Highlights Description of 4 cases outside Asia of invasive infection by hypervirulent K. pneumoniae. These are patients from the community without any type of epidemiological background or previous trips to the endemic area. Unlike other series in our case, these are patients without one of the classic risk factors: no patient is diabetic. Patients present both serotype K1 and K2, not finding a prevalent serotype in our series.

We report the emergence of an isolate belonging to the sequence type (ST)131-Escherichia coli high-risk clone with ceftazidime-avibactam resistance recovered from a patient with bacteremia in 2019. Antimicrobial susceptibility was determined and whole genome sequencing (Illumina-NovaSeq6000) and cloning experiments were performed to investigate its resistance phenotype. A KPC-3-producing E. coli isolate susceptible to ceftazidime-avibactam (MIC = 0.5/4 mg/L) and with non-wild type MIC of meropenem (8 mg/L) was detected in a blood culture performed at hospital admission. Following 10-days of standard ceftazidime-avibactam dose treatment, a second KPC-producing E. coli isolate with a phenotype resembling an extended-spectrum β-lactamase (ESBL) producer (meropenem 0.5 mg/L, piperacillin-tazobactam 16/8 mg/L) but resistant to ceftazidime-avibactam (16/4 mg/L) was recovered. Both E. coli isolates belonged to ST131, serotype O25:H4 and sublineage H30R1. Genomics analysis showed a core genome of 5,203,887 base pair with an evolutionary distance of 6 single nucleotide polymorphisms. A high content of resistance and virulence genes was detected in both isolates. The novel KPC-49 variant, an Arg-163-Ser mutant of blaKPC-3, was detected in the isolate with resistance to ceftazidime-avibactam. Cloning experiments revealed that blaKPC-49 gene increases ceftazidime-avibactam MIC and decreases carbapenem MICs when using a porin deficient Klebsiella pneumoniae strain as a host. Both blaKPC-3 and blaKPC-49 genes were located on the transposon Tn4401a as a part of an IncF [F1:A2:B20] plasmid. The emergence of novel blaKPC genes conferring decreased susceptibility to ceftazidime-avibactam and resembling ESBL production in the epidemic ST131-H30R1-E. coli high-risk clone presents a new challenge in clinical practice.

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Background: Accelerating the diagnosis of bacteremia is one of the biggest challenges in clinical microbiology departments. The fast establishment of a correct treatment is determinant on bacteremic patients’ outcomes. Our objective was to evaluate the impact of antimicrobial therapy and clinical outcomes of a rapid blood culture workflow protocol in positive blood cultures with Gram-negative bacilli (GNB). Methods: A quasi-experimental before–after study was performed with two groups: (i) control group (conventional work-protocol) and (ii) intervention group (rapid workflow-protocol: rapid identification by Matrix-Assisted Laser Desorption/Ionization-Time-Of-Flight (MALDI-TOF) and antimicrobial susceptibility testing (AST) from bacterial pellet without overnight incubation). Patients were divided into different categories according to the type of intervention over treatment. Outcomes were compared between both groups. Results: A total of 313 patients with GNB-bacteremia were included: 125 patients in the control group and 188 in the intervention. The time from positive blood culture to intervention on antibiotic treatment decreased from 2.0 days in the control group to 1.0 in the intervention group (p < 0.001). On the maintenance of correct empirical treatment, the control group reported 2.0 median days until the clinical decision, while in the intervention group was 1.0 (p < 0.001). In the case of treatment de-escalation, a significant difference between both groups (4.0 vs. 2.0, p < 0.001) was found. A decreasing trend on the change from inappropriate treatments to appropriate ones was observed: 3.5 vs. 1.5; p = 0.12. No significant differences were found between both groups on 7-days mortality or on readmissions in the first 30-days. Conclusions: Routine implementation of a rapid workflow protocol anticipates the report of antimicrobial susceptibility testing results in patients with GNB-bacteremia, decreasing the time to effective and optimal antibiotic therapy.

According to a recent report by the World Health Organization, 1 epilepsy is one of the most common neurologic diseases worldwide, with an estimated prevalence of 50 million cases. Patients with epilepsy are three times more likely to die than the general population. 1 The estimated global incidence of epilepsy is 61.4 cases per 100,000 inhabitants a year, although rates are lower in more developed countries. 1 One of the largest epidemiologic studies of epilepsy to date found an incidence of 44 cases per 100,000 population. 2 In Europe, the incidence in adults has been reported at between 24 and 56 cases, 3 while closer to our region, in southwest France, the rate is 71 cases per 100,000 population, but this includes single seizures. 4

Background Pseudomonas aeruginosa is of great concern among MDR bacteria and rapid and reliable in vitro antibiotic susceptibility testing methods are extremely necessary. Colistin is, in many cases, among the limited useful alternatives for these isolates. Unfortunately, only a few reliable in vitro methods are validated for testing susceptibility to colistin. Although EUCAST and CLSI recommend broth microdilution (BMD) as the standard method for antibiotic susceptibility testing, this method is not routinely performed in microbiology laboratories. However, some commercial products based upon BMD have tested well and offer consistent results. Objectives To evaluate the performance of the colorimetric Rapid Polymyxin Pseudomonas Test (RPPT) (ELITech Microbiology, France). Methods Eighty-seven clinical P. aeruginosa strains, prospectively collected in two microbiology laboratories exhibiting either susceptibility or various degrees of multidrug resistance, including to colistin, were used. Different susceptibility testing methods were simultaneously performed and compared with reference BMD and interpreted using 2020 EUCAST criteria. Results Results indicate an essential agreement (EA) of 97.7% for RPPT while the other tests did not reach 90% of EA [66.7% MicroScan, 63.2% Etest (bioMérieux, France) and 60.9% other MIC Test Strips (MTS, Liofilchem, Italy)]. The categorical agreement was 98.9% for RPPT, 87.4% for MTS, 85.1% for Etest and 64.4% for MicroScan. Conclusions The RPPT was able to accurately detect both colistin-susceptible and -resistant isolates within 4 h, offering a rapid alternative for a prompt decision about the inclusion of this antibiotic in a patient’s treatment.