RESUMEN
PURPOSE: Data regarding the implementation of state-of-the-art methicillin-resistant Staphylococcus aureus (MRSA) control procedures in Italy are lacking. There is a need to evaluate compliance with MRSA recommendations (CR) in Italian hospitals. METHODS: A 67-question closed-answer survey was sent to all Italian hospitals, in order to analyze and evaluate program consistency with CR [hand hygiene (HH), contact precautions, screening of high-risk patients, decolonization, feedback on surveillance data, and antimicrobial guidelines and education programs]. RESULTS: 205 hospitals, which account for 42 % of national admissions, returned questionnaires. 131 hospitals (64 %) did not have written MRSA control guidelines. Hospitals reported the following levels of compliance with CR: (1) HH: 67 hospitals (33 %); (2) contact precautions: 33 (16 %); (3) MRSA screening: 66 (32 %); (4) MRSA decolonization: 42 (20 %); (5) surveillance data feedback: 87 (43 %); and (6) antimicrobial guidelines and education programs: 41 (20 %). One hospital (0.5 % of responses) had implemented all recommendations and 28 hospitals (14 %) had implemented four or five recommendations. 31 % of hospitals surveyed had implemented none. Multivariate analysis showed that the only factor identified as being associated with the implementation of MRSA control recommendations was the number of meetings/year of the infection control team (ICT) (p = 0.004). CONCLUSIONS: Written MRSA control guidelines are available in only one-third of Italian facilities. An organized system, with ≥4 interventions, has been implemented in just 1 out of 7 hospitals. HH programs and ICT activity are related to better MRSA control. In Italy, there is significant opportunity for improvement in MRSA control.
Asunto(s)
Investigación sobre Servicios de Salud , Control de Infecciones/métodos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/prevención & control , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Adhesión a Directriz/estadística & datos numéricos , Hospitales , Humanos , Italia/epidemiología , Infecciones Estafilocócicas/microbiología , Encuestas y CuestionariosAsunto(s)
Portador Sano/epidemiología , Staphylococcus aureus Resistente a Meticilina , Casas de Salud , Infecciones Estafilocócicas/epidemiología , Anciano , Anciano de 80 o más Años , Portador Sano/microbiología , Femenino , Humanos , Italia/epidemiología , Masculino , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Persona de Mediana Edad , Prevalencia , Infecciones Estafilocócicas/microbiologíaRESUMEN
OBJECTIVE: To study clustered Mycobacterium tuberculosis isolates as an indicator of recent TB transmission in a small urban setting in Italy, and to determine associated risk factors. METHODS: M. tuberculosis strains isolated between 1991 and 1997 were characterised by IS6110 restriction fragment length polymorphism (RFLP) analysis. RESULTS: One hundred and ninety-five isolates were available for RFLP analysis, which revealed 163 different patterns. Available cases were represented by 137 Italians (70%), 32 Senegalese (17%), and 26 other foreign-born cases (13%). A unique fingerprint pattern was found in 143 cases (73.3%), while 52 strains (26.7%) were grouped into 20 clusters. Nineteen cases (10%) were resident in the same quarter of Brescia with a high density of Senegalese immigrants (Area A). An increased probability of yielding clustered M. tuberculosis strains was associated with residence in Area A (OR 3.87, 95%CI 1.42-10.56; P = 0.02) and being Senegalese (OR = 5.96, 95%CI 1.48-23.97; P = 0.005). In the logistic regression analysis, being Senegalese was independently associated with yielding a clustered M. tuberculosis strain. CONCLUSIONS: Our results demonstrate a clustering of TB cases among Senegalese immigrants and suggest that RFLP analysis may be used to identify geographical areas where efforts can be targeted to interrupt TB transmission.
Asunto(s)
Emigración e Inmigración , Mycobacterium/aislamiento & purificación , Tuberculosis/microbiología , Tuberculosis/transmisión , Adulto , Anciano , Humanos , Italia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Proyectos Piloto , Polimorfismo de Longitud del Fragmento de Restricción , Factores de RiesgoAsunto(s)
Infección Hospitalaria/etiología , Infección Hospitalaria/patología , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Infecciones por Mycobacterium no Tuberculosas/patología , Mycobacterium chelonae/patogenicidad , Viaje , Adulto , Humanos , Italia , Masculino , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/patologíaRESUMEN
SETTING: Practical or cost-effective strategies to identify undocumented immigrants with latent tuberculosis infection and to deliver treatment for latent TB infection are still unavailable. OBJECTIVES: To compare completion rates of screening procedures for TB infection and disease among undocumented immigrants at specialised (TB) and unspecialised health services in Italy. DESIGN: A TB unit (TBU) and an unspecialised health service unit for migrants (MHCU) served as recruitment sites for recent undocumented immigrants from TB endemic areas. The screening included a symptom questionnaire, a tuberculin skin test and a chest X-ray. RESULTS: Of 1318 eligible subjects, 1232 (93.4%) accepted the screening. Screening was completed by 993 (80.6%) individuals overall, 86.5% and 71.4% at the TBU and MHCU services, respectively. In a multivariate analysis model, the only variable associated with an increased probability of completing screening was being enrolled at the TBU site (OR 2.5, 95%CI 1.8-3.5; P < 0.001). Three hundred and ninety-two subjects (39.4%) had a TST test of > or = 10 mm. Eight cases of active tuberculosis were detected, with a calculated prevalence of disease of 650/100,000. CONCLUSIONS: Undocumented immigrants to Italy can be screened for TB at an unspecialised health service unit, although not as efficiently as at a specialised TB unit.
Asunto(s)
Emigración e Inmigración , Servicios de Salud , Tuberculosis/diagnóstico , Latencia del Virus/inmunología , Estudios de Factibilidad , Femenino , Humanos , Italia , Masculino , Radiografías Pulmonares Masivas , Tamizaje Masivo , Oportunidad Relativa , Participación del Paciente , Análisis de Regresión , Factores Socioeconómicos , Prueba de Tuberculina , Tuberculosis/inmunología , Tuberculosis/fisiopatologíaRESUMEN
In a multicenter, prospective, randomized, open-label study of isoniazid-preventive therapy (IPT) for latent tuberculosis infection, illegal immigrants from countries where tuberculosis is highly endemic were enrolled at two clinical sites in Northern Italy. Of 208 eligible subjects, 82 received supervised IPT at a dose of 900 mg twice weekly for 6 mo (Regimen A), 73 received unsupervised IPT 900 mg twice weekly for 6 mo (Regimen B), and 53 received unsupervised IPT 300 mg daily for 6 mo (Regimen C). Supervised IPT was delivered at either one tuberculosis clinic or one migrant clinic. The probability of completing a 26-wk regimen was 7, 26, and 41% in Regimens A, B, and C, respectively (p < 0.005, Log- rank test calculated using Kaplan-Meier plots). The mean time to dropout was 3. 8, 6, and 6.2 wk in Regimens A, B, and C, respectively (p = 0.003 for regimen A versus either Regimens B or C). Treatment was stopped in five subjects (2.4%) because of adverse events. The rate of completion of preventive therapy for latent tuberculosis infection among illegal immigrants was low. Supervised, clinic-based administration of IPT significantly reduced adherence. Alternative strategies to implement preventive therapy in illegal immigrants are clearly required.
Asunto(s)
Antituberculosos/administración & dosificación , Emigración e Inmigración , Isoniazida/administración & dosificación , Cooperación del Paciente , Tuberculosis Pulmonar/prevención & control , Adolescente , Adulto , Antituberculosos/efectos adversos , Femenino , Humanos , Isoniazida/efectos adversos , Italia , Masculino , Estudios Prospectivos , Factores SocioeconómicosRESUMEN
SETTING: Tuberculosis is the world's foremost cause of death from a single infectious agent among adults. Although morbidity and mortality rates are highest in low income countries, industrialized countries have also faced a recent resurgence of the tuberculosis epidemic. In Europe and the United States increasing tuberculosis incidence rates are observed, particularly among persons with the human immunodeficiency virus infection and immigrants from highly endemic countries. OBJECTIVE: To measure the incidence of tuberculosis in a retrospective cohort of Senegalese immigrants in a closed community. DESIGN: During 1991, 721 of 794 (91%) community residents were actively screened using the tuberculin skin test and chest X-ray. In 1995 the out-patient clinical charts and the tuberculosis notification registers were reviewed to determine tuberculosis incidence. RESULTS AND CONCLUSION: A total of 328 subjects (45.4% of those screened) was retrospectively followed for a cumulative period of 10 147 months. Ten cases of active tuberculosis were detected. The annual incidence rate for tuberculosis was 11.8/1000, compared to 15.1/ 100 000 in the general population. Tuberculosis incidence was similar in subjects with a positive (12.3/1000), compared to a negative baseline tuberculin test (12.5/1000). Tuberculosis incidence is very high, and recent infections might account for a substantial proportion of cases among immigrants living in closed communities.
Asunto(s)
Emigración e Inmigración , Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Senegal/etnologíaRESUMEN
Neurocysticercosis is rarely reported in short-term travelers, although the disease remains a major public health problem in tropical regions. We present a case of neurocysticercosis that was probably acquired by ingestion of Taenia solium eggs contained in the stomach of a pig butchered by the traveler. Complete clinical resolution was obtained by medical treatment, underlying the importance of early suspicion and diagnosis of the disease.
Asunto(s)
Parasitología de Alimentos , Neurocisticercosis/diagnóstico , Viaje , Adulto , Albendazol/uso terapéutico , Animales , Antihelmínticos/uso terapéutico , Encéfalo/patología , Ensayo de Inmunoadsorción Enzimática , Guatemala , Humanos , Italia/etnología , Imagen por Resonancia Magnética , Masculino , Carne/parasitología , Neurocisticercosis/etiología , Porcinos/parasitología , TaeniaAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/parasitología , Estrongiloidiasis/fisiopatología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Encefalopatías/complicaciones , Encefalopatías/diagnóstico , Encefalopatías/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estrongiloidiasis/complicaciones , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
We describe the management practices adopted in a case of pulmonary and extra-pulmonary tuberculosis caused by an isoniazid/pyrazinamide resistant strain of Mycobacterium bovis in a 26-week pregnant woman. She was initially treated with rifampin, isoniazid and ethambutol, pre-term delivery was induced and streptomycin was then added to the regimen. Screening of the new-born revealed no signs of either disease or infection. Isoniazid prophylaxis was not administered and the new-born was vaccinated and isolated from the mother for two months; however she continued to be fed with her mother's milk for the whole period.
Asunto(s)
Antituberculosos/uso terapéutico , Mycobacterium bovis/efectos de los fármacos , Complicaciones Infecciosas del Embarazo/microbiología , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Adulto , Quimioterapia Combinada , Emigración e Inmigración , Femenino , Humanos , Italia/epidemiología , Marruecos/etnología , Mycobacterium bovis/aislamiento & purificación , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológicoRESUMEN
Macrolide resistance in disseminated Mycobacterium avium infection is of major concern in AIDS patients as these drugs represent the main component of combination therapy. Clarithromycin and azithromycin should not be used alone for the treatment and prophylaxis of the disease because of the risk of selecting resistant strains. We report the case of a clarithromycin resistant disseminated M. avium infection in an AIDS patient, acquired after long term monotherapy with clarithromycin for the treatment of cryptosporidiosis.