Skin and Soft Tissue Infections in Patients with Solid Tumours

Background. Skin and soft tissue infections (SSTIs) in cancer patients represent a diagnostic challenge, as etiologic diagnosis is often missing, and clinical assessment of severity is difficult. Few studies have described (SSTIs) in patients with solid tumours (STs). Patients and Methods. Records of patients with ST and SSTI, cared for at the University Hospital of Heraklion, from 2002 to 2006 were retrospectively studied. Results. A total of 81 episodes of SSTIs, occurring in 71 patients with ST, have been evaluated. Their median age was 65 years (34–82). The most common underlying malignancy was breast cancer in 17 patients (24%). Most episodes (89%) occurred in nonneutropenics. Cellulitis/erysipelas was the most common clinical presentation (56; 69%). Bacterial cultures were possible in 29 (36%) patients. All patients received antimicrobial therapy, while in 17 episodes (21%) an incision and drainage was required. Treatment failure occurred in 20 episodes (25%). Five patients (7%) died due to sepsis. None was neutropenic. Severe sepsis on admission (=0.002) and prior blood transfusion (=0.043) were independent predictors of treatment failure. Conclusion. SSTIs can be life threatening among patients with ST. Early diagnosis and appropriate treatment are of the utmost importance, since sepsis was proven a significant factor of unfavourable outcome

An analysis of existing national action plans for antimicrobial resistance-gaps and opportunities in strategies optimising antibiotic use in human populations.

At the 2015 World Health Assembly, UN member states adopted a resolution that committed to the development of national action plans (NAPs) for antimicrobial resistance (AMR). The political determination to commit to NAPs and the availability of robust governance structures to assure sustainable translation of the identified NAP objectives from policy to practice remain major barriers to progress. Inter-country variability in economic and political resilience and resource constraints could be fundamental barriers to progressing AMR NAPs. Although there have been regional and global analyses of NAPs from a One Health and policy perspective, a global assessment of the NAP objectives targeting antimicrobial use in human populations is needed. In this Health Policy, we report a systematic evidence synthesis of existing NAPs that are aimed at tackling AMR in human populations. We find marked gaps and variability in maturity of NAP development and operationalisation across the domains of: (1) policy and strategic planning; (2) medicines management and prescribing systems; (3) technology for optimised antimicrobial prescribing; (4) context, culture, and behaviours; (5) operational delivery and monitoring; and (6) patient and public engagement and involvement. The gaps identified in these domains highlight opportunities to facilitate sustainable delivery and operationalisation of NAPs. The findings from this analysis can be used at country, regional, and global levels to identify AMR-related priorities that are relevant to infrastructure needs and contexts

Amoxicillin dosing recommendations are very different in European countries : a cross-sectional survey

National antibiotic stewardship programmes recommend monitoring antibiotic consumption and benchmarking. The WHO recommend the Anatomic Therapeutic Chemical classification and respective Defined Daily Doses (DDD) for drug utilization research. This is the most frequently used unit of measure within the European Union (EU). Wide variations in antibiotic consumption exist between EU countries in the outpatient setting, ranging in 2012 from 11.3 (the Netherlands) to 31.9 DDD per 1000 inhabitants and per day (Greece). Penicillins are the most consumed antibacterial agents in the community in all EU countries. Amoxicillin and amoxicillin/clavulanate are the two most widely prescribed penicillins, except in Denmark, Norway and Sweden where penicillin V and other very narrow-spectrum penicillins are used preferentially.peer-reviewe

Outcomes of octogenarians and nonagenarians with Pseudomonas aeruginosa bacteremia: a multicenter retrospective study

[Background] P. aeruginosa bacteremia is a common and severe infection carrying high mortality in older adults. We aimed to evaluate outcomes of P. aeruginosa bacteremia among old adults (≥ 80 years).[Methods] We included the 464/2394 (19%) older adults from a retrospective multinational (9 countries, 25 centers) cohort study of individuals hospitalized with P. aeruginosa bacteremia. Bivariate and multivariable logistic regression models were used to evaluate risk factors for 30-day mortality among older adults.[Results] Among 464 adults aged ≥ 80 years, the mean age was 84.61 (SD 3.98) years, and 274 (59%) were men. Compared to younger patients, ≥ 80 years adults had lower Charlson score; were less likely to have nosocomial acquisition; and more likely to have urinary source. Thirty-day mortality was 30%, versus 27% among patients 65–79 years (n = 894) and 25% among patients < 65 years (n = 1036). Multivariate analysis for predictors of mortality among patients ≥ 80 years, demonstrated higher SOFA score (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.23–1.51, p < 0.001), corticosteroid therapy (OR 3.15, 95% CI: 1.24–8.01, p = 0.016) and hospital acquired P. aeruginosa bacteremia (OR 2.30, 95% CI: 1.33–3.98, p = 0.003) as predictors. Appropriate empirical therapy within 24 h, type of definitive anti-pseudomonal drug, and type of regimen (monotherapy or combination) were not associated with 30-day mortality.[Conclusions] In older adults with P. aeruginosa bacteremia, background conditions, place of acquisition, and disease severity are associated with mortality, rather than the antimicrobial regimen. In this regard, preventive efforts and early diagnosis before organ failure develops might be beneficial for improving outcomes.Peer reviewe

Clinical and seroepidemiological aspects of Q fever in Crete, culture and isolation of Coxiella burnetii

Ο ΠΥΡΕΤΟΣ Q ΟΦΕΙΛΕΤΑΙ ΣΤΗΝ COXIELLA BURNETII ΕΝΑ ΜΙΚΡΟΒΙΟ ΤΟ ΟΠΟΙΟ ΑΝΕΥΡΙΣΚΕΤΑΙ ΣΕ ΟΛΟΚΛΗΡΟ ΤΟΝ ΚΟΣΜΟ. ΣΚΟΠΟΣ ΤΗΣ ΠΑΡΟΥΣΗΣ ΜΕΛΕΤΗΣ ΗΤΑΝ Η ΚΛΙΝΙΚΗ ΚΑΙ ΕΠΙΔΗΜΙΟΛΟΓΙΚΗ ΜΕΛΕΤΗ ΤΟΥ ΠΥΡΕΤΟΥ Q ΣΤΗΝ ΚΡΗΤΗ. ΑΝΑΜΕΣΑ ΣΤΑ ΕΤΗ 1989 - 1996 ΕΞΕΤΑΣΘΗΚΑΝ ΟΡΟΛΟΓΙΚΑ ΓΙΑ ΤΗΝ ΑΝΕΥΡΕΣΗ ΑΝΤΙΣΩΜΑΤΩΝ ΕΝΑΝΤΙ ΤΗΣ C. BURNETII 3466 ΑΣΘΕΝΕΙΣ. ΒΡΕΘΗΚΑΝ ΕΚΑΤΟΝ ΤΡΙΑΝΤΑ ΟΚΤΩ ΑΣΘΕΝΕΙΣ ΠΟΥ ΠΛΗΡΟΥΣΑΝ ΤΑ ΚΛΙΝΙΚΑ ΚΑΙ ΟΡΟΛΟΓΙΚΑ ΚΡΙΤΗΡΙΑ ΤΗΣ ΝΟΣΟΥ. ΣΕ ΟΚΤΩ ΑΣΘΕΝΕΙΣ ΕΓΙΝΕ ΑΠΟΜΟΝΩΣΗ ΚΑΙ ΚΑΛΛΙΕΡΓΕΙΑ ΤΗΣ C.BURNETII. ΑΠΟ ΤΗΝ ΠΑΡΟΥΣΑ ΜΕΛΕΤΗ ΠΡΟΚΥΠΤΕΙ ΟΤΙ Ο ΠΥΡΕΤΟΣ Q ΕΙΝΑΙ ΕΝΔΗΜΙΚΗ ΝΟΣΟΣ ΣΤΗΝ ΚΡΗΤΗ ΜΕ ΣΥΧΝΟΤΕΡΗ ΚΛΙΝΙΚΗ ΕΚΔΗΛΩΣΗ ΤΗΝ ΑΤΥΠΗ ΠΝΕΥΜΟΝΙΑ. ΠΡΟΚΕΙΤΑΙ ΓΙΑ ΚΑΛΟΗΘΕΣ ΑΥΤΟΙΩΜΕΝΟ ΝΟΣΗΜΑ. ΜΠΟΡΕΙ ΟΜΩΣ ΝΑ ΕΠΙΠΛΑΚΕΙ ΑΠΟ ΜΙΑ ΠΛΕΙΑΔΑ ΣΟΒΑΡΩΝ ΕΠΙΠΛΟΚΩΝ.C. BURNETII IS AN INTRACELLULAR PARASITE WITH WORLDWIDE DISTRIBUTION. THIS STUDY HAS BEEN UNDERTAKEN BETWEEN 1989 - 1996 IN THE GREEK ISLAND OF CRETE. SERA FROM 3466 PATIENTS WITH THE CLINICAL DIAGNOSIS OF FEBRILE ILLNESS HAVE BEEN EXAMINATED FOR THE PRESENCE OF ANTIBODIES AGAINST C. BURNETII 138 PATIENTS WHO FULLFILLED THE CLINICAL AND SEROLOGICAL CRITERIA OF Q FEVER WERE STUDIED.PNEUMONIA WAS THE MOST PREVALENT CLINICAL MANIFESTATION OF THE PATIENTS. C.BURNETII WAS CULTURED AND ISOLATED FROM 8 PATIENTS

Pre-Existing Liver Disease and Toxicity of Antifungals

Pre-existing liver disease in patients with invasive fungal infections further complicates their management. Altered pharmacokinetics and tolerance issues of antifungal drugs are important concerns. Adjustment of the dosage of antifungal agents in these cases can be challenging given that current evidence to guide decision-making is limited. This comprehensive review aims to evaluate the existing evidence related to antifungal treatment in individuals with liver dysfunction. This article also provides suggestions for dosage adjustment of antifungal drugs in patients with varying degrees of hepatic impairment, after accounting for established or emerging pharmacokinetic&#8315;pharmacodynamic relationships with regard to antifungal drug efficacy in vivo

Fungemia by <i>Wickerhamomyces anomalus</i>—A Narrative Review

Wickerhamomyces anomalus has been previously classified as Hansenula anomala, Pichia anomala, and Candida pelliculosa and was recently reclassified in the genus Wickerhamomyces after phylogenetic analysis of its genetic sequence. An increasing number of reports of human infections by W. anomalus have emerged, suggesting that this microorganism is an emerging pathogen. The present review aimed to provide data on the epidemiology, antifungal resistance, clinical characteristics, treatment, and outcomes of fungemia by W. anomalus by extracting all the available information from published original reports in the literature. PubMed/Medline, Cochrane Library, and Scopus databases were searched for eligible articles reporting data on patients with this disease. In total, 36 studies involving 170 patients were included. The age of patients with fungemia by W. anomalus ranged from 0 to 89 years; the mean age was 22.8 years, the median age was 2.2 years, with more than 37 patients being less than one month old, and 54% (88 out of 163 patients) were male. Regarding patients’ history, 70.4% had a central venous catheter use (CVC), 28.7% were on total parenteral nutrition (TPN), 97% of neonates were hospitalized in the neonatal ICU (NICU), and 39.4% of the rest of the patients were hospitalized in the intensive care unit (ICU). Previous antimicrobial use was noted in 65.9% of patients. The most common identification method was the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in 34.1%, VITEK and VITEK 2 in 20.6%, and ID32 C in 15.3%. W. anomalus had minimal antifungal resistance to fluconazole, echinocandins, and amphotericin B, the most commonly used antifungals for treatment. Fever and sepsis were the most common clinical presentation noted in 95.8% and 86%, respectively. Overall mortality was 20% and was slightly higher in patients older than one year. Due to the rarity of this disease, future multicenter studies should be performed to adequately characterize patients’ characteristics, treatment, and outcomes, which will increase our understanding and allow drawing safer conclusions regarding optimal management

<i>Pseudomonas</i> Bacteremia in a Tertiary Hospital and Factors Associated with Mortality

Pseudomonas aeruginosa is the third most commonly identified cause among gram-negative microorganisms causing bloodstream infection (BSI) and carries a very high mortality, higher than that by other gram-negative pathogens. The aim of the present study was to assess the epidemiological and microbiological characteristics of patients with BSI by Pseudomonas spp. in a tertiary hospital, characterize the resistance rates of different Pseudomonas strains to the most clinically relevant anti-microbials, estimate the mortality rate, and identify factors independently associated with mortality. In total, 540 cultures from 419 patients sent to the microbiology department of the hospital during the 8-year period of the study were positive. Patients had a median age of 66 years, and 262 (62.5%) were male. The blood culture was drawn in the ICU in 201 of the patients (48%). The infection was hospital-acquired in 329 patients (78.5%) and the median hospital day when the blood culture was drawn was 15, with a range of 0 to 267 days. Median duration of stay in the hospital was 36 days, hospital mortality was 44.2% (185 patients), and 30-day mortality was 29.6% (124 patients). The most commonly isolated Pseudomonas species were P. aeruginosa followed by P. putida and P. oryzihabitans. There was a statistically significant reduction of P. aeruginosa isolation relative to non-aeruginosa Pseudomonas species in the post-COVID-19 era. Antimicrobial resistance of P. aeruginosa in clinically relevant antimicrobials with anti-pseudomonal activity was similar before and after the onset of the COVID-19 pandemic with the exception of gentamicin and tobramycin, with P. aeruginosa being more susceptible to these two antimicrobials in the post-COVID-19 era. Rates of multi-drug resistant (MDR), extensively-drug resistant (XDR), and difficult-to-treat (DTR) P. aeruginosa isolation were lower after the onset of the COVID-19 pandemic, even though a carbapenem-focused antimicrobial stewardship program had been implemented in the meantime. Increased age, ICU-acquisition of BSI, and more days in the hospital when positive blood culture was drawn were positively associated with 30-day mortality of patients with Pseudomonas BSI. The fact that rates of MDR, XDR, and DTR P. aeruginosa isolation were lower late in the study period, with a carbapenem-focused antimicrobial stewardship intervention being implemented in the meantime, further increases the understanding that implementation of antimicrobial stewardship interventions may halt the increase in antimicrobial resistance noted previously

Infective Endocarditis by <em>Moraxella</em> Species: A Systematic Review

Moraxella catarrhalis is the most clinically relevant species among Moraxella spp. For decades, it was considered to be part of the normal human flora in the upper respiratory tract. However, since the late 1970s, considerable evidence has proposed that M. catarrhalis is an important pathogen in the human respiratory tract. Even though Infective Endocarditis (IE) is rarely caused by Moraxella spp., these infections can be problematic due to the lack of experience in their management. The aim of this study was to systematically review all published cases of IE by Moraxella spp. A systematic review of PubMed, Scopus and Cochrane library (through 8 December 2021) for studies providing epidemiological, clinical, microbiological data as well as treatment data and outcomes of IE by Moraxella spp. was performed. A total of 27 studies, containing data for 31 patients, were included. A prosthetic valve was present in 25.8%. Mitral valve was the most commonly infected site. Fever, sepsis and embolic phenomena were the most common clinical presentations. Cephalosporins, aminoglycosides, aminopenicillins and penicillin were the most commonly used antimicrobials. Overall mortality was 12.9%