Limited impact of colistin resistance on mortality of intensive care patients with carbapenem-resistant bacteraemia

Background Increasing incidence of carbapenem-resistant Gram-negative bacteraemia (CR-GNB) has triggered increased use of polymyxins, likely fuelling the emergence and spread of colistin resistance. Aim To estimate the excess clinical burden of colistin resistance in intensive care patients with CR-GNB. Methods A cohort was constructed of patients with CR-GNB during their stay in the intensive care unit (ICU) of a university hospital in Greece, over a 4-year period (2020-2023). Competing risks survival analysis was performed to estimate the burden associated with colistin resistance. Findings In 177 ICU patients with CR-GNB, 134 (76%) had colistin-resistant isolates, predominantly Acinetobacter baumannii (79%), identified by broth microdilution. Patients with colistin resistant infection were similar to those with colistin susceptible with respect to age, sex, APACHE II score, Charlson comorbidity index, Pitt bacteraemia score, prior surgery and the occurrence of polymicrobial cultures. However, patients in the colistin resistant group had lower mortality risk compared to the colistin susceptible (31% vs. 44%, P = 0.004 at 14 days; 46% vs. 56% at 28 days, P = 0.173; respectively). Multivariable regression analysis confirmed that colistin resistant CR-GNB was associated with significantly lower hazard of inpatient death compared to colistin susceptible infection at 14 days (cause-specific hazard ratio [csHR], 0.53; 95% CI 0.28 - 1.01) and 28 days (csHR, 0.55; 95% CI 0.31 - 0.95) of infection onset. Conclusion Limited impact of colistin resistance on mortality was demonstrated in a large contemporary cohort of ICU patients with CR-GNB, possibly reflecting the recent shift away from colistin-based treatment regimens

Rome’s pasts and the creation of new urban spaces: brecciation, matter, and the play of surfaces and depths

In this paper I look at how the discovery of remnants contributes to creating new spaces in the city. I use the geological metaphor of brecciation drawing upon the work of Sigmund Freud to elaborate on how materials from the past and the present are jumbled in a nonlinear fashion to enable spatial multiplicity. I then illustrate these ideas through the case study of the Sala Trevi/Mondadori building in Rome which exemplifies the ongoing dynamics of the play of surfaces and depths when remnants are featured as part of the design. This is done by outlining ways in which the building unfolds spatial and material juxtapositions, and by elaborating on three elements that are indicative of the metaphor of brecciation. I conclude that when material and spatial entanglements occur, the metaphor of brecciation goes further than the metaphor of the palimpsest in facilitating spatial transformation in the city: spaces can be modified and create new possibilities with the past, enabling tensions to coexist in the present whilst not limiting reconfiguration in the future

ΕΥΨΥΧΙΑ. Mélanges offerts à Hélène Ahrweiler

Hélène Ahrweiler est l'une des grandes figures des études byzantines de ces quarante dernières années ; elle a suscité la vocation de nombreux élèves et s'est attiré l'amitié et la considération de nombreux collègues dans le monde entier. Les Mélanges qui lui sont offerts sont le reflet de cette double réussite, puisqu'ils réunissent plus d'une cinquantaine de contributions provenant des centres les plus prestigieux du byzantinisme français et international. Dans leur article, les participants aux Mélanges se font l'écho des principaux thèmes qu'Hélène Ahrweiler a développés dans ses recherches : histoire des institutions, histoire économique et sociale, idéologie politique de l'Empire, géographie historique de l'Italie au Caucase. Hélène Ahrweiler, nommée professeur à la Sorbonne en 1967, a participé à la création de l'Université de Paris I (Panthéon-Sorbonne) où, succédant à Paul Lemerle, elle a développé le Centre de recherches d'histoire et de civilisation byzantines. Par la suite, elle est devenue président de Paris I, puis recteur de l'Académie de Paris avant d'être nommée à la tête du Centre Georges Pompidou