Colonization by multidrug-resistant organisms in long-term care facilities in Italy: a point-prevalence study.

OBJECTIVES: To determine prevalence and risk factors for colonization by multidrug-resistant organisms (MDROs) in long-term care facility (LTCF) residents in Italy. Genotypes of MDRO isolates were investigated. METHODS: A point-prevalence study was conducted at 12 LTCFs located in four Italian cities (2 February to 14 March 2015). Rectal swabs, faeces and nasal/auxiliary swabs were cultured for extended-spectrum ß-lactamase (ESBL)- and/or carbapenemase-producing Enterobacteriaceae, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) respectively. Antimicrobial susceptibility testing, detection of ESBL and/or carbapenemase genes and molecular typing of MDROs were performed. Risk factors for colonization were determined by univariate and multivariate analysis. RESULTS: A total of 489 LTCF residents aged ≥65 years were enrolled. The prevalence of colonization by ESBL-producing Enterobacteriaceae, MRSA and C. difficile was 57.3% (279/487), 17.2% (84/487) and 5.1% (21/409) respectively. Carriage rate of carbapenemase-producing Enterobacteriaceae was 1% (5/487). Being bedridden was a common independent risk factor for colonization by all MDROs, although risk factors specific for each MDRO were identified. ESBL-producing Escherichia coli carriage was associated with the sequence type (ST) 131-H30 subclone, but other minor STs predominated in individual LTCF or in LTCFs located in the same city, suggesting a role for intrafacility or local transmission. Similarly, MRSA from LTCF residents belonged to the same spa types/ST clones (t008/ST8 and t032/ST22) commonly found in Italian acute-care hospitals, but infrequent spa types were recovered in individual LTCFs. The prevalent C. difficile PCR ribotypes were 356/607 and 018, both common in Italian acute-care hospitals. CONCLUSIONS: MDRO colonization is common among residents in Italian LTCFs.

IncI1 plasmids associated with the spread of CMY-2, CTX-M-1 and SHV-12 in Escherichia coli of animal and human origin.

Fourteen plasmids carrying blaCTX -M-1, blaSHV -12 or blaCMY -2 genes from Escherichia coli of both avian and human origin were analysed. IncI1 plasmids were largely predominant. Plasmid mutilocus sequence typing and comparative analysis revealed that the blaCMY -2 -ST12-IncI1 plasmids from avian E. coli were identical to those previously found in Salmonella from humans, but different to those associated with human E. coli. The IncI1-ST3 plasmids carrying blaCTX -M-1 or blaSHV -12 were related to those previously identified in avian E. coli, but different to those identified in human E. coli. Overall, no plasmids shared by E. coli of both origin (human/avian) were identified; however, further investigations are needed.

Ciprofloxacin-resistant, CTX-M-15-producing Escherichia coli ST131 clone in extraintestinal infections in Italy.

Quinolone and ß-lactam resistance mechanisms and clonal relationships were characterized among Escherichia coli isolates resistant to ciprofloxacin and extended-spectrum cephalosporins associated with human extra-intestinal infections in Rome. The E. coli. ST131 clone was found to be prevalent. This clone invariably carried a specific pattern of substitutions in the topoisomerase genes and all isolates but one produced CTX-M-15. One ST131 isolate produced SHV-12. The new ST131 variant described here is of particular concern because it combines fluoroquinolone resistance and chromosomally encoded CTX-M-15.

Electrogram width parameter analysis in implantable cardioverter defibrillators: Influence of body position and electrode configuration.

The "EGM width criterion" is a discrimination algorithm that was available in the last generation ICDs. It improved ventricular tachycardia detection by withholding inappropriate therapy deliveries in the presence of narrow QRS tachycardias. The accuracy of the algorithm depends on the optimal settings of the intracardiac EGM source, the "slew thresholds," and the "width threshold." The possible dependence of these parameters on body position may affect the detection efficacy. Whether these effects can be minimized by a proper choice of the electrode configuration used for signal analysis is still to be investigated. This study aimed to evaluate the stability of the slew threshold and width threshold obtained in the supine and orthostatic positions detected by the tip-to-ventricular coil and can-to-ventricular coil electrode configurations. Their time dependence was also evaluated at the 6-month follow-up. Fifty-eight patients who were recipients of an ICD (model Medtronic 7223cx and 7227cx) were included in the study. Changing from supine to orthostatic position caused a marked variation of slew and width thresholds (21.0 +/- 13.9 V/s and 10.1 +/- 9.6 ms, respectively) in 36% of patients with tip-to-ventricular coil and in 44% of patients with can-to-defibrillating coil (the mean slew threshold variation was in this case 17.6 +/- 15.8 V/s, while the mean width threshold variation was 18.8 +/- 21.0 ms). Width threshold variation was statistically significant (P < 0.02) with the latter electrode configuration. Slew thresholds settings changed between the 1- and 6-month follow-ups in the 75% of patients with can-to-defibrillating coil configuration and in 50% with tip-to-defibrillating coil. These time related variations were significantly larger with the tip-to-defibrillating coil configuration (P < 0.01). In conclusion, EGM width parameters may change between supine and orthostatic position and over time with tip-to-defibrillating coil configuration and can-to-defibrillating coil configuration. The former configuration was less sensitive to body position changes, but more sensitive to time related variations. These findings may be useful for optimal programming of the EGM width criterion, but if parameter programming based on these results can improve the discrimination specificity still needs to be investigated.