Microbiological surveillance of flexible bronchoscopes after a high-level disinfection with peracetic acid: preliminary results from an Italian teaching hospital.

BACKGROUND: Flexible bronchoscopes are heat labile, complex and difficult to clean, and some nosocomial outbreaks related to bronchoscopy have been reported in literature. The aim of our study was to determine, through a systematic monitoring, whether bronchoscopes' cleaning and disinfection procedures have been correctly adopted by health operators. METHODS: We conducted a 19 months-long prospective study in the Unit of Pulmonology at Careggi Teaching Hospital (Florence, Italy), analyzing endoscopes that were reprocessed through a high-level disinfection procedure. Samples collection was performed weekly by two trained operators. Results were organized in a database and then exported for descriptive and inferential statistical analysis. RESULTS: From February 2016 to September 2017 we collected 218 samples from bronchoscopes' valves (N=109) and from their inner channels (N=109). Staphylococci were found in 34 samples (15.69% of all samples). Pseudomonas was found in 11 samples (5.04% of all samples). Pseudomonas aeruginosa wasn't found in any sample. CONCLUSIONS: Our results came out to be better than similar studies in literature and demonstrated that a correct endoscopes' hygiene should be part of a more complex strategy of surveillance and control of healthcare-associated infections. However, a continuous monitoring of endoscopes could provide a wider view about this problem, and more reliable results.

Mycotic and aflatoxin contamination in Myristica fragrans seeds (nutmeg) and Capsicum annum (chilli), packaged in Italy and commercialized worldwide.

Aflatoxins are secondary metabolites of moulds known to be carcinogenic for humans, and therefore should not be ingested in high doses. This study aimed to determine the level of mould and aflatoxin contamination in dehydrated chilli and nutmeg imported from India and Indonesia, respectively, packaged in Italy, and commercialized worldwide. We tested 63 samples of chilli (22 sanitized through heat treatment and 41 not heat-treated) and 52 samples of nutmeg (22 heat-treated and 30 not heat-treated) for aflatoxin, moulds and moisture content. Heat-treated samples were less contaminated than untreated samples. Spices in powder form (both chilli and nutmeg) were more contaminated than whole ones. In untreated spices, we observed a positive correlation between mould and moisture content. Of the powdered nutmeg and chilli samples, 72.5% and 50% tested positive for aflatoxin contamination, with a range of 0-17.2 µg kg(-1) and 0-10.3 µg kg(-1), respectively. The steam treatment of spices would be useful in reducing the initial amount of moulds. Although the risk from the consumption of spices contaminated with aflatoxins is minimal, owing to the small amount used in food, preventive screening of the whole food chain is very important, especially because the most frequently identified toxin was B1, which is the most dangerous of the four toxins (B1, B2, G1, G2).

Occurrence of Acrylamide in breakfast cereals and biscuits available in Italy.

INTRODUCTION: Acrylamide, produced during thermal processing of carbohydrate-rich foods, is classified as "probably carcinogenic to humans" by the International Agency for Research on Cancer. OBJECTIVE: The aim of this study was to determine acrylamide levels in biscuits and breakfast cereals considering the widespread use of these products for all ages. METHOD: Acrylamide determination was carried out in 56 samples by HPLC-UV technique. RESULTS AND DISCUSSION: The results showed a considerable variability in the contents of acrylamide in the samples analysed, most likely due to differences in industrial processing and ingredients. The percentages of contaminated samples tested were very high (95.5% of the biscuits and 75% of the breakfast cereals) with a wide range of contamination: from 30 µg/kg to 940 µg/kg. Our results showed that 22.7% of biscuits and 33% of breakfast cereals exceeded the indicative values recommended by EC 2013/647 set at 500 µg/kg and 200-400 µg/kg (according to the composition) respectively. CONCLUSIONS: Our findings suggest concern about the risk for human health.

Prevalence and antibiotic resistance of Enterococcus spp. isolated from retail cheese, ready-to-eat salads, ham, and raw meat.

Food specimens were analyzed in order to research Enterococcus spp.: 636 samples of raw meat (227 beef, 238 poultry, and 171 pork), 278 samples of cheese (110 fresh soft cheese and 168 mozzarella cheese), 214 samples of ready-to-eat salads, and 187 samples of ham. 312 strains of Enterococcus spp samples were isolated, then identified and submitted to susceptibility tests against 11 antimicrobial agents. The predominant species were Enterococcus faecalis in raw meat and Enterococcus faecium in retail products. Low percentages of microorganisms were resistant to vancomycin (3.53%), teicoplanin (2.24%), linezolid (0.32%), and amoxicillin in combination with clavulanic acid (0.32%). A high percentage of resistance was noted in E. faecalis at high level gentamicin (21.9%) and tetracycline (60.6%). In general, strains of E. faecalis were more resistant than E. faecium. Enterococci should be considered not only potential pathogens, but also a reservoir of genes encoding antibiotic resistance which can be transferred to other microorganisms. Continuous monitoring of their incidence and emerging resistance is important in order to identify foods which potentially represent a real risk to the population, and to ensure effective treatment of human enterococcal infections.

Prevalence of hepatitis A virus infection in sewage plant workers of Central Italy: is indication for vaccination justified?

Prevalence of antibodies to hepatitis A virus (HAV) was studied in a group of 65 sewage plant workers living in Tuscany, Central Italy. In order to evaluate the effect of several confounders (age, place of birth, income, educational degree, sea-food consumption, etc.), subjects under study were matched with 160 other workers residing in the same area. Anti-HAV was detected in about 51% of sewage workers and 44% of other employees. The difference was not statistically significant. Both univariate and multivariate analysis showed that the main variables related to previous HAV infection were increasing age (P<0.001), birth in Southern Italy (P<0.01) and lower educational degree (P<0.001). Although other studies in Northern and Central Europe showed a slightly higher risk of infection in sewage workers versus general population, lack of evidence of occupational risk in Italy might be explained by the relative importance of a higher degree of viral circulation in the past. The changing epidemiology of HAV infection in Italy with increasing numbers of susceptibles in adults and the potential occupational risk suggest that the present indication to immunize sewage plant workers against hepatitis A should be maintained.

Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh.

We extracted, purified and characterized 8 sesquiterpene fractions from Commyphora molmol. In particular, we focused our attention on a mixture of furanodiene-6-one and methoxyfuranoguaia-9-ene-8-one, which showed antibacterial and antifungal activity against standard pathogenic strains of Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans, with minimum inhibitory concentrations ranging from 0.18 to 2.8 micrograms/ml. These compounds also had local anaesthetic activity, blocking the inward sodium current of excitable mammalian membranes.

Impact of routine infant and adolescent hepatitis B vaccination in Tuscany, Central Italy.

BACKGROUND: In Italy routine infant and adolescent immunization against hepatitis B was introduced in 1991. OBJECTIVE: Evaluation of (1) coverage with three doses of hepatitis B vaccine in infants and adolescents; (2) seroconversion to anti-hepatitis B surface antigen antibody (anti-HBs) in adolescents receiving three doses of vaccine; (3) concordance of coverage rates in infants with prevalence of neutralizing antibodies in sera from anonymous children; (4) trend of notified cases of acute hepatitis B. METHODS: A sample of infants and adolescents living in Tuscany was studied during 6 years (1992 through 1997) by matching birth records and immunization certificates. Sera from 139 adolescents who completed the vaccination course and from 159 anonymous children belonging to immunized cohorts (1 to 5 years) were tested with a quantitative anti-HBs assay. Incidence of acute hepatitis B by age was calculated from regional statistics on notified infectious diseases between 1992 and 1996. RESULTS: Overall 10,606/11,164 (95%) infants and 10,599/11,100 (95%) adolescents received 3 doses of vaccine. Seroconversion to anti-HBs was detected in 98% of adolescent vaccinees. Anti-HBs titers > or =10 IU/l were detected in 87% of children. A 49% decline of acute hepatitis B cases was registered between 1992 and 1996 in 15- to 24-year-olds living in Tuscany. No case occurred in vaccinated adolescents. CONCLUSIONS: Coverage against hepatitis B is excellent in cohorts subject to mandatory immunization. If efforts to vaccinate are maintained at these levels, elimination of hepatitis B virus transmission could occur within few decades in Italy.

Prevalence of diphtheria toxin antibodies in human sera from a cross-section of the Italian population.

A polycentric study was carried out between 1993 and 1995 in order to evaluate diphtheria immunity on a representative sample of population from different areas of Italy. To determine diphtheria antitoxin, sera from 5187 apparently healthy subjects, divided according to sex and age groups, were titrated using an ELISA indirect method. A basic protective titre of diphtheria antitoxin (> 0.01 IU ml-1) was found in 4080 (78.6%) subjects. No statistically significant differences between males and females were observed. Our findings show that the proportion of susceptibles increases with age and a high proportion of adults no longer has diphtheria antitoxin at protective levels since toxigenic C. diphtheriae circulation is presently lacking in Italy.

[The use of hydrophobic PALL BB22-15MS filters in cross-infection prevention during anesthesia]. / Impiego dei filtri idrofobici PALL BB22-15MS nella prevenzione delle infezioni crociate in corso di anestesia.

OBJECTIVE: Microbiological testing evaluations of hygienic procedure properties using PALL BB22-15MS filters to prevent contamination of "single use" breathing circuits during anesthesia. DESIGN: Prospective study. SETTING: Two operating rooms in a University hospital. PATIENTS: One hundred and thirty eight patients underwent general anesthesia for urologic surgery procedures. Patients with positive tests for HIV, B and C hepatitis and those considered to be at risk for HIV infection were excluded. The study was divided into five phases on the basis of times of usage of the same circuit for an increasing number of patients: in phase I, microbiological tests were performed on 4 circuits used on 4 different patients; in phase II the same tests were performed on 2 circuits each used on two different groups of three patients; in phase III, a circuit was used on a group of 15 patients and another on a group of 16 patients and the results were analysed; in phase IV a circuit used in a group of 32 patients was evaluated and phase V involved the analysis of a circuit that was used in a group of 65 patients. INTERVENTIONS: A filter was left in place between the patient and the circuit's Y-piece during all phases of anesthesia. The level of microbial contamination of breathing circuits was analysed in order to evaluate the reliability of the procedure. RESULTS: All analysed circuits remained uncontaminated. Staphylococcus hominis was revealed in respiratory circuit no. 6 of phase II, probably as a consequence of secondary contamination. CONCLUSIONS: Our results confirm that this procedure with the routine placement of a PALL BB22-15MS filter at the circuit's Y-piece can provide an adequate level of protection against cross-infections during anesthesia. The hygienic protocol proposed may allow the change of the anesthetic breathing only once a month.

Experience of hepatitis A vaccination during an outbreak in a nursery school of Tuscany, Italy.

An outbreak of hepatitis A started in late October 1996 in a nursery school in Tuscany, Italy. A programme of hepatitis A vaccination without the use of immunoglobulin started at the beginning of December 1996 and included 33 children, 21 household contacts and 6 adults working in the school. Overall, 11 cases occurred in children attending the school (attack rate 27%) and 10 among their household contacts (attack rate 9 %). The latter also included parents, and, in two cases, grandmothers. The data indicate that susceptibility to HAV has increased over recent decades in central Italy. Past and recent experience shows that the usual duration of hepatitis A epidemics in the absence of immune prophylaxis is longer than that described here. The use of hepatitis A vaccine probably contributed to the early extinction of the outbreak, because no further cases were notified in the area after 7 February 1997.

In vivo plaque formation on cast ceramic (Dicor) and conventional ceramic.

This study compared plaque accumulation on glazed and nonglazed metal ceramic porcelain surfaces with shaded and nonshaded Dicor cast ceramic surfaces. Plaque accumulation on natural teeth was also measured at 4, 12, 24, and 48 hours. Bacterial cultures were prepared from each sample to establish the aerobic and anaerobic charge. Plaque accumulation between 12 and 24 hours was measured on different materials. No significant differences were discovered between the plaque-retaining capacities of metal ceramic porcelain and Dicor ceramic surfaces. There was less plaque accumulation on glazed surfaces than on nonglazed surfaces.

Low prevalence of diphtheria immunity in the population of Florence, Italy.

A seroepidemiological study was conducted in 1994 on a representative sample of the population of Florence in order to verify the immunity coverage against diphtheria. Subjects were divided according to sex and age class. Sera from each selected class were at least 1.5/1000 of the residing population. Diphtheria antitoxin was titrated using a quantitative ELISA test. The results show an overall adjusted prevalence of diphtheria immunity (> or = 0.01 IU/ml) equal to 63.7%. Subjects of younger age classes have good protection levels (85.5% immune under 30 years), while only half individuals aged > or = 50 years have antibody titres > or = 0.01 IU/ml. Full protection (antibody titre > or = 0.1 IU/ml) was detected only in a very small proportion of those aged > or = 40 years. Our data show (1) how a recrudescence of diphtheria could theoretically take place in older subjects living in Italy, and (2) stress the importance of periodical re-vaccination of adults.

Anti-hepatitis C virus epidemiological study in two dialysis centers in Florence.

We studied the prevalence and incidence of anti-hepatitis C virus (HCV) antibodies in 350 patients during 15 months and looked for some risk factors. We found a significant correlation between anti-HCV positivity and length of dialysis treatment and treatment in more than one center. We propose some prophylactic rules.