Hospital-acquired infections in Italy: a region wide prevalence study.

Between October and December 2000, a region-wide prevalence study of hospital-acquired infections (HAI) was conducted in all public hospitals (59 facilities with ca. 16000 beds; 560000 admission yearly) in Piemonte Region, Italy, and in the one hospital of the neighbouring autonomous region of Valle d'Aosta. The study population comprised a total of 9467 patients hospitalized for at least 24 h. The prevalence of HAI was 7.84%, with marked differences in prevalence among the participating hospitals (range: 0-47.8%). The higher relative frequency of urinary tract infections (UTI; 52.7%) was due to the inclusion of urine cultures obtained on the day of the study from asymptomatic UTI in catheterized patients. A significant correlation was found with major risk factors related to medical procedures (urinary catheter, mechanical ventilation, surgical drainage, intravascular catheters). Patients with HAI were found to be older and to have a greater mean length of stay in hospital. Multiple logistic regression analyses showed that lack of independence, indwelling urinary catheter and mechanical ventilation were the risk factors more significantly associated with HAI. The use of antibiotics, in particular prophylactic agents used in surgery (cephalosporins, glycopeptides), provided an incentive for corrective intervention in antibiotic administration and in training of healthcare workers.

Characterisation and reactivity of a glycidic antigenic component in Toxoplasma gondii.

Toxoplasma gondii is composed of a complex antigenic mosaic and some antigenic fractions are of major diagnostic interest. We studied an antigenic fraction with molecular weight < 17 kda, identified by SDS-PAGE 15% and immunoblotting. This fraction could be easily extracted from the whole antigen with phenol/CH-Cl3 and its analysis showed a mainly carbohydrate composition. With immunoblotting this fraction showed strong reactivity with specific IgM and IgG in early-acute infection; IgM reactivity disappears or is much less marked in chronic acquired infection. Extraction with phenol/CHCl3 allows this fraction to be used as an antigen in other diagnostic methods.

Use of IgG Avidity test in case definitions of toxoplasmosis in pregnancy.

A survey network for congenital toxoplasmosis (TOXO-NET) was set up in December 1996 in Piedmont (Italy). Participants were asked to classify the infections in pregnant mothers and newborns by the criteria of the European Network on Congenital Toxoplasmosis published by Lebech in 1996. Because the IgG Avidity test is largely employed as a 2nd level test in toxoplasmosis diagnosis and it could be helpful to date infection, the co-ordinators of TOXO-NET suggested including it in the "case definition" of "probable" infection and "unlikely" infection. 117 cases of toxoplasmosis in pregnancy divided into the risk categories under Lebech's criteria were re-examined using the "new" case definitions. 77 out of 117 (65.8%) Toxoplasma gondii infections during pregnancy could be defined with only one serum sample using the IgG Avidity test. The IgG Avidity test proved a useful method to classify the Toxoplasma gondii infections in pregnancy, especially when we had only one serum sample.

[Prenatal diagnosis and treatment of congenital toxoplasmosis: a program of regional surveillance]. / Diagnosi prenatale e trattamento della toxoplasmosi congenita: un programma di sorveglianza regionale.

Toxo-net is a regional program of survey on congenital toxoplasmosis which has two aims: 1) to estimate the incidence of gestational and congenital toxoplasmosis in our Region (Piemonte); 2) to assess the compliance to our diagnostic, therapeutic and follow-up protocols which are thoroughly described. Thirty-two obstetrical, neonatal and laboratory units of Piemonte Region have been involved. During 18 months (January 1997-June 1998) 365 pregnant women were studied because of suspected seroconversion: in 129 patients infection was confirmed. Amniocentesis for prenatal diagnosis was carried on 11 patients; two fetuses were affected. 35% of the mothers were untreated or inadequately treated. Hydrocephaly was observed in two fetuses. Neonatal follow-up at 12 months is available for 68 of the 129 infected mothers. Four babies (5.8%) were infected, three of them being symptomatic; their mothers had not been treated. It is concluded that the implementation of a screening program for toxoplasmosis during pregnancy seems to be beneficial. However an effort to improve the surveillance system and the education of the gynecologists, general practitioners and of the patients is needed, and economic evaluations are warranted.

[Poliomyelitis surveillance: seroepidemiologic study on a Piedmont population sample]. / Sorveglianza della poliomielite: indagine sieroepidemiologica su un campione di popolazione piemontese.

In order to assess the immunity/receptivity towards the three poliovirus strains, a sample representative of the sex and age composition of the resident population in Piedmont at census 1981, was examined. For each subject data were collected in order to identify the population from social-ambient point of view. For the evaluation of antibodie's title to poliovirus 1, 2, 3, the serums were analyzed with the neutralization method using the microtitolation plates and epithelial larynx cancer cells (HEp-2), like revealing system. The samples with > or = 2 title were considered positives for specific antibodies. To determine the relation between presence/absence of specific poliovirus antibodies and the other variables, a multiple logistic regression was fitted and the odds ratio was calculated. The results of our study show an immunity in all age groups, underlying a herd immunity condition. Furthermore the incomplete antibodies response to the three poliovirus strains seems to be influenced by age only.

[Immunogenicity of a recombinant vaccine against viral hepatitis B]. / Analisi dell'immunogenicità di un vaccino recombinante anti-epatite virale di tipo B.

The introduction in Italy of recombinant DNA hepatitis B vaccines has allowed to plan out a very important programme of vaccination; in Italy the compulsory vaccination against hepatitis B virus begun from 1991. Because of the reduction of vaccine cost, the screening for serum markers of HBV infection is needless. On the contrary, the test of antiHBs titres after the vaccination is important in order to take into account a booster vaccine dose and to carry out revaccination strategies. In this study, we analyzed 419 subjects vaccinated with Engerix-B; the immune response was correlated with private and behaviour data.

[Satisfaction of parents or accompanying persons with vaccination services for children and youngsters being vaccinated]. / Studio sulla "soddisfazione" verso i servizi vaccinali dei genitori o degli accompagnatori dei bambini e dei ragazzi che effettuano le vaccinazioni.

A patient satisfaction survey aimed to assess the quality of immunization services was carried out as part of the new regional vaccination plan launched in Piemonte in 1999 to comply with the targets of the national immunization program. In January and February 2001, persons accompanying children for vaccination at the outpatient clinics were requested to fill a self-administered questionnaire with questions on the organization of the immunization services, the health care facilities, the attitude of the health care workers and the quality of the information provided. The response rate was 93%. Overall, satisfaction with the immunization services scored generally high, except for the quality of the information provided to the public. Many interviewees complained that the written/verbal information about the vaccination schedules was either lacking or insufficient. The survey results indicate a need for better training and updating of health care workers so that they can give immunization service users correct information as requested.

[Cost analysis of toxoplasma infection control in pregnancy]. / Analisi dei costi relativi al controllo dell'infezione toxoplasmica in corso di gravidanza.

In Italy, the management of Toxoplasma infection screening in pregnant women is often unproductive and inefficient and generates a wide variability of costs. This study evaluated performance parameters in the screening management of a population of pregnant women, estimated its costs and compared them with the costs of a full application of Ministerial Documents of 1995 and 1998. We controlled until delivery 830 pregnant women who had done the first blood test between September 1st and December 31st 1997. The costs of direct and indirect testing were analysed using the Excel database and statistical software package. Of the 573 pregnant women defined 'susceptible' at the first test, only 240 (42%) did further blood tests during the II and III trimesters, 30% did no more tests and the remaining women adopted a heterogeneous behaviour. The mean cost of each screening was found to be euro 54.47/pregnancy and euro 60.05/pregnancy with a full application of the Ministerial Document of 1995. A full application of Ministerial Document of 1998, instead, would have involved a cost of euro 94.28/pregnancy for 5 tests, euro 111.40/pregnancy for 6 tests and euro 128.51 for 7 tests. The study shows that the management of toxoplasmosis screening during pregnancy needs greater attention to the prescription of tests, so that useless testing can be reduced and the efficacy of the screening improved, two important goals the Ministerial Documents were designed to achieve.