ABSTRACT
Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000â¯cfu/L). Legionella pneumophila serogroup 2-15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.
Subject(s)
Infection Control/methods , Legionella pneumophila/isolation & purification , Legionellosis/prevention & control , Water Supply , Cross Infection/epidemiology , Cross Infection/prevention & control , Cross-Sectional Studies , Disinfection , Humans , Italy/epidemiology , Legionellosis/epidemiology , Surveys and Questionnaires , Water MicrobiologyABSTRACT
We report, in a clinical setting, the tigecycline concentration and area under the concentration-time curve (AUC) - both in blood and in cerebrospinal fluid (CSF) - of a patient with a ventriculo-atrial shunt infection. Tigecycline weakly penetrates CSF the CSF-to-serum concentration ratio was 0.079 and CSF-to-serum AUC(0-12) ratio was 0.067.
Subject(s)
Anti-Bacterial Agents/pharmacokinetics , Cerebrospinal Fluid/chemistry , Minocycline/analogs & derivatives , Adult , Anti-Bacterial Agents/administration & dosage , Area Under Curve , Bacterial Infections/drug therapy , Cerebrospinal Fluid Shunts/adverse effects , Female , Humans , Minocycline/administration & dosage , Minocycline/pharmacokinetics , Plasma/chemistry , TigecyclineABSTRACT
We describe a case of a 66-year-old immunocompetent man affected by Achromobacter denitrificans renal abscess related to renal stones. The patient was treated successfully with meropenem 1 g three times daily for 60 days. To our knowledge, this is the first ever case reported of Achromobacter denitrificans renal abscess.
Subject(s)
Abscess/microbiology , Achromobacter denitrificans/isolation & purification , Kidney Diseases/microbiology , Achromobacter denitrificans/genetics , Aged , Anti-Bacterial Agents/therapeutic use , Humans , Kidney Diseases/drug therapy , Male , Meropenem , Thienamycins/therapeutic useABSTRACT
Propionibacterium acnes is a member of the human microbiota that has been recently associated with late-onset infections of indwelling devices, especially shoulder prosthesis. Aortic graft infection are rare events with significant morbidity and mortality. Here, we describe the case of an abdominal aortic graft infection due to P. acnes with an unusual early onset. A review of the recent English language literature has been added.
Subject(s)
Aorta, Abdominal/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis/adverse effects , Gram-Positive Bacterial Infections/microbiology , Propionibacterium acnes/pathogenicity , Prosthesis-Related Infections/microbiology , Aged , Gram-Positive Bacterial Infections/surgery , Humans , Male , Prognosis , Prosthesis-Related Infections/surgeryABSTRACT
In renal allograft recipients, infection disease complications remain an important cause of morbidity and mortality during the post-transplant period. This complication occurs more frequently from 1 to 6 months after transplant. The epidemiology of infection during the postoperative period is less well characterized, because recipients routinely reside at home. We describe a case of late onset Candida albicans and HSV-1 esophagitis, and Pneumocystis carinii pneumonia, that occurs 9 years after renal transplantation in a patient with severe CD4+ T-lymphocytopenia and hypogammaglobulinaemia. We underline the importance of monitoring immunosuppressive therapy in these patients and the usefulness of prophylaxis against P. carinii pneumonia
Subject(s)
Bacteremia/microbiology , Kidney Transplantation , Opportunistic Infections/etiology , Pneumonia, Pneumocystis/etiology , Postoperative Complications/microbiology , Pseudomonas Infections/etiology , Agammaglobulinemia/etiology , Aged , CD4 Lymphocyte Count , Fatal Outcome , Glomerulonephritis, Membranoproliferative/surgery , Heart Failure/etiology , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Lymphopenia/etiology , Male , Pseudomonas Infections/microbiologyABSTRACT
According to the National Nosocomial Infection Surveillance system we analysed the post-surgical nosocomial infections in a surgery ward of Perugia University. Between May 2000 and April 2001, 677 patients were enrolled mean age 51.5 years: 355 (52%) male, 462 (68%) ASA score 1, "clean" surgery in 355 cases (52%), cephazolin prophylaxis in 256 (38%); 11 (2%) patients deceased perioperatively. A total of 37 nosocomial infections, in 33 patients, were detected: 18 pneumonia (48.6%), 10 surgical site infections (27%) with 18 isolated: 12 gram-negative (E. coli 3, Acinetobacter baumannii 2, Providencia stuartii 2, Pseudomonas aeruginosa 2, Achromobacter spp. 1, Citrobacter freundii 1, Morganella morgani 1) and 6 gram-positive (Staphylococcus aureus meticillin resistant 3, Enterococcus faecalis 2, Streptococcus salivarius 1); 7 sepsis (19%) due to 7 gram-positive (S. aureus meticillin resistant 4, S. aureus meticillin susceptible 1, Staphylococcus coagulase negative 1, Clostridium spp 1), 2 urinary tract infections (5.4%). Patients without infections and with nosocomial infections spent in hospital 6.3 and 16.6 days respectively. We can image that in one year 53 surgical procedure were lost, with a lost gain of 79.500-291.500 euro/year.
Subject(s)
Bacterial Infections/epidemiology , Cross Infection/epidemiology , Female , Humans , Male , Middle Aged , Surgery Department, HospitalABSTRACT
Among the hospital related complications the nosocomial infections are a major source of problems, especially in the Intensive Care and in the Surgery Units. It has been clearly demonstrated that infection control programs, in Surgery Units, have a large benefit in the reduction of surgical site infections (SSIs) rates. The surveillance method, sponsored by the Centers for Diseases Control of Atlanta, is the most consolidated system and it is active since '70 years. We used this method in the Vascular Surgery Unit of Perugia Hospital. During a 12-month period, 668 consecutive patients were enrolled and followed, after surgery, for 30 days (without implantable devices) or 1 year (with prosthesis). A total of 14 (2.1%) patients had SSIs: 4 superficial, 4 deep, 6 organ-space. We isolated 13 pathogens: 8 gram-positive, 4 gram-negative, and one Candida albicians. The most prevalent pathogen isolated was Staphylococcus aureus methicillin-susceptible. This first positive experience will be used for further more generalized work involving the principal surgical Unit of the Umbria Region.
Subject(s)
Cross Infection/epidemiology , Vascular Surgical Procedures/adverse effects , Adult , Aged , Aged, 80 and over , Cross Infection/microbiology , Female , Humans , Male , Middle Aged , Population SurveillanceABSTRACT
Cardiovascular disease (CVD) is an increasing concern for human immunodeficiency virus (HIV)-infected patients, and risk assessment is recommended in routine HIV care. The absolute cardiovascular risk in an individual is determined by several factors, and various algorithms may be applied. To date, few comparisons of HIV patients with persons of the same age from the general population have been conducted. We hypothesized that the calculated risk of CVD may be increased in HIV patients. The probability for acute coronary events within 10 y (Framingham Risk Score) and the probability for fatal cardiovascular disease (SCORE algorithm) were assessed in 403 consecutive HIV-positive subjects free from overt cardiovascular disease, as well as in 96 age- and gender-matched control subjects drawn from the general population living in the same geographical area. The average 10-y risk for acute coronary events (Framingham Risk Score) was 7.0%+/-5% in HIV subjects and 6.3%+/-5% in the control group (p =0.32). The 10-y estimated risk for cardiovascular mortality (SCORE algorithm) was 1.23%+/-2.3% and 0.83%+/-0.9%, respectively (p =0.01). The main contributor to the increased CVD risk was the high proportion of smokers, but not an increase in cholesterol level. In conclusion, a limited increase in estimated risk of CVD was found in HIV-infected patients compared to the general population. In HIV-infected individuals other factors of less value in the general population and not included in any cardiovascular algorithm might be important. In our patients intervention to modify traditional risk factors should be addressed primarily towards modifying smoking habits.