Convalescent Plasma for Hospitalized COVID-19 Patients: A Single-Center Experience.

In Winter 2020, Italy, and in particular the Lombardy region, was the first country in the Western hemisphere to be hit by the COVID-19 pandemic. Plasma from individuals recovered from COVID-19 (COVID-19 convalescent plasma, CCP) was the first therapeutic tool adopted to counteract the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In this retrospective cohort study, we report the experience of the city hospital of Mantua, Lombardy region, on the compassionate use of CCP in patients hospitalized for severe COVID-19. Between April 2020 and April 2021, 405 consecutive COVID-19 patients received 657 CCP units with a median anti-SARS-CoV-2 neutralizing antibody (nAb) titer of 160 (interquartile range (IQR), 80−320). Their median age was 68 years (IQR, 56−78 years), and 62% were males. At enrollment, 55% of patients had an increased body mass index (BMI), and 25.6% had at least three comorbidities. The 28-day crude mortality rate was 12.6% (51/405). Young age (<68 years), mild disease (admission to low-intensity departments) and early treatment (<7 days from symptoms onset) with high nAb titer (≥320) CCP were found as independently associated with a favorable response to CCP treatment. No safety concerns were recorded, with a rate of CCP-related adverse reactions (all of mild intensity) of 1.3%. In our real-life experience, the first in the western world, early administration of high-titer CCP was a safe and effective treatment for hospitalized COVID-19 patients.

[The COVID-19 Epidemic: the experience in the Social and Health Care Center of the Mantua District (Lombardy Region, Northern Italy)]. / Epidemia di COVID-19: l'esperienza della struttura socio sanitaria territoriale provinciale di Mantova.

OBJECTIVES: to describe the course of COVID-19 epidemic in the hospitals of the ASST of Mantua (Lombrady Region, Northern Italy) from February 2020 to April 2021. DESIGN: observational study. SETTING AND PARTICIPANTS: data from hospital discharging chart of all patients admitted to the hospitals of ASST were collected from 26.02.2020 to 30.04.2021 with COVID-19 diagnosis. Data from Emergency Rooms for patients evaluated but not admitted to departments were also collected. MAIN OUTCOME MEASURES: the data from hospital discharging were crossed for diagnosis with data from laboratory. The department were classified into 'low intensity' and 'middle/high intensity'. The comparison was according to the different periods of epidemic. RESULTS: patients admitted to the hospitals were 2,738: 510 died (17.3%) and 1,736 patients were evaluated in the Emergency Rooms but not admitted to departments. Among these patients, 166 died (9.6%). The prevailing age class were >=65 years, with a trend to reduction in the third wave. The proportion of admission in middle/high intensity departments was significantly higher in the second wave than in the first. N. 510 deaths by 2,738 (17.3%) were observed, with significant reduction in the second and third waves in the low intensity departments (from 21.9% to 14.3% and 12.7%) (p<0.001), while mortality was substantially unchanged in the middle/high intensity departments (28.0%, 29.6%, and 28.3%). The mortality for patients with >=65 years was 26.7%. Females showed lower mortality (OR 0.690; CI95% 0.560-0.840) and lower incidence of admissions in middle/high intensity departments (OR 0.556; CI95% 0.459-0.673) in the three waves. Finally, including also the patients not admitted, the general mortality was 15.1%. CONCLUSIONS: a worse outcome by mortality and severity of disease was observed for male gender compared to female and for older age classes. Moreover, a significant improvement of outcomes in the second and third waves, compared to the first, was pointed out.

[Prevention and management of antibiotic-resistant bacterial infections in patients on hemodialysis]. / Prevenzione e gestione delle infezioni da germi antibiotico-resistenti nei pazienti emodializzati.

Infections contracted during hemodialysis are an important aspect of the issue of healthcare-associated infections (HCAIs). The dialyzed kidney patient has a very high risk of infections, which may be life-threatening. Only the strict application of proper nursing standards, in addition to surveillance and good management of the patient, will allow to lower the incidence of infections. We studied the hemodialysis-related infection risk by evaluating the types of patients, medical devices, and nursing practices involved. Patient outcome can be improved by the implementation of correct management practices. The analysis of variables including standards of good practice, hand washing, and surveillance of colonized patients will promote the development of effective measures to reduce the incidence of infections, particularly antibiotic-resistant ones.

[Epidemiology of ESBL-positive Enterobacteriaceae in Mantova hospital (Italy)]. / La problematica della circolazione di Enterobacteriaceae ESBL positive: situazione epidemiologica nell'Azienda Ospedaliera di Mantova.

In a retrospective study concerning the epidemiology of extended-spectrum beta-lactamase (ESBL) positive Enterobacteriaceae during 2007-2008 in the wards of the Carlo Poma hospital in Mantova, Mercurio surveillance software was used to detect alert microorganisms. Our objective was to link the epidemiological data with the type of patient and ward, and to assess the risk factors for such infections in particular nosocomial environments. The study enabled the change in the relative epidemiological data to be detected, and showed that such bacteria can be found almost throughout the hospital.

[Reduced incidence of Staphylococcus isolation in nosocomial setting after introducing preoperative antibiotic prophylaxis guidelines]. / Riduzione dell'incidenza di isolamento di stafilococchi in ambiente nosocomiale dopo I'introduzione di linee-guida di antibioticoprofilassi preoperatoria.

We compare epidemiological data from two twelve-month periods, before and after the introduction of preoperative antibiotic prophylaxis guidelines at Carlo Poma hospital in Mantova, Italy, in June 2003. Considering the results from the microbiology laboratory and the data from the pharmacy, concerning the consumption of some antimicrobials, we noted a significant decrease in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in surgical wards, where the incidence of MRSA had previously exceeded that in medical wards. At the same time, analysis of antibiotic consumption revealed a considerable decrease in third and fourth-generation cephalosporins and an increasing use of cephazolin, in compliance with prophylaxis protocol rules. This trend was confirmed by analysis of the same data regarding the first six months of 2006.