Peristomal skin complications in ileostomy and colostomy patients: a systematic literature review

Background

Peristomal skin complications (PSCs) are one of the main post-operative complications of ostomy surgery. They have a considerable impact on patients’ quality of life and represent a challenge for healthcare professionals involved in their management. The majority of PSCs is preventable and costly. Knowing their burden could guide decision makers on the ostomy patients’ management who are predominantly cancer and chronic bowel disease patients. Thus, the aim of this study was to summarize existing literature regarding the clinical-epidemiological burden of PSCs in ostomy patients.

Methods

A systematic literature review was performed querying three database (PubMed, Scopus, Web of Science) from January 2012 to February 2022. It included studies in English language and focused on the clinical and epidemiological burden of PSCs in the adult patients with ileostomy and colostomy.

Results

Overall, 35 studies were considered. Epidemiological data on PSCs were not systematically collected in the available literature. The principal underlying disease requiring the ostomy surgery were rectal, colon and gynaecological cancers, inflammatory bowel diseases, diverticulitis, occlusion and intestinal perforation. It was described a range of PSCs from 11% to 45%. The PSCs were most commonly erythema, papules, erosion, ulceration and vesciculation. Skin complications increased the average number of hospitalization days and of hospital readmission within 120-day following surgery.

Conclusions

The data on PSCs are still limited. Estimating the PSCs burden could support healthcare professionals and decision makers called upon to identify the most appropriate responses to patients’ health needs. The management of these complications plays a vital role to improve patient’s quality of life and a multidisciplinary approach with the active involvement of stomatherapist, surgeon and dermatologist is critical. Furthermore, a better patient education and empowerment is needed.

Key messages

• Developing a multidisciplinary approach to managing PSCs is essential in order to provide the best treatment possible and the best outcomes for patients.

• Further studies should be conducted in order to better define the clinical-epidemiological burden of ileo- and colostomies and to support better health planning.

In memory of Giovanni Berlinguer. The Man, the Scientist, the Politician

On this occasion I am very grateful to the Academic Authorities for having asked me to illustrate the life of Giovanni Berlinguer as a Researcher, a Professor and a Doctor of Public Health. I will try to fulfill this duty, perhaps with some reservations, because I find it almost impossible to think of Giovanni as a researcher and a professor separately from his complex personality and his role as a politician and a brilliant and prolific writer. This is because Giovanni was an inextricable combination of all these roles, which cannot be described separately.

Metformin regulates the incretin receptor axis via a pathway dependent on peroxisome proliferator-activated receptor-α in mice

AIMS/HYPOTHESIS

Metformin is widely used for the treatment of type 2 diabetes. Although it reduces hepatic glucose production, clinical studies show that metformin may reduce plasma dipeptidyl peptidase-4 activity and increase circulating levels of glucagon-like peptide 1 (GLP-1). We examined whether metformin exerts glucoregulatory actions via modulation of the incretin axis.

METHODS

Metformin action was assessed in Glp1r(-/-), Gipr(-/-), Glp1r:Gipr(-/-), Pparα (also known as Ppara)(-/-) and hyperglycaemic obese wild-type mice with or without the GLP-1 receptor (GLP1R) antagonist exendin(9-39). Experimental endpoints included glucose tolerance, plasma insulin levels, gastric emptying and food intake. Incretin receptor expression was assessed in isolated islets from metformin-treated wild-type and Pparα(-/-) mice, and in INS-1 832/3 beta cells with or without peroxisome proliferator-activated receptor (PPAR)-α or AMP-activated protein kinase (AMPK) antagonists.

RESULTS

In wild-type mice, metformin acutely increased plasma levels of GLP-1, but not those of gastric inhibitory polypeptide or peptide YY; it also improved oral glucose tolerance and reduced gastric emptying. Metformin significantly improved oral glucose tolerance despite loss of incretin action in Glp1r(-/-), Gipr(-/-) and Glp1r(-/-) :Gipr(-/-) mice, and in wild-type mice fed a high-fat diet and treated with exendin(9-39). Levels of mRNA transcripts for Glp1r, Gipr and Pparα were significantly increased in islets from metformin-treated mice. Metformin directly increased Glp1r expression in INS-1 beta cells via a PPAR-α-dependent, AMPK-independent mechanism. Metformin failed to induce incretin receptor gene expression in islets from Pparα(-/-) mice.

CONCLUSIONS/INTERPRETATION

As metformin modulates multiple components of the incretin axis, and enhances expression of the Glp1r and related insulinotropic islet receptors through a mechanism requiring PPAR-α, metformin may be mechanistically well suited for combination with incretin-based therapies.

[Assessment of seawater quality along the Asinara Gulf. Note 1: preliminary results of seawater monitoring using Dicentrarchus labrax and Sparus aurata as bioindicators]

In recent years, physical-chemical, chemical and microbiological testing systems to water's control was matched by the use of "biomarkers" such as algae, nematodes, Anellidi, Porifera, molluscs and arthropods (crustaceans), although these are phylogenetically distant from humans and they differ in methods of recruitment, toxico-kinetics and metabolism of xenobiotics. That is why today the predatory fishes (tuna, mackerel, sea bream, sea bass and swordfish) are among the most widely used in biomonitoring studies. In particular Sparus aurata and Dicentrarchus labrax (sea bream and sea bass) are appropriate in warning of environmental pollution. Moreover since the two species are precious and particularly present in food, they could represent a potential vehicle for the transport of contaminants to humans. To this end, the aim of this note, part of a complex research project launched in line with the provisions of the ministry for the environment, land and sea, is to evaluate the quality of coastal waters by using of Sparus aurata and Dicentrarchus labrax. The results obtained show that the area concerned, at present, is not affected by serious pollution processes, as the human pressure is highlighted by the presence of phenols in sea water and heavy metals (Cd and Hg) in the bioindicators. The detection of these toxic elements in fish species, could also not be directly attributable to any condition of impairment of the environment. However given the accumulation of these contaminants in the parts are edible, the consumption of fish could be a source of exposure particularly for those most exposed to health risks (children, elderly, sick and pregnant women).

Monitoring on chemical and biological pollutants in sea waters of central-northern Sardinia

INTRODUCTION

The aims of this study are to assess the quality of the coastal waters of central-northern Sardinia through data from a monitoring network and to outline maps and experimental models of environmental risk correlated to the presence of chemical and microbiological contaminants. The area studied is the coast between Capo Falcone and the mouth of the river Coghinas, in the northwestern part of the island.

METHODS

In a first phase, 7 sampling stations of sea water and 1 sampling station of bivalve molluscs (Mytilus galloprovincialis Lam.) were identified. For each transept 3 different collection points at respectively 500, 1000, and 3000 meters from the coast for a total 21 sampling sites were identified. In a second phase, another 7 transepts were identified, 2 of which on the island of Asinara.

RESULTS

As regards the microbiological monitoring of the sea water, very low concentrations of Total coliforms, Faecal coliforms and Faecal Streptococci were found and no Salmonella were isolated. Chemical analysis of the waters showed a high constant presence of phenols. In the bivalves we found rather high concentrations of Faecal coliforms without any clear seasonal variation, while no Salmonella was isolated in any of the examined samples.

DISCUSSION

The results show that the considered area is not affected by serious pollution processes, thus allowing to express a completely satisfactory judgement on its state of health. However anthropic pressure in the considered territory is testified by the presence in the water of high concentrations of phenols.

CONCLUSIONS

The results point out to the necessity of targeted and rational preventive action by means of control and protection measures for environmental ecosytems.

Regulation of insulin signalling, glucose uptake and metabolism in rat skeletal muscle cells upon prolonged exposure to resistin

AIMS/HYPOTHESIS

Debate exists regarding the role of resistin in the pathophysiology of insulin resistance. The aim of this study was to directly assess the effects of resistin (0-24 h) on basal and insulin-stimulated glucose uptake and metabolism in skeletal muscle cells and to investigate the mechanisms responsible for the effects of resistin.

METHODS

We used L6 rat skeletal muscle cells and examined [(3)H]2-deoxyglucose uptake, GLUT4 translocation and GLUT protein content. We assessed glucose metabolism by measuring the incorporation of D-[U-(14)C]glucose into glycogen, (14)CO(2) and lactate production, as well as the phosphorylation level and total protein content of insulin signalling proteins, including insulin receptor beta-subunit (IRbeta), insulin receptor substrate (IRS), Akt and glycogen synthase kinase-3beta (GSK-3beta).

RESULTS

Treatment of L6 rat skeletal muscle cells with recombinant resistin (50 nmol/l, 0-24 h) reduced levels of basal and insulin-stimulated 2-deoxyglucose uptake and decreased insulin-stimulated GLUT4myc content at the cell surface, with no alteration in the production of GLUT4 or GLUT1. Resistin also decreased glycogen synthesis and GSK-3beta phosphorylation. Insulin-stimulated oxidation of glucose via the Krebs cycle was reduced by resistin, whereas lactate production was unaltered. Although insulin receptor protein level and phosphorylation were unaltered by resistin, production of IRS-1, but not IRS-2, was downregulated and a decreased tyrosine phosphorylation of IRS-1 was detected. Reduced phosphorylation of Akt on T308 and S473 was observed, while total Akt and Akt1, but not Akt2 or Akt3, production was decreased.

CONCLUSIONS/INTERPRETATION

Our data show that resistin regulates the function of IRS-1 and Akt1 and decreases GLUT4 translocation and glucose uptake in response to insulin. Selective decreases in insulin-stimulated glucose metabolism via oxidation and conversion to glycogen were also induced by resistin. These observations highlight the potential role of resistin in the pathophysiology of type 2 diabetes in obesity.

[Epidemiological survey on smoking habit among young students in Sardinia. A cross sectional study]

The study reports the prevalence of cigarette smoking among 11401 high school Sardinian students. The prevalence of smokers (40.2%) significantly differs between gender (41.1% males and 38.4% females). Males have an early initiation of smoking with an evident addictive effect by age. 54.3% are daily smokers and 21.4% smoke 15 or more cigarettes per day. More than 50% smoke to look grown-up and to be accepted by the group. Besides age (OR=1.10; 95%CI: 1.06-1.15), other factors are associated with smoke: low education level of father (OR=1.08; 95%CI: 1.02-1.15), no maternal support (OR = 1.73; 95%CI: 1.17-2.54), to have at least one smoker cohabitant (OR=1.66; 95%CI: 1.54-1.80) and alcohol drinking (OR=3.46; 95%CI: 3.04-3.93). The smokers' knowledge on smoke topics significantly differ from non smokers. Our results suggest the need of community preventive interventions, diversified for specific target populations, to modify the students' behaviours so that they respect their own health and that of their fellow citizens.

Globular adiponectin increases GLUT4 translocation and glucose uptake but reduces glycogen synthesis in rat skeletal muscle cells

AIMS/HYPOTHESIS

The aim of this study was to determine whether adiponectin elicits glucose uptake via increased GLUT4 translocation and to investigate the metabolic fate of glucose in skeletal muscle cells treated with globular adiponectin.

MATERIALS AND METHODS

Basal and insulin-stimulated 2-deoxy-D: -[(3)H]glucose uptake, cell surface myc-tagged GLUT4 content, production of (14)CO(2) by oxidation of D: -[U-(14)C]glucose and [1-(14)C]oleate, and incorporation of D: -[U-(14)C]glucose into glycogen and lactate were measured in the presence and absence of globular adiponectin.

RESULTS

RT-PCR and Western blot analysis revealed that L6 cells and rat skeletal muscle cells express AdipoR1 mRNA and protein. Globular adiponectin increased both GLUT4 translocation and glucose uptake by increasing the transport V(max) of glucose without altering the K(m). Interestingly, the incorporation of D: -[U-(14)C]glucose into glycogen under basal and insulin-stimulated conditions was significantly decreased by globular adiponectin, whereas lactate production was increased. Furthermore, globular adiponectin did not affect glucose oxidation, but enhanced phosphorylation of AMP kinase and acetyl-CoA carboxylase, and fatty acid oxidation.

CONCLUSIONS/INTERPRETATION

The present study is the first to show that globular adiponectin increases glucose uptake in skeletal muscle cells via GLUT4 translocation and subsequently reduces the rate of glycogen synthesis and shifts glucose metabolism toward lactate production. These effects are consistent with the increased phosphorylation of AMP kinase and acetyl-CoA carboxylase and oxidation of fatty acids induced by globular adiponectin.

Epidemiology of hydatidosis in the province of Sassari, Italy

Cystic echinococcosis is endemic in certain parts of the world, including Sardinia, Italy. It was performed a study in the province of Sassari in order to evaluate the incidence of the infection in man and the effects of control programs since 1964 to 2002. Data obtained by surgical records, hospital discharge forms, radiological and pathological files were collected using a case report form. During the years 1964-2002, 2702 new cases were identified (average annual incidence: 17 per 100,000) and 1981 (73.3%) were submitted to surgical treatment. In 57.3% municipalities no cases were observed during the years 1998-2002. Males are more affected (56.2%), mostly farmers-shepherdess (68.6 per 100,000) and pensioners (59.6 per 100,000). Control measures led to a significant decline in the incidence rate of hydatidosis during the period 1964-2002, dropping by 27.6 per 100,000. The mean age of surgical patients increased during the years of surveillance, such as the surgical liver/lung ratio as a consequence of a cohort effect. The durability of control programs is the corner stone for obtaining a significant decrease of this infection.

Detection of isoniazid and rifampin resistance in Mycobacterium tuberculosis strains by single-strand conformation polymorphism analysis and restriction fragment length polymorphism

Anti-Mycobacterium tuberculosis drug-resistance, mainly multi-drug resistance (MDR-TB), represents an important public health problem in several countries. Aim of our study is to identify the presence of these mutations in M. tuberculosis isoniazid- and rifampin-resistant strains isolated in our Institute; to evaluate linkage between type of mutation and level of resistance; to determine the usefulness of easy molecular techniques for rapid detection of such mutations on body specimens. Isoniazid- and rifampin-resistance was tested on 67 M. tuberculosis strains by Single-Strand Conformation Polymorphism (SSCP) and Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) assays, using HaeIII, PstuI, BsteII, BstuI enzymes. Drug-resistance of control strains was determined by cultural techniques (fluorimetry- BACTEC 9120). Cultural assay showed isoniazid- and rifampin-resistance in 6.12 and 2%, respectively (data confirmed by SSCP assay). Mutation of katG, linked to isoniazid resistance, was detected using BstuI enzyme, and mutation of rpoB, expression of reduced sensitivity to rifampin, using HaeIII. 15 body specimens, M. tuberculosis-positive to conventional assays, were tested by SSCP technique. Epidemiologic reports of numerous cases of tuberculosis due to MDR strains induce to detect quickly both Mycobacteria and drug-resistance, in order to start prompt effective therapy. On this basis, molecular assays are useful for a rapid therapeutic decision.

[The debate in Italy and in Europe about the adoption of pneumococcal vaccine in children]

Since the introduction of the conjugate vaccine PnC-7, for the prevention of invasive pneumococcal infections for at-risk children, a controversy has arisen about the need for a universal vaccination under the age of two years. This article reviews the pathogenesis and the changing epidemiological pattern of pneumococcal diseases, the emergence of drug resistant S. pneumoniae and the costs and benefits of vaccination. Furthermore, the recommendations of various European countries and an up to date of the Italian ones are illustrated. It concludes with the public health perspective on the adoption of this pneumococcal vaccine and future recommendations for vaccination.

Pretreatment antibiotic resistance in Helicobacter pylori infection: results of three randomized controlled studies

BACKGROUND

Although combinations of antibiotics and antisecretory drugs are useful for treatment of Helicobacter pylori infection, treatment failure is common. The aim of this study was to evaluate the relation between pretreatment antibiotic resistance and outcome by using six different treatment regimens for H. pylori infection.

PATIENTS AND METHODS

Three hundred sixty-nine consecutive H. pylori-infected patients with dyspeptic symptoms were enrolled in three consecutive randomized, controlled, single-center clinical trials: trial A, 128 patients; trial B, 125 patients; trial C, 116 patients. Treatments consisted of (A) a 15-day course of dual therapy (omeprazole, 20 mg bid, and amoxicillin, 1 gm bid, or clarithromycin, 500 mg tid) (OA vs OC); (B) a 7-day triple therapy of omeprazole, 20 mg bid, plus metronidazole, 500 mg bid, and amoxicillin, 1,000 mg bid, or clarithromycin, 500 mg tid (OMA vs OMC); or (C) omeprazole, 20 mg bid, plus metronidazole, 500 mg bid, plus tetracycline, 500 mg qid, or doxycycline, 100 mg tid (OMT vs OMD). Diagnostic endoscopy was made in all patients before and 5 to 6 weeks after therapy. Six biopsies were taken from each patient for histology, rapid urease test, and H. pylori culture; antibiotic susceptibility testing was performed using the E-test method.

RESULTS

Overall cure rates were poor for both dual therapies OA and OC (38% and 37%, respectively) and for triple therapies OMA, OMC, and OMD (57%, 55%, and 58%, respectively). The OMT combination was successful in 91% (95% confidence interval [CI], 80.4%-97%). Metronidazole resistance was present in 29.7% (95% CI, 24%-35%), amoxicillin resistance was present in 26% (95% CI, 21%-32%), clarithromycin resistance was present in 23.1% (95% CI, 18%-29%), tetracycline resistance was present in 14% (95% CI, 10%-20%), and doxycycline resistance was present in 33.3% (95% CI, 21%-47%). Antibiotic resistance markedly reduced the cure rates and accounted for most of the poor results with the triple therapies: 89% versus 23%; 77% versus 26%; 100% versus 60%; and 67% versus 23% for OMC, OMA, OMT, and OMD, respectively. OMT appeared to be the best because of the high success rate with metronidazole-resistant H. pylori (71%) and in low-level tetracycline resistance.

CONCLUSIONS

Pretreatment antibiotic-resistant H. pylori can, in part, explain the low cure rate of the infection and the variability in outcome in reported trials.

Amoxycillin resistance is one reason for failure of amoxycillin-omeprazole treatment of Helicobacter pylori infection

BACKGROUND

The efficacy of omeprazole and amoxycillin dual therapy to treat Helicobacter pylori infection has been inconsistent, suggesting the presence of host or bacterial factors influencing treatment success. The aim of this study was to assess the role of pre-treatment amoxycillin resistance in the efficacy of omeprazole and amoxycillin dual therapy.

METHODS

We studied 43 consecutive dyspeptic patients with H. pylori infection. Pre-treatment H. pylori infection was established by the combination of positive rapid urease test, culture and histology. Amoxycillin susceptibility testing was performed by an Epsilometer test (E-test) method and amoxycillin resistance was defined as minimum inhibitory concentration greater than 8 microg/mL. Patients received 20 mg omeprazole twice daily for 28 days and amoxycillin 1000 mg twice daily for 2 weeks. Adverse effects were documented using a questionnaire. H. pylori status was reassessed 6-8 weeks after the end of treatment by rapid urease testing and histological examination of gastric biopsies.

RESULTS

Forty-two dyspeptic patients completed the study, and one patient dropped out. H. pylori infection was cured in 2 3 of 42 patients (55%). The cure rate was higher in patients harbouring amoxycillin-sensitive organisms than in those with resistant strains: 66% (19/29) vs. 31% (4/13), respectively (P = 0.049). No significant differences in cure rates were evident in relation to age, sex, smoking habits or compliance.

CONCLUSIONS

The effectiveness of amoxycillin-omeprazole dual therapy was greatly reduced in the presence of pre-treatment amoxycillin-resistant H. pylori. The success rate in patients with amoxycillin-sensitive H. pylori was only 66%, suggesting the presence of additional factors affecting the efficacy of this therapy.

IS200 fingerprint of Salmonella enterica serotype Typhimurium human strains isolated in Sardinia

A collection of Salmonella enterica serotype Typhimurium human strains isolated in Northern Sardinia (Italy) was examined for the insertion sequence IS200, phage type, antibiotic profile, ribotyping polymorphisms and plasmid profile. All clinical isolates studied contained from 4 to 10 copies of the IS200 element. IS200 permitted to discriminate Typhimurium strains and to identify five IS200 types, some of them circulating in Sardinia at least since 1900. Strains belonging to phage DT104 predominated and correlated with a specific IS200 pattern.

Comparative in vitro activity of cefodizime and other antibiotics against pathogens recently isolated in Italy

In the present study we tested the susceptibility to cefodizime on 1,985 selected nosocomial pathogens isolated in five laboratories. Moreover, we evaluated the epidemiology of the resistance of the tested strains to cefodizime and to other antibiotics clinically available in Italy. The susceptibility to cefodizime was determined with both MIC (microdilution method) and the agar diffusion method (Kirby-Bauer). The Kirby-Bauer method was used to compare the antibiotics. Cefodizime was equivalent in activity to ceftazidime and ceftriaxone and was more active than piperacillin and amoxicillin + clavulanic acid. The activity of gentamicin (where tested) was generally comparable to that of cefodizime; ciprofloxacin had lower percentages of resistance against some species of Enterobacteriaceae and staphylococci.

[Microbiological aspects of antibiotics with immunomodulating action]

Through the introduction of a 7-mercapto-1,3-thiazole chain at position 3' of the dihydrothiazine ring, cefodizime, which is structurally similar to cefotaxime, has acquired a number of remarkable immunomodulatory properties while retaining a potent antimicrobial spectrum of activity. Cefodizime penetrates in fact readily through the bacterial cell wall and interacts with its molecular targets in such a way that at high concentrations cell death and lysis are rapidly induced. Its spectrum of action encompasses the Enterobacteria, Neisseriae, Haemophilus, Moraxella catarrhalis, methicillin-susceptible staphylococci and streptococci, with pneumococci included. Cefodizime is devoid of useful potency against Pseudomonas, Acinetobacter and enterococci. Given the wide occurrence of strains synthesizing beta-lactamases in several primary pathogens of community-acquired and nosocomial infections, the complete stability of cefodizime towards the most prevalent of these hydrolytic enzymes (TEM-1, TEM-2, SHV-1, BRO-1 and the staphylococcal penicillinases) seems reassuring. Only a few chromosomally-coded and extended spectrum beta-lactamases produced by gram-negative microorganisms inactivate the new cephalosporin. Since the distribution of pathogens carrying these enzymes depends on the local trends of antibacterial consumption and cannot be easily predicted, a large multicenter study in Italy has recently assessed the antibacterial potency of cefodizime, in comparison with suitable drugs, on 1985 selected nosocomial strains. In this survey cefodizime was more effective in vitro than amoxicillin-clavulanate, gentamicin and piperacillin while being substantially similar in the rates of eradication of gram-negative and gram-positive organisms to other third generation cephalosporins like ceftazidime and ceftriaxone.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative study of a whole-cell pertussis vaccine and a recombinant acellular pertussis vaccine. The Italian Multicenter Group for the Study of Recombinant Acellular Pertussis Vaccine

The safety and immunogenicity of an acellular pertussis vaccine containing the genetically detoxified pertussis toxin PT-9K/129G, filamentous hemagglutinin, and pertactin, together with diphtheria and tetanus toxoids, were compared with those of a whole-cell pertussis component-diphtheria-tetanus vaccine. Four hundred eighty infants were enrolled into this prospective, multicenter, double-blind study. Each infant was randomly given three doses of one of the two vaccines at 2, 4, and 6 months of age. Both local and systemic adverse reactions, reported within 48 hours and 7 days of each injection, were less frequent after the acellular vaccine than after the whole-cell vaccine. The enzyme-linked immunosorbent assay titers to pertussis toxin, filamentous hemagglutinin, and pertactin, as well as the pertussis toxin-neutralizing titer measured by the Chinese hamster ovary cell assay, were significantly higher after the acellular vaccine was given. Both vaccines induced adequate levels of anti-diphtheria and anti-tetanus antibodies. We conclude that the recombinant acellular pertussis vaccine produces fewer reactions than the whole-cell vaccine and provides a high antibody response against the antigens of Bordetella pertussis involved in bacterial adhesion and systemic toxic effects.

Comparative in-vitro activity of piperacillin and piperacillin plus tazobactam towards beta-lactamase producing clinical isolates

The authors evaluated the in-vitro antibacterial activity of piperacillin alone and of piperacillin combined with tazobactam, a new beta-lactamase inhibitor, on 398 clinical isolates, both Gram-positive and Gram-negative. The piperacillin/tazobactam combination was evaluated in the fixed ratio 8:1. The vast majority of the microorganisms tested had reduced susceptibility to piperacillin (minimum inhibitory concentration (MIC) range 0.12- greater than 256 mg/l) due to beta-lactamase production. The following results were obtained: against Haemophilus influenzae, tazobactam was effective in reducing the MICs of piperacillin by 512 fold. The activity of piperacillin/tazobactam was lower against Pseudomonas sp., while some activity was demonstrated against some strains of Klebsiella. Good activity was seen not only against methicillin-susceptible (MS) staphylococci but also against some methicillin-resistant (MR) strains. In the latter, the combination of piperacillin/tazobactam was active only if the strains showed beta-lactamase production. These findings are interesting above all in regard to the synergistic effect demonstrated against MR beta-lactamase producing staphylococci and the Klebsiella-Enterobacter-Serratia (KES) group.

Circulation in Italy of beta-lactamase-producing strains within the major groups of bacterial pathogens

A multicenter study was undertaken in Italy to assess the circulation of beta-lactamase-producing organisms and their current incidence within the major groups of bacterial pathogens. Almost four thousand strains, all freshly isolated from clinical material, were examined at four centers serving different areas of Italy. Despite some significant center-to-center differences, this survey documented the occurrence of a large overall circulation of beta-lactamase-producing organisms among clinical bacterial isolates. In particular, ampicillin resistance was recorded in one third to one half of the isolates of some Enterobacteriaceae, including Escherichia coli, Proteus, and Citrobacter species, and 80-90% of these resistant strains proved to be beta-lactamase producers. Both ampicillin resistance and beta-lactamase production were almost the rule in other Enterobacteriaceae, including Klebsiella, Enterobacter, and Serratia species. beta-lactamase was also produced by about 80% of glucose-non-fermenting gram-negative bacteria and Aeromonas hydrophila strains, by all of the isolates of Branhamella catarrhalis manifesting ampicillin resistance (i.e. more than half the total number of isolates), and by about two thirds of the ampicillin-resistant Haemophilus strains (which accounted for 20-25% of all Haemophilus isolates examined). In contrast, no beta-lactamase producers were observed among Neisseria gonorrhoeae isolates.

Hepatitis A virus infection in children in Sardinia, Italy

The prevalence of antibody to hepatitis A virus (anti-HAV) in a sample of 1662 Sardinian children aged 3 to 11 years was estimated by ELISA. The overall anti-HAV prevalence was 3.8 per cent; it increased from zero among children of 3 to 7.2 per cent in children of 11 years. A slight male predominance was observed (4 versus 3.6 per cent). Anti-HAV prevalence was inversely related to the number of years of education received by the father and positively related to the number of households in the sample. Children whose fathers had received less than six years of schooling, had a 6.2-fold risk (Cl 95 per cent = 2.6-15.3) and children with five or more households under one roof had a 2.6-fold risk (Cl 95 per cent = 1.4-5.0) of previous exposure to hepatitis A virus (HAV) infection. These findings suggest that exposure of Sardinian children to hepatitis A virus is relatively low, probably because of improvements in socioeconomic conditions in recent years in the island. However, overcrowding and poor education in the father of schooling appear to be important determinants of infection.

Hepatitis B virus infection in children in Sardinia, Italy

Possible hepatitis B immunization of all newborns, regardless of the mother's HBsAg status, is a strategy under consideration for selected hyperendemic areas in Italy. Sardinia is one such area. However, in 1987 in Sardinia, the prevalence of hepatitis B markers in children under 11 years was estimated at 1.7% and the prevalence of hepatitis B surface antigen (HBsAg) at 0.2%. A much higher prevalence of HBsAg was recently observed among adults in this area: 8.7% among men and 5.2% among pregnant women. This contrasting pattern is unlikely to be due to bias: the sampling procedures adopted were appropriate and the percentage of refusals was very low (2.2%). The observed low hepatitis B marker prevalence in young age groups might be the result of a cohort effect due to the improved socio-economic conditions and changes in behaviour that have occurred in Sardinia over the last few years. The finding of only 3 HBsAg+ individuals out of 1,826 children tested, in spite of the 5.2% HBsAg prevalence among pregnant women in that region, is probably attributable to the low proportion of HBeAg positive individuals among the HBsAg+ carrier mothers in this area. At present, immunization of all newborns in Sardinia cannot be recommended.

Efficacy of hepatitis B immunization with reduced intradermal doses

Intradermally (I.D.) administered reduced doses of HB-Vax and Hevac-B were tested against the standard protocols for administering these two vaccines. Immunogenicity, efficacy and possible side effects were evaluated. Four-hundred-sixty-two healthy subjects were vaccinated as follows: Fifty-two subjects received HB-Vax and 99 Hevac B according to the standard regimens. The remaining subjects received 3 I.D. injections in the deltoid region at one-month intervals in the following doses: 165 subjects with 2 micrograms doses of HB-Vax, 118 subjects with 1 microgram doses of Hevac-B and 28 subjects with 0.5 micrograms (minimal) doses of Hevac-B. Post-vaccination tests (anti-HBs titres and other serological markers for HBV) were to be performed 30, 60, 90, 180, 270 and 360 days after the first injections. Side effects seen with the experimental protocols were acceptable and limited to local reactions. It was found that, on the whole, reduced I.D. doses of both vaccines produced very high immune responses showing a consistently greater efficacy than those of the standard protocols, though the differences were not always statistically significant. Ninety days after the first injections, 80.8% and 82.7% of subjects vaccinated with reduced I.D. doses of HB-Vax showed seroconversion as opposed to only 62.0% of those receiving standard protocol HB-Vax. Seroconversion rates at 90 days in subjects receiving reduced I.D. doses of Hevac-B were 92.0% and 87.9% and for those receiving the minimal doses of this vaccine, 94.1%. The rate of seroconversion obtained with standard administration of Hevac-B was 83.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Infections of Salmonella in Sassari (Sardinia, Italy). Epidemiology from 1973 to 1976 (author's transl)]

The epidemiology of Salmonella infections in Sassari in the last four years was reported. The remarkable increase of gastroenteritis caused by uncommon Salmonella and by S. wien in 1975 and 1976 was point out: about all cases were related with 3 epidemic episodes in hospitalized patients that were notified as paratyphoid cases in 91% and as infancy's gastroenteritis in 9%. The 201 strains of Salmonella isolated from June 1975 to May 1976 belong for 91% to group B (for 80,5% to S. wien), for 2% to group C1, for 1,5% to group C2, for 5% to group D1 and for 0,5% to group E4. The hypothesis on introduction of S. wien in Sardinia were examined; the rules for limitation of Salmonella diffusion and for prevention of the endemicity of new imported strains, were examined.

[Incidence of Australia antigen (HBs Ag) in a group of apparently healthy population of the Sassari province]

In 3828 subjects (1489 males and 2339 females) apparently healthy was investigated the presence in the serum of Australia antigen and of corrispondent antibody with electrosyneresis, the activity of the G6PD eritrocytic and the eventual condition of carrier of microcytemic tare. An incidence of HBs Ag of 1.83% (2.75% in males and 1.24% in females) without any statistically important differences in the age groups and habitual residence and also the grade of G6PD eritrocytary activity was detected. A more elevated statistical incidence was observed among the carriers of thalassemic caracter never transfused. The anti HBs Ag antibodes were observed in 0.26% of the examined subjects.