Molecular Epidemiology of Multidrug-Resistant Acinetobacter baumannii in a Tertiary Care Hospital in Naples,Italy, Shows the Emergence of a Novel Epidemic Clone

The molecular epidemiology of multidrug-resistant Acinetobacter baumannii was investigated in two intensive care units of the V. Monaldi university hospital in Naples, Italy, from May 2006 to December 2007. Genotype analysis by pulsed-field gel electrophoresis (PFGE), trilocus sequence-based typing (3LST), and multilocus sequence typing (MLST) of A. baumannii isolates from 71 patients identified two distinct genotypes, one assigned to PFGE group A, 3LST group 1, and ST2 in 14 patients and the other to PFGE group B, 3LST group 6, and ST78 in 71 patients, that we named ST2/A and ST78/B, respectively. Of these, ST2/A corresponded to European clone II identified in the same hospital during 2003 and 2004; ST78/B was a novel genotype that was isolated for the first time in May 2006 but became prevalent during 2007. The ST78/B profile was also identified in five patients from two additional hospitals in Naples during 2007. The ST2/A and ST78/B isolates were resistant to all antimicrobials tested, including carbapenems, but were susceptible to colistin. Both ST2/A and ST78/B isolates possessed a plasmid-borne carbapenem-hydrolyzing oxacillinase gene, bla_OXA-58, flanked by ISAba2 and ISAba3 elements at the 5′ and 3′ ends, respectively. The selection of the novel ST78/B A. baumannii clone might have been favored by the acquisition of the bla_OXA-58 gene.Acinetobacter baumannii is an emerging opportunistic nosocomial pathogen, with increasing prevalence worldwide, responsible for a variety of nosocomial infections, especially in intensive care unit (ICU) patients (10, 15). Several hospital outbreaks caused by the selection of multiresistant A. baumannii clones have been described in Europe and worldwide (1, 10, 15, 27). Genotypic characterization of epidemic A. baumannii isolates through amplified fragment length polymorphism analysis has identified clusters of highly similar strains, which were assumed to represent distinct clonal lineages and were defined as European clones I, II, and III (9, 24). Similarly, three distinct groups were recently identified among A. baumannii isolates from five different countries by sequence-based typing (ST): group 1, corresponding to European clone II; group 2, corresponding to European clone I; and group 3, corresponding to European clone III (22). Moreover, epidemics caused by A. baumannii genotypes assigned to novel ST groups 4 and 5 have been recently described in different Greek and Turkish cities (11). The majority of the outbreaks occurring in Europe were caused by carbapenem-resistant strains that carried the bla_OXA-58 gene or a distinct carbapenem-hydrolyzing oxacillinase (CHDL) gene (4, 8, 11-13, 16, 20, 27, 28).We have previously reported the occurrence of two sequential outbreaks from August 1999 to February 2001 and from January 2002 to December 2002 along with the emergence of carbapenem-resistant A. baumannii in the ICU of the Federico II university hospitals in Naples, Italy, during 2002 (26). More recently, we have shown that the same epidemic A. baumannii clone isolated during 2002 was responsible for a large and sustained outbreak in the V. Monaldi tertiary care teaching hospital of Naples between June 2003 and June 2004 (25). An increase in the number of cases of A. baumannii infection was observed after 2 years in the V. Monaldi hospital. The objectives of the present study were (i) to investigate the molecular epidemiology of A. baumannii in the V. Monaldi hospital, (ii) to study the genetic characteristics of A. baumannii isolates responsible for the epidemic, and (iii) to analyze the antimicrobial susceptibilities of the A. baumannii isolates and their mechanisms of resistance.     

Hazard and risk assessment of a nanoparticulate cerium oxide-based diesel fuel additive - a case study

Envirox is a scientifically and commercially proven diesel fuel combustion catalyst based on nanoparticulate cerium oxide and has been demonstrated to reduce fuel consumption, greenhouse gas emissions (CO(2)), and particulate emissions when added to diesel at levels of 5 mg/L. Studies have confirmed the adverse effects of particulates on respiratory and cardiac health, and while the use of Envirox contributes to a reduction in the particulate content in the air, it is necessary to demonstrate that the addition of Envirox does not alter the intrinsic toxicity of particles emitted in the exhaust. The purpose of this study was to evaluate the safety in use of Envirox by addressing the classical risk paradigm. Hazard assessment has been addressed by examining a range of in vitro cell and cell-free endpoints to assess the toxicity of cerium oxide nanoparticles as well as particulates emitted from engines using Envirox. Exposure assessment has taken data from modeling studies and from airborne monitoring sites in London and Newcastle adjacent to routes where vehicles using Envirox passed. Data have demonstrated that for the exposure levels measured, the estimated internal dose for a referential human in a chronic exposure situation is much lower than the no-observed-effect level (NOEL) in the in vitro toxicity studies. Exposure to nano-size cerium oxide as a result of the addition of Envirox to diesel fuel at the current levels of exposure in ambient air is therefore unlikely to lead to pulmonary oxidative stress and inflammation, which are the precursors for respiratory and cardiac health problems.     

Elderly patients with non-cardiac admissions and elevated high-sensitivity troponin: the prognostic value of renal function

BACKGROUND High-sensitivity cardiac troponin(hs-cTn) levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events. However, most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities.AIM To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels.METHODS In this retrospective study, we selected patients who were aged ≥ 65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons. Eligible patients were those who had hs-cTnI concentrations ≥ 100 ng/L. We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis.RESULTS One hundred and forty-six patients(59% female) were selected with an age range from 65 to 100(mean ± SD: 85.4 ± 7.61) years. The median hs-cTnI value was 284.2 ng/L. For 72(49%) patients the diagnosis of hospitalization was an infectious disease. The overall in-hospital mortality was 32%(47 patients). Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive(median: 314.8 vs 282.5 ng/L; P = 0.565). There was no difference in mortality in patients with infectious vs non-infectious disease(29% vs 35%). Multivariable analysis showed that age(OR 1.062 per 1 year increase, 95%CI: 1.000-1.127; P = 0.048) and creatinine levels(OR 2.065 per 1 mg/dL increase, 95%CI: 1.383-3.085; P 0.001) were the only independent predictors of death. Mortality was 49% in patients with eGFR 30 mL/min/1.73 m2.CONCLUSION Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons. The presence of severe renal impairment is a marker of extremely high in-hospital mortality.     

Role of the Adenoplus test in refractory,recurrent and clinically undiagnosed conjunctivitis

Background

In diagnosing adenoviral conjunctivitis, polymerase chain reaction (PCR) is widely adopted as a diagnostic tool. A new antigen-based immunoassay test (AdenoPlus; Rapid Pathogen Screening Inc, Sarasota, Fla.) is commercially available as an alternative diagnostic test. To date, evidence around the role of this test in the clinical setting has been limited and contradictory.

Intra-operative intravenous fluid restriction reduces perioperative red blood cell transfusion in elective cardiac surgery,especially in transfusion-prone patients: a prospective,randomized controlled trial

Background  

Cardiac surgery is a major consumer of blood products, and hemodilution increases transfusion requirements during cardiac surgery under CPB. As intraoperative parenteral fluids contribute to hemodilution, we evaluated the hypothesis that intraoperative fluid restriction reduces packed red-cell (PRC) use, especially in transfusion-prone adults undergoing elective cardiac surgery.     

Prevalence of clinical vaginal candidiasis in a university hospital and possible risk factors

OBJECTIVE: The aim of this study was to evaluate the prevalence of symptomatic vaginal candidiasis and probable predisposing factors in a university-based hospital. STUDY DESIGN: A total of 576 cases of clinical vaginal candidiasis were enrolled in this survey and wet mount preparations, Gram-stained smears and vaginal cultures were assessed. Possible risk factors, such as pregnancy, diabetes mellitus, contraceptive and antibiotic use were evaluated. RESULTS: Clinical vaginal candidiasis was detected in 12.1% of the cases. Candida albicans was isolated in 80.2% of patients and non-albicans species in 19.8%. Pruritus was the most common symptom (85.9%), followed by vaginal discharge (66.1%), soreness (31.1%) and dyspareunia (5.0%). Reproductive age, pregnancy, diabetes, contraception as well as recent antibiotic use correlated positively with both C. albicans and non-albicans isolates. Soreness and dyspareunia were significantly related to non-albicans species. The overall recurrence rate was 8.5%. Recurrences correlated positively to non-albicans infections. CONCLUSIONS: C. albicans was, by far, the predominant yeast isolate. Non-albicans isolates caused significantly more frequent soreness, dyspareunia and recurrences than C. albicans. Clinical and laboratory findings, together with possible predisposing factors must be taken into consideration in order to achieve appropriate treatment.