The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic

Specific immune suppression types have been associated with a greater risk of severe COVID-19 disease and death. We analyzed data from patients >17 years that were hospitalized for COVID-19 at the “Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico” in Milan (Lombardy, Northern Italy). The study included 1727 SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8–20.4%) had at least one condition defining immune suppression. Immune suppressed subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p < 0.001) and be vaccinated (37% vs. 12.7%, p < 0.001). We evaluated the contribution of immune suppression to hospitalization during the various stages of the epidemic and investigated whether immune suppression contributed to severe outcomes and death, also considering the vaccination status of the patients. The proportion of immune suppressed patients among all hospitalizations (initially stable at <20%) started to increase around December 2021, and remained high (30–50%). This change coincided with an increase in the proportions of older patients and patients with co-morbidities and with a decrease in the proportion of patients with severe outcomes. Vaccinated patients showed a lower proportion of severe outcomes; among non-vaccinated patients, severe outcomes were more common in immune suppressed individuals. Immune suppression was a significant predictor of severe outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization, and vaccination status (OR: 1.64; 95% CI: 1.23–2.19), while vaccination was a protective factor (OR: 0.31; 95% IC: 0.20–0.47). However, after November 2021, differences in disease outcomes between vaccinated and non-vaccinated groups (for both immune suppressed and immune competent subjects) disappeared. Since December 2021, the spread of the less virulent Omicron variant and an overall higher level of induced and/or natural immunity likely contributed to the observed shift in hospitalized patient characteristics. Nonetheless, vaccination against SARS-CoV-2, likely in combination with naturally acquired immunity, effectively reduced severe outcomes in both immune competent (73.9% vs. 48.2%, p < 0.001) and immune suppressed (66.4% vs. 35.2%, p < 0.001) patients, confirming previous observations about the value of the vaccine in preventing serious disease

Non-native species in Ialian freshwater habitats: a macroecological assessment of invasion drivers

The relative role of propagule pressure, abiotic and biotic variables as determinants of non-native species occurrence differs among studies, hindering the synthesis of emergent patterns in invasion ecology and preventing generalization for conservation actions. In order to produce a broad and general assessment of the occurrence of alien species in aquatic habitats, we proposed a macroecological approach to assess the drivers of occurrence of alien species in all biota (microorganisms, plants and animals) across several natural habitats in freshwater ecosystems in Italy, and we generalised the results of the analysis to provide a risk map of the occurrence of alien species. We determined that abiotic climatic variables were good predictors of alien species occurrence. Indeed, these variables, together with propagule pressure, expressed as the proximity to major inhabited areas, and differences in the receiving community, expressed as the native species richness, played a crucial role in determining the number of alien species. Furthermore, we found evidence of an influence of body size in determining the occurrence of the non-native species. By using the predictions of our model, we addressed the probability of the occurrence of alien species in freshwater habitats across the whole country and highlighted areas at higher risk

Alien species in Italian freshwater ecosystems: a macroecological assessment of invasion drivers

The relative role of propagule pressure, abiotic and biotic variables as determinants of alien species occurrence differs among studies. This limits the synthesis of emergent patterns in invasion ecology and generalisations for conservation actions. In order to produce a broad and general assessment of the invasion pattern in aquatic habitats we here propose a macroecological approach to assess the drivers of occurrence of alien species within the whole biota (microorganisms, plants and animals) across several natural freshwater ecosystems of Italy. We simultaneously tested three groups of variables (propagule pressure, abiotic and biotic characteristics), selected as putative predictors of invasibility of a site. Propagule pressure, expressed as proximity to larger inhabited areas, and differences in the native species richness of the receiving community, had a significant role in determining the number of alien species occurrences. Furthermore, body size influenced the occurrence and colonization processes of alien species. Finally, climatic characteristics were relevant in determining the chances that a site was invaded, confirming the role of these abiotic filters in the invasion process

A geographic distribution data set of biodiversity in Italian freshwaters

We present a data set on the biodiversity of Italian freshwaters, including lakeshores and riverbanks of natural (N=379: springs, streams and lakes) and artificial (N=11: fountains) sites. The data set belongs partly to the Italian Long Term Ecological Research network (LTER-Italy) and partly to LifeWatch, the European e-Science infrastructure for biodiversity and ecosystem research. The data included cover a time period corresponding to the last fifty years (1962-2014). They span a large number of taxa from prokaryotes and unicellular eukaryotes to vertebrates and plants, including taxa linked to the aquatic habitat in at least part of their life cycles (like immature stages of insects, amphibians, birds and vascular plants). The data set consists of 6463 occurrence data and distribution records for 1738 species. The complete data set is available in csv file format via the LifeWatch Service Centre

A geographic distribution data set of biodiversity in Italian freshwaters

We present a data set on the biodiversity of Italian freshwaters, including lakeshores and riverbanks of natural (N=379: springs, streams and lakes) and artificial (N=11: fountains) sites. The data set belongs partly to the Italian Long Term Ecological Research network (LTER-Italy) and partly to LifeWatch, the European e-Science infrastructure for biodiversity and ecosystem research. The data included cover a time period corresponding to the last fifty years (1962-2014). They span a large number of taxa from prokaryotes and unicellular eukaryotes to vertebrates and plants, including taxa linked to the aquatic habitat in at least part of their life cycles (like immature stages of insects, amphibians, birds and vascular plants). The data set consists of 6463 occurrence data and distribution records for 1738 species. The complete data set is available in csv file format via the LifeWatch Service Centre

Plankton dynamics across the freshwater, transitional and marine research sites of the LTER-Italy Network. Patterns, fluctuations, drivers

A first synoptic and trans-domain overview of plankton dynamics was conducted across the aquatic sites belonging to the Italian Long-Term Ecological Research Network (LTER-Italy). Based on published studies, checked and complemented with unpublished information, we investigated phytoplankton and zooplankton annual dynamics and long-term changes across domains: from the large subalpine lakes to mountain lakes and artificial lakes, from lagoons to marine coastal ecosystems. This study permitted identifying common and unique environmental drivers and ecological functional processes controlling seasonal and long-term temporal course. The most relevant patterns of plankton seasonal succession were revealed, showing that the driving factors were nutrient availability, stratification regime, and freshwater inflow. Phytoplankton and mesozooplankton displayed a wide interannual variability at most sites. Unidirectional or linear long-term trends were rarely detected but all sites were impacted across the years by at least one, but in many case several major stressor(s): nutrient inputs, meteo-climatic variability at the local and regional scale, and direct human activities at specific sites. Different climatic and anthropic forcings frequently co-occurred, whereby the responses of plankton communities were the result of this environmental complexity. Overall, the LTER investigations are providing an unparalleled framework of knowledge to evaluate changes in the aquatic pelagic systems and management options

Extended Infusion of beta-Lactams for Bloodstream Infection in Patients With Liver Cirrhosis: An Observational Multicenter Study

Background. We analyzed the impact of continuous/extended infusion (C/EI) vs intermittent infusion of piperacillin-tazobactam (TZP) and carbapenems on 30-day mortality of patients with liver cirrhosis and bloodstream infection (BSI). Methods. The BICRHOME study was a prospective, multicenter study that enrolled 312 cirrhotic patients with BSI. In this secondary analysis, we selected patients receiving TZP or carbapenems as adequate empirical treatment. The 30-day mortality of patients receiving C/EI or intermittent infusion of TZP or carbapenems was assessed with Kaplan-Meier curves, Cox-regression model, and estimation of the average treatment effect (ATE) using propensity score matching. Results. Overall, 119 patients received TZP or carbapenems as empirical treatment. Patients who received C/EI had a significantly lower mortality rate (16% vs 36%, P = .047). In a Cox-regression model, the administration of C/EI was associated with a significantly lower mortality (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.11-0.936; P = .04) when adjusted for severity of illness and an ATE of 25.6% reduction in 30-day mortality risk (95% CI, 18.9-32.3; P = 25 (HR, 0.26; 95% CI, 0.08-0.92). At competing risk analysis, C/EI of beta-lactams was associated with significantly higher rates of hospital discharge (subdistribution hazard [95% CI], 1.62 [1.06-2.47]). Conclusions. C/EI of beta-lactams in cirrhotic patients with BSI may improve outcomes and facilitate earlier discharge