Available therapeutic options against carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are limited because of the high level of resistance to other antimicrobial classes including polymyxins. The double-carbapenem regimen has been recently considered a possible therapeutic strategy. In the present study, we evaluated the in vitro bactericidal and synergistic activity of a double-carbapenem regimen consisting of ertapenem plus high-dose meropenem in a series of patients with healthcare-associated CR-Kp infections in whom the use of colistin was not indicated because of potential nephrotoxicity and/or resistance. In vitro synergy was evaluated using checkerboard and killing studies. A total of 15 patients were included in the study, with sepsis, severe sepsis and septic shock found in two (13.3%), five (33.3%) and one (6.7%) patients, respectively. Overall, the clinical/microbiological response was 12/15 (80%). Synergy was observed in 11/14 (78.6%) isolates using the checkerboard method whereas in killing studies 12/14 (85.7%) and 14/14 (100%) strains were synergistic and bactericidal at 24 h at concentrations of 1 × MIC MEM+1 × MIC ERT and 2 × MEM+1 × MIC ERT, respectively, with a significant decrease of log CFU/mL compared with other combinations (p <0.0001). The double-carbapenem regimen showed clinical and in vitro effectiveness in patients with CR-Kp infections.

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The precipitation of calcium carbonate was carried out in the presence of the intraskeletal organic matrix (OM) extracted from Mediterranean corals. They were diverse in growth form and trophic strategy, Balanophyllia europaea and Leptopsammia pruvotisolitary corals, only the first zooxanthellate coraland Cladocora caespitosa and Astroides calyculariscolonial corals, only the first zooxanthellate coral. The results showed that, although the OM marked differences among species, the diverse influence over the calcium carbonate precipitation was evident only for B. europaea. This OM was the most prone to favor the precipitation of aragonite in the absence of magnesium ions, according to overgrowth and solution precipitation experiments. In artificial seawater, where magnesium ions were present, this OM, as well the one from A. calycularis, precipitated mainly a form of amorphous calcium carbonate different from that obtained with SOM from L. pruvoti or C. caespitosa. The amorphous calcium carbonate from B. europaea was the most stable upon heating up to 100 °C and was the one that mainly converted into aragonite instead of magnesium calcite after heating at 300 °C. All this indicated a higher control of B. europaea OM over the calcium carbonate polymorphism than the other species. The influence of SOMs over precipitate morphology turned out to be also species related. In conclusion, this comparative study has shown that the influence of OM on in vitro precipitation of calcium carbonate was not related to the coral ecology, solitary vs colonial and zooxanthellate vs nonzooxanthellate, and suggested that the coral control over biomineralization process was species specific and encoded in coral genes.

Investments at the organismal level towards reproduction and growth are often used as indicators of health. Understanding how such energy allocation varies with environmental conditions may, therefore, aid in predicting possible responses to global climatic change in the near future. For example, variations in seawater temperature may alter the physiological functioning, behavior, reproductive output and demographic traits (e.g., productivity) of marine organisms, leading to shifts in the structure, spatial range, and abundance of populations. This study investigated variations in reproductive output associated with local seawater temperature along a wide latitudinal gradient on the western Italian coast, in the zooxanthellate Mediterranean coral, Balanophyllia europaea. Reproductive potential varied significantly among sites, where B. europaea individuals from the warmest site experienced loss of oocytes during gametogenesis. Most of the early oocytes from warmest sites did not reach maturity, possibly due to inhibition of metabolic processes at high temperatures, causing B. europaea to reabsorb the oocytes and utilize them as energy for other vital functions. In a progressively warming Mediterranean, the efficiency of the energy invested in reproduction could be considerably reduced in this species, thereby affecting vital processes. Given the projected increase in seawater temperature as a consequence of global climate change, the present study adds evidence to the threats posed by high temperatures to the survival of B. europaea in the next decades.

Phenotype can express different morphologies in response to biotic or abiotic environmental influences. Mollusks are particularly sensitive to different environmental parameters, showing macroscale shell morphology variations in response to environmental parameters. Few studies concern shell variations at the different scale levels along environmental gradients. Here, we investigate shell features at the macro, micro and nanoscale, in populations of the commercially important clam Chamelea gallina along a latitudinal gradient (~400 km) of temperature and solar radiation in the Adriatic Sea (Italian cost). Six populations of clams with shells of the same length were analyzed. Shells from the warmest and the most irradiated population were thinner, with more oval shape, more porous and lighter, showing lower load fracture. However, no variation was observed in shell CaCO3 polymorphism (100% aragonite) or in compositional and textural shell parameters, indicating no effect of the environmental parameters on the basic processes of biomineralization. Because of the importance of this species as commercial resource in the Adriatic Sea, the experimentally quantified and significant variations of mass and fracture load in C. gallina shells along the latitudinal gradient may have economic implications for fisheries producing different economical yield for fishermen and consumers along the Adriatic coastline.

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Atmospheric carbon dioxide enrichment alters seawater carbonate chemistry, thus threatening calcifying organisms such as corals. Coral populations at carbon dioxide vents are natural acidification experiments that mimic organism responses to seawater pH values projected for 2100. Even if demographic traits are paramount information to assess ecological relationships and habitat suitability, population dynamics studies on corals thriving under acidified conditions are lacking. Here, we investigate the demography and reproduction of populations of the solitary, symbiotic, temperate coral Balanophyllia europaea naturally living along a pH gradient at a Mediterranean CO 2 vent. Gametogenesis and larval production were unaffected while recruitment efficiency collapsed at low and variable pH, contributing to coral abundance decline and suggesting that life stages between larval release and early polyp growth are hindered by acidification. Exploring these processes is crucial to assess coral fate in the forthcoming acidified oceans, to preserve coral ecosystems and the socioeconomic services they provide.