Our analysis indicates that mixed subpopulations of ceftazidime/avibactam-resistant KPC-Kp emerge after ceftazidime/avibactam treatment. The evolution of different subpopulations that are highly resistant to ceftazidime/avibactam likely contributes to treatment failure, thereby highlighting the need for combination treatment strategies to limit selection of ceftazidime/avibactam-resistant KPC-Kp subpopulations.
BackgroundHuman platelets are a rich reservoir of molecules that promote regenerative processes and microbicidal activity. This activity might be increased by concentration in platelet-rich plasma (PRP) products and modulated by the presence of leukocytes. Despite extensive use in clinical procedures, only few studies have investigated PRP’s real microbicidal potential. Therefore, this study aimed at comparing the in vitro microbicidal activity of platelets and leukocyte-enriched PRP (L-PRP) to pure platelet-rich plasma (P-PRP) and the contribution of leukocytes to microbicidal properties.Antimicrobial effects of P- and L-PRP were tested against Escherichia Coli, Staphylococcus Aureus, Klebsiella Pneumoniae, Pseudomonas Aeruginosa and Enterococcus Faecalis. Furthermore, L-PRP was frozen (L-PRP cryo) to assess whether the preparation maintained in vitro characteristics. Microbicidal proteins released by the three preparations were also evaluated.ResultsL-PRP, L-PRP cryo and P-PRP generally induced comparable bacterial growth inhibition for up to 4 h’ incubation, range 1–4 log. MIP-1α, RANTES, GRO-α, IL-8, NAP-2, SDF-1α and IL-6 showed strong microbicidal potential.ConclusionsWe found in vitro antibacterial activity of L-PRP and P-PRP and the possibility to cryopreserve L-PRP, without important changes to its effectiveness; similar microbicidal activity between preparations containing or not leukocytes; and the contribution of three new molecules (NAP-2, SDF-1α and IL-6).
BACKGROUND
In this study we evaluated the effectiveness of a management bundle for Enterococcus spp BSI (E-BSI).
METHODS
This was a single-center quasi-experimental (pre/post) study. In the “pre” phase (January 2014 to December 2015) patients with monomicrobial E-BSI were retrospectively enrolled. During the “post” or “intervention” phase (January 2016 to December 2017), all patients with incident E-BSI were prospectively enrolled in a non-mandatory intervention arm consisting in infectious disease consultation, echocardiography, follow-up blood cultures and early targeted antibiotic treatment. Patients were followed-up to 1 year after E-BSI. The primary outcome was 30-day mortality.
RESULTS
Overall, 368 patients were enrolled, 173 in the “pre” phase and 195 in the “post” phase. The entire bundle was applied in 15% and 61% patients during the “pre” and “post” phase, respectively (P<0.001). Patients enrolled in the post-phase had a significant lower 30-day mortality rate (20% vs 32%, P=0.0042). At multivariate analysis, factors independently associated to mortality were age [HR 1.03 (95%CI 1.00-1.05)], ICU admission [HR 2.51 (95%CI 1.18-3.89)] healthcare associated [HR 2.32 (95%CI 1.05-5.16)] and hospital-acquired infection [HR 2.85 (95%CI 1.34-4.76)] whereas being enrolled in the “post” period [HR 0.49 (95%CI 0.32-0.75)] was associated with improved survival. Results were consistent also in the subgroups with severe sepsis [HR 0.37 (95%CI 0.16-0.90)] or healthcare-associated infections [HR 0.53 (95%CI 0.31-0.93)]. A significative lower 1-year mortality was observed in patients enrolled in the “post” period (50% vs 68%,p<0.001).
CONCLUSION
The introduction of a bundle for the management of E-BSI was associated with improved 30-day and 1-year survival.
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