ABSTRACT
In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) have increased since November 2018. Between November 2018 and October 2019, 1,645 samples were NDM-CRE-positive: 1,270 (77.2%) cases of intestinal carriage, 129 (7.8%) bloodstream infections and 246 (14.9%) infections/colonisations at other sites. Klebsiella pneumoniae were prevalent (1,495; 90.9%), with ST147/NDM-1 the dominant clone. Delayed outbreak identification and response resulted in sustained NDM-CRE transmission in the North-West area of Tuscany, but successfully contained spread within the region.
Subject(s)
Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Disease Outbreaks , Klebsiella Infections/epidemiology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , beta-Lactamases/metabolism , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Drug Resistance, Multiple, Bacterial/drug effects , Female , Humans , Infant , Infant, Newborn , Italy/epidemiology , Klebsiella Infections/drug therapy , Klebsiella pneumoniae/enzymology , Klebsiella pneumoniae/metabolism , Male , Microbial Sensitivity Tests , Middle Aged , Young Adult , beta-Lactamases/drug effects , beta-Lactamases/geneticsABSTRACT
The objective of this study was to verify if the enrollement of patients aged over sixty-five (over 65), in the territorial assistance programs of a mountain area, has reduced and optimized the volume of hospitalizations. During 2009, 422 patients over 65 who were non self-sufficient, with iso-severity level (IL) from 5 to 0 (Regione Toscana, Decreto n. 1354 del 25 Marzo 2010), were enrolled in home care programs. These data were processed despite the following analytical limitations: 1) inability to provide all tax codes (entered manually in database), the corrisponding personal data; 2) necessity to make cross-comparisons among numerous archives of data from different sources; and 3) lack to identify the outcome indicators for each patient. The assisted patients are characterized by a very high hospitalization rate. Among the main diseases, the following needed at least one hospitalization: dementia, stroke, cancer, osteoarticular diseases, cerebrovascular disease and Parkinson's disease. Therefore it is necessary to re-evaluate the current procedures adopted for the management of chronic diseases in the elderly in their own homes.
