18 research outputs found
Mold contamination in a controlled hospital environment: a 3-year surveillance in southern Italy.
No full textBackground: Environmental monitoring of airborne filamentous fungi is necessary to reduce fungal concentrations
in operating theaters and in controlled environments, and to prevent infections. The present study reports results of
a surveillance of filamentous fungi carried out on samples from air and surfaces in operating theaters and
controlled environments in an Italian university hospital.
Methods: Sampling was performed between January 2010 and December 2012 in 32 operating theaters and five
departments with high-risk patients. Indoor air specimens were sampled using a microbiological air sampler; Rodac
contact plates were used for surface sampling. Fungal isolates were identified at the level of genera and species.
Results: Sixty-one samples (61/465; 13.1%) were positive for molds, with 18 from controlled environments (18/81;
22.2%) and 43 (43/384; 11.2%) from operating theaters. The highest air fungal load (AFL, colony-forming units per
cubic meter [CFU/m3]) was recorded in the ophthalmology operating theater, while the pediatric onco-hematology
ward had the highest AFL among the wards (47 CFU/m3). The most common fungi identified from culture of air
specimens were Aspergillus spp. (91.8%), Penicillium spp., (6%) and Paecilomyces spp. (1.5%). During the study period,
a statistically significant increase in CFU over time was recorded in air-controlled environments (p = 0.043), while
the increase in AFL in operating theaters was not statistically significant (p = 0.145). Molds were found in 29.1% of
samples obtained from surfaces. Aspergillus fumigatus was the most commonly isolated (68.5%).
Conclusions: Our findings will form the basis for action aimed at improving the air and surface quality of these
special wards. The lack of any genetic analysis prevented any correlation of fungal environmental contamination
with onset of fungal infection, an analysis that will be undertaken in a prospective study in patients admitted to
the same hospital
Gut Microbiota Features in Young Children with Autism Spectrum Disorders. [*Coretti L. corresponding author]
No full textProliferation and/or depletion of clusters of specific bacteria regulate intestinal functions and may interfere with neuro-immune communication and behavior in patients with autism spectrum disorder (ASD). Consistently, qualitative and quantitative alteration of bacterial metabolites may functionally affect ASD pathophysiology. Up to date, age-restricted cohort studies, that may potentially help to identify specific microbial signatures in ASD, are lacking. We investigated the gut microbiota (GM) structure and fecal short chain fatty acids (SCFAs) levels in a cohort of young children (2-4 years of age) with ASD, with respect to age-matched neurotypical healthy controls. Strong increase of Bacteroidetes and Proteobacteria and decrease of Actinobacteria was observed in these patients. Among the 91 OTUs whose relative abundance was altered in ASD patients, we observed a striking depletion of Bifidobacterium longum, one of the dominant bacteria in infant GM and, conversely, an increase of Faecalibacterium prausnitzii, a late colonizer of healthy human gut and a major butyrate producer. High levels of F. prausnitzii were associated to increase of fecal butyrate levels within normal range, and over representation of KEGG functions related to butyrate production in ASD patients. Here we report unbalance of GM structure with a shift in colonization by gut beneficial bacterial species in ASD patients as off early childhood
Susceptibility to echinocandins of Candida spp. strains isolated in Italy assessed by European Committee for Antimicrobial Susceptibility Testing and Clinical Laboratory Standards Institute broth microdilution methods
No full textBackground: The echinocandins are recommended as first-line therapy for Candida species infections, but drug resistance, especially among Candida glabrata, is becoming more frequent. We investigated the antifungal susceptibility of anidulafungin, caspofungin, and micafungin against 584 isolates of Candida spp. (bloodstream, other sterile sites) collected from patients admitted to an Italian university hospital between 2000 and 2013. The susceptibility was evaluated using the broth microdilution method according to both the European Committee for Antimicrobial Susceptibility Testing (EUCAST EDef 7.2) and the Clinical Laboratory Standards Institute (CLSI M27-A3). The echinocandin susceptibilities were assessed on the basis of the species-specific clinical breakpoints proposed by the EUCAST version 6.1 and CLSI M27-S4 documents. The two methods were comparable by assessing essential agreement (EA), categorical agreement (CA), and Spearman's correlation analysis (rho, r).
Results: The modal minimum inhibitory concentrations (MICs; mu g . mL(-1)) values by both methods (EUCAST/CLSI) for anidulafungin, caspofungin, and micafungin for each species were, respectively, as follows: C. albicans, 0.03/0.12, 0.016/0.5, and 0.016/0.008; C. parapsilosis complex, 2/1, 2/2, and 2/1; C. tropicalis, 0.06/0.12, 0.06/0.12, and 0.06/0.12; C. glabrata complex, 0.03/0.25, 0.06/0.12, and 0.03/0.06; C. guilliermondii, 2/1, 2/2, and 2/2; and C. krusei, 0.06/0.12, 0.12/0.5, and 0.06/0.12. The overall resistance rates for EUCAST/CLSI were as follows: anidulafungin, 2.5/0.9 %; caspofungin, breakpoint not available/3.8 %; micafungin, 2.7/1.5 %.
Candida glabrata complex was the least susceptible to all three echinocandins, and the percentages of resistant isolates by EUCAST/CLSI were as follows: anidulafungin, 13.5/2.7 %; caspofungin, breakpoint not available/16.2 %; micafungin, 18.9/13.5 %. The overall EA was 93 % for micafungin, 92 % for anidulafungin, and 90 % for caspofungin. The CA was >90 % for all organism-drug combinations with the exception of C. glabrata and anidulafungin (89 %). Spearman's rho for EUCAST/CLSI was 0.89 (p < 0.001) for caspofungin, 0.85 (p < 0.001) for anidulafungin, and 0.83 for micafungin (p < 0.001).
Conclusions: Independent of the procedure applied, no alarming resistance to the tested agents was found, although a reduced susceptibility was detected for C. glabrata complex. The EUCAST and CLSI methods produce similar MICs, indicating that using one method or the other should not result in susceptibilities different enough to affect treatment decisions
Investigating the generalizability of Economic Evaluations conducted in Italy: a critical review
No full textbstract: Aim. To assess the methodological quality of Italian HEEs and their generalizability or
transferability to different settings.
Methods. A literature search was performed on Pubmed search engine to identify trial-based, non-
experimental prospective studies or model-based full economic evaluations, carried out in Italy from
1995 to 2013. The studies were randomly assigned to four reviewers who applied a detailed checklist
to assess the generalizability and the quality of reporting. The review process followed a three-step
blinded procedure. The reviewers who carried out the data extraction were blind as to the name of the
author(s) of each study. Second, after the first review, articles were re-assigned through a second blind
randomization to a second reviewer. Finally, any disagreement between the first two reviews was
solved by a senior researcher.
Results. One-hundred fifty-one economic evaluations eventually met the inclusion criteria. Over time,
we observed an increasing transparency of methods and a greater generalizability of results, along
with a wider and more representative sample in trials and a larger adoption of transition-Markov
models. On the other hand, often context-specific economic evaluations are carried out and not enough
effort is done to assure the transferability of their results to other contexts. In recent studies, Cost-
Effectiveness Analyses and the use of the Incremental Cost-Effectiveness Ratio were preferred.
Conclusion. Despite a quite positive temporal trend, generalizability of results still appears as an
unsolved question, even if some indication of improvement within Italian studies has been observe
Diagnostic performance of 1→3-β-D-Glucan in neonatal and pediatric patients with candidemia
No full textFungal sepsis is one of the major problems in neonatal and pediatric care unit settings. The availability of new diagnostic techniques could allow medical practitioners to rapidly identify septic patients and to improve their outcome. The aim of this study was to evaluate the performance of the 1→3-β-D-glucan (BDG), individually and in comparison with the Candida mannan (CM) antigen, in ten preterm infants and five onco-haematological pediatric patients with Candida bloodstream infections already proven by positive culture. The serum levels of BDG were >80 pg/mL on the same day as a positive blood culture in all examined patients, while CM antigen was negative in the patients with C. parapsilosis fungemia and in one further case due to C. albicans. These results suggest that a regular monitoring of serum circulating antigens (i.e., 1→3-β-D-glucan) combined with other microbiological and clinical information, may allow earlier and accurate diagnosis. However, further studies are necessary to confirm its usefulness in routine clinical practice
Investigating the Generalizability of Economic Evaluations Conducted in Italy: A Critical Review
No full textObjectives To assess the methodological quality of Italian health economic evaluations and their generalizability or transferability to different settings. Methods A literature search was performed on the PubMed search engine to identify trial-based, nonexperimental prospective studies or model-based full economic evaluations carried out in Italy from 1995 to 2013. The studies were randomly assigned to four reviewers who applied a detailed checklist to assess the generalizability and quality of reporting. The review process followed a three-step blinded procedure. The reviewers who carried out the data extraction were blind as to the name of the author(s) of each study. Second, after the first review, articles were reassigned through a second blind randomization to a second reviewer. Finally, any disagreement between the first two reviewers was solved by a senior researcher. Results One hundred fifty-one economic evaluations eventually met the inclusion criteria. Over time, we observed an increasing transparency in methods and a greater generalizability of results, along with a wider and more representative sample in trials and a larger adoption of transition-Markov models. However, often context-specific economic evaluations are carried out and not enough effort is made to ensure the transferability of their results to other contexts. In recent studies, cost-effectiveness analyses and the use of incremental cost-effectiveness ratio were preferred. Conclusions Despite a quite positive temporal trend, generalizability of results still appears as an unsolved question, even if some indication of improvement within Italian studies has been observed
Epidemiology of invasive fungal infections in the intensive care unit: results of a multicenter Italian survey (AURORA Project).
No full textAbstract
Purpose: The aims of this study are to evaluate the epidemiology of invasive fungal infections (IFIs) in patients admitted to an intensive care unit (ICU) in Southern Italy and the in vitro antifungal susceptibility of isolates. Methods: A surveillance program was implemented in 18 ICUs. IFI cases were recorded using a standardized form. Results: A total of 105 episodes of IFIs occurred in 5,561 patients during the 18-month study. The main infections were caused by yeasts, more than filamentous fungi (overall incidence of 16.5 cases per 1,000 admissions and 2.3 cases per 1,000 admissions, respectively). The overall crude mortality rate was high (42.8 %), particularly for mold infections (61.5 %). All yeast infections were Candida bloodstream infections. Over half (59.8 %) were caused by Candida non-albicans, with C. parapsilosis being the most common (61.8 %). In the multivariate model, trauma admission diagnosis, prolonged stay in the ICU, and parenteral nutrition were independently associated with candidemia due to C. parapsilosis [odds ratio (OR) 3.5, (1.8-5.2); OR 3.5, (1.02-3.5); OR 3.6, (1.28-6.99), respectively]. Among mold infections, 12 patients suffered from invasive pulmonary aspergillosis, with Aspergillus fumigatus as the predominant pathogen (41.7 %). One case of brain scedosporiosis was identified. Overall, azoles and echinocandins resistance was uncommon. Conclusions: Candida non-albicans species are the most frequent cause of candidemia in ICU patients. Mold infections are associated with a high mortality rate. This study confirms the importance of the epidemiological surveillance on IFIs in the ICU setting for documenting species distribution and antimicrobial susceptibility patterns to guide therapeutic choices. © 2013 The Author(s)
Candida Colonization Index in Patients Admitted to an ICU
No full textMultiple-site colonization with Candida spp is commonly recognized as a risk factor for invasive fungal infection in critically ill patients. We carried out a study to determine the relationship between Candida colonization and invasive infection in neurological patients admitted to an ICU. At admission (T0) and every three days for two weeks, different samples (pharynx swab, tracheal secretions, stomach contents, etc.) were collected for mycological surveillance. Candida mannan antigen and Candida anti-mannan antibodies were assayed. The Colonization Index (CI) and Corrected Colonization Index were calculated for each time point. Of all patients 70% was already colonized by Candida spp at T0 and six of them had CI ≥0.5. Three patients developed candidemia; they had CI ≥0.5 before infection. Positive values of Candida mannan antigen and anti-mannan antibodies were found only in the patients with candidemia. The sensitivity and specificity of the Candida mannan test were 66.6% and 100%, respectively, while the sensitivity and specificity of the anti-mannan antibody test were 100%. In accordance with other authors, we find the surveillance cultures are useful to monitor the Candida colonization in ICU patients. In addition, the sequential observation of anti-mannan antibodies could contribute to early diagnosis of candidiasis more than Candida mannan antigen in immunocompetent patients
Evolving unilateral thalamic lesion in Phelan–McDermid syndrome: 7-year follow-up MRI and literature review
No full textAbstract Purpose Phelan–McDermid syndrome is a rare genetic disorder caused by Shank3 protein deficiency, resulting from rearrangements of chromosome 22q13.3 in the region containing the SHANK3 gene. Shank proteins serve as pivotal scaffolding proteins in the postsynaptic density of excitatory synapses in the mammalian brain. Clinical features of Phelan–McDermid syndrome include global developmental delay, hypotonia, impaired language, dysmorphic features, sleep disturbances, and epileptic seizures. Brain magnetic resonance imaging (MRI) findings are typically limited and nonspecific. To our knowledge, no previous report has described an evolving unilateral thalamic focal lesion, its biopsy, and concomitant white matter changes as demonstrated by diffusion tensor imaging (DTI). Methods A 7-year clinical and MRI follow-up was conducted. At age 5, the patient exhibited emerging symptoms, including attention deficit and language impairment, prompting an array-comparative genomic hybridization analysis. MRI examinations included standard morphological sequences as well as advanced techniques such as DTI, spectroscopy, dynamic contrast enhancement, and dynamic susceptibility contrast perfusion imaging. A biopsy of the lesion was performed, and fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) of various brain structures were analyzed. Results Magnetic resonance spectroscopy revealed alterations in the ratios of choline/creatine, myo-inositol/creatine, and N-acetylaspartate/creatine in the evolving right thalamic lesion. Significant differences in DTI parameters were observed only in the right posterior thalamic radiation. Histopathological analysis of the biopsy did not demonstrate any malignant cellular elements. Conclusions In Phelan–McDermid syndrome, a unilateral, evolving focal thalamic lesion has not been previously described. Effective management of this condition necessitates comprehensive data collection to gain unique insights into this complex and rare syndrome
