profiles of different serovars in Sicily is discussed.

Molecular characterization of Yersinia strains isolated from human and environmental sources.

Thirty-seven strains of Yersinia isolated from human and environmental sources were investigated for virulence and molecular characteristics. Clinical isolates of Y. enterocolitica serotypes 0:3 and 0:9, harbouring the 45 MDa virulence plasmid were Ca++ dependent and responded positively to the CV-binding assay. The environmental Y. kristensenii strain, although harbouring a 45 MDa plasmid proved to be negative for both assays. All the environmental strains showed pyrazinamidase activity, while isolates from human sources proved negative. Two different plasmid profiles were disclosed: one Y. enterocolitica strain (serotype 0:7, 8) showed one plasmid of 67 MDa and one plasmid of 1.5 MDa. Eleven human isolates of Y. enterocolitica and one environmental strain of Y. krinstensenii showed only one plasmid of 45 MDa. Restriction endonuclease analysis of the 45 MDa plasmids supported the hypothesis that the environmental Y. krinstensenii plasmid is unrelated to the family of homologous virulence plasmids of Y. enterocolitica.

[Isolation of S. mbdakada from a child seen at the University of Messina pediatric clinic]. / Isolamento di S. mbandaka da un minore ricoverato nella clinica pediatrica dell'università di Messina.

The authors made some diagnostic investigation into a serious case of diarrhoea observed in an infant in the pediatric ward of the University hospital of Messina (Sicily). They brought into evidence some of the causes of the world wide spread of salmonella infection, in particular the spread of new serum-types, such as S. mbandaka, which was involved in this case.

Molecular characterization of trimethoprim resistance in Shigella sonnei in Sicily.

During the 3-year period 1985-7, all strains of Shigella sonnei isolated in Catania, Sicily, showed a high level of resistance to trimethoprim (Tp) which was invariably associated with resistance to other antibiotics. Plasmid analysis showed 18 different electropherotypes: 35 of 37 strains harboured a plasmid of 70 Megadaltons (MDa), and 29 of 37 strains a plasmid of 130 MDa. Restriction endonuclease fingerprinting of purified 70 MDa plasmid DNA from different strains demonstrated that these plasmids were similar but not identical. In some strains with transferable Tp resistance, DNA hybridization analysis demonstrated the presence of gene coding for the production of dihydrofolate reductase (DHFR) type V. In contrast, there was no detectable hybridization with DNA probes specific for genes coding for DHFR types I, II and IV. This is the first report of the DHFR type V gene outside Sri Lanka.

Plasmid resistance to ampicillin in Salmonella typhi.

A Salmonella typhi strain resistant to ampicillin, streptomycin and sulfonamides was isolated in Catania in 1988. It has been shown that these resistances were encoded by an auto-transferable R-plasmid, of molecular weight 70 Md, belonging to the incompatibility group B.

Antibiotic resistance and R plasmids in endemic strains of Salmonella typhimurium isolated in Sicily.

The characteristics of R plasmids in strains of Salmonella typhimurium isolated in Sicily during 1983 from apparently isolated cases of human infection have been determined. A plasmid of the Inc group 10-B-0, characterized by ApSm resistance markers and with a molecular weight of 70 Md, was found in strains belonging to different phage types (2, 3, 117, 135, NT). The data obtained suggest that strains of the same phage type harboring such plasmids come from the same bacterial clone which has continued to be endemic through interhuman contagion. Instead, the presence of the same plasmid in strains of different phage type could indicate its spreading in different bacterial clones.