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Abstract Quantification of antibiotic utilization is an essential component of antibiotic stewardship programs. In this multicentric study, we used different metrics to evaluate inpatient antibiotic use in children. The study objectives were to describe point prevalence of antibiotic use by indication and patient characteristics, to evaluate DOTs, LOTs and PDDs, and to compare PDDs to DDDs, which assume average maintenance dose per day in adults. All children hospitalized on the days of the study were included. Trained personnel collected demographic and clinical data from patients’ clinical records. We recorded information about antibiotics administered on the date of data collection, and in the previous 30 days of hospitalization. Of 810 patients, 380 (46.9%; CI 95%: 43.4–50.4) received one or more antibiotics; prevalence of use was 27.0% for prophylaxis (219/810), and 20.7% (168/810) for treatment. Overall, 587 drugs were issued to the 380 patients receiving antibiotics (1.5 antibiotic per patient). When considering treatments, DOT and LOT per 100 patient-days were 30.5 and 19.1, respectively, resulting in a DOT/LOT ratio of 1.6. PDDs increased with age and approached DDDs only in children aged ≥ 10 years; the ratio between PDDs estimated in children aged ≥ 10 years and in 0–11 month-old infants ranged from 2 for sulfamethoxazole and trimethoprim, to 25 for meropenem. Our results confirm that DOT, LOT and PDD are better alternatives to DDD in children.

Legionnaire’s disease is a life threatening respiratory tract infection that is commonly associated with a stay in communal accommodations such as hotels, hostels, guesthouses and camping sites. In the European Alps and some other areas of the world mountain refuges and huts can sometimes accommodate over 100 guests in almost hotel like comfort. Such a “hut” may have cramped dormitories with multi-occupancy bunks and a basic water supply system possibly with hot water. Some will have showers. The water supply may be limited by the environment. As such these may pose a high risk for transmission of Legionellosis. In an environment of a hut which is more difficult to control than others. Unfortunately countries differ in their guidelines for the prevention of Legionnaire’s disease transmission within tourist accommodation. The aim of this paper is to propose a set of simple and pragmatic rules that can prevent the development of Legionella infections in mountain huts and other accommodations situated in the wilderness environment.

Background Italy records very alarming levels antimicrobial resistance (AMR), so a National Action Plan on Antimicrobial resistance (PNCAR) was developed, adopting the AMR European Union’s recommendations based on the results of the ECDC site visit of January 2017. For achieving PNCAR objectives, it is necessary to support and harmonize the implementation of recommendations in all the different healthcare levels (regional authorities and local trusts), so the SPiNCAR project was launched to create a tool for reaching this goal. Methods We developed a framework based on a scientific literature and national and international guidelines. Firstly, we identified the major intervention areas for tackling AMR, then, for each area, we built a set of standards, both for regional authorities than for local trusts. Every standard is composed by a set of essential and additional criteria, which refer to a minimum or supplemental performance level respectively. The contents were firstly discussed by the project’s team during face-to-face kick-off meetings, then confirmed with Delphi methodology and finally validated through a pilot study. Results The final framework consists of seven different areas that reflect the PNCAR structure: Governance, Surveillance and Monitoring, Appropriate Use of antimicrobials, Healthcare-associated Infections (HAIs) control and prevention, Education and Training, Alliance among Stakeholders, Implementation. The total number of standards for the regional framework was 34 with 264 criteria and for the local version 36 criteria with 279 standards. Conclusion The ongoing use of this tool, developed on international evidences and recommendations that were tailored on the Italian specific context, allows monitoring the improvement achieved over time and plan the next steps.

Introduction: Human papillomavirus infection (HPV) affects 70–80% of female population throughout the lifetime, exposing them to the risk of developing genital warts and cervical cancer. Despite these correlated risks and the demonstrated efficacy of the vaccine, coverage rates for two-three doses are around 70% in Italy and 67% in Piemonte (below the expected 95%). Aim of the study is to investigate whether this situation is due to a lack of information and awareness among young adults. Results: Students showed increased knowledge after the intervention and more than 90% found the 3 informative materials as sources of useful information. After the intervention students would strongly recommend HPV vaccination (OR = 3.45; p

Background: Rotavirus-induced gastroenteritis (RVGE) represents the most frequent form of severe gastroenteritis in children. In such a scenario, the availability of an efficient anti-Rotavirus (anti-RV) vaccine represents an effective prevention tool able to prevent those complications mainly linked to the moderate-severe forms of this disease, which require hospital care. The aim of the present study is to estimate the cost effectiveness of universal routine infant RV vaccination program and its budget impact on the Regional Health Service (RHS) of Piedmont, Italy, in order to evaluate the opportunity of the implementation of a national anti-Rotavirus vaccination programme. Methods: The researchers performed a cost-effectiveness analysis comparing costs and benefits of a Rotarix two-dose vaccination versus non vaccination and a budget impact analysis (BIA), complementary to the cost-effectiveness analysis. Results: Our results show that the mass implementation of an anti-RV vaccination in Piedmont, in addition to the expected public health benefits, also allows the RHS to save a considerable amount of money within a short period of time, due to the remarkable reduction of direct health costs associated with RVGE management. In fact, as the analysis shows, a universal vaccination against RV results in money-saving for the RHS already from the 2nd year (with a vaccination coverage of 50%). During the five year period, the active and free offer of the anti-RV vaccination would determine a total saving for RHS of about € 503.000. The cost-effectiveness analysis results showed a cost-saving ICER (incremental cost-effectiveness ratio) relevant to the RHS and equal to – €12.197/QALY. Conclusion: In conclusion the adoption of a universal preventive strategy for all the infants in the Piedmont Region may contribute significantly towards the control of RVGE incidence, thus allowing a noteworthy saving of economic and social resources for both the RHS and the general public. Keywords: Rotavirus, Cost-effectiveness, Economic analysis, Burden of disease, Vaccine

Background/Aims The microbiological surveillance of endoscopes and automated flexible endoscope reprocessing have been proven to be two of the most difficult and controversial areas of infection control in endoscopy. The purpose of this study was to standardize a sampling method for assessing the effectiveness of standard reprocessing operating procedures for flexible fiberoptic laryngoscopes (FFLs). Methods First, the sampling devices were directly inoculated with Bacillus atrophaeus spores; second, tissue non tissue (TNT) wipes were tested on artificially contaminated surfaces and on FFLs. Results Comparison of the sponges, cellulose, and TNT wipes indicated that the TNT wipes were more effective in releasing spores (93%) than the sponges (49%) and cellulose wipes (52%). The developed protocol provides a high efficiency for both collection and extraction from the stainless steel surface (87% of the spores were removed and released) and from the FFL (85% of the spores were removed and released), with relatively low standard deviations for recovery efficiency, particularly for the analysis of the FFL. Conclusions TNT wipes are more efficient for sampling surface areas, thereby aiding in the accuracy and reproducibility of environmental surveillance.