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In Italy, rifampicin-resistant and MDR-TB were high in foreign-born persons, but decreased from 2009 to 2016

Early institution of effective antibiotic therapy and source control are pivotal to improve survival of abdominal septic patients. Xpert® Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert® Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert® Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdominal drainage fluid for each patient. We included 20 patients for a total of 45 comparisons between the two methods. In our clinical setting, the overall performance of Xpert® Carba-R for detection of carbapenem resistance in the presence of genes detectable and non-detectable by the method was: sensitivity 50% (95% CI 24.6-75.3); specificity 93.1% (95% CI 77.2-99.1); positive predictive value (PPV) 80% (95% CI 44.4-97.5); negative predictive value (NPV) 77.1% (95% CI 56.9-89.6). The inter-rater agreement was 0.47 (SE 0.14; 95% CI 0.20-0.74). When considering the only 5 mechanisms of resistance detected by both methods, the overall diagnostic performance was: sensitivity 100% (95% CI 69.1-100), specificity 94.2 (95% CI 80.8-99.3), PPV 83.3 (95% CI 59.6-97.9) and NPV 100% (95% CI 89.4-100). The inter-rater agreement was 0.88 (SE 0.08; 95% CI 0.71-1). Xpert® Carba-R may be considered an additional diagnostic tool for early diagnosis of carbapenem resistance in abdominal septic patients. Clinicians should be aware of their epidemiology before its introduction in the diagnostic protocol of their intensive care units.

A novel thermal treatment for microorganism inactivation, characterized by a very rapid temperature increase (up to 30C/s) and a low final temperature (up to 65C) maintained for a relatively short holding time, has been recently presented and tested by the authors, showing microbial load reduction greater than 5 log units against several common bacteria and yeasts. With the aim of extending the possible use of the new thermal treatment to a wider microorganisms class, in this work the dynamic irreversible thermoporation (DIT) treatment was further tested on a well-known thermoresistant strain, the Enterococcus hirae: The results of these new experimental tests confirmed the reliability of the process, which allowed to reach the 5 log microbial reduction once the adequate holding time was employed. The comparison with simple immersion in a thermostatic bath, where the very slow heating process with 0.3C/s has been performed, confirmed the crucial role of the thermal shock for the success of the treatment. The inactivation kinetics of E. hirae in isothermal conditions immediately after the application of thermal shock has also been studied. Finally, the morphological analysis performed by using a scanning electron microscope clearly revealed the rupture of the cell membrane, leading to identification of the process called dynamic irreversible thermoporation (DIT).

The Erice Charter was unanimously approved at the conclusion of the 47th Residential Course "Adapted Physical Activity in Sport, Wellness and Fitness: New Challenges for Prevention and Health Promotion", held on 20-24 April 2015 in Erice, Italy, at the "Ettore Majorana" Foundation and Centre for Scientific Culture, and promoted by the International School of Epidemiology and Preventive Medicine "G. D'Alessandro" and the Study Group on Movement Sciences for Health of the Italian Society of Hygiene, Preventive Medicine and Public Health. After an intense discussion the participants identified the main points associated with the relevance of physical activity for Public Health, claiming the pivotal role of the Department of Prevention in coordinating and managing preventive actions. The participants underlined the importance of the physicians specialized in Hygiene, Preventive Medicine and Public Health. The contribution of other operators such as physicians specialized in Sport Medicine was stressed. Further, the holders of the new degree in Human Movement and Sport Sciences were considered fundamental contributors for the performance of physical activity and their presence was seen as a promising opportunity for the Departments of Prevention. Primary prevention based on recreational physical activities should become easily accessible for the population, avoiding obstacles such as certification steps or complex bureaucracy. The Sport Doctor is recognized as the principal referent for preliminary physical evaluation and clinical monitoring in secondary and tertiary prevention actions based on adapted physical activities. Developing research in the field is essential as well as implementing higher education on physical activity management in Schools of Public Health.

to assess the trends of foodborne diseases in respect of the abolition of food handler certification by Italian Regions.

La termoporazione dinamica irreversibile (DIT) consiste in un nuovo tipo di tecnologia di pastorizzazione ideato da Koulik e colleghi basato su un processo termico dinamico, caratterizzato da riscaldamenti molto rapidi (shock termici) a temperature finali non superiori a 70°C. L’obiettivo del nostro studio è stato la valutazione dell’influenza di parametri di processo quali la temperatura di partenza (T1 ) del campione da trattare, la temperatura finale in corso di trattamento (T 2), la differenza tra temperatura iniziale e temperatura finale (ΔT), la velocità di riscaldamento (θ) e la durata del trattamento sull’abbattimento della carica batterica nella matrice alimentare

Summary In 2007, three strains of Salmonella enterica serotype Rissen (S. Rissen) were isolated in the laboratory of diagnostic microbiology of the General Hospital of Prato, Tuscany, Italy, over a 1 month and half interval of time. The first isolate was recovered on January 26 from an outpatient with enteritis. Then, two strains were isolated on February 16 and March 11 respectively, from central venous catheters of patients who were being hospitalized in two departments of the Hospital. An epidemiologically linked cluster of cases of salmonellosis was suspected. The three strains were submitted to single enzyme-amplified fragment length polymorphism (SE-AFLP) and XbaI macrorestriction and pulsed-field gel electrophoresis (PFGE) that yielded undistinguishable profiles. Epidemiological investigations failed to identify a common source of infection within the Hospital. Moreover, the third patient had been exclusively total parenteral nutrition fed since his admission with a stomach cancer diagnosis. The first patient had a community-acquired infection, but the source of her illness was uncertain. Twenty-five further isolates identified in the years 2004–2007 in the same geographical area showed distinctly different PFGE and SE-AFLP patterns. The three patients seemed to represent a cluster of epidemiologically unrelated cases caused by a previously never recognized S. Rissen strain. Rapid subtyping of isolates is essential in the early investigation of potential outbreaks, but synthesis of conventional and molecular epidemiological investigation and availability of surveillance data is often critical to prevent the initiation of time-consuming, expensive and ineffective further investigations and control interventions.

Obiettivi. Descrivere l’andamento dei casi di tubercolosi (TB) in Sicilia negli anni 2010-2013. Disegno e partecipanti. Indagine osservazionale delle notifiche di TB relative agli anni 2010-2013 mediante l’analisi dei dati del Sistema informativo delle malattie infettive (SIMI) e indagine epidemiologico-molecolare mediante tipizzazione spoligo- e 24- loci mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) dei ceppi di Mycobacterium tuberculosis complex (MTBC) isolati a Palermo negli anni 2012-2013. Risultati. Negli anni 2010-2013 sono stati notificati in Sicilia 876 casi di TB con un tasso medio annuale di notifica pari a 4,4 casi per 100.000 abitanti. La proporzione di casi di TB in soggetti nati all’estero è crescente e nel 2012 e 2013 supera quella nella popolazione autoctona. L’età mediana dei pazienti stranieri è risultata significativamente inferiore agli italiani (30,5 vs. 51,2 anni, p 64 anni. Nell’82,5% dei casi è stata diagnosticata una localizzazione polmonare. La tipizzazione molecolare è stata effettuata su 151 ceppi di MTBC. Mediante spoligotyping essi sono stati attribuiti a 14 differenti lineage e 33 sublineage rappresentati con frequenza diversa tra le due subpopolazioni di pazienti. Soltanto nove ceppi (6,2%) sono stati inclusi in quattro cluster. Sono stati identificati, infine, due ceppi multiresistenti. Conclusioni. L’epidemiologia della TB in Sicilia è complessa e in rapida evoluzione, con una crescente proporzione di casi in soggetti non italiani e una grande eterogeneità dei ceppi di MTBC circolanti. L’integrazione di strumenti convenzionali e molecolari è necessaria per una sorveglianza efficace e un’interpretazione accurata dell’epidemiologia della TB in Sicilia.

Gram-negative pathogens producing carbapenemases represent an alarming clinical threat with serious effects on patient outcomes ([3][1], [7][2]). In 2001, Yigit et al. ([11][3]) reported a novel β-lactamase termed “ K lebsiella pneumoniae carbapenemase” (KPC-1) in North Carolina. KPC-producing

Prevalence of overweight and obesity is approximately 40% in Sicilian schoolchildren at age 11 and over 25% at age 15. The objective of this study was to evaluate knowledge, perception and awareness of the obesity as a condition amongst a sample of parents living inner-city areas of Palermo, Italy. A cross-sectional survey was performed enrolling 311 parents/gradients of children attending schools located in inner district of Palermo, Italy, with low to medium income. Association of answer patterns with socio-demographic characteristics was evaluated by univariate and multivariate regression analysis. Although 83% considered weight excess in childrenas a health hazard, 30% considered it as a healthy condition. Junk food/beverages (78.0%), fast food (63.2%) and lack of exercise in school curriculum (48.7%) were identified as the most significant contributors to childhood obesity. Responsibility in tackling childhood obesity varied significantly according to the education level of the parents: low educated mothers less frequently perceived junk food/beverages, lack of exercise at school, lack of places to exercise and lack of security as threats to children health. Furthermore, mother’s low education was negatively associated with their awareness of the roles played by food companies, school and healthcare services in the childhood obesity causative network. An increasing public awareness is required as key variable role in order to tackle the childhood obesity crisis.

This study aimed at detecting the presence of antibiotic-resistant Gram-negatives in samples of meals delivered at the University General Hospital of Palermo, Italy. Antibiotic resistant Gram negatives were isolated in July—September 2007 ffrom cold dishes and food contact surfaces and utensils. Bacterial strains were submitted to susceptibility test and subtyped by random amplification of polymorphic DNA (RAPD). Forty-six of 55 (83.6%) food samples and 14 of 17 (82.3%) environmental swabs were culture positive for Gram negative bacilli resistant to at least one group of antibacterial drugs. A total of 134 antibiotic resistant strains, 51 fermenters and 83 non-fermenters, were recovered. Fermenters and non-fermenters showed frequencies as high as 97.8% of resistance to two or more groups of antibiotics and non fermenters were 28.9% resistant to more than three groups. Molecular typing detected 34 different profiles among the fermenters and 68 among the non-fermenters. Antibiotic resistance was very common among both fermenters and non-fermenters. However, the wide heterogeneity of RAPD patterns seems to support a prominent role of cross-contamination rather than a clonal expansion of a few resistant isolates. A contribution of commensal Gram negatives colonizing foods to a common bacterial resistance pool should not been overlooked.

L’edizione italiana di questo volume rappresenta uno strumento molto utile per chi si interessa degli aspetti sanitari collegati agli ambienti acquatici nei quali si svolge attività ricreativa: viene quindi messo a disposizione del lettore il testo di riferimento più autorevole sugli aspetti igienico-sanitari propri della frequentazione di piscine e di ambienti simili. I contenuti derivano dalla revisione completa della letteratura scientifica sull’argomento, alla quale abbiamo contribuito con numerosi studi svolti sul nostro territorio nazionale, e permettono utili confronti tra diverse realtà a livello internazionale. È comunque da rilevare come si tratti di un documento senza alcuna valenza di tipo normativo o impositivo: vengono presentate infatti indicazioni, vere e proprie “linee-guida”, che possono essere adattate alle diverse realtà locali, con l’intento di contribuire alla salute pubblica in una prospettiva di autocontrollo che prevede una stretta collaborazione tra l’autorità sanitaria, i gestori e gli utenti. Ed è grazie alla coerenza tra la natura propositiva di queste linee-guida e l’interesse alla promozione della salute pubblica da parte di un gruppo di studiosi della SItI che ne è stata predisposta la traduzione italiana: il gruppo che ha svolto il lavoro è costituito da docenti universitari afferenti all’area dello sport (Scienze Motorie e Sportive), spesso molto vicini nelle proprie sedi regionali sia al mondo delle Federazioni sia a quello delle Aziende Unità Sanitarie Locali, e dai loro studenti, appassionati utilizzatori delle piscine. Queste linee-guida hanno quindi un primo obiettivo: quello di fornire un riferimento di base, già condiviso da esperti di molti paesi, sulle caratteristiche di qualità degli ambienti acquatici ad uso ricreativo, che possono variare in funzione dei diversi tipi di struttura. Quanto riportato è stato tratto dai numerosi studi scientifici che hanno riguardato, tra gli altri temi, la valutazione dei rischi per la salute e l’efficacia delle misure di prevenzione e di controllo, unitamente ad una descrizione completa delle possibilità di monitoraggio e di valutazione di salubrità in un’ottica di tutela della salute pubblica. L’adozione di queste linee-guida fornirà quindi un suggerimento per il metodo di lavoro che può essere adottato dai gestori e dai controllori locali, oltre che rappresentare un riferimento autorevole per i progettisti di impianti di piscina e per le industrie che operano nel settore.

Aim: We describe a one-year investigation of colonization by imipenemresistant, metallo-β-lactamase (MBL) producing Pseudomonas aeruginosa in a neonatal intensive care unit (NICU) of the University Hospital of Palermo, Italy. Methods: A prospective epidemiological investigation was conducted in the period 2003 January to 2004 January. Rectal swabs were collected twice a week from all neonates throughout their NICU stay. MBL production by imipenem-resistant strains of P aeruginosa was detected by phenotypic and molecular methods. Pulsed field gel electrophoresis (PFGE) was carried out on all isolates of P aeruginosa. The association between risk factors and colonization by imipenem-resistant, imipenem-susceptible P aeruginosa isolates and other multidrug-resistant Gram negative (MDRGN) organisms was analyzed for variables present at admission and during the NICU stay. Data analysis was carried out by the Cox proportional hazards regression model. Results: Twentytwo of 210 neonates were colonized with imipenem-resistant, MBL-producing P aeruginosa isolates and 14 by imipenem-susceptible P aeruginosa isolates. A single pulsotype, named A, was shared by all imipenem-resistant isolates. Colonization by P aeruginosa of pulsotype A was positively correlated with breast milk feeding and administration of ampicillin-sulbactam, and inversely correlated with exclusive feeding by formula. In the Cox proportional hazards regression model, birthweight of more than 2500 g and breast milk feeding were independently associated with an increased risk of colonization by MBLproducing P aeruginosa. Conclusion: The results strongly support an association between colonization by a well-defined imipenem-resistant, MBL producing P aeruginosa strain and breast milk feeding. Such a study may highlight the need for implementation of strategies to prevent expressed breast milk from becoming a vehicle of health care-associated infections.

Phenotyping and genotyping have been carried out on 64 epidemic and sporadic isolates of Shigella sonnei identified in Italy in the years 2001 to 2003. Class 2 integron carriage has been also investigated. Isolates from four of the five outbreaks and four of six sporadic cases were biotype g , pulsed-field gel electrophoresis type B, and class 2 integron positive, suggesting emergence and spread of an epidemic clone in Italy.