Diagnostic and infection control strategies for Clostridioides difficile infections in a setting of high antimicrobial resistance prevalence.

Clostridioides difficile (CD) is a major nosocomial pathogen and the leading cause of antibiotic-associated diarrhoea. In light of the strong association between antimicrobial use and CD infections (CDI), it may be hypothesised that areas at higher prevalence of antimicrobial resistance, like the region of Campania in southern Italy, could also have a higher rate of CDI. In this multicentre, region-based, prospective study, we analysed such issues, exploiting CDI incidence data collected from local hospitals. In 2016, the Italian National Centre for Disease Control supported a project involving three Italian regions: Friuli Venezia Giulia, Lazio and Campania. In Campania, a network of 49 hospitals willing to participate in the project was created. The project consisted of two phases: a survey on practice patterns concerning CDI and an epidemiological surveillance study. We identified a stringent need to improve awareness about CDI among the regional health-care community, as a widespread lack of surveillance programmes for CDI control was observed (existing in only 40% of participating facilities). Moreover, almost half of the participating hospitals (n=16, 43%) had no standardised procedures or protocols to control and prevent CDI. In the second phase of the study, we collected data of CDI cases during a six-month surveillance programme. In all, 87 CDI cases were observed, for a total of 903,334 patient bed-days and 122,988 admissions. According to the above data, CDI incidence was 0.96 cases/10000 patient bed-days, much lower than expected based on prior studies conducted elsewhere. The results of our study suggest CDI remains a rather neglected clinical issue in Campania. Despite a high burden of antimicrobial resistance and antimicrobial use in our geographic setting, we observed a very low incidence of CDI. Such a low incidence could be explained by underdiagnosis, but could also be related to actual diet, the lower patient age or the specific genetic background. However, further studies are warranted to either confirm or rebut the above hypotheses.

[Candidal vulvovaginitis: an epidemiological survey among immigrant prostitutes]. / Sorveglianza epidemiologica della vulvovaginite da Candida in una popolazione di prostitute extracomunitarie.

OBJECTIVES: Candidal vulvovaginitis is a frequent infectious process in adult women that assumes particular clinical, epidemiological and social importance in prostitutes due to its possible sexual transmission. The aim of the study was to evaluate the frequency of symptomatic or non-symptomatic vulvovaginitis caused by Candida spp and its possible relationship to behavioural risk factors, by a prospective study carried on 153 immigrant prostitutes from various African countries. PATIENTS AND METHODS: All subjects (average age 27 yrs; range 18-50 yrs) coming from sub-Saharan areas (Nigeria, Ghana, Benin, Senegal) and resident in the coastal area northwest of Naples (southern Italy) underwent a microbiological investigation to detect the possible presence of Candida in vaginal, rectal and pharyngeal swabs. Agar Sabouraud with the addition of chloramphenicol was used for cultures and the mycotube system for identification; in vitro sensitivity tests with amphotericin, nystatin, 5-fluorocytosine, econazole, and fluconazole were also performed according to the Kirby Bauer technique. RESULTS: The rate of Candida detection from vaginal swabs was 45% (69/153) with the following distribution by specie: C. albicans 75.4%, C. glabrata 7.2%, C. krusei 2.9%, C. tropicalis 1.4%, Candida spp 13%. The incidence of Candida from pharyngeal and rectal swabs was 18.3% and 26.1%, respectively. The overall resistance of Candida was comprised between 6% for fluconazole and 27% for econazole. No strain was resistant to 5-fluorocytosine, nystatin and amphotericin. CONCLUSIONS: The incidence of Candida in this particular population of immigrates was very high and correlated to many well-identified risk factors.