In Europe, the respiratory syncytial virus (RSV) surveillance system is very heterogeneous and there is growing evidence of the importance of RSV infections resulting in hospitalization of elderly patients. The aim of this study was to assess the severity of RSV infection in the elderly living in the aged Southern European countries. We conducted a retrospective study of elderly patients ( ≥65‐year old) admitted for laboratory‐confirmed RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons (2017–2018). Uni‐multivariable analyses were carried out to evaluate the effect of clinical variables on radiologically confirmed pneumonia, use of noninvasive ventilation (NIV), and in‐hospital death (IHD). A total of 166 elderly patients were included. Pneumonia was evident in 29.5%. NIV was implemented in 16.3%, length of stay was 11.8 ± 12.2 days, and IHD occurred in 12.1%. Multivariable analyses revealed that the risk of pneumonia was higher in patients with chronic kidney disease (CKD) (odds ratio [OR]: 2.57; 95% confidence interval [CI]: 1.12–5.91); the use of NIV was higher in patients with obstructive sleep apnea or obesity hypoventilation syndrome (OSA or OHS) (OR: 5.38; 95% CI: 1.67–17.35) and CKD (OR: 2.52; 95% CI: 1.01–6.23); the risk of IHD was higher in males (OR: 3.30; 95% CI: 1.07–10.10) and in patients with solid neoplasm (OR: 9.06; 95% CI: 2.44–33.54) and OSA or OHS (OR: 8.39; 95% CI: 2.14–32.89). Knowledge of factors associated with RSV infection severity may aid clinicians to set priorities and reduce disease burden. Development of effective antiviral treatment and vaccine against RSV is highly desirable.

In vitro activity of cefiderocol against ceftazidime-avibactam susceptible and resistant KPC-producing Enterobacterales: cross-resistance and synergistic effects --Manuscript Draft--Manuscript Number: EJCM-D-21-00999R2 Full Title: In vitro activity of cefiderocol against ceftazidime-avibactam susceptible and resistant KPC-producing Enterobacterales: cross-resistance and synergistic effects Article Type:

No abstract

Sir, Ceftazidime/avibactam, a novel b-lactam/b-lactamase inhibitor combination, is currently approved for the treatment of KPCproducing Enterobacterales infections. However, mutations in the b-lactamase gene, especially at key residues in the active site, increase ceftazidime/avibactam MIC values leading to the emergence of resistant strains. 1 Strains harbouring KPC-3 or KPC-2 mutations in the X-loop have been reported in Klebsiella pneumoniae following ceftazidime/avibactam treatment. [2][3][4][5][6] We recently observed the in vivo selection of two subpopulations of K. pneumoniae carrying KPC-2 variants conferring increased ceftazidime/avibactam MICs following prolonged exposure to ceftazidime/avibactam. A critically ill patient with KPCproducing K. pneumoniae rectal colonization presented with ventilator-associated pneumonia. He started receiving ceftazidime/avibactam with progressive clinical improvement. On day 16 of antimicrobial therapy the patient presented with fever and elevation of inflammatory markers. Two pairs of aerobic and anaerobic blood cultures (BCs) were drawn peripherally and two specimens were positive with a time of detection of 8.3 and 8.5 h using the Bact Alert Virtuo System (bioMérieux, France). Gramstaining showed Gram-negative bacilli, whereas MALDI-TOF MS analysis performed directly from BC bottles identified K. pneumoniae for both. NG-Test Carba 5 (NG Biotech, France) was performed for both bottles according to the manufacturer's instructions and detected the presence of KPC enzyme in only one of them. Overnight subcultures revealed two pure K. pneumoniae isolates with no difference in colony morphology.

Purpose: Bacterial ocular infections can result in loss of all or part of the ocular structures, contributing to a high disability charge. Local surveillance of etiology and susceptibility patterns is crucial for an appropriate empiric management of ocular infections. The aim of this study was to analyze of bacterial spectrum in culture-proven ocular infections and trends of antimicrobial susceptibility patterns. Methods: A monocentric retrospective study was performed including ocular infection cases diagnosed at the Microbiology Unit of Turin Ophthalmic Hospital between 1988 and 2017. Spectrum of pathogens that caused bacterial culture-proven ocular infections and trends of antimicrobial susceptibility patterns were analyzed. Results: A total of 15,517 culture-positive isolates were identified as causative agents of ocular infections. Gram-positive bacteria were deemed to cause infection in 73.5% of cases. Staphylococcus spp. and Pseudomonas spp., coagulase-negative staphylococci, Staphylococcus aureus were the leading causative pathogens of keratitis, endophthalmitis, and conjunctivitis, respectively. Statistically significant changes in temporal trends were observed for all analyzed microorganism groups except for Enterobacteriaceae group. Overall, fluoroquinolones and chloramphenicol demonstrated to be the most effective antimicrobials in vitro toward bacterial ocular infections, followed by tetracycline, ampicillin, and aminoglycosides. Enterobacteriaceae isolates showed higher multi-drug resistance rate, followed by coagulase-negative staphylococci. Analysis of resistance rates over time highlighted increasing resistance trend for aminoglycosides among Gram-negative and for both aminoglycosides and fluoroquinolones among Gram-positive pathogens, especially for S. aureus. Conclusion: This study provided a 30-year assessment of bacterial ocular infections in an urban area of Italy, giving support to epidemiological consciousness and guiding empiric antimicrobial therapy.