Incidence and Predictors of Healthcare-Associated Infections in Patients Admitted to a Temporary Intensive Care Unit during the COVID-19 Pandemic Waves: A Two-Year (2021-2023) Retrospective Cohort Study in Rome, Italy.

To manage the number of critical COVID-19 patients, Umberto I Teaching Hospital in Rome established a temporary ICU on March 1, 2021. This study investigated the incidence and risk factors of healthcare-associated infections (HAIs) among these patients during various COVID-19 waves. Patients were grouped by admission date according to the dominant SARS-CoV-2 variant prevalent at the time (Alpha, Delta, Omicron BA.1, Omicron BA.2, Omicron BA.5, and Omicron XBB). First-HAI and mortality rates were calculated per 1000 patient-days. Predictors of first-HAI occurrence were investigated using a multivariable Fine-Gray regression model considering death as a competing event. Among 355 admitted patients, 27.3% experienced at least one HAI, and 49.6% died. Patient characteristics varied over time, with older and more complex cases in the later phases, while HAI and mortality rates were higher in the first year. Pathogens responsible for HAIs varied over time, with first Acinetobacter baumannii and then Klebsiella pneumoniae being progressively predominant. Multivariable analysis confirmed that, compared to Alpha, admission during the Omicron BA.1, BA.2, BA.5, and XBB periods was associated with lower hazards of HAI. Despite worsening COVID-19 patient conditions, late-phase HAI rates decreased, likely due to evolving pathogen characteristics, improved immunity, but also better clinical management, and adherence to infection prevention practices. Enhanced HAI prevention in emergency situations is crucial.

In vivo evolution to hypermucoviscosity and ceftazidime/avibactam resistance in a liver abscess caused by Klebsiella pneumoniae sequence type 512.

Carbapenemase-producing Klebsiella pneumoniae represents a major public health issue globally. Isolates with resistance to the newest drugs, like ceftazidime/avibactam (CZA), are increasingly reported. In this study, we analyzed the evolution of KPC-3-producing sequence type (ST) 512 K. pneumoniae strains isolated at three different times (hospitalization days 45, 56, and 78) from the same patient, two of which were observed in a pericholecystic liver abscess. The three K. pneumoniae isolates (295Kp, 304Kp, and hmv-318Kp) from the same patient were subjected to antimicrobial susceptibility testing, whole-genome sequencing, sedimentation assay, biofilm measurement, serum resistance assay, macrophage phagocytosis, and adhesion assays. KPC-producing isolate hmv-318Kp exhibited carbapenem susceptibility, hypermucoviscous (hmv) colony phenotype and CZA resistance. Virulence markers of hypervirulent Klebsiella were absent. Two non-synonymous mutations were identified in the hmv-318Kp genome comparing with isogenic strains: a single-nucleotide polymorphism (SNP) occurred in the pKpQIL plasmid, changing blaKPC-3 in the blaKPC-31 gene variant, conferring CZA resistance; and a second SNP occurred in the wzc gene of the capsular biosynthesis cluster, encoding a tyrosine kinase, resulting in the F557S Wzc protein mutation. The Klebsiella pneumoniae strain exhibiting an hmv phenotype (hmv-Kp) phenotype has been previously associated with amino acid substitutions occurring in the Wzc tyrosin kinase protein. We observed in vivo evolution of the ST512 strain to CZA resistance and acquisition of hypermucoviscosity. The pathogenetic role of the detected Wzc substitution is not fully elucidated, but other Wzc mutations were previously reported in hmv K. pneumoniae. Wzc mutants may be more frequent than expected and an underreported cause of hypermucoviscosity in K. pneumoniae clinical isolates. IMPORTANCE: Here we describe the evolution of KPC-3-producing ST512 K. pneumoniae isolated at three different times from the same patient of which the last one, from a biliary abscess, showed CZA resistance by KPC-31 production and manifested hmv colony phenotype. Hypervirulent Klebsiella pneumoniae (hv-Kp) isolates are increasingly reported worldwide. Their hypervirulent traits are associated with the presence of rmpA/A2 genes and an hmv. In this study, we identified an hmv-Kp that lacked the rmpA-D cluster but showed an amino acid substitution in the Wzc tyrosin kinase protein, involved in the capsular biosynthesis. This hmv-Kp strain emerged in vivo and evolved resistance to ceftazidime/avibactam resistance in a liver abscess of a patient. Our findings suggest that wzc mutations may be underreported, making it challenging to distinguish hv-Kp from "classic" K. pneumoniae with an hmv phenotype.

Decline in academic performance and mental health during the COVID-19 pandemic: a cross-sectional survey among Sapienza University of Rome students.

Introduction: The COVID-19 pandemic has posed significant challenges to the education system, leading to changes in student academic performance and mental health. The aim of this study was to evaluate variables relating to changes in academic performance and mental health during the pandemic. Methods: We carried out a cross-sectional study from 28 February 2022 to 13 April 2022, during the free SARS-CoV-2 screening campaign offered by Sapienza University of Rome. A structured questionnaire was constructed to explore the decline in academic performance during the COVID-19 pandemic. The Coronavirus Anxiety Scale (CAS), a validated self-reporting mental health screener of dysfunctional anxiety associated with the coronavirus crisis, was used. Results: A sample of 1,134 students was enrolled. A total of 25.4% of the participants reported a decline in academic performance. In addition, Coronavirus Anxiety Scale scores revealed that 133 (11.5%) students had a dysfunctional anxiety problem due to COVID-19. A multivariable logistic regression model showed that being a senior student (aOR: 0.70 95% CI: 0.52-0.96) and having good financial status (aOR: 0.64, 95% CI: 0.47-0.88) decrease the likelihood of a decline in academic performance, while not being Italian (aOR: 2.12, 95% CI: 1.29-3.48), having felt the need for psychological support (aOR: 2.58, 95% CI: 1.87-3.55) and being enrolled in a science/technology faculty (aOR: 1.81, 95% CI: 1.27-2.57) were more likely to result in a decline in academic performance. Conclusion: Our results show that the pandemic has affected academic performance. The COVID-19 emergency highlighted the importance of considering mental health and economic status in policymaking to effectively support students.

Prevalence and predictors of hand hygiene compliance in clinical, surgical and intensive care unit wards: results of a second cross sectional study at the Umberto I teaching hospital of Rome.

Introduction: Hand hygiene is the most cost-effective procedure for the prevention of healthcare-associated infections, but healthcare worker compliance is often insufficient. Research Design: The objective of this second cross-sectional study was to quantify hand hygiene compliance among the healthcare workers of a large teaching hospital, to explore associated factors and to compare results to those of the 2021 study. Methods: In 2022, educational sessions were conducted within each hospital department during which hospital healthcare workers received tailored feedback on the hand hygiene compliance registered in the previous year. Then, one month later, direct observations hand hygiene compliance with five World Health Organization recommendations were collected again by anonymous observers in each ward. Data were grouped by healthcare area (clinical, surgical and intensive care), and three multivariable logistic regression models were built to identify predictors of hand hygiene compliance. Result: Overall, 5,426 observations were collected by 73 observers in three weeks. Hand hygiene compliance was 79.7%, 73.5% and 63.1% in clinical, surgical and intensive care areas, respectively, increasing in clinical wards but decreasing in surgical departments compared to the 2021 study. The multivariable analyses showed that hand hygiene compliance after patient contact was consistently higher than before patient contact, while there was some variability in compliance with other factors across the three areas. Conclusion: The study found suboptimal adherence to good hand hygiene practice, with the lowest rates observed before patient interaction, which, together with the variability recorded across departments, underscores the challenges involved in achieving a uniform level of compliance. Hence, additional training is essential to raise awareness among healthcare workers, while repeating this survey over time will also be crucial, so that hand hygiene compliance can be monitored and any major issue identified.

Public health genomics research in Italy: an overview of ongoing projects.

Public health genomics (PHG) aims to integrate advances in genomic sciences into healthcare for the benefit of the general population. As in many countries, there are various research initiatives in this field in Italy, but a clear picture of the national research portfolio has never been sketched. Thus, we aimed to provide an overview of current PHG research projects at the national or international level by consultation with Italian institutional and academic experts. We included 68 PHG projects: the majority were international projects in which Italian researchers participated (n = 43), mainly funded by the European Commission, while the remainder were national initiatives (N = 25), mainly funded by central government. Funding varied considerably, from € 50,000 to € 80,803,177. Three main research themes were identified: governance (N = 20); precision medicine (PM; N = 46); and precision public health (N = 2). We found that research activities are preferentially aimed at the clinical application of PM, while other efforts deal with the governance of the complex translation of genomic innovation into clinical and public health practice. To align such activities with national and international priorities, the development of an updated research agenda for PHG is needed.

Keeping university open did not increase the risk of SARS-CoV-2 acquisition: A test negative case-control study among students.

BACKGROUND: During the SARS-CoV-2 testing program offered through the RT-PCR test by Sapienza University of Rome, we conducted a test-negative case-control study to identify risk factors for acquiring SARS-CoV-2 infection among university students. METHODS: Each SARS-CoV-2-positive case detected was matched to two controls randomly selected from students who tested negative on the same day. 122 positive students and 244 negative students were enrolled in the study. Multivariable conditional logistic regression models were built. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. A second model was limited to students who had attended campus. RESULTS: Out of 8223 tests for SARS-CoV-2, 173 students tested positive (2.1%), of whom 122 (71.5%) were included in the case-control study. In the first analysis, being a non-Italian student (aOR: 8.93, 95% CI: 2.71-29.41), having received only the primary vaccination course (aOR: 2.94, 95% CI: 1.24-6.96) compared to the booster dose, known exposure to a COVID-19 case or someone with signs/symptoms suggestive of COVID-19 (aOR: 6.51, 95% CI: 3.48-12.18), and visiting discos (aOR: 4.07, 95% CI: 1.52-10.90) in the two weeks before testing increased the likelihood of SARS-CoV-2 infection. Conversely, students attending in-person lectures on campus seemed less likely to become infected (aOR: 0.34, 95% CI: 0.15-0.77). No association was found with other variables. The results of the second model were comparable to the first analysis. CONCLUSIONS: This study indicates that if universities adopt strict prevention measures, it is safe for students to attend, even in the case of an infectious disease epidemic.

How well does vaccine literacy predict intention to vaccinate and vaccination status? A systematic review and meta-analysis.

This review quantified the association of vaccine literacy (VL) and vaccination intention and status. PubMed, Scopus, and Web of Science were searched. Any study, published until December 2022, that investigated the associations of interest were eligible. For each outcome, articles were grouped according to the vaccine administrated and results were narratively synthesized. Inverse-variance random-effect models were used to compare standardized mean values in VL domain(s) between the two groups: individuals willing vs. unwilling to get vaccinated, and individuals vaccinated vs. unvaccinated. This review of 18 studies shows that VL strongly predicts the vaccination intention while its association with vaccination status is attenuated and barely significant, suggesting that other factors influence the actual vaccination uptake. However, given the scarce evidence available, the heterogeneity in the methods applied and some limitations of the studies included, further research should be conducted to confirm the role of VL in the vaccination decision-making process.

Reduced Reliability of Procalcitonin (PCT) as a Biomarker of Bacterial Superinfection: Concerns about PCT-Driven Antibiotic Stewardship in Critically Ill COVID-19 Patients-Results from a Retrospective Observational Study in Intensive Care Units.

BACKGROUND: The aim of this study was to assess whether procalcitonin levels is a diagnostic tool capable of accurately identifying sepsis and ventilator-associated pneumonia (VAP) even in critically ill COVID-19 patients. METHODS: In this retrospective, observational study, all critically ill COVID-19 patients who survived for ≥2 days in a single university hospital and had at least one serum procalcitonin (PCT) value and associated blood culture and/or culture from a lower respiratory tract specimen available were eligible for the study. RESULTS: Over the research period, 184 patients were recruited; 67 VAP/BSI occurred, with an incidence rate of 21.82 episodes of VAP/BSI (95% CI: 17.18-27.73) per 1000 patient-days among patients who were included. At the time of a positive microbiological culture, an average PCT level of 1.25-3.2 ng/mL was found. Moreover, also in subjects without positive cultures, PCT was altered in 21.7% of determinations, with an average value of 1.04-5.5 ng/mL. Both PCT and PCT-72 h were not linked to a diagnosis of VAP/BSI in COVID-19 patients, according to the multivariable GEE models (aOR 1.13, 95% CI 0.51-2.52 for PCT; aOR 1.32, 95% CI 0.66-2.64 for PCT-72 h). CONCLUSION: Elevated PCT levels might not always indicate bacterial superinfections or coinfections in a severe COVID-19 setting.

State of the Art on Family and Community Health Nursing International Theories, Models and Frameworks: A Scoping Review.

A Family and Community Health Nursing (FCHN) model was first conceptualized by the WHO approximately 25 years ago in response to the epidemiological transition leading to major changes in the population health needs. To date, no study has comprehensively explored the adherence of current applications of FCHN to the WHO original framework. We carried out a scoping review on PubMed, Scopus and CINAHL with the aim to compare the main features of FCHN models developed at the international level with the WHO's framework. We identified 23 studies: 12 models, six service/program descriptions, four statements and one theoretical model. The FCHN models appear to focus primarily on sick individuals and their family, mainly providing direct care and relying on Interaction, Developmental and Systems Theories. While these features fit the WHO framework, others elements of the original model are poorly represented: the involvement of FCHN in prevention activities is scarce, especially in primary and secondary prevention, and little attention is paid to the health needs of the whole population. In conclusion, current applications of FCHN show a partial adherence to the WHO framework: population approaches should be strengthened in current FCHN models, with a stronger involvement of nurses in primary and secondary prevention.

Adherence to SARS-CoV-2 Vaccination Recommendations among Patients with Substance Use Disorders: A Cross-Sectional Study in Rome, Italy.

Adherence to vaccination recommendations is a challenge for national immunization programs. We quantified adherence to COVID-19 vaccination recommendations in people with substance use disorders (SUDs) attending an outpatient addiction center in Rome, Italy; we investigated the determinants of adherence, and also analyzed patient risk perception and compliance with preventive measures. A multivariable logistic regression model identified predictors of adherence to vaccination recommendations, with statistical validity tested by estimating adjusted odds ratios (aORs) and 95% confidence intervals (CIs). From December 2021 to January 2022, 200 SUD patients completed a questionnaire, 80% of whom reported being vaccinated against SARS-CoV-2 (minimum one dose). Negative predictors of vaccine uptake included being non-Italian (aOR: 0.36, 95% CI: 0.13-0.97), having coexisting comorbidities (aOR: 0.35, 95% CI: 0.13-0.95), and previous use of heroin (aOR: 0.24, 95% CI: 0.08-0.71). No difference was found for cocaine use, demographic characteristics, previous COVID-19 infection, methadone therapy, or compliance with preventive measures. Major reasons for non-adherence to vaccination recommendations were fear of side effects, insufficient recognition of the importance of vaccination, bureaucratic issues, and lack of trust in the authorities. Given their vulnerability, additional efforts are needed to facilitate access to vaccination for people with SUDs, and to limit disinformation around vaccines..

Compliance with hand-hygiene guidelines among healthcare workers: a cross-sectional study at the Umberto I teaching hospital of Rome, Italy.

INTRODUCTION: Healthcare-associated infections are often associated with poor hand hygiene (HH) by healthcare workers (HCWs). The objective of this cross-sectional study at the Umberto I teaching hospital in Rome was to quantify compliance with HH by direct observation following a multimodal strategy devised by the World Health Organisation and to map critical areas for improvement. METHODS: Predictors of HH compliance were identified using a multivariable logistic regression model. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Eighty-four trained observers from 50 wards collected 4,081 observations showing that overall HH compliance was 71.9%. The multivariable analysis found a positive association with the outcome for midwives compared to physicians (aOR=2.5, 95% CI: 1.5-4.1), and a negative association for healthcare assistants (aOR=0.5, 95% CI: 0.3-0.8). There was greater compliance during public holidays and weekends (aOR=1.5, 95% CI: 1.1-2.1), but compliance was lower for external staff (aOR=0.7, 95% CI: 0.5-0.9). We found a positive association with all HH indications after interaction with a patient or with patient surroundings compared with the indication "before touching a patient" (all p<0.001); the highest association was with the indication "after contact with biological fluids" (aOR=7.7, 95% CI: 4.7-12.5). CONCLUSION: Overall, we observed reasonable compliance levels, but it is important to increase adherence to HH practice and monitor any behaviour change.

Attitudes of University Students towards Mandatory COVID-19 Vaccination Policies: A Cross-Sectional Survey in Rome, Italy.

Mandatory vaccination (MV) against COVID-19 is a contentious topic. In this study, we used logistic regression models to identify attitudes among Sapienza University students towards MV for COVID-19. We considered three different scenarios: mandatory COVID-19 vaccination (MCV) for healthcare workers (HCWs) (Model 1), for all people aged ≥ 12 years (Model 2), and for admission to schools and universities (Model 3). We collected 5287 questionnaires over a six-month period and divided these into three groups (September-October 2021, November-December 2021, and January-February 2022). MCV for HCWs was the most strongly supported policy (69.8% in favour), followed by MCV for admission to schools and universities (58.3%), and MCV for the general population (54.6%). In a multivariable analysis, the models showed both similarities and differences. There was no association of socio-demographic characteristics with the outcomes, apart from being enrolled in non-healthcare courses, which negatively affected Models 2 and 3. A greater COVID-19 risk perception was generally associated with a more positive attitude towards MCV, although heterogeneously across models. Vaccination status was a predictor of being in favour of MCV for HCWs, whereas being surveyed in November-February 2022 favoured MCV for admission to schools and universities. Attitudes towards MCV were variable across policies; thus, to avoid unintended consequences, these aspects should be carefully considered by policymakers.

Incidence of Healthcare-Associated Infections in a Neonatal Intensive Care Unit before and during the COVID-19 Pandemic: A Four-Year Retrospective Cohort Study.

The COVID-19 pandemic may have had an impact on healthcare-associated infection (HAI) rates. In this study, we analyzed the occurrence of HAIs in a neonatal intensive care unit (NICU) of the Umberto I teaching hospital in Rome before and during the pandemic. All infants admitted from 1 March 2018 to 28 February 2022 were included and were divided into four groups according to their admission date: two groups before the pandemic (periods I and II) and two during the pandemic (periods III and IV). The association between risk factors and time-to-first event was analyzed using a multivariable Cox regression model. Over the four-year period, a total of 503 infants were included, and 36 infections were recorded. After adjusting for mechanical ventilation, birth weight, sex, type of delivery, respiratory distress syndrome, and previous use of netilmicin and fluconazole, the multivariable analysis confirmed that being hospitalized during the pandemic periods (III and IV) was the main risk factor for HAI acquisition. Furthermore, a change in the etiology of these infections was observed across the study periods. Together, these findings suggest that patient management during the pandemic was suboptimal and that HAI surveillance protocols should be implemented in the NICU setting promptly.

The other side of COVID-19: A cross-sectional study on mental health in a sample of Italian nurses during the second wave.

Introduction: The COVID-19 pandemic has led to a drastic increase in the workload of healthcare professionals, particularly nurses, with serious consequences for their psychological well-being. Our study aimed to identify demographic and work-related factors, as well as clinical predictors of post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD), in nurses employed during the COVID-19 pandemic. Methods: We carried out a cross-sectional study between December 2020 and April 2021 on nurses employed during the COVID-19 second wave (October - December 2020). We evaluated PTSD and GAD using two validated questionnaires: i) the Impact of Event Scale - Revised (IES-R); and ii) General Anxiety Disorder -7 (GAD-7). Results: Overall, 400 nurses, whose mean age was 34.3 years (SD ± 11.7), were included in the study. Most were female (78.5%), unmarried (58.5%) and employed in the central (61.5%) regions of Italy. A total of 56.8% of all participants had clinical predictors of PTSD, recording a median IES-R score (IQR) of 37.0 (22.0, 51.0) (range 1-84; cut-off >33 for PTSD). Furthermore, 50% of respondents reported moderate-to-severe symptoms consistent with GAD, recording a median GAD-7 score (IQR) of 9.5 (6.0,14.0) (range 0-21; cut-off >10 for GAD). Multivariable analysis showed that moderate-to-severe GAD (aOR = 4.54, 95% CI: 2.93 - 7.05), being employed in the critical care area (aOR = 1.74, 95% CI: 1.01 - 3.00) and being female (aOR= 1.88, 95% CI: 1.09 - 3.22) were significantly associated with the presence of clinical predictors of PTSD. Discussion: The levels of PTSD symptoms and anxiety among nurses were high during the pandemic. PTSD and GAD represent a public health problem that should be addressed in the post-pandemic period. Healthcare organizations need to activate specific support and rehabilitation networks and programs for healthcare professionals employed during the COVID-19 pandemic.

High Incidence of Candidemia in Critically Ill COVID-19 Patients Supported by Veno-Venous Extracorporeal Membrane Oxygenation: A Retrospective Study.

BACKGROUND: The incidence of candidemia in severe COVID-19 patients (0.8-14%) is two- to ten-fold higher than in non-COVID-19 patients. METHODS: This retrospective analysis aimed to analyse the incidence of bloodstream infections (BSI) due to Candida in a cohort of COVID-19 patients supported with ECMO. RESULTS: Among 138 intubated and ventilated patients hospitalized for ≥10 days in the intensive care unit of a teaching hospital, 45 (32.6%) patients received ECMO support, while 93 patients (67.4%) did not meet ECMO criteria and were considered the control group. In the ECMO group, 16 episodes of candidaemia were observed, while only 13 in patients of the control group (36.0% vs. 14.0%, p-value 0.004). It was confirmed at the survival analysis (SHR: 2.86, 95% CI: 1.39-5.88) and at the multivariable analyses (aSHR: 3.91, 95% CI: 1.73-8.86). A higher candida score seemed to increase the hazard for candidemia occurrence (aSHR: 3.04, 95% CI: 2.09-4.42), while vasopressor therapy was negatively associated with the outcome (aSHR: 0.15, 95% CI: 0.05-0.43). CONCLUSIONS: This study confirms that the incidence of candidemia was significantly higher in critically ill COVID-19 patients supported with VV-ECMO than in critically ill COVID patients who did not meet criteria for VV-ECMO.

The Association of Health Literacy with Intention to Vaccinate and Vaccination Status: A Systematic Review.

Despite health literacy (HL) being recognized as a driver of health-promoting behavior, its influence on the vaccination decision-making process remains unclear. This study summarized current evidence on the association between HL and both intention to vaccinate and vaccination status. We searched PubMed, Scopus, and Web of Science, retrieving observational studies published until January 2022 that used HL-validated tools to investigate the above associations for any vaccine. Quality was assessed using the Newcastle-Ottawa scale. Twenty-one articles were included; of these, six investigated the intention to vaccinate and the remainder vaccination status. Articles on intention looked at SARS-CoV-2 vaccination using heterogeneous HL tools and were of high/fair quality. Vaccination status, mainly for influenza or pneumococcal vaccines, was explored using various HL tools; the quality was generally high. We found inconsistent results across and within vaccine types, with no clear conclusion for either vaccination intention or status. A weak but positive association was reported between a high HL level and influenza vaccination uptake for individuals aged more than 65 years. HL did not seem to significantly influence behavior towards vaccination. Differences in the methods used might explain these results. Further research is needed to investigate the role of HL in the vaccination decision-making process.

Prevalence of SARS-CoV-2 infection and associated risk factors: A testing program and nested case-control study conducted at Sapienza University of Rome between March and June 2021.

Background: To safely resume in-person activities during the COVID-19 pandemic, Sapienza University of Rome implemented rigorous infection prevention and control measures, a successful communication campaign and a free SARS-CoV-2 testing program. In this study, we describe the University's experience in carrying out such a program in the context of the COVID-19 response and identify risk factors for infection. Methods: Having identified resources, space, supplies and staff, from March to June 2021 Sapienza offered to all its enrollees a molecular test service (8.30 AM to 4 PM, Monday to Thursday). A test-negative case-control study was conducted within the program. Participants underwent structured interviews that investigated activity-related exposures in the 2 weeks before testing. Multivariable conditional logistic regression analyses were performed. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated. Results: A total of 8,959 tests were administered, of which 56 were positive. The detection trend followed regional tendencies. Among 40 cases and 80 controls, multivariable analysis showed that a known exposure to a COVID-19 case increased the likelihood of infection (aOR: 8.39, 95% CI: 2.38-29.54), while having a job decreased it (aOR: 0.23, 95% CI: 0.06-0.88). Of factors that almost reached statistical significance, participation in activities in the university tended to reduce the risk (aOR: 0.32, 95% CI: 0.09-1.06), while attendance at private gatherings showed an increasing risk trend (aOR: 3.48, 95% CI: 0.95-12.79). Age, gender, activities in the community, visiting bars or restaurants, and use of public transportation were not relevant risk factors. When those students regularly attending the university campus were excluded from the analysis, the results were comparable, except that attending activities in the community came close to having a statistically significant effect (aOR: 8.13, 95% CI: 0.91-72.84). Conclusions: The testing program helped create a safe university environment. Furthermore, promoting preventive behavior and implementing rigorous measures in public places, as was the case in the university setting, contributed to limit the virus transmission.

Predictors of SARS-CoV-2 Infection in University Students: A Case-Control Study.

Closure of Higher Education Institutions in the early phase of the SARS-CoV-2 pandemic was largely diffused. With their reopening, numerous preventive measures have been enacted, but limited evidence exists on students' behavior that could influence their infection risk. We conducted a case-control study at the Sapienza University of Rome to identify protective and risk factors for SARS-CoV-2 infection. Students attending the campus within 48 h of SARS-CoV-2 infection were considered cases. Controls were students who come in contact with a confirmed case within the campus. Demographic features and activities carried out before positivity or contact were investigated. Multivariable logistic regression models were built to identify factors associated with SARS-CoV-2 infection, estimating adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). The analysis showed an increased risk of SARS-CoV-2 infection for attending the second year or above of university (aOR 17.7, 95% CI 2.21-142.82) and participating in private parties or ceremonies (aOR 15.9, 95% CI 2.30-109.67) while living outside the family (aOR 0.08, 95% CI 0.01-0.54) and attending practical activities or libraries on campus (aOR 0.29, 95% CI 0.08-0.97) reduced the risk. Data strongly suggests that it may be safe to participate in activities organized under strict infection prevention guidelines. Tailored prevention measures might reduce the risk of infection in university students.