1
|
Sandbekken IH, Utne I, Hermansen Å, Grov EK, Løyland B. Impact of multimodal interventions targeting behavior change on hand hygiene adherence in nursing homes: An 18-month quasi-experimental study. Am J Infect Control 2024; 52:29-34. [PMID: 37499759 DOI: 10.1016/j.ajic.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Nursing home residents are vulnerable and frail, and hand hygiene adherence is often too low to prevent transmission of infections. This study's aim was to investigate whether interventions targeting behavior change can improve hand hygiene adherence in nursing homes. METHODS Over 18 months, 22 nursing home wards participated in this quasi-experimental study. Three intervention wards were selected based on the mean values of hand hygiene adherence, infections, and antibiotic use. Multimodal interventions targeting behavior change, including education, UV-light boxes, and posters, were implemented. RESULTS Hand hygiene adherence increased to 60.9% in the intervention wards and decreased to 51.3% in the control wards. The control wards experienced lower adherence in all indications of WHO's "My five moments for hand hygiene." DISCUSSION Interventions should target proper hand hygiene before patient contact and glove use because health care workers have low adherence in these areas. The findings indicate that the type of intervention is less important than attention to hand hygiene and activating workers' motivation. Using a behavior change approach and continuous reinforcement is important because the effects of interventions diminish over time. CONCLUSIONS Our findings showed that multimodal interventions targeting behavior change may increase hand hygiene adherence.
Collapse
Affiliation(s)
- Ida H Sandbekken
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Norway
| | - Inger Utne
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Norway
| | - Åsmund Hermansen
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | - Ellen K Grov
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Norway
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Norway.
| |
Collapse
|
2
|
Suppini N, Oancea C, Fira-Mladinescu O, Traila D, Pescaru C, Marc MS, Manolescu D, Vastag E, Ali A, Hogea E, Pilut CN. Post-Infection Oscillometry and Pulmonary Metrics in SARS-CoV-2 Patients: A 40-Day Follow-Up Study. Diseases 2023; 11:102. [PMID: 37606473 PMCID: PMC10443293 DOI: 10.3390/diseases11030102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has had significant impacts on pulmonary function. This study aimed to comprehensively evaluate pulmonary function and structure in patients 40 days post-SARS-CoV-2 infection, employing an array of testing methodologies including spirometry, plethysmography, forced oscillometry, and CT scanning. It also sought to establish potential correlations between these metrics and evaluate if forced oscillometry could provide additional value in post-infective lung function assessment. A 40-day post-infection follow-up observational study was conducted involving 66 patients with confirmed SARS-CoV-2 infection. The results revealed decreases in FVC and FEF25-75 with the increasing severity of COVID-19. Specifically, patients with severe symptoms exhibited statistically significant decreases in FVC (mean = 86.8) compared with those with mild symptoms (mean = 106.0; p = 0.018). The FEF25-75 showed a similar trend, with severe patients exhibiting a mean of 77.7 compared with 82.9 in the mild group (p = 0.017). Furthermore, resonant frequency (RF) increased with disease severity, with the severe group exhibiting a statistically significant increase (mean = 17.4) compared with the mild group (mean = 14.3; p = 0.042). CT scans showed an increase in ground-glass opacities with disease severity, with 81.8% of severe patients demonstrating this finding (p = 0.037). Multiple regression analysis revealed that Reactance at 4 Hz (X4), Forced Expiratory Flow 25-75% (FEF25-75), and Resonant Frequency (RF) were significantly related to COVID-19 severity. Specifically, for each unit increase in these factors, the risk of the event was estimated to increase by a factor of 3.16, 2.09, and 1.90, respectively. Conversely, Resistance at 4 Hz (R4) and Airway Resistance (RAW) were found to significantly decrease the event hazard, highlighting their potential protective role. Spirometry, plethysmography, and forced oscillometry are effective in assessing these changes. Forced oscillometry may be particularly beneficial in identifying subtle changes in lung function post-COVID-19. Further studies are warranted to validate these findings and develop strategies to manage post-infective pulmonary changes in SARS-CoV-2 patients.
Collapse
Affiliation(s)
- Noemi Suppini
- Discipline of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Cristian Oancea
- Discipline of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Ovidiu Fira-Mladinescu
- Discipline of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Daniel Traila
- Discipline of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Camelia Pescaru
- Discipline of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Monica Steluta Marc
- Discipline of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Diana Manolescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Department of Radiology and Medical Imaging, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Emanuela Vastag
- Discipline of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Ayesha Ali
- Bhaskar Medical College, Amdapur Road 156-162, Hyderabad 500075, Telangana State, India
| | - Elena Hogea
- Department of Microbiology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Ciprian Nicolae Pilut
- Department of Microbiology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| |
Collapse
|
3
|
Sexton NR, Cline PJ, Gallichotte EN, Fitzmeyer E, Young MC, Janich AJ, Pabilonia KL, Ehrhart N, Ebel GD. SARS-CoV-2 entry into and evolution within a skilled nursing facility. Sci Rep 2023; 13:11657. [PMID: 37468595 DOI: 10.1038/s41598-023-38544-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023] Open
Abstract
SARS-CoV-2 belongs to the family Coronaviridae which includes multiple human pathogens that have an outsized impact on aging populations. As a novel human pathogen, SARS-CoV-2 is undergoing continuous adaptation to this new host species and there is evidence of this throughout the scientific and public literature. However, most investigations of SARS-CoV-2 evolution have focused on large-scale collections of data across diverse populations and/or living environments. Here we investigate SARS-CoV-2 evolution in epidemiologically linked individuals within a single outbreak at a skilled nursing facility beginning with initial introduction of the pathogen. The data demonstrate that SARS-CoV-2 was introduced to the facility multiple times without establishing an interfacility transmission chain, followed by a single introduction that infected many individuals within a week. This large-scale introduction by a single genotype then persisted in the facility. SARS-CoV-2 sequences were investigated at both the consensus and intra-host variation levels. Understanding the variability in SARS-CoV-2 during transmission chains will assist in understanding the spread of this disease and can ultimately inform best practices for mitigation strategies.
Collapse
Affiliation(s)
- Nicole R Sexton
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
- Nebraska Center for Virology, School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, 68504, USA
| | - Parker J Cline
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Emily N Gallichotte
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Emily Fitzmeyer
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Michael C Young
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Ashley J Janich
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Kristy L Pabilonia
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Nicole Ehrhart
- Columbine Health Systems Center for Healthy Aging and Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - Gregory D Ebel
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523, USA.
| |
Collapse
|
4
|
Yilmaz FK, Cakir M, Ikiisik H, Maral I. The Effect of Pneumococcal, Influenza, and COVID-19 Vaccinations on COVID-19 Hospitalization and Progression in People over 65 Years Old Living in Nursing Homes. Vaccines (Basel) 2023; 11:vaccines11050943. [PMID: 37243046 DOI: 10.3390/vaccines11050943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
Infectious diseases pose a major threat to elderly populations. Streptococcus pneumonia bacteria, influenza-causing viruses, and COVID-19 viruses cause three pathologies in the respiratory system with similar symptoms, transmission routes, and risk factors. Our study aimed to evaluate the effects of pneumococcal, influenza, and COVID-19 vaccinations on the status of COVID-19 hospitalization and progression in people over 65 years of age living in nursing homes. This study was performed in all nursing homes and elderly care centers in the Uskudar district of Istanbul.The diagnosis rate of COVID-19 was determined as 49%, the rate of hospitalization as 22.4%, the rate of hospitalization in the intensive care unit as 12.2%. The rate of intubation was determined as 10.4%, the rate of mechanical ventilation as 11.1% and the rate of COVID-19 related mortality rate as 9.7%. When the factors affecting the diagnosis of COVID-19 were examined, the presence and dose of COVID-19 vaccine was protective. When the factors affecting hospitalization status were examined, male sex and presence of chronic disease were risk factors; four doses of COVID-19 vaccine and influenza vaccine and pneumococcal vaccine together with COVID-19 vaccine were protective. When the factors affecting COVID-19-related death were examined, the male sex was a risk factor; the pneumococcal and influenza vaccine together with COVID-19 vaccine were protective. Our results revealed that the availability of influenza and pneumococcal vaccines positively impacted the progression of COVID-19 disease in the elderly population living in nursing homes.
Collapse
Affiliation(s)
- Feyza Kutay Yilmaz
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul 34700, Turkey
| | - Mustafa Cakir
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul 34700, Turkey
| | - Hatice Ikiisik
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul 34700, Turkey
| | - Isil Maral
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul 34700, Turkey
| |
Collapse
|
5
|
San Román J, Candel FJ, del Mar Carretero M, Sanz JC, Pérez-Abeledo M, Barreiro P, Viñuela-Prieto JM, Ramos B, Canora J, Barba R, Zapatero A, Martínez-Peromingo FJ. Cross-Sectional Analysis of Risk Factors for Outbreak of COVID-19 in Nursing Homes for Older Adults in the Community of Madrid. Gerontology 2022; 69:163-171. [PMID: 35654010 PMCID: PMC9393782 DOI: 10.1159/000524553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/10/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Nursing homes for older adults have been hot spots for SARS-CoV-2 infections and mortality. Factors that facilitate COVID-19 outbreaks in these settings need to be assessed. METHODS A retrospective cross-sectional study of a cohort of residents and workers in nursing homes taking occasion of a point seroprevalence survey was done in the Community of Madrid. Factors related to outbreaks in these facilities were analyzed. RESULTS A total of 369 nursing homes for older adults, making a population of 23,756 residents and 20,795 staff members, were followed from July to December 2020. There were 54.2% SARS-CoV-2 IgG+ results in residents and in 32.2% of workers. Sixty-two nursing homes (16.8%) had an outbreak during the follow-up. Nursing homes with outbreaks had more residents than those without (median number of 81 [IQR, 74] vs. 50 [IQR, 56], p < 0.001). Seropositivity for SARS-CoV-2 was lower in facilities with versus without outbreaks, for residents (42.2% [IQR, 55.7] vs. 58.7% [IQR, 43.4], p = 0.002) and for workers (23.9% [IQR, 26.4] vs. 32.8% [IQR, 26.3], p = 0.01). For both residents and staff, the number of infections in outbreaks was larger in centers with lower, as compared with intermediate or high seroprevalence. The size of the facility did not correlate with the number of cases in the outbreak. Taking the incidence of cases in the community as a time-dependent variable (p = 0.03), a Cox analysis (HR [95% CI], p) showed that intermediate or high seroprevalence among residents in the facility was related to a reduction of 55% (0.45 [0.25-0.80], p = 0.007) and 78% (0.22 [0.10-0.48], p < 0.001) in the risk of outbreaks, respectively, as compared with low sero-prevalence. Also, as compared with smaller, medium (1.91 [1.00-3.65], p = 0.05) or large centers (4.57 [2.38-8.75], p < 0.001) had more respective risk of outbreaks. CONCLUSIONS The size of the facility and the seroprevalence among residents in nursing homes, and the incidence of infections in the community, are associated with the risk of outbreaks of COVID-19. Facilities with greater proportion of seropositives had smaller number of cases. Monitoring of immunity in nursing homes may help detect those at a greater risk of future cases.
Collapse
Affiliation(s)
- Jesús San Román
- Department of Medical Specialties and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Francisco J. Candel
- Clinical Microbiology and Infectious Diseases, IdISSC and IML Health Institutes, Hospital Universitario San Carlos, Madrid, Spain
| | | | - Juan Carlos Sanz
- Regional Public Health Laboratory, Community of Madrid, Madrid, Spain
| | | | - Pablo Barreiro
- Infectious Diseases, Internal Medicine, Hospital General Universitario La Paz, Madrid, Spain,*Pablo Barreiro,
| | | | - Belén Ramos
- Regional Public Health Laboratory, Community of Madrid, Madrid, Spain
| | - Jesús Canora
- Assistant to the Vice-counselor of Public Health, Community of Madrid, Madrid, Spain
| | - Raquel Barba
- Service of Internal Medicine, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Antonio Zapatero
- Vice-counselor of Healthcare and Public Health, Community of Madrid, Madrid, Spain
| | | | | |
Collapse
|
6
|
Aghili MS, Darvishpoor Kakhki A, Gachkar L, Davidson PM. Predictors of contracting COVID-19 in nursing homes: Implications for clinical practice. J Adv Nurs 2022; 78:2799-2806. [PMID: 35170066 DOI: 10.1111/jan.15188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/23/2021] [Accepted: 01/15/2022] [Indexed: 11/30/2022]
Abstract
AIMS The aim of the study was to identify the predictors of contracting COVID-19 among older people in nursing homes in Iran. DESIGN A case-control study. METHODS Four-hundred-nine nursing home residents aged 60 years and above, with a 1:2 ratio of those infected with SARS-CoV-2 to those not infected, from six nursing homes in Tehran between 25 March and 12 July 2021 were recruited. Participants completed a questionnaire comprising demographic and underlying disease questions, practice about prevention principles of SARS-CoV-2 infection, probably predisposing factors of the infection, and environmental and staff characteristic of nursing homes. Logistic regression was used to determine risk factors associated with contracting COVID-19. RESULTS The mean age was 77.37 (±9.20) years; 54% were female. A logistic regression model showed that the most important predictors of becoming infected by SARS-CoV-2 included not using mask outside the room (odds ratio [OR]: 3.37, 95% CI: 1.74-6.53), longer staff shifts (OR: 3.02, 95% CI: 1.68-5.43), using cloth mask or not wearing a mask (OR: 2.47, 95% CI: 1.13-5.42) and not having glass barrier in visitors space (OR: 1.95, 95% CI: 1.11-3.50). CONCLUSION The results indicate that an increase in older people becoming infected by SARS-CoV-2 in nursing homes is probably because of not wearing a mask in common places, use of a cloth mask, longer staff shift durations and not having a glass shield when interacting with visitors from outside of nursing homes. IMPACT The predictors identified in this study can assist in reducing SARS-CoV-2 infections in older people institutionalized in nursing homes. These data items can also inform the development of interventions to improve principles of infection prevention and control.
Collapse
Affiliation(s)
- Mohammad Sadegh Aghili
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Darvishpoor Kakhki
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Latif Gachkar
- Department of Infectious Diseases, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
7
|
Blasi F, Di Pasquale M, Gramegna A, Viale P, Iacobello C, Gori A, Tumbarello M, Esposito S, Richeldi L, Bassetti M. A new call for influenza and pneumococcal vaccinations during COVID-19 pandemic in Italy: A SIP/IRS (Italian Respiratory Society) and SITA (Italian Society of Antiinfective therapy) statement. Respir Med 2021; 190:106674. [PMID: 34788734 PMCID: PMC8559458 DOI: 10.1016/j.rmed.2021.106674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 01/01/2023]
Abstract
Influenza and pneumococcal disease represent a well-known burden on healthcare systems worldwide, as well as they still have an attributed morbidity and mortality, especially in elderly individuals and vulnerable populations. In the context of the ongoing pandemic of COVID-19, a series of considerations in favor of extensive influenza and pneumococcal vaccination campaign are emerging, including a possible reduction of hospital extra burden and saving of sanitary resources. In addition, recent studies have suggested that prior vaccinations towards non SARS-CoV-2 pathogens might confer some protection against COVID-19. In this paper the authors consider all factors in support of these hypotheses and provide a consensus statement to encourage influenza and pneumococcal vaccinations in targeted populations.
Collapse
Affiliation(s)
- Francesco Blasi
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy.
| | - Marta Di Pasquale
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gramegna
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Carmelo Iacobello
- UOC Malattie Infettive, Azienda Ospedaliera per L'Emergenza Cannizzaro-Catania, Italy
| | - Andrea Gori
- Infectious Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Mario Tumbarello
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luca Richeldi
- Complex Operative Unit of Pneumology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Bassetti
- Department of Health Science, University of Genoa, Italy; Infectious Diseases Clinic, Policlinico San Martino Hospital - IRCCS, Genoa, Italy
| |
Collapse
|