A severe foodborne outbreak of diarrhoea linked to a canteen in Italy caused by enteroinvasive Escherichia coli, an uncommon agent.

We describe a foodborne outbreak in Italy caused by enteroinvasive Escherichia coli (EIEC), an enteric pathogen uncommon in industrialized countries. On 14 April 2012 a number of employees of the city of Milan Fire Brigade (FB) were admitted to hospital with severe diarrhoea after attending their canteen. Thirty-two patients were hospitalized and a total of 109 cases were identified. A case-control study conducted on 83 cases and 32 controls attending the canteen without having symptoms identified cooked vegetables to be significantly associated with the disease. Stool samples collected from 62 subjects were screened for enteric pathogens using PCR-based commercial kits: 17 cases and two asymptomatic kitchen-workers were positive for the Shigella marker gene ipaH; an ipaH-positive EIEC strain O96:H19 was isolated from six cases. EIEC may cause serious dysentery-like outbreaks even in Western European countries. Microbiologists should be aware of microbiological procedures to detect EIEC, to be applied especially when no common enteric pathogens are identified.

Zygomycosis in Italy: a survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology).

The aims of the study were to analyze the clinical and epidemiological characteristics and treatments for patients who developed zygomycosis enrolled in Italy during the European Confederation of Medical Mycology of medical mycology survey. This prospective multicenter study was performed between 2004 and 2007 at 49 italian Departments. 60 cases of zygomycosis were enrolled: the median age was 59.5 years (range 1-87), with a prevalence of males (70%). The majority of cases were immunocompromised patients (42 cases, 70%), mainly hematological malignancies (37). Among non-immunocompromised (18 cases, 30%), the main category was represented by patients with penetrating trauma (7/18, 39%). The most common sites of infection were sinus (35%) with/without CNS involvement, lung alone (25%), skin (20%), but in 11 cases (18%) dissemination was observed. According to EORTC criteria, the diagnosis of zygomycosis was proven in 46 patients (77%) and in most of them it was made in vivo (40/46 patients, 87%); in the remaining 14 cases (23%) the diagnosis was probable. 51 patients received antifungal therapy and in 30 of them surgical debridement was also performed. The most commonly used antifungal drug was liposomal amphotericin B (L-AmB), administered in 44 patients: 36 of these patients (82%) responded to therapy. Altogether an attributable mortality rate of 32% (19/60) was registered, which was reduced to 18% in patients treated with L-AmB (8/44). Zygomycosis is a rare and aggressive filamentous fungal infection, still associated with a high mortality rate. This study indicates an inversion of this trend, with a better prognosis and significantly lower mortality than that reported in the literature. It is possible that new extensive, aggressive diagnostic and therapeutic procedures, such as the use of L-AmB and surgery, have improved the prognosis of these patients.

Increasing resistance according to patient's age and sex in Escherichia coli isolated from urine in Italy.

The prevalence of Escherichia coli among the uropathogens routinely isolated in non-hospital laboratories (Labs) and its susceptibility profiles were investigated. Thirty-three Labs were selected throughout Italy. In vitro assays were performed by means of disk diffusion according to the CLSI. Females were prevalent (79.9%) and the mean patient age was 58.6 (sd 20.4) years. Overall, the prevalence of E. coli was 55.3% (1375 strains), with Enterococcus spp 10.2 %, Proteus mirabilis 4.8%, coagulase-negative staphylococci 4.3% and Klebsiella 3.8% being the next most frequently encountered species. High compliance with quality control program was observed. Susceptibility figures in E. coli were consistently low for many antimicrobial agents such as ampicillin (51.3%) and co-trimoxazole (74.6%) and higher for others such as gentamicin (87.9%) and ceftazidime (95.1%). Resistance rates were higher among male patients and increased according to the patient's age.

Prevalence of nosocomial infections in 15 Italian hospitals: first point prevalance study for the INF-NOS project.

BACKGROUND: The aim of our study was to assess the magnitude of nosocomial infections (NI) in 15 Italian hospitals. PATIENTS AND METHODS: A multicenter point prevalence study of NI was carried out in October 2001 among eight medical, surgical and intensive care units in hospitals with more than 400 beds, after a pilot phase performed in April 2001. RESULTS: Of the 2,165 surveyed patients, 163 had a total of 179 NIs. The global prevalence rate of patients with NI and of NI was respectively 7.5% (95% CI 6.4-8.6) and 8.3% (95% CI 7.1-9.4), ranging from 5.5% (95% CI 4.2-6.8) in medical wards to 34.2% (95% CI 25.7-42.7) in intensive care units (ICUs). The NI prevalence was higher in: hospitals that did not have an infection control committee (ICC) compared to hospitals with an ICC (10.3%, 95% CI 6.4-10.1 versus 7.2, 95% CI 6.0-8.3, p = 0.08); university hospitals compared with non-teaching hospitals (9.4%, 95% CI 4.5-14.2 versus 7.4%, 95% CI 6.3-8.5, p = 0.4) and; hospitals with 1,000 or more beds compared to lower volume hospitals (9.5%, 95% CI 7.3-11.7 versus 6.6%, 95% CI 5.3-7.8, p = 0.02). The most prevalent infections found were lower respiratory tract infections, urinary tract infections and surgical-site infections, representing 38.0%, 20.1% and 12.8%, respectively, of all NI. Among 1,674 patients without any infection, 575 (34.3%) of them had been undergoing antibiotic treatment at the time of the survey. CONCLUSION: The high rate of NI, particularly in ICUs, and the high number of improper procedures emphasize the need to develop clinically-oriented guidelines, tailor active infection control programs and implement an active ICU surveillance system.

Antimycobacterial chemotherapy in inflammatory bowel disease.

We report on a case, ulcerative colitis and another of Crohn's disease. During a relapse which was unresponsive to conventional therapy, acid-fast bacilli were found in colonic biopsies. Conventional therapy was substituted with antimycobacterial chemotherapy (rifampicin, isoniazid and ethambutol) which was responsible for a marked improvement. However, a relapse occurred during chemotherapy and no acid-fast bacilli were found. The patients became responsive to sulphasalazine and corticosteroid therapy once again. It appears that Mycobacteria play a collateral role in inflammatory bowel disease and that once they have been eliminated the original disease re-emerges.

Evaluation of a computer-assisted method of analysing SDS-PAGE protein profiles in tracing a hospital outbreak of Serratia marcescens.

Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) profiles of bacterial proteins have been successfully used for taxonomical purposes. More recently this technique has been applied to epidemiological investigations in respect of various micro-organisms including Neisseria meningitidis, Staphylococcus aureus and Clostridium difficile. The main limitations of the methods so far described are lack of standardisation in extraction and separation as well as in the analysis of results. Although reproducibility in the same laboratory has been shown to be satisfactory, comparison of results among laboratories is still difficult. Moreover, assessment of differences and/or similarities among chromatograms or autoradiographs showing many bands depends upon qualitative descriptions. Interpretation of densitometric scannings is laborious and time-consuming. In this paper we present our experience of a completely standardised, fully computer-controlled procedure for SDS-PAGE (AMBIS System) in analysing 35S-methionine-labelled total proteins. The methodology proved very useful in monitoring a hospital outbreak of Serratia marcescens. It allowed us to make quantitative comparison in a shorter time as well as to handle easily a great amount of data and usefully integrate it with those obtained with other systems such as serotyping. Furthermore, when the two systems are used together, more precise information can be gained. In this epidemic, serotyping indicated the presence of two groups which would have been missed by PAGE analysis alone. Electrophoretotyping, however, focused on similarities of cellular proteins among the epidemic strains. This allowed us to distinguish them from epidemiologically unrelated strains of the same serogroup.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of changes in pH, medium and inoculum size on the in vitro activity of different quinolone and fluoroquinolone antibiotics against urinary pathogens.

The antibacterial activity of quinolones and fluoroquinolones was evaluated against several strains of enterobacteria growing in Mueller-Hinton broth and in urine at different pH. The data obtained in alkaline urine and in Mueller-Hinton broth indicate that the MIC values of the fluoroquinolones are about 16-32 times inferior to those found in urine at pH 6. On the other hand, the activity of nalidixic acid and more particularly that of cinoxacin in urine appears to be optimum at this lower pH, showing MIC values only 2-4 times higher than those obtained in Mueller-Hinton media. Although the fluoroquinolones appear to have the highest degree of activity, a better MBC/MIC ratio was observed for cinoxacin and for nalidixic and oxolinic acids.