Analysis of the Clinical and Epidemiological Meaning of Screening Test for SARS-CoV-2: Considerations in the Chronic Kidney Disease Patients during the COVID-19 Pandemic.

The COronaVIrus Disease 19 (COVID-19) pandemic is an emerging reality in nephrology. In a continuously changing scenario, we need to assess our patients' additional risk in terms of attending hemodialysis treatments, follow-up peritoneal dialysis, and kidney transplant visits. The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-20 infection in the general population plays a pivotal role in estimating the additional COVID-19 risk in chronic kidney disease (CKD) patients. Unfortunately, local prevalence is often obscure, and when we have an estimation, we neglect the number of asymptomatic subjects in the same area and, consequently, the risk of infection in CKD patients. Furthermore, we still have the problem of managing COVID-19 diagnosis and the test's accuracy. Currently, the gold standard for SARS-CoV-2 detection is a real-time reverse transcription-polymerase chain reaction (rRT-PCR) on respiratory tract samples. rRT-PCR presents some vulnerability related to pre-analytic and analytic problems and could impact strongly on its diagnostic accuracy. Specifically, the operative proceedings to obtain the samples and the different types of diagnostic assay could affect the results of the test. In this scenario, knowing the local prevalence and the local screening test accuracy helps the clinician to perform preventive measures to limit the diffusion of COVID-19 in the CKD population.

The first Italian case report of leg ulcer and sepsis caused by Shewanella algae in a immunocompetent patient.

We describe the first Italian case of Shewanella algae septicemia in an immunocompetent patient with chronic leg ulcers. The patient had been exposed to seawater before the onset of symptoms. Despite the absence of severe underlying diseases, the primary soft tissue infection of the leg was complicated by hematogenous dissemination.

Rapid containment of nosocomial transmission of a rare community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clone, responsible for the Staphylococcal Scalded Skin Syndrome (SSSS).

BACKGROUND: The aims of this study were to identify the source and the transmission pathway for a Staphylococcal Scalded Skin Syndrome (SSSS) outbreak in a maternity setting in Italy over 2 months, during 2014; to implement appropriate control measures in order to prevent the epidemic spread within the maternity ward; and to identify the Methicillin-Resistant Staphylococcus aureus (MRSA) epidemic clone. METHODS: Epidemiological and microbiological investigations, based on phenotyping and genotyping methods, were performed. All neonates involved in the outbreak underwent clinical and microbiological investigations to detect the cause of illness. Parents and healthcare workers were screened for Staphylococcus aureus to identify asymptomatic carriers. RESULTS: The SSSS outbreak was due to the cross-transmission of a rare clone of ST5-CA-MRSA-SCCmecV-spa type t311, exfoliative toxin A-producer, isolated from three neonates, one mother (from her nose and from dermatological lesions due to pre-existing hand eczema) and from a nurse (colonized in her nose by this microorganism). The epidemiological and microbiological investigation confirmed these as two potential carriers. CONCLUSIONS: A rapid containment of these infections was obtained only after implementation of robust swabbing of mothers and healthcare workers. The use of molecular methodologies for typing was able to identify all carriers and to trace the transmission.

Clostridium difficile ribotype 033 colitis in a patient following broad-spectrum antibiotic treatment for KPCproducing Klebsiella pneumoniae infection, Italy.

This report describes a case of Clostridium difficile ribotype 033 colitis in a patient treated with multiple antibiotics for KPC-producing Klebsiella pneumoniae pancreatitis. Diagnostic, clinical and therapeutic features are discussed. To the best of our knowledge, this is the first case of C. difficile ribotype 033 clinical infection reported from Italy.

Severe invasive pulmonary zygomycosis by Rhizomucor pusillus and concomitant severe bacterial endocarditis in acute promyelocytic leukaemia.

We describe a severe pulmonary invasive zygomycosis sustained by Rhizomucor pusillus and concomitant bacterial endocarditis in a woman diagnosed with acute promyelocytic leukaemia.

Are E-test and Vitek2 good choices for tigecycline susceptibility testing when comparing broth microdilution for MDR and XDR Acinetobacter baumannii?

This study reports the results of antimicrobial susceptibility testing of 10 MDR and 74 XDR Acinetobacter bauman- nii clinical isolates from our hospital routine. We used three different methods: two automated systems (Sensititre and VITEK 2) and one standardized manual method (E-test). Since many published papers refer to in vitro tests performed by E-test, the aim of this study was to test if this method is reliable for testing tigecycline. The results obtained show that E-test significantly overestimates the MIC of the broth microdilution (reference test), thus ob- taining a significant number of major errors (resistant instead of sensitive). VITEK 2 also shows the same problem, but it is less critical. We therefore conclude that these methods do not seem to be very reliable in the performance of susceptibility testing of MDR and XDR Acinetobacter baumannii against tigecycline.

Comparison of different methods for determining beta-lactam susceptibility in Pseudomonas aeruginosa.

This study compared the results of antimicrobial susceptibility testing of 77 clinical strains isolated for Pseudomonas aeruginosa to five beta-lactam agents: aztreonam, ceftazidime, imipenem, meropenem and piperacillin+tazobactam. Four different methods were employed: two automated systems (VITEK 2 and Sensititre) and two standardized manual methods (Kirby-Bauer and E-test). The concordances for the susceptibility categories were better for Kirby-Bauer (medium value =89.6%), followed by Sensititre (medium value =87.0%) and VITEK 2 (medium value =82.8%). The disk diffusion method did not present very major errors in comparison to the two automated systems.

[Study on in vitro susceptibility of Candida spp. isolated from blood culture]. / Studio sulla incidenza e sulla sensibilità in vitro di ceppi di Candida spp. isolati da sangue.

In recent years the incidence of bloodstream infections due to Candida species has progressively increased, partly due to the more critical conditions of hospitalized patients. There has been a significant increase in immune-compromised, diabetic and/or elderly patients, also with venous access, with a subsequent increase in Candida species isolated from bloodstream infections. In 2009-2010 in the hospitals of Mestre and Venice we isolated 123 Candida species from bloodstream infections: 59 Candida albicans, 28 Candida parapsilosis, 12 Candida glabrata, 9 Candida tropicalis, and 4 Geotrichum capitatum, while the 11 others belong to 8 different species. We calculated MIC for the following antifungal agents: fluconazole, itraconazole, voriconazole, 5-flucytosine, amphotericin B and caspofungin.

[Study on in-vitro susceptibility of ESBL-positive Escherichia coli isolated from urine specimens]. / Studio sulla sensibilità in vitro di ceppi di Escherichia coli ESBL-produttori isolati da campioni urinari.

Treatment of infections by beta-lactamase-producing microorganisms is very difficult. Our aim was to determine the in vitro susceptibility of 430 ESBL-positive Escherichia coli strains isolated from urinary tract infections. All the microorganisms were isolated in the Microbiology Unit at the Ospedale dell'Angelo in Mestre (Venice) between May 2008 and September 2009 and were confirmed by the double-disk test. All microorganisms were sensitive to imipenem and meropenem, 98.4% to tigecycline, 95.1% to amikacin, 89.3% to nitrofurantoin, 67.5% to gentamycin and 63.2% to piperacillin/tazobactam. Only 22.6% were sensitive to cotrimoxazole, while fluoroquinolone (norfloxacin and levofloxacin) activity was found to be very low (6%).