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Promoting vaccination for coronavirus disease 2019 (COVID-19), especially for high-risk groups such as the elderly and persons with comorbidities, is important for reducing the incidence of severe disease and death.Retrospective cross-sectional study of factors associated with COVID-19 vaccination, including previous influenza vaccination, among all persons who received medical services in a rural area in Crete, Greece, between October 2020-May 2021.Among 3129 participants, receipt of influenza vaccination in 2020-21 was strongly associated with COVID-19 vaccination, as was influenza vaccination in 2019-20, albeit to a lesser extent. In addition, persons older than 59 years (with exception of those 90 + years old) and those who lived closer to the hospital/health center, were more likely to vaccinate for COVID-19. Persons younger than 40 years of age, females, persons with mental illness or neurologic disease, were also less likely to vaccinate for COVID-19 (all p 0.001).COVID-19 vaccination was more likely among those who were vaccinated for influenza before and during the pandemic. Access to healthcare services and specific comorbidities, were important influencers for vaccination, underlying the importance of tailored interventions to enforce vaccination in high-risk groups.

Scope: The aim of the guidelines is to provide recommendations on perioperative antibiotic prophylaxis (PAP) in adult inpatients who are carriers of multidrug-resistant Gram-negative bacteria (MDR-GNB) before surgery. Methods: These evidence-based guidelines were developed after a systematic review of published studies on PAP targeting the following MDR-GNB: extended-spectrum cephalosporin-resistant Enterobacterales, carbapenem-resistant Enterobacterales (CRE), aminoglycoside-resistant Enterobacterales, fluoroquinolone-resistant Enterobacterales, cotrimoxazole-resistant Stenotrophomonas maltophilia, carbapenem-resistant Acinetobacter baumannii (CRAB), extremely drug-resistant Pseudomonas aeruginosa, colistin-resistant Gram-negative bacteria, and pan-drug-resistant Gram-negative bacteria. The critical outcomes were the occurrence of surgical site infections (SSIs) caused by any bacteria and/or by the colonizing MDR-GNB, and SSI-attributable mortality. Important outcomes included the occurrence of any type of postsurgical infectious complication, all-cause mortality, and adverse events of PAP, including development of resistance to targeted (culture-based) PAP after surgery and incidence of Clostridioides difficile infections. The last search of all databases was performed until April 30, 2022. The level of evidence and strength of each recommendation were defined according to the Grading of Recommendations Assessment, Development and Evaluation approach. Consensus of a multidisciplinary expert panel was reached for the final list of recommendations. Antimicrobial stewardship considerations were included in the recommendation development. Recommendations: The guideline panel reviewed the evidence, per bacteria, of the risk of SSIs in patients colonized with MDR-GNB before surgery and critically appraised the existing studies. Significant knowledge gaps were identified, and most questions were addressed by observational studies. Moderate to high risk of bias was identified in the retrieved studies, and the majority of the recommendations were supported by low level of evidence. The panel conditionally recommends rectal screening and targeted PAP for fluoroquinolone-resistant Enterobacterales before transrectal ultrasound-guided prostate biopsy and for extended-spectrum cephalosporin-resistant Enterobacterales in patients undergoing colorectal surgery and solid organ transplantation. Screening for CRE and CRAB is suggested before transplant surgery after assessment of the local epidemiology. Careful consideration of the laboratory workload and involvement of antimicrobial stewardship teams before implementing the screening procedures or performing changes in PAP are warranted. High-quality prospective studies to assess the impact of PAP among CRE and CRAB carriers performing high-risk surgeries are advocated. Future well-designed clinical trials should assess the effectiveness of targeted PAP, including the monitoring of MDR-GNB colonization through postoperative cultures using European Committee on Antimicrobial Susceptibility Testing clinical breakpoints.

Infection prevention and control (IPC) is associated with improved healthcare, better quality of life and cost-effectiveness in disease prevention [...]

Despite gaps in knowledge, long-term sequelae of coronavirus disease 2019 (COVID-19) infections are globally acknowledged and thus require special attention by public health organizations and services. Therefore, it is necessary to support and promote public health initiatives that address long-term disability due to COVID-19.

Background The worldwide spread of carbapenemase-producing Gram-negative bacteria (GNB) in healthcare settings is worrying. Of particular concern is the occurrence of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KP). In recent years, several guidelines and recommendations have focused on the control of carbapenem-resistant GNB. It remains, however, unknown to what extent individual infection control measures are effective. Our aim was to critically review the recent evidence regarding the effectiveness of measures to control KPC-KP spread in healthcare settings. Methods Critical review of the literature aiming to evaluate, in accordance with published recommendations, all available studies reporting infection control (IC) measures to control KPC-KP published in the past 5 years. Results Among 11 included studies, the majority consisted of outbreak reports, where application of measures was reported in the absence of control groups. Variability was observed related to the frequency of application of recommended measures for control of KPC-KP. Additional measures were recorded, such as environmental sampling and staff screening, whereas compliance with hand hygiene was measured in relatively few studies. Finally, mortality in patients harbouring KPC-KP was notable, reaching 42.9% of included patients. Conclusions Despite successful control of KPC-KP spread during outbreaks, the impact of individual IC measures is difficult to assess, as the quality of published evidence is low and controlled intervention studies are lacking. The distribution of studies, the number of reported cases and the high mortality rates, clearly show that KPC-KP remains a major healthcare problem worldwide.

We aimed to describe the influenza vaccination rate and its determinants among infection control team (ICT) across different countries. Online multilingual survey consisting of 23 items, between 17 May -15 July of 2019 targeting the opinions and practices of ICTs regarding the 2018-2019 influenza season was employed. Participants were reached via European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and European Union Certificate for Infection Control (EUCIC) newsletters,social media, and national societies. In total, 899 participants from 56 countries responded to the survey. The overall vaccination rate was 76%, being the highest in Finland, Portugal, Norway, and Israel (100%), whereas the lowest in Italy (68%) and Turkey (39%). Influenza vaccination rate was 86% among IC physicians and 52% among IC nurses. The most significant factors affecting participants' decision were personal influenza vaccine experience (49%) and attitude of the scientific authorities (48%). In multivariate analysis, vaccination of the ICT head (OR: 16.04, 95%CI: 8.4-30.8, p

Objectives We explored the effectiveness of COVID-19 vaccines in preventing reinfection in the Republic of Cyprus. Study design Matched case-control study (1:2). Methods Cases were adults with a first episode of SARS-CoV-2 infection in 2020 and a second episode (i.e., reinfection) between June-August 2021. Controls were adults with only one infection episode in 2020 (i.e., not reinfected). Matching was performed by age, gender, and week of diagnosis for first episode. The reinfection date of a case was applied to the matched controls for estimating full or partial vaccination status. Cases and controls were classified as unvaccinated, partially vaccinated (i.e., vaccination series not completed or final dose received ≤14 days before the reinfection date) or fully vaccinated (i.e., final dose received >14 days before the reinfection date). Conditional logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (CI) for full or partial vaccination, against no vaccination, between controls and cases. Results This study showed that controls were more likely to be vaccinated (OR for full vaccination: 5.51, 95% CI: 2.43-12.49) than cases. Conclusions This finding answers a pressing question of the public and supports the offer of vaccination to people with previous SARS-CoV-2 infection.

Objectives: Optimal treatment of carbapenem-resistant Gram-negative bacteria (CR-GNB) infections is uncertain because of the lack of good-quality evidence and the limited effectiveness of available antibiotics. The aim of this survey was to investigate clinicians' prescribing strategies for treating CR-GNB infections worldwide. Methods: A 36-item questionnaire was developed addressing the following aspects of antibiotic prescribing: respondent's background, diagnostic and therapeutic availability, preferred antibiotic strategies and rationale for selecting combination therapy. Prescribers were recruited following the snowball sampling approach, and a post-stratification correction with inverse proportional weights was used to adjust the sample's representativeness. Results: A total of 1012 respondents from 95 countries participated in the survey. Overall, 298 (30%) of the respondents had local guidelines for treating CR-GNB at their facility and 702 (71%) had access to Infectious Diseases consultation, with significant discrepancies according to country economic status: 85% (390/502) in high-income countries versus 59% (194/283) in upper-medium-income countries and 30% (118/196) in lower-middle-income countries/lower-income-countries). Targeted regimens varied widely, ranging from 40 regimens for CR-Acinetobacter spp. to more than 100 regimens for CR-Enterobacteriaceae. Although the majority of respondents acknowledged the lack of evidence behind this choice, dual combination was the preferred treatment scheme and carbapenem-polymyxin was the most prescribed regimen, irrespective of pathogen and infection source. Respondents noticeably disagreed around the meaning of ‘combination therapy’ with 20% (150/783) indicating the simple addition of multiple compounds, 42% (321/783) requiring the presence of in vitro activity and 38% (290/783) requiring in vitro synergism. Conclusions: Management of CR-GNB infections is far from being standardized. Strategic public health focused randomized controlled trials are urgently required to inform evidence-based treatment guidelines.

Scope: this guideline addresses the indications for direct testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic individuals in health care facilities, with the aim to prevent SARS-CoV-2 transmissions in these settings. The benefit of testing asymptomatic individuals to create a safe environment for patients and health care workers must be weighed against potential unintended consequences, including delaying necessary treatments owing to false positive results and lower quality of care owing to strict isolation measures. Methods: a total of nine PICOs (population, intervention, comparison, outcome) on the topic of testing asymptomatic individuals was selected by the panel members. Subsequently, a literature search for existing guidelines and systematic reviews was performed on PubMed, Epistemonikos, and RecMap using relevant filters available in each database. Data on article/recommendation type, setting, target population, intervention, and quality of the evidence were extracted. Credibility of the systematic reviews was evaluated using the AMSTAR tool, and level of agreement with available recommendation was evaluated with the AGREE II score. Because the evidence available from systematic reviews was deemed insufficiently updated to formulate relevant recommendations, an additional search targeting relevant guidance documents from major public health institutions and original studies was performed. Provisional recommendations were discussed via web conferences until agreement was reached, and final recommendations were formulated according to the grade approach. Recommendations: recommendations were formulated regarding systematic testing in asymptomatic individuals upon admission to a health care setting, during hospital stay, before elective procedures, and before scheduled nonsurgical procedures. Moreover, recommendations regarding testing of asymptomatic visitors, personal caregivers, and health care workers in health care facilities were presented. Recommendations also were given on contact tracing in asymptomatic patients or health care workers and the possibility of a negative screening test to shorten the quarantine period. Furthermore, if applicable, recommendations were specified to transmission rate and vaccination coverage., NA

Infectious diseases constitute a significant problem globally and healthcare professionals (HCP) show suboptimal vaccination rates. We aimed to evaluate the determinants affecting vaccination against influenza and SARS-CoV-2 among medical students in Cyprus.We conducted a cross-sectional study based on a self-reported, anonymous questionnaire that was sent to all medical students of two Medical Schools in the Republic of Cyprus.Among 266 respondents, 50.8% had been vaccinated against influenza in the past and 20.1% in 2020-21. The majority believed that influenza and SARS-CoV-2 vaccines are safe and effective. Regarding vaccination in Cyprus, 41.3% did not know the current recommendations and a higher proportion of preclinical students replied incorrectly, compared to clinical students. Slightly over half (56.4%) considered themselves adequately informed about influenza vaccination, with more clinical students appearing confident (p=0.068). An overwhelming 71.2% were concerned about contracting SARS-CoV-2, compared to 25.4% with regards to influenza. Up to 76.8% considered themselves adequately informed about SARS-CoV-2 vaccination, with significantly more clinical students being confident (p0.001). Although more preclinical students appeared hesitant, most students had either been vaccinated against SARS-CoV-2 (49.4%) or would be as soon as possible (32.1%). Vaccination refusal was 2.3%, a group comprised entirely of preclinical students.Our study provides relevant and actionable information about differences in attitudes and perceptions between clinical and preclinical medical students regarding vaccination against influenza and SARS-CoV-2 and highlights the importance of organized, systemic efforts to increase vaccination coverage.

Diabetes mellitus (DM) is defined as a chronic disease of disordered metabolism with an ongoing increase in prevalence and incidence rates. Renal disease in patients with diabetes is associated with increased morbidity and premature mortality, particularly attributed to their very high cardiovascular risk. Since this group of patients frequently lacks specific symptomatology prior to the adverse events, a screening tool for the identification of high-risk patients is necessary. The epicardial adipose tissue (EAT) is a biologically active organ having properties similar to visceral adipose tissue and has been associated with metabolic diseases and coronary artery disease. Superior to conventional cardiovascular risk factors and anthropometric measures, including body mass index and waist circumference, the EAT can early predict the development of coronary artery disease. Assessment of EAT can be performed by two-dimensional echocardiography, magnetic resonance imaging or computer tomography. However, its role and significance in patients with DM and nephropathy has not been thoroughly evaluated. The aim of the current editorial is to evaluate all available evidence regarding EAT in patients with DM and renal impairment. Systematic search of the literature revealed that patients with DM and nephropathy have increased EAT measurements, uncontrolled underlying disease, high body mass index and raised cardiovascular risk markers. Acknowledging the practical implications of this test, EAT assessment could serve as a novel and non-invasive biomarker to identify high-risk patients for cardiovascular adverse events.

Μελέτη 1: Μελέτη της μικροβιακής αντοχής και της κατανάλωσης αντιβιοτικών στο Πανεπιστημιακό Γενικό Νοσοκομείο ΗρακλείουΣκοπός: η μελέτη των επικρατέστερων μικροργανισμών, των κυριότερων αντοχών και τηςεξέλιξής τους στο χρόνο, καθώς και της εξέλιξης της κατανάλωσης των αντιβιοτικών στοΠαΓΝΗ και ανά τμήμα.Μέθοδοι: Kατά το διάστημα Ιανουάριος 2009 - Μάρτιος 2010 (15 μήνες), προοπτικήκαθημερινή καταγραφή όλων των μικροβίων που απομονώθηκαν στο μικροβιολογικόεργαστήριο του νοσοκομείου και των αντοχών τους. Για την αποτύπωση της εξέλιξης τηςαντοχής συσχετίσθηκαν με δεδομένα καταγραφών των αντοχών κατά την πενταετία2005–2009. Επιπλέον συλλέχθηκαν και αναλύθηκαν αθροιστικά δεδομένα από τηνκατανάλωση αντιβιοτικών για δύο διακριτές χρονικές περιόδους, 2004-06 και 2008-09. Ηταξινόμηση της κατανάλωσης αντιβιοτικών έγινε σύμφωνα με την ομάδα J01 τουσυστήματος ταξινόμησης Anatomical Therapeutic Chemical (ATC) 2006 του ΠαγκόσμιουΟργανισμού Υγείας. Τα αποτελέσματα συγκρίθηκαν με αντίστοιχα δεδομένα του ΠαΓΝΗκαι της διεθνούς βιβλιογραφίας.Αποτελέσματα: απομονώθηκαν 6364 μοναδικά (non duplicate) στελέχη, εκ των οποίων4705 (73.9%) προέρχονταν από τμήματα του νοσοκομείου. Από αυτά, το 39.1%προέρχονταν από παθολογικά τμήματα, το 26.6% από χειρουργικά τμήματα, το 17.8%από τη ΜΕΘ και το 16.5% από παιδιατρικά τμήματα. Οι συχνότεροι μικροργανισμοί ήτανκοαγκουλάση-αρνητικοί σταφυλόκοκκοι (CNS, 18.4% του συνόλου), Escherichia coli(16.0%), Enterococcus spp (11.1%), Klebsiella pneumoniae (8.5%) και Pseudomonasaeruginosa (7.4%). Οι CNS ήταν οι συχνότεροι μικροργανισμοί σε καλλιέργειες αίματος(46.6% του συνόλου των αιμοκαλλιεργειών), τα E. coli ήταν τα συχνότερα απομονωθένταστα ούρα (54.4%), ενώ από τα δείγματα κατώτερου αναπνευστικού συχνότερα ήταν ταστελέχη Acinetobacter baumannii (19.9%), P. aeruginosa (13.5%), K. pneumoniae (11.1%) και Staphylococcus aureus (10.6%). Σε σχέση με τα προηγούμενα έτη, οι περισσότερες αντοχές εμφανίζουν σταθερή ή μειούμενη επίπτωση, με την εξαίρεση των στελεχών K.pneumoniae που παρουσιάζουν σαφή αύξηση των αντοχών σε όλα τα αντιβιοτικά (56.7% ποσοστό παραγωγής ESBL, 42.2% αντοχή στην ιμιπενέμη, 51.7% στις φθοριοκινολόνες, 7.1% στην κολιστίνη). Επίσης παρατηρήθηκε αύξηση της αντοχής των στελεχών E. coli στις φθοριοκινολόνες, σταθερά υψηλό ποσοστό αντοχής (82.9%) των A. baumannii στις καρβαπενέμες, με ιδαίτερη αύξηση στα τμήματα ΜΕΘ, Γενικής Παθολογίας, Αιματολογίας, Νεφρολογίας, Νευροχειρουργικής. Οι αντοχές της P. aeruginosa είναι σταθερές, σε επίπεδα συγκρίσιμα με τη διεθνή βιβλιογραφία (19.8% στην ιμιπενέμη, 12.4% στις φθοριοκινολόνες, 7.2% στη γενταμικίνη). Η επίπτωση των κυριότερων αντοχών των gram-θετικών παθογόνων (εντερόκοκκου στη βανκομυκίνη, S. aureus και CNS στη μεθικιλίνη) εμφανίζουν μείωση το 2009 σε σχέση με τα προηγούμενα έτη, με αντίστοιχα ποσοστά παρόμοια ή και χαμηλότερα από διεθνείς μελέτες. Στη ΜΕΘ, οι CNSεπικρατούσαν στις απομονώσεις στο αίμα (53.7% των αιμοκαλλιεργειών), ενώ στιςαπομονώσεις κατώτερου αναπνευστικού ήταν συχνότερα τα A. baumannii (25.6%) και K.pneumoniae (13.2%). Στη ΜΕΘ παρατηρήθηκαν υψηλά ποσοστά αντοχών στα στελέχη K.pneumoniae και A. baumannii, ενώ οι αντοχές των σταφυλοκόκκων, εντερόκοκκων, E. coliκαι P. aeruginosa ήταν σε επίπεδα παρόμοια ή χαμηλότερα από αυτά της διεθνούςβιβλιογραφίας.Όσον αφορά στην κατανάλωση αντιβιοτικών, οι κεφαλοσπορίνες ήταν τασυχνότερα χορηγούμενα αντιβιοτικά (20% της συνολικής κατανάλωσης),ακολουθούμενες από τις φθοριοκινολόνες (15%) και συνδυασμούς β-λακταμών/αναστολέων (13%), με σημαντική αύξηση της συνολικής κατανάλωσηςαντιβιοτικών (αύξηση κατά 73% το 2009 σε σχέση με το 1998) και ιδιαίτερα αυτών μεευρύ φάσμα. Σε σχέση με τις περισσότερες μελέτες, στο ΠαΓΝΗ παρατηρείται ίση ήχαμηλότερη κατανάλωση πενικιλινών, αλλά αρκετά υψηλότερη κατανάλωσηκεφαλοσπορινών, καρβαπενεμών, και νεότερων αντιβιοτικών όπως φθοριοκινολόνες,γλυκοπεπτίδια, λινεζολίδη, πολυμυξίνες, δαπτομυκίνη και τιγκεκυκλίνη. Η συνολικήκατανάλωση αντιβιοτικών στη ΜΕΘ ήταν πολύ υψηλή σε σύγκριση τόσο με τη συνολικήκατανάλωση στο ΠαΓΝΗ, όσο και με άλλες ΜΕΘ από το διεθνή χώρο.Συμπεράσματα: τα κυριότερα προβλήματα που εντοπίσθηκαν είναι τα υψηλά ποσοστάαντοχών στα συχνότερα απομονωθέντα gram-αρνητικά. Επιπλέον, παρατηρείταιαυξημένη κατανάλωση αντιβιοτικών ευρέως φάσματος και νεότερων, τελευταίαςγραμμής αντιβιοτικών, ενώ αντίθετα παρατηρείται μείωση της κατανάλωσηςαντιβιοτικών με ειδικότερο ή στενότερο φάσμα. Στη ΜΕΘ ΠαΓΝΗ, λόγω των υψηλώνποσοστών αντοχής στα στελέχη K. pneumoniae και A. baumannii και της μεγάληςκατανάλωσης αντιβιοτικών, είναι απαραίτητη η ενίσχυση των μέτρων ελέγχου τηςαντοχής και η εφαρμογή προγράμματος βελτίωσης των πρακτικών χορήγησηςαντιβιοτικών.Μελέτη 2: Λοιμώξεις από πανανθεκτικά gram-αρνητικά βακτήρια: κλινικάχαρακτηριστικά, θεραπευτική αντιμετώπιση και έκβαση, σε μια σειρά 21 ασθενώνΣκοπός: η περιγραφή και ανάλυση των κλινικών χαρακτηριστικών, του θεραπευτικούχειρισμού και της έκβασης των λοιμώξεων από πανανθεκτικά gram-αρνητικά μικρόβιαστο ΠαΓΝΗ.Μέθοδοι: προοπτική μελέτη παρατήρησης σειράς ασθενών με λοίμωξη από πανανθεκτικάgram-αρνητικά βακτήρια από τον Απρίλιο 2006 έως και τον Απρίλιο 2008 στο ΠαΓΝΗ. Τααπομονωθέντα στελέχη A. baumannii, K. pneumoniae και P. aeruginosa θεωρούντανπανανθεκτικά εάν εμφάνιζαν αντοχή σε όλες τις ομάδες αντιβιοτικών πουχρησιμοποιούνταν για εμπειρική θεραπεία.Αποτελέσματα: Βρέθηκαν 21 ασθενείς με λοίμωξη από 23 πανανθεκτικά gram-αρνητικάβακτήρια. Η μέση τιμή APACHE II score ήταν 18.8, η μέση τιμή δείκτη συννοσηροτήτωνCharlson ήταν 2.9 και 20 (95.2%) ασθενείς είχαν ιστορικό νοσηλείας στη ΜΕΘ. Όλοι οιασθενείς είχαν πρόσφατη λήψη πολλαπλών αντιβιοτικών (διάμεσος 6 ομάδεςαντιβιοτικών). Οι λοιμώξεις εμφανίστηκαν 41.5 ημέρες (μέση τιμή) μετά την εισαγωγήστο νοσοκομείο. Η μέση διάρκεια νοσηλείας μετά τη λοίμωξη ήταν 54.6 ημέρες και 5ασθενείς (23.8%) απεβίωσαν λόγω της λοίμωξης. Η θεραπεία των λοιμώξεων βασιζότανκυρίως σε σχήματα που περιείχαν κολιστίνη (47.6%) ή τιγκεκυκλίνη (33.3%). Παρόλο πουείχαν παρόμοια κλινικά και δημογραφικά χαρακτηριστικά με τους υπόλοιπους ασθενείς,οι 7 ασθενείς που έλαβαν τιγκεκυκλίνη ιάθηκαν και είχαν στατιστικά σημαντικάμικρότερη διάρκεια νοσηλείας μετά τη λοίμωξη.Συμπεράσματα: ασθενείς με λοίμωξη από πανανθεκτικά gram-αρνητικά βακτήριαχαρακτηρίζονται από πολλαπλές και σοβαρές συννοσηρότητες, μακρά νοσηλεία καιπροηγούμενη έκθεση σε πολλαπλά αντιβιοτικά και παρεμβάσεις. Υπαρχει σημαντικήπαράταση της νοσηλείας μετά τη λοίμωξη, αλλά η θνητότητα δεν είναι όσο υψηλή θααναμενόταν. Η χορήγηση τιγκεκυκλίνης σχετίσθηκε με ίαση και με χαμηλότερη διάρκειανοσηλείας, όμως χρειάζεται προσοχή στη χρήση της για τη διατήρηση του αντιβιοτικούαυτού σαν επιλογή σε λοιμώξεις από πανανθεκτικά στελέχη.Μελέτη 3: Εξέλιξη της πολυαντοχής σε στελέχη Klebsiella pneumoniae στα νοσοκομεία της ΚρήτηςΕισαγωγή: Η Klebsiella pneumoniae τύπου ST258 που παράγει την καρβαπενεμάση KPC-2μεταδίδεται ταχέως και συχνά σχετίζεται με σοβαρές νοσοκομειακές λοιμώξεις, μεαποτέλεσμα ως μοναδικές θεραπευτικές επιλογές να παραμένουν τελευταίας γραμμήςαντιβιοτικά, όπως κολιστίνη και τιγκεκυκλίνη.Σκοπός: Η περιγραφή της γονιδιακής βάσης επίκτητης αντοχής σε στελέχη K. pneumoniaeανθεκτικά στις καρβαπενέμες και η μελέτη της εξέλιξής τους στο χρόνο, στα νοσοκομείατης Κρήτης.Μέθοδοι: Συλλέχθησαν 34 στελέχη K. pneumoniae με αντοχή στις καρβαπενέμες απόασθενείς νοσηλευόμενους σε 3 νοσοκομεία της Κρήτης (ΠαΓΝΗ, Βενιζέλειο ΓενικόΝοσοκομείο Ηρακλείου, Γενικό Νοσοκομείο Ρεθύμνου) τις περιόδους 2010 και 2013/14.Πραγματοποιήθηκε φαινοτυπική ανάλυση, ταυτοποίηση στελεχών και ανάλυσηγονιδιώματος (whole genome sequencing) για ανίχνευση μηχανισμών επίκτητης αντοχής.Επίσης έγινε σύγκριση των ποσοστών αντοχής και της εξέλιξης του γονιδιώματος στιςδύο χρονικές περιόδους.Αποτελέσματα: Το 2013/14, βρέθηκαν 6/23 στελέχη ανθεκτικά σε όλα τα αντιβιοτικά πουελέγχθηκαν. Όλα τα στελέχη KPC-KP ήταν θετικά για παραγωγή της καρβαπενεμάσηςKPC-2 που θεωρείται ενδημική στον ελληνικό χώρο. Όλα τα στελέχη πλην ενός ανήκανστον τύπο ST258. Σημαντικά υψηλότερα ποσοστά αντοχής στην κολιστίνη καιτιγκεκυκλίνη ανιχνεύθηκαν την περίοδο 2013/14 σε σχέση με το 2010. Η αντοχή στηνκολιστίνη σχετίζεται με μεταλλάξεις στο γονίδιο mgrB, ενώ η αντοχή στην τιγκεκυκλίνησχετίζεται με μεταλλάξεις στο γονίδιο ramR ή με απουσία γονιδίων του οπερονίουRamRA. Αναγνωρίσθηκαν πολλαπλά γονίδια επίκτητης αντοχής σε διάφορα αντιβιοτικάκαι μεταλλάξεις, τα οποία καταδεικνύουν υψηλή δυναμική μεταδοτικότητας.Συμπεράσματα: Η παρούσα μελέτη είναι μία αναφορά των γενετικών καθοριστώνεπίκτητης αντοχής σε β-λακταμικά και μη-λακταμικά αντιβιοτικά σε ανθεκτική στιςκαρβαπενέμες K. pneumoniae σε 3 νοσοκομεία της Κρήτης. Περιγράφονται οι μοριακοίμηχανισμοί πίσω από τις αντοχές αυτές καθώς και η εμφάνιση πανανθεκτικών στελεχών.Η εξέλιξη της αντοχής μεταξύ των 2 περιόδων που μελετήθηκαν δείχνει την ταχύτητα μετην οποία πολλαπλασιάζονται οι μηχανισμοί αντοχής σε ένα στέλεχος. Η ανάλυση με coregenome-MLST θα μπορούσε στο μέλλον να χρησιμοποιηθεί σαν εργαλείο ταχείαςαναγνώρισης μοριακών δεικτών της KPC-KP ST258. Επιπλέον, καθίσταται προφανής ηανάγκη εφαρμογής παρεμβάσεων για την αποτροπή της περαιτέρω μετάδοσης τουφαινότυπου αυτού, που κρύβει σοβαρές επιπτώσεις στο σύστημα υγείας.Μελέτη 4: Εφαρμογή διεθνών οδηγιών για τον έλεγχο μίας νοσοκομειακής επιδημίας από πολυανθεκτικά μικρόβια: Το παράδειγμα της επιδημίας από πανανθεκτικό Acinetobacter baumanniiΕισαγωγή: Η εμφάνιση και μετάδοση πανανθεκτικών βακτηρίων στο νοσοκομειακό χώροθα είχε σοβαρές επιπτώσεις τόσο στο σύστημα υγείας, όσο και στην αντιμετώπιση καιέκβαση των ασθενών.Σκοπός: Η μελέτη αυτή παρουσιάζει την αποτελεσματικότητα της εφαρμογής δέσμηςμέτρων που εφαρμόσθηκαν για τον περιορισμό μίας επιδημίας από πανανθεκτικό A.baumannii (PDR-AB) στο τριτοβάθμιο Βενιζέλειο Γενικό Νοσοκομείο, ενώ περιγράφονταιοι μικροβιολογικοί, μοριακοί και κλινικοί χαρακτήρες του επιδημικού στελέχους.Μέθοδοι: Βάσει των παρεμβάσεων που εφαρμόσθηκαν, η επιδημία εξελίχθηκε σε 3 φάσειςαπό το Φεβρουάριο μέχρι τον Οκτώβριο 2014. Πραγματοποιήθηκε μοριακή και γονιδιακήανάλυση του υπεύθυνου για την επιδημία στελέχους, ενώ παράλληλα καταγράφηκαν τακλινικά χαρακτηριστικά και η έκβαση των λοιμώξεων. Παρά τα αρχικά μέτρα πουαφορούσαν σε ενίσχυση της υγιεινής χεριών και εκπαίδευση, η επιδημία συνεχίσθηκε, μεαποτέλεσμα να κριθεί αναγκαία η εφαρμογή πλέον μίας δέσμης μέτρων ελέγχου καιπρόληψης λοιμώξεων, σύμφωνα με τις πρόσφατα δημοσιευμένες οδηγίες της EuropeanSociety of Clinical Microbiology and Infectious Diseases (ESCMID). Οι παρεμβάσεις αυτέςπεριλάμβαναν: ενίσχυση της υγιεινής χεριών, απομόνωση επαφής ασθενών, έλεγχο(screening) ασθενών και περιβάλλοντος για αποικισμό από PDR-AB, πλύσιμο ασθενών μεχλωρεξιδίνη, σηματοδότηση ασθενών για έγκαιρη αναγνώριση, προληπτική (pre-emptive)απομόνωση επαφής ασθενών στη ΜΕΘ, συνεχή και υποχρεωτική εκπαίδευσηπροσωπικού σε θέματα ελέγχου λοιμώξεων, εντατικό περιβαλλοντικό καθαρισμό καιτροποποίηση υποδομών.Αποτελέσματα: Συνολικά κατά την 9-μηνη διάρκεια της επιδημίας, απομονώθηκε PDR-ABσε 39 ασθενείς, εκ των οποίων οι 22 ήταν στη ΜΕΘ. Η ανάλυση με Rep-PCR έδειξε ότι ηεπιδημία οφειλόταν σε κλωνική διασπορά. Πλήρης γονιδιακή ανάλυση αποκάλυψε τηγονιδιακή βάση της αντοχής του υπεύθυνου στελέχους. Η αντοχή στις καρβαπενέμεςοφειλόταν στο ενδογενές blaOXA-66 και στο επίκτητο blaOXA-23. Ο περιορισμός της επιδημίας ήταν επιτυχής μόνο όταν εφαρμόσθηκε πλήρως όλη η δέσμη παρεμβάσεων. Η θνητότητα στις λοιμώξεις από PDR-AB έφτασε το 57.1%.Συμπεράσματα: Η μελέτη αυτή ανέδειξε τη σημασία της εφαρμογής δέσμης παρεμβάσεωνβάσει διεθνών συστάσεων στον περιορισμό της επιδημίας από PDR-AB.

P-class pumps are specific ion transporters involved in maintaining intracellular/extracellular ion homeostasis, gene transcription, and cell proliferation and migration in all eukaryotic cells. The present review aimed to evaluate the role of P-type pumps [Na+/K+ ATPase (NKA), H+/K+ ATPase (HKA) and Ca2+-ATPase] in cancer cells across three fronts, namely structure, function and genetic expression. It has been shown that administration of specific P-class pumps inhibitors can have different effects by: i) Altering pump function; ii) inhibiting cell proliferation; iii) inducing apoptosis; iv) modifying metabolic pathways; and v) induce sensitivity to chemotherapy and lead to antitumor effects. For example, the NKA β2 subunit can be downregulated by gemcitabine, resulting in increased apoptosis of cancer cells. The sarcoendoplasmic reticulum calcium ATPase can be inhibited by thapsigargin resulting in decreased prostate tumor volume, whereas the HKA α subunit can be affected by proton pump inhibitors in gastric cancer cell lines, inducing apoptosis. In conclusion, the present review highlighted the central role of P-class pumps and their possible use and role as anticancer cellular targets for novel therapeutic chemical agents.

Data sharing: The data used to inform this policy paper can be made able, upon reasonable request from Esmita Charani, e.charani@imperial.ac.uk. Copyright © 2021 The Author(s). Addressing the silent pandemic of antimicrobial resistance (AMR) is a focus of the 2021 G7 meeting. A major driver of AMR and poor clinical outcomes is suboptimal antimicrobial use. Current research in AMR is inequitably focused on new drug development. To achieve antimicrobial security we need to balance AMR research efforts between development of new agents and strategies to preserve the efficacy and maximise effectiveness of existing agents. Combining a review of current evidence and multistage engagement with diverse international stakeholders (including those in healthcare, public health, research, patient advocacy and policy) we identified research priorities for optimising antimicrobial use in humans across four broad themes: policy and strategic planning; medicines management and prescribing systems; technology to optimise prescribing; and context, culture and behaviours. Sustainable progress depends on: developing economic and contextually appropriate interventions; facilitating better use of data and prescribing systems across healthcare settings; supporting appropriate and scalable technological innovation. Implementing this strategy for AMR research on the optimisation of antimicrobial use in humans could contribute to equitable global health security. Wellcome Trust; Economic and Social Research Council (ESRC); National Institute for Health Research ASPIRES project (Antibiotic use across Surgical Pathways: Investigating, Redesigning and Evaluating Systems) (https://www.imperial.ac.uk/arc/aspires/); National Institute for Health Research, UK Department of Health [HPRU-2012-10047] in partnership with Public Health England.

Contaminated healthcare workers’ (HCW) clothing risk transferring methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. We performed a systematic review in Pubmed and Scopus for 2000–2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to analyze evidence of MRSA on HCW attire. The primary study outcome was MRSA isolation rates on HCW clothing in healthcare settings. Out of 4425 articles, 23 studies were included: 18 with 1760 HCWs, four with 9755 HCW–patient interactions and one with 512 samples. There was a notable variation in HCWs surveyed, HCW attires, sampling techniques, culture methods and laundering practices. HCW attire was frequently colonized with MRSA with the highest rates in long-sleeved white coats (up to 79%) and ties (up to 32%). Eight studies reported additional multidrug-resistant bacteria on the sampled attire. HCW attire, particularly long-sleeved white coats and ties, is frequently contaminated with MRSA. Banning certain types and giving preference to in-house laundering in combination with contact precautions can effectively decrease MRSA contamination and spread.

P-class pumps are specific ion transporters involved in maintaining intracellular/extracellular ion homeostasis, gene transcription, and cell proliferation and migration in all eukaryotic cells. The present review aimed to evaluate the role of P-type pumps [Na+/K+ ATPase (NKA), H+/K+ ATPase (HKA) and Ca2+-ATPase] in cancer cells across three fronts, namely structure, function and genetic expression. It has been shown that administration of specific P-class pumps inhibitors can have different effects by: i) Altering pump function; ii) inhibiting cell proliferation; iii) inducing apoptosis; iv) modifying metabolic pathways; and v) induce sensitivity to chemotherapy and lead to antitumor effects. For example, the NKA β2 subunit can be downregulated by gemcitabine, resulting in increased apoptosis of cancer cells. The sarcoendoplasmic reticulum calcium ATPase can be inhibited by thapsigargin resulting in decreased prostate tumor volume, whereas the HKA α subunit can be affected by proton pump inhibitors in gastric cancer cell lines, inducing apoptosis. In conclusion, the present review highlighted the central role of P-class pumps and their possible use and role as anticancer cellular targets for novel therapeutic chemical agents.

Coronavirus disease 2019 (COVID-19) has significantly affected the well-being of individuals worldwide. We herein describe the epidemiology of COVID-19 in the Republic of Cyprus during the first epidemic wave (9 March&ndash, 3 May 2020). We analyzed surveillance data from laboratory-confirmed cases, including targeted testing and population screening. Statistical analyses included logistic regression. During the surveillance period, 64,136 tests (7322.3 per 100,000) were performed, 873 COVID-19 cases were diagnosed, and 20 deaths were reported (2.3%). Health-care workers (HCWs) represented 21.4% of cases. Overall, 19.1% of cases received hospital care and 3.7% required admission to Intensive Care Units. Male sex (adjusted Odds Ratio (aOR): 3.04, 95% Confidence Interval (CI): 1.97&ndash, 4.69), increasing age (aOR: 1.56, 95%CI: 1.36&ndash, 1.79), symptoms at diagnosis (aOR: 6.05, 95%CI: 3.18&ndash, 11.50), and underlying health conditions (aOR: 2.08, 95%CI: 1.31&ndash, 3.31) were associated with hospitalization. For recovered cases, the median time from first to last second negative test was 21 days. Overall, 119 primary cases reported 616 close contacts, yielding a pooled secondary attack rate of 12% (95%CI: 9.6&ndash, 14.8%). Three population-based screening projects, and two projects targeting employees and HCWs, involving 25,496 people, revealed 60 positive individuals (0.2%). Early implementation of interventions with targeted and expanded testing facilitated prompt outbreak control on the island.

Objectives: To determine mortality predictors following fall related fractures in older patients. Materials and methods: Patients aged ≥ 70 years hospitalized for fall related fractures were prospectively evaluated. Mortality was the main outcome. Age, functional-cognitive function, medications, comorbidities, fall history, fear of falls were also assessed. Outcomes: A total of 100 patients were enrolled. Ninety-one out of 100 (91%) suffered a hip fracture; 92 (92%) had surgery. The one-year post-discharge mortality was 20%. Univariate analysis revealed that older age, increased Charlson comorbidity index, low abbreviated mental test on admission, low modified Barthel index (MBI), fear of falls and delirium were significantly correlated with one-year post discharge mortality (p=.03, p=.003, p=.04, p=.005, p=.004, p=.015, respectively). Conclusion: Age, fear of falls and Charlson comorbidity index are predictors of one-year mortality after hospitalization for fracture. It is of utmost importance to identify older patients suffering from fracture at risk of dying that may benefit from patient-centered care.

Objectives Both diabetic peripheral neuropathy and depression have significant implications on patients’ quality of life, management and outcomes. We aimed to evaluate all available evidence concerning patients with co-existent diabetic peripheral neuropathy and depression, and describe their clinical characteristics, in order to promote early recognition and management. Methods Systematic search of PubMed for studies providing data on patients with diabetic peripheral neuropathy and depression. The primary outcome was to evaluate all available evidence related to characteristics of diabetes, diabetic peripheral neuropathy and depression. Secondary study outcomes included comorbid conditions and complications in these patients. Results Final analysis included 24 studies with data on 205 patients. Most patients were adults between 18–65 years of age. Mean HbA1c value was above 8% and most patients were treated with insulin. Neuropathy was predominantly painful and most patients with available data were considered to have major depressive disorder. In addition to diabetic peripheral neuropathy and depression, diabetes-related complications were recorded in 43 patients, the most common being autonomic neuropathy, retinopathy and nephropathy. The most frequently reported comorbidities were weight loss (72 patients), impotence (60 patients), hypertension (23 patients) and coronary artery disease (22 patients). Conclusions The present study describes the characteristics of patients with co-existent diabetic peripheral neuropathy and depression, aiming for prompt detection, prevention of further deterioration and improvement of patient outcomes. Available evidence shows that the majority of these patients are adults, with painful peripheral neuropathy and with insulin-treated and inadequately controlled diabetes.

BACKGROUND Despite reports of fungal infections in patients with inflammatory bowel disease (IBD), their clinical and microbiological characteristics remain unknown. OBJECTIVES The aim of this systematic review was to examine all available evidence regarding fungal infections in patients with IBD. METHODS Systematic search of PubMed (through 27 May 2017) for studies providing data on clinical, microbiological, treatment and outcome data of fungal infections in patients with IBD. The primary study outcome was to record the most common fungal species in patients with IBD. Secondary outcomes were classified into 3 categories: (i) characteristics of fungal infections; (ii) data on IBD and (iii) treatment and outcomes of fungal infections in patients with IBD. RESULTS Fourteen studies with data on 1524 patients were included in final analysis. The most common fungal infections in patients with IBD were caused by Candida species (903 infections); the most commonly reported site of Candida infection was the gastrointestinal tract. Available evidence shows that most fungal infections occur within 12 months of IBD treatment and within 6 months when anti-TNFa agents are used. CONCLUSIONS This systematic review thoroughly describes fungal infections in patients with IBD and provides important information for the early detection and management of these infections.

BACKGROUND: mcr-1 has been reported as first plasmid gene to confer colistin-resistance. In KPC-producing Klebsiella pneumoniae (KPC-KP) isolates, however, colistin resistance is rapidly emerging through other mechanisms. This is frequently the result of disruption of mgrB gene by insertion sequences, for instance ISL3. The aim of this study is to investigate the expansion of mgrB-mutated KPC-KP. In addition, we identify localization and targets of ISL3 sequences within the core and accessory genome of common KPC-KP lineages.METHODS: Twenty-nine clinical isolates of K. pneumoniae collected from Italian patients were randomly selected. Whole genome sequences (WGS) were analysed for resistance genes, plasmids, and insertion sequences. Additionally, 27 colistin-resistant KPC-KP isolates from a previous study from Crete was assessed.FINDINGS: We observed clonal expansion of KPC-KP isolates with various mutations in mgrB among all lineages. In two Italian MLST ST512 isolates, and eight Greek ST258 isolates an identical copy of the ISL3 was inserted in mgrB nucleotide position 133. ISL3s, transposable restriction modification systems of 8154 nucleotides, were positioned on pKpQIL carrying isolates and may transpose into the chromosome. In 4 isolates, chromosomal integration of ISL3 in diverse inner-membrane proteins other than mgrB was identified.INTERPRETATION: Colistin resistance is most often explained by clonal expansion of isolates with mutated mgrB. pKpQIL-like plasmids, which are omnipresent in KPC-KP, carry insertion sequences such as ISL3 that have mgrB as a target hotspot for transposition. Transposition of insertion sequences from plasmids and subsequent clonal expansion may contribute to the emerging colistin resistance in KPC-KP.