BACTERIAL EPIDEMIOLOGY AND ANTIMICROBIAL RESISTANCE IN THE SURGERY WARDS OF A LARGE TEACHING HOSPITAL IN SOUTHERN ITALY

Objectives: Surgical infections represent an increasingly important problem for the National Health System. In this study we retrospectively evaluated the bacterial epidemiology and antimicrobial susceptibility of the microorganisms concerned as well as the utilization of antibiotics in the General and Emergency Surgery wards of a large teaching hospital in southern Italy in the period 2011-2013. Methods: Data concerning bacterial isolates and antimicrobial susceptibility were retrieved from the Vitek II database. The pharmacy provided data about the consumption of antibiotics in the above reported wards. Chi-square or Fisher’s exact test were used to analyze categorical variables. Results: In all, 94 Gram-negative were isolated in 2011, 77 in 2012, and 125 in 2013, Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa always being the most frequently isolated microorganisms. In the same years, there were respectively 105, 93, and 165 Gram-positive isolated, Enterococcus faecalis, Staphylococcus epidermidis and Staphylococcus aureus being the most commonly found. No significant variation in the antibiotic susceptibility pattern was observed, either among Gram-negative or among Gram-positive pathogens; carbapenems (especially meropenem) consumption remained stable over time. Conclusions: Our results show no significant increase in antimicrobial resistance over the period in question, and a higher rate of both MRSA isolates and resistance to carbapenems in A. baumannii compared with other European data

[Skin and soft tissue infections: current therapeutic options]

In the present review, the authors focus on skin and soft tissue infections (SSTIs), a set of commonly observed pathologies which can present different features in terms of site and localization, clinical characteristics, and the aetiological agent responsible; their severity is related to the depth of the affected sites. After a brief introduction to the diverse classification criteria which are currently adopted by various authors, the aetiology and role of the most frequently occurring pathogen, Staphylococcus aureus, often methicillin-resistant is discussed, as well as the possible therapeutic options. We first present the internationally recommended guidelines, and stress that SSTI management has to conform to different criteria, in accordance with the different clinical settings: mild infections require simple and cost-saving treatments while severe infections make timely and aggressive treatments mandatory. The review then reports the recent data concerning the efficacy of new antimicrobials for treating SSTIs. In particular, results observed with linezolid, tigecycline, and daptomycin are discussed

Update on treatment of COVID-19: ongoing studies between promising and disappointing results

The COVID-19 pandemic represents the greatest global public health crisis since the pandemic influenza outbreak of 1918. We are facing a new virus, so several antiviral agents previously used to treat other coronavirus infections such as SARS and MERS are being considered as the first potential candidates to treat COVID-19. Thus, several agents have been used by the beginning of the current outbreak in China first and all over the word successively, as reported in several different guidelines and therapeutic recommendations. At the same time, a great number of clinical trials have been launched to investigate the potential efficacy therapies for COVID-19 highlighting the urgent need to get as quickly as possible high-quality evidence. Through PubMed, we explored the relevant articles published on treatment of COVID-19 and on trials ongoing up to April 15, 2020

Management of severe bacterial infections

Defining the severity of an infection can play a central role for a correct therapeutic choice, avoiding inadequate antimicrobial treatments. Severe bacterial infections are, in fact, characterized by high morbidity and mortality rates so that the appropriateness of therapy can have a profound clinical impact. Indeed, initial inappropriate empirical therapies, and the further need to modify them, substantially increase the mortality risk. Several strategies have been suggested to improve the clinical outcome of patients affected by severe bacterial infections, such as the use of guidelines, use of antibiotics in combination, de-escalation therapy, cycling therapy and the use of infectious disease specialist consultation. A closer collaboration between the medical staff in the wards and infectious disease specialists can possibly bridge the gap between different strategies and individual needs of the patient, thereby improving the decision-making process

Management of severe bacterial infections and role of the infectious disease specialist: results of an interview-based survey

Ascertainment of SBIs plays a central role in their management, which can affect the prognosis, hopefully avoiding an inappropriate antibacterial therapy concerning choice, dosing, timing, duration and route of administration of antibiotics. Different aspects of SBI management were evaluated by interviewing doctors practising in ICU, Surgery and Haematology wards. In the period 16 June - 7 July 2003, 150 doctors, equally distributed by specialty and geographical location, experienced in the management of antibiotic therapy, were interviewed in order to acquire the following information: criteria adopted to define SBIs, presumed incidence, most frequent diagnosis, initial approach to antibiotic therapy (empirical or not, route of administration, mono- or combination therapy), ID consultation request. In most cases generic and empirical criteria are used to define SBI, generally associated to the presence of co-morbidities, the highest rates being reported in ICUs (35.1%) and Haematology (34.7%) wards. Pneumonia is the top reported SBI in all the wards, followed by sepsis in ICUs and Haematology, and by intrabdominal infections in Surgery. Antibiotic therapy is often empirical (~90%), often performed i.v. with antibiotics given in combination. Following treatment failure, which occurs on average in 35.5% of cases, ID consultation and microbiological investigation are required. ID consultation is required in 20.2%, 26.1% and 28.1% of cases by haematologists, surgeons and ICU specialists, respectively. SBIs frequently occur in all the wards where the interviews were conducted. Their management is generally empirical and either ID consultation or microbiological investigation is infrequently required especially as an initial approach. The use of appropriate guidelines and ID consultation, as proven in many controlled studies, could be efficacious in reducing the incidence of inappropriate therapies and increasing favourable outcome rates