Temporal trends of healthcare associated infections and antimicrobial use in 2011-2013, observed with annual point prevalence surveys in Ferrara University Hospital, Italy.

INTRODUCTION: Healthcare associated infections (HAIs) and misuse of antimicrobials (AMs) represent a growing public health problem. The Point Prevalence Surveys (PPSs) find available information to be used for specific targeted interventions and evaluate their effects. The objective of this study was to estimate the prevalence of HAIs and AM use, to describe types of infections, causative pathogens and to compare data collected through three PPSs in Ferrara University Hospital (FUH), repeated in 3 different years (2011-2013). The population-based sample consists of all patients admitted to every acute care and rehabilitation Department in a single day. METHODS: ECDC Protocol and Form for PPS of HAI and AM use, Version 4.2, July 2011. Risk factor analysis was performed using logistic regression. RESULTS: 1,239 patients were observed. Overall, HAI prevalence was 9.6%; prevalence was higher in Intensive Care Units; urinary tract infections were the most common HAIs in all 3 surveys; E.coli was the most common pathogen; AM use prevalence was 51.1%; AMs most frequently administered were fluoroquinolones, combinations of penicillins and third-generation cephalosporins. According to the regression model, urinary catheter (OR: 2.5) and invasive respiratory device (OR: 2.3) are significantly associated risk factors for HAIs (p < 0.05). CONCLUSIONS: PPSs are a sensitive and effective method of analysis. Yearly repetition is a useful way to maintain focus on the topic of HAIs and AM use, highlighting how changes in practices impact on the outcome of care and providing useful information to implement intervention programs targeted on specific issues.

Risk perception of sexually transmitted diseases and teenage sexual behaviour: attitudes towards in a sample of Italian adolescents.

The aim of the study is to determine awareness about sexually transmitted diseases (STDs) and their prevention in people aged 14-19 of Ferrara and province. The study was carried out using a self-administered standardised anonymous questionnaire in a sample of students attending to three upper secondary schools. Total number of collected questionnaires was 2695, the average age of interviewed was 17.1. Only 52.3% of respondents correctly recognized STD definition. Over 95% of subjects identified acquired immune deficiency syndrome (AIDS), while properly classification of Hepatitis B increased with age and lowest degree of knowledge concerned herpes infection and Candidiasis. Sex without condom (95.97%) and needle exchange in drugs abusers (94.9%) are considered high risk behaviours. 80.3% of interviewed, without distinction of school attendance, sex, and age considered lack of information as a situation of high risk. Condoms are not used by 46.4% of the subjects in case of sex with a regular partner and by 9.5% with casual partner. Majority of students declared condoms very safe in preventing STDs but an important percentage indicated also contraception methods; correct answers were higher among females and increased with age. Main sources of information were TV (21.6%), school (21.1%) and friends (14.8%) and a few sought information from family doctor (7.4%) and web (4.8%). The study suggests, as priority, to improve teenagers' awareness about risk behaviours and prevention of STDs. School can play an important role in reinforcement of sexual education programmes and directing young people to general practitioners and primary sexual health care services.

Molecular vs culture methods for the detection of bacterial faecal indicators in groundwater for human use.

AIMS: The current standard culture methods are unable to detect nongrowing bacteria and, thus, might not be sufficient for precise monitoring of the microbiological quality of waters. The use of a molecular method such as PCR could be a valid alternative to detect bacterial faecal contamination indicators such as Escherichia coli and Enterococcus faecalis and reveal the presence of culturable and nonculturable bacterial forms. METHODS AND RESULTS: The presence of E. coli and Ent. faecalis cells in 30 groundwater samples was evaluated with the standard culture method and compared with a specific PCR protocol. A substantial percentage (50%) of the samples not containing culturable cells proved positive in the search for Ent. faecalis DNA by PCR. Quantification by competitive PCR (cPCR) of the DNA detected allowed us to calculate the number of nonculturable cells present in water samples: the number varied from 2 to 120 cells ml(-1). Only four samples were positive for E. coli DNA and the corresponding nonculturable cells varied from 24 to 70 ml(-1). CONCLUSIONS: This study demonstrates that the standard culture methods in use are unable to detect a substantial proportion of the bacterial population which is nonculturable but, as previously demonstrated, potentially still viable and able to express those pathogenic factors needed for causing infections in humans. SIGNIFICANCE AND IMPACT OF THE STUDY: To protect human health it is necessary to develop and use methods which detect the nonculturable as well as culturable bacteria present in water.

Resuscitation rate in different enterococcal species in the viable but non-culturable state.

AIMS: The viable but non-culturable (VBNC) state is a survival strategy adopted by bacteria when exposed to environmental stress. When in this state bacteria are no longer culturable on conventional growth media, but cells display metabolic activity and maintain pathogenicity factors/genes and, in some cases, resuscitation from the VBNC state has been shown. This state has been described for both human pathogens and faecal pollution indicators. In this study, we present evidence for entry of different enterococcal species into the VBNC state in an oligotrophic microcosm. METHODS AND RESULTS: The duration of the viability of the cells in the VBNC state was measured either by detecting the presence of pbp5 mRNA or by quantifying their resuscitation capability. Enterococci showed different behaviours. Enterococcus faecalis and Enterococcus hirae entered into the VBNC state within 2 weeks and remained in that state for 3 months. In the experiments described the resuscitation rate was 1:10 000 cells as soon as the cells entered the VBNC state and decreased gradually to undetectable levels over the following 3 months. Enterococcus faecium, however, remained culturable up to 4 weeks. After this time period, when the population was totally unculturable, the cells were far less resuscitable than other enterococci and only over a narrow time interval (2 weeks). CONCLUSIONS: These results suggest that Ent. faecalis and Ent. hirae enter the VBNC state but that Ent. faecium, in an oligotrophic laboratory environment, tends to die instead of entering the VBNC state. SIGNIFICANCE AND IMPACT OF THE STUDY: These experiments may mimic what happens when enterococci are released by humans and animals in natural environments.