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Background: Awareness and compliance with international guidelines for diagnosis and clinical management of Clostridioides difficile infection (CDI) are unknown.Aim: To compare the awareness and compliance with the recommended strategies for diagnosis and clinical management of CDI across Europe in 2018-2019.Methods: Hospital sites and their associated community practices across 12 European countries completed an online survey in 2018-2019, to report on their practices in terms of surveillance, prevention, diagnosis, and treatment of CDI. Responses were collected from 105 hospitals and 39 community general practitioners (GPs).Findings: Hospital sites of 11 countries reported participation in national surveillance schemes compared with six countries for international schemes. The European Society of Clinical Microbiology and Infectious Diseases (ESCMID)-recommended CDI testing meth-odologies were used by 82% (86/105) of hospitals, however countries reporting the highest incidence of CDI used non-recommended tests. Over 75% (80/105) of hospitals were aware of the most recent European CDI treatment guidelines at the time of this survey compared with only 26% (10/39) of surveyed GPs. However, up to 15% (16/105) of hospitals reported using the non-recommended metronidazole for recurrent CDI cases, sites in countries with lower awareness of CDI treatment guidelines. Only 37% (39/105) of hospitals adopted contact isolation precautions in case of suspected CDI.Conclusion: Good awareness of guidelines for the management of CDI was observed across the surveyed European hospital sites. However, low compliance with diagnostic testing guidelines, infection control measures for suspected CDI, and insufficient awareness of treatment guidelines continued to be reported in some countries. 2022 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia. Patients admitted to a COVID-hospital in Rome with SARS-CoV-2 infection and mild/moderate pneumonia were retrospectively evaluated. The primary endpoint was the time from hospital admission to orotracheal intubation/death (OTI/death). A total of 449 patients were included: 39% female, median age 63 (IQR, 50–77) years. The estimated probability of OTI/death for patients receiving pLMWH was: 9.5% (95% CI 3.2–26.4) by day 20 in those not receiving pLMWH vs. 10.4% (6.7–15.9) in those exposed to pLMWH; p-value = 0.144. This risk associated with the use of pLMWH appeared to vary by PaO2/FiO2 ratio: aHR 1.40 (95% CI 0.51–3.79) for patients with an admission PaO2/FiO2 ≤ 300 mmHg and 0.27 (0.03–2.18) for those with PaO2/FiO2 > 300 mmHg; p-value at interaction test 0.16. pLMWH does not seem to reduce the risk of OTI/death mild/moderate COVID-19 pneumonia, especially when respiratory function had already significantly deteriorated. Data from clinical trials comparing the effect of prophylactic vs. therapeutic dosage of LMWH at various stages of COVID-19 disease are needed.

To test if and how chemotherapy-induced peripheral neurotoxicity (CIPN) is perceived differently by patients and physicians, making assessment and interpretation challenging. We performed a secondary analysis of the CI-PeriNomS study which included 281 patients with stable CIPN. We tested: (a) the association between patients' perception of activity limitation in performing eight common tasks and neurological impairment and (b) how the responses to questions related to these daily activities are interpreted by the treating oncologist. To achieve this, we compared patients' perception of their activity limitation with neurological assessment and the oncologists' blind interpretation. Distribution of the scores attributed by oncologists to each daily life maximum limitation ("impossible") generated three groups: Group 1 included limitations oncologists attributed mainly to motor impairment; Group 2 ones mainly attributed to sensory impairment and Group 3 ones with uncertain motor and sensory impairment. Only a subset of questions showed a significant trend between severity in subjective limitation, reported by patients, and neurological impairment. In Group 1, neurological examination confirmed motor impairment in only 51%-65% of patients; 76%-78% of them also had vibration perception impairment. In Group 2, sensory impairment ranged from 84% to 100%; some degree of motor impairment occurred in 43%-56% of them. In Group 3 strength reduction was observed in 49%-50% and sensory perception was altered in up to 82%. Interpretation provided by the panel of experienced oncologists was inconsistent with the neurological impairment. These observations highlight the need of a core set of outcome measures for future CIPN trials.

The search for novel drug delivery systems (DDSs) able to improve the performance of old-generation antibiotics is a topic of great interest due to overcoming problems associated with antibiotic resistance [1]. Polycationic calixarene derivatives able to self-assemble in nanoaggregates are promising novel nanocontainers for delivering antibiotics to bacteria due to their ability to establish electrostatic interactions with the negatively charged bacterial membranes [2]. In particular, a polycationic amphiphilic calix[4]arene, bearing choline groups and dodecyl aliphatic chains at the cavity upper and lower rim respectively, proved to be a promising nanocarrier for drug delivery [3]. The determination of the strength and nature of drug-micelle interactions is crucial for the design of novel medicines and the modification or selection of suitable shuttles for target-oriented drug delivery. However, despite the wide interest in the examination of these interactions, a quantitative analysis of the species, binding constants and thermodynamic parameters for the recognition/inclusion of a drug with(in) micellar assemblies has rarely been addressed. The present work deals with the study of the binding features of polycationic calix[4]arene derivatives (CholineC4dod, MedeaC4dod and MedeaC4prop) with ofloxacin, chloramphenicol or tetracycline in neutral aqueous solution for investigating the capability of micellar aggregates to recognize and host three old generation antibiotics. These molecules were selected as models of antibiotics affected by the onset of resistance phenomena with the aim of contributing to the design and development of effective DDSs for the repurposing of old-fashioned drugs. The study of the solution equilibria and the determination of the binding parameters in neutral aqueous solution were carried out using nano-isothermal titration calorimetry, that allows obtaining both stability constant and enthalpy change values for host-guest complex formation [4] and/or selforganization of surfactants into micelles by a single experiment [5,6]. ITC measurements showed that the formation of the chloramphenicol-micelle adduct is always an enthalpically driven process while the adducts with ofloxacin and tetracycline are always entropically driven and enthalpically unfavored. NMR experiments confirmed the picture on the positioning of the antibiotics within the micellar backbone provided by the ITC data [7]. [1] R. K. Kobayashi, G. Nakazato, Front. Microbiol. 2020, 11, 1421. [2] I. Di Bari, R. Picciotto, G. Granata, A. R. Blanco, G. M. L. Consoli, S. Sortino, Org. Biomol. Chem. 2016, 14(34), 8047. [3] G. Granata, S. Petralia, G. Forte, S. Conoci, G. M. L. Consoli, Mater. Sci. Eng. C 2020, 111, 110842. [4] C. Bonaccorso, R. Migliore, M. A. Volkova, G. Arena, C. Sgarlata, Thermochim. Acta 2017, 656, 47. [5] W. Loh, C. Brinatti, K. C. Tam, Biochim. Biophys. Acta 2016, 1860(5), 999. [6] R. Migliore, PhD Thesis, University of Catania, 2019. [7] R. Migliore, G. Granata, A. Rivoli, G. M. L. Consoli, C. Sgarlata, Front. Chem. 2021, 8, 626467.