Tracking Multidrug-Resistant Klebsiella pneumoniae from an Italian Hospital: Molecular Epidemiology and Surveillance by PFGE, RAPD and PCR-Based Resistance Genes Prevalence.

Antimicrobial-resistant Klebsiella pneumoniae represent a global public health concern. K. pneumoniae strains isolated during 2010 and 2014-2016 within a single hospital of Molise Region, Central Italy, were analyzed testing antimicrobial susceptibility, clonality by pulsed-field gel electrophoresis (PFGE) and random amplified polymorphic DNA (RAPD)-PCR, and prevalence of carbapenem resistance genes by PCR. Forty isolates (23 wild-type in 2010 and 17 non-wild-type in 2014-2016) were collected from hospitalized patients (65.2 ± 18.1 years old, 75% male, 80% from intensive care unit-ICU). K. pneumoniae showed multidrug-resistant profiles and 15 resistotypes were identified (discriminatory power D = 0.88). The 69.6 and 17.4% of isolates in 2010 resulted intermediate and resistant to imipenem, respectively, and 91.3% was sensitive to meropenem, while 88.2% of isolates of 2014-2016 were resistant to both antibiotics. PFGE identified 16 clusters versus 23 by RAPD, 26 pulsotypes versus 33 RAPD patterns (D ≥ 0.97). PFGE separated strains according to isolation period and identified an outbreak occurred in the ICU during December 2014 and January 2015. No strains harbored blaGES, blaIMP, blaNDM-1, and blaOXA-48 genes, as well as AmpC plasmid-mediated beta-lactamases genes. Only K. pneumoniae isolated during 2014-2016 were blaKPC positive. Prevalence of blaVIM was 87 and 76.5% during 2010 and 2014-2016, respectively. No strains colistin-resistant harbored mcr-1 plasmid-mediated resistance gene. The study findings underline an increased circulation of multidrug-resistant K. pneumoniae within the hospital, and the acquisition of carbapenem resistance mechanism. The implementation of surveillance and molecular characterization of isolates are needed to identify outbreaks, reduce the spread of resistance, and guide empirical therapy.

Healthcare-associated infections point prevalence survey and antimicrobials use in acute care hospitals (PPS 2016-2017) and long-term care facilities (HALT-3): a comprehensive report of the first experience in Molise Region, Central Italy, and targeted intervention strategies.

BACKGROUND: Healthcare associated infections (HAIs) are a major public health concern both in acute hospitals and long-term care facilities (LTCFs), considering the clinical presentations and related costs. The study describes the first regional experience on HAIs and antimicrobials consumption obtained through point prevalence survey (PPS) 2016-2017 in the "Antonio Cardarelli" acute hospital, and in the LTCF of Larino municipality (Healthcare-associated infections and Antimicrobial use in European Long-Term care facilities, HALT-3) of Molise Region, Central Italy, both coordinated by the European Center for Disease Control (ECDC). METHODS: PPS was carried out during 24-26 November 2016, while HALT-3 on 29 June 2017. Standardized protocols and software provided by ECDC were used to collect facilities information, patients/residents, HAIs and antibiotic consumption data. RESULTS: An active HAI was found in 16 (7.1%) of 224 admitted patients in the acute hospital, and 50% occurred in a clinical specialty ward. Bundles, checklist for HAIs prevention and antimicrobial stewardship were lacking. Among 29 LTCF residents the HAIs prevalence was 3.4%. Surveillance programs for HAIs and antimicrobial stewardship strategy were not available. CONCLUSION: The overall results identified the need and types of interventions to be implemented in both settings, either at organizational or individual level, to improve antibiotic prescription practice and limit risk factors involved in potentially preventable infections.

Type-specific persistence and associated risk factors of human papillomavirus infections in women living in central Italy.

OBJECTIVE: We examined persistence and clearance of human papillomavirus (HPV) infections and risk factors associated with persistence in 79 women based on the results of two sequential tests performed over 12-24 months. STUDY DESIGN: Between February 2008 and August 2009, 398 women aged 18-63 years were examined for presence of cervical HPV infection by cervical scrape specimen and PCR. Detection was performed using Linear Array (LA) HPV Genotyping Test. All women were interviewed, and a short questionnaire was administered to collect information on socio-demographic characteristics, sexual and reproductive history, smoking habits, oral contraceptive use, history of sexually transmitted diseases, and Chlamydia trachomatis or Mycoplasma spp. infections. Pearson's χ² test was used to verify the association between all independent variables with the response variable. RESULTS: Initially, high risk-HPV (HR-HPV) and low risk-HPV (LR-HPV) infection was detected in 69.6% and 30.4% of the women, respectively, whilst multiple infections occurred in 53.2%. HPV 16 was the most common (20.2%) high-risk type, followed by 52, 31 and 53. At follow-up, HR-HPV infection was detected in 50.6% of the women; among these, 67.5% had persistent infection, while 12.5% acquired other high-risk types, and 20.0% of those positive for LR-HPV at entry had a new HR-HPV infection. Multiple infections were detected in 38.0% of the women. HPV 16 and 31 were the most frequent types, followed by HPV 73. Type-specific HR-HPV persistence was found in 49.1% of women. HPV 31, 39 and 73 were the most frequently persistent types, whilst HPV 16 was the least persistent. No significant age difference between women with persistence or clearance was found. The highest HR-HPV persistence occurred in the 22-27 years old group, whereas clearance increased in women aged 28-33 years. No significant association between persistent HR-HPV infection and oral contraceptive use, smoking habits and history of sexually transmitted disease was detected both at entry and follow-up study. The association between C. trachomatis or Mycoplasma spp. and HPV persistence could not be investigated because of the low detection rate of these microorganisms. CONCLUSIONS: The persistence of HR-HPV infection level was similar to that reported elsewhere, and HPV 31, 39 and 73 showed the highest likelihood of persistence, partially in agreement with other studies. The clinical relevance of the low persistence of HPV 16 and other HR-HPV is unknown. Persistent HR-HPV infection in women aged 22-27 years was in agreement with other authors. To the best of our knowledge, this is the first report on persistence of HR-HPV infections in Italy in a general population, although we examined a small sample in a short follow-up time.

Prevalence and genotype identification of human papillomavirus in women undergoing voluntary cervical cancer screening in Molise, central Italy.

We examined the prevalence of HR- and LR-HPV by Linear Array genotyping test in 299 women aged 18-63 years who consecutively visited Molise Region main hospitals for routine Pap smear between February and August 2008. Ninety women were positive for any HPV (30.1%), and 66 for any HR-HPV (22.1%). The most prevalent HR-HPV types were HPV 16 (22.2% of all women with HPV infection), HPV 53 (14.4%), and HPV 66 (14.4%). HPV infections increased from 15.8% in the 18-20 years group to 50.0% in the 21-23 years group and then decreased to 9.1% in those aged 50 years or more (p=0.008). Multiple HPV infections were observed in 15.7% of the study sample (52.2% of all HPV positive). There is a significantly higher prevalence of multiple infections in 18-32 years group women (24.5%) compared with females aged 33 years or more (6.8%) (p<0.005). Current smokers were at increased risk of HPV infection (44.2% of HPV infections compared with 23.5% in never smokers, and 25.3% of multiple HPV infections compared with 11.3%; p=0.001). HR-HPV infections were higher in women never been pregnant (27.1% compared with 7.7%; p=0.001). Oral contraceptive use was completely unrelated to infection. Among the 122 women who had both cytological examination and HPV results, multiple HR-HPV types were found in 36.8% of those with abnormal cervical findings, and in 13.6% of those with normal cervical findings (p=0.05). The results of the present investigation provide further evidence for the notion that cervical HPV infection is more widespread than previously suggested.