The increasing incidence of infections by carbapenemresistant enterobacteria (CRE), in particular carbapenemresistant Klebsiella pneumoniae (CRKp), is a significant public health challenge worldwide.1 The interim results of the last European survey on CRE (EuSCAPE project 2013) indicate that CRKp is endemic in Italy, and that this endemicity is mostly contributed to by strains producing KPC-type carbapenemases.CRKp infections are associated with high morbidity and mortality rates, particularly among Intensive Care Units (ICU) patients, recipients of solid organ transplants (SOT) and patients with hematological malignancies. 1-3The Gruppo Italiano Trapianto Midollo Osseo (GITMO) recently performed a retrospective study (2010)(2011)(2012)(2013) which involved 52 stem cell transplant (SCT) centers to assess the epidemiology and the prognostic factors of CRKp infections in autologous and allogeneic SCT.4 Cases of CRKp infection were reported in 53.4% of the centers and were documented in 0.4% of autologous and 2% of allogeneic SCTs. A CRKp colonization was followed by an infection in about 30% of cases. The infection-related mortality rate was 16% in autologous and 64.4% in allogeneic SCT. A pre-transplant CRKp infection and inadequate first-line treatment were independent factors associated with an increase in mortality in allogeneic SCT patients who developed a CRKp infection. Indeed, despite the administration of a first-line CRKp-targeted antibiotic therapy (CTAT) (see below), 55% of patients who received a CTAT still died. These data underscored the challenge regarding CRKp infections, particularly in the allogeneic-SCT setting, in terms of outcome and management of post-transplant complications, and also raised an issue about the eligibility for transplant among patients who got colonized or had developed a CRKp infection before transplant.Based on these original data and on the recent literature, a multidisciplinary group of experts from GITMO, the Italian Association of Clinical Microbiologists (Associazione Microbiologi Clinici Italiani; AMCLI), the Italian Society of Infectious and Tropical Diseases (Società Italiana Malattie Infettive e Tropicali; SIMIT), and the Italian National Transplant Center (Centro Nazionale Trapianti; CNT) was convened with the aim of providing consensus recommendations for the management of CRKp infection/colonization in autologous and allogeneic-SCT recipients.The Expert Panel (EP) included 17 specialists in hematology, infectious diseases, clinical microbiology and nursing, who were selected by virtue of their expertise in research and clinical practice of infections in SCT. The areas of major concern were defined by generating clinical key issues using the criterion of clinical relevance, i.e. impact on patient management and risk of inappropriateness, and recommendations were obtained according to a nominal group technique.The EP focused its discussion on four key-issues considered relevant for the present recommendations that are shown in Table 1.Detection of CRKp carriers b...
[1] In this paper we look at changes of the statistics of the stationary explosive process at a basaltic volcano as a proxy for departures from thermodynamic equilibrium conditions in the shallow plumbing system. Specifically, we investigate the explosion process of Stromboli volcano that occurred during 2002-2003, 2006-2007 and 2010-2011. The first two periods were characterized by eruptions with significant lava effusion and strong paroxysmal events, while the last one shows persistent explosive activity accompanied by minor episodes of lava flow. We use three-component seismic data recorded by broadband stations operating on the volcano and, for 2007 and 2010-2011 cases, strainmeter data from a Sacks-Evertson borehole dilatometer. For each time interval we study the explosive process by looking at the interoccurrence times and at the amplitude distribution. Moreover, we analyze its waveforms, spectral content and polarization properties. In all three cases we find sharp increases of the explosion rate associated with swarms. Swarms are characterized by quasi-monochromatic seismic events with frequency peak close to about 3 Hz, higher amplitude than the usual explosions and variability coefficient of the inter-occurrence times close to 0.5. In correspondence to the swarms, we also observe negative variations in the strain signals, which indicate a depressurization in the shallow plumbing system. This depressurization emerges clearly from the data collected during 2010-2011, whereas it is less sharp for the 2007 episode, and has been estimated in about 10 5 Pa. From the polarization analysis we infer that this depressurization affects the upper 0.3-0.8 km of the plumbing system.
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