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Biomedical subjects

M L Moro

Publications and source records attributed to M L Moro.

49 records · Page 3Linked to original sources
PubMed1987

Surveillance activity in Italy.

Surveillance activities in Italy during the last 5 years can be summarized in three broad categories: collection of data in order to describe the epidemiological pattern of hospital acquired infections, achieved through multicenter studies, involving hospitals or focused on specialized units; organizational efforts for the implementation of Infection Control Committees in Hospitals stimulated by official guidelines (the 1985 Health Ministry Act on this issue); evaluation of preventive strategies in Italy. Results of a one-day prevalence survey conducted in 1983, involving 130 public hospitals, are presented. Out of 34,577 patients surveyed, prevalence of hospital acquired infection was 6.8% and of community-acquired infections 12.5%. Preliminary results of PRINOS (Preventive Study on Hospital Infections) show a 4.6% incidence rate of infections in 16 surgical wards surveilled. Design of the study and target objectives are discussed.

Cross Infection↗
PubMed1986

National prevalence survey of hospital-acquired infections in Italy, 1983.

In 1983 a national prevalence survey was conducted in Italy to discover the general distribution of infection among patients in public hospitals. Thirty-four thousand, five hundred and seventy-seven acute patients were surveyed in 130 hospitals spread throughout the country: 6668 patients (19.3%) had an active infection at the time of the survey; the infection was hospital-acquired in 2361 (6.8%) and community-acquired in 4307 (12.5%). The urinary tract was the site most frequently involved in hospital infection (30.2% of patients with hospital-acquired infection). The respiratory tract was the site most often involved in community infections (35.7% for the lower tract and 9.1% for the upper). Hospital-acquired infections were more frequent in intensive care units (12.4%) and in geriatric (11.6%), orthopaedic (8.2%) and surgical wards (7.6%). The prevalence of urinary tract infection was 10.4% among the 9.4% of patients who were catheterized compared with a prevalence of 2.6% in the uncatheterized. Thirty-five point five per cent of patients were receiving an antimicrobial on the day of the survey.

Adolescent↗
PubMed1984

National survey of hospital infection control organization in Italian public hospitals.

A questionnaire was mailed to 1073 Italian public hospitals in an attempt to find out if infection control programmes existed, the type of programme used and available resources. After two attempts a total of 54.9 per cent of the hospitals responded to the request and of these 16.1 per cent claimed to have an infection control programme. Sixty-six per cent of the hospitals who have a control programme also have a system of continuous surveillance whilst the remainder investigated epidemics only. Infection control programmes were encountered most frequently in paediatrics, obstetrics and surgical departments. The organisms most often surveyed were the salmonellas, other types of enterobacteria, staphylococci and streptococci.

Cross Infection↗
PubMed1981

T-dependent immunity in aged humans. I. Evaluation of T-cell subpopulations before and after short term administration of a thymic extract.

T lymphocytes, T lymphocyte subpopulations and delayed hypersensitivity reactions to recall antigens were studied in 20 aged subjects clinically unaffected by disorders of the immune system. T-cells evaluated by the sheep rosette test and absolute T-cell number were within normal range. T-cell subsets were studied by the high affinity rosetting test and by the sheep rosette test after pre-incubation with theophylline; such methods have been shown by others to discriminate between T-cells with helper or suppressor activity. We did not observe an imbalance of such subpopulations. Skin reactivity to recall antigens (Candida and SK-SD) was depressed in several cases. Since a decline in serum levels of thymic hormones has been reported in the ageing and it is suggested that this could account for the T-dependent immunity defect, we treated these patients with a bovine thymic extract (thymostimulin, TP-1) 1 mg/kg/day for three consecutive days. Immunological tests were performed again after this therapy but no modifications were observed. We may conclude that the aged subjects studied in this paper present normal relative and absolute number of T-cells and T subpopulations, whereas the function of T-cells, as assessed by skin reactivity to recall antigens is often depressed. Short term therapy with TP-1 at the above mentioned dosage was ineffective in modifying the parameters analysed.

Aged↗
PubMedDate not supplied

[Tuberculosis in Italy: available data and open questions].

OBJECTIVES: To describe the epidemiological trend of tuberculosis (TB) in Italy. DESIGN: Descriptive study on the basis of routine information sources: TB deaths (1955-1993) and TB notifications (1955-1995). To identify persons with AIDS (PWAs) among notified TB cases, a record linkage with the National AIDS Registry was performed. RESULTS: From 1955 to 1993, the TB mortality constantly decreased by a mean of 7.6% per year. From 1955 to 1995, the crude annual total incidence of TB decreased from 25.26 to 9.12 per 100,000. The trend of decrease of pulmonary TB ceased in 1980, whereas the incidence of extrapulmonary TB began to markedly increase in 1980. Between 1992 and 1995, the average annual meningitis notification rate in children < five years was 0.045 per 100,000. In 1995, the curve of incidence rates by age shows two peaks (> 75 years and 25-34 years). Persons with AIDS and foreigner-born persons represented in total 11.3% of TB cases (1992-1995); in the age class 25-34 years, this proportion was 32.5% (34.1% in 1995). A considerable undernotification of TB among PWAS was detected. CONCLUSION: The TB incidence is no longer decreasing due to the changes of TB case definition in 1987 and the.

Adult↗
PubMedDate not supplied

[Antibiotic microbial resistance surveillance in invasive infections caused by Streptococcus pneumoniae and Staphylococcus aureus: the EARSS (European Antimicrobial Resistance Surveillance System) project in Italy (April 1999-April 2000)].

This paper presents the results of an Italian multicentric study conducted in the period April 1999-April 2000 in 64 clinical microbiology laboratories, aimed at collecting antimicrobial resistance data using a standard European protocol (EARSS Project, European Antimicrobial Surveillance System). A total of 1701 strains of Staphylococcus aureus were isolated from blood and 367 strains of Streptococcus pneumoniae were isolated from blood (72.7%) or from CSF (27.3%). Methicillin resistance in S. aureus was found to be 42.1%; it was significantly higher in adults (RR = 6.6, CI 95% 2.5-17.0), in hospitals of Centre and North of Italy (respectively RR = 1.45, CI 95% 1.1-2.0; RR = 1.6, CI 95% 1.1-2.2), and in intensive care and surgery units (respectively RR = 1.8, IC 95% 1.6-2.0 and RR = 1.7, CI 95% 1.4-1.9). Penicillin resistance in S. pneumoniae was found to be 12.1%; it was higher in South Italy (RR = 3.5, CI 95% 1.9-6.6, in meningitis compared to sepsis (RR = 2.5, CI 95% 1.4-2.5) and in intensive care units compared to other departments (RR = 2.2, CI 95% 1.0-4.8). The level of erythromycin resistance in S. pneumoniae was of 28.2%, reaching 56.4% in penicillin resistant strains. These results suggest that a continued surveillance and effective control measures are required.

Adolescent↗
PubMedDate not supplied

[Surgical chemoprophylaxis in the Emilia Romagna region].

The aim of this study is to assess the compliance with evidence based medicine of the practices of administration of perioperative surgical chemoprophylaxis in the Emilia Romagna region. Prospective study of 1 month duration including 31 of the 36 public hospital existing in the region. For all the patients admitted to one of the 121 participating units and undergoing a surgical operation, data were collected on the surgical prophylaxis administered, including type of antibiotic, time of administration and duration. Surgical prophylaxis was given in 4,946 surgical operations of the 6,167 included in the study. The median frequency of surgical prophylaxis administration was 81% ranging from 67% to 97% in different Local Health Authorities. Chemoprophylaxis was given also for surgical operations where, according to systematic literature reviews, the cost-benefit ratio is absolutely unfavourable to the use of antibiotics. In 2,120 cases (42.9%) the time of administration was not perioperative and, thus, differed from the recommended practice: in 264 cases (5%), antibiotics were administered after the operation. In 42.6% of the cases the duration of administration was not a short-term prophylaxis, being longer than 24 hours: in these 2,108 cases, the median duration was 4 days ranging form 1 to 90 days. In 48% of the cases cefazolin was administered; in 1,347 cases (23.4%), instead, a third or fourth generation cephalosporin was used. The survey pointed out an overuse of antibiotics, both for indications and duration, even when clear evidences of efficacy are lacking; moreover, the criteria for selection of specific antibiotics frequently did not take into account the risk of selecting antimicrobial resistance strains.

Antibiotic Prophylaxis↗
PubMedDate not supplied

Risk factors for surgical wound infections in clean surgery: a multicenter study. Italian PRINOS Study Group.

OBJECTIVE: To investigate potential risk factors for surgical wound infections in clean surgery. STUDY DESIGN: Multicenter prospective study in eight general surgical wards and one thoracic surgical ward. METHODS: All patients undergoing clean operations in the nine wards were included in the study. The following data were collected for each study participant: demographic characteristics, underlying disease, predisposing factors, type of surgery, length of operation, preoperative shaving, type and duration of surgical drains, and length of hospital stay. After surgery, patients were visited daily by an intern surgeon in order to detect infections. Infections occurring after discharge were not actively surveyed. A multiple logistic regression was performed to obtain an adjusted estimate of the odds ratios and to identify which factors were independently associated with surgical infection. RESULTS: 2,262 patients were included in the study: eighty three patients (3.7%) developed a surgical infection. The highest infection rates were observed following vascular surgery, thoracic surgery and herniorraphy. Seven factors appeared to be significantly and independently associated with an increased risk of SWIs in a logistic regression model; age greater than 85 years, obesity, patients undergoing high risk operations or more than one operation during stay, length of operation greater than 120, preoperative shaving, open surgical drains lasting more than three days. CONCLUSIONS: The high incidence of infection observed in our study population indicates potential problems in quality of care. In order to prevent SWIs in patients undergoing clean operations, more efforts should be placed on the prevention of the risk associated with two modifiable risk factors, that is preoperative shaving and use of open surgical drains.

Adult↗
PubMedDate not supplied

[The effect of changing some patient care practices on the incidence of surgical wound infections following "clean" interventions. PRINOS group of study].

OBJECTIVES: To evaluate the changes in patient care practices following an intervention program in general surgery and their impact on surgical wound infections (SWI) associated with clean operations. STUDY DESIGN: A "before-after" study design was used. Active surveillance was implemented in each ward; the intervention consisted of an educational program, whose effectiveness was evaluated comparing SWI rates before and after its implementation. RESULTS: A total of 799 patients undergoing clean operations from three general surgical wards were included in the study: 606 before and 193 after the intervention program. The observed reduction in the SWI incidence was 79.2%; the most striking change in patient care practices observed after the intervention was the substitution of open surgical drains with closed drains. High risk operations (RR 8.4), length of operation greater than 2 hours (RR 11.2), and open surgical drains lasting more than three days (RR 5.1) significantly increased the risk of SWIs in the preintervention phase, according to the logistic regression analysis. Of the observed pre-intervention SWIs, 46.2% was attributable to exposure to open drains. CONCLUSIONS: Many postoperative infections can be prevented in environments where patient care practices fall well below the accepted standards. More efforts should be placed on the prevention of the risk associated with modifiable risk factors, such as open surgical drains.

Adult↗