Volume 8, Issue 1, 2000
Review
Setting priorities in the prevention and control of nosocomial infections: an economic perspective
Tramarin Andrea,
Bragagnolo Luciana,
Scagnelli Mariuccia,
de Lalla Fausto
Nosocomial infections are a good indicator of the quality of health care provided by hospitals. Despite their cost-effectiveness, nosocomial infection programs are rarely applied in Italy. Epidemiological surveillance is the simplest measure to adopt because it allows us to monitor the baseline endemic rates, identify new epidemics and assess the improvements achieved by interventions provided. The presence of continuous epidemiological surveillance must be considered the exception rather than the rule in Italy. In this paper, the prevention of nosocomial infections was analysed through two economic evaluation techniques (i.e. cost-benefit and cost effectiveness). A hierarchy of intervention based on cost effectiveness, hospital size and organisational setting was also provided. The main conclusions are the following: 1. Benefits associated to prevention of nosocomial infections are considered small because of the uncertainty associated to the future. Therefore a discount factor must be applied. 2. Local factors and specific reasons are usually advocated to explain the simple fact that infection control programs are only formally implemented and usually limited to the constitution of a nosocomial infections committee. 3. The prevention of nosocomial infections must be provided for under specific laws which take into account the various organisations and structures found in different hospitals.
Fifty years of cephalosporins: rationale for success
Cornaglia Giuseppe
The cephalosporins constitute the antibiotic class possibly showing the widest flexibility of usage, due to their very great versatility in terms of molecular features, antibacterial spectrum, and administration schedules. In this half-century, cephalosporins have undoubtedly figured as one of the most commonly used and most successful classes of antibiotics against a vast range of bacterial infections.
Cephalosporin activity against Gram-positive bacteria is generally good and, above all, largely predictable on the basis of the epidemiological data. Methicillin-resistant staphylococci and enterococci, of course, are excluded from their spectrum of action. Despite the diffusion of resistance mechanisms among Gram-negative organisms, mostly broad- and extended-spectrum beta-lactamases, cephalosporins are still highly effective against the vast majority of H. influenzae, Enterobacteriaceae and, albeit to a lesser extent, Pseudomonas spp. The growing diffusion of resistance, however, makes thorough assessment of antibiotic assay data mandatory, especially for Gram-negative strains isolated from departments at particularly high risk.
Observance of these basic precautions may contribute towards the improved use of cephalosporins and towards maintaining their substantial efficacy in the face of the disturbing worldwide increase in resistance to all known antibiotics.
Original article
Clinical and molecular epidemiology of an outbreak of infusion-related Acinetobacter baumannii bacteremia in an Intensive Care Unit
Menichetti Francesco,
Tascini Carlo,
Ferranti Simone,
Moroni Alcide,
Baldoni Lucia,
Bozza Silvia,
Fedele Monica,
Bifarini Giuliano,
Del Favero Albano,
Bistoni Francesco,
no surname no name
Objective: To describe the clinical and molecular epidemiology of an outbreak of infusion-related Acinetobacter baumannii bacteremia in an intensive care unit (ICU).
Methods: Six cases of A. baumannii bacteremia identified in the Foligno Hospital ICU, Italy, were peer reviewed. Antibiotic susceptibility and genotyping (PFGE and RAPD) of A. baumannii isolates were carried out.
Results: All A. baumannii blood isolates and a strain isolated from parenteral solution had an identical genotype. The strains were susceptible to carbapenems and the combination of meropenem plus amikacin or piperacillin/ tazobactam plus netilmicin was synergistic. A. baumannii bacteremia persisted for several days in almost all patients; catheter tip cultures were always positive for A. baumannii. Three patients, with an elevated Apache II score, died of sepsis.
Conclusions: The outbreak was related to contaminated parenteral solutions improperly prepared in the ward. Aseptic preparation in the hospital pharmacy allowed for an interruption of the outbreak.
Evolution of hepatitis G in children with vertically transmitted HGV
Minola Eliseo,
Berera Francesca,
Fracassetti Osvaldo,
Quinzan Giampaolo,
Lorenzi Natale,
Delvecchio Giacomo
Background A new hepatitis-associated RNA virus, belonging to the Flaviviridae, has been recently discovered and called HGV (GBV-C). This virus has been shown to be transmitted parenterally. In this study we examined a group of children born to HCV infected women.
Methods Between September 1994 and December 1998, we studied a cohort of 53 pregnant women, aged between 20 and 43 years. They were all HCV Ab and HCV RNA positive, with a diagnosis of chronic hepatitis. One patient was HbsAg positive and 4 patients (pts.) (7.5%) were HIV Ab positive. Anamnestic information revealed that: 28 pts. (52.8%) were IVDUs, 11 pts. (20.8%) had been haemotransfused and 14 pts. (26.4%) had no risk factors. We examined HGV RNA by RT nested PCR, using primers from the 5’UTR of HGV. Anti-HGV antibodies (anti-E2) were detected with an ELISA test using recombinant E2 protein. Ten of the 53 pregnant women (18.9%) were HGV RNA positive (32 other pts., 60.4%, were positive for anti-E2 antibodies). We monitored their children for 18-24 months (with clinicai and haematological controls), looking for HGV RNA, anti-E2 antibodies, HCV RNA and for ALT serum levels.
Results Seven (70%) new-bom children proved HGV RNA positive at follow-up; all babies were HCV RNA negative at controls. Four of them were born vaginally; none of them was breast-fed. HGV RNA was first detectable at the 3rd month of life in 3 babies, and all babies were HGV RNA positive at the 6th month of life. Six babies (85.7%) remained positive during the observation period. One baby (14.3%) seroconverted at 10 months, developing anti E-2 antibodies and becoming HGV RNA negative. Four babies (57.1%) maintained normal ALT serum levels during the whole follow-up period, while 3 patients showed a low increase in ALT serum levels. The ALT values normalised at later controls.
Conclusions HGV infection shows a very high (70%) rate of vertical transmission but a low and doubtful pathogenicity with asymptomatic evolution in babies. Patients who did not develop anti-E2 antibodies at the 12th month of life remained infected without persistent signs of hepatic failure.
In vitro susceptibility of different erythromycin-resistant phenotypes of Streptococcus pyogenes to moxifloxacin and other fluoroquinolones
Noviello Silvana,
Ianniello Filomena,
Esposito Silvano,
Novelli Andrea
The aim of the present study was to evaluate the in vitro activity of moxifloxacin (BAY 12-8039) compared with ciprofloxacin, ofloxacin and sparfloxacin against 156 Group A beta-haemolytic Streptococcus (GABHS) strains.
Sixty strains were macrolide- lincosamide- and streptogramin B susceptible; 16 strains exhibited a constitutive resistance phenotype; 32 strains exhibited an inducible phenotype; and 48 strains were characterized by the M-type efflux-dependent phenotype. The MICs were determined by an agar dilution method according to NCCLS-approved guidelines.
Moxifloxacin showed an enhanced activity compared with the other fluoroquinolones against all the different macrolide-resistant phenotypes.
Case report
Recurrent cystopyelitis related to inguinal bladder hernia: a case report evaluated by color Doppler US
Sapienza Mauro,
Farina Renato,
Pennisi Francesco,
Costa Salvatore,
Di Gregorio Pietro
The authors describe an unusual inguinal bladder hernia responsible for recurrent urinary tract infections.
The Eco Color Doppler technique allowed correct diagnosis of the pathology, whose first signs (recurrent cystopyelitis) could have been erroneously correlated to the diabetic status of the patient Subsequently, the authors stress the importance of this technique as a useful tool to ensure swift and correct diagnosis.
The Infections in the History of Medicine
Malaria in Bologna in the eighteenth and nineteenth centuries: environment and the role of human intervention
Sabbatani Sergio,
Sandri Antonio
The authors, after an excursus on the events that have characterised the territorial attitude in the plain to the north of Bologna, emphasising the strong influence that the work of man has developed (development of the rice growing, presence of the residues for hemp’s processing, construction of military defenses, etc.) on the deterioration of this territory, they analyse the characteristics of the malarial endemic that affected the area of Bologna in the XVIII and XIX century.
After the specification of the part that the plentiful atmospheric precipitations of the end of XIX century played, they describe the course of the malarial epidemic which affected Bologna between 1899 and 1901. By using a Geographic information System (G.I.S) they state in which places the malaria affected and they point out its epidemiological characteristics.
