bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antimicrobial stewardship programs in Italy: structure, process and outcome indicators, 2017-2019
Authors: Vicentini C , Blengini V , Libero G , Raso R , Zotti CM 
Published: October 2022

Abstract

Background
The increasing spread of antimicrobial resistance (AMR) represents a global public health threat, and a significant challenge for healthcare delivery. Antimicrobial stewardship (AMS) programs have proven to be effective and cost-effective strategies for optimizing antimicrobial use. We aimed to assess key aspects of AMS programs implemented in acute-care trusts of the region of Piedmont, and to evaluate changes in antimicrobial usage against a score we attributed to structural and functional elements of AMS programs.

Methods
AMS programs operating in acute-care trusts in the region of Piedmont were investigated via a survey addressing program characteristics, divided into structure and process quality indicators. All public health trusts of the region of Piedmont were invited to complete the survey. The indicators were selected based on core elements identified by international guidelines and were reviewed by a multi-disciplinary panel. Antimicrobial usage was expressed as defined daily doses, DDD per 1000 patient-days. The annual means for the years 2017-2019 were considered, as well as the percentage change between 2017 and 2019. Variables were investigated in relation to structure and process scores using Spearman correlation. Analyses were performed using SPSS v. 27.0 (SPSS Inc., Armonk, NY).

Results
In total, 25 AMS programs were surveyed. Higher scores were achieved for process rather than structure indicators. Improvements in total antimicrobial usage (-4%) were found between 2017 and 2019. A moderate correlation was found between structure score and percentage change in antimicrobial usage (Spearman’s ρ -0.603, p 0.006).

Conslusions
This study highlighted important areas for improvement, such as accountability, microbiological laboratory quality management and feedback. Repeated measurements of structure, process and outcome indicators will be important to guide continuing quality improvement efforts.

Key messages
• Results of this study support the effectiveness of AMS programs in reducing antimicrobial use.
• Important areas for improvement were identified. Improving the organization of AMS programs in particular should be prioritized.
Understanding barriers to dTap vaccination recommendations during pregnancy among healthcare workers
Authors: Bianco A , Angelillo S , Riillo C , Nobile CGA , Campione C , Freccia S , Romeo M , Licata F 
Published: October 2022

Abstract

Background
Diphtheria, tetanus and pertussis (dTap) vaccination is heavily endorsed during pregnancy. However, maternal dTap immunization rates in Italy remain low. Lack of healthcare workers (HCWs) recommendation to get vaccinated represents one of the main barriers to immunization during pregnancy. Therefore, this study aimed to investigate what HCWs know about dTap vaccination, practices and potential barrier to recommending immunization during pregnancy.

Methods
This cross-sectional study was conducted among obstetricians-gynaecologists (OBs), midwives and general practitioners (GPs) in 2 regions of Southern Italy. An anonymous self-administered questionnaire was used to collect data on professional information, knowledge, risk perceptions and practices regarding dTap vaccination during pregnancy.

Results
Until now 94 HCWs were recruited (36.2% OBs, 35.1% GPs and 28.7% midwives). Overall, 63.8% knew that dTap vaccination has to be administered during the third trimester of gestation and 94.7% that it is able to protect newborns against pertussis before active immunization. One-third of the HCWs believed that vaccines in pregnancy were more dangerous than safe. Seven out of ten HCWs routinely recommended dTap vaccine and provided information about dTap vaccination to all pregnant women. Most frequent reported reasons for not recommending dTap vaccination during pregnancy were that it was outside the scope of their practice (72.4%), that women are more vaccine hesitant during pregnancy (42.9%), lack of time (28.6%), lack of knowledge on the topic (28.6%) and the belief that the vaccine could interfere with the development of the fetus (14,3%).

Conclusions
Lack of knowledge, unsatisfactory recommendation of dTap immunization during pregnancy and uncertainty over their responsibility around vaccination suggest that public health organisations should strengthen dissemination and implementation of evidence-based recommendations.

Key messages
• Barriers to recommending dTap immunization during pregnancy remain among healthcare workers.
• Strategies (e.g. electronic reminders) to facilitate HCWs in recommending and informing on dTap immunization should be implemented and evaluated to improve vaccination coverage in pregnant women.
Self-reported vaccination against SARS-CoV-2 and adverse events in multiple cohorts
Authors: Klett-Tammen CJ , Heise JK , Soja SM , Janzen I , Jenniches F , Kemmling Y , Behrens G , Schulz TF , Wegener R , Castell S 
Published: October 2022

Abstract

In two studies (“App-based infection assessment in RESIST (iAR)” and “Digital infection monitoring in persons living with immunodeficiency (DIMI)” ), we monitor health related items, as vaccination against SARS-CoV-2 and conduct syndromic surveillance of acute respiratory infections in high-risk populations, i.e. elderly persons and persons living with HIV, respectively. In a third very similar study (“Sensors for measuring aerosols and reactive gases to deduce health effects (SMARAGD)”) mainly healthy adults participate. To record incident or recurring transient health events, risk factors and further health data in real-time, we developed the eResearch system “PIA - Prospective Monitoring and Management App”. Recruitment for RESIST, SMARAGD and DIMI started in March 2021 and is ongoing. The questionnaire was presented in April 2022. Preliminary results include 86 participants from the three cohorts. In total, one indicated to be not vaccinated, none were vaccinated once, three (3.5%) twice, 63 (73.3%) three times and 19 (22.1%) four times. Participants reported the following adverse events after immunization (AEFI): after 40 applied doses with Vaxzevria® 24 AEFI (60%); after 158 doses of Comirnaty® 41 AEFI (26%); after 62 doses of Spikevax® 19 AEFI (30.7%); and after three doses of Janssen®, one AEFI (33.3%). In these cohorts, 20 (23.36%) participants stated having had a SARS-CoV-2 infection, of these 16 (80%) after the last vaccination dose, three (15%) before the first dose and one (5%) in between doses. Most participants were vaccinated three times, with Comirnaty being the most applied vaccine, as in officially reported numbers. AEFI varied according to vaccine and were higher than in the German surveillance system (1.64/1000 doses). Most infections were indicated to have been diagnosed after the booster vaccination. The results are limited by the small sample size and possible bias through self-reporting and social desirability regarding vaccination status.

Key messages
• Overall, most participants were vaccinated with Comirnaty and had three doses of vaccine. Of the participants with a diagnosed SARS-CoV-2-infection, most got infected after the booster vaccine.
• The number of reported AEFI was higher than in the official surveillance in Germany.
Elizabethkingia miricola: an opportunistic pathogen in ICU
Authors: Soler E , Marín E , Guerrero I , Martínez S , Fernández MA , Valero C 
Published: October 2022

Abstract

Background
The Elizabethkingia genus is formed by a group of bacteria which are widely distributed in nature. Elizabethkingia is not part of human microbiota, therefore is considered to be an opportunistic pathogen. In the last years, it has become a cause of potentially fatal disease, becoming an emerging bacteria of increasing relevance. The objective of this study is to describe the impact of Elizabethkingia bacteria in infected patients in the ICU of a hospital in Granada.

Methods
Descriptive study. Patients who have been isolated in a biological sample of Elizabethkingia miricola throughout the year 2.021 in the ICU of San Cecilio University Hospital in Granada. Date and place of isolation were registered. Other variables registered were sex, age, length of ICU stay, days between ICU admission and bacterium isolation, days between bacterium isolation and death, infection, cause of admission or cause of death.

Results
Bacterium was isolated in 15 patients. Cause of admission was COVID-19 in 73.3% of patients. 73.3% were men and 26.6% women.The average age was 56.9 years. The average length of ICU stay was 43.8 days. 4 patients were diagnosed with ventilator-associated pneumonia and 5 patients were diagnosed with tracheobronchitis.The average days between ICU admission and bacterium isolation was 26,4 days. The average days between mechanical ventilation and bacterium isolation was 25.9 days. 53.3% of patients died. The average days between bacteria isolation and death was 18.2 days.

Conclusions
Elizabethkingia miricola is an emerging bacterium under special vigilance due to its capacity to cause major morbidity and mortality in admitted patients in ICU. The rapid identification and the study of the antibiotic susceptibility is considered of special relevance so they can be correctly managed to avoid infections and complications resulting from this microorganism.

Key messages
• Elizabethkingia is a special surveillance bacterie due to its morbidity and mortality effects.
• Elizabethkingia could be a severity indicator in admitted patients to the ICU.
Vaccines for older adults; the low-hanging fruit of disease prevention
Authors: Wennekes MD , Eilers R , Caputo A , Gagneux-Brunon A , Gavioli R , Nicoli F , Quatrehomme MMM , Vokó Z , Timen A 
Published: October 2022

Abstract

Background
The COVID-19 pandemic highlighted the significance of vaccination for older adults (OA), however, more health benefits could be gained with vaccination against influenza, pneumococcal disease, herpes zoster and tetanus as their uptake remains rather low. As healthcare professionals (HCP) play an important role in the vaccination decision making of OA, this study identifies obstacles in vaccination communication between HCP and OA.

Methods
80 in-depth structured interviews have been conducted with HCPs in Hungary (HU), Italy (IT), the Netherlands (NL) and France (FR). Participants were general practitioners, medical specialists, public health physicians, occupational physicians, pharmacists, geriatricians, specialists elderly care and nurses. The interview included questions on HCPs’ perceptions regarding information provision to OA on vaccines. Data were analyzed cross-country, using thematic analysis.

Results
Preliminary results reveal that a factor hindering HCPs to initiate conversations with OA on vaccines was lack of time (FR, IT, HU, NL). In hospitals this was often due to (acute) clinical problems taking precedence over discussing vaccines (IT, NL). In ambulatory settings the high number of patients waiting to be seen prevented discussing vaccines with OA (HU). Moreover, HCPs sometimes forgot to discuss vaccines with OA (NL, HU, IT). Patient factors hindering the conversation of HCPs on OA vaccines were a negative attitude (IT, HU) and lack of understanding the information provided (IT, HU). Also, misinformation on vaccines (FR, HU), as well as anti-vax beliefs from patients (NL) or their relatives (FR, IT) hampered the conversation on vaccines. HCPs mentioned their need to learn communication skills to convince OA on vaccines (FR, IT, HU).

Conclusions
HCPs encounter various obstacles in communicating with OA about vaccines. Lack of time and not recognizing the opportunity to discuss vaccines are important barriers for initiating vaccine conversations.

Key messages
• Providing HCPs with communication strategies is important to support HCPs in discussing vaccines with OA.
• Reminder systems are important to help HCPs remember address vaccination.
Integrated monitoring of AMR and enterotoxins genes of S. aureus isolated in Lombardy
Authors: Spinelli E , Magagna G , Tilola M , Rossi F , Filipello V , Guarneri F , Formenti N , Ianieri A , Alborali GL , Finazzi G 
Published: October 2022

Abstract

Background
S. aureus is a widespread pathogen responsible for mild to severe human and animals’ infections. The abuse of antimicrobials provides the potential for selection of resistant strains in livestock, which represents a public health concern. S. aureus can carry several virulence factors of which staphylococcal enterotoxins (SEs) play a key role during food poisoning in human populations. The aim of this study is to monitor the prevalence of antimicrobial resistance factors in S. aureus isolates and their ability to produce enterotoxins.

Methods
Within an ongoing monitoring plan for the assessment of antimicrobial resistance in S. aureus strains, a total of 83 isolates collected from food, and swine and dairy farms, between 2020-2022, were characterized using MLST and then screened for the presence of methicillin resistance and SEs genes. The isolates were tested for susceptibility to a panel of 14 antimicrobial agents using the disc agar diffusion method on Mueller-Hinton agar.

Results
Among 83 S. aureus isolates, 53% carried at least one SEs gene. Eighteen isolates were methicillin-resistant of which 17 were no-enterotoxigenic strains belonging to ST398, and one was a food origin ST8 strain and harbored SEs genes. Among the ST398 isolates, only one was a food origin strain, while the others were from swine farms. The antibiogram showed that a few isolates were susceptible to nalidixic acid, and 42% resulted multidrug-resistant.

Conclusions
Our results showed that more than half of S. aureus isolates were enterotoxigenic, the majority belonging to food industries. Numerous tested isolates resulted multidrug-resistant, confirming that antimicrobial resistance is a critical public health threat in a food safety perspective.

Key messages
• The antimicrobial resistance profiles of S. aureus isolates underlines the importance of monitoring plans with a One Health perspective.
• The prevalence of enterotoxins genes in S. aureus strains in Lombardy confirms the relevance of the microorganism as a foodborne pathogen.
Social differences in COVID-19 vaccination rates–Findings from a German nationwide study
Authors: Bartig S , Müters S , Hoebel J , Schmid-Küpke NK , Hövener C 
Published: October 2022

Abstract

Background
The COVID-19 vaccination aims to prevent the transmission of the novel coronavirus (SARS-CoV-2) as well as to reduce severe courses of the disease and deaths. But various studies indicate social differences in willingness to be vaccinated. This study aims to examine the influence of different social determinants on COVID-19 vaccination in Germany.

Methods
The analyses are based on data from the sixth follow-up survey of the German Health Update (GEDA 2021), a nationwide cross-sectional telephone survey of the adult population living in Germany. COVID-19 vaccination rates are analyzed considering age, education, income, urban-rural residence and migration background. Poisson regressions were used to examine associations of each social determinant with COVID-19 vaccination rates. Adjustments were made for age, sex, (education) and date of participation.

Results
Overall, the rate of COVID-19 vaccination for the survey period was 86.7%, with significant differences in vaccination rate by social determinants. The vaccination rate increases significantly with age (94.2% for over 60-year-olds), higher level of education (91.5%) or income (93.0%). In addition, people living in rural areas in Germany (83.5%) and people with an own migration experience (79.1%) had a significantly lower vaccination rate. An age-differentiated analysis also showed the social differences in COVID-19 vaccination rate are significantly lower among those over 60-years old.

Conclusions
The results suggest social differences in COVID-19 vaccination especially in younger age groups. This should be considered when designing targeted measures to overcome potential barriers to vaccination. However, a large number of other factors affecting vaccination behavior must be taken into account like structural barriers, confidence in decision-makers, the safety of vaccination, and a sense of responsibility towards the community.

Key messages
• Sociodemographic and socioeconomic determinants affect COVID-19 vaccination rates.
• The social differences in COVID-19 vaccination are lower among those over 60-years old.
Seroprevalence and SARS-CoV-2 antibodies distribution in Portugal following mass vaccination campaign
Authors: Kislaya I , Gonçalves P , Gaio V , Matos R , Barreto M , Melo A , Guiomar R , Rodrigues A P , ISNCOVID-19 group PT 
Published: October 2022

Abstract

Introduction
Information on post-infection and vaccine-induced SARS-CoV-2 seroprevalence is important for public health policies. A 3rd wave of National Serological Survey (ISN3COVID-19) was conducted to measure SARS-CoV-2 seroprevalence and characterize specific antibodies distribution in Portuguese population in September - November 2021, following a mass vaccination campaign.

Methods
ISN3COVID-19 was a cross-sectional epidemiological study that collected serum samples and questionnaire data on a sample of Portuguese residents aged 1 year or older (n = 4545). SARS-CoV-2 IgG anti-nucleoprotein and anti-spike antibody levels were measured using Abbott Chemiluminescent Microparticle Immunoassays. Seroprevalence was estimated for the overall sample and stratified by age group, sex, region and self-reported chronic conditions. Medians and respective 95% confidence intervals (95%CI) were used to describe the distribution of SARS-CoV-2 antibodies in specific population subgroups.

Results
The overall seroprevalence of SARS-CoV-2 (post-infection or vaccine-induced) was 86.4% (95%CI: 85.2 to 87.6%), post-infection seroprevalence was 7.5% (95%CI: 6.6 to 8.5). Higher seroprevalence was observed among 50-59 years-old (96.5%), women (88.3%), and those with two or more self-reported chronic conditions (90.8%). Higher IgG (anti-Spike) levels were estimated for individuals vaccinated with the booster dose (median=12601.3 AU/ml; 95%CI: 4127.5 to 19089.1) and for those vaccinated with two doses of Spikevax® vaccine (median=7012.7 AU/ml, 95%CI: 5568.8 to 8456.6).

Conclusions
The SARS-CoV-2 seroprevalence was high and consistent with vaccine coverage in Portugal. Seropositivity was associated with sex, age and previous chronic conditions. The anti-SARS-CoV-2 anti-spike IgG levels varied according to vaccine brand and number of doses. These results show that monitoring seroprevalence and SARS-CoV-2 antibody distribution is of paramount importance to guide public health policies.

Key messages
• Significant increase in SARS-CoV-2 seroprevalence following the mass vaccination campaign consistent with the high vaccine coverage achieved in Portugal.
• Continuous monitoring of the population-level IgG response after vaccination remains important to guide further public health measures.
Prevalence of injected drug use and access to OAT in prison: survey in 7 EU countries, 2014-2018
Authors: Mazzilli S , Royuela L , Tavoschi L , Vandam L , Montanari L 
Published: October 2022

Abstract

Background
People in prison report high rates of drug use and drug-related problems and people who use or inject drugs (PWUD) have higher rates of offending and an increased likelihood of spending part of their lives in prison. They represent a vulnerable population with high burden of diseases, socio-economic disadvantages and limited access to healthcare. In this study, we aimed to describe the lifetime prevalence (LTP) of heroin use, injected drug use and opioid agonist therapy (OAT) among people living in prison.

Methods
Individual data collection was carried out in seven European countries (Czech Republic, Latvia, Lithuania, Poland, Portugal, Slovenia, Spain) between 2014 and 2018 with a model European Questionnaire on Drug use among people in Prison. Risk factors analysis was carried out using multivariate logistic regression model.

Results
The analysis of EQDP data found that the LTP of heroin use was overall 22.4% (ranged from 7.3% in Poland to 27.5% in Spain). Female, recidivist offenders, individuals aged below 44 and with an history of mental health condition had a higher likelihood of being heroin user (p-value&lt;0.05). The LTP of injected drug use was overall 20.6%(2176/10,587), while the prevalence of injected drug use in prison was 8.1%(745/9273) (with higher prevalence in countries that did not allow OAT initiation in prison: 17.5% in Latvia, 22.1% in Lithuania and 26.7% in Czech Republic). Among those who used heroin, 44.5%(772/1735) had access to OAT and among them 95.8(566/591) had access to OAT in prison.

Conclusions
Despite the heterogeneity of the results, there is a clear evidence that people in prison have a high prevalence of heroin and injected drug use. Prisons are an important point of access to OAT, and where treatment is available there is a reduction in risk behaviour. It is also important to implement tailored preventive interventions among vulnerable social groups at the community level.

Key messages
• People in prison in Europe have a high prevalence of heroin and injected drug use. Prisons can represent a point of access to integrated prison-community healthcare and social services for PWUD.
• In order to plan adequate healthcare interventions, there is an urgent need to assess and monitor the prevalence of drug use also in other European countries.
Integrated system for the proactive analisys of risk infection in patient’s surgical route
Authors: Montella E , Iodice S , Bellopede S , Frangiosa A , Giovagnoli A , Mazia G , Triassi M 
Published: October 2022

Abstract

Background
The most common hospital safety incidents are Hospital-Acquired-Infections (HAI) and among these Surgical Site Infections (SSIs). Our study proposes the use of a proactive system to manage risk combining the new Risk Identification Framework by WHO (IPCAF), the Lean method and the hospital’s Procedure Analysis. Each of the methods has pros and cons, and there is no existing literature that researches the concurrent use of all three methods. We focused on analysing patients’ surgical route to demonstrate that using an integrated system for preventing SSIs delivers enhanced results and significantly contibutes to a reduction in occurence of SSIs.

Methods
We conducted a retrospective observational study from 18 March 2019 to 20 April 2019 at Azienda Ospedaliera Universitaria Federico II di Napoli, Italia (Europa). The study is structured in 3 phases:
Phase 1- application of proactive risk management tools (18 March- 15 April 2019);
Phase 2-integration of results with the elaboration of a single system for proactive risk management (15-20 April 2019);
Phase 3- collection of epidemiologic data concerning SSI. We used the incidence of surgical site as efficiency indicator (1-10 March 2022).
The endpoints identified were:
Primary Endpoint: a reduction of infection occurrence in surgical sites
Secondary Endpoint: identification of critical points and control points within the surgical process with relevant corrective measures

Results
The rate of incidence of SSIs was selected as the efficacy indicator for the system. Our study recorded a 2.40% incidence rate for SSIs in 2020, compared to an incidence rate of 3.80% in 2018 and of 3.5% in 2017.

Conclusions
Considering the economic impact of the infections, along with the increased incidence of mortality and morbidity, employing all available tools to try and reduce SSIs incidence becomes paramount. A small reduction can produce significant cost savings that can be invested in other prevention programs.

Key messages
• Integrated system in proactively and promptly identifying risks related to patients’ surgical routes is effectiveness.
• The system can be adapted to different healthcare settings, to prevent adverse incidents by employing a risk management strategy, and to further enhance existing strategies.