scholarly journals Antimicrobial Bacteria and Viruses Detected Through Systematic Sampling in the Childcare Environment

2020 ◽  
Vol 41 (S1) ◽  
pp. s461-s461
Author(s):  
Khalil Chedid ◽  
Michael Hayashi ◽  
Peter DeJonge ◽  
Olivia Yancey ◽  
Elliane Siebert ◽  
...  
Keyword(s):  
Close Contact ◽  
Multidrug Resistant ◽  
Systematic Sampling ◽  
Shared Environment ◽  
Play Area ◽  
Increased Risk ◽  
Standard Plate ◽  
Plastic Toys ◽  
Small Wood ◽  
Childcare Center

Background: Approximately two-thirds of children aged <5 years receive out-of-home child care. Childcare attendees have an increased risk of infections compared to children not in childcare settings, possibly due to their close contact in a shared environment. As multidrug-resistant organisms (MDROs) increasingly move from healthcare-associated to community settings, childcare can provide a venue for further transmission of these pathogens. Our objective was to evaluate the bioburden of pathogens present on fomites in childcare centers and how surface contamination changes over time. Methods: The study was conducted in the single-room play area of an Ypsilanti, Michigan, childcare center caring for children aged 3–5 years. Polyester swabs were used to collect surface samples from 16 locations in the room, including (1) laminate, wood and plastic tabletops and furniture; (2) a stainless steel sink and adjacent plastic trash bin; and (3) wood, metal and plastic toys. A water sample was also collected at a 17th site. Samples were collected twice weekly for 5 of 6 weeks, followed by 1 additional collection (September–October 2019). Tryptic soy agar was used for standard plate counts and selective media were used to identify methicillin-resistant Staphylococcus aureus (MRSA), Vvancomycin-resistant Enterococcus (VRE), and extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae. Single-plex RT-PCR was used to detect norovirus and adenovirus. Results: Among 175 samples collected on 11 days, MRSA and ESBL-producing Enterobacteriaceae were detected from 10.3% (18 of 175) and 8.0% (14 of 175), respectively, of environmental specimens. No specimens were positive for VRE or norovirus. Adenovirus was detected in 20 of 175 specimens (11.4%). Median bioburden by site ranged from 85 CFU/mL to 2,510 CFU/mL. The highest median bioburden was observed at the sink (2,510 CFU/mL), followed by the plastic building block table (1,620 CFU/mL), the small wood blocks (1,565 CFU/mL) and water from a water play area and an adjacent tabletop (1,260 and 1,100 CFU/mL respectively). The highest single day bioburden was 273,000 CFU/mL at the sink. Conclusion: The presence of MDROs on childcare center fomites raised concern for exposure to these pathogens among vulnerable populations. More study is needed to determine the degree to which these contaminated fomites drive transmission between children. We found the highest bioburdens on sites where children played or washed with water, identifying potential targets for more frequent cleaning.Funding: NoneDisclosures: Emily T. Martin reports a consulting from Pfizer.

scholarly journals Biofilms as Promoters of Bacterial Antibiotic Resistance and Tolerance

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 3
Author(s):  
Cristina Uruén ◽  
Gema Chopo-Escuin ◽  
Jan Tommassen ◽  
Raúl C. Mainar-Jaime ◽  
Jesús Arenas
Keyword(s):  
Close Contact ◽  
Animal Health ◽  
Deep Understanding ◽  
Growth Conditions ◽  
Multidrug Resistant ◽  
Extracellular Dna ◽  
Resistant Bacteria ◽  
Resistance To Antibiotics ◽  
Global Threat ◽  
Biofilm Development

Multidrug resistant bacteria are a global threat for human and animal health. However, they are only part of the problem of antibiotic failure. Another bacterial strategy that contributes to their capacity to withstand antimicrobials is the formation of biofilms. Biofilms are associations of microorganisms embedded a self-produced extracellular matrix. They create particular environments that confer bacterial tolerance and resistance to antibiotics by different mechanisms that depend upon factors such as biofilm composition, architecture, the stage of biofilm development, and growth conditions. The biofilm structure hinders the penetration of antibiotics and may prevent the accumulation of bactericidal concentrations throughout the entire biofilm. In addition, gradients of dispersion of nutrients and oxygen within the biofilm generate different metabolic states of individual cells and favor the development of antibiotic tolerance and bacterial persistence. Furthermore, antimicrobial resistance may develop within biofilms through a variety of mechanisms. The expression of efflux pumps may be induced in various parts of the biofilm and the mutation frequency is induced, while the presence of extracellular DNA and the close contact between cells favor horizontal gene transfer. A deep understanding of the mechanisms by which biofilms cause tolerance/resistance to antibiotics helps to develop novel strategies to fight these infections.

Healthcare microenvironments define multidrug-resistant organism persistence

2021 ◽  
pp. 1-7
Author(s):  
Brendan J. Kelly ◽  
Selamawit Bekele ◽  
Sean Loughrey ◽  
Elizabeth Huang ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
16S Rrna ◽  
Hot Spots ◽  
Multidrug Resistant ◽  
Systematic Sampling ◽  
Resistant Organism ◽  
Rrna Gene ◽  
Environmental Cleaning ◽  
Healthcare Environment ◽  
Clostridioides Difficile ◽  
Modifiable Factors

Abstract Background: Multidrug-resistant organisms (MDROs) colonizing the healthcare environment have been shown to contribute to risk for healthcare-associated infections (HAIs), with adverse effects on patient morbidity and mortality. We sought to determine how bacterial contamination and persistent MDRO colonization of the healthcare environment are related to the position of patients and wastewater sites. Methods: We performed a prospective cohort study, enrolling 51 hospital rooms at the time of admitting a patient with an eligible MDRO in the prior 30 days. We performed systematic sampling and MDRO culture of rooms, as well as 16S rRNA sequencing to define the environmental microbiome in a subset of samples. Results: The probability of detecting resistant gram-negative organisms, including Enterobacterales, Acinetobacter spp, and Pseudomonas spp, increased with distance from the patient. In contrast, Clostridioides difficile and methicillin-resistant Staphylococcus aureus were more likely to be detected close to the patient. Resistant Pseudomonas spp and S. aureus were enriched in these hot spots despite broad deposition of 16S rRNA gene sequences assigned to the same genera, suggesting modifiable factors that permit the persistence of these MDROs. Conclusions: MDRO hot spots can be defined by distance from the patient and from wastewater reservoirs. Evaluating how MDROs are enriched relative to bacterial DNA deposition helps to identify healthcare micro-environments and suggests how targeted environmental cleaning or design approaches could prevent MDRO persistence and reduce infection risk.

POSSIBLE HEALTH CONSEQUENCES FOR NEWBORNS FROM MOTHERS WHO SUFFERED COVID-19 DURING PREGNANCY

2021 ◽  
pp. 35-47
Author(s):  
Tamara G. Denisova ◽  
Adelina I. Sergeeva ◽  
Alexandra S. Grigorieva ◽  
Enje E. Rechapova ◽  
Ivan I. Sergeev ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Negative Impact ◽  
Close Contact ◽  
Relevant Literature ◽  
Clinical Manifestations ◽  
Future Generation ◽  
World Health ◽  
Practical Significance ◽  
Increased Risk ◽  
Coronavirus Infection

According to the WHO statement dated March 11, 2020, the coronavirus infection SARS-CoV-2 has reached the scale of a pandemic and is currently a world health problem. A special group of the population that requires increased attention is pregnant women due to the fact that pneumonia occupies the third place in the structure of indirect causes of maternal mortality. Pregnant women whose immune system has changed appeared to be at an increased risk of infection. Pregnancy is a risk factor for the development of a more severe course of acute respiratory viral diseases and influenza. To date, the issue of intrauterine transmission of coronavirus disease remains completely unexplored, which causes fear among pregnant women for the future generation. Addition of a new coronavirus infection SARS-CoV-2 has a negative impact on pregnancy, childbirth and the postpartum period, the health of newborns, especially in patients with a burdened obstetric history. Pregnancy itself and childbirth do not affect the course of COVID-19, but the infection addition can complicate the course of gestation, causing respiratory distress syndrome, premature birth and spontaneous miscarriages, congenital pneumonia and antenatal death of newborns born from covid-positive mothers. The literature published from December 1, 2019 to July 30, 2021 was searched in several databases, including PubMed, Web of Science, Google Scholar and the WHO COVID-19 database, of which 52 articles were selected for detailed consideration. The relevant literature was searched to understand the issues of infection transmission to newborns from infected mothers and the clinical manifestations of the disease in the former. As a result, it was found that newborns can become infected with SARS-Cov-2 in close contact with infected patients or asymptomatic virus carriers. However, based on the data of modern literature, it is impossible to unequivocally answer the questions posed, more facts are needed to solve the problem. The practical significance of the work is that the results of the study should be used for further studying the consequences of COVID-19 for the health of newborn children.

scholarly journals Nasal carriage of Staphylococcus aureus in farm animals and breeders in North of Morocco

2020 ◽  
Author(s):  
Nadira Mourabit ◽  
Abdelhay Arakrak ◽  
Mohammed Bakkali ◽  
Zeineb Zian ◽  
Joaira Bakkach ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Virulence Genes ◽  
Close Contact ◽  
Nasal Carriage ◽  
High Rate ◽  
Farm Animals ◽  
Carriage Rate ◽  
Increased Risk ◽  
Significant Difference ◽  
Mrsa Strains

Abstract Background: The objectives of this study were to determine for the first time, in Morocco, the nasal carriage rate, antimicrobial susceptibility profiles and virulence genes of S.aureus isolated from animals and breeders in close contact.Methods: From 2015 to 2016, 421 nasal swab samples were collected from 26 different Livestock areas in Tangier. The antimicrobial susceptibility phenotypes were determined by disk diffusion according to EUCAST 2015. The presence of nuc, mecA, mecC, lukS/F-PV, and tst genes were determined by PCR for all isolates. Results: The overall S. aureus nasal carriage rate was low in animals (9.97%) and high in breeders (60%) with a statistically significant difference, (OR= 13.536; 95% CI = 7.070- 25.912; p< 0.001).In general, S. aureus strains were susceptible to the majority of antibiotics and the highest resistance rates were found against tetracycline (16.7% in animals and 10% in breeders). No MRSA was detected in animals and breeders. A high rate of tst and lukS/F-PV genes has been recovered only, from animals (11.9% and 16.7%, respectively).Conclusion: Despite the lower rate of nasal carriage of S. aureus and the absence of MRSA strains in our study, S. aureus strains harbored a higher frequency of tst and lukS/F-PV of virulence genes, which is associated to an increased risk of infection dissemination in humans. This highlights the need for implementing adequate approaches for prevention.Further larger and multi-center studies are needed to validate and confirm our findings.

scholarly journals Behavioural response to the Covid-19 pandemic in South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250269
Author(s):  
Umakrishnan Kollamparambil ◽  
Adeola Oyenubi
Keyword(s):  
South Africa ◽  
Low Income ◽  
Close Contact ◽  
Preventive Strategy ◽  
Social Distancing ◽  
Response Behaviour ◽  
Health Response ◽  
Increased Risk ◽  
Preventive Behaviour ◽  
Nationally Representative

Background Given the economic and social divide that exists in South Africa, it is critical to manage the health response of its residents to the Covid-19 pandemic within the different socio-economic contexts that define the lived realities of individuals. Objective The objective of this study is to analyse the Covid-19 preventive behaviour and the socio-economic drivers behind the health-response behaviour. Data The study employs data from waves 1 and 2 of South Africa’s nationally representative National Income Dynamics Study (NIDS)—Coronavirus Rapid Mobile Survey (CRAM). The nationally representative panel data has a sample of 7073 individuals in Wave 1 and 5676 individuals in Wave 2. Methods The study uses bivariate statistics, concentration indices and multivariate estimation techniques, ranging from a probit, control-function approach, special-regressor method and seemingly unrelated regression to account for endogeneity while identifying the drivers of the response behaviour. Findings The findings indicate enhanced behavioural responsiveness to Covid-19. Preventive behaviour is evolving over time; the use of face mask has overtaken handwashing as the most utilised preventive measure. Other measures, like social distancing, avoiding close contact, avoiding big groups and staying at home, have declined between the two periods of the study. There is increased risk perception with significant concentration among the higher income groups, the educated and older respondents. Our findings validate the health-belief model, with perceived risk, self-efficacy, perceived awareness and barriers to preventive strategy adoption identified as significant drivers of health-response behaviour. Measures such as social distancing, avoiding close contact, and the use of sanitisers are practised more by the rich and educated, but not by the low-income respondents. Conclusion The respondents from lower socio-economic backgrounds are associated with optimism bias and face barriers to the adoption of preventive strategies. This requires targeted policy attention in order to make response behaviour effective.

scholarly journals Nasal carriage of Staphylococcus aureus in livestock in North of Morocco

2020 ◽  
Author(s):  
Nadira Mourabit ◽  
Abdelhay Arakrak ◽  
Mohammed Bakkali ◽  
Zeineb Zian ◽  
Joaira Bakkach ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Susceptibility ◽  
Virulence Genes ◽  
Close Contact ◽  
Nasal Carriage ◽  
High Rate ◽  
Carriage Rate ◽  
Increased Risk ◽  
Significant Difference ◽  
Mrsa Strains

Abstract Background : In Morocco, data of LA-MRSA nasal carriage are still limited. The objectives of this study were to determine for the first time the nasal carriage rate, antimicrobial susceptibility profiles and virulence genes of S aureus isolated from animals and breeders in close contact. Methods : From 2015 to 2016, 480 nasal swab samples were collected from 27 different Livestock areas in Tangier. The antimicrobial susceptibility phenotypes were determined by disk diffusion according to EUCAST 2016. The presence of nuc , mec A and his homologue mec C, lukS/F-PV, and tst genes were determined by PCR for all isolates. Results : The overall S. aureus nasal carriage rate was low in animals (9.97%) and high in breeders (60%) with a statistically significant difference, (OR = 14.321; 95% CI = 7.484- 27.405; p< 0.0001). In general, S. aureus strains were susceptible to the majority of antibiotics and the higher resistance rates were found against tetracycline (16.7% in animals and 10% in breeders). No MRSA was detected in animals and breeders. A high rate of tst and lukS/F-PV genes has been found only in animals (11.9% and 16.7%, respectively). Conclusion : Despite the lower colonization rate of S. aureus and the absence of MRSA strains in our study, S. aureus strains harbored a higher frequency of tst and lukS/F-PV of virulence genes, which is associated to an increased risk of infection dissemination in humans. This highlights the need for implementing adequate approaches for prevention. Further larger and multi-center studies are needed to validate and confirm our findings. Keywords: Staphylococcus aureus , nasal carriage, animals, breeders, MRSA, Morocco

scholarly journals 834. Characterization of Heavily Treatment Experienced HIV-1 Infected Clinical Trial Participants Infected with SARS-CoV-2 COVID 19: Fostemsavir BRIGHTE Phase 3 Clinical Trial

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S509-S509
Author(s):  
Shiven Chabria ◽  
Stephane De Wit ◽  
Amy Pierce ◽  
Bronagh M Shepherd ◽  
Michael Warwick-Sanders ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Supplemental Oxygen ◽  
Multidrug Resistant ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Research Support ◽  
Increased Risk ◽  
Living With Hiv ◽  
Hiv 1

Abstract Background BRIGHTE is an ongoing global study evaluating the gp120 attachment inhibitor fostemsavir (FTR) in heavily treatment-experienced (HTE) adults with multidrug resistant (MDR) HIV-1 unable to form a viable antiretroviral (ARV) regimen. An estimated 2 million people living with HIV-1 have been infected with SARS-CoV-2. Those with HIV viremia and/or low CD4+ counts are at increased risk of serious adverse outcome. We describe the reported COVID cases in a clinical trial population of people living with MDR HIV and immune suppression. Methods At the start of the COVID pandemic, all ongoing BRIGHTE subjects had achieved ≥ 192 weeks on FTR and optimized background ARVs; results through Week 96 were presented previously. Investigators used WHO guidelines for COVID diagnosis and reported exposure, testing results and symptom presence. Figure 1. BRIGHTE Study Design Results 371 subjects [272 Randomized Cohort (RC), 99 Non-Randomized Cohort (NC)] were enrolled; 44% were ≥ 50 years of age and 86% had an AIDS history. Median CD4+ count at study start of was 80 cells/mm3 (IQR 11–202); 30% with ≤ 20 cells/mm3. 250 subjects remained in BRIGHTE at pandemic start. By April 2021, 17 subjects (14 RC, 3 NC) had confirmed COVID infection (positive PCR test). Severity was Grade 1-3, all cases resolved with no deaths. Six subjects were hospitalized (Table 1); most recent CD4+ count prior to COVID were 293-1641 cells/mm3 and 5/6 subjects were virologically suppressed. Treatments often included prophylactic anticoagulants and supplemental oxygen; no cART changes were made. The remaining 11/17 confirmed cases were managed outpatient. Five more subjects had suspect COVID not confirmed by PCR and 2 subjects had negative PCR tests. Table 1. Characterization of Participants with Serious AEs of Confirmed COVID-19 Infections – All Hospitalizations Conclusion A total of 22/250 COVID-19 cases (17 confirmed, 5 unconfirmed) have been reported in BRIGHTE. Outcomes were reassuring with no deaths or known persistent sequelae, despite having advanced HIV and comorbid diseases at baseline associated with poorer COVID outcomes. Outcomes may have benefitted from immunologic improvement during the trial. Disclosures Shiven Chabria, MD, Viiv Healthcare (Employee) Stephane De Wit, MD, Gilead (Grant/Research Support)Janssen (Grant/Research Support)Merck Sharpe & Dohme (Grant/Research Support)ViiV Healthcare (Grant/Research Support) Amy Pierce, BS, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Bronagh M. Shepherd, PhD, GlaxoSmithKline (Employee, Shareholder) Michael Warwick-Sanders, BM BSc DPM MFPM, GSK (Employee) Marcia Wang, PhD, GlaxoSmithKline (Employee, Shareholder) Andrew Clark, MD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Peter Ackerman, MD, GSK/ViiV Healthcare (Employee, Shareholder)

scholarly journals Genetic Diversity of IFγ, IL1β, TLR2, and TLR8 Loci in Pulmonary Tuberculosis in Kazakhstan

2014 ◽  
Vol 3 ◽  
Author(s):  
Dauren Yerezhepov ◽  
Axat Zhabagin ◽  
Ayken Askapuli ◽  
Saule Rakhimova ◽  
Zhannur Nurkina ◽  
...  
Keyword(s):  
Epidemiological Data ◽  
Multidrug Resistant ◽  
Taqman Assay ◽  
World Population ◽  
Protection Mechanism ◽  
Pulmonary Tb ◽  
Increased Risk ◽  
Mdr Tb ◽  
Latent Tb ◽  
Genotype A

Introduction. Tuberculosis (TB) is caused by bacterium Mycobacterium tuberculosis (MTB), and according to the WHO, up to 30% of world population is infected with latent TB. Pathogenesis of TB is multifactorial, and its development depends on environmental, social, microbial, and genetic factors of both the bacterium and the host. The number of TB cases in Kazakhstan has decreased in the past decade, but multidrug-resistant (MDR) TB cases are dramatically increasing. Polymorphisms in genes responsible for immune response have been associated with TB susceptibility. The objective of this study was to investigate the risk of developing pulmonary TB (PTB) associated with polymorphisms in several inflammatory pathway genes among Kazakhstani population.Methods. 703 participants from 3 regions of Kazakhstan were recruited for a case-control study. 251 participants had pulmonary TB (PTB), and 452 were healthy controls (HC). Males and females represented 42.39% and 57.61%, respectively. Of all participants, 67.4% were Kazakhs, 22.8% Russians, 3.4% Ukrainians, and 6.4% were of other origins. Clinical and epidemiological data were collected from medical records, interviews, and questionnaires. DNA samples were genotyped using TaqMan assay on 4 polymorphisms: IFNγ (rs2430561) and IL1β (rs16944), TLR2 (rs5743708) and TLR8 (rs3764880). Statistical data was analyzed using SPSS 19.Results. Genotyping by IFγ, IL1β, TLR2 showed no significant association with PTB susceptibility (p > 0.05). TLR8 genotype A/G was significantly higher in females (F/M – 41.5%/1.3%) and G/G in males (M/F – 49%/20.7%) (χ2=161.43, p < 0.001). A significantly increased risk of PTB development was observed for TLR A/G with an adjusted OR of 1.48 (95%, CI: 0.96 - 2.28), and a protective feature was revealed for TLR8 G/G genotype (OR: 0.81, 95%, CI: 0.56 - 1.16, p = 0.024). Additional grouping by gender revealed that TLR8 G/G contributes as protective genotype (OR: 1.83, 95%, CI: 1.18 - 2.83, p = 0.036) in males of the control group.Conclusion. Results indicate that heterozygous genotype A/G of TLR8 increases the risk of PTB development, while G/G genotype may serve as protection mechanism. A/A genotype is strongly associated with susceptibility to PTB. To clarify the role of other polymorphisms in susceptibility to PTB in Kazakhstani population, further investigations are needed. 

An Outbreak of Multidrug-ResistantPseudomonas AeruginosaAssociated with Increased Risk of Patient Death in an Intensive Care Unit

2002 ◽  
Vol 23 (8) ◽  
pp. 441-446 ◽  
Author(s):  
Geir Bukholm ◽  
Tone Tannæs ◽  
Anne Britt Bye Kjelsberg ◽  
Nils Smith-Erichsen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Bacterial Isolates ◽  
Patient Death ◽  
Antibiotic Policy ◽  
Outbreak Period ◽  
Increased Risk ◽  
Gastric Tubes

Objective:To investigate an outbreak of multidrug-resistantPseudomonas aeruginosain an intensive care unit (ICU).Design:Epidemiologic investigation, environmental assessment, and ambidirectional cohort study.Setting:A secondary-care university hospital with a 10-bed ICU.Patients:All patients admitted to the ICU receiving ventilator treatment from December 1,1999, to September 1, 2000.Results:An outbreak in an ICU with multidrug-resistant isolates ofP. aeruginosabelonging to one amplified fragment-length polymorphism (AFLP)–defined genetic cluster was identified, characterized, and cleared. Molecular typing of bacterial isolates with AFLP made it possible to identify the outbreak and make rational decisions during the outbreak period. The outbreak included 19 patients during the study period. Infection with bacterial isolates belonging to the AFLP cluster was associated with reduced survival (odds ratio, 5.26; 95% confidence interval, 1.14 to 24.26). Enhanced barrier and hygiene precautions, cohorting of patients, and altered antibiotic policy were not sufficient to eliminate the outbreak. At the end of the study period (in July), there was a change in the outbreak pattern from long (December to June) to short Quly) incubation times before colonization and from primarily tracheal colonization (December to June) to primarily gastric or enteral Quly) colonization. In this period, the bacterium was also isolated from water taps.Conclusion:Complete elimination of the outbreak was achieved after weekly pasteurization of the water taps of the ICU and use of sterile water as a solvent in the gastric tubes.

scholarly journals Increased Risk of COVID-19-Related Deaths among General Practitioners in Italy

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 155 ◽  
Author(s):  
Alberto Modenese ◽  
Fabriziomaria Gobba
Keyword(s):  
General Practitioners ◽  
Close Contact ◽  
Medical Specialties ◽  
Work Related ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Specific Safety ◽  
Medical Examinations ◽  
Safety Procedures ◽  
Death Cases

To date, data on COVID-19-related death cases among physicians from different medical specialties are incomplete and scattered. In Italy, available data highlight that general practitioners (GPs) are, apparently, the most heavily affected group. Indeed, they currently represent 44.1% of the total COVID-19 related death cases occurred among physicians, whereas they constitute about 15% of the total number of doctors. This high proportion is most likely the consequence of a work-related contagion happening especially during the first weeks of the epidemic, and persisting also in the following weeks, after the national lockdown. There are various reasons for these higher contagion rates: GPs perform a lot of medical examinations daily, usually in close contact with patients. Especially at the beginning of the epidemic, GPs might have had scant information on the specific safety procedures for the prevention of SARS-CoV-2 transmission (e.g., there was limited knowledge on the possibility of contagions deriving from asymptomatic patients) and, moreover, the availability of personal protective equipment was insufficient. Furthermore, the risk of infection is highly increased by the virus’ characteristics, like its survival for several hours/days on different surfaces and its persistence in the air after an aerosolization process, with possibilities to be transmitted over distances longer than two meters. Following these observations, and considering the high cost in term of GPs’ lives, the COVID-19 pandemic will probably revolutionize the approach to patients in general practice. Clear and effective guidelines are absolutely and urgently needed for the refinement of adequate measures to prevent SARS-CoV-2 infections among GPs.

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