Antibiotico-resistenza, da Bari la rivoluzione della diagnosi rapida per limitare le infezioni in ospedale [Infettivologia]

Antibiotico-resistenza: ogni anno, circa 200mila persone in Italia sono colpite da infezioni causate da batteri resistenti agli antibiotici. Ma solo il 5% dei pazienti ospedalizzati con infezioni respiratorie riceve una diagnosi corretta attraverso un esame di laboratorio che identifichi il patogeno responsabile, confondendo così infezioni virali e batteriche. Da Bari viene rilanciata la rete nazionale per potenziare la diagnostica microbiologica, con l’obiettivo di frenare un’emergenza sanitaria globale che costa vite, allunga le degenze e aumenta i costi per il sistema sanitario.

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Antibiotici in gravidanza: rischio malformativo associato al trimetoprim-sulfametossazolo nel primo trimestre [Infettivologia]

Le infezioni delle vie urinarie (IVU) rappresentano una delle complicanze infettive più frequenti durante la gravidanza, sia nella forma di batteriuria asintomatica che di cistite acuta. Entrambe le condizioni, se non trattate, possono favorire esiti avversi perinatali, ma il primo trimestre di gestazione è una fase estremamente delicata per lo sviluppo fetale, in cui l’esposizione a farmaci potenzialmente teratogeni può aumentare il rischio di malformazioni congenite. In questo contesto, l’uso di antibiotici deve bilanciare attentamente i benefici per la madre con i possibili rischi per il nascituro.

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Expert consensus on solutions to improve implementation of NICE type 2 diabetes guideline (NG28) by health systems in England: a Delphi panel by the INNOVATE-28 Working Group

Objectives
To provide expert consensus recommendations to support health systems in England to improve prioritisation and implementation of cardiovascular and renal risk-based type 2 diabetes (T2D) care, achieving quality improvement in line with the National Institute for Health and Care Excellence (NICE) NG28 guideline.

Design
A two-round modified Delphi panel was conducted.

Setting
Participants represented health system leadership from a cross-section of integrated care systems across England. Delphi panel statements were relevant to both primary and secondary care.

Participants
A panel of 28 participants took part in the Delphi panel (10.7% drop-off rate between rounds). Statement development was guided by a separate committee of 11 topic experts, forming the Implementing NICE NG28 by harnessing Opportunities for adVanced integrated cAre Transformation and Excellence (INNOVATE)-28 Working Group.

Results
In total, 84% (n=32/38) statements reached consensus across both Delphi rounds. There was agreement that health systems need to prioritise prevention of cardiovascular and renal complications in T2D, particularly for those at ‘high’ or at ‘rising’ cardiovascular and renal risk. Consensus was also reached that quality improvement should be incentivised based on local population needs, with investment into digital systems and supporting roles to aid this. Panellists further agreed that investment should be channelled into community-led resources to reinforce a preventative approach and help to ensure people living with T2D receive care in the most appropriate setting. Finally, collaboration between health and social care, health innovation networks and industry partners was highlighted as an opportunity to leverage support for the delivery of risk-based T2D care.

Conclusions
The recommendations from this Delphi panel are intended to support health systems to consistently implement the NG28 guideline and facilitate quality improvement to deliver equitable T2D care and mitigate cardiovascular and renal risk. By being innovative and bold with commissioning and ways of working, and leveraging partnerships, health system leaders can enact the transformational and sustainable change needed to improve outcomes for people living with T2D, tackle healthcare inequalities and optimise system resilience.

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