S ystolic blood pressure (BP) and pulse pressure (PP) are known to be higher when assessed at the brachial artery compared with the aorta because of PP amplification across the arterial tree.1 From the physiological point of view, target organs, such as the heart and large arteries, are directly exposed to central rather than brachial BP, which could translate into superior predictive value of the former.1 A recent meta-analysis concluded that central PP is marginally superior to brachial PP in predicting clinical events. 2 Intense research has been recently performed on the clinical relevance of central BP assessed noninvasively using different techniques, and reference values have been recently estimated.1,3 A crucial remaining question is whether central BP offers significant improvement in cardiovascular risk assessment and stratification compared with brachial (peripheral) BP. Several studies showed superiority of central compared with brachial BP in terms of association with several indices of preclinical target-organ damage; yet these findings have not always been consistent (online-only Data Supplement).A systematic review and meta-analysis of the evidence on the relationship of central versus brachial BP with preclinical target-organ damage were performed. Methods Search StrategyA systematic literature search was performed in PubMed database to identify studies published until April 2014 providing comparative data on the association of central versus brachial BP and target-organ damage. Keywords for the search were: central pressure, target organ, left ventricular, carotid intima-media thickness, urine albumin, pulse wave velocity, or arterial stiffness. Data sources were also identified through manual search of references of articles. The study selection and data extraction were performed independently by 2 investigators (S.L. and M.E.Z.). Disagreements were resolved by consensus with a senior author (A.K.). Abstract-Accumulating Selection Criteria and Data ExtractionA systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations (http://www.prisma-statement.org). Eligible studies were full-text articles in English and presenting data from observational (cross-sectional or case-control), longitudinal, retrospective, and prospective studies in adults, which included assessment of central BP and evaluation of indices of preclinical target-organ damage. For the systematic review, all studies reporting any kind of relationship between central BP and target-organ damage (ie, bivariate correlations, univariate or multivariate regression analyses with the target variables or their log-transformed values) were included. Central BP was considered suitable if it was assessed noninvasively by recording pressure waveforms at the radial, carotid, or brachial arteries, using either applanation tonometry or oscillometry. Likewise, indices of target-organ damage that were considered appropriate for the analysis included (1) echocardiograph...

The recent expansion of multidrug resistant and pan-drug-resistant pathogens poses significant challenges in the treatment of healthcare associated infections. An important advancement, is a handful of recently launched new antibiotics targeting some of the current most problematic Gram-negative pathogens, namely carbapenem-producing Enterobacteriaceae (CRE) and carbapenem-resistant P. aeruginosa (CRPA). Less options are available against carbapenem-resistant Acinetobacter baumannii (CRAB) and strains producing metallo-beta lactamases (MBL). Ceftazidime-avibactam signaled a turning point in the treatment of KPC and partly OXA- type carbapenemases, whereas meropenem-vaborbactam was added as a potent combination against KPC-producers. Ceftolozane-tazobactam could be seen as an ideal beta-lactam backbone for the treatment of CRPA. Plazomicin, an aminoglycoside with better pharmacokinetics and less toxicity compared to other class members, will cover important proportions of multi-drug resistant pathogens. Eravacycline holds promise in the treatment of infections by CRAB, with a broad spectrum of activity similar to tigecycline, and improved pharmacokinetics. Novel drugs and combinations are not to be considered “panacea” for the ongoing crisis in the therapy of XDR Gram-negative bacteria and colistin will continue to be considered as a fundamental companion drug for the treatment of carbapenem-resistant Enterobacteriaceae (particularly in areas where MBL predominate), for the treatment of CRPA (in many cases being the only in vitro active drug) as well as CRAB. Aminoglycosides are still important companion antibiotics. Finally, fosfomycin as part of combination treatment for CRE infections and P. aeruginosa , deserves a greater attention. Optimal conditions for monotherapy and the “when and how” of combination treatments integrating the novel agents will be discussed.

Severe coronavirus disease 2019 (COVID-19) is associated with increased risk of venous thromboembolism events (VTE). This study performed a systematic review in PubMed/EMBASE of studies reporting the prevalence of VTE in patients with COVID-19 who were totally screened/assessed for deep vein thrombosis (DVT) and/or for pulmonary embolism (PE). Among 47 candidate studies ( n = 6459; 33 in Europe), 17 studies ( n = 3973; weighted age 63.0 years, males 60%, intensive care unit (ICU) 16%) reported the prevalence of PE with a pooled estimate of 32% (95% CI: 25, 40%), and 32 studies ( n = 2552; weighted age 62.6 years, males 57%, ICU 49%) reported the prevalence of DVT with a pooled estimate of 27% (95% CI: 21, 34%). A total of 36 studies reported the use of at least prophylactic antithrombotic treatment in the majority of their patients. Meta-regression analysis showed that the prevalence of VTE was higher across studies with a higher percentage of ICU patients and higher study population mean D-dimer values, and lower in studies with mixed dosing of anticoagulation in ⩾ 50% of the population compared to studies with standard prophylactic dosing of anticoagulation in < 50% of the population. The pooled odds ratio for death in patients with COVID-19 and VTE versus those without VTE (17 studies, n = 2882) was 2.1 (95% CI: 1.2, 3.6). Hospitalized patients with severe COVID-19 are at high VTE risk despite prophylactic anticoagulation. Further research should investigate the individualized VTE risk of patients with COVID-19 and the optimal preventive antithrombotic therapy. PROSPERO Registration No.: CRD42020185543.

Supported by grants by the Hellenic Institute for the Study of Sepsis and by bioMérieux. Procalcitonin assays, material for detection of fecal colonization and laboratory training were provided by bioMérieux. Contribution of authors EJGB conceptualized the study design, participated in data analysis and drafting the manuscript, had full access to all of the study data and takes responsibility for their integrity and the accuracy of the analysis. EK participated in data analysis, drafted the manuscript, had full access to all of the study data and takes responsibility for their integrity and the accuracy of the analysis. MK performed data analysis and