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Drug-resistant derivatives of serovar-specific virulence plasmids, such as pSLT, in clinically-relevant Salmonella enterica serovar Typhimurium strains, represent a threat for human health. We have analysed 14 S. Typhimurium isolates recovered in Italy and the United Kingdom from swine and from cases of human infection for the presence of virulence-resistance (VR) plasmids. They were negative for the multidrug resistance (MDR) region of the Salmonella genomic island 1 (SGI1), but expressed resistance to ampicillin, chloramphenicol, streptomycin/ spectinomycin, sulfamethoxazole, and tetracyclines. The isolates were characterised by XbaI pulsed-field gel electrophoresis, multilocus sequence typing, and detection of resistance and virulence determinants (PCR/ sequencing). Identification of VR plasmids was accomplished by PCR detection of bla genes (encoding ampicillin resistance), class 1 integrons and the pSLT virulence gene spvC. Plasmid analyses were performed by alkaline lysis, S1-nuclease digestion, replicon typing, conjugation, restriction analyses, and Southern blot/hybridization. Two blaOXA-1 positive isolates contained pSLT-derived plasmids related to pUO-StVR2. In nine isolates, eight from swine and one from a patient, MDR-conferring-IncFII-VR plasmids were detected. They contained the blaTEM-1 gene as well as a nonconventional class 1 integron with dfrA12-aadA2 gene cassettes in its variable region, and a sul3 gene in the 3' conserved segment. Restriction analysis suggested a novel pSLT variant. The results obtained underline the role of swine as a potential reservoir for the blaTEM-1-IncFII-plasmids. The occurrence and spread of virulence- and MDR-conferring plasmids should be considered as a potential public health problem. [ABSTRACT FROM AUTHOR]

Campylobacter spp. is the most common gastrointestinal pathogen worldwide with a very low reported incidence in Italy. In November of 2013, local and national public health authorities investigated an outbreak caused by Campylobacter jejuni among children in a kindergarten in Northern Italy. A case was defined as a child who had diarrhea with a laboratory-confirmed diagnosis of C. jejuni between 11 and 30 November. Stool samples from the kindergarten kitchen staff and environmental samples from the kitchen were examined for enteric pathogens. As food leftovers were not available, the menu logbook of the refectory was reviewed to identify a possible source of the outbreak. C. jejuni strains were tested for antimicrobial susceptibility and subtyped by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). We identified 20 cases among 247 schoolchildren (attack rate = 8%), all who reported having lunch in the kindergarten. The stools from the kitchen staff as well as the environmental samples were negative for enteric pathogens. The identified outbreak strains (n = 5) were sensitive to all of the antimicrobials tested; the first four strains showed an identical PFGE profile, whereas the fifth strain showed a PFGE pattern similarity of 89%. Using MLST, all five strains were assigned to a single sequence type (ST), ST451 (clonal complex, CC21); this was the first identification of ST and the third reported outbreak of C. jejuni in Italy. Molecular typing confirmed that most of the cases belonged to a clonal cluster supporting the hypothesis of a common source; however, the source was not identified. Due to a delayed start of the investigation, it was not possible to perform any microbiological evaluation of the food consumed.

Monophasic variant of Salmonella enterica subspecies enterica serovar Typhimurium (monophasic S. Typhimurium), with antigenic structure 1,4,[5],12:i:-, appears to be of increasing importance in Europe. In Italy, monophasic S. Typhimurium represented the third most frequent Salmonella serovar isolated from human cases between 2004 and 2008. From June 2013 to October 2014, a total of 206 human cases of salmonellosis were identified in Abruzzo region (Central Italy). Obtained clinical isolates characterised showed S. Typhimurium 1,4,[5],12:i:- with sole resistance to nalidixic acid, which had never been observed in Italy in monophasic S. Typhimurium, neither in humans nor in animals or foods. Epidemiological, microbiological and environmental investigations were conducted to try to identify the outbreak source. Cases were interviewed using a standardised questionnaire and microbiological tests were performed on human as well as environmental samples, including samples from fruit and vegetables, pigs, and surface water. Investigation results did not identify the final vehicle of human infection, although a link between the human cases and the contamination of irrigation water channels was suggested.

Salmonella enterica serovar Napoli is an emerging serovar in Italy, France, and Switzerland, but little is known about its pathogenicity to humans. A collection of 112 strains of Salmonella Napoli isolated in Italy from human cases, foods of animal origin, and the environment have been characterized by the detection of a set of virulence genes, pulsed-field gel electrophoresis (PFGE), and antibiotic susceptibility. All the strains examined were susceptible to all the antimicrobials tested. The Salmonella pathogenicity islands genes ssaQ, mgtC spi_4D, and sopB were present from 75.0% to 100% of the tested strains. Only one human and four environmental strains showed the avrA gene. The phage-related sopE1 gene was present in 93% of the strains, whereas sodC1 and gipA genes were only in four and two environmental strains, respectively. The bcfC fimbrial gene was present in all the animal/food strains, in the 71.4% of environmental strains, and in 46.8% of the human strains, respectively. Overall, we observed 10 distinct virulence profiles (VP), but VP1-2-3 included 99 out of 112 strains. PFGE showed that 103 out of 111 isolates were grouped in four major clusters and three minor clusters, whereas two strains were totally unrelated. The most represented PFGE clusters mainly correlated with the virulotypes are VP1, VP2, and VP3. Salmonella Napoli shows an array of virulence genes similar to other serovars considered of public health importance and confirming its capability to cause infection in human. Concerning possible source of infection or reservoirs, the results did not point out any, but our hypothesis is that the environment can act as the main reservoir for Salmonella Napoli, and from there it can spill over to animals and humans. Further studies are needed to increase the knowledge on the ecology of Salmonella Napoli serovar and on the main risk factors for human infection.

A qnrB19 gene variant, carried by an IncL/M-like plasmid, was detected in a multidrug Salmonella enterica serovar Typhimurium human strain with reduced susceptibility to ciprofloxacin. The genetic environment around the gene was fully sequenced (20 kb). A large gene cluster, containing the aph, qnrB19, and blaSHV-12-like resistance genes, is inserted inside a Tn3 transposon.

Salmonella enterica serovar Typhimurium (STM) represents the prevalent cause of foodborne gastroenteritis in Italy with the majority of isolates exhibiting multidrug resistance. A resistant pattern that includes ampicillin (A), streptomycin (S), sulfonamide (Su), and tetracycline (T) (ASSuT) but lacks resistance to chloramphenicol (C) has recently emerged in Italy among strains of STM and of its monophasic variant, S. enterica subspecies enterica serovar S. 4,[5],12:i:-. With the aim to evaluate their clonal relationships, 553 strains of STM and S. 4,[5],12:i:- with the ASSuT and ACSSuT resistance patterns isolated in Italy from human infections between 2003 and 2006 were characterized by pulsed-field gel electrophoresis (PFGE) according to the PulseNet-Europe protocol and nomenclature. Among both the STM and S. 4,[5],12:i:- ASSuT strains, the predominant PFGE profile was STYMXB.0079 (53.2-73.0% of strains, respectively), while the STM ACSSuT strains belonged to the STYMXB.0061 (37.2% of strains) and STYMXB.0067 (29.9% of strains). Bionumerics cluster analysis of the nonunique PFGE profiles showed that more than 90% of ASSuT and ACSSuT-resistant strains were included in two distinct clusters with a genetic homology of 73% each other, suggesting that the ASSuT-resistant strains belong to a same clonal lineage different from that of the ACSSuT strains. Phage typing showed that 23% of the ASSuT STM strains were not typeable and 22.3% were U302. The same phage types were observed among the ASSuT strains of S. 4,[5],12:i:-. A different figure was observed for the ACSSuT strains: the STM isolates mostly belonged to DT104 (70.2%), while none of the S. 4,[5],12:i:- strains belonged to this phage type. This study indicates that the tetra-resistant ASSuT strains of STM and S. 4,[5],12:i:-, increasingly isolated in Italy, belong to a same clonal lineage and that the S. 4,[5],12:i:- strains circulating in our country mainly derive from this STM clonal lineage.

Background: Previous studies have suggested that fluoroquinolone-resistant strains of Escherichia coli that infect humans probably emerged as a consequence of using fluoroquinolones in poultry. This study aims to provide further insight into the possible avian origin of fluoroquinolone-resistant extraintestinal pathogenic E. coli (ExPEC) strains that infect humans., Methods: We compared the phylogenetic backgrounds, virulence gene profiles, and genetic relatedness of 125 ExPEC strains recovered from humans (61 were ciprofloxacin susceptible and 64 were ciprofloxacin resistant) and 113 E. coli strains recovered from poultry (47 were ciprofloxacin susceptible and 66 were ciprofloxacin resistant)., Results: Ciprofloxacin-resistant strains of both human and avian origin harbored fewer virulence genes than did ciprofloxacin-susceptible strains, but ciprofloxacin-resistant strains from humans were found to be clearly distinct from ciprofloxacin-resistant avian strains, based on their phylogenetic backgrounds and virulence gene profiles. The phylogenetic background of ciprofloxacin-susceptible and ciprofloxacin-resistant strains of human origin was not different, and no shift from the phylogenetic group B2 toward other groups was detected in association with ciprofloxacin resistance. No genetic relatedness was observed among human and avian strains that belonged to the major virulence profile (traT-iucD-iutA)., Conclusions: Our results did not support the hypothesis of an avian origin for the ciprofloxacin-resistant human ExPEC strains analyzed. Nevertheless, prudent use of fluoroquinolones in both human and veterinary medicine is recommended.

On November 15, 2004, a cluster of three cases of Salmonella Thompson infection was registered by the Norwegian reference laboratory. In the following days further cases occurred, prompting a case-control study among the first 13 cases and 26 matched controls. By December 31, 21 cases had been reported, with the first onset on October 24. Consumption of rucola lettuce (Eruca sativa, also known as rocket salad or arugula) (OR 8,8 [1,2-infinity]) and mixed salad (OR 5,0 [1,0-infinity]) was associated with illness. On November 26, Swedish authorities notified the finding of Salmonella Thompson in rucola lettuce through the EU Rapid Alert System for Food and Feed. Later, several countries reported finding this and other Salmonella serovars and Campylobacter in rucola produced in Italy. In response to our alert through the international Enter-net surveillance network, Sweden and England also reported an increase of cases. Salmonella Thompson isolates from products and patients from several countries showed high similarity by pulsed-field gel electrophoresis, but some isolates showed significant differences. We think that the outbreak in Norway reflected a larger international outbreak caused by rucola imported from one Italian producer. Findings of other pathogens indicate a massive contamination, possibly caused by irrigation with nonpotable water. Rapid international information exchange is invaluable when investigating outbreaks caused by internationally marketed products.

In this study 45 epidemic and sporadic isolates of Acinetobacter baumannii were investigated by antimicrobial resistance, integron identifications and genotyping. Isolates were genotyped by random amplified polymorphism (RAPD) DNA and pulsed-field gel electrophoresis (PFGE). Four different RAPD patterns were observed among the isolates of our collection, further discerned in six PFGE types. Two prevalent genotypes were identified, one corresponding to a carbapenem resistant epidemic clone, causing an outbreak at the intensive care unit of a hospital of Rome. Two class 1 integrons, carrying different gene cassette arrays, were identified among the two prevalent genotypes. Nucleotide analysis of the integron-variable regions revealed the presence of the aacA4, orfO, bla(OXA-20), and aacC1, orfX, orfX', aadA1 gene cassette arrays, respectively. All the carbapenem resistant strains analyzed in this study carried the bla (OXA-58) gene located on plasmids.

We investigated an outbreak of Acinetobacter baumannii in the intensive care unit (ICU) of a hospital in Rome, Italy. The outbreak involved 14 patients whose isolates were most frequently recovered from bronchoalveolar lavage. All isolates were multidrug-resistant and showed diminished susceptibility or resistance to carbapenems. A. baumannii strains with a similar antibiotic susceptibility pattern were isolated from the environment. Pulsed-field gel electrophoresis identified a single clone from both the patients' and environmental isolates. Because of the lack of a single source of infection, the eradication of the epidemic required a broad approach, including contact isolation and cohorting, aggressive environmental disinfection, and close monitoring of the ward staff's performance. Infected patients were successfully treated with combined therapy. Although considered of low virulence, A. baumannii can be particularly aggressive and difficult to treat in ICU patients.

Salmonella enterica subsp. enterica serotype Enteritidis is not readily subtyped beyond the level of phage type (PT). Pulsed field gel electrophoresis (PFGE) is generally acknowledged to be the most discriminating typing method for Salmonella, but only a restricted variety of PFGE types has been described for S. enterica serotype Enteritidis. In the present study, a modification of the SE-AFLP typing method was used to investigate both outbreak and apparently sporadic isolates of S. enterica serotype Enteritidis belonging to different PTs and/or PFGE types. The method proved to be as discriminatory as PFGE when combined with phage typing, and provided subtyping data consistent with epidemiological information. Although the modified SE-AFLP typing method did not prove to achieve a superior discriminatory ability in resolving clusters, it has a high enough throughput for use in outbreak investigations. This method can be used in combination with other typing methods to obtain epidemiologically relevant subtyping data on S. enterica serotype Enteritidis.

In 1994 a cholera epidemic occurred in Italy and Albania after more than a decade of case absence. To investigate genotypic characteristics and the origin of the epidemic strains, 110 Vibrio cholerae O1 El Tor isolates from Italy and Albania were studied by randomly amplified polymorphic DNA analysis (RAPD), BglI ribotyping, and pulsed-field gel electrophoresis (PFGE) of genomic DNA. The Italian and Albanian strains were all ribotype 6 and their RAPD and PFGE patterns were identical as well. These findings indicated that the 1994 isolates belonged to the same clone and that the clone was part of the larger global spread of epidemic ribotype 6 strains, which started in southern Asia in 1990.

Foodborne infections are an important Public Health concern worldwide. Most of the pathogens that play a role in foodborne diseases have a zoonotic origin. The epidemiology of foodborne infections as well as the food production and distribution chains, have remarkably changed during the past ten years. Understanding of how pathogens arrive, persist in animal reservoir or enter the food chain is a crucial step in prevention strategies. These need to be aimed to measure the overall impact of the infections,to identify trends in incidence and to recognise rapidly outbreaks also at transnational level. Enter-Net is an example of an international laboratory based surveillance network which contribute largely to European foodborne zoonosis surveillance.

Gastrointestinal infections represent one of the main cause of morbidity both in developing and industrialized areas. Quality of coastal waters is particularly important for countries as Italy that has several regions on coasts. Public health and economy aspects could be hardly affected by poor quality of sea waters. Several studies have been addressed to the association between sea recreational water and development of gastrointestinal infection but in Italy only sporadic cases of infection have been reported especially in immunocompromised hosts. Results of this study, either in the case control or in the active surveillance study seem to confirm the absence of an association between sea exposure and intestinal infections. One of the main risk factors for the development of these infections is still represented by the seafood consumption especially shellfish.