VIM-1 Metallo-β-lactamase in Acinetobacter baumannii

In 2004 and 2005, 5 metallo-β-lactamase (MBL)-positive Acinetobacter baumannii isolates were found in 2 Greek hospitals. Isolates were unrelated and carried blaVIM-1 in a class 1 integron; blaOXA-51- and blaOXA-58-like carbapenemase genes were also detected. VIM-1 MBL in Acinetobacter spp. causes concern, given the increasing resistance of this species

Exploring colistin pharmacodynamics against Klebsiella pneumoniae: A need to revise current susceptibility breakpoints

Objectives: Because the pharmacokinetic/pharmacodynamic (PK/PD) characteristics of colistin against Enterobacteriaceae are not well explored, we studied the activity of colistin against K. pneumoniae in an in vitro PK/PD model simulating different dosing regimens. Methods: Three clinical isolates of K. pneumoniae with MICs of 0.5, 1 and 4mg/L were tested in an in vitro PK/PD model following a dose-fractionation design over a period of 24h. A high and low inoculumof 107 and 104 cfu/mL with and without a heteroresistant subpopulation, respectively, were used. PK/PD indices associated with colistin activity were explored and Monte Carlo analysis was performed in order to determine the PTA for achieving a bactericidal effect (2 log kill). Results: The fAUC/MIC (R2"0.64-0.68) followed by fCmax/MIC (R2=0.55-0.63) best described colistin's 24 h log10 cfu/mL reduction for both low and high inocula. Dosing regimens with fCmax/MIC≥6 were always associated with a bactericidal effect (P=0.0025). However, at clinically achievable concentrations, usually below fCmax/MIC=6, an fAUC/MIC ≤25 was more predictive of a bactericidal effect. Using a dosing regimen of 9 MU/ day, the PTA for this pharmacodynamic target was 100%, 5%-70%and 0%, for isolates with MICs of ≤0.5, 1 and ≥2 mg/L, respectively. Dosing regimens that aim for a trough level of 1 mg/L achieve coverage of strains up to 0.5 mg/L (target trough/MIC=2 mg/L). Conclusions: Characterization of the pharmacodynamics of colistin against Enterobacteriaceae in an in vitro model of infection indicates that a revision of current susceptibility breakpoints is needed. Therapeutic drug monitoring of colistin to achieve pharmacodynamic targets in individual patients is highly recommended

Lessons from a historic example of diving safety rules violation: the case of Greek sponge divers

This study presents a historical example of systematic safety rules violations by professional sponge divers in Greece during the early 20th century. In light of absolute unaccountability in favour of economic competition and in the absence of state oversight, the profession of sponge diving had developed into a deadly undertaking. The study is based on a report compiled by Professor of Hygiene and Microbiology Konstantinos Savvas, which was addressed to the Ministry of Marine Affairs. Savvas’ report rested on data concerning hospitalised divers derived from the medical records of warship ‘Kriti’ (Crete), which escorted groups of Greek fishing vessels to four of their expedition in the Mediterranean over the period 1900–1903. Although the events explored herein took place at a time much different from the modern era with its numerous advancements in hyperbaric medicine, enhanced divers’ professionalism and the establishment of labour rights and strict safety regulations, we should not overlook the human factor of professional exploitation that leads to the violation of safety rules. On the other hand, supervisory authorities entrusted with the responsibility of overseeing professional activities ought to be vigilant on a constant basis, especially in times of economic crisis that may lead to lax state functioning

The challenges of antimicrobial drug resistance in Greece

timicrobial drug resistance rates in Greece are among the highest in Europe. The prevalence of carbapenem-resistant Gram-negative species has increased considerably, including endemic strains in intensive care units. Pandrug-resistant Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa are sporadically reported. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus rates are also high in Greek hospitals. Multidrug resistance increases risk of mortality, hospitalization duration and costs, and undermines the medical system. Administrative responses initiated include action plans, monitoring systems, and guidelines. Common terminology among involved parties for defining and grading resistance is required. Multidrug-resistant microorganisms challenge clinical laboratories; uniform recommendations towards detection of resistance mechanisms need to be established. Prospective multicenter outcome studies comparing antibiotic regimens and containment methods are needed. Because new antimicrobials against Gram-negative pathogens are not foreseeable, judicious use of the existing and strict adherence to infection control best practice might restrain resistance spread. Awareness of resistance patterns and organisms prevailing locally by reporting laboratories and treating physicians is important

Infectious Diseases Associated with Hydrometeorological Hazards in Europe: Disaster Risk Reduction in the Context of the Climate Crisis and the Ongoing COVID-19 Pandemic

Hydrometeorological hazards comprise a wide range of events, mainly floods, storms, droughts, and temperature extremes. Floods account for the majority of the related disasters in both developed and developing countries. Flooding alters the natural balance of the environment and frequently establish a favorable habitat for pathogens and vectors to thrive. Diseases caused by pathogens that require vehicle transmission from host to host (waterborne) or a host/vector as part of their life cycle (vector-borne) are those most likely to be affected by flooding. Considering the most notable recent destructive floods events of July 2021 that affected several Central Europe countries, we conducted a systematic literature review in order to identify documented sporadic cases and outbreaks of infectious diseases in humans in Europe, where hydrometeorological hazards, mainly floods, were thought to have been involved. The occurrence of water-, rodent-, and vector-borne diseases in several European countries is highlighted, as flooding and the harsh post-flood conditions favor their emergence and transmission. In this context, strategies for prevention and management of infectious disease outbreaks in flood-prone and flood-affected areas are also proposed and comprise pre- and post-flood prevention measures, pre- and post-outbreak prevention measures, as well as mitigation actions when an infectious disease outbreak finally occurs. Emphasis is also placed on the collision of floods, flood-related infectious disease outbreaks, and the evolving COVID-19 pandemic, which may result in unprecedented multi-hazard conditions and requires a multi-hazard approach for the effective disaster management and risk reduction

The Impact of Earthquakes on Public Health: A Narrative Review of Infectious Diseases in the Post-Disaster Period Aiming to Disaster Risk Reduction

Earthquakes are among the most impressive natural phenomena with very high potential to set off a chain of effects that significantly affects public health through casualties and injuries. Related disasters are attributed not only to the strong ground motion and coseismic phenomena but also to secondary effects, comprising mainly landslides and tsunamis, among others. All these can create harsh conditions favorable for the emergence of infectious diseases that are capable of causing additional human and economic losses and disruption of the emergency and recovery process. The present study comprises an extensive narrative review of the existing literature on the earthquake-triggered infectious diseases recorded worldwide, along with their symptoms, causative pathogens, associated risk factors, most vulnerable population groups, and prevention strategies. Respiratory, gastrointestinal, and vector-borne diseases, as well as wound and skin infections, are mainly recorded among the earthquake-affected population. Measures for effectively preventing earthquake-triggered infectious diseases are also proposed. One of the widely proposed measures is the establishment of a proper disease surveillance system in order to immediately and effectively identify the pre- and post-disaster occurrence of infectious diseases. This approach significantly contributes to disease trends monitoring, validation of early warning, and support of the emergency response and recovery actions