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Despite vaccination, a substantial proportion of immunocompromised patients have an increased risk for severe Covid-19. Treatment with SARS-CoV-2 neutralizing monoclonal antibodies has been shown to be safe and can prevent Covid-19 associated hospitalization and death. Monoclonal antibodies neutralize the virus and promote the immune response against SARS-CoV-2. Treatment with monoclonal antibodies is a potential breakthrough for the treatment of patients who are at high risk for severe disease when given early after infection. The first encouraging clinical trial data and the imminent availability of combination antibody therapy create a "momentum" to address several essential questions that are necessary to address for the structural use of this treatment in routine clinical care. These concern the real-world effect and sustainability of treatment of vulnerable patients, the optimal logistics and the cost-effectiveness of these novel compounds.

To systematically collect clinical data from patients with a proven COVID-19 infection in the Netherlands.Data from 2579 patients with COVID-19 admitted to 10 Dutch centers in the period February to July 2020 are described. The clinical data are based on the WHO COVID case record form (CRF) and supplemented with patient characteristics of which recently an association disease severity has been reported.Survival analyses were performed as primary statistical analysis. These Kaplan-Meier curves for time to (early) death (3 weeks) have been determined for pre-morbid patient characteristics and clinical, radiological and laboratory data at hospital admission.Total in-hospital mortality after 3 weeks was 22.2% (95% CI: 20.7% - 23.9%), hospital mortality within 21 days was significantly higher for elderly patients (70 years; 35, 0% (95% CI: 32.4% - 37.8%) and patients who died during the 21 days and were admitted to the intensive care (36.5% (95% CI: 32.1% - 41.3%)). Apart from that, in this Dutch population we also see a risk of early death in patients with co-morbidities (such as chronic neurological, nephrological and cardiac disorders and hypertension), and in patients with more home medication and / or with increased urea and creatinine levels.Early death due to a COVID-19 infection in the Netherlands appears to be associated with demographic variables (e.g. age), comorbidity (e.g. cardiovascular disease) but also disease char-acteristics at admission.

Since February, 27 2019, when the first patient with coronavirus disease 2019 (Covid-19) was identified in the Netherlands it has rapidly spread throughout the country. Exactly one month later 8603 people had been tested positive for SARS-CoV-2, 2500 patients were or had been admitted to the hospital and 456 patients died. Here the clinical data are summarized of the first 236 patients that have been admitted to hospitals in Uden, Breda and Tilburg which were all at the centre of the initial outbreak in the Netherlands. This commentary focusses on the clinical characteristics of the patients that are currently being treated on the Dutch clinical corona units, their medical management and the first clinical outcomes. Data is compared to current cohort studies from China, Italy and the United States.

The worldwide rapid increase in antibiotic resistance means that new therapeutic measures are urgently needed. Older antibiotics, such as colistin, fosfomycin, minocycline, mecillinam and temocillin, which had fallen from grace due to the development of more effective and less toxic drugs are now of renewed interest in the treatment of infections caused by multiresistant bacteria. Two new glycopeptides (oritavancin and dalbavancin) and a new oxazolidinone (tedizolid) are now registered for the treatment of acute skin and soft-tissue infections. In the treatment of infections caused by Gram-negative bacteria, cephalosporins are combined with beta-lactamase inhibitors which protect them from various beta-lactamases and also make them effective against extended spectrum beta-lactamase-producing bacteria. Examples of these are ceftolozane-tazobactam, ceftazidime-avibactam and meropenem-vaborbactam. Results of preclinical research on the effectiveness of new antibiotics are hopeful. There has been a great increase in investment in the development of new antimicrobials. Also, regulatory agencies have accelerated their assessment of these new - and urgently needed - drugs.

Many people question if the current microbiome research trend really does have medical implications for patients or if it is just hype to generate research funding. Cumulative funding for the microbiome likely runs into hundreds of millions and over the last five years there has been rapid and exponential growth of microbiome-related publications. Here we examine if the microbiome has any real relevance in current clinical practice.

The human gut microbiota, formerly known as 'gut flora', may be regarded as an external organ with many physiological functions in metabolism, development of the immune system and defense against pathogens. The adult gut microbiota consist of 1013-1014 micro-organisms. The aggregate genome of these, known as the microbiome, is 100 times larger than the human genome. The gut microbiotica may be involved in the pathogenesis of a range of syndromes, such as inflammatory bowel disease, obesity, diabetes mellitus and atopic disorders. It should be noted that until now most of the studies conducted have been association studies, without proof of causality. This increasing insight has led to identification of new therapeutic strategies, which are currently being investigated in clinical studies. Although the implications of this knowledge for individual patients have yet to become clear, various interventions are conceivable, such as supplementation of nutritional elements, prebiotics or probiotics and feces transplantation.

The incidence of sepsis is increasing worldwide, yet the mortality rate has barely decreased during the past decades and remains unacceptably high at between 20% - 40%. New knowledge on host-pathogen interactions has greatly increased our insights in the pathogenesis of sepsis. It is now clear that sepsis is not only characterized by proinflammation but also by immunosuppression. Here we give an overview of the functional interactions between bacteria and our immune system. Microbial virulence factors, pathogen recognition receptors, activation of coagulation, apoptosis and a wide range of new mediators of sepsis play a role in these interactions. Implementation of evidence-based guidelines for the rapid diagnosis and adequate treatment of sepsis has been shown to be instrumental in improving survival in sepsis. The increasing insights into the pathogenesis of sepsis have identified a whole new range of potential drugs which are currently being tested in clinical trials.