Catheter-associated urinary tract infection: Role of the setting of catheter insertion

BACKGROUND

This study aimed to describe the epidemiology of catheter-associated urinary tract infections (CAUTIs) in patients admitted to a surgical ward in Central Italy and to analyze the associated risk factors.

METHODS

An active surveillance program for CAUTI was carried out in patients catheterized for at least 48 hours. Place of catheter insertion (operating room, hospital ward, cystoscopy room, emergency care unit), indication for catheterization and its duration, among other risk factors were monitored until discharge. Antibiotic resistance profiles of isolates were analyzed.

RESULTS

There were 641 catheterized patients monitored for CAUTI onset. Of these, 40 (6.2%) developed a CAUTI (rates were 15.1/1,000 catheter days, 95% confidence interval [CI], 11.9-22.6; 8.7/1,000 patient days, 95% CI, 6.9-13.1). Patients with CAUTI were older (P < .05) and their durations of hospitalization and catheterization were both longer compared with those who were not affected (P < .05). Catheterization >4 days (odds ratio [OR] = 8.21; 95% CI, 3.79-17.73; P < .05) and place of catheter insertion different from the operating room (OR = 7.9; 95% CI, 2.83-22.08; P < .05, for catheters placed in the ward) were associated with CAUTI. Among the micro-organisms isolated in CAUTIs, the most common were Pseudomonas aeruginosa (41.5%), Klebsiella pneumoniae (19.5%), and Escherichia coli (12.2%); 82.5% of them were resistant to different classes of antibiotics.

CONCLUSION

These results highlight the role played by the setting of catheter insertion in CAUTIs onset, therefore reflecting the importance of hand hygiene and proper aseptic insertion techniques as crucial determinants in CAUTIs prevention.

Albedo neutron dosimetry in Germany: regulations and performance

Personal neutron dosimetry has been performed in Germany using albedo dosemeters for >20 y. This paper describes the main principles, the national standards, regulations and recommendations, the quality management and the overall performance, giving some examples.

Microbiological assessment of freshly-shot wild boars meat in Lazio Region, Viterbo territory: a preliminary study

During the wild boars hunting season (2012-2013), 6508 adults were shot in Lazio Region, Viterbo territory. Out of the 6508, 393 subjects were sampled to be tested for the detection of Salmonella spp., Yersinia enterocolitica, E. coli VTEC and Trichinella spp. For this purpose, diaphragm and skeletal muscles samples were collected after the shooting, and tested at the Istituto Zooprofilattico Sperimentale Lazio and Toscana laboratories, Rome, Italy. Samples were tested respectively by polymerase chain reaction, enzyme linked immunofluorescent assay, microbiological and parasitological assays. The positivity percentages are 3.6% for Salmonella spp., 14.8% (out of 230 samples tested) for Yersinia enterocolitica, 4.6% for E.coli VTEC (vtx 1 and 2 genes). Each positive sample for vtx 1 and 2 was tested to isolate Verotoxigenic E.coli strains; none of them was positive for the same virulence genes. All diaphragm samples were negative to the trichinoscopic test. Every bacterial strain was identified serologically by seroagglutination test.

Vitamin D supplementation is required to normalize serum level of 25OH-vitamin D in older adults: an observational study of 974 hip fracture inpatients

BACKGROUND

Vitamin D deficiency is highly prevalent in older adults in all continents. In this study we assessed the vitamin D status of hip fracture subjects across different hospitals in a real word situation using the data from a multicenter cohort study on outcomes in orthogeriatric units.

METHODS

We performed a prospective cohort study on 974 consecutive patients 75 yr or older admitted with fragility hip fracture over a 12 months period at 4 general hospitals of different districts in Emilia Romagna Region, Italy. Data collected included comorbidity, cognitive impairment, prefracture functional status, walking ability, living arrangement along with the use of antiosteoporotic drugs, serum intact PTH and serum 25-hydroxyvitamin D [25(OH)D].

RESULTS

Mean 25(OH)D serum levels were 12.2±9.4 ng/ml and 84.2% of patients had levels below recommended values. Male had a higher probability to have values within the reference range [odds ratio (OR): 1.74 (1.13-2.67); p=0.012] while living in nursing resulted negatively related even if only close to statistical significance [OR: 0.24 (0.06-1.02); p=0.051]. Vitamin D supplementation appeared to be the strongest factor associated with adequate level of vitamin D levels [OR: 4.50 (2.57-7.88); p<0.001).

CONCLUSION

This study confirmed the very high rate of severe vitamin D deficiency in Italian subjects admitted with hip fracture. Our study also showed that supplementation of vitamin D is the strongest determinant influencing serum 25(OH)D level of older persons with hip fracture and these results should be taken into account when planning treatment in older persons.

Antioxidant capacity of the algae using a biosensor method

Three different methods, i.e. a biosensor method, a voltammetric method and a spectrophotometric method, have been used to evaluate the total antioxidant capacity of certain types of algae. In the final evaluation of the data also the variation in time of the antioxidant capacity of cultivated algae was considered and some experimental factors, such as the use of different solvent mixtures to extract the antioxidant substances contained in the algae, were discussed.

A whole-body dosimetry system for personal monitoring based on hot-pressed thin layer TLD

We are introducing a new high-capacity thermoluminescent dosemeter (TLD) system to measure the whole body values of H(p)(10) and H(p)(0.07) from photons for use in individual monitoring services. Small and light-weight badges allow a convenient application in a wide variety of workplaces with photon radiation from 20 keV to at least 7 MeV. The main advantage of this system will be the large capacity of ∼ 100,000 dosemeters per month at costs equivalent to the current film monitoring. The hot-pressed thin-layer TL detector (LiF:Mg,Ti) is welded onto an aluminium substrate and provided with a data matrix code for automatic processing. The detector holder has been optimised, that no additional filter is necessary. The new designed TLD reader with readout times <10 s will allow a large throughput and a considerable degree of automation.

Extended-spectrum beta-lactamases Klebsiella pneumoniae: multimodal infection control program in intensive care units

INTRODUCTION

The aims of our study were to investigate a nosocomial spread of an extended-spectrum fl-lactamases-Klebsiella pneumoniae cluster at a University teaching hospital in Italy, to describe, and to monitor the implementation of a multimodal infection control program in two mixed ICUs.

METHODS

During the 1 October 2005-30 September 2006 period, 79 colonized patients have been identified. Isolates were genotyped by pulsed-field gel electrophoresis (PFGE). A mutimodal infection control program with monitoring of alcohol-based hand rub was performed in Intensive Care Units (ICU A and ICU B).

RESULTS

The epidemiological investigation and PFGE showed a horizontal transmission of the same PFGE genotype, with the isolation of the outbreak strain on the hand of one healthcare operator. Alcohol based hand rub was adopted in ICUA on 18 March 2006, in addition to hand washing with plain or antiseptic soap. ICU B did not change its hand hygiene habits. Following the implementation of the program, the incidence density rate (IDR) in ICU A fell down from 4.50 to 1.68/1000 patient days.

DISCUSSION AND CONCLUSIONS

Our findings confirm the important role of personnel in cross-transmission. Moreover the inbuilt control group involuntarily offered by the delaying of the intervention in ICU B has given the opportunity to verify the epidemiological association between the actual implementation of infection control practices and the outbreak control.

West Nile virus circulation in Emilia-Romagna, Italy: the integrated surveillance system 2009

Following a large West Nile virus (WNV) epidemic in northeastern Italy in 2008, human and animal surveillance activities were implemented in Emilia Romagna. Human surveillance was performed by serology or genome detection on blood and cerebrospinal fluid for all suspected cases suffering from acute meningoencephalitis in the regional territory. Animal surveillance consisted of passive and active surveillance of horses and active surveillance of wild birds and mosquitoes. Between 15 June and 31 October 2009, nine of 78 possible cases of West Nile neuroinvasive disease were confirmed (three fatal). From May to October, 26 cases of neurological West Nile disease were confirmed among 46 horses. The overall incidence of seroconversion among horses in 2009 was 13%. In 2009, 44 of 1,218 wild birds yielded positive PCR results for WNV infection. The planned veterinary and entomological surveillance actions detected WNV activity from the end of July 2009, about 2-3 weeks before the onset of the first human neurological case. Passive surveillance of horses seems to be an early and suitable tool for the detection of WNV activity, but it will be less sensitive in the future, because an intensive programme of horse vaccination started in June 2009.

West Nile virus circulation in Emilia-Romagna, Italy: the integrated surveillance system 2009

Following a large West Nile virus (WNV) epidemic in northeastern Italy in 2008, human and animal surveillance activities were implemented in Emilia Romagna. Human surveillance was performed by serology or genome detection on blood and cerebrospinal fluid for all suspected cases suffering from acute meningoencephalitis in the regional territory. Animal surveillance consisted of passive and active surveillance of horses and active surveillance of wild birds and mosquitoes. Between 15 June and 31 October 2009, nine of 78 possible cases of West Nile neuroinvasive disease were confirmed (three fatal). From May to October, 26 cases of neurological West Nile disease were confirmed among 46 horses. The overall incidence of seroconversion among horses in 2009 was 13%. In 2009, 44 of 1,218 wild birds yielded positive PCR results for WNV infection. The planned veterinary and entomological surveillance actions detected WNV activity from the end of July 2009, about 2-3 weeks before the onset of the first human neurological case. Passive surveillance of horses seems to be an early and suitable tool for the detection of WNV activity, but it will be less sensitive in the future, because an intensive programme of horse vaccination started in June 2009.