Clostridium difficile-associated disease (CDAD) is a growing health care problem. Elderly patients with multiple comorbidities and repeated hospitalization are at high risk for developing the disease. Few data are available on epidemiology of CDAD in Italy and no studies have focused on CDAD burden in internal medicine wards. We retrospectively analysed all CDAD cases in four internal medicine wards of a city hospital in northern Italy and reviewed the medical records of patients who developed CDAD during hospitalization. We identified 146 newly acquired cases, yielding a cumulative incidence of 2.56 per 100 hospitalizations and an incidence rate of 23.3 per 10,000 patient-days. Main risk factors were advanced age and length of hospitalization. A high proportion of CDAD patients had several comorbidities and had been treated with more than one antibiotic. The incidence is among the highest previously reported, this may be due to the characteristics of patients admitted to internal medicine wards and to the wards per se. We conclude that efforts are needed to reduce CDAD's burden in this setting, paying attention to logistics, patients care and antibiotic use.
CPAP is associated with cardiovascular and respiratory changes and plays a key role in the management of respiratory failure. Scanty data are available on the effects of CPAP on autonomic control in healthy subjects.The aim of this study was to evaluate the effects of different pressures on cardiorespiratory and autonomic variables in young volunteers.In 11 subjects we recorded ECG, continuous blood pressure (BP), respiration and end tidal CO2 (etCO2) at baseline (B) and during CPAP application using a face mask. Three different CPAP pressures (4,8 and 12 cmH20) were delivered in random order in each session.Spectral analysis of heart rate variability (HRV) was used to assess sympathovagal balance: low frequency (LF) and high frequency (HF) oscillations are markers of sympathetic and parasympathetic modulation respectively. Spontaneous baroreflex sensitivity (BRS) was calculated using the spectral alpha index.CPAP induced a significant decrease in heart rate (HR) and an increase in total power (TP) compared to B. No changes in HR and TP were observed among the different pressures. LF, HF, respiratory frequency and BRS were not affected by CPAP. EtCO2 and BP were unmodified during the experiments.The data suggest that CPAP acutely modifies HR and TP independently by changes in sympathovagal balance and BRS; direct mechanical effects induced by CPAP might explain these preliminary data. ASI Grant
A 29-year-old woman presented to the Fondazione IRCCS “Cà Granda” Ospedale Maggiore, a tertiary care university hospital in Milan (Italy), with skin lesions, fever, myalgia, joint pain and swelling, and a one-week history of low back pain. The diagnosis was Staphylococcus aureus (S. aureus) bacteraemia spreading to skin, bones, and joints and a lumbosacral epidural abscess L5-S2. Neither initial focus nor predisposing conditions were apparent. The antibiotic therapy was prolonged for six-weeks with the resolution of fever, skin lesions, articular inflammation, and the epidural abscess. Community-acquired S. aureus infections can affect patients without traditional healthcare-associated risk factors, and community acquisition is a risk-factor for the development of complications. Raised awareness of S. aureus bacteraemia, also in patients without healthcare-associated risk factors, is important in the diagnosis, management, and control of this infection, because failure to recognise patients with serious infection and lack of understanding of empirical antimicrobial selection are associated with a high mortality rate in otherwise healthy people.
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