Nightmare in the ward: difficult Clostridioides infection.

Clostridioides difficile is a Gram-positive, anaerobic, spore-forming bacillus. It is isolated in 80% of the stools of children and infants and in 3% of healthy adults. It causes gastrointestinal tract infections and affects patients who make prolonged use of antibiotics. It causes C. difficile colitis with symptoms ranging from diarrhoea to pseudomembranous colitis to toxic megacolon. The main virulence factors of C. difficile are toxin A, toxin B, and binary toxin. It is one of the most common nosocomial infections but in recent years, however, many infections have also been found at the community level. They are associated not only with a high risk of mortality but also with a prolongation of hospital stay. One of the critical aspects of C. difficile infections is also represented by the high frequency of relapses. Consequently, the economic impact is significant. Specific situations constitute risk factors for infection, such as exposure to antibiotic therapy in the previous months, in particular fluoroquinolones, third-generation cephalosporins, clindamycin, repeated hospitalizations in healthcare facilities, including long-term care, as well as the patient's clinical conditions such as comorbidities, age >65, chemotherapy and immunosuppressive treatments, recent surgery of any type, and pump inhibitor therapy. Treatment protocols will be described in the paper.

Clostridium difficile infection in the elderly.

The incidence of C. difficile infections (CDI) in the elderly continues to rise and infection is associated with increased morbidity and mortality when compared to those affected in younger age-groups. Immunosenescence may be a contributory factor yet the exact immune responses that may protect against CDI are incompletely understood. Increased exposure to antibiotics, frequent and/or prolonged hospital admissions and residing in long-term care facilities provide multiple opportunities for host and pathogen to coincide. This review explores the epidemiology, diagnostic parameters and management of the spectrum of disease in the geriatric population. Deaths attributed to CDI are most common in the elderly population and are a major contributor to gastroenteritis-associated mortality in many countries. The elderly represent an at-risk population from this pathogen and efforts must be directed to preventing infection and optimising treatment in this group.

Case report: safety and efficacy of tocilizumab in a patient with rheumatoid arthritis and chronic hepatitis C.

Tocilizumab is a monoclonal humanized anti-IL-6-receptor antibody used for the treatment of rheumatoid arthritis. The safety of tocilizumab in HCV patients is an open question. We report on safety and efficacy of tocilizumab in a 71-year-old female with rheumatoid arthritis and chronic hepatitis C. Monotherapy with tocilizumab (8 mg/kg every 4 weeks, i.v.) was prescribed after the discontinuation, determined by clinical inefficacy, of anti-TNF-alfa agents (adalimumab and, subsequently, etanercept). We have registered an optimal and rapid clinical response to tocilizumab with early remission (SDAI <3.3 since 4 weeks). The safety was good with no adverse events and maintenance, during a six-month followup, of normal liver enzymes. These data suggest a good safety profile of tocilizumab in patients with rheumatoid arthritis and chronic hepatitis C virus pathology.

[Rheumatoid arthritis: a typical multifactorial genetic disease: review of the literature]. / L'artrite reumatoide come modello di malattia genetica multifattoriale: una rassegna della letteratura.

Environmental factors can be triggers for the clinical appearance of rheumatoid arthritis in subjects with genetic susceptibility. Genetic factors account for 60% of disease susceptibility. This review is focused on the genetic and environmental basis of the susceptibility to arthritis.

Molecular findings and antibiotic-resistance in an outbreak of Acinetobacter baumannii in an intensive care unit.

We investigated an outbreak of Acinetobacter baumannii in the intensive care unit (ICU) of a hospital in Rome, Italy. The outbreak involved 14 patients whose isolates were most frequently recovered from bronchoalveolar lavage. All isolates were multidrug-resistant and showed diminished susceptibility or resistance to carbapenems. A. baumannii strains with a similar antibiotic susceptibility pattern were isolated from the environment. Pulsed-field gel electrophoresis identified a single clone from both the patients' and environmental isolates. Because of the lack of a single source of infection, the eradication of the epidemic required a broad approach, including contact isolation and cohorting, aggressive environmental disinfection, and close monitoring of the ward staff's performance. Infected patients were successfully treated with combined therapy. Although considered of low virulence, A. baumannii can be particularly aggressive and difficult to treat in ICU patients.