Multidrug Resistant Bacterial Co-Infections in Critically Ill Patients with COVID-19: A Review after Three Years of Pandemic

Secondary bacterial infections and co-infections frequently affect COVID-19 patients. However, bacterial coinfection rates increase in patients admitted in the Intensive Care Units (ICUs), and those diseases can be due to superinfections by Multidrug-Resistant (MDR) bacteria. Most of these infections are related to high-risk carbapenemase-producing clones and occasionally with resistance to new β-lactam-β-lactamase inhibitor combinations. This highlights the urgency to revise frequent and empiric prescription of broad-spectrum antibiotics in COVID-19 patients, with more attention to evidence-based studies and the need to maintain antimicrobial stewardship and infection control programs in pandemic crises. Additionally, the SARS-CoV-2 pandemic highlighted the challenge that an emerging pathogen provides in adapting prevention measures regarding both the risk of exposure to caregivers and the need to maintain quality of care

Dalbavancina long-acting per il trattamento delle infezioni batteriche acute di cute e strutture cutanee (ABSSSI): confronto con gli schemi terapeutici tradizionali

Introduction Acute bacterial skin and skin structure infections (ABSSSI) have increased in incidence and severity. The involvement of resistant organisms, particularly methicillinresistant Staphylococcus aureus, presents additional challenges. Dalbavancin, a lipoglycopeptide antibiotic agent active against gram-positive pathogens, has a prolonged half-life allowing for one shot (one single dose) or once-weekly treatment for ABSSSI. The objective of the analysis was to assess the noninferiority of dalbavancin when compared with other conventional therapies and evaluate the economic impact of dalbavancin in the hospital setting for patients with ABSSSI. Methods We retrospectively reviewed patients with ABSSSI hospitalized in Azienda Ospedaliero-Universitaria in Ferrara during 2017-2018. Patients received several antibiotic treatments, including daptomycin, vancomycin, linezolid, tigecycline, clindamycin, amoxicillin/clavulanic acid. The clinical outcome was evaluated considering the clinical improvement, C-reactive protein (CRP) level, adverse effects and recurrences. For the economical evaluation we considered the comparison between the cost of therapy with dalbavancin versus daptomycin. Results Seventy nine patients with ABSSSI hospitalized between 2017-2018 were analyzed (18 with dalbavancin and 61 patients with conventional treatment). Only the 82% of patients who received conventional treatments had a CRP level decrease compared to 100% of those treated with dalbavancin. The use of intravenous dalbavancin 1,000 mg plus 500 mg once a week versus the use of daptomycin was associated with a cost saving of approximately € 4,400 in a day hospital setting and € 2,400 for an hospitalization of 6 days. Conclusions Once-weekly intravenous dalbavancin was not inferior to daily intravenous conventional therapies and has the potential of being a cost saving option from a hospital perspective, because the patients with acute bacterial skin and skin structure infections could have discharged earlier

Protocollo diagnostico-terapeutico del paziente con infezioni acute di cute e strutture cutanee (ABSSSI) nel setting ospedaliero e ambulatoriale: take home messages

Acute bacterial skin and skin-structure infections (ABSSSIs) collect a cluster of common types of infection, including abscesses, cellulitis, and wound infections, that require an immediate effective antibacterial treatment. The high level of resistance to many antibiotic drugs in the prevalent pathogens, mainly methicillin-resistant Staphylococcus aureus (MRSA), and the presence of risk factors and comorbidities make the appropriate selection of the antibiotic highly challenging. In recent years, new antibiotics have been developed with a spectrum targeted at Gram-positive bacteria and MRSA. Among them, dalbavancin, an effective long-acting antibiotic, can reduce the hospitalization time of patients, decreasing the risk of hospital infections and saving the costs of therapy. The current paper highlights the key management time-points that treating physicians must be aware of in order to achieve clinical success and to discharge patients from the hospital as early as possible

Co-Infections in Critically Ill Patients with or without COVID-19: A Comparison of Clinical Microbial Culture Findings

Co-infections in critically ill patients hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an important impact on the outcome of coronavirus disease 2019 (COVID-19). We compared the microbial isolations found in COVID-19 patients hospitalized in an intensive care unit (ICU) with those in a non-COVID-19 ICU from 22 February to 30 April 2020 and in the same period of 2019. We considered blood, urine or respiratory specimens obtained with bronchoalveolar lavage (BAL) or bronchial aspirate (BASP), collected from all patients admitted in ICUs with or without COVID-19 infection. We found a higher frequency of infections due to methicillin-resistant (MR) staphylococci, vancomycin-resistant Enterococcus faecium, carbapenemresistant Acinetobacter baumannii and Candida parapsilosis in COVID-19-positive patients admitted in ICUs compared to those who were COVID-19 negative. Carbapenem-resistant Pseudomonas aeruginosa was more frequently isolated from patients admitted in non-COVID-19 ICUs. Several conditions favor the increased frequency of these infections by antibiotic-resistant microorganisms. Among all, the severity of the respiratory tracts was definitely decisive, which required assisted ventilation with invasive procedures. The turnover in the ICU of a large number of patients in a very short time requiring urgent invasive interventions has favored the not always suitable execution of assistance procedures. No less important is the increased exposure to infectious risk from bacteria and fungi in patients with severe impairment due to ventilation. The highest costs for antifungal drugs were shown in the ICU-COVID group

Pregnancy outcome after early detection of bacterial vaginosis

Objective: To assess if detecting bacterial vaginosis either in early pregnancy or at midtrimester may predict adverse pregnancy outcome in women at risk for preterm delivery. Study design: 242 pregnant women with a previous preterm delivery were evaluated for bacterial vaginosis either in the first trimester (prior to 10 + 0 weeks) or in the second one (24-26 weeks). Adverse outcome was intended as miscarriage (≤25 weeks), or premature delivery (≤36 + 6). Results: The risk of adverse pregnancy outcome was significantly increased in women diagnosed at first trimester with bacterial vaginosis (OR: 4.56; 95% CI: 2.54-8.93); the same finding at midtrimester did not increase significantly the risk of preterm delivery. Conclusions: Early screening for bacterial vaginosis in pregnant women who experienced a preterm delivery may help in predicting the risk of adverse outcome

New radiocarbon dating results from the Upper Paleolithic-Mesolithic levels in Grotta Romanelli (Apulia, Southern Italy)

In this paper, we present the results of the accelerator mass spectrometry radiocarbon (AMS14C) dating campaign performed on samples selected from different levels in Grotta Romanelli (Castro, Italy). Grotta Romanelli is one of the key sites for the chronology of Middle Pleistocene–Holocene in Mediterranean region. After the first excavation campaigns carried out in the first decades of the 1900s, the cave has been systematically re-excavated only since 2015. During the last excavation campaigns different faunal remains were selected and submitted for 14C dating in order to confirm the chronology of the cave with a higher resolution. Isotopic ratio mass spectrometry (IRMS) measurements were also carried out on faunal remains

New radiocarbon dating results from the Upper Paleolithic-Mesolithic levels in Grotta Romanelli (Apulia, Southern Italy)

In this paper, we present the results of the accelerator mass spectrometry radiocarbon (AMS14C) dating campaign performed on samples selected from different levels in Grotta Romanelli (Castro, Italy). Grotta Romanelli is one of the key sites for the chronology of Middle Pleistocene–Holocene in Mediterranean region. After the first excavation campaigns carried out in the first decades of the 1900s, the cave has been systematically re-excavated only since 2015. During the last excavation campaigns different faunal remains were selected and submitted for 14C dating in order to confirm the chronology of the cave with a higher resolution. Isotopic ratio mass spectrometry (IRMS) measurements were also carried out on faunal remains