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Methicillin-Resistant Staphylococcus aureus: HELP
Articles from Milan
Based on 71 articles published since 2008

These are the 71 published articles about Methicillin-Resistant Staphylococcus aureus that originated from Milan during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial Spreading the Benefits of Infection Prevention in the Neonatal Intensive Care Unit. 2015

Cantey, Joseph B / Ronchi, Andrea / Sánchez, Pablo J. ·Department of Pediatrics, Texas A&M Health Science Center, Baylor Scott & White Health, Temple. · Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. · Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital, The Ohio State University, Columbus. ·JAMA Pediatr · Pubmed #26501886.

ABSTRACT: -- No abstract --

2 Review Early recognition of methicillin-resistant 2017

Sganga, G / Tascini, C / Sozio, E / Colizza, S. ·Istituto Clinica Chirurgica, Divisione Chirurgia Generale e del Trapianto di Fegato, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Largo Gemelli, 8, 00168 Roma, Italia. · Prima Divisione Malattie Infettive, Azienda Ospedaliera dei Colli, Napoli, Italia. · U.O. Medicina d'Urgenza Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italia. · Master Sepsi in Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italia. ·World J Emerg Surg · Pubmed #28616060.

ABSTRACT: BACKGROUND: Surgical site infections (SSIs) constitute a major clinical problem in terms of morbidity, mortality, duration of hospital stay, and overall costs. The bacterial pathogens implicated most frequently are METHODS: Through a literature review, we identified possible major and minor risk factors for, and protective factors against MRSA SSIs. We then submitted statements on these factors to 228 Italian surgeons to determine, using the Delphi method, the degree of consensus regarding their importance. The consensus was rated as positive if >80% of the voters agreed with a statement and as negative if >80% of the voters disagreed. In other cases, no consensus was reached. RESULTS: There was positive consensus that sepsis, >2 weeks of hospitalization, age >75 years, colonization by MRSA, and diabetes were major risk factors for MRSA SSIs. Other possible major risk factors, on which a consensus was not reached, e.g., prior antibiotic use, were considered minor risk factors. Other minor risk factors were identified. An adequate antibiotic prophylaxis, laparoscopic technique, and infection committee surveillance were considered protective factors against MRSA SSIs. All these factors might be used to build predictive criteria for identifying SSI due to MRSA. CONCLUSIONS: In order to help to recognize and thus promptly initiate an adequate antibiotic therapy for MRSA SSIs, we designed a gradation of risk and protective factors. Validation, ideally prospective, of this score is now required. In the case of a SSI, if the risk that the infection is caused by MRSA is high, empiric antibiotic therapy should be started after debriding the wound and collecting material for culture.

3 Review STROBE-AMS: recommendations to optimise reporting of epidemiological studies on antimicrobial resistance and informing improvement in antimicrobial stewardship. 2016

Tacconelli, Evelina / Cataldo, Maria A / Paul, M / Leibovici, L / Kluytmans, Jan / Schröder, Wiebke / Foschi, Federico / De Angelis, Giulia / De Waure, Chiara / Cadeddu, Chiara / Mutters, Nico T / Gastmeier, Petra / Cookson, Barry. ·Division of Infectious Diseases, Department of Internal Medicine I, University Hospital, Tübingen, Germany German Centre for Infection Research (DZIF), Tübingen, Germany. · National Institute for Infectious Diseases "Lazzaro Spallanzani", 2nd Infectious Disease Division, Rome, Italy. · Department of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel. · Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Petach-Tikva, Israel. · Amphia Hospital Breda and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, location Molengracht, Laboratory for Microbiology and Infection Control, Breda, The Netherlands. · Institute of Public Health, Catholic University of the Sacred Heart, Rome, Italy. · Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany. · Institute for Hygiene and Environmental Health, Charité, Medical University Berlin, Berlin, Germany. · Department of Infection and Immunity, University College London, London University, London, UK. ·BMJ Open · Pubmed #26895985.

ABSTRACT: OBJECTIVES: To explore the accuracy of application of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool in epidemiological studies focused on the evaluation of the role of antibiotics in selecting resistance, and to derive and test an extension of STROBE to improve the suitability of the tool in evaluating the quality of reporting in these area. METHODS: A three-step study was performed. First, a systematic review of the literature analysing the association between antimicrobial exposure and acquisition of methicillin-resistant Staphylococcus aureus and/or multidrug-resistant Acinetobacter baumannii was performed. Second, articles were reviewed according to the STROBE checklist for epidemiological studies. Third, a set of potential new items focused on antimicrobial-resistance quality indicators was derived through an expert two-round RAND-modified Delphi procedure and tested on the articles selected through the literature review. RESULTS: The literature search identified 78 studies. Overall, the quality of reporting appeared to be poor in most areas. Five STROBE items, comprising statistical analysis and study objectives, were satisfactory in <25% of the studies. Informative abstract, reporting of bias, control of confounding, generalisability and description of study size were missing in more than half the articles. A set of 21 new items was developed and tested. The new items focused particularly on the study setting, antimicrobial usage indicators, and patients epidemiological and clinical characteristics. The performance of the new items in included studies was very low (<25%). CONCLUSIONS: Our paper reveals that reporting in epidemiological papers analysing the association between antimicrobial usage and development of resistance is poor. The implementation of the newly developed STROBE for antimicrobial stewardship (AMS) tool should enhance appropriate study design and reporting, and therefore contribute to the improvement of evidence to be used for AMS programme development and assessment.

4 Review Methicillin-resistant Staphylococcus aureus: source control and surveillance organization. 2009

Tacconelli, E. ·Department of Infectious Diseases, Catholic University, Rome, Italy. etacconelli@rm.unicatt.it ·Clin Microbiol Infect · Pubmed #19951332.

ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) has been a common nosocomial pathogen since the 1960s, and has become a major problem in hospitals worldwide. Patients and the public are increasingly seeing MRSA and rates of MRSA infections as indicators of the quality of patient care. The control measures aimed at reducing the spread of MRSA among hospitals and communities include the following: education of healthcare workers, with implementation and adherence to hand-washing practices; restriction of antibiotic use; active surveillance cultures (ASCs); contact isolation of MRSA-positive patients; and pre-emptive isolation of high-risk patients. However, despite these interventions, MRSA is still endemic in many hospitals worldwide. In particular, the role of ASCs is still under debate. International guidelines suggest that extensive ASCs should only be used in intensive-care units (ICUs), and routine screening of all hospital admissions is not usually advocated. Local decisions can be made on the basis of types of risk factor of non-ICU patients. Before starting ASCs, laboratories should be prepared for the workload, and the turn-around time for screening tests should be reduced and arrangements made to monitor the effectiveness of this intervention. Most recently, rapid methods for molecular detection of MRSA colonization have been developed. Published studies differ in their settings (ICU, medical wards, surgical wards), choice of patient population, severity of illness, hospital infection control measures, and study design. The existing evidence does not support the wide application of rapid molecular screening for MRSA.

5 Review Screening and isolation for infection control. 2009

Tacconelli, E. ·Department of Infectious Diseases, Università Cattolica Sacro Cuore, Rome, Italy. etacconelli@rm.unicatt.it ·J Hosp Infect · Pubmed #19699554.

ABSTRACT: Control measures aimed to reduce the prevalence of healthcare-associated infections include active surveillance cultures (ASCs), contact isolation of patients colonised with epidemiologically significant pathogens, and pre-emptive isolation of high risk patients. However, the benefits of these measures are questionable. A systematic review of isolation policies demonstrated that intensive concerted interventions including isolation can substantially reduce nosocomial meticillin-resistant Staphylococcus aureus (MRSA) infection. Monitoring of interventions is fundamental. Surveillance data should be presented and fed back appropriately. International guidelines suggest that only intensive care units should apply extensive ASCs. However, legislation for mandatory screening at hospital admission has been advocated in many countries. Targeted screening could be used to limit the potential for dissemination of antibiotic-resistant pathogens from otherwise unsuspected carriers from the start of patients' hospitalisation, as opposed to other strategies, in which screening programmes target patients already hospitalised. Although the influx of antibiotic-resistant pathogens into the hospital would not change, early detection would reduce the time colonised patients might have to disseminate pathogens. Recently, rapid methods for molecular detection of MRSA have been developed. Data on the impact of these tests on the MRSA acquisition rate are extremely heterogeneous. Published studies differ according to the settings in which they have been evaluated, the choice of patient population to be screened, other infection control measures employed and, most importantly, study design and baseline prevalence of MRSA. Based on these studies, definitive recommendations cannot be made.

6 Review Rapid screening tests for meticillin-resistant Staphylococcus aureus at hospital admission: systematic review and meta-analysis. 2009

Tacconelli, Evelina / De Angelis, Giulia / de Waure, Chiara / Cataldo, Maria A / La Torre, Giuseppe / Cauda, Roberto. ·Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy. etacconelli@rm.unicatt.it ·Lancet Infect Dis · Pubmed #19695491.

ABSTRACT: Detection and eradication of meticillin-resistant Staphylococcus aureus (MRSA) represents a public health priority worldwide. Our aim was to do a systematic review and meta-analysis of randomised, non-randomised, and observational studies to summarise the available evidence on the effect of MRSA detection by rapid screening tests on hospital-acquired MRSA infections and acquisition rate. Eligible studies were retrieved from Medline, EmBase, Science Citation Index, and the Cochrane database. We judged as eligible those studies that compared hospitals and wards in which active screening for the detection of MRSA carriers was done at hospital admission by use of a rapid molecular test to those in which active screening was done with culture alone or not at all. To account for statistical heterogeneity between studies, random-effects models were used. Ten studies (nine interventional studies and one unblinded, cluster-randomised, crossover trial) were reviewed. Meta-analysis was done for studies reporting data on the same outcome. Primary outcomes included MRSA acquisition rate per 1000 patient-days (four studies); incidence of MRSA bloodstream infections per 1000 patient-days (three studies); and incidence of MRSA surgical-site infections per 100 surgical procedures (five studies). Compared with culture screening, use of rapid screening tests was not associated with a significant decrease in MRSA acquisition rate (risk ratio 0.87, 95% CI 0.61-1.24). Between wards applying rapid screening tests and those not applying screening, we noted a significantly decreased risk for MRSA bloodstream infections (0.54, 95% CI 0.41-0.71), but not for MRSA surgical-site infections (0.69, 95% CI 0.46-1.01). We conclude that active screening for MRSA is more important than the type of test used. Since important and costly decisions, such as mandatory legislation for MRSA universal screening, are under consideration in many countries worldwide, policy makers should be aware of the limits and the heterogeneity of the available evidence.

7 Review Pneumonia due to methicillin-resistant Staphylococcus aureus: clinical features, diagnosis and management. 2009

Tacconelli, Evelina / De Angelis, Giulia. ·Department of Infectious Diseases, Università Cattolica Sacro Cuore, Rome, Italy. etacconelli@rm.unicatt.it ·Curr Opin Pulm Med · Pubmed #19373090.

ABSTRACT: PURPOSE OF REVIEW: The review highlights the clinical findings and the management of community-acquired, health-care associated and nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). RECENT FINDINGS: Although previously considered as a purely nosocomial event, community-acquired MRSA pneumonia is underestimated and is spreading worldwide. A retrospective study showed that almost half of patients with nonnosocomial MRSA pneumonia admitted to a large teaching hospital did not present established criteria for healthcare-associated infections. Recent data show that MRSA ventilator-associated pneumonia is associated with significantly higher mortality than ventilator-associated pneumonia caused by methicillin-susceptible Staphylococcus aureus. Therefore, prompt and appropriate therapy is essential. The optimal therapy for MRSA pneumonia has not been fully elucidated. Although vancomycin has been considered the gold standard for the treatment of MRSA infections, clinical failures have also been reported in the presence of in-vitro susceptibility. Linezolid may provide improved outcomes compared with vancomycin in patients with MRSA pneumonia, but validation in a prospective trial is currently lacking. Recently licensed tigecycline and dalbavancin, a drug in phase III trial, look promising. Animal models showed that immunization against a cytolytic toxin secreted by most Staphylococcus aureus strains protects against lethal pneumonia. SUMMARY: Rapid recognition of possible staphylococcal infection in patients with severe pneumonia is essential. The treatment of MRSA pneumonia must be prompt and effective in order to allow a fast microbiological clearance and to successfully manage the infection.

8 Clinical Trial Bioactive glass BAG-S53P4 for the adjunctive treatment of chronic osteomyelitis of the long bones: an in vitro and prospective clinical study. 2013

Drago, Lorenzo / Romanò, Delia / De Vecchi, Elena / Vassena, Christian / Logoluso, Nicola / Mattina, Roberto / Romanò, Carlo Luca. ·Laboratory of Clinical Chemistry and Microbiology, I,R,C,C,S, Galeazzi Orthopaedic Institute, Via R, Galeazzi 4, Milan 20161, Italy. lorenzo.drago@unimi.it. ·BMC Infect Dis · Pubmed #24325278.

ABSTRACT: BACKGROUND: This study aimed to explore the in vitro antibacterial activity of the bioglass BAG S53P4 against multi-resistant microorganisms commonly involved in osteomyelitis and to evaluate its use in surgical adjunctive treatment of osteomyelitis. METHODS: In vitro antibacterial activity of BAG-S53P4 against methicillin resistant Staphylococcus aureus and Staphylococcus epidermidis, Pseudomonas aeruginosa and Acinetobacter baumannii isolates was evaluated by means of time kill curves, with colony counts performed after 24, 48 and 72 hours of incubation. In vivo evaluation was performed by prospectively studying a cohort of 27 patients with a clinically and radiologically diagnosed osteomyelitis of the long bones in an observational study. Endpoints were the absence of infection recurrence/persistence at follow-up, no need for further surgery whenever during follow-up and absence of local or systemic side effects connected with the BAG use. RESULTS: In vitro tests regarding the antibacterial activity of BAG S53P4 showed a marked bactericidal activity after 24 hrs against all the tested species. This activity continued in the subsequent 24 hrs and no growth was observed for all strains after 72 hrs. Results of the clinical study evidenced no signs of infection in 24 patients (88.9%) at the follow-up, while 2 subjects showed infection recurrence at 6 months from index operation and one more needed further surgical procedures. BAG-S53P4 was generally well tolerated. CONCLUSIONS: The in vitro and in vivo findings reinforce previous observations on the efficacy of BAG-S53P4 for the treatment of chronic osteomyelitis of the long bones, also in the presence of multi-resistant strains and in immunocompromised hosts, without relevant side effects and without the need for locally adding antibiotics. TRIAL REGISTRATION: Deutschen Register Klinischer Studien (DRKS) unique identifier: DRKS00005332.

9 Article A rare case of native pulmonary valve infective endocarditis complicated by septic pulmonary embolism. 2019

Sonaglioni, Andrea / Binda, Giulia / Rigamonti, Elisabetta / Vincenti, Antonio / Trevisan, Roberta / Nicolosi, Gian Luigi / Zompatori, Maurizio / Lombardo, Michele / Anzà, Claudio. ·Department of Cardiology. · Department of Radiology, Ospedale San Giuseppe MultiMedica Milan. · Cardiology Clinic, Policlinico San Giorgio, Pordenone. · Cardiovascular Department, MultiMedica IRCCS, Sesto San Giovanni, Milano, Italy. ·J Cardiovasc Med (Hagerstown) · Pubmed #30664073.

ABSTRACT: -- No abstract --

10 Article Methicillin-resistant Staphylococcus aureus CC22-MRSA-IV as an agent of dairy cow intramammary infections. 2018

Magro, Giada / Rebolini, Marta / Beretta, Daniele / Piccinini, Renata. ·Department of Veterinary Medicine, University of Milan, Via Celoria 10, 20133, Milan, Italy. · Department of Agricultural and Environmental Sciences - Production, Land, Agroenergy, University of Milan, Via Celoria 2, 20133, Milan, Italy. · Allegrini S.p.A, Zootechnics division, Vicolo Salvo D'Acquisto 2, 24050, Grassobbio, Italy. · Department of Veterinary Medicine, University of Milan, Via Celoria 10, 20133, Milan, Italy. Electronic address: renata.piccinini@unimi.it. ·Vet Microbiol · Pubmed #30473348.

ABSTRACT: Methicillin-resistant S. aureus (MRSA) lineages have become major responsible of healthcare- and community-associated infections in human population. Bovine MRSA are sporadically detected in the dairy herd, but its presence enhances the risk of zoonosis. Some lineages are able to lose the specific host tropism, being easily transmitted from animals to humans and vice-versa. The present study aims at clarifying the epidemiology of MRSA intramammary infections in a closed dairy herd, which was running a mastitis control program since years. Quarter milk samples were collected from all lactating cows once a week for 9 weeks and bacteriologically tested. At the end of the follow-up period, also a self-taken nasal swab of the milker was analysed. Three cows (12.5%) were MRSA positive, a fourth showed a transient infection and MRSA was isolated also from the milker's nose. Somatic cell counts of infected quarters fluctuated from 1000 to 1,800,000 cells/mL. The isolates were genotyped using DNA microarrays and identified as the epidemic UK-EMRSA-15 grouping in CC22. All strains carried the genes for β-lactam and macrolide resistance. The milker isolate differed from cow isolates mainly for the absence of the untruncated β-haemolysin and the presence of the immune evasion cluster. The milker had been volunteering in a nursing home since months, thus playing the role of MRSA vector into the herd. Our results showed the adaptive capacity of such MRSA to the bovine host. Therefore, we suggest that CC22-MRSA should be regarded as a potential cause of reverse zoonosis in dairy cattle herds.

11 Article Staphylococcus aureus colonization and risk of surgical site infection in children undergoing clean elective surgery: A cohort study. 2018

Esposito, Susanna / Terranova, Leonardo / Macchini, Francesco / Bianchini, Sonia / Biffi, Giulia / Viganò, Martino / Pelucchi, Claudio / Leva, Ernesto / Principi, Nicola. ·Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia. · Pediatric Highly Intensive Care Unit, Università degli Studi di Milano. · Unit for Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. · Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. ·Medicine (Baltimore) · Pubmed #29979379.

ABSTRACT: Staphylococcus aureus persistently colonizes the skin and nasopharynx of approximately 20% to 30% of individuals, with the highest rates in younger children. To avoid clinical problems for carriers and the spread of S aureus to other hospitalized patients, screening and decolonization of carriers undergoing surgery has been recommended. However, the best approach to patients undergoing clean surgery is not precisely defined. To evaluate whether children carrying S aureus admitted to the hospital for clean elective surgery have an increased risk of postoperative surgical infections, 393 infants and children (77.1% males; mean age ± standard deviation, 7.6 ± 4.5 years) who were scheduled for clean elective surgery procedures were evaluated for S aureus carriage on the day of intervention and 5 days after it. Both anterior nares and pharyngeal swabs were collected. S aureus was identified using the RIDAGENE methicillin-resistant S aureus (MRSA) system (R-Biopharm AG, Darmstadt, Germany), according to the manufacturer's instructions. At admission, 138 (35.1%) children screened positive for S aureus. MRSA was identified in 40 (29.0% of S aureus positive subjects) cases. The carriage rates of S aureus and MRSA varied considerably with age, and in children <2 years old the rate was significantly lower than in any other age group (P < .05). Surgical site infection was demonstrated in 4 out of 109 (3.7%) children who were initially colonized by S aureus and in 5 out of 201 (2.5%) children with a negative screening, without any statistically significant difference between groups (P = .72). None of these children had MRSA. These results seem to suggest that children undergoing clean elective surgery do not need to be screened for S aureus colonization because, although positive, they have no increased risk of surgical site infection. Following this statement, preoperative procedures should be simplified with relevant advantages from a clinical, social, and economic point of view.

12 Article Incidence and antimicrobial resistance trends in bloodstream infections caused by ESKAPE and Escherichia coli at a large teaching hospital in Rome, a 9-year analysis (2007-2015). 2018

De Angelis, Giulia / Fiori, Barbara / Menchinelli, Giulia / D'Inzeo, Tiziana / Liotti, Flora Marzia / Morandotti, Grazia Angela / Sanguinetti, Maurizio / Posteraro, Brunella / Spanu, Teresa. ·Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy. · Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy. maurizio.sanguinetti@unicatt.it. · Institute of Public Health (Section of Hygiene), Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy. ·Eur J Clin Microbiol Infect Dis · Pubmed #29948360.

ABSTRACT: The proportion of antimicrobial resistance (AMR) among the ESKAPE and Escherichia coli (ESKAPEEc) pathogens causing bloodstream infection (BSI) increased worldwide. We described longitudinal trends in ESKAPEEc BSI and AMR over 9 years (2007-2015) at a large teaching hospital in Italy. Of 9720 unique BSI episodes, 6002 (61.7%) were caused by ESKAPEEc pathogens. The majority of these episodes (4374; 72.9%) were hospital-onset infections. The most frequent pathogen was E. coli (32.8%), followed by Staphylococcus aureus (20.6%), Klebsiella pneumoniae (16.1%), and Pseudomonas aeruginosa (11.6%). There was a significant increase of hospital-onset K. pneumoniae (from 2.3 to 5.0 per 10,000 patient-days; P = 0.001) and community-onset E. coli (from 3.3 to 9. 1 per 10,000 emergency admissions; P = 0.04) BSIs. Among hospital-onset BSIs, increases of extended-spectrum β-lactamase (ESBL)-producing E. coli (from 25.4 to 35.2%, P = 0.006), carbapenemase-producing K. pneumoniae (from 4.2 to 51.6%, P < 0.001), and methicillin-resistant S. aureus (from 33.9 to 44.4%, P < 0.001) BSIs were observed between the 2007-2009 and 2010-2012 study periods. In contrast, a decrease of BSIs caused by P. aeruginosa resistant to ceftazidime (from 45.5 to 28.2%, P < 0.001), ciprofloxacin (from 46 to 36.3%, P = 0.05), and meropenem (from 55 to 39.9%, P = 0.03) was observed through all 9 years of the study period. Among community-onset BSIs, increases of BSIs caused by ESBL-producing E. coli (from 28.6 to 42.2%, P = 0.002) and carbapenemase-producing K. pneumoniae (from 0 to 17.6%) were observed between the 2007-2009 and 2010-2012 study periods. Our findings show increased rates of BSI and relative AMR for specific pathogen-health care setting combinations, and call for continued active surveillance and infection control policies.

13 Article Epidemiological trends of infective endocarditis in a single center in Italy between 2003-2015. 2018

Ferraris, Laurenzia / Milazzo, Laura / Rimoldi, Sara Giordana / Mazzali, Cristina / Barosi, Alberto / Gismondo, Maria Rita / Vanelli, Paolo / Cialfi, Alessandro / Sollima, Salvatore / Galli, Massimo / Antona, Carlo / Antinori, Spinello. ·a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy. · b Laboratory of Clinical Microbiology, Virology and Bioemergencies , ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy. · c Department of Management, Economics and Industrial Engineering (DIG) , Politecnico di Milano , Milan , Italy. · d Department of Cardiology , ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy. · e Cardiosurgery Unit, ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy. ·Infect Dis (Lond) · Pubmed #29842820.

ABSTRACT: OBJECTIVE: Changes in the incidence, clinical features and microbiology of infective endocarditis (IE) observed in a single center in Italy were compared between the period 2003-2010 and 2011-2015. METHODS: All cases of IE, defined as definite or possible according to the modified Duke criteria, observed at the 'L. Sacco' Hospital in Milan, Italy between 2003 and 2015 were retrospectively reviewed. RESULTS: 366 episodes of IE were identified in 325 patients. The mean number of incident IE over the period 2003-2015 was 1.43 (range: 0.6-2.1) cases per 1000 admissions, with a significantly increasing trend from a mean of 1.28-1.72 cases per 1000 admissions/year in 2003-2010 and 2011-2015, respectively (+34%; p = .04). Staphylococci remain the leading pathogens causing IE (29%) with a relative increase of methicillin-resistant Staphylococcus aureus between the two periods. Streptococci and enterococci account for 26% and 18% of IE, respectively. We found an increase in the proportion of cases due to enterococci (from 14% in 2003-2010 to 22% in 2011-2015). The rate of in-hospital mortality was 19%, similar in the two periods studied. CONCLUSION: The incidence of IE continuously increased in our cohort over the past decade and, along with the aging of the population, a raise in the incidence of health care-associated infections and a change in the distribution of prevalent pathogens were observed. Surgery was independently associated with higher in-hospital survival (AOR, 95% CI: 0.38, 0.19-0.74; p = .005). A constant surveillance is required to guide the optimal management of the changing epidemiology of IE.

14 Article Cervical spondylodiscitis subsequent to peripherally inserted central catheter-related sepsis: A case report. 2018

Leoni, Matteo Luigi Giuseppe / Terranova, Gaetano. ·1 Department of Anaesthesia, Istituti Clinici Scientifici Maugeri, Pavia, Italy. · 2 Department of Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy. ·J Vasc Access · Pubmed #29772985.

ABSTRACT: -- No abstract --

15 Article Risk factors associated with complications/sequelae of acute and subacute haematogenous osteomyelitis: an Italian multicenter study. 2018

Chiappini, Elena / Krzysztofiak, Andrzej / Bozzola, Elena / Gabiano, Clara / Esposito, Susanna / Lo Vecchio, Andrea / Govoni, Maria Rita / Vallongo, Cristina / Dodi, Icilio / Castagnola, Elio / Rossi, Nadia / Valentini, Piero / Cardinale, Fabio / Salvini, Filippo / Bona, Gianni / Bossi, Grazia / Olivieri, Alma Nunzia / Russo, Fiorella / Fossali, Emilio / Bottone, Gabriella / Dellepiane, Marta / De Martino, Maurizio / Villani, Alberto / Galli, Luisa. ·a Department of Health Sciences, Paediatric Infectious Diseases Unit, Department of Paediatric Medicine , Anna Meyer Children's University Hospital , Firenze , Italy. · b University and Hospital Pediatric Department, Pediatric and Infectious Disease Unit , Children Hospital Bambino Gesù , Rome , Italy. · c Department of Public Health and Pediatric Sciences , University of Turin, Pediatric Unit, Regina Margherita Children's University Hospital , Turin , Italy. · d Pediatric Clinic, Department of Surgical and Biomedical Sciences , University of Studies of Perugia , Perugia , Italy. · e Department of Translational Medical Sciences - Section of Pediatrics, Pediatric Infectious Diseases Unit , University of Naples Federico II , Naples , Italy. · f Department of Reproduction and Growth , St. Anna Hospital , Ferrara , Italy. · g Department of Pediatrics , "Dell'Angelo" Hospital , Verona , Italy. · h Department of Pediatrics , Parma University Hospital , Parma , Italy. · i IRCCS Giannina Gaslini , Infectious Diseases Unit , Genua , Italy. · j Department of Child and Maternal Health, Pediatric Clinic , "Ss. Annunziata Hospital" , Chieti , Italy. · k Institute of Pediatrics , Catholic University of Sacred Heart, Gemelli Hospital , Rome , Italy. · l Department of Pediatrics and Respiratory Allergies , Giovanni XXIII Pediatric Hospital , Bari , Italy. · m Department of Pediatrics , University of Milan- ASST Santi Paolo e Carlo , Milan , Italy. · n Pediatric Division , "Maggiore Carità" Hospital, University of Piemonte orientale , Novara , Italy. · o Pediatric Clinic , University of Pavia, IRCCS Policlinico "S. Matteo" Foundation , Pavia , Italy. · p Department of Woman, Child, and General and Specialistic Surgery , Second University of Studies of Naples , Naples , Italy. · q Desio Hospital , Pediatrics and Neonatology Unit , Desio , Italy. · r Pediatric Emergency Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy. · s Department of Internal Medicine and Public Health , University of L'Aquila , L'Aquila , Italy. ·Expert Rev Anti Infect Ther · Pubmed #29569505.

ABSTRACT: BACKGROUND: Acute/subacute haematogenous osteomyelitis (AHOM/SAHOM) are potentially devastating diseases. Updated information about the epidemiology, management and outcome of AHOM/SAHOM is needed to minimize the risk of complications and sequelae. METHODS: A multicenter study was performed to evaluate retrospectively the management and outcome of AHOM/SAHOM in Italy. Data from children aged >1 month, and hospitalized between 2010 and 2016, in 19 pediatric centers, were analyzed. RESULTS: 300 children with AHOM and 98 with SAHOM were included. Median age was 6.0 years (IQR: 2.0-11.0). No clinical difference was observed with the exception of fever at onset (63.0% vs. 42.9%; P < 0.0001), and a more common spinal involvement in SAHOM (6.7% vs 20.4%; P < 0.001). Fifty-Eight Staphylococcus aureus strains were isolated; 5 (8.6%) were MRSA. No Kingella kingae infection was documented. No different risk for complication/sequela was observed between AHOM and SAHOM (38.3% vs. 34.7%; OR:0.85; 95%CI: 0.53-1.38; P = 0.518). Duration and type of antibiotic therapy were not associated with risk of complication/sequelae. CONCLUSION: AHOM and SAHOM displayed some differences, however occurrence and risk factors for complications and sequelae are similar, and the same empiric treatment might be recommended.

16 Article The current role of glycopeptides in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in not neutropenic adults: the viewpoint of a group of Italian experts. 2018

Concia, Ercole / Viscoli, Claudio / Del Bono, Valerio / Giannella, Maddalena / Bassetti, Matteo / De Rosa, Giuseppe Francesco / Durante Mangoni, Emanuele / Esposito, Silvano / Giusti, Massimo / Grossi, Paolo / Menichetti, Francesco / Pea, Federico / Petrosillo, Nicola / Tumbarello, Mario / Stefani, Stefania / Venditti, Mario / Viale, Pierluigi / Anonymous7260934. ·a Università degli Studi di Verona, Italy - Dipartimento Diagnostica e Sanità Pubblica - Sezione Malattie Infettive. · b A.O.U. IRCCS San Martino/Università degli Studi, Genova, Italy - Clinica delle Malattie Infettive. · c Università degli Studi di Bologna/Ospedale Sant'Orsola-Malpighi, Bologna, Italy - Dipartimento di Scienze Mediche e Chirurgiche, Settore Malattie Infettive. · d A.O.U. Santa Maria della Misericordia, Udine, Italy - Clinica di Malattie Infettive (Bassetti), Istituto di Farmacologia Clinica (Pea). · e Università degli Studi di Torino, Italy - Dipartimento di Scienze Mediche, Malattie Infettive. · f Università degli Studi della Campania Luigi Vanvitelli. · g Università degli Studi di Salerno, Italy, Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana". · h A.O. San Giovanni Bosco, Torino, Italy - Reparto di Medicina Interna A. · i Università degli Studi dell'Insubria, Varese, Italy - Dipartimento di Medicina Interna - Malattie infettive e tropicali. · j A.O.U. Pisana, Pisa, Italy - Direttore di Unità Operativa - U.O. Malattie Infettive. · k Istituto Nazionale Malattie Infettive "Lazzaro Spallanzani", Roma, Italy - U.O.C. Infezioni Sistemiche e dell'Immunodepresso. · l Università Cattolica del Sacro Cuore, Roma, Italy - Facoltà di Medicina e Chirurgia, Clinica delle Malattie Infettive. · m Università degli Studi di Catania, Italy - Dipartimento di Scienze Biomediche e Biotecnologiche. · n Università "La Sapienza"/A.O. Policlinico Umberto I, Roma, Italy - Dipartimento di Sanità Pubblica e Malattie Infettive. ·J Chemother · Pubmed #29380676.

ABSTRACT: Staphylococcus aureus is still an important problem in clinical and therapeutic area, worldwide. In Italy, in recent years, methicillin resistance remained stable, yet considerably high, the percentage of strains of MRSA being around 40%. It was deemed interesting and timely to carry out a consensus conference using the RAND/UCLA method to collect the opinion of a group of experts in infectious diseases on the role of glycopeptides in the management of MRSA infections within several clinical scenarios and namely in pneumonia, bacteremia and endocarditis, joint replacement infections, skin and soft tissue infections, diabetic foot, abdominal infections and central nervous system infections. The scenarios proposed by the Scientific Committee have been validated by a group of experts in infectious diseases and then voted in three meetings of infectious disease specialists. The results obtained on each individual condition were analyzed and therapeutic recommendations on each of these were released.

17 Article Design and Synthesis of 4-Alkylidene-β-lactams: Benzyl- and Phenethyl-carbamates as Key Fragments to Switch on Antibacterial Activity. 2017

Giacomini, Daria / Martelli, Giulia / Piccichè, Miriam / Calaresu, Enrico / Cocuzza, Clementina Elvezia / Musumeci, Rosario. ·Department of Chemistry "G. Ciamician", University of Bologna, Via Selmi 2, 40126, Bologna, Italy. · Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy. ·ChemMedChem · Pubmed #28737008.

ABSTRACT: The emergence of multidrug-resistant bacterial strains is particularly important in chronic pathologies such as cystic fibrosis (CF), in which persistent colonization and selection of resistant strains is favored by the frequent and repeated use of antibacterial agents. Staphylococcus aureus is a common pathogen in CF patients that has an associated increased multidrug resistance. In previous studies we demonstrated that the presence of a 4-alkylidene side chain directly linked to a β-lactam appeared to strengthen the potency against S. aureus, especially against methicillin-resistant S. aureus (MRSA) strains. In the present study, 21 new 4-alkylidene-β-lactams were synthesized and evaluated for antibacterial activity. We designed the new compounds to have aryl, benzyl, or phenethyl-carbamate groups on the C3 hydroxyethyl side chain. We found a correlation between biological activity and the nitrogen substituent of the carbamate group, and two phenethyl-carbamate β-lactams were shown to be valuable antibacterial agents against selected linezolid-resistant strains, with a minimum inhibitory concentrations of 2-4 mg L

18 Article Antimicrobial resistance rates in gram-positive bacteria do not drive glycopeptides use. 2017

Gladstone, Beryl Primrose / Cona, Andrea / Shamsrizi, Parichehr / Vilken, Tuba / Kern, Winfred V / Malek, Nisar / Tacconelli, Evelina. ·Infectious Diseases, Department of Internal Medicine I, DZIF Partner, Tübingen University Hospital, Tübingen, Germany. · Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Milan, Italy. · Infectious Diseases, Department of Medicine, University Hospital and Medical Center and Albert-Ludwigs-University Faculty of Medicine, Freiburg, Germany. ·PLoS One · Pubmed #28727741.

ABSTRACT: Surveillance data are considered essential to appropriate empiric antibiotic therapy and stewardship. The objective of this study was to determine if a change in the rates of antibiotic resistance impacts antibiotic use in European hospitals. Glycopeptides use was selected to study the correlation between resistance rates and antibiotic use because of the restricted spectrum against resistant gram positive bacteria. PubMed, ECDC databases and national/regional surveillance systems were searched to identify glycopeptides´ consumption in defined daily dose per 1000 inhabitant-days (DID) and rate of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase negative staphylococci (MRCoNS), and vancomycin-resistant enterococci (VRE) in bloodstream infections (BSIs) in European countries between 1997 and 2015. Time trends were studied and associations between DID and BSI resistance rates were tested using multi-level mixed effect models. To account for the gap in the publication and dissemination of the yearly resistance data, a 2-year lag in the resistance rates was applied. Data on glycopeptides´ DID and resistance rates of target microorganisms in blood cultures were identified among 31 countries over a 19-year period. Glycopeptides use significantly increased (p<0·0001) while rates of MRSA BSIs decreased in majority of the countries (p<0·0001) and MRCoNS and VRE BSIs remained stable. Variation in glycopeptides' DID was not associated with variation in BSIs due to MRSA (p = 0·136) and VRE (p = 0·613). After adjusting for MRCoNS and VRE resistance rates, among 21 countries, 11 (52%) had a concordant and 10 (48%) a discordant trend in yearly glycopeptides´ DID and MRSA BSI rates. No correlation was found between resistance rates and DID data even among 8 countries with more than 5% decrease in MRSA rates over time. (RC -0·009, p = 0·059). Resistance rate of MRSA, MRCoNS, and VRE BSIs does not impact DID of glycopeptides in European hospitals. This finding is key to redefining the role and structure of antimicrobial surveillance and stewardship programmes.

19 Article Prevalence and molecular characteristics of Staphylococcus aureus, including methicillin resistant strains, isolated from bulk can milk and raw milk products in pastoral communities of South-West Uganda. 2017

Asiimwe, Benon B / Baldan, Rossella / Trovato, Alberto / Cirillo, Daniela M. ·Emerging Bacterial Pathogens Unit, IRCCS, Via Olgettina 58, Milan, Italy. basiimwe@chs.mak.ac.ug. · Universita Vita-Salute San Raffaele, Via Olgettina 58, Milan, Italy. basiimwe@chs.mak.ac.ug. · Department of Medical Microbiology, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. basiimwe@chs.mak.ac.ug. · Emerging Bacterial Pathogens Unit, IRCCS, Via Olgettina 58, Milan, Italy. · Universita Vita-Salute San Raffaele, Via Olgettina 58, Milan, Italy. ·BMC Infect Dis · Pubmed #28610560.

ABSTRACT: BACKGROUND: Staphylococcus aureus strains are now regarded as zoonotic agents. In pastoral settings where human-animal interaction is intimate, multi-drug resistant microorganisms have become an emerging zoonotic issue of public health concern. The study of S. aureus prevalence, antimicrobial resistance and clonal lineages in humans, animals and food in African settings has great relevance, taking into consideration the high diversity of ethnicities, cultures and food habits that determine the lifestyle of the people. Little is known about milk carriage of methicillin resistant S. aureus strains (MRSA) and their virulence factors in Uganda. Here, we present the prevalence of MRSA in bulk can milk and raw milk products in pastoral communities of south-west Uganda. We also present PFGE profiles, spa-types, as well as frequency of enterotoxins genes. METHODS: S. aureus was identified by the coagulase test, susceptibility testing by the Kirby-Bauer disc diffusion and E-test methods and MRSA by detection of the mecA gene and SCCmec types. The presence of Panton - Valentine Leucocidin (PVL) genes and staphylococcal enterotoxins was determined by PCR, while genotyping was by PFGE and spa typing. RESULTS: S. aureus were isolated from 30/148 (20.3%) milk and 11/91(12%) sour milk samples. mecA gene carriage, hence MRSA, was detected in 23/41 (56.1%) of the isolates, with 21 of the 23 (91.3%) being SCCmec type V; while up to 30/41 (73.2%) of the isolates were resistant to tetracycline. Only five isolates carried the PVL virulence gene, while PFGE typing revealed ten clusters (ranging from two seven isolates each) that comprised 83% of the sample, and only eight isolates with unique pulsotypes. The largest PFGE profile (E) consisted of seven isolates while t7753, t1398, and t2112 were the most common spa-types. Thirty seven of the 41 strains (90.2%) showed at least one of the eight enterotoxin genes tested, with sem 29 (70.7%), sei 25 (61%) and seg 21 (51.2%) being the most frequently observed genes. CONCLUSION: This is the first study to demonstrate MRSA and enterotoxin genes in raw milk and its products in Uganda. The fact that over 90% of the isolates carried at least one gene encoding enterotoxins shows a high risk of spread of foodborne diseases through milk in this setting.

20 Article 2,6-Difluorobenzamide Inhibitors of Bacterial Cell Division Protein FtsZ: Design, Synthesis, and Structure-Activity Relationships. 2017

Straniero, Valentina / Zanotto, Carlo / Straniero, Letizia / Casiraghi, Andrea / Duga, Stefano / Radaelli, Antonia / De Giuli Morghen, Carlo / Valoti, Ermanno. ·Department of Pharmaceutical Sciences, Università degli Studi di Milano, via Mangiagalli 25, 20133, Milano, Italy. · Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, via Vanvitelli 32, 20129, Milano, Italy. · Department of Biomedical Sciences, Humanitas University, via Manzoni 113, 2, 0089, Rozzano-Milano, Italy. · Humanitas Clinical and Research Center, via Manzoni 56, 20089, Rozzano-Milano, Italy. · Department of Pharmacological and Biomolecular Science, Università degli Studi di Milano, via Balzaretti 9, 20133, Milano, Italy. · Cellular and Molecular Pharmacology Section, National Research Council (CNR), Institute of Neurosciences, Università degli Studi di Milano, via Vanvitelli 32, 20129, Milano, Italy. · Catholic University "Our Lady of Good Counsel", Rr. Dritan Hoxha, Tirana, Albania. ·ChemMedChem · Pubmed #28586174.

ABSTRACT: A wide variety of drug-resistant microorganisms are continuously emerging, restricting the therapeutic options for common bacterial infections. Antimicrobial agents that were originally potent are now no longer helpful, due to their weak or null activity toward these antibiotic-resistant bacteria. In addition, none of the recently approved antibiotics affect innovative targets, resulting in a need for novel drugs with innovative antibacterial mechanisms of action. The essential cell division protein filamentous temperature-sensitive Z (FtsZ) has emerged as a possible target, thanks to its ubiquitous expression and its homology to eukaryotic β-tubulin. In the latest years, several compounds were shown to interact with this prokaryotic protein and selectively inhibit bacterial cell division. Recently, our research group developed interesting derivatives displaying good antibacterial activities against methicillin-resistant Staphylococcus aureus, as well as vancomycin-resistant Enterococcus faecalis and Mycobacterium tuberculosis. The aim of the present study was to summarize the structure-activity relationships of differently substituted heterocycles, linked by a methylenoxy bridge to the 2,6-difluorobenzamide, and to validate FtsZ as the real target of this class of antimicrobials.

21 Article Preoperative colonization in pediatric cardiac surgery and its impact on postoperative infections. 2017

Silvetti, Simona / Ranucci, Marco / Isgrò, Giuseppe / Villa, Valentina / Costa, Elena. ·Department of CardioVascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Piazza Edmondo Malan, Milan, Italy. · Hospital Health Direction, IRCCS Policlinico San Donato, Piazza Edmondo Malan, Milan, Italy. · Chemistry Laboratory, IRCCS Policlinico San Donato, Piazza Edmondo Malan, Milan, Italy. ·Paediatr Anaesth · Pubmed #28504326.

ABSTRACT: BACKGROUND: Patients with congenital heart defects are frequently hospitalized before surgery. This exposes them to a high risk for pathogen colonization. There are limited data on colonization prevalence in the pediatric cardiac population, and limited data concerning its potential role in the risk of developing infections after cardiac surgery. AIM: This study aimed to verify the impact of preoperative colonization on postoperative infections in a population of pediatric cardiac surgery patients coming from Italy and developing countries. METHODS: This was a retrospective study conducted in all the patients aged ≤18 years who underwent pediatric open-heart surgery in the year 2015. Clinical data were retrieved from the institutional database for cardiac surgery patients. Data on swab cultures were retrieved from the laboratory database. Swab colonization was tested for association with infection and other outcomes. RESULTS: Among 169 children who performed the screening for pathogen colonization, 50% had at least one positive swab. Italian patients were (P=.001) less likely to be colonized with respect to foreign patients (relative risk 0.17, 95% CI 0.09-0.35). Postoperative infections in colonized patients occurred at a similar rate as in noncolonized patients (relative risk 1.24, 95% CI 0.64-2.39; P=.532). Colonized patients had a preoperative stay (P=.021) longer than noncolonized patients (mean difference 2 days, 95% CI 0.3-3.8 days). CONCLUSION: The results of our study suggest that the impact of preoperative colonization on outcome and postoperative infections may be negligible; larger series are required to clearly define this issue.

22 Article Characteristics of Staphylococcus aureus Bacteraemia and Predictors of Early and Late Mortality. 2017

Bassetti, Matteo / Peghin, Maddalena / Trecarichi, Enrico Maria / Carnelutti, Alessia / Righi, Elda / Del Giacomo, Paola / Ansaldi, Filippo / Trucchi, Cecilia / Alicino, Cristiano / Cauda, Roberto / Sartor, Assunta / Spanu, Teresa / Scarparo, Claudio / Tumbarello, Mario. ·Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy. · Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy. · IRCCS AOU San Martino IST, Department of Health Sciences, University of Genoa; Genoa, Italy. · Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy. · Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy. ·PLoS One · Pubmed #28152067.

ABSTRACT: We aimed to describe the characteristics of patients with Staphylococcus aureus bacteremia and to evaluate the risk factors associated with early (7-day) and late (30-day) mortality. We performed an observational study including all consecutive episodes of Staphylococcus aureus bacteremia diagnosed at two Italian university hospitals during 2010-2014. A total of 337 patients were included. Mean age was 69 years (range, 57-78) and 65% were males. Methicillin-resistant S. aureus (MRSA) was identified in 132/337 (39%)cases. Overall 7- and 30-day mortality were 13% and 26%, respectively. Early mortality was associated with increased Charlson scores (OR 1.3, 95% CI 1.1-1.5), MRSA bacteremia (OR 3.2, 95% CI 1.4-8.1), presentation with septic shock (OR 13.5, 95% CI 5.4-36.4), and occurrence of endocarditis (OR 4.5, 95%CI 1.4-14.6). Similar risk factors were identified for late mortality, including increased Charlson scores (OR 1.2, 95% CI 1.1-1.4), MRSA bacteremia (OR 2.1, 95% CI 1.2-3.9), presentation with septic shock (OR 4, 95%CI 1.7-9.7), occurrence of endocarditis (OR 3.8, 95% CI 1.4-10.2) as well as Child C cirrhosis (OR 3.9, 95% CI 1.1-14.4) and primary bacteremia (OR 2.5, 95%CI 1.3-5). Infectious disease consultation resulted in better outcomes both at 7 (OR 0.1, 95% CI 0.05-0.4) and at 30 days (OR 0.4, 95% CI 0.2-0.7). In conclusion, our study highlighted high rates of MRSA infection in nosocomial Staphylococcus aureus bacteremia. Multiple comorbidities, disease severity and methicillin-resistance are key factors for early and late mortality in this group. In patients with Staphylococcus aureus bacteremia, infectious disease consultation remains a valuable tool to improve clinical outcome.

23 Article Molecular epidemiology of Panton-Valentine Leukocidin-positive community-acquired methicillin resistant Staphylococcus aureus isolates in pastoral communities of rural south western Uganda. 2017

Asiimwe, Benon B / Baldan, Rossella / Trovato, Alberto / Cirillo, Daniela M. ·Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 58, Milano, Italy. basiimwe@chs.mak.ac.ug. · Universita Vita-Salute San Raffaele, Via Olgettina 58, Milano, Italy. basiimwe@chs.mak.ac.ug. · Department of Medical Microbiology, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda. basiimwe@chs.mak.ac.ug. · Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 58, Milano, Italy. · Universita Vita-Salute San Raffaele, Via Olgettina 58, Milano, Italy. ·BMC Infect Dis · Pubmed #28056833.

ABSTRACT: BACKGROUND: The emergence of multidrug resistant Staphylococcus aureus strains, including methicillin resistant (MRSA), is a global concern. Treatment of bacterial infections in Uganda's health care settings is largely empirical, rarely accompanied by laboratory confirmation. Here we show the burden, characteristics of MRSA and epidemiology of Panton-Valentine Leukocidin (PVL) positive strains in asymptomatic carriers in pastoral households of south-west Uganda. METHODS: Nasal swabs from 253 participants were cultured following standard methodology. MRSA strains were identified by detection of the mecA gene and SCCmec typing, and PVL genes detected by PCR. Pulsed Field Gel Electrophoresis (PFGE) was done to evaluate possible transmission patterns. Spa typing of PVL positive isolates was done to study the epidemiology of virulent strains in this setting. RESULTS: S. aureus was isolated in 29% (n = 73) of the participants, of which 48 were MRSA by mecA typing. PVL-encoding genes were found in 49.3% (n = 36) of the 73 isolates, of which 25 were also mecA positive. Among the PVL negative strains (n = 37), 62.2% (n = 23) carried the mecA gene. The most common SCCmec type was V, detected in 39 (18 PVL positive and 21 PVL negative) isolates. PFGE clustered 21/36 (58.3%) PVL positive isolates divided in four pulsotypes and 18/37 (48.6%) PVL negative isolates divided in eight pulsotypes. The most prevalent Spa types were t318 (26.5%, n = 9) and t645 (20.6%, n = 7); while other common Spa types were t11656 (n = 3), t127 (n = 3) and t355 (n = 3). CONCLUSION: The study shows a high prevalence of community acquired (CA)-MRSA, and PVL-positive isolates with two predominant spa types in rural Uganda, further complicating infection control strategies in these underprivileged communities.

24 Article A stochastic model for MRSA transmission within a hospital ward incorporating environmental contamination. 2017

Lee, X J / Fulford, G R / Pettitt, A N / Ruggeri, F. ·School of Mathematical Sciences,Queensland University of Technology,Brisbane,Queensland,Australia. · Centre of Research Excellence in Reducing Healthcare Associated Infections (CRE-RHAI), Queensland University of Technology,Brisbane,Queensland,Australia. · Institute of Applied Mathematics and Information Technology (CNR IMATI), Italian National Research Council,Milano,Italy. ·Epidemiol Infect · Pubmed #27938427.

ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) transmission in hospital wards is associated with adverse outcomes for patients and increased costs for hospitals. The transmission process is inherently stochastic and the randomness emphasized by the small population sizes involved. As such, a stochastic model was proposed to describe the MRSA transmission process, taking into account the related contribution and modelling of the associated microbiological environmental contamination. The model was used to evaluate the performance of five common interventions and their combinations on six potential outcome measures of interest under two hypothetical disease burden settings. The model showed that the optimal intervention combination varied depending on the outcome measure and burden setting. In particular, it was found that certain outcomes only required a small subset of targeted interventions to control the outcome measure, while other outcomes still reported reduction in the outcome distribution with up to all five interventions included. This study describes a new stochastic model for MRSA transmission within a ward and highlights the use of the generalized Mann-Whitney statistic to compare the distribution of the outcome measures under different intervention combinations to assist in planning future interventions in hospital wards under different potential outcome measures and disease burden.

25 Article A thrombotic storm. 2017

Damanti, Sarah / Artoni, Andrea / Lucchi, Tiziano / Mannucci, Pier Mannuccio / Mari, Daniela / Bergamaschini, Luigi. ·Geriatric Unit IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. sarah.damanti@hotmail.it. · Department of Medical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. sarah.damanti@hotmail.it. · A.Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. · Geriatric Unit IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. · Department of Medical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. · Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy. · A.S.P. Pio Albergo Trivulzio, Milan, Italy. ·Intern Emerg Med · Pubmed #27878662.

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