RESUMO
INTRODUCTION: Relationships between inflammation and mood have been observed in terms of pro-inflammatory effects induced by depressive conditions and, in parallel, by an antidepressant-induced favorable effect on the recovery of inflammatory states. Selective serotonin reuptake inhibitor (SSRI) drugs were hypothesized to improve the prognosis of COVID-19 pneumonia, a typical acute inflammation, in terms of decreased mortality rate and pro-inflammatory cytokine serum levels. METHODS: The medical records of COVID-19 pneumonia inpatients at Careggi University Hospital (Florence) were analyzed for prognosis and Interleukin 6 (IL-6) after admission for over a period of 22 months. Medical records of patients treated at admission and not discontinued until discharge with an SSRI or with vortioxetine were identified. Two groups, one treated with antidepressants, the other not treated, were evaluated according to the mentioned parameters. Multiple linear regression and logistic regression were performed. RESULTS: The entire sample composed of 1236 records (recovered patients 77.1%, deceased patients 22.9%). The treated group (n = 107) had a better prognosis than the untreated group in spite of age and comorbidity both being greater than in the untreated group. Correspondingly, IL-6 levels in the treated group were significantly lower (p < 0.01) than the levels in the untreated group, in every comparison. CONCLUSIONS: Outcomes of this study support the hypothesis of the favorable influence of some antidepressants on the prognosis of COVID-19, possibly mediated by IL-6 modulation. Reduction in acute inflammation induced by the action of antidepressants was confirmed.
Assuntos
COVID-19 , Inibidores Seletivos de Recaptação de Serotonina , Humanos , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Estudos Retrospectivos , Interleucina-6 , Antidepressivos/uso terapêutico , Inflamação/tratamento farmacológicoRESUMO
PURPOSE: Computer-aided diagnosis (CAD) may improve prostate cancer (PCa) detection and support multiparametric magnetic resonance imaging (mpMRI) readers for better characterization. We evaluated Watson Elementary® (WE®) CAD system results referring to definitive pathological examination in patients treated with robot-assisted radical prostatectomy (RARP) in a tertiary referral center. METHODS: Patients treated with RARP between 2020 and 2021 were selected. WE® calculates the Malignancy Attention Index (MAI), starting from the information contained in the mpMRI images. Outcome measures were the capability to predict the presence of PCa, to correctly locate the dominant lesion, to delimit the largest diameter of the dominant lesion, and to predict the extraprostatic extension (EPE). RESULTS: Overall, tumor presence was confirmed in 46 (92%) WE® highly suspicious areas, while it was confirmed in 43 (86%) mpMRI PI-RADS ≥ 4 lesions. The WE® showed a positive agreement with mpMRI of 92%. In 98% of cases, visible tumor at WE® showed that the highly suspicious areas were within the same prostate sector of the dominant tumor nodule at pathology. WE® showed a 2.5 mm median difference of diameter with pathology, compared with a 3.8 mm of mpMRI versus pathology (p = 0.019). In prediction of EPE, WE® and mpMRI showed sensitivity, specificity, positive and negative predictive value of 0.81 vs 0.71, 0.56 vs 0.60, 0.88 vs 0.85 and 0.42 vs 0.40, respectively. CONCLUSION: The WE® system resulted accurate in the PCa dominant lesion detection, localization and delimitation providing additional information concerning EPE prediction.
Assuntos
Neoplasias da Próstata , Robótica , Masculino , Humanos , Próstata/patologia , Neoplasias da Próstata/patologia , Imageamento por Ressonância Magnética/métodos , Estudos Retrospectivos , Prostatectomia/métodos , ComputadoresRESUMO
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.
Assuntos
Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Surtos de Doenças , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , beta-Lactamases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/metabolismo , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Adulto Jovem , beta-Lactamases/efeitos dos fármacos , beta-Lactamases/genéticaRESUMO
OBJECTIVE: Impulsivity and impaired decision-making have been proposed as obsessive-compulsive disorder (OCD) endophenotypes, running in OCD and their healthy relatives independently of symptom severity and medication status. Deep brain stimulation (DBS) targeting the ventral limb of the internal capsule (vALIC) and the nucleus accumbens (Nacc) is an effective treatment strategy for treatment-refractory OCD. The effectiveness of vALIC-DBS for OCD has been linked to its effects on a frontostriatal network that is also implicated in reward, impulse control, and decision-making. While vALIC-DBS has been shown to restore reward dysfunction in OCD patients, little is known about the effects of vALIC-DBS on impulsivity and decision-making. The aim of the study was to compare cognitive impulsivity and decision-making between OCD patients undergoing effective vALIC-DBS or treatment as usual (TAU), and healthy controls. METHODS: We used decision-making performances under ambiguity on the Iowa Gambling Task and reflection impulsivity on the Beads Task to compare 20 OCD patients effectively treated with vALIC-DBS, 40 matched OCD patients undergoing effective TAU (medication and/or cognitive behavioural therapy), and 40 healthy subjects. Effective treatment was defined as at least 35% improvement of OCD symptoms. RESULTS: OCD patients, irrespective of treatment modality (DBS or TAU), showed increased reflection impulsivity and impaired decision-making compared to healthy controls. No differences were observed between OCD patients treated with DBS or TAU. CONCLUSION: OCD patients effectively treated with vALIC-DBS or TAU display increased reflection impulsivity and impaired decision-making independent of the type of treatment.
Assuntos
Tomada de Decisões , Estimulação Encefálica Profunda/métodos , Comportamento Impulsivo , Transtorno Obsessivo-Compulsivo/terapia , Adulto , Estimulação Encefálica Profunda/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
AIM: To estimate the prevalence of pressure ulcers in nursing homes and its variability, the frequency of use of preventive measures and treatment. BACKGROUND: Pressure ulcer is a frequent pathology across healthcare settings. Most pressure ulcers are preventable and are considered an important quality of care indicator. METHODS: Assessments were done on a single day of November 2015 in nursing homes in Geneva, Switzerland. Of the 51 institutions (3824 patients) eligible, 33 homes agreed to participate, representing 2671 patients (69.8%). One referent nurse per nursing home received training on pressure ulcer detection. To estimate the residual variability in prevalence and in number of prevention measures, adjusted multilevel logistic regressions were used. RESULTS: Patients were on average 85.6â¯years old, with a median length of stay of 2.1â¯years. The overall prevalence was 5.7% but varied considerably, from 0% to 19.6%. The variability across nursing homes decreased slightly when taking into account patient-level and institution-level characteristics. In the adjusted models, pressure ulcers prevalence was significantly associated with Braden risk; number of preventive measures was significantly associated with nursing home size, and Braden risk, and marginally associated with length of stay. CONCLUSIONS: Overall prevalence of pressure ulcers was relatively low. While several prevention measures for patients at risk were taken, the correct use of all of them was rare. The variability in prevalence and in number of preventive measures across nursing homes was very high. Programmes focusing on the correct use of all recommended prevention measures could help reducing pressure ulcers prevalence.
Assuntos
Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Suíça/epidemiologiaRESUMO
INTRODUCTION: The sense of dignity is a multifactorial feeling influenced also by the healthcare context. PDI-IT is a tool that measures this construct, but its psychometric characteristics have not been adequately investigated in patients which are not experiencing and End- Of-Life condition. The aim of this study is to examine the psychometric characteristics of PDI-IT in a group of non-terminal chronic patients and to verify the instrument's invariance with respect to the individual characteristics of patients. METHODS: A multicentric study was conducted on 421 patients undergoing ambulatory care or hospitalized in specialized medical, surgical and oncological areas. The study of the PDIIT validity in this population was achieved by structural equation (SEM) models; reliability was assessed by Cronbach's Alpha, whereas invariance was studied through multigroup analysis. RESULTS: Findings show an excellent reliability and confirm the monodimensionality of the theoretical structure. After the model optimization interventions, fit indices point out a good data fitting on the reference model. The instrument is invariant with respect to individual characteristics (sex and age) but does not appear to be appropriate for all chronic patients. DISCUSSION: Although with some cautions about the state of progression of the disease, PDIIT seems to be a valid and reliable tool, useful in measuring the sense of dignity even in populations of chronic patients. Future research should address the development of a short form of the tool.
Assuntos
Atitude Frente a Saúde , Doença Crônica , Pessoalidade , Autorrelato , Humanos , PsicometriaRESUMO
OBJECTIVE: The aim of this study was to evaluate the feasibility and reproducibility of diffusion-weighted imaging in distinguishing between mucin-producing and serous pancreatic cysts. METHODS: Forty-four pancreatic cysts (43 patients, 27 women; mean age, 57 years; 26 mucin-producing cysts, 18 serous cysts) that underwent histological examination or cyst analysis after diffusion-weighted magnetic resonance imaging were retrospectively reviewed. Three blinded readers independently evaluated signal intensity and apparent diffusion coefficient (ADC). Intraobserver and interobserver agreements were calculated. Fisher exact test and Welch t test were used to compare signal intensity and ADC values, respectively, with pathological results. Receiver operating characteristic analysis was used to determine diagnostic accuracy of various thresholds for ADC. A P value less than 0.05 was considered statistically significant. RESULTS: Mean ADC values of the mucin-producing cysts were 3.26 × 10, 3.27 × 10, and 3.35 × 10 mm/s for the 3 readers, respectively. Mean ADC values of the serous cysts were 2.86 × 10, 2.85 × 10, and 2.85 × 10 mm/s for the 3 readers, respectively. Differences in ADC values between the 2 cyst groups were 12.4%, 12.9%, and 14.8% for the 3 readers, respectively (P < 0.001). Intraobserver and interobserver agreement was excellent. A threshold ADC of 3 × 10 mm/s resulted in correct identification of cysts in 77% to 81% of cases, with sensitivity and specificity ranging between 84% and 88% and 66% and 72%, respectively. CONCLUSIONS: Diffusion-weighted imaging may be a helpful tool in distinguishing between mucin-producing and serous pancreatic cysts.
Assuntos
Cistadenoma Mucinoso/diagnóstico por imagem , Cistadenoma Seroso/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Interpretação de Imagem Assistida por Computador/métodos , Cisto Pancreático/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: The aim of the study was to investigate the prevalence rates of obsessive-compulsive disorder (OCD) and hypochondriasis in schizophrenic patients treated with atypical antipsychotics (AAPs) and to investigate the different comorbidity rates of OCD and hypochondriasis between clozapine-treated patients and patients treated with other AAPs. METHODS: We therefore recruited 60 schizophrenic patients treated with clozapine or other AAPs. We assessed the prevalence rates of OCD or OC symptoms and hypochondriasis or hypochondriac symptoms in the whole group of patients and in clozapine-treated patients versus patients treated with other AAPs. RESULTS: Schizophrenic patients had a higher comorbidity rate of OCD (26.6% vs 1-3%) and hypochondriasis (20% vs 1%) than the general population. These comorbidities were more frequent in schizophrenic patients treated with clozapine versus patients treated with other AAPs (36.7% vs 16.7% and 33.3% vs 6.7%). Clozapine-treated patients showed a higher mean Y-BOCS and HY-BOCS score when compared to patients treated with other AAPs (10.90 vs 5.90, p = .099; 15.40 vs 8.93, p = .166). A statistical significant correlation was found between the Y-BOCS and HY-BOCS scores of the whole group (r = .378, p = 0.03). Furthermore, we found an inverse correlation between the global level of functioning and the diagnosis of hypochondriasis (p = .048) and the severity of hypochondriac symptoms (p = .047). CONCLUSIONS: Hypochondriasis could represent an important clinical feature of schizophrenic patients treated with atypical antipsychotics, and further research is needed in this field.
Assuntos
Hipocondríase/epidemiologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Esquizofrenia/epidemiologia , Adulto , Amissulprida , Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Benzodiazepinas/uso terapêutico , Clozapina/uso terapêutico , Comorbidade , Feminino , Humanos , Hipocondríase/psicologia , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/psicologia , Olanzapina , Palmitato de Paliperidona/uso terapêutico , Prevalência , Fumarato de Quetiapina/uso terapêutico , Risperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Sulpirida/análogos & derivados , Sulpirida/uso terapêuticoRESUMO
INTRODUCTION: One of the leading causes of morbidity and mortality worldwide is out-of-hospital cardiac arrest. Early defibrillation and high-quality cardiopulmonary resuscitation (CPR) have improved survival. The main goal of CPR is to achieve return of spontaneous circulation (ROSC), which is assessed by looking for a pulse, analyzing the heart rhythm, and assessing carbon dioxide levels. The use of cartography during CPR to confirm the correct position of the endotracheal tube during intubation or to assess the effectiveness of chest compressions has increased significantly in the last years. The aim of this review was to identify correlations between end-tidal carbon dioxide levels and the likelihood of ROSC in patients with out-of-hospital cardiac arrest. METHODS: A literature search was performed in MEDLINE (via Pubmed), Scopus, Web of Science, and Google Scholar databases from September to November 2022. Keywords combined with the Boolean operators (AND/OR) were used in both free text and Medical Subject Headings. Studies on adult patients published between 01/01/2016 and 28/09/2022 were searched, with no geographical restrictions. RESULTS: At the end of the selection process, 14 studies were included that investigated capnography in out-of-hospital CPR and reported at least 1 outcome between end-tidal carbon dioxide and ROSC or survival. DISCUSSION: Capnography is an advantageous tool due to its noninvasive characteristics, ease of use, and immediacy of data. In out-of-hospital cardiac arrest, the use of the end-tidal carbon dioxide appears to be an appropriate complementary tool to support clinical decisions, such as correct positioning of the endotracheal tube, optimizing ventilation in CPR, and as a predictor of ROSC.
Assuntos
Capnografia , Dióxido de Carbono , Reanimação Cardiopulmonar , Parada Cardíaca Extra-Hospitalar , Retorno da Circulação Espontânea , Parada Cardíaca Extra-Hospitalar/terapia , Humanos , Dióxido de Carbono/análiseRESUMO
In March 2020, the Italian government imposed a national lockdown which was almost completely removed in June 2020. Due to the abrupt stop of human activities, emissions of air pollutants decreased. Air pollution is an environmental risk factor for noncommunicable disease and mortality. Emerging evidence also suggests a role in male infertility. In this study, we compared sperm DNA fragmentation (sDF) levels and conventional semen parameters between subjects undergoing sDF determination and routine semen analysis in a single Italian centre, during about 6 months before (N = 119) and after lockdown (N = 105). After lockdown, we found an improvement of sperm progressive motility (48.00[38.50-58.00]% vs. 42.00[33.00-53.00]%) and sDF levels (as total: 24.79[18.33-33.97]% vs. 35.02[25.04-45.73]%, p < .001; brighter: 14.02[10.69-17.93]% vs 18.54[13.58-25.82]%, p < .001 and dimmer sDF: 9.24[5.64-15.78]% vs. 12.24[8.08-19.10]%, p < .01), mirrored by a decrease of leukocyte semen concentration (p < .01). The improvement of sperm motility and DNA quality was maintained after adjusting for leukocyte concentration and several conditions known to affect sperm motility and/or sDF levels. With a significant decrease in air pollution observed in Tuscany during and after lockdown, associated improvement in sperm motility and DNA quality in patients referred to the infertility clinic is suggestive of the potential role of air pollution in male infertility.
Assuntos
Poluição do Ar , Infertilidade Masculina , Masculino , Humanos , Sêmen , Fragmentação do DNA , Motilidade dos Espermatozoides , Espermatozoides , Infertilidade Masculina/etiologia , Poluição do Ar/efeitos adversos , Itália/epidemiologia , DNARESUMO
Introduction: Access to the healthcare system when patients are vulnerable and living outside metropolitan areas can be challenging. Our objective was to explore healthcare system satisfaction of urban and rural inhabitants depending on financial and health vulnerabilities. Methods: Repeated cross-sectional data from 353,523 European citizens (2002-2016). Multivariable associations between rural areas, vulnerability factors and satisfaction with the healthcare system were assessed with linear mixed regressions and adjusted with sociodemographic and control factors. Results: In unadjusted analysis, the people who lived in houses in the countryside and those who lived in the suburbs were the most satisfied with the healthcare system. In the adjusted model, residents living in big cities had the highest satisfaction. Financial and health vulnerabilities were associated with less satisfaction with the healthcare system, with a different effect according to the area of residence: the presence of health vulnerability was more negatively correlated with the healthcare system satisfaction of big city inhabitants, whereas financial vulnerability was more negatively correlated with the satisfaction of those living in countryside homes. Conclusion: Vulnerable residents, depending on their area of residence, may require special attention to increase their satisfaction with the healthcare system.
Assuntos
Satisfação Pessoal , Populações Vulneráveis , Estudos Transversais , Atenção à Saúde , Humanos , População RuralRESUMO
STUDY DESIGN: An observational study based on an online survey to explore if the participant had experienced (1) cancellation or delay of scheduled health services (2) reduction of assistance provided by a caregiver (3) barriers to social participation and recreational activities. Three validated questionnaires to investigate well-being and symptoms of anxiety and depression were also administered. OBJECTIVES: Our main aim was to quantify the obstacles experienced by adults living with SCI in Italy during COVID-19 pandemic, to explore the presence of depression and anxiety symptoms and to quantify subjective well-being. SETTING: Outpatient clinic of a Spinal Unit in Italy. METHODS: Online survey via direct contact and by e-mail lists. RESULTS: In total, 101 individuals completed the survey. Of, 82.2% participants reported a history of deferment or cancellation of non-COVID-19 health services. The majority (56.4%) revealed that, at least seldom, they have chosen to reduce their usual everyday activities and more than one third (37.6%) affirmed that they had been forced to renounce to one or more of their occupations. Discontinuation of assistance by caregivers was uncommon. The median score of questionnaires measuring depression and anxiety symptoms do not differ significatively when compared with prior studies. The variable that explored the limitations experienced in everyday activities showed a significant correlation with the results of the questionnaires measuring well-being and symptoms of anxiety. CONCLUSIONS: We believe that our results could contribute to the discussion ongoing inside our community on how to answer to the new challenges of this pandemic period and of the post-pandemic future.
Assuntos
COVID-19 , Traumatismos da Medula Espinal , Adulto , Humanos , Pandemias , Percepção , SARS-CoV-2 , Traumatismos da Medula Espinal/epidemiologia , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Relatively few studies focused on the coping strategies adopted by the healthcare workers during the second phase of the pandemic. The present study compared the coping strategies between Italian nurses working in Covid-19 and in other units and it explored whether socio-demographic and work-related variables moderate the relation between the type of unit and coping strategies. METHODS: A web-based questionnaire that included sociodemographic and work-related questions and the Coping Orientation to Problem Experienced-New Italian Version-25 item was administered. Moderation effects between variables and coping strategies were analyzed using generalized linear models. RESULTS: 253 nurses participated. Nurses who worked in a Covid-19 unit had significantly lower scores on Avoidance Strategies subscale and higher scores on Positive Attitude and Social Support subscales than nurses working in other units. DISCUSSION: Gender differences emerged only on the social support coping dimension, with women being more likely to adopt social support than men. No association between the type of unit and the other coping strategies was found. CONCLUSION: Nurses working in Covid-19 units showed better coping strategies than their colleagues: this suggests that support interventions aimed to promote coping strategies should be offered also to Covid-19-free units' nurses.
Assuntos
COVID-19 , Adaptação Psicológica , Modificador do Efeito Epidemiológico , Feminino , Humanos , Masculino , Pandemias , Apoio SocialRESUMO
BACKGROUND: Infection prevention and control (IPC) is a prioritised task for healthcare workers in emergency department (ED). Here, we examined compliance with admission screening (AS) and additional precautions (AP) measures for patients at risk of infection with multidrug-resistant organisms (MDROs) by using a two-stage, multifaceted educational intervention, also comparing the cost of a developed automated indicator for AS and AP compliance and clinical audits to sustain observed findings. METHODS: In the first stage, staff in the ED of the University Hospitals of Geneva, Switzerland, were briefed on IPC measures (AS and AP). A cross-sectional survey was then conducted to assess barriers to IPC measures. In the second stage, healthcare workers underwent training sessions, and an electronic patient record 'order-set' including AS and AP compliance indicators was designed. We compared the cost-benefit of the audits and the automated indicators for AS and AP compliance. RESULTS: Compliance significantly improved after training, from 36.2% (95% CI 23.6% to 48.8%) to 78.8% (95% CI 67.1% to 90.3%) for AS (n=100, p=0.0050) and from 50.2% (95% CI 45.3% to 55.1%) to 68.5% (95% CI 60.1% to 76.9%) for AP (n=125, p=0.0092). Healthcare workers recognised MDRO screening as an ED task (70.2%), with greater acknowledgment of risk factors at AS considered an ED duty. The monthly cost was higher for clinical audits than the automated indicator, with a reported yearly cost of US$120 203. The initial cost of developing the automated indicator was US$18 290 and its return on investment US$3.44 per US$1 invested. CONCLUSION: Training ED staff increased compliance with IPC measures when accompanied by team discussions for optimal effectiveness. An automated indicator of compliance is cheaper and closer to real-time than a clinical audit.
Assuntos
Infecção Hospitalar , Farmacorresistência Bacteriana Múltipla , Análise Custo-Benefício , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Hospitais Universitários , HumanosRESUMO
BACKGROUND: Carbapenemase-producing Enterobacterales (CPE), particularly those producing metallo-ß-lactamases, are among the most challenging antibiotic-resistant pathogens, causing outbreaks of difficult-to-treat nosocomial infections worldwide. Since November 2018, an outbreak of New Delhi metallo-ß-lactamases-positive CPE (NDM-CPE) has emerged in Tuscany, Italy. In this study, we aimed to investigate the NDM-CPE associated with the outbreak and characterise the responsible Klebsiella pneumoniae clone. METHODS: We used whole-genome sequencing and bioinformatic analysis to characterise NDM-CPE isolates that caused bloodstream infections in 53 patients at 11 hospitals in Tuscany and that were collected between Jan 1, 2018, and July 5, 2019 (ie, the early phase of the outbreak and preceding months). The CPE isolates characterised in this study were isolated and identified at the species level and as NDM producers by six diagnostic microbiology laboratories that serve the 11 hospitals. We used comparative genomic analysis, antimicrobial susceptibility testing, plasmid conjugal transfer assays, evaluation of virulence potential in the Galleria mellonella infection model, and serum bactericidal assays to further characterise the clone causing the outbreak. FINDINGS: The outbreak was sustained by an ST147 K pneumoniae producing NDM-1, which had a complex resistome that mediated resistance to most antimicrobials (except cefiderocol, the aztreonam-avibactam combination, colistin, and fosfomycin). The clone belonged to a sublineage of probably recent evolution, occurred by the sequential acquisition of an integrative and conjugative element encoding the yersiniabactin siderophore, an FIB(pQil)-type multiresistance plasmid carrying blaNDM-1, and a transferable chimeric plasmid, derived from virulence elements of hypervirulent K pneumoniae, carrying several resistance and virulence determinants. Infection of G mellonella larvae revealed a variable virulence potential. The behaviour in serum bactericidal assays was different from typical hypervirulent K pneumoniae strains, with variable grades of serum resistance apparently associated with mutations in specific chromosomal loci (csrD, pal, and ramR). INTERPRETATION: This description of a sublineage of ST147 K pneumoniae with a complex resistome and virulome that is capable of sustaining a large regional outbreak adds to existing research on the evolutionary trajectories within high-risk clones of K pneumoniae. Global surveillance programmes are warranted to track the dissemination of these lineages, and to prevent and control their spread. FUNDING: Italian Ministry of Health and Department of Experimental and Clinical Medicine, University of Florence.
Assuntos
Infecções por Klebsiella , Klebsiella pneumoniae , Antibacterianos/farmacologia , Surtos de Doenças , Humanos , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , beta-Lactamases/genéticaRESUMO
Portable blood gas analyzers are intended for blood Point-of-care testing (POCT); they make it possible to perform the examination directly at the patient's bed. During the SARS-CoV-2 pandemic, this device proved useful in emergency medical service for the early assessment of respiratory distress, allowing the appropriate care level to be determined for each patient. 25 cases of covid-19 positive patients in the province of Arezzo were analyzed; POCT blood gas analysis made it possible to evaluate and treat at home about half of the patients (52%) and to admit the others directly to the most appropriate ward. However, some critical issues were found; the limited sample size suggest further research to assess the actual impact of this technology.
Assuntos
COVID-19 , Serviços Médicos de Emergência , Gasometria , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , SARS-CoV-2RESUMO
INTRODUCTION: Pressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes. METHODS: Pressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses. RESULTS: A total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers. CONCLUSION: Audit and feedback is relatively easy to implement at the regional level in nursing homes and can enhance adherence to preventive measures and reduce pressure ulcers prevalence in the homes.
Assuntos
Instituição de Longa Permanência para Idosos , Casas de Saúde , Úlcera por Pressão/prevenção & controle , Programas Médicos Regionais , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Feminino , Instituição de Longa Permanência para Idosos/economia , Humanos , Estudos Longitudinais , Masculino , Auditoria de Enfermagem/economia , Casas de Saúde/economia , Úlcera por Pressão/epidemiologia , Úlcera por Pressão/enfermagem , Prevalência , Estudos Prospectivos , Programas Médicos Regionais/economia , Programas Médicos Regionais/estatística & dados numéricos , Programas Médicos Regionais/tendências , Suíça/epidemiologiaRESUMO
Limited data about New Delhi metallo-ß-lactamase (NDM) bacteremia are available. Blood isolates from 40 patients with NDM bacteremia were studied for antibiotic susceptibility and whole-genomic sequencing. NDM bacteremia has high 30-day mortality. In most cases, aztreonam-avibactam is active in vitro. Ceftazidime-avibactam plus aztreonam may represent a feasible therapeutic option.