Effect of ceftazidime/avibactam plus fosfomycin combination on 30 day mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae. Results from a multicentre retrospective study

Introduction The primary outcome of the study was to evaluate the effect on 30 day mortality of the combination ceftazidime/avibactam + fosfomycin in the treatment of bloodstream infections (BSIs) caused by KPC-producing Klebsiella pneumoniae (KPC-Kp). Materials and methods From October 2018 to March 2021, a retrospective, two-centre study was performed on patients with KPC-Kp BSI hospitalized at Sapienza University (Rome) and ISMETT-IRCCS (Palermo) and treated with ceftazidime/avibactam-containing regimens. A matched cohort (1:1) analysis was performed. Cases were patients receiving ceftazidime/avibactam + fosfomycin and controls were patients receiving ceftazidime/avibactam alone or in combination with in vitro non-active drugs different from fosfomycin (ceftazidime/avibactam +/- other). Patients were matched for age, Charlson comorbidity index, ward of isolation (ICU or non-ICU), source of infection and severity of BSI, expressed as INCREMENT carbapenemase-producing Enterobacteriaceae (CPE) score. Results Overall, 221 patients were included in the study. Following the 1:1 match, 122 subjects were retrieved: 61 cases (ceftazidime/avibactam + fosfomycin) and 61 controls (ceftazidime/avibactam +/- other). No difference in overall mortality emerged between cases and controls, whereas controls had more non-BSI KPC-Kp infections and a higher number of deaths attributable to secondary infections. Almost half of ceftazidime/avibactam + fosfomycin patients were prescribed fosfomycin without MIC fosfomycin availability. No difference in the outcome emerged after stratification for fosfomycin susceptibility availability and dosage. SARS-CoV-2 infection and ICS >= 8 independently predicted 30 day mortality, whereas an appropriate definitive therapy was protective. Conclusions Our data show that fosfomycin was used in the treatment of KPC-Kp BSI independently from having its susceptibility testing available. Although no difference was found in 30 day overall mortality, ceftazidime/avibactam + fosfomycin was associated with a lower rate of subsequent KPC-Kp infections and secondary infections than other ceftazidime/avibactam-based regimens

Clinical course of Coronavirus Disease-19 in patients with haematological malignancies is characterized by a longer time to respiratory deterioration compared to non-haematological ones: results from a case-control study

Background We evaluated clinical features and risk factors for mortality in patients with haematological malignancies and COVID-19. Methods Retrospective, case-control (1:3) study in hospitalized patients with COVID-19. Cases were patients with haematological malignancies and COVID-19, controls had COVID-19 without haematological malignancies. Patients were matched for sex, age and time of hospitalization. Results Overall, 66 cases and 198 controls were included in the study. Cases had higher prior corticosteroid use, infection rates, thrombocytopenia and neutropenia and more likely received corticosteroids and antibiotics than controls. Cases had higher respiratory deterioration than controls (78.7% vs 65.5%, p = 0.04). Notably, 29% of cases developed respiratory worsening > 10 days after hospital admission, compared to only 5% in controls. Intensive Care Unit admission and mortality were higher in cases than in controls (27% vs 8%, p = 0.002, and 35% vs 10%, p < 0.001). At multivariable analysis, having haematological malignancy [OR4.76, p < 0.001], chronic corticosteroid therapy [OR3.65, p = 0.004], prior infections [OR57.7, p = 0.006], thrombocytopenia [OR3.03, p < 0.001] and neutropenia [OR31.1, p = 0.001], low albumin levels [OR3.1, p = 0.001] and >= 10 days from hospital admission to respiratory worsening [OR3.3, p = 0.002] were independently associated with mortality. In cases, neutropenia [OR3.1, p < 0.001], prior infections [OR7.7, p < 0.001], >= 10 days to respiratory worsening [OR4.1, p < 0.001], multiple myeloma [OR1.5, p = 0.044], the variation of the CT lung score during hospitalization [OR2.6, p = 0.006] and active treatment [OR 4.4, p < 0.001] all were associated with a worse outcome. Conclusion An underlying haematological malignancy was associated with a worse clinical outcome in COVID-19 patients. A prolonged clinical monitoring is needed, since respiratory worsening may occur later during hospitalization

Долгосрочное качество жизни после лечения в отделении реанимации и интенсивной терапии (одноцентровое обсервационное исследование)

Patients may experience long-term physical, psychological and cognitive impairment after intensive care unit (ICU) discharge, a condition commonly described as post-intensive care syndrome. The relative contribution of each of these components to long-term quality of life was never investigated.The aim of this study is to identify the type and severity of disability and QoL at the discharge from ICU and up to following 6 months.Material and Methods. All patients (n=218) discharged from a university hospital ICU between April 2016 and July 2017 were eligible. Exclusion criteria included: age <18 years, brain or spinal injury, life expectancy <90 days, and ICU stay <12 hours. The Short Form Health Survey (SF-36), and 5-level EuroQoL-5D (EQ-5D-5L) questionnaires were administered at ICU discharge, and at 30-, 90- and 180-days. We compared patients requiring short-term ICU monitoring (IM, Intensive Monitoring, n=109) or patients requiring ICU treatment (IT, Intensive Treatment, n=109).Results. All dimensions of SF-36 and EQ-5D-5L parameters increased from ICU discharge to 180-days, except for the SF-36 Synthetic index linked to mental health (P=0.08). All EQ-5D-5L parameters improved significantly in the IT group, while only Visual Analog Scale Health Perception improved in the IM group.Conclusion. ICU survivors suffer long-term physical and psychological sequelae. The perception of Quality of Life is reduced after ICU discharge. The psychological and cognitive dimensions were more compromised than physical ones. Patients discharged from the ICU may benefit from specific intensive care follow-up clinics addressing their needs in term of psychological and cognitive support.После выписки из отделения интенсивной терапии у пациентов может развиваться «синдром последствий интенсивной терапии», включающий долговременные соматические, психологические и когнитивные нарушения. Относительный вклад данных нарушений в долгосрочное качество жизни пациентов практически не изучен.Цель исследования — определить тип и степень тяжести функциональных расстройств и нарушения качества жизни при выписке из отделения реанимации и интенсивной терапии (ОРИТ) и на протяжении последующих 6 месяцев.Материал и методы. В исследование включили 218 пациентов, выписанных из ОРИТ университетской больницы в период между апрелем 2016 и июлем 2017 гг. Критерии исключения: возраст младше 18 лет, повреждение головного или спинного мозга, ожидаемая продолжительность жизни менее 90 дней, период пребывания в ОРИТ менее 12 часов. Использовали опросники SF-36 (краткая форма оценки здоровья) и 5-уровневый EQ-5D-5L (Европейский опросник оценки качества в 5 областях), которые пациенты заполняли при выписке и через 30, 90 и 180 дней после нее. Проводили сравнение пациентов, которым требовалось кратковременное пребывание в ОРИТ (группа интенсивного наблюдения, n=109), и тех, которые прошли курс лечения в ОРИТ (группа интенсивной терапии, n=109).Результаты. Через 180 дней все показатели опросников SF-36 и EQ-5D-5L повысились по сравнению с моментом выписки, за исключением общего показателя психического здоровья SF-36 (p=0,08). В группе интенсивной терапии значительно улучшились все показатели EQ-5D-5L, в то время как в группе интенсивного наблюдения улучшились только показатели визуально-аналоговой шкалы оценки здоровья данного опросника.Заключение. У пациентов, выписанных из ОРИТ, наблюдали длительные соматические и психологические неблагоприятные последствия. После выписки из ОРИТ снижается оценка собственного качества жизни. Нарушения показателей, характеризующих психологическую и когнитивную сферы, были более выраженным, чем у параметров соматического состояния пациентов. Ситуацию поможет исправить наблюдение и лечение пациентов, выписанных из ОРИТ, в специальных постреанимационных клиниках с упором на необходимость психологической и когнитивной поддержки больных

Long-term Quality of Life After Intensive Care Unit Admission (a Single-Center Observational Study)

Patients may experience long-term physical, psychological and cognitive impairment after intensive care unit (ICU) discharge, a condition commonly described as post-intensive care syndrome. The relative contribution of each of these components to long-term quality of life was never investigated.The aim of this study is to identify the type and severity of disability and QoL at the discharge from ICU and up to following 6 months.Material and Methods. All patients (n=218) discharged from a university hospital ICU between April 2016 and July 2017 were eligible. Exclusion criteria included: age <18 years, brain or spinal injury, life expectancy <90 days, and ICU stay <12 hours. The Short Form Health Survey (SF-36), and 5-level EuroQoL-5D (EQ-5D-5L) questionnaires were administered at ICU discharge, and at 30-, 90- and 180-days. We compared patients requiring short-term ICU monitoring (IM, Intensive Monitoring, n=109) or patients requiring ICU treatment (IT, Intensive Treatment, n=109).Results. All dimensions of SF-36 and EQ-5D-5L parameters increased from ICU discharge to 180-days, except for the SF-36 Synthetic index linked to mental health (P=0.08). All EQ-5D-5L parameters improved significantly in the IT group, while only Visual Analog Scale Health Perception improved in the IM group.Conclusion. ICU survivors suffer long-term physical and psychological sequelae. The perception of Quality of Life is reduced after ICU discharge. The psychological and cognitive dimensions were more compromised than physical ones. Patients discharged from the ICU may benefit from specific intensive care follow-up clinics addressing their needs in term of psychological and cognitive support

Design and field validation of a low power wireless sensor node for structural health monitoring

Smart monitoring systems are currently gaining more attention and are being employed in several technological areas. These devices are particularly appreciated in the structural field, where the collected data are used with purposes of real time alarm generation and remaining fatigue life estimation. Furthermore, monitoring systems allow one to take advantage of predictive maintenance logics that are nowadays essential tools for mechanical and civil structures. In this context, a smart wireless node has been designed and developed. The sensor node main tasks are to carry out accelerometric measurements, to process data on-board, and to send wirelessly synthetic information. A deep analysis of the design stage is carried out, both in terms of hardware and software development. A key role is played by energy harvesting integrated in the device, which represents a peculiar feature and it is thanks to this solution and to the adoption of low power components that the node is essentially autonomous from an energy point of view. Some prototypes have been assembled and tested in a laboratory in order to check the design features. Finally, a field test on a real structure under extreme weather conditions has been performed in order to assess the accuracy and reliability of the sensors

Manipulations of cellular iron metabolism for modulating normal and malignant cell proliferation: achievements and prospects.

Analysis of the role of iron in cell proliferation, and of manipulations of cellular iron metabolism for modulating normal and malignant cell proliferatio