Rhino-cerebral zygomycosis (RCZ) is an acute rapidly progressive fungal infection usually occurring in patients with diabetes mellitus and ketoacidosis. Patients typically complain of pain located in the facial, nasal or orbital regions, followed by sudden blindness and cranial nerve palsy. Early diagnosis, correction of risk factors, prompt surgical removal and aggressive antifungal therapy are warranted as life-saving treatments. The following report describes a case of a lethal RCZ which occurred in an apparently healthy woman with latent non-decompensated diabetes mellitus and a fetal-type posterior (FTP) circle of Willis.

INTRODUCTION: Among the health professions with a long period of training, the students of the Nursing Bachelor's Degree are the most exposed to biological risk resulting from accidents, in particular with needles and cutting edges. The aim of the study was to estimate the frequency and the circumstances for the occurrence of needle stick injuries, as a knowledge base for targeted prevention interventions. METHODS: The study was carried out between May and July 2017 in 11 Universities in Italy and 1 in Albania (associated with the "Tor Vergata" University of Rome). An anonymous semi-structured questionnaire was proposed to 1st (second semester), 2nd and 3rd year students of Nursing Bachelor's Degree. RESULTS: A total of 2742 questionnaires were collected. The average age of participants was 22.9 years (median 22, range 19-60 years), 73% of whom were females. A total of 381 injuries were reported. Three hundred and sixteen students (11.8%) underwent at least 1 injury (12.7% among females, 9.7% among males); 41 students declared two or more injuries; four students did not report the number of injuries occurred. The first injury occurred, as an average, 17 days after the start of the internship (median 15 days) and, in 25% of the cases, during the first 9 days. The highest percentage of accidents occurred during the first internship (25.3% of the total) and decreased with the progress of the training path. The injuries occurred in 38% of cases during drug preparation, 24% when disposing of sharp devices, 15% while re-capping needles, 13% during blood sampling and 10% in other circumstances. In 51.2% of cases, the needle was not sterile. Among the nursing students who suffered a needle stick injury, 58.1% declared that they had performed the post-exposure prophylaxis. 96% of students stated to be vaccinated against Hepatitis B virus. Amongst the students who had their serological status checked (74%), 18% stated the antibody titre was not protective. 49.8% of students answered to have been trained in advance on the correct procedures to avoid needle stick and cutting edges injuries in each clinical ward attended, 41.2% referred that this occurred only in some wards and 10% in no ward at all. CONCLUSION: The results of this study show a high percentage of needle stick injuries in students of the Nursing Bachelor's Degree. Therefore, there is a need for careful reflection on the most effective methods of targeted training acquisition of knowledge, skills and behavioural models useful for the exercise of the profession.

The purpose of this study was to describe the susceptibility of environmental strains of Legionella spp. to 10 antimicrobials commonly used for legionellosis therapy. A study of environmental strains could be useful to timely predict the onset of antibiotic resistance in the environment before it is evidenced in clinical specimens.

Nosocomial yeast infections have increased significantly worldwide and especially in surgical and intensive care unit (ICU) patients. Although Candida species have various degrees of susceptibility to frequently used drugs, antifungal resistance is rare. A ten-year retrospective surveillance of candidemia was carried out in a University Hospital of Southern Italy. The aim of this study was the determination of Candida bloodstream infections (BSI) and central venous catheter (CVC)-related episodes, prevalence and in vitro susceptibility. 320 candidemia episodes were registered and 374 yeasts collected. Etest and Sensititre methods were used to test the isolates' susceptibility to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, posaconazole and voriconazole. The results were compared with those of CLSI reference broth microdilution method. Most yeasts were susceptible to all antifungal drugs, with the exception of C. glabrata susceptibility to triazoles and C. tropicalis to fluconazole and voriconazole. As expectedC. parapsilosis isolates were generally associated with higher echinocandin minimum inhibitory concentrations (MICs) than the other Candida species. This study confirms the different antifungal susceptibility patterns among species, and underlines the need to perform antifungal susceptibility testing of clinically relevant yeasts.

BACKGROUND The Italian meat supply chain is a large-scale industry typically characterized linked to circuit of DOP (Protected Designation of Origin) products. In this reality all workers are exposed to a wide range of biological agents that have developed antibiotic resistance and, therefore, represent a public and occupational health issue. METHODS An anamnestic semi-structured interview was performed to the study participants, in order to better define the risk exposure, which was followed by physical examination of the skin and skin appendages. Samples of nasal swabs were sown, within 24 hours, in Mannitol Salt Agar growth medium, specific for the detection of Staphylococcus Aureus. After an incubation period, we selected positive colonies for S. aureus in order to undergo genetic tests to detect the presence of MRSA. MRSA positive samples were analyzed, at last, with a specific PCR for the ST398, swine specific sequence type. RESULTS 162 workers joined the study, which was performed a physical examination of hand skin, a nasal swab and then given an anamnestic semi-structured interview. The sample was composed of 139 males and 23 females, mean age 45 years, with average seniority of 10 years. From 162 nasal swabs championships, a first analysis of culture media for Staphylococcus Aureus showed 35 positive (21.6%). The molecular analysis revealed only one MRSA sample, belonging to a butcher's meat processing company. (0.6%). The molecular analysis did not confirm the positivity for genotype 398, which characterizes the infection in pigs. CONCLUSION Recontamination with Staphylococcus Aureus occurs via surface treating machinery, as a result of fecal contamination at evisceration, or via increased human handling during meat processing. Our study revealed a low risk for MRSA, because of superficial heat treatments such as scalding and flaming that reduce significantly the burden of MRSA on the carcasses.

BACKGROUND: The practice of tattooing and piercing has expanded in western society. In order to verify young adults' knowledge of the risk and practices related to body art, an investigation was conducted among freshmen of the University of Bari in the region of Apulia, Italy. METHODS: The study was carried out in the Academic Year 2009-2010 through an anonymous self-administered written questionnaire distributed to 1.656 freshmen enrolled in 17 Degree Courses. RESULTS: Of the 1.598 students included in the analysis, 78.3% believe it is risky to undergo piercing/tattoo practices. AIDS was indicated as a possible infection by 60.3% of freshmen, hepatitis C by 38.2%, tetanus by 34.3% and hepatitis B by 33.7% of the sample. 28.1% of freshmen were not aware that there are also non-infectious complications. 29% of the sample had at least one piercing or tattoo (this percentage does not include earlobe piercing in women). Of those with body art, the decision to undergo body art was made autonomously in 57.9% of the participants. 56.3% of freshmen undergoing body art had taken less than a month to decide. With regard to the reasons that led the sample to undergo body art, 28.4% were unable to explain it, 23.8% answered to improve their aesthetic aspect, 18.4% to distinguish themselves from others, 12.3% for fashion; 17.1% for other reasons. 25.4% of the sample declared that they had a piercing (79.8% female vs 20.2% male; ratio M/F 1:4.0). The average age for a first piercing was 15.3 years (range 10-27; SD ± 2.9). 9.6% of the sample declared that they have a tattoo (69.9% female vs 30.1% male; ratio M/F 1:2.3). The average age for a first tattoo was 17.5 years (range 10-26, SD ± 2.4). CONCLUSIONS: Most of the freshmen knew about AIDS-related risks but not other potential risks. Body art is fairly common among young adults (especially women). The decision is often not shared with the family and is undertaken mostly without a specific reason or for the improvement of aesthetic aspect. Information about freshmen's knowledge, attitudes and practices could help in effective planning of health promotion strategies

Multiple-site colonization with Candida spp. is commonly recognized as a risk factor for invasive fungal infection in critically ill patients. We carried out a study to determine the relationship between Candida colonization and invasive infection in neurological patients admitted to an ICU. At admission (T0) and every three days for two weeks, different samples (pharynx swab, tracheal secretions, stomach contents, etc.) were collected for mycological surveillance. Candida mannan antigen and Candida anti-mannan antibodies were assayed. The Colonization Index (CI) and Corrected Colonization Index were calculated for each time point. Of all patients 70% was already colonized by Candida spp. at T0 and six of them had CI ≥ 0.5. Three patients developed candidemia; they had CI ≥ 0.5 before infection. Positive values of Candida mannan antigen and anti-mannan antibodies were found only in the patients with candidemia. The sensitivity and specificity of the Candida mannan test were 66.6% and 100%, respectively, while the sensitivity and specificity of the anti-mannan antibody test were 100%. In accordance with other authors, we find the surveillance cultures are useful to monitor the Candida colonization in ICU patients. In addition, the sequential observation of anti-mannan antibodies could contribute to early diagnosis of candidiasis more than Candida mannan antigen in immunocompetent patients.

BACKGROUND: Almonds are healthy nutraceuticals, which vary across different cultivars. We compared the composition, agreeability and gastrointestinal effects of two almond cultivars from different areas. METHODS: Californian Carmel (CAcv) and local Apulian Filippo Cea (FCcv) cultivars were compared for the chemical composition and sensory evaluation according to visual analogue and semiquantitative scales in 60 volunteers. Gallbladder/gastric motility (ultrasonography) and orocecal transit time (H2-breath test) were studied in another 24 subjects by comparing the effects of a standard liquid test meal with isovolumetric almond test meals (24 g of CAcv or FCcv almonds). RESULTS: Proteins prevailed in CAcv, while FCcv contained more lipids and 10-times more total phenol content than CAcv. For agreeability, CAcv scored higher than FCcv for smell, texture and appearance, although different perceptions existed in lean (scores for smell, taste, texture, appearance higher for CAcv than FCcv), obese (CAcv better than FCcv only for appearance) and elderly subjects (CAcv better than FCcv only for texture). Gallbladder emptying was stronger with FCcv than CAcv. Antral dilatation after ingestion of both cultivars was greater than the dilatation observed after the test meal. Gastric emptying, however, was similar after FCcv, CAcv and the test meal. The orocecal transit time in response to both cultivars was shorter than after the test meal. CONCLUSIONS: Differences in composition and effects of FCcv and CAcv cultivars support their potential use as valuable nutraceutical tools, to be confirmed in further clinical studies.

According to Italian Ministerial Decree No. 185 of 12 June 2003, water is considered suitable for irrigation if levels of fecal bacteria (i.e., Escherichia coli and Salmonella) are within certain parameters. The detection of other microorganisms is not required. The aim of this study is to determine the bacteriological quality of groundwater used for irrigation and the occurrence of enteric viruses (Norovirus, Enterovirus, Rotavirus, Hepatovirus A), and to compare the presence of viruses with the fecal bacteria indicators. A total of 182 wells was analyzed. Widespread fecal contamination of Apulian aquifers was detected (141 wells; 77.5%) by the presence of fecal bacteria (i.e., E. coli, Salmonella, total coliforms, and enterococci). Considering bacteria included in Ministerial Decree No. 185, the water from 35 (19.2%) wells was unsuitable for irrigation purposes. Among 147 wells with water considered suitable, Norovirus, Rotavirus, and Enterovirus were detected in 23 (15.6%) wells. No Hepatovirus A was isolated. Consequently, 58 wells (31.9%) posed a potential infectious risk for irrigation use. This study revealed the inadequacy of fecal bacteria indicators to predict the occurrence of viruses in groundwater and it is the first in Italy to describe the presence of human rotaviruses in well water used for irrigation.

BACKGROUND: Candidemia has become an increasingly important problem in infants hospitalized in the Neonatal Intensive Care Units (NICUs). Candida species are the third most common agents of late-onset infections in critically ill neonates and they are associated with high morbidity and mortality rates. In this study we evaluated the epidemiology of Candida bloodstream infections in the NICU of an Italian university hospital during a 15-year period. Our specific aims were to analyze the change in species distribution and the vitro susceptibility of these yeasts to fluconazole (FCZ) and amphotericin B (AmB). METHODS: A retrospective study of candidemia in the NICU of a university hospital in southern Italy, covering the years 2000-2014 was carried out. The isolates were identified using the VITEK2 yeast identification system and antifungal susceptibility was determined using the E-test method. RESULTS: Among the 57 patients with confirmed candidemia, 60% were males (n = 34 cases) and 82% (n = 47) had a gestational age of 24-32 weeks. Twenty-seven neonates (47%) had a very low birth weight (<1500 g), 20 (35%) an extremely low birth weight (<1000 g), and 10 (18%) a low birth weight (<2500 g). The most important potential risk factors were the placement of a central venous catheter, total parenteral nutrition, and endotracheal intubation (100%, each). Candida albicans was the most frequent yeast (47%), followed by Candida parapsilosis (44%). The proportion of Candida non-albicans increased slightly, from 46% in 2000-2004 to 71% in 2010-2014 (χ2 test for trend, p = 0.030). All isolates were susceptible to FCZ and AmB. CONCLUSIONS: The detection in this epidemiologic study of an increase in Candida non-albicans highlights the importance of correct species-level identification in the rapid diagnosis for an efficient treatment of candidemia. Knowledge of the local epidemiological trends in Candida species isolated in blood cultures will facilitate therapeutic decision-making.

Purpose: The aims of this study are to evaluate the epidemiology of invasive fungal infections (IFIs) in patients admitted to an intensive care unit (ICU) in Southern Italy and the in vitro antifungal susceptibility of isolates. Methods: A surveillance program was implemented in 18 ICUs. IFI cases were recorded using a standardized form. Results: A total of 105 episodes of IFIs occurred in 5,561 patients during the 18-month study. The main infections were caused by yeasts, more than filamentous fungi (overall incidence of 16.5 cases per 1,000 admissions and 2.3 cases per 1,000 admissions, respectively). The overall crude mortality rate was high (42.8 %), particularly for mold infections (61.5 %). All yeast infections were Candida bloodstream infections. Over half (59.8 %) were caused by Candida non-albicans, with C. parapsilosis being the most common (61.8 %). In the multivariate model, trauma admission diagnosis, prolonged stay in the ICU, and parenteral nutrition were independently associated with candidemia due to C. parapsilosis [odds ratio (OR) 3.5, (1.8-5.2); OR 3.5, (1.02-3.5); OR 3.6, (1.28-6.99), respectively]. Among mold infections, 12 patients suffered from invasive pulmonary aspergillosis, with Aspergillus fumigatus as the predominant pathogen (41.7 %). One case of brain scedosporiosis was identified. Overall, azoles and echinocandins resistance was uncommon. Conclusions: Candida non-albicans species are the most frequent cause of candidemia in ICU patients. Mold infections are associated with a high mortality rate. This study confirms the importance of the epidemiological surveillance on IFIs in the ICU setting for documenting species distribution and antimicrobial susceptibility patterns to guide therapeutic choices.

Legislators have implemented policies to improve food labelling to protect consumers and to make the presentation of ingredients and nutritional information more transparent. Proper food labelling allows consumers who may suffer from food allergies or intolerances to know exactly what ingredients a product contains, and it also helps them make more informed health and nutrition choices. This paper deals with the most current European and Italian legislation on food labelling, actions taken in non-EU countries to increase health choices, and the expected impact on Public Health.

We determined the in vitro antifungal activity of liposomal amphotericin B (L-AmB) against 604 clinical yeast isolates. Amphotericin B deoxycholate (D-AmB) was tested in parallel against all the isolates. Susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) M27-A3 method. Overall, L-AmB was highly active against the isolates (mean MIC = 0.42 μg/ml; MIC90= 1μg/ml; 97.2% of MICs were ≤ 1μg/ml) and comparable to D-AmB (mean MIC = 0.48μg/ml; MIC90= 1μg/ml; 97.3% of MICs were ≤ 1μg/ml). The in vitro activity of D-AmB and L-AmB was correlated (R2 = 0.61; exp (Coef.) = 2.3; 95% IC= 2.19-2.44, p&lt;0.001). Candida albicans (mean MICs of D-AmB and L-AmB, 0.39 μg/ml and 0.31 μg/ml, respectively) and Candida parapsilosis (mean MICs of D-AmB and L-AmB, 0.38 μg/ml and 0.35 μg/ml, respectively) were the species most susceptible to the agents tested, while Candida krusei (currently named Issatchenkia orientalis) (mean MICs of D-AmB and L-AmB, 1.27 μg/ml and 1.13 μg/ml, respectively) was the least susceptible. The excellent in vitro activity of L-AmB may have important implications for empirical treatment approaches and support its role in treatment of a wide range of invasive infections due to yeasts

The antifungal susceptibilities of 598 isolates of Candida spp. (bloodstream, other sterile sites) to liposomal amphotericin B (L-AmB) versus amphotericin B (AmB) were determined. Minimal inhibitory concentrations (MICs) were calculated using the Clinical and Laboratory Standards Institute broth microdilution (BMD; M27-A3) method for L-AmB and the E-test method for AmB. The MIC50/MIC90 (µg ml-1) values for L-AmB BMD and AmB E-test were 0.25/1 and 0.19/0.5, respectively. The overall essential agreement (± 2 dilutions) was 91.5%, ranging from 37.5% (Candida lusitaniae) to 100% (Candida glabrata and Candida krusei). Categorical agreement (CA) between the two methods was categorized on the basis of previously published breakpoint (susceptible/resistant MIC cut-off of 1 µg ml-1). The overall CA at the 48-h reading was 97.3%, ranging from 72.7% (C. krusei) to 100% (Candida albicans). Major and very major discrepancies occurred in 2.3% and 0.3%, respectively. Spearman's rho was 0.48 (p < 0.0001). These results demonstrate the utility of the AmB E-test as a surrogate marker to predict the sensibility and resistance of Candida species to L-AmB, and thus to support its use in antifungal treatment.

This study furnishes deeper insights to previous works on anidulafungin, demonstrating the potent activity against Candida strains planktonic cells and biofilms. Candida sp., associated with many biomaterial-related infections, give rise to infective pathologies typically associated with biofilm formation. We recently determined the in vitro antifungal activities of echinocandin anidulafungin in association with some antifungal drugs against some Candida strains in their planktonic states. A total of 11 Candida strains biofilms were tested in this study: six Candida albicans, three C. parapsilosis and two C. tropicalis. All yeast isolates and ATCC strains were stored at 20 1C in glycerol stocks and were subcultured on antimicrobial agent-free Sabouraud dextrose agar plates. MIC endpoints were determined colorimetrically by using the indicator 2,3-bis(2-methoxy-4-nitro-5- sulphophenyl)-5-[(phenylamino)carbonyl]-2H-tetrazolium hydroxide (XTT) with menadione as electron-coupling agent. The activity of anidulafungin was assessed using in vitro microbiological model relevant for clinical practice. Anidulafungin showed a strong activity in vitro against both planktonic and biofilms cells, and our study confirms that high anidulafungin concentrations might establish paradoxical growth effect in C. albicans and C. tropicalis biofilms.

In this paper the authors investigated a synergistic antimycotic effect between four antifungal drugs Ampho- tericin B, Fluconazole, Tioconazole, and Flucytosine individually combined with Anidulafungin compound. This latter is considered a drug of choice in the treatment of fungal infections; it has good activity both in vitro and in vivo against yeasts and moulds, as Candida and Aspergillus. The goal of this study was to evaluate the in vitro interaction of Anidula- fungin in the synergic combinations with previous reported drugs against 12 Candida strains according to CLSI M27-A3 protocol. A synergistic interaction was observed against the most antifungal strains; in particular an increasing of the an- timycotic efficacy was obtained from the association between Anidulafungin and Amphotericin B or Fluconazole (Mix- ture 4:6). In contrast the association Tioconazole/Anidulafungin was less effective on fungal species growth. The antimy- cotics MIC reduction values were more evident against some strains as C. glabrata, C. krusei, C. tropicalis and C. parap- silosis.

The aim of this multicenter prospective study was to evaluate the incidence of invasive fungal infections (IFIs) in adult and pediatric patients with hematologic malignancies, involving nine nosocomial facilities in Southern Italy over a period of 18 months. Furthermore, results of an environmental microbial surveillance routinely carried out in some of the enrolled hospitals are reported. A total of 589 oncohematological patients were enrolled and 27 IFIs were documented. The main infections were caused by yeasts, more than filamentous fungi (overall incidence of 2.7% and 1.9%, respectively). The yeasts were mainly represented by Candida spp. (87.5%), all isolated by blood cultures; C. parapsilosis was the most common species. Among mould infections, the most frequent site was the lung, with regard to aspergillosis (81.8%). In six of the 10 patients with suspected aspergillosis, the diagnosis was made by the detection of galactomannan and (1,3)-β-D-glucan antigens. The microbiological surveillance carried out on 156 air, 312 water and 312 surface samples revealed low environmental contamination: Alternaria alternata was the only fungus isolated from two surface samples. Our data, especially the low occurrence of filamentous fungi, suggest a particular local epidemiology. Further studies are needed to confirm this microbiological trend in onco-hematological patients in Southern Italy, the results of which might be helpful to improve the management of these patients.

BACKGROUND: Traumatic dental injuries occur frequently in children and adolescents. The purpose of the present study is to examine the levels of knowledge and behaviors regarding dental trauma among parents of children attending primary schools in the Apulia region of Italy. METHODS: The study was carried out using an anonymous questionnaire with closed answers distributed to 2,775 parents who were enrolled based on the entire regional school population. Analyses were conducted using the PROC CORRESP (procedure to perform multiple correspondence analysis) and PROC FASTCLUS (procedure to perform cluster analysis). Statistical significance was set at p-value <0.05. RESULTS: A total 15.5% of the sample reported that their children had experienced dental trauma. Overall, 53.8% of respondents stated that they knew what to do in cases of dental injury. Regarding the time limit within which it is possible to usefully intervene for dental trauma, 56.8% of respondents indicated "within 30 minutes". Of the total sample, 56.5% knew how to preserve a displaced tooth. A total 62.9% of parents felt it was appropriate for their children to use dental guards during sports activities. The multivariate analysis showed that wrong knowledge are distributed among all kinds of subject. Parents with previous experience of dental trauma referred right behaviours, instead weak knowledge and wrong behaviours are associated with parents that easily worried for dental events. CONCLUSIONS: This study showed that most parents reported no experience of dental trauma in their children, and half of them did not know what to do in case of traumatic dental injury and they would intervene within 30 minutes, suggesting that dental trauma may trigger panic. However, they did not have the information needed to best assist the affected child. Motivating parents to assume a preventive approach towards dental trauma may produce positive changes that would result an increase of long-term health benefits among both parents and children.

This study represents the first investigation of microbiological groundwater pollution as a function of aquifer type and season for the Apulia region of southern Italy. Two hundred and seven wells were randomly selected from those monitored by the Regional Agency for Environmental Protection for emergency use. Both compulsory (Escherichia coli, Total Coliform, and Enterococci) and optional (Pseudomonas aeruginosa, Salmonella spp., Heterotrophic Plate Count at 37 and 22 °C) microbiological parameters were assessed regularly at these wells. Groundwater from only 18 of the 207 (8.7 %) wells was potable; these all draw from karst-fissured aquifers. The remaining 189 wells draw from karst-fissured (66.1 %) or porous (33.9 %) aquifers. Of these, 82 (43.4 %) tested negative for Salmonella spp. and P. aeruginosa, while 107 (56.6 %) tested positive for P. aeruginosa (75.7 %), Salmonella spp. (10.3 %), or for both Salmonella spp. and P. aeruginosa (14 %). A logistic regression model shows that the probability of potable groundwater depends on both season and aquifer type. Typically, water samples were more likely to be potable in autumn-winter than in spring-summer periods (odds ratio, OR = 2.1; 95 % confidence interval, 95 % CI = 1.6-2.7) and from karst-fissured rather than porous aquifers (OR = 5.8; 95 % CI = 4.4-7.8). Optional parameters only showed a seasonal pattern (OR = 2.6; 95 % CI = 1.7-3.9). Clearly, further investigation of groundwater microbiological aspects should be carried out to identify the risks of fecal contamination and to establish appropriate protection methods, which take into account the hydrogeological and climatic characteristics of this region.

The Candida parapsilosis group encompasses three species: C. parapsilosis, C. orthopsilosis, and C. metapsilosis. Here, we describe the incidence and echinocandin susceptibility profile of bloodstream isolates of these three species collected from patients admitted to an Italian university hospital from 2007 to 2014. Molecular identification of cryptic species of the C. parapsilosis complex was performed using polymerase chain reaction amplification of the gene encoding secondary alcohol dehydrogenase, followed by digestion with the restriction enzyme BanI. Minimum inhibitory concentrations were determined using the broth microdilution method according to European Committee for Antimicrobial Susceptibility Testing (EUCAST EDef 7.2) and Clinical Laboratory Standards Institute (CLSI M27-A3) guidelines, and the results were compared with those obtained using the E-test and Sensititre methods. Of the 163 C. parapsilosis complex isolates, 136 (83.4%) were identified as C. parapsilosis, and 27 (16.6%) as C. orthopsilosis. The species-specific incidences were 2.9/10,000 admissions for C. parapsilosis and 0.6/10,000 admissions for C. orthopsilosis. No resistance to echinocandins was detected with any of the methods. The percent essential agreement (EA) between the EUCAST and E-test/Sensititre methods for anidulafungin, caspofungin, and micafungin susceptibility was, respectively, as follows: C. parapsilosis, 95.6/97.8, 98.5/88.2, and 93.4/96.3; C. orthopsilosis, 92.6/92.6, 96.3/77.8, and 63.0/66.7. The EA between the CLSI and E-test/Sensititre methods was, respectively, as follows: C. parapsilosis, 99.3/100, 98.5/89.0, and 96.3/98.5; C. orthopsilosis, 96.3/92.6, 100/81.5, and 92.6/88.9. Only minor discrepancies, ranging from 16.9% (C. parapsilosis) to 11.1% (C. orthopsilosis), were observed between the CLSI and E-test/Sensititre methods. In conclusion, this epidemiologic study shows a typical C. parapsilosis complex species distribution, no echinocandin resistance, and it reinforces the relevance of using commercially available microbiological methods to assess antifungal susceptibility. These data improve our knowledge of the national distribution of species of the psilosis group, as there are very few studies of these species in Italy

BACKGROUND: Nosocomial environmental contamination plays an important role in the transmission of several health care-associated pathogens. Control of surfaces contamination can reduce the risk of cross-infection in hospitals. The aim of our study is to evaluate the disinfectant effectiveness of hydrogen peroxide and silver ions, against nosocomial multidrug-resistant strains, when it's used directly on surfaces. METHODS: Staphylococcus aureus ATCC 6538, Pseudomonas aeruginosa ATCC 15442 and the same multidrug-resistant clinical isolates were selected to study the effectiveness of the disinfectant used in suspension or on the clean and dirty surface. RESULTS: Regarding the suspension activity test, the hydrogen peroxide and silver ions resulted effective after 5 min for ATCC strains and after 10 min for multidrug-resistant isolates; about the surface activity test, its action resulted after 10 min for ATCC strains and after 15 min for multidrug-resistant isolates. Moreover, it was more effective when used in the absence or in presence of a low concentration of biological materials. CONCLUSIONS: In a complex environment such as hospital wards, to have a disinfectant notoriously effective but more easy and quick to use would be an useful solution to treat small surfaces occasionally contaminated by biological materials.

Methicillin-resistant S. aureus (MRSA) is a pathogen spread not only in the hospital environment but also in the community and amongst livestock (LA-MRSA). LA-MRSA can be transmitted to humans that live in close contact with MRSA-colonized animals, and human colonization and/or infection has been reported worldwide, particularly among those involved with livestock farming. In this study the authors evaluated the prevalence of S. aureus and MRSA among healthy carriers who worked in the food industry in Apulia, Southern Italy.

OBJECTIVE: This study aim was to determine the prevalence of microorganisms in the respiratory tract of patients with cystic fibrosis (CF) admitted to the CF Reference Centre in Southern Italy between 2002-2010. METHODS: Microbiology assessment of samples (sputum and tracheal aspirates) collected from patients with pulmonary exacerbation admitted to hospital was carried out. All patients were registered in a database and clinical and microbiological data were retrospectively analysed. RESULTS: Overall, 188 patients were included and a total of 1217 samples were analysed. The most common microorganisms were Staphylococcus aureus (78.7% of the patients) and Pseudomonas aeruginosa (58%), followed by Candida albicans (19.1%), Haemophilus influenzae (13.3%) and Aspergillus fumigatus (9.6%). CONCLUSION: Compared to similar studies performed in other European countries, our microbiological data, especially the low occurrence of filamentous fungi, suggest a specific local epidemiology, probably related to some uncommon CFTR mutations, which are specific to Southern Italy.

Introduzione La filiera della carne è una grande realtà industriale in Italia, caratterizzata dal circuito Denominazione di Origine Protetta (DOP).Tutti i lavoratori sono esposti a una vasta gamma di agenti biologici che hanno sviluppato antibiotico resistenza e, di conseguenza, rappresentano un problema di salute pubblica ed occupazionale. Obiettivi Valutare il rischio biologico da MRSA in lavoratori della filiera delle carni. Metodi Sono stati reclutati, previo consenso, 162 lavoratori della filiera delle carni del Sud Italia.Tutti i partecipanti hanno risposto ad una intervista semi-strutturata , sono stati sottoposti ad esame obiettivo della cute ed a prelievo di un tampone nasale.Il questionario ha indagato la storia clinica e professionale, storia residenziale, la presenza di animali domestici, il contatto extra-professionale con animali d’allevamento e sul consumo di carne cruda o poco cotta.Eventuali infezioni respiratorie e/o cutanee, dissenteria, malattie infettive, stato immunodepressivo, recenti interventi chirurgici e ricoveri ospedalieri, infortuni, assunzione di antibiotici, sono stati considerati criteri di esclusione ai fini della valutazione del tampone nasale.I campioni di tamponi nasali sono stati seminati, entro 24 ore, in terreno di crescita Mannitol Salt Agar, specifica per il rilevamento di Staphylococcus Aureus. Dopo un periodo di incubazione, sono state selezionate colonie positive per S. Aureus sulle quali sono stati ricercati i geni 447bp NUC, che codifica per la nucleasi, e il gene mecA, che codifica per la sequenza della meticillino-resistenza, utilizzando la procedura Multiplex Polymerase Chain Reaction (MPCR).I campioni positivi per MRSA sono stati analizzati, infine, con una PCR specifica per la ST398, sequenza specifica per la specie suina. Risultati Sono stati reclutati 139 maschi e 23 femmine, con età media di 45 anni ed anzianità lavorativa media di 10 anni. Dalla semina dei 162 tamponi nasali, una prima analisi ha mostrato positività per lo Staphylococcus Aureus in 35 campioni (21,6%).L'analisi molecolare ha rivelato un solo campione positivo per MRSA (0,6%), in un lavoratore addetto alla trasformazione della carne..L'analisi molecolare non ha confermato la positività per il genotipo ST398, caratteristico dell'infezione nei suini. Conclusioni Il nostro studio ha rivelato un basso rischio per MRSA, condizionato dall’uso di antibiotici in ambito veterinario e dai trattamenti termici superficiali effettuati sulle carcasse, come scottature e flambature, che riducono significativamente la presenza di MRSA. La ricontaminazione con S. Aureus, tuttavia, potrebbe verificarsi a seguito di contaminazione fecale durante l’eviscerazione, tramite una maggiore manipolazione delle carni da parte degli operatori durante la lavorazioni ed, infine, attraverso il contatto con le superfici potenzialmente infette dei macchinari. Bibliografia 1. Colosio C. et al. Linee Guida per la Sorveglianza Sanitaria in agricoltura. 2012 SIMLII 2. Il rischio biologico nei luoghi di lavoro (2011) INAIL 3. Livermore, Antibiotic resistance in staphylococci, International Journal of Antimicrobial Agent 16 (2000) S3 – S10

PURPOSE: We compared the risk factors, the diagnostic tools and the outcome of filamentous fungal infections (FFIs) in hematological patients (HAEs) and non-hematological patients (non-HAEs). METHODS: Prospective surveillance (2009-2011) of proven and probable FFIs was implemented in 23 Italian hospitals. RESULTS: Out of 232 FFIs, 113 occurred in HAEs and 119 in non-HAEs. The most frequent infection was invasive aspergillosis (76.1 % for HAEs, 56.3 % for non-HAEs), and the localization was principally pulmonary (83.2 % for HAEs, 74.8 % for non-HAEs). Neutropenia was a risk factor for 89.4 % HAEs; the main underlying condition was corticosteroid treatment (52.9 %) for non-HAEs. The distribution of proven and probable FFIs was different in the two groups: proven FFIs occurred more frequently in non-HAEs, whereas probable FFIs were correlated with the HAEs. The sensitivity of the galactomannan assay was higher for HAEs than for non-HAEs (95.3 vs. 48.1 %). The overall mortality rate was 44.2 % among the HAEs and 35.3 % among the non-HAEs. The etiology influenced the patient outcomes: mucormycosis was associated with a high mortality rate (57.1 % for HAEs, 77.8 % for non-HAEs). CONCLUSIONS: The epidemiological and clinical data for FFIs were not identical in the HAEs and non-HAEs. The differences should be considered to improve the management of FFIs according to the patients' setting.

In most regions of the world, safeguarding groundwater resources is a serious issue, particularly in coastal areas where groundwater is the main water source for drinking, irrigation and industry. Water availability depends on climate, topography and geology. The aim of this paper is to evaluate aquifer recharge as a possible strategy to relieve water resource scarcity. Natural aquifer recharge is defined as the downward flow of water reaching the water table, increasing the groundwater reservoir. Hydro-meteorological factors (rainfall, evapotranspiration and runoff) may alter natural recharge processes. Artificial aquifer recharge is a process by which surface water is introduced with artificial systems underground to fill an aquifer. As a consequence of global warming that has increased the frequency and severity of natural disasters like the drought, the impacts of climate change and seasonality, the artificial recharge has been considered as a viable option. Different direct and indirect techniques can be used, and the choice depends on the hydrologic characteristics of a specific area. In Italy, Legislative Decree no. 152/06 plans artificial aquifer recharge as an additional measure in water management, and Decree no. 100/2016 establishes quantitative and qualitative conditions for recharge. Many projects examine aquifer recharge, such us WADIS-MAR in the southern Mediterranean region, WARBO in Italy and municipal wastewater treatment project in Apulia, a southern Italian region. However, aside from groundwater recharge, the community must foster a spirit of cooperation to manage groundwater as a sustainable resource.