Colistin emerged in the last decade as a savior for the treatment of critically septic patients who suffer MDR-GNB infections. This development came in time with the drying new antibacterial pipelines. MDR-GNB became problematic in ICU's including MDR Acinetobacter spp., Pseudomonas aeruginosa, and carbapenemase-producing Enterobacteriaecae (CPE). With the resurgence of wide colistin prescription especially in ICU's, awareness on when to switch to this reintroduced drug is required. Recently, it is observed that there are differences between the past dosages and the currently proposed dosages. Nephrotoxicity and neurotoxicity are observed to be less than what was published in the past. This may be due to more pure preparations and attention to other drug therapies that are employed in the critically ill patients residing the ICU's. However,randomized control studies are still lacking to shed light on its efficacy and safety. Agreement is still looming on dosages, and monotherapy of colistin versus its combination with other agents.

An indigenous case of M. ulcerans (Buruli ulcer) is reported for the first time from Jordan and the surrounding region.

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Studies disputed the use of tocilizumab in the treatment of COVID-19 patients, retrospective studies and one interventional study from the RECOVER study supported tocilizumab use, however, many other interventional and a retrospective propensity score-matched studies did not find a benefit from its use, in contrast, increased mortality was demonstrated, this study aims to add knowledge on this topic. Records for 1124 COVID-19 admitted patients were reviewed. Patients were recruited from three participating hospitals. Characteristics of all-cohort and propensity score-adjusted (PSadjusted) patients were described, data was analyzed as propensity score matching (PSM) and a stabilized inverted probability of treatment weighting (SIPTW). Management of patients was up to the treating physicians who varied in the treatment approach., the effect difference was estimated by χ2. Further, the study was analyzed as logistic regression to assure robustness of the inferred outcomes; recovery, need for home oxygen, and all-cause mortality. All-cause mortality for patients was 12.7% (143) and in ICU was 54.0% (128). In the all-cohort, there was an increase of patients' recovery in controls; 39.6% versus tocilizumab 9.9% (P<0.000). The need for home oxygen was more in tocilizumab; 59.2%, controls 38.6% (P<0.000). Mortality was higher in tocilizumab than the controls (25.4% versus 10.9%, P<0.000). Analyses as PSM-adjustment and SIPTW continued to demonstrate significantly less recovery and more mortality with using tocilizumab (P ≤ 0.002), but tocilizumab and the control did not differ significantly for the need for home oxygen therapy (49.1% vs. 48.6% respectively, P=0.945). No benefit was seen for tocilizumab in the treatment of COVID-19 patients, quite the opposite, it showed no recovery benefit, increased mortality, and did not impact the need for home oxygen.

Background Vitamin D3 (1,25(OH)2 cholecalciferol) as a treatment for COVID 19 patients is being disputed, and a clear clinical benefit is not being confirmed. Methods A retrospective evaluation for COVID-19 patients who were treated with various cumulative doses of vitamin D. Data was extracted from the COVID-19 database, it included patients admitted to three hospitals in Amman, Jordan. Characteristics of patients were tabulated and compared for all-cohort, and propensity score index (PSI) adjustment, The comparison was based on two vitamin D strata ((≤ 149,000 i.u. and > 150,000 i.u.). Logistic regression analysis was utilized to predict recovery, the need for oxygen, and all-cause mortality for all-cohort, IPSW, and IPTW patients, based on vitamin D cumulative doses during their hospital stay. Results             1131 all-cohort and 768 PSI-adjusted patients were recruited. Except for antibiotics and antivirals, all other characteristics were balanced (P = NS). There were 1017 patients on vitamin D, 847 received cumulative ≤ 149,000 i.u., and 170 patients received cumulative dose ≥ 150,000 i.u. (Range 1000 – 385000). It was demonstrated that escalating cumulative doses of vitamin D did not contribute to the assessed outcomes; all-cohort patients (OR = 1.000, 95% C.I. 1.000 to 1.000), IPSW (OR = 1.000, 95% C.I. 1.000 to 1.000), and the IPTW (OR = 1.000, 95% C.I. 1.000 to 1.000). Conclusion             In our patients’ cohorts, we could not demonstrate a beneficial effect for vitamin D therapy in COVID-19 patients for recovery, the need for home oxygen, and all-cause mortality, by hospital discharge.

A prospective patient surveillance and analysis in three urban hospitals with the objective of comparing the mortality rates among patients with antimicrobials-sensitive versus -resistant gram-negative bacterial bloodstream infections. The analysis focused on the rates of in-hospital and 28-days mortality. There were 189 patients with BSI, drug-susceptible gram-negative bacteria (DSGNB) 40.7%, multi-drug resistant bacteria (MDRGNB) 42.3% and extensive-drug resistant bacteria (XDRGNB) 16.9%. The mean age, gender, SOFA score on the initial evaluation, APACHE II score, comorbidities, identified bacterial species, and BSI-associated diagnoses were not statistically different except for VAP (P = 0.000) in the XDRGNB infected patients. In-hospital and 28-days mortalities were significantly higher in the XDRGNB-BSI group (P = 0.000), and ICU length of stay (P = 0.000). XDRGNB-BSI was significantly higher in inappropriate and delayed treated patients (P < 0.05). Logistic regression analysis demonstrated no significant interaction for the 28 days mortality neither with the admission diagnoses, the antimicrobial class (except aminoglycosides), the comorbidities (except for solid tumors) (P > 0.05, Nagelkerke R 2 < 0.4). In conclusion, BSI due to multiple class antimicrobial resistance has higher mortality and ICU length of stay.

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Introduction: To evaluate the speed of recovery in CAP-treated adults with Moxifloxacin versus levofloxacin. Methodology:A retrospective multicenter study between January 14, 2010 - March 23, 2017. Patients' records with the diagnosis of community-acquired pneumonia (CAP), age ≥ 18 and ≤ 60 years old, susceptible bacteria to the prescribed fluoroquinolone, completed three days of antimicrobial therapy and who were switched from parenteral to the oral form for the same antimicrobial agent were included. Results: 701 charts were reviewed, 367 were excluded; not on respiratory fluoroquinolones (RFQ), age > 60 or < 18 years old, not enough data, prior antimicrobials, hospital-associated pneumonia, < 3 days of therapy, and one pregnant woman. 334 patients were Included; 167 levofloxacin and 167 moxifloxacin, with 68.5% males (P = 0.259), no significant difference in comorbidities (P > .05), but increased diabetes mellitus in moxifloxacin-treated patients (P = 0.012). No significant difference in Pneumonia Severity Index (PSI). Multivariate and univariate analysis demonstrated that day 3 rate of improvement; levofloxacin-treated patients 75.9% (95% CI, 69.9 to 81.8), and 84.0% (95% CI, 78.1 to 89.9) for Moxifloxacin (difference -8.1%, 95% CI, -16.5 - .003, P = 0.058). And day 5 rates of improvement in Levofloxacin-treated patients was 91.9%, (95% CI, 88.3 – 95.6), and 95.5% (95% CI, 91.8 - 99.2) for moxifloxacin (difference -3.5%, 95% CI, -8.7 - 1.7, P = 0.184). There was no significant difference for patients with radiological diagnoses for day 3 (P = 0.832) and 5 (P = 0.929). Conclusions: Our uni-and-multivariate analyses demonstrated that moxifloxacin exhibited no significant differences in the rates of improvement on days 3 and 5.