Search

A total of 476 European isolates (310 Cryptococcus neoformans var. grubii, 150 C. neoformans var. neoformans, and 16 C. gattii species complex) from both clinical and environmental sources were analyzed by multi-locus sequence typing. Phylogenetic and population genetic analyses were performed. Sequence analysis identified 74 sequence types among C. neoformans var. neoformans (VNIV), 65 among C. neoformans var. grubii (56 VNI, 8 VNII, 1 VNB), and 5 among the C. gattii species complex (4 VGI and 1 VGIV) isolates. ST23 was the most frequent genotype (22%) among VNI isolates which were mostly grouped in a large clonal cluster including 50% of isolates. Among VNIV isolates, a predominant genotype was not identified. A high percentage of autochthonous STs were identified in both VNI (71%) and VNIV (96%) group of isolates. The 16 European C. gattii species complex isolates analyzed in the present study originated all from the environment and all belonged to a large cluster endemic in the Mediterranean area. Population genetic analysis confirmed that VNI group of isolates were characterized by low variability and clonal expansion while VNIV by a higher variability and a number of recombination events. However, when VNI and VNIV environmental isolates were compared, they showed a similar population structure with a high percentage of shared mutations and the absence of fixed mutations. Also linkage disequilibrium analysis reveals differences between clinical and environmental isolates showing a key role of PLB1 allele combinations in host infection as well as the key role of LAC1 allele combinations for survival of the fungus in the environment. The present study shows that genetic comparison of clinical and environmental isolates represents a first step to understand the genetic characteristics that cause the shift of some genotypes from a saprophytic to a parasitic life style. C1 [Cogliati, Massimo] Univ Milan, Dip Sci Biomed Sallee, Via Pascal 36, I-20133 Milan, Italy. [Desnos-Ollivier, Marie] CNRS, UMR2000, Natl Reference Ctr Invas Mycoses & Antifungal, Inst Pasteur,Mol Mycol Unit, Paris, France. [McCormick-Smith, Ilka; Rickerts, Volker] Robert Koch Inst, Berlin, Germany. [Ferreira-Paim, Kennio; Meyer, Wieland] Univ Sydney, Marie Bashier Inst Emerging Infect Dis & Biosecur, Westmead Inst Med Res,Sydney Med Sch,Westmead Cli, Mol Mycol Res Lab,Ctr Infect Dis,Fac Med & Hlth,W, Westmead, NSW, Australia. [Ferreira-Paim, Kennio] Univ Fed Triangulo Mineiro, Dept Microbiol, Uberaba, MG, Brazil. [Boekhout, Teun; Hagen, Ferry; Theelen, Bart] Westerdijk Fungal Biodivers Inst, Utrecht, Netherlands. [Boekhout, Teun] Univ Amsterdam, IBED, Amsterdam, Netherlands. [Inacio, Joao; Alonso, Beatriz] Univ Brighton, Sch Pharm & Biomol Sci, Brighton, E Sussex, England. [Alonso, Beatriz] Hosp Gegorio Maranon, Inst Invest Sanitaria Gregorio Maranon IisGM, Madrid, Spain. [Colom, Maria F.] Univ Miguel Hernandez, Alicante, Spain. [Trilles, Luciana] Fundacao Oswaldo Cruz, FIOCRUZ, Rio De Janeiro, Brazil. [Montagna, Maria Teresa] Univ Bari Aldo Moro, Bari, Italy. [De Donno, Antonella] Univ Salento, DiSTeBA, Lecce, Italy. [Susever, Serdar] Cyprus Near East Univ, Nicosia, Cyprus. [Ergin, Cagri] Pamukkale Univ, Denizli, Turkey. [Velegraki, Aristea] Univ Athens, Med Sch, Athens, Greece. [Ellabib, Mohamed S.] Univ Tripoli, Med Coll, Tripoli, Libya. [Nardoni, Simona] Univ Pisa, Pisa, Italy. [Macci, Cristina] CNR, Res Inst Terr Ecosystems IRET, Pisa, Italy. [Trovato, Laura] Univ Catania, Catania, Italy. [Dipineto, Ludovico] Univ Napoli Federico II, Naples, Italy. [Akcaglar, Sevim] Uludag Univ, Sch Med, Bursa, Turkey. [Mlinaric-Missoni, Emilija] Croatian Natl Inst Publ Hlth, Zagreb, Croatia. [Bertout, Sebastien] Univ Montpellier, Unite Mixte Int Rech Translat Infect VIH & Malad, Montpellier, France. [Venca, Ana C. F.] Inst Higiene & Med Trop, Lisbon, Portugal. [Sampaio, Ana C.] Univ Tras os Montes & Alto Douro, CITAB, Quinta Prados, Vila Real, Portugal. [Criseoa, Giuseppe] Univ Messina, Dept Chem Biol Pharmaceut & Environm Sci, Messina, Italy. [Ranque, Stephane] Aix Marseille Univ, IHU Mediterranee Infect, AP HM, IRD,SSA,VITROME, Marseille, France. [Cerikcioglu, Nilgun] Marmara Univ, Sch Med, Istanbul, Turkey. [Marchese, Anna] Univ Genoa, IRCCS Policlin San Martino Genova, Sez Microbiol DISC, Genoa, Italy. [Vezzulli, Luigi] Univ Genoa, Dipartimento Sci Terra Ambiente & Vita DISTAV, Genoa, Italy. [Ilkit, Macit] Univ Cukurova Saricam, Adana, Turkey. [Pasquale, Vincenzo] Univ Napoli Parthenope, Naples, Italy. [Polacheck, Itzhack] Hadassah Hebrew Univ, Med Ctr, Jerusalem, Israel. [Lockhart, Shawn R.] Ctr Dis Control & Prevent, Atlanta, GA USA.

Although hospital hygiene has a long history in Italy it is necessary to reflect about it because of the innovation in healthcare systems and because of the evolution due to European Union related activities. Different traditions exist in European countries about hospital hygiene and European Centre for Disease Prevention and Control (ECDC) adopted the term of "infection control and hospital hygiene" which includes all the engaged European healthcare professionals. We propose to modify hospital hygiene as "healthcare organisation hygiene" in order to focalise the attention to all care settings not only hospitals and to adopt the following definition: "all activities aimed to guarantee, in an appropriate, scientifically sound and efficient way, that structures and processes support healthcare practices in a safe comfortable and healthy environment both for patients, caregivers and healthcare workers". Hospital hygiene and its professionals, besides the long tradition, still remain a relevant pillar in guaranteeing quality and safety of healthcare in Italy.

Fundamental niche prediction of Cryptococcus neoformans and Cryptococcus gattii in Europe is an important tool to understand where these pathogenic yeasts have a high probability to survive in the environment and therefore to identify the areas with high risk of infection. In this study, occurrence data for C. neoformans and C. gattii were compared by MaxEnt software with several bioclimatic conditions as well as with soil characteristics and land use. The results showed that C. gattii distribution can be predicted with high probability along the Mediterranean coast. The analysis of variables showed that its distribution is limited by low temperatures during the coldest season, and by heavy precipitations in the driest season. C. neoformans var. grubii is able to colonize the same areas of C. gattii but is more tolerant to cold winter temperatures and summer precipitations. In contrast, the C. neoformans var. neoformans map was completely different. The best conditions for its survival were displayed in sub-continental areas and not along the Mediterranean coasts. In conclusion, we produced for the first time detailed prediction maps of the species and varieties of the C. neoformans and C. gattii species complex in Europe and Mediterranean area.

In order to elucidate the distribution of Cryptococcus neoformans and C. gattii in the Mediterranean basin, an extensive environmental survey was carried out during 2012-2015. A total of 302 sites located in 12 countries were sampled, 6436 samples from 3765 trees were collected and 5% of trees were found to be colonized by cryptococcal yeasts. Cryptococcus neoformans was isolated from 177 trees and C. gattii from 13. Cryptococcus neoformans colonized 27% of Ceratonia, 10% of Olea, Platanus and Prunus trees and a lower percentage of other tree genera. The 13 C. gattii isolates were collected from five Eucalyptus, four Ceratonia, two Pinus and two Olea trees. Cryptococcus neoformans was distributed all around the Mediterranean basin, whereas C. gattii was isolated in Greece, Southern Italy and Spain, in agreement with previous findings from both clinical and environmental sources. Among C. neoformans isolates, VNI was the prevalent molecular type but VNII, VNIV and VNIII hybrid strains were also isolated. With the exception of a single VGIV isolate, all C. gattii isolates were VGI. The results confirmed the presence of both Cryptococcus species in the Mediterranean environment, and showed that both carob and olive trees represent an important niche for these yeasts.

To document reported Intubator Associated Pneumonia (IAP) prevention practices in Intensive Care Units (ICUs) and attitudes towards the implementation of a measurement system.In the framework of the SPIN-UTI project the «Italian Nosocomial Infections Surveillance in ICUs network», two questionnaires were made available online. The first was filled out by physicians working in ICUs in order to collect data on characteristics of physicians and ICUs, on clinical and measurement practices for IAP prevention, and attitudes towards the implementation of a measurement system. The second questionnaire was filled out for each intubated patient in order to collect data on prevention practices during ICU stay.ICUs participating to the fourth edition (2012-2013) of the SPIN-UTI project.Compliance to the component of the European bundle.The components of the bundle for the prevention of IAP are implemented, although to a different level, in the 26 participating ICUs. Overall compliance to all five practices of the European bundle has been reported in 21.1% of the 768 included patients.The present survey has documented a large potential for improvement in clinical and non-clinical practices aimed at preventing IAP in ICUs.

Summary Background Implementing infection control measures in light of healthcare-associated infection (HAI) surveillance data can prevent HAIs. Surveillance has been associated with a reduction of HAI in intensive care unit (ICU) patients, though the reasons for this improvement remain unclear. Aim To evaluate changes in healthcare-associated infection (HAI) rates during three surveys of the Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) network (SPIN-UTI) six-year project and to explore sources of variation of indicators of HAI in the 65 participating ICUs. Methods The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance. Cumulative incidence, incidence density, infection rates adjusted for device-days, and device utilization ratios were calculated for each survey and compared. To identify risk factors multiple logistic regression analyses were performed. Crude excess mortality was computed as the difference between the crude overall case-fatality rate of patients with and without HAI. Findings The risk of ICU-acquired infections increased in the third survey compared with previous (relative risk: 1.215; 95% confidence interval: 1.059–1.394). Among risk factors, the number of hospitalized patients requiring ICU admission and the Simplified Acute Physiology Score II increased from 73.7% to 78.1% and from 37.9% to 40.8% respectively. Although mortality rates remained unchanged, HAIs trebled the risk of death. Acinetobacter baumannii was the most frequently reported micro-organism in the third survey (16.9%), whereas in the previous surveys it ranked third (7.6%) and second (14.3%). Conclusions The study highlighted the increased risk of HAI, at least partially explained by the greater severity and number of hospitalized patients requiring ICU admission. Furthermore, the management of intubation procedures and of ventilated patients was identified as a potential target for infection control interventions to decrease the growing risk of HAI in ICUs.

A study was undertaken to determine the resources available in Italian hospitals for the control of nosocomial infections and the factors favouring a successful approach. During January-May 2000 a questionnaire about infection control was sent to the hospital health director of all Italian National Health System hospitals treating acute patients and with more than 3500 admissions in 1999. An active programme was defined as a hospital infection control committee (HICC) meeting at least four times in 1999, the presence of a doctor with infection control responsibilities, a nurse employed in infection control and at least one surveillance activity and one infection control guideline issued or updated in the past two years. There was a response rate of 87.5% (463/529). Almost fifteen percent (69/463) of hospitals had an active programme for Infection Control and 76.2% (353/463) had a HICC. Seventy-one percent (330/463) of the hospitals had a hospital infection control physician and 53% (250/463) had infection control nurses. Fifty-two percent (242/463) reported at least one surveillance activity and 70.8% (328/463) had issued or updated at least one guidance document in the last two years. The presence of regional policies [odds ratio (OR) 8.7], operative groups (OR 4.2), at least one full-time nurse (OR 4.6) and a hospital annual plan which specified infection control (OR 2.1) were statistically associated with an active programme in the multivariate analysis.

The dental practice is associated with a high risk of infections, both for patients and healthcare operators, and the environment may play an important role in the transmission of infectious diseases. A microbiological environmental investigation was carried out in six dental clinics as a pilot study for a larger multicentre study that will be performed by the Italian SItI (Society of Hygiene, Preventive Medicine and Public Health) working group "Hygiene in Dentistry". Microbial contamination of water, air and surfaces was assessed in each clinic during the five working days of the week, before and during treatments. Air and surfaces were also examined at the end of the daily activity. A wide variation was found in microbial environmental contamination, both within the participating clinics and relative to the different sampling times. Microbial water contamination in Dental Unit Water Systems (DUWS) reached values of up to 26 × 104 cfu/mL (colony forming units per millilitre). P. aeruginosa was found in 33% of the sampled DUWS and Legionella spp. in 50%. A significant decrease in the Total Viable Count (TVC) was recorded during the activity. Microbial air contamination showed the highest levels during dental treatments and tended to decrease at the end of the working activity (p < 0.05). Microbial buildup on surfaces increased significantly during the working hours. As these findings point out, research on microbial environmental contamination and the related risk factors in dental clinics should be expanded and should also be based on larger collections of data, in order to provide the essential knowledge aimed at targeted preventive interventions.

Lack of knowledge is the major reason for non-compliance with correct healthcare-associated infections (HAI) prevention procedures. The aim of this study was to evaluate knowledge of the Dental School (DSS) and Dental Hygiene (DHS) students with regard to the prevention of HAI, as basic knowledge for improving and harmonizing the educational content in the different Italian Universities.A cross-sectional study was carried out using an anonymous questionnaire that was completed by DSS (I, II, III, IV, and V year) in seven Universities and DHS (I, II, and III year) in three Universities. The questions dealt with three specific areas: healthcare-associated infections, standard precautions and hand hygiene. Factors associated with an unacceptable level of knowledge (score17.5) were analyzed using a logistic regression model. A p value0.05 was considered to be significant.Five hundred and four questionnaires were collected: 81.5% for DSS and 18.5% for DHS. Mean overall score (±DS) achieved by the total number of students was 18.2±2.93 on an overall perfect score of 25; 18.2±3.04 for DSS and 17.8±2.31 for DHS. Stratifying by area, the average score 2.7±1.07 (53%) for HAI, 10.3±1.61 (85.9%) for standard precautions, and 5.2±1.44 (64.8%) for hand hygiene was observed. A significantly different level of knowledge (p0.001) between DSS and DHS was observed only for HAI (2.8±1.07 for DSS vs 2.1±0.96 for DHS). Significant differences among the academic years were found only for DSS concerning HAI and standard precautions. The logistic regression model showed that an age23 years was a risk factor for lack of knowledge on HAI, but a protective factor for lack of knowledge about standard precautions and hand hygiene; attending DH degree course was associated with lack of knowledge on HAI.Although the overall score obtained both by DSS and DHS indicated an acceptable level of knowledge, lack of knowledge was highlighted, in particular, for hand hygiene. Therefore, it is necessary to implement and validate effective teaching models in undergraduate courses in order to provide the scientific basis and the theoretical and practical preparation for the prevention and control of HAI.

Italy is one of the countries participating in a prospective epidemiological survey of cryptococcosis set up in July 1997 by the European Confederation of Medical Mycology (ECMM). Over a 30-month period 156 cases, all caused by Cryptococcus neoformans var. neoformans, were reported by 29 hospitals in 9 regions. An ECMM questionnaire was used to report the clinical presentation and the diagnostic and treatment approach used. Cryptococcosis was associated with HIV infection in 147 cases and was considered indicative of AIDS in 65%. The estimated incidence in the Lombardy region was 0.85/100 in the AIDS population. One isolate from each of 129 patients was serotyped and genotyped. PCR fingerprinting using the primer (GACA)(4) proved to be a more reproducible typing method than the slide agglutination test. Genotypes VN1 (serotype D), VN6 (serotype A) and VN3-VN4 (serotype AD hybrid strains) occurred in Italy at similar levels nationwide, but VN1 (D) was prevalent in the North. In vitro resistance to antifungals was uncommon.

Up to now no specific legislation on water’s microbiological characteristics in basins used for aquaculture is available; therefore, it is very important to monitor their hygienic and sanitary quality. Fish inhabiting faecally polluted bodies of water are often used for human consumption. Such fish can be contaminated by enteric human pathogens and may pose a potential risk to public health. Aim of the present study was to estimate the level of hygiene and sanitation on the brackish water basin of Acquatina used for extensive and semi-intensive fish-culture. Six sampling points were set up and the following microbiological parameters were measured: total and faecal coliforms, faecal streptococci and Salmonella spp. The highest level of total coliforms and faecal coliforms were observed in the channels (Cardone 636 TC 100 mL−1, 305 FC 100 mL−1 and Giammatteo 267 TC 100 mL−1 229 FC 100 mL−1) while the concentration of contaminants of faecal origin in the basin was quite low during the whole year studied. Therefore, these results suggest that freshwater introduced by the channels could be a potential source of faecal contamination.

Two recently described pathogenic Candida species, C. nivariensis and C. bracarensis, share many phenotypic characteristics with C. glabrata and are easily misidentified as such. The aim of this study was to determine the occurrence of these cryptic species in Italy. One thousand yeast isolates collected in 14 Italian regions and identified as C. glabrata by phenotypic and biochemical methods were included in this study: 928 were screened on CHROMagar and 72 were analysed by a multiplex PCR. None of these cryptic species was identified despite the nationwide distribution and the variety of biological origin of the isolates.

Comparative survival tests of faecal coliforms (FC), faecal streptococci (FS), Salmonella spp. and Staphylococcus aureus grown in sea (35‰ of salinity) and brackish water (27‰ of salinity) were performed in the dark at room temperature (22 ± 2°C). In seawater T90 was: S. aureus > FS > Salmonella spp. > FC. Survival in brackish water generally appeared to be higher than in seawater; in particular this increased from 48 to 72 h, from 88 to 104 h and from 56 to 80 h, respectively for FC, FS and Salmonella spp. A lower salinity had no effect on the survival rates of S. aureus whose T90 remained stable (96 h). FC proved to be the most sensitive bacteria to salinity and S. aureus the most adaptable one. There should be caution in interpreting these data; however it seems that S. aureus could be an effectiveindicator of humanpollution and that the microbiological parameters used for the control of seawater could be reconsidered.