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Objective: To provide the first Italian data on pathogens causing early-onset sepsis (EOS) and their antimicrobial susceptibility, after the successfully prevention of Group B streptococcus (GBS) EOS. Methods: Retrospective area-based cohort study from Emilia-Romagna (Italy). Cases of EOS registered (from 2009 to 2012) in all gestational age neonates were reviewed. Results: Live births (LB) numbered 146 682. Ninety neonates had EOS and 12 died (incidence rates of 0.61 and 0.08/1000 LB, respectively). EOS and mortality were the highest among neonates with a birth weight n = 27, 0.18/1000 LB) and Escherichia coli (n = 19, 0.13/1000 LB). Most infants affected by E. coli EOS were born preterm (n = 13), had complications (n = 4) or died (n = 7). Among 90 isolates tested, only 3 were resistant to both first line empirical antibiotics. Multivariate logistic regression analysis showed that low gestational age, caesarean section and low platelet count at presentation were significantly associated with death or brain lesions (area under ROC curve = 0.939, H-L = 0.944, sensitivity 76.0%, specificity 90.7%). Conclusions: GBS slightly exceeds E. coli as a cause of EOS. However, E. coli is the prominent cause of death, complications and in most cases affects preterm neonates. Empirical antimicrobial therapy of EOS seems appropriate.

Pulse wave velocity (PWV) and pulse pressure amplification (PPA) are independent predictors of cardiovascular risk, mainly in the elderly. The aim of the current research was to determine the influence of PPA and PWV, both manifestations of arterial stiffness, on heart disease in the elderly.The study population consisted of 1042 participants (814 women) aged 80 years and over who participated in the PARTAGE study. Carotid-femoral PWV was determined in order to assess aortic stiffness. Central aortic blood pressure values and central pulse wave analysis were obtained using the calibration method applied on the common carotid artery by a PulsePen tonometer. Amplification phenomenon was expressed as PPA, that is, the percentage of increase of pulse pressure in the brachial artery relative to central pulse pressure. Heart disease was defined as presence of heart failure, ischemic heart disease or atrial fibrillation.PPA was significantly lower in patients with heart disease, independently of the presence of hypertension, diabetes or both. Heart disease was present in 61.8% of participants with PPA less than 10%, in 46.2% of participants with PPA between 10 and 20% (P0.01), in 42.6% of participants with PPA between 20 and 30% (P0.005) and in 32.5% of participants with PPA more than 30% (P0.001). PWV, on the contrary, was not influenced by the presence of heart disease (12.3 ± 4.0 vs. 13.5 ± 4.6 m/s) but significantly increased in presence of hypertension (14.4 ± 5.0 m/s, P0.001) or diabetes (16.1 ± 5.1 m/s, P0.001).In the very elderly, low brachial/aortic PPA is associated with higher prevalence of heart disease.

In most children, coronavirus disease 2019 (COVID-19) is a mild or moderate disease. Moreover, in a relevant number of cases, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains totally asymptomatic. All these findings seem to suggest that otherwise healthy children with suspected COVID-19 might be managed in the community in most cases, thus avoiding hospital admission and closely related medical, social and economic problems, including overwhelming hospitals. Unfortunately, home management of children with suspected COVID-19 rarely occurs, and many children with suspected or laboratory-confirmed SARS-CoV-2 infection are frequently hospitalized irrespective of the severity of disease. To evaluate the role of community health houses (CHHs) in the management of children with COVID-19, 1,009 children with suspected SARS-CoV-2 infection were studied in Emilia-Romagna Region, Italy. Among them, 194 (19.2%) resulted positive for SARS-CoV-2. The majority (583, 58%) were tested at home by CHHs, while 426 (42%) were brought to the hospital for testing. The patients who were managed in the hospital had a significantly lower median age than those who were managed at home (2 vs. 12 years, p < 0.001). Exposure to SARS-CoV-2 cases within the family was significantly more frequent among those who were managed at home (82 vs. 46%, p < 0.05). The clinical findings were similar between the children who were managed at home and those who were managed in the hospital. Only one of the children managed at home (0.7%) required hospitalization; in comparison, 26 (48%) of those whose swab samples were taken at the hospital were hospitalized. Our research shows for the first time the importance of CHHs in the management of COVID-19 in children; because of the high frequency of mild to moderate cases, management by CHHs can reduce the care load in hospitals, providing enormous advantages on the familial, medical, social, and economic levels. These findings could be useful for suggesting a territorial rather than hospital-based strategy in pediatrics in the case of a new wave of the epidemic.