EXTENDED VALIDATION OF DYNAMIC IRREVERSIBLE THERMOPORATION: A NOVEL THERMAL PROCESS FOR MICROBIAL INACTIVATION

A novel thermal treatment for microorganism inactivation, characterized by a very rapid temperature increase (up to 30C/s) and a low final temperature (up to 65C) maintained for a relatively short holding time, has been recently presented and tested by the authors, showing microbial load reduction greater than 5 log units against several common bacteria and yeasts. With the aim of extending the possible use of the new thermal treatment to a wider microorganisms class, in this work the dynamic irreversible thermoporation (DIT) treatment was further tested on a well-known thermoresistant strain, the Enterococcus hirae: The results of these new experimental tests confirmed the reliability of t…

Outbreak of ST395 KPC-Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit in Palermo, Italy

Effectiveness of a new method of disinfecting the root canal, using Er, Cr:YSGG laser to kill Enterococcus faecalis in an infected tooth model.

Some lasers have demonstrated to provide effective disinfection when used as adjunctive device to the conventional treatment. The aim of this in vitro study was to determine the effectiveness of the erbium, chromium:yttrium scandium gallium garnet (Er, Cr:YSGG) laser by measuring its bactericidal effect inside the root canal experimentally colonized with Enterococcus faecalis. The laser was tested at different irradiation times (30 and 60 s) and energy of impulses (75 and 25 mJ). A total of 52 single-rooted extracted human teeth were endodontically prepared with rotary instrumentation. All were sterilized and inoculated with a suspension of E. faecalis (105 bacteria/ml). The teeth were rand…

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

This article reports an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) sequence type (ST) 258 in a neonatal intensive care unit (NICU) in Palermo, Italy. KPC-Kp ST258 was detected by an active surveillance culture programme. Between 18th September and 14th November 2012, KPC-Kp was isolated from 10 out of 54 neonates admitted in the outbreak period. No cases of infection were recorded. Male sex was associated with colonization, whereas administration of ampicilline-sulbactam plus gentamicin was protective. Infection control interventions interrupted the spread of KPC-Kp without the need to close the NICU to new admissions. (C) 2013 The Healt…

Outbreak of colonizations by extended-spectrum β-lactamase-producing Escherichia coli sequence type 131 in a neonatal intensive care unit, Italy

Abstract Background Extended spectrum β-lactamases (ESBLs) often associated with resistance to aminoglycosides and fluoroquinolones have recently emerged in community-associated Escherichia coli. The worldwide clonal dissemination of E. coli sequence type (ST)131 is playing a prominent role. We describe an outbreak of colonizations by ESBL-producing E. coli (ESBL-E. coli) in the neonatal intensive care unit (NICU) of the University Hospital, Palermo, Italy. Methods An epidemiological investigation was conducted with the support of molecular typing. All children admitted to the NICU and colonized by ESBL-E. coli between January and June 2012, were included in the study. Cases were defined as…

Extended Validation of Dynamic Irreversible Thermoporation: A Novel Thermal Process for Microbial Inactivation

A novel thermal treatment for microorganism inactivation, characterized by a very rapid temperature increase (up to 30°C/s) and a low final temperature (up to 65°C) maintained for a relatively short holding time, has been recently presented and tested by the authors, showing microbial load reduction greater than 5 log units against several common bacteria and yeasts. With the aim of extending the possible use of the new thermal treatment to a wider microorganisms class, in this work the dynamic irreversible thermoporation (DIT) treatment was further tested on a well-known thermoresistant strain, the Enterococcus hirae: The results of these new experimental tests confirmed the reliability of…

EPIDEMIOLOGIA DELLA LEISHMANIOSI IN SICILIA: STIMA DEL BURDEN DI MALATTIA ATTRAVERSO L’ANALISI DEI FLUSSI SANITARI CORRENTI.

INTRODUZIONE: La Sicilia è notoriamente terra endemica per la leishmaniosi, ma mancano, allo stato attuale, dei sistemi di sorveglianza attiva che permettano di quantificare precisamente il carico di malattia attribuibile a questa patologia protozoaria. Obiettivo del presente lavoro è stato quello di analizzare i flussi sanitari correnti disponibili al fine di stimare l’impatto della leishmaniosi sulla popolazione siciliana residente. MATERIALI E METODI: Lo studio ha analizzato due fonti: a) tutte le notifiche in classe II di leishmaniosi effettuate tra gennaio 2010 e dicembre 2013; b) le schede di dimissione ospedaliera (SDO) riportanti i codici ICD9-CM 085.1, 085.2, 085.3, 085.4, 085.5 ed…

Candida SPP. Colonization in NICU: A 2-Year Surveillance Study

Introduction: Fungal infections are an important cause of increased morbidity and mortality in infants admitted to neonatal intensive care units (NICUs). In VLBW infants, Candida (C.) albicans is the third most common cause of neonatal late onset sepsis (LOS). The overall incidence of candidemia in NICU is increasing because of the longer survival and the invasive procedures related with the intensive care of extremely preterm infants. Prevention of candidemia in neonates is supported by the identification and adequate management of specific risk factors, including low birth weight, use of invasive devices, prolonged hospitalization and use of broad-spectrum antimicrobial agents. Effective …

SORVEGLIANZA DELLE COLONIZZAZIONI DA STAPHYLOCOCCUS AUREUS METICILLINO-RESISTENTE E GRAM-NEGATIVI MULTI-RESISTENTI NELLE UNITA’ DI TERAPIA INTENSIVA NEONATALE DELLA CITTÀ DI PALERMO

INTRODUZIONE: La diffusione della resistenza batterica, sia in ospedale che in comunità, costituisce un serio motivo di allarme. La disseminazione di microrganismi resistenti in ospedale, particolarmente accentuata in reparti critici quali le terapie intensive, è favorita oltre che dall’uso dei farmaci antimicrobici, da procedure chirurgiche e/o invasive, dalla presenza di pazienti compromessi e dal trasferimento da una struttura sanitaria ad un’altra di pazienti colonizzati o infetti. Una conoscenza dettagliata dell’entità del fenomeno e dei principali microrganismi antibiotico-resistenti in ambito nosocomiale è essenziale per lo sviluppo di strategie volte a prevenire tale fenomeno. In qu…

A Snapshot on MRSA Epidemiology in a Neonatal Intensive Care Unit Network, Palermo, Italy

Objectives. We performed a one-year prospective surveillance study on MRSA colonization within the five NICUs of the metropolitan area of Palermo, Italy. The purpose of the study was to assess epidemiology of MRSA in NICU from a network perspective. Methods. Transfer of patients between NICUs during 2014 was traced based on the annual hospital discharge records. In the period February 2014 – January 2015, in the NICU B, at the University teaching hospital, nasal swabs from all infants were collected weekly, whereas in the other four NICUs (A, C, D, E) at four week-intervals of time. MRSA isolates were submitted to antibiotic susceptibility testing, SCCmec typing, PCR to detect lukS-PV and l…

SORVEGLIANZA DELLE COLONIZZAZIONI DA CANDIDA SPP. IN TERAPIA INTENSIVA NEONATALE

Candida spp., colonizzazione, UTIN

Branched High Molecular Weight Glycopolypeptide With Broad-Spectrum Antimicrobial Activity for the Treatment of Biofilm Related Infections.

There are few therapeutic options to simultaneously tackle Staphylococcus aureus and Pseudomonas aeruginosa, two of the most relevant nosocomial and antibiotic-resistant pathogens responsible for implant, catheters and wound severe infections. The design and synthesis of polymers with inherent antimicrobial activity have gained increasing attention as a safe strategy to treat multi-drug-resistant microbes. Here, we tested the activity of a new polymeric derivative with glycopolypeptide architecture (PAA-VC) bearing l-arginine, vancomycin, and colistin as side chains acting against multiple targets, which give rise to a broad spectrum antimicrobial activity favorably combining specific and n…

Impact of Candida species colonization and azoles resistance in a neonatal intensive care unit

Background: Candida species are among the top 10 most frequently isolated nosocomial bloodstream pathogens in Europe. In particular, in neonatal intensive care units (NICUs) Candida infections are an emerging concern because of the increasing incidence, the related high morbidity and mortality rates reported. Moreover, the epidemiology of Candida infection rapidly changed in these years leading to the selection of less sensitive strains and species. Surveillance studies are mandatory to identify the local distribution of species, their antifungal susceptibility profiles and the emergence of resistance strains. Material/methods: From December 2012 we performed a cohort prospective surveillan…

Healthcare associated pathogens in a changing world

In developed countries about 10% of the hospitalizations are complicated by a healthcare-associated infection [1]. Up to 75% of these infections are due to multidrug-resistant organisms (MDROs) [1]. Antimicrobial resistant bacterial infections are associated to higher morbidity, mortality and healthcare costs than those caused by susceptible organisms [1]. The findings of the point prevalence survey in European acute care hospitals published in 2013 by the European Centre for Disease Control and Prevention (ECDC) show large variations between countries and between different regions of the same country, with Italy being allocated within the high-endemic areas for both MRSA and MDROs [2]. Des…

An Update of the Evolving Epidemic of blaKPC Carrying Klebsiella pneumoniae in Sicily, Italy, 2014: Emergence of Multiple Non-ST258 Clones

Background: In Italy, Klebsiella pneumoniae carbapenemase producing K. pneumoniae (KPC-Kp) strains are highly endemic and KPC producing CC258 is reported as the widely predominating clone. In Palermo, Italy, previous reports have confirmed this pattern. However, recent preliminary findings suggest that an epidemiological change is likely ongoing towards a polyclonal KPC-Kp spread. Here we present the results of molecular typing of 94 carbapenem non susceptible K. pneumoniae isolates detected during 2014 in the three different hospitals in Palermo, Italy. Methods and Results: Ninety-four consecutive, non replicate carbapenem non susceptible isolates were identified in the three largest acute…

Circolazione di MRSA in età pediatrica in ambiente ospedaliero e in comunità

Introduzione. Negli ultimi anni si è assistito ad un generale incremento e ad una sempre più estesa diffusione, sia in ambito ospedaliero che comunitario, di microrganismi multiresistenti. In assenza ed in attesa di trattamenti farmacologici efficaci maggiore attenzione deve essere impiegata alla realizzazione di strategie di sorveglianza mirate. Il primo isolamento di un ceppo di Staphylococcus aureus meticillinoresistente (MRSA) risale al 1961 e fu seguito da una repentina diffusione negli ospedali di tutto il mondo. Ad oggi MRSA è riconosciuto come uno dei principali agenti responsabili delle infezioni nosocomiali e le percentuali di isolamento variano da Paese in Paese in maniera notevo…

Use of Cepheid Xpert Carba-R® for rapid detection of carbapenemase-producing bacteria in critically ill, abdominal surgical patients: first report of an observational study

Introduction Xpert Carba-R® (Cepheid®, USA) is a PCR-based assay for rapid (<1 hour) detection of bacteria carrying carbapenem-resistance genes (KPC, NDM, VIM, OXA-48, IMP-1). The aim of the study is to compare PCR with microbiological cultures in critically ill, abdominal surgical patients. Methods We performed an observational study at University Hospital 'P. Giaccone' Palermo. We enrolled abdominal surgical patients admitted to the ICU with suspected abdominal sepsis or developing sepsis during the ICU stay. We obtained two rectal swab specimens and two drainage samples to perform PCR assay and classic culture tests. We used Cohen's K to test concordance of results. We considered conc…

Is the monoclonal spread of the ST258, KPC-3-producing clone being replaced in southern Italy by the dissemination of multiple clones of carbapenem-nonsusceptible, KPC-3-producing Klebsiella pneumoniae?

D. M. Geraci, C. Bonura, M. Giuffre, L. Saporito, G. Graziano, A. Aleo, T. Fasciana, F. Di Bernardo, T. Stampone, D. M. Palma and C. Mammina 1) Department of Sciences for Health Promotion and Mother-Child Care ‘G. D’Alessandro’, University of Palermo, 2) Postgraduate Specialty School in Hygiene and Preventive Medicine, University of Palermo, 3) Laboratory of Microbiology, General Hospital ARNAS ‘Civico, Di Cristina & Benfratelli’, 4) Laboratory of Microbiology, General Hospital Azienda Ospedaliera ‘Villa Sofia-V, Cervello’ and 5) II Intensive Care Unit, General Hospital ARNAS ‘Civico, Di Cristina & Benfratelli’, Palermo, Italy

Epidemiologia locale di MRSA, con riferimento alla circolazione di cloni ospedalieri e comunitari e al possibile ruolo della catena alimentare

ABSTRACT Local epidemiology of MRSA,with reference to the circulation of hospital and community strains and the possible role of the food chain Introduction The aim of this PhD project is to evaluate the local epidemiology of MRSA strains and the related risk to the healthcare environment, the community and the food production chain. According to literature, MRSA is a rising problem in different settings and new strains are spreading all over the world. In addition to HA-MRSA, CA-MRSA e LA-MRSA are new important problems to face. In this contest, this study is focused to estimate the frequency of isolation of MRSA in different kind of samples and to analyze the main features of the collecte…

Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors

Objective: To describe epidemiologic features and identify risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in a level III neonatal intensive care unit (NICU). Setting: A prospective, cohort study in a university-affiliated NICU with an infection control program including weekly nasal cultures of all neonates. Methods: Demographic, clinical, and microbiologic data were prospectively collected between June 2009 and June 2013. Molecular characterization of MRSA isolates was done by multilocus variable number tandem repeat fingerprinting, staphylococcal cassette chromosome mec typing, and on representative isolates by multilocus sequence typing and s. pa typing. …

Methicillin-resistant Staphylococcus aureus colonization: a three-year prospective study in a neonatal intensive care unit in Italy.

Background: Methicillin resistant Staphylococcus aureus (MRSA) is a major etiological agent of infection in neonatal intensive care units (NICUs). Routes of entry of this organism can be different and the transmission pathway complex. Colonized neonates are the main endogenous reservoir. Methods and Results: We conducted a prospective three-year study on MRSA colonization recruiting 722 neonates admitted between 2009 and 2012. Nasal swabs were cultured weekly and MRSA isolates were submitted to molecular typing. The annual incidence density of acquisition of MRSA ranged from a maximum of 20.2 cases for 1000 patient-days during the first year to a minimum of 8.8 cases in the second one to ra…

Surveillance of methicillin-resistant Staphylococcus aureus, multidrug-resistant Gram-negatives and fungi colonization in the Neonatal Intensive Care Units in the city of Palermo.

Introduction Multidrug-resistant organisms are a serious public health problem, particularly in critical hospital wards such as the Neonatal Intensive Care Units (NICUs). Hospitalized neonates are at high risk for healthcare-associated infections leading to higher morbidity and mortality rates, because of their poor immune defences, frequent exposure to antibiotics, invasive procedures and contacts with healthcare-workers. Our study aimed to evaluate the prevalence of colonization by methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negatives (MDRGNs) and fungi in the five NICUs of the city of Palermo. Methods From February 2014 to January 2015, an active surveill…

VALUTAZIONE DELLA TERMOPORAZIONE DINAMICA IRREVERSIBILE (DIT) COME STRUMENTO PER L’ABBATTIMENTO DELLA CARICA BATTERICA IN MATRICI ALIMENTARI

A multifunctional peptidomimetic macromolecule to fight polymicrobial infections

tst1-positive ST22-MRSA-IVa in healthy Italian preschool children

A survey was performed in May 2013 to assess methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in healthy children attending 26 municipal daycare centres in Palermo, Italy. Of the 500 children, ten (2 %) tested positive. Eight MRSA isolates were tst1-positive ST22-MRSA-IVa, spa t223; the other two isolates were identified as ST1-IVa and ST398-V, respectively. tst1-positive ST22-MRSA, spa t223 has been previously identified only in the Middle Eastern area.

PREVENTION OF NOSOCOMIAL INFECTIONS AND SURVEILLANCE OF EMERGING RESISTANCES IN A NEONATAL INTENSIVE CARE UNIT (NICU): A SIX-YEAR PROSPECTIVE COHORT STUDY

NOSOCOMIAL INFECTIONS, EMERGING RESISTANCES SURVEILLANCE, NICU

Epidemic spread of ST1-MRSA-IVa in a neonatal intensive care unit, Italy

Abstract Background Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has recently emerged as an important pathogen in neonatal intensive care units (NICUs). The purposes of this study were to characterize methicillin-resistant isolates from an outbreak in a NICU, to examine the genetic traits and clonality of CA-MRSA, and to review the characteristics and outcomes of the neonatal cases and investigate the routes of entry and transmission of the MRSA outbreak strain in the NICU under study. Methods The study NICU practiced an active surveillance program for multidrug-resistant organisms, including weekly cultures for detection of MRSA from nasal swabs among all the …

The Increasing Challenge of Multidrug-Resistant Gram-Negative Bacilli: Results of a 5-Year Active Surveillance Program in a Neonatal Intensive Care Unit

Colonization and infection by multidrug-resistant gram-negative bacilli (MDR GNB) in neonatal intensive care units (NICUs) are increasingly reported.We conducted a 5-year prospective cohort surveillance study in a tertiary NICU of the hospital "Paolo Giaccone," Palermo, Italy. Our objectives were to describe incidence and trends of MDR GNB colonization and the characteristics of the most prevalent organisms and to identify the risk factors for colonization. Demographic, clinical, and microbiological data were prospectively collected. Active surveillance cultures (ASCs) were obtained weekly. Clusters of colonization by extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebs…

OXA-48-producing Klebsiella pneumoniae in a neonatal intensive care unit in Palermo, Italy

Objectives Surveillance cultures are of great importance to detect the emergence of multidrug resistant (MDR) bacteria in high-risk settings and prevent the occurrence of colonization and clinical infection cases. We report the isolation of OXA-48-harbouring Klebsiella pneumoniae sequence type (ST) 530 in a Neonatal Intensive Care Unit (NICU) in Palermo, Italy. Methods Since June 2009, a routine surveillance protocol is in place in the NICU of the University Hospital of Palermo, including nasal and rectal swabs obtained on a weekly basis to monitor the prevalence of colonization by methicillin- resistant Staphylococcus aureus, MDR Gram-negatives and glycopeptide-resistant enterococci. Enter…

Colonizzazione da Staphylococcus Aureus Meticillino-Resistente (MRSA) in epoca di vita neonatale nell’U.O. Neonatologia e TIN dell’AOUP “P.Giaccone” di Palermo nel periodo 2009 - 2015

Colonizzazione, MRSA, UTIN

The burden of Candida species colonization in NICU patients: a colonization surveillance study

Fungal infections are an important cause of morbidity and mortality in neonatal intensive care units (NICUs). The identifi-cation of specific risk factors supports pre-vention of candidemia in neonates. Effec-tive prophylactic strategies have recently become available, but the identification and adequate management of high-risk in-fants is still a priority. Prior colonization is a key risk factor for candidemia. For this reason, surveillance studies to monitor in-cidence, species distribution, and antifun-gal susceptibility profiles, are mandatory. Among 520 infants admitted to our NICU between January 2013 and December 2014, 472 (90.77%) were included in the study. Forty-eight out of 472 (…

Colonization of pressure ulcers by multidrug-resistant microorganisms in patients receiving home care

Colonization and/or infection with multidrug-resistant microorganisms (MDRO) of pressure ulcers in patients receiving care at home have seldom been investigated. The objective of this study was to assess the prevalence of MDRO colonization in pressure ulcers of patients receiving home care in Palermo, Italy. Vancomycin-resistant Enterococcus (VRE), methicillinresistant Staphylococcus aureus (MRSA), and multidrug-resistant Gram-negative bacilli (MDRGN) were isolated, identifi ed, and characterized from pressure ulcers and selected home environment surfaces. Thirty-two patients were enrolled, of whom 12 were under antimicrobial therapy. Five patients had been admitted to hospital in the prece…