Infections in lung transplanted patients: A review.

Lung transplantation can improve the survival of patients with severe chronic pulmonary disorders. However, the short- and long-term risk of infections can increase morbidity and mortality rates. A non-systematic review was performed to provide the most updated information on pathogen, host, and environment-related factors associated with the occurrence of bacterial, fungal, and viral infections as well as the most appropriate therapeutic options. Bacterial infections account for about 50% of all infectious diseases in lung transplanted patients, while viruses represent the second cause of infection accounting for one third of all infections. Almost 10% of patients develop invasive fungal infections during the first year after lung transplant. Pre-transplantation comorbidities, disruption of physical barriers during the surgery, and exposure to nosocomial pathogens during the hospital stay are directly associated with the occurrence of life-threatening infections. Empiric antimicrobial treatment after the assessment of individual risk factors, local epidemiology of drug-resistant pathogens and possible drug-drug interactions can improve the clinical outcomes.

Derogation from drinking water quality standards in Italy according to the European Directive 98/83/EC and the Legislative Decree 31/2001 - a look at the recent past.

BACKGROUND: Until 2012, the European Directive 98/83/EC and the Italian Legislative Decree 31/2001 allowed derogation from the drinking water quality standards in Italy with a number of requests higher than any other European country. The present work aims to assess the extent of the derogation granted in Italy, in particular by noting those issued from 2001 to 2012, in order to obtain a retrospective quality indicator, useful for evaluating the risk arising from population exposure. METHODS: The most significant factors leading to derogation were analyzed. We first carried out an in-depth analysis of the European, national and regional legislation and subsequently distributed the obtained data according to: parameters regarding derogation; length of the derogation; area involved; and maximum parameter value granted by the derogation acts. RESULTS: We found approximately 100 derogation acts, granted in 14 Regions and concerning 19, mostly chemical, parameters. The most frequently granted derogation, in 12 Regions, was due to the presence of arsenic. Furthermore, given its 10-year presence in Campania and Lazio, fluoride was the most widespread parameter in the Italian territory. The year 2006 had the largest number of derogations issued with 22 acts found: this decreased to one during the third three-year derogation granted in 2012. CONCLUSIONS: Data collected showed how often Italy applied for drinking water quality derogation in recent years, going so far as to request a third three-year derogation. While this phenomenon has highlighted a practice largely ignored by the public, derogation acts have often involved the same parameters, underlining how difficult it can be to comply with the standards in a timely manner.

Social deprivation indexes and anti-influenza vaccination coverage in the elderly in Sardinia, Italy, with a focus on the Sassari municipality.

The aim of the present study was to evaluate the relationship between social deprivation indexes and anti-influenza vaccination coverage in the elderly population (over 65 years old) in Sardinia. This relationship was first observed in a regional context. An already-known deprivation index was used, and its trivial relationship with anti-influenza vaccination coverage was evaluated. Secondly, the same relationship was assessed in the homogeneous area of the Municipality of Sassari. This required the adoption of an ad hoc deprivation index, which allowed us to stratify the population into deprivation groups and to correlate vaccination coverage with socio-economic variables. The results showed that regional anti-influenza vaccination coverage increased linearly as deprivation decreased. This trend was confirmed in the Municipality of Sassari. Pearson's analysis highlighted factors that significantly correlate with vaccination coverage. In Sardinia, the relationship between anti-influenza vaccination coverage and socio-economic status is consistent with the international panorama, and highlights the necessity to implement interventions to promote vaccination coverage among the elderly.

Validation of intensive care unit-acquired infection surveillance in the Italian SPIN-UTI network.

Validity is one of the most critical factors concerning surveillance of nosocomial infections (NIs). This article describes the first validation study of the Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) project (SPIN-UTI) surveillance data. The objective was to validate infection data and thus to determine the sensitivity, specificity, and positive and negative predictive values of NI data reported on patients in the ICUs participating in the SPIN-UTI network. A validation study was performed at the end of the surveillance period. All medical records including all clinical and laboratory data were reviewed retrospectively by the trained physicians of the validation team and a positive predictive value (PPV), a negative predictive value (NPV), sensitivity and specificity were calculated. Eight ICUs (16.3%) were randomly chosen from all 49 SPIN-UTI ICUs for the validation study. In total, the validation team reviewed 832 patient charts (27.3% of the SPIN-UTI patients). The PPV was 83.5% and the NPV was 97.3%. The overall sensitivity was 82.3% and overall specificity was 97.2%. Over- and under-reporting of NIs were related to misinterpretation of the case definitions and deviations from the protocol despite previous training and instructions. The results of this study are useful to identify methodological problems within a surveillance system and have been used to plan retraining for surveillance personnel and to design and implement the second phase of the SPIN-UTI project.

[Thermal comfort in perioperatory risk's evaluation]. / Il comfort termico indicatore del rischio perioperatorio.

Studies till now conducted about operating rooms' microclimate have been focused mainly on operators' thermal comfort, considering that uneasiness conditions may compromise their working performance. In last years, nevertheless, the anesthesiologic community recalled attention on patients' risks determined by perioperatory variations of normothermia, underlining the necessity of orientating studies to individuate microclimate characteristics act to guarantee thermal comfort of the patient too. Looking at these considerations, a study has been conducted in the operating rooms of the hospital-university Firm and the n.1 USL of Sassari, finalized, on one hand, to determinate microclimate characteristics of the operating blocks and to evaluate operators' and patients' thermal comfort, on the other to individuate, through a software simulation, microclimate conditions that ensure contemporarily thermal comfort for both the categories. Results confirm the existence of a thermal "gap" among operators and patients, these last constantly submitted to "cold-stress", sometimes very accentuated. So, we underline microclimate's importance in operating rooms, because there are particular situations that can condition perioperatory risks. Moreover it can be useful to integrate risk's classes of the American Society of Anestesiology (ASA) with a score attributed to the PMV/PPD variation, reaching more real operatory risk indicators.

Monitoring on chemical and biological pollutants in sea waters of central-northern Sardinia.

INTRODUCTION: The aims of this study are to assess the quality of the coastal waters of central-northern Sardinia through data from a monitoring network and to outline maps and experimental models of environmental risk correlated to the presence of chemical and microbiological contaminants. The area studied is the coast between Capo Falcone and the mouth of the river Coghinas, in the northwestern part of the island. METHODS: In a first phase, 7 sampling stations of sea water and 1 sampling station of bivalve molluscs (Mytilus galloprovincialis Lam.) were identified. For each transept 3 different collection points at respectively 500, 1000, and 3000 meters from the coast for a total 21 sampling sites were identified. In a second phase, another 7 transepts were identified, 2 of which on the island of Asinara. RESULTS: As regards the microbiological monitoring of the sea water, very low concentrations of Total coliforms, Faecal coliforms and Faecal Streptococci were found and no Salmonella were isolated. Chemical analysis of the waters showed a high constant presence of phenols. In the bivalves we found rather high concentrations of Faecal coliforms without any clear seasonal variation, while no Salmonella was isolated in any of the examined samples. DISCUSSION: The results show that the considered area is not affected by serious pollution processes, thus allowing to express a completely satisfactory judgement on its state of health. However anthropic pressure in the considered territory is testified by the presence in the water of high concentrations of phenols. CONCLUSIONS: The results point out to the necessity of targeted and rational preventive action by means of control and protection measures for environmental ecosytems.

[Smoking habit and behaviour among health professionals]. / Indagine conoscitiva sull'abitudine al fumo del personale sanitario.

The study reports the results of a survey by questionnaire on the health staff's smoking habits in the Hospital-University Complex of Sassari. Thirty-one percent are smokers: 35.5% among nurses, 21.4% among doctors and 40.4% among service staff. Daily smokers are 87.2% and 46% smoke 10 or more cigarettes per day. The great part of the sample thinks that it has to participate in tobacco control programs, although 6.0% of doctors disagree. Multiple correspondence analysis showed different profiles on attitudes and smoking habits among health staff components. Among no-smokers, nurses, technicians and service staff are not favorable to the tobacco control campaigns thinking they should not be a role model to others. Among smokers, service staff and some physicians showed a similar profile; moreover, they smoke in front of patients. These results indicate that the smoking attitude of some health staff components might be a "negative" model to which refer and it might interfere with tobacco control programs.

[Epidemiological survey on smoking habit among young students in Sardinia. A cross sectional study]. / Il fumo fra i giovani: indagine trasversale nelle scuole medie superiori della Sardegna.

The study reports the prevalence of cigarette smoking among 11401 high school Sardinian students. The prevalence of smokers (40.2%) significantly differs between gender (41.1% males and 38.4% females). Males have an early initiation of smoking with an evident addictive effect by age. 54.3% are daily smokers and 21.4% smoke 15 or more cigarettes per day. More than 50% smoke to look grown-up and to be accepted by the group. Besides age (OR=1.10; 95%CI: 1.06-1.15), other factors are associated with smoke: low education level of father (OR=1.08; 95%CI: 1.02-1.15), no maternal support (OR = 1.73; 95%CI: 1.17-2.54), to have at least one smoker cohabitant (OR=1.66; 95%CI: 1.54-1.80) and alcohol drinking (OR=3.46; 95%CI: 3.04-3.93). The smokers' knowledge on smoke topics significantly differ from non smokers. Our results suggest the need of community preventive interventions, diversified for specific target populations, to modify the students' behaviours so that they respect their own health and that of their fellow citizens.

[Prevalence of antibodies to Borrelia burgdorferi in Sardinian teen-agers]. / Indagine sieroepidemiologica sulla presenza di anticorpi anti-Borrelia burgdorferi in giovani del Nord-Sardegna.

A cross-sectional sero-epidemiological study was conducted on teen-agers in Northern Sardinia, a low risk population for Lyme borreliosis. The adjusted sero-prevalence estimate for Enzyme Linked Immunofluorescent Assay on 443 teen-agers (229 males and 214 females) was 6.1%. The females vs males Odds Ratio was 5.1 (CI95%: 2.1-12.8). The prevalence was associated with the family size (chi2 for trend: p=0.03); teenagers without cohabitants, except parents, had a five fold risk (CI95%: 1.2-20.7) of sero-positivity in comparison to those with wider families. No significant association was found with other socio-economical indices nor with pet-owning. In conclusion, positive Lyme serology is not common in Northern Sardinia, but further sero-epidemiological survey on at high-risk population (forestry workers, hunters, shepherds) are needed.

[Water resources destined for human consumption: qualitative monitoring]. / Risorse idriche destinate al consumo umano: esperienze di monitoraggio qualitativo.

The work is a synthesis of the qualitative monitoring on waters resources (specially surface water), that were potable and distributed as drinkable waters in north Sardinia between 1996-2002. The obtained results point out: for the surface waters, recurrent problems of elevated turbidity, color, oxidability, microbial contamination and eutrofication; for the ground waters, lower levels of pollutants even if an high content of natural elements and substances that, for as of natural origin, could endanger and limit the use as drinkable water (sodium, chlorides, iron, manganese). Drinking water plants have, largely, solved the main causes of ineffectiveness of treatment such as the demolition of the organic load and the formation of trihalomethanes but it as been found an high concentration of chlorites; occasionally, the values of ammonia, aluminum, iron, manganese and, rarely, trihalomethanes are out law in piped.

[Survey on accidental exposure to biological materials in the Hospital-University Complex of Sassari during the period 1995-2000]. / Indagine sugli incidenti a rischio infettivo nel Complesso Ospedale-Università di Sassari durante il periodo 1995-2000.

To study professional exposure to biological materials an investigation was carried out in the Hospital-University Complex of Sassari during the period January 1st 1995-December 31 2000. 1003 occupational accidents were notified (incidence rate=6%). Infirmaries were the most at risk category (45%) and about the half part of the accidents occurred in surgical area (44.7%). The most frequent accident was needle puncture (53%); exposure involved principally the hands (76.3%). The basal serology of injured personnel showed low positivity for any HBV markers (72.7%), HCV (0.4%) and no positivity for HIV; while high levels were found among source patients. From the comparison between serological data (injured vs source), when ascertainable, emerged a biological hazard of 7.7% for HBV, 30.2% for HCV and 3.2% for HIV; however no seroconversions were observed at follow up. The study also pointed out the need of improve prevention programmes.

[Microbial air monitoring in operating theatre: active and passive samplings]. / Confronto tra due metodi di campionamento nel monitoraggio microbiologico in sala operatoria: campionamento attivo e passivo.

Microbial air contamination was evaluated in 11 operating theatres using active and passive samplings. SAS (Surface Air System) air sampling was used to evaluate cfu/m3 and settle plates were used to measure the index of microbial air contamination (IMA). Samplings were performed at the same time on three different days, at three different times (before, during and after the surgical activity). Two points were monitored (patient area and perimeter of the operating theatre). Moreover, the cfu/m3 were evaluated at the air inlet of the conditioner system. 74.7% of samplings performed at the air inlet and 66.7% of the samplings performed at the patient area before the beginning of the surgical activity (at rest) exceeded the 35 cfu/m3 used as threshold value. 100% of IMA values exceeded the threshold value of 5. Using both active and passive sampling, the microbial contamination was shown to increase significantly during activity. The cfu values were higher at the patient area than at the perimeter of the operating theatre. Mean values of the cfu/m3 during activity at the patient area ranged from a minimum of 61+/-41 cfu/m3 to a maximum of 242+/-136 cfu/m3; IMA values ranged from a minimum of 19+/-10 to a maximum of 129+/-60. 15.2% of samplings performed at the patient area using SAS and 75.8% of samplings performed using settle plates exceeded the threshold values of 180 cfu/m3 and 25 respectively, with a significant difference of the percentages. The highest values were found in the operating theatre with inadequate structural and managerial conditions. These findings confirm that the microbiological quality of air may be considered a mirror of the hygienic conditions of the operating theatre. Settle plates proved to be more sensitive in detecting the increase of microbial air contamination related to conditions that could compromise the quality of the air in operating theatres.

Detection of isoniazid and rifampin resistance in Mycobacterium tuberculosis strains by single-strand conformation polymorphism analysis and restriction fragment length polymorphism.

Anti-Mycobacterium tuberculosis drug-resistance, mainly multi-drug resistance (MDR-TB), represents an important public health problem in several countries. Aim of our study is to identify the presence of these mutations in M. tuberculosis isoniazid- and rifampin-resistant strains isolated in our Institute; to evaluate linkage between type of mutation and level of resistance; to determine the usefulness of easy molecular techniques for rapid detection of such mutations on body specimens. Isoniazid- and rifampin-resistance was tested on 67 M. tuberculosis strains by Single-Strand Conformation Polymorphism (SSCP) and Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) assays, using HaeIII, PstuI, BsteII, BstuI enzymes. Drug-resistance of control strains was determined by cultural techniques (fluorimetry- BACTEC 9120). Cultural assay showed isoniazid- and rifampin-resistance in 6.12 and 2%, respectively (data confirmed by SSCP assay). Mutation of katG, linked to isoniazid resistance, was detected using BstuI enzyme, and mutation of rpoB, expression of reduced sensitivity to rifampin, using HaeIII. 15 body specimens, M. tuberculosis-positive to conventional assays, were tested by SSCP technique. Epidemiologic reports of numerous cases of tuberculosis due to MDR strains induce to detect quickly both Mycobacteria and drug-resistance, in order to start prompt effective therapy. On this basis, molecular assays are useful for a rapid therapeutic decision.

Immunity to diphtheria in the 3-19 year age group in Italy.

In Italy, immunization with diphtheria toxoid has been compulsory for all newborns since 1939. The last two clinical cases of diphtheria were reported in 1987. During the period 1987-1989, immunity against diphtheria was assessed by neutralization test in a random sample of 1740 healthy subjects 3-19 years old, from five geographical areas of Italy. Of the total population, 76.5% showed antibody levels considered to be protective (greater than or equal to 0.1 IU ml-1), 17.2% had a relative degree of protection (0.01-0.09 IU ml-1), and 6.3% lacked immunity (less than 0.01 IU ml-1). The percentage of unprotected subjects increased from 6.1% in the age group of 3-5 years to 11.4% in the age group of 18-19 years (p less than 0.01). A smaller proportion of males (5.3%) than of females (7.2%) was unprotected, but this difference was not statistically significant. Subjects residing in the south and the islands were more likely to be unprotected than those residing in the north (7.4 versus 4.1%, p less than 0.01). No association was found between lack of protective antibodies and family size (odds ratio 1.35, confidence interval 95% = 0.77-2.36). However, paternal education of less than 12 years was associated with a higher prevalence of non-responders. In order to maintain a high degree of immunity in the adult population, a routine adult booster dose of diphtheria toxoid is advisable.