Bloodstream infections due to carbapenemase-producing Enterobacteriaceae in Italy: results from nationwide surveillance, 2014 to 2017.

Following the rapid increase of infections due to carbapenemase-producing Enterobacteriaceae (CPE) in Italy, the national surveillance of bloodstream infections (BSI) due to CPE (Klebsiella pneumoniae and Escherichia coli) was instituted in 2013. All CPE-BSI cases reported to the surveillance in the years 2014-17 were analysed in order to investigate incidence rate (IR), trend, main individual characteristics and enzymes involved in CPE resistance. Throughout this period, 7,632 CPE-BSI cases (IR: 3.14/100,000 inhabitants) were reported from all 21 regions and autonomous provinces in Italy, with an increasing number of reported cases (2014: 1,403; 2015: 1,838; 2016: 2,183; 2017: 2,208). CPE-BSI cases mainly occurred in subjects aged over 60 years (70.9%) and more frequently in males (62.7%) than in females. Most of the cases originated in hospitals (87.2%), mainly in intensive care units (38.0%), and were associated with central or peripheral venous catheter use (23.9%) or with urinary tract infections (21.1%). Almost all CPE-BSI (98.1%) were due to K. pneumoniae carrying the K. pneumoniae carbapenemase (KPC) enzyme (95.2%). These data show that carbapenemase-producing K. pneumoniae are endemic in our country, causing a high number of BSI and representing a threat to patient safety.

The impact of immunization programs on 10 vaccine preventable diseases in Italy: 1900-2015.

BACKGROUND: Vaccination has determined a dramatic decline in morbidity and mortality from infectious diseases over the last century. However, low perceived risk of the infectious threat and increased concern about vaccines' safety led to a reduction in vaccine coverage, with increased risk of disease outbreaks. METHODS: Annual surveillance data of nationally communicable infectious diseases in Italy between 1900 and 2015 were used to derive trends in morbidity and mortality rates before and after vaccine introduction, focusing particularly on the effect of vaccination programs. Autoregressive integrated moving average models were applied to ten vaccine-preventable diseases: diphtheria, tetanus, poliomyelitis, hepatitis B, pertussis, measles, mumps, rubella, chickenpox, and invasive meningococcal disease. Results of these models referring to data before the immunization programs were projected on the vaccination period to estimate expected cases. The difference between observed and projected cases provided estimates of cases avoided by vaccination. RESULTS: The temporal trend for each disease started with high incidence rates, followed by a period of persisting reduction. After vaccine introduction, and particularly after the recommendation for universal use among children, the current rates were much lower than those forecasted without vaccination, both in the whole population and among the 0-to-4 year olds, which is, generally, the most susceptible age class. Assuming that the difference between incidence rates before and after vaccination programs was attributable only to vaccine, more than 4 million cases were prevented, and nearly 35% of them among children in the early years of life. Diphtheria was the disease with the highest number of prevented cases, followed by mumps, chickenpox and measles. CONCLUSIONS: Universal vaccination programs represent the most effective prevention tool against infectious diseases, having a major impact on human health. Health authorities should make any effort to strengthen public confidence in vaccines, highlighting scientific evidence of vaccination benefits.

People diagnosed with HIV and in care in Italy in 2014: results from the second national survey.

We conducted a second National survey in all Italian Infectious Disease clinics to assess the number of people diagnosed and linked to care and, among these, the number of people on antiretroviral therapy and viral load suppressed. In 2014, 100,049 (0.16 per 100 residents) people diagnosed and linked to care were estimated, corresponding to an increase of 6.3% compared to the survey conducted in 2012. Among people diagnosed and linked to care, 91.9% were on antiretroviral therapy (increase of 11.4% compared to 2012), and among these, 87.7% were viral load suppressed. Overall, the majority were males (72.1%), Italians (82.7%), aged 25-49 years (45.6%); the most common HIV mode of transmission was reported to be in heterosexual contact (37.9%) and men who had sex with men (31.3%); 8.8% had less than 350 CD4 cells/µL, 82.4% had VL <50 copies and 22.9% had a CDC stage C. In conclusion, the number of people diagnosed and linked to care was increasing. The vast majority of them was receiving ART but the percentage of people still with a detectable viral load was lower than the 90-90-90 WHO target.

Characterization of a Kluyveromyces lactis mutant with altered regulation of mitochondrial alcohol dehydrogenases.

KlADH3 and KlADH4 are Kluyveromyces lactis genes encoding the two mitochondrial alcohol dehydrogenase activities located within mitochondria. In this yeast, ethanol induces the transcription of KlADH4 and, conversely, represses that of KlADH3. In this study, we describe the effects of the aar900 mutation on such regulation. This mutation, firstly isolated in a strain devoid of alcohol dehydrogenase genes except KlADH4, conferred to cells resistance to allyl alcohol because of the absence of the KlAdh4p activity. When the mutation was transferred by crosses to an isogenic strain containing all the alcohol dehydrogenase genes, we found that the KlADH3 gene was highly expressed even in the presence of ethanol. In addition, we observed that the absence of KlAdh4p resulted from a post-transcriptional control in that KlADH4 was transcriptionally induced by ethanol. We also found that KlPDC1, another ethanol-repressible gene, was not transcribed in the mutant in the presence of this carbon source, indicating that the escape of KlADH3 from ethanol repression was a peculiar feature of this gene. Genetic analysis showed a Mendelian segregation of the mutation that was mapped in a region of chromosome III close to the ade1 locus. Interestingly, the aar900 mutants had a pleiotropic phenotype and showed increased resistance to monovalent cations and benomyl, suggesting that the mutation could also affect genes other than the alcohol dehydrogenase ones. Strains carrying the aar900 mutation could represent useful tools to unravel the peculiar regulation of KlADH3 and KlADH4 by ethanol.