Carbapenem-resistant Klebsiella pneumoniae (CR-KP) is becoming a common cause of healthcare-associated infection in Italy, with high morbidity and mortality. Prevalent CR-KP clones and resistance mechanisms vary between regions and over time. Therapeutic approaches and their impact on mortality have to be investigated. We performed a prospective study of patients with CR-KP isolation, hospitalized in nine hospitals of Rome, Italy, from December 2010 to May 2011, to describe the molecular epidemiology, antibiotic treatment and risk factors for mortality. Overall, 97 patients (60% male, median age 69 years) were enrolled. Strains producing blaKPC-3 were identified in 89 patients, blaVIM in three patients and blaCTX-M-15 plus porin defects in the remaining five patients. Inter-hospital spread of two major clones, ST512 and ST258, was found. Overall, 36.1% and 20.4% of strains were also resistant to colistin and tigecycline, respectively. Infection was diagnosed in 91 patients who received appropriate antibiotic treatment, combination therapy and removal of the infectious source in 73.6%, 59.3% and 28.5% of cases, respectively. Overall, 23 different antibiotic regimens were prescribed. In-hospital mortality was 25.8%. Multivariate analysis adjusted for appropriate treatment, combination therapy and infectious-source removal, showed that Charlson comorbidity score, intensive-care unit onset of infection, bacteraemia and infection due to a colistin-resistant CR-KP strain were independent risk factors for mortality. The spread of clones producing K. pneumoniae carbapenemases, mainly ST258, is currently the major cause of CR-KP infection in central Italy. We observed a high rate of resistance to colistin that is independently associated with worse outcome.

The Gram-negative opportunistic pathogen, Klebsiella pneumoniae, is responsible for causing a spectrum of community-acquired and nosocomial infections and typically infects patients with indwelling medical devices, especially urinary catheters, on which this microorganism is able to grow as a biofilm. The increasingly frequent acquisition of antibiotic resistance by K. pneumoniae strains has given rise to a global spread of this multidrug-resistant pathogen, mostly at the hospital level. This scenario is exacerbated when it is noted that intrinsic resistance to antimicrobial agents dramatically increases when K. pneumoniae strains grow as a biofilm. This review will summarize the findings about the antibiotic resistance related to biofilm formation in K. pneumoniae.

SARS-CoV-2 mRNA vaccination induces stem cell memory T cells specific for the virus that persist up to 6 months.

This study produces new findings that highlight a positive correlation between antibiotic resistance profile and biofilm-forming ability in XDR K. pneumoniae strains. These new evidences might contribute to the progress in selection of therapeutic treatments of infections caused by K. pneumoniae resistant also to the 'last line of defence' antibiotics, that is, carbapenems.

Objectives-We aimed to analyze the influence of hypertension on early large artery remodeling. Methods and Results-Carotid intima-media thickness (IMT) and diameter were measured ultrasonographically in 394 normotensive subjects and 327 untreated and 528 treated hypertensive patients. IMT and diameter were increased in hypertensive groups, treated or untreated, compared with the normotensive group (PϽ0.001). Positive association existed between diameter and IMT in the overall study population (PϽ0.001), and this association interacted with the category of clinical groups (PϽ0.01). Key Words: carotid arteries Ⅲ remodeling Ⅲ hypertension Ⅲ ultrasonics Ⅲ antihypertensive treatment A rterial remodeling is potentially important in atherosclerosis, aiming at counteracting the development of lumen compromise of large artery by mutual adaptation of diameter to wall thickening. 1 At the early stage of atherosclerosis characterized by slightly intrusive or preintrusive wall thickening, the lumen size of the artery remains constant or even increases (compensatory enlargement). 2 Advances in highresolution B-mode ultrasonography offer the possibility of assessing concomitantly intima-media thickness (IMT) and diameter of carotid artery 3 and obtaining in vivo information on the adaptation of IMT to diameter. 4,5 Positive relationships were found between carotid diameter and IMT in populations of healthy subjects, independently of coexisting cardiovascular risk factors. 6 -8 However, these relations have not been examined specifically in patients with hypertension, even though the influence of blood pressure on large artery geometry and structure may change the ability of arteries to remodel their lumen as wall thickness increases. Therefore, the objective of the present study was to assess and compare the adaptation of lumen diameter to IMT in the common carotid artery of 3 groups of untreated and treated hypertensive patients and normotensive subjects. Methods Study SubjectsOne thousand two hundred forty-nine consecutive subjects referred between April 2000 and May 2001 for cardiovascular risk assessment and having undergone appropriate ultrasonographic carotid examination were included in the study. They were divided into 2 groups according to the presence (hypertensive group, nϭ855) or absence (normotensive group, nϭ394) of hypertension defined as blood pressure Ն140 systolic or Ն90 mm Hg diastolic or the current use of antihypertensive treatment. Hypertensive patients were subdivided into 2 groups of untreated (nϭ327) and treated (nϭ528) subjects according to the absence or presence of current antihypertensive treatment for the past 3 months. Among treated hypertensive patients, 314 were treated with a class of drug given alone (monotherapy) or in association with a diuretic (diuretic bitherapy) and subdivided into the following 4 groups according to the class of drug: calcium antagonists, nϭ81; angiotensin converting enzyme inhibitors, nϭ82; ␤ blockers, nϭ93; and angiotensin receptors antagonists, nϭ58. Risk Factors Ev...