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A 24-year-old male Bangladeshi asylum seeker presented to the emergency department of Policlinico A. Gemelli of Rome, Italy with multiple nodular, pruritic lesions on both lower limbs and both elbows. We present a skin disease typical for persons living in crowded conditions.

Introduction: The complexity of the MS patient’s management is constantly growing. Consequently, the MS care unit requires a multidisciplinary approach, including an infectious disease specialist to minimise the risk of infectious complications related both to the disease and DMTs. Materials and methods: We retrospectively evaluated the infectious disease consultations performed from 2015 to 2019 in our MS centre. Results: We identified 107 patients with at least one infectious disease consultation out of 1088 patients. We found a progressive increase in the number of consultations from 2015 to 2019. Nearly half of the consultations were requested at the time of starting MS treatment. The most frequent requests were represented by chronic or acute infections. The most prevalent infectious agents were Herpesviridae and Mycobacterium tuberculosis. Antibiotic or antiviral treatment and prophylactic treatment or vaccination represented together the most frequent outcomes of the consultations. Finally, a treatment delay was significantly associated with the advice of a prophylactic treatment or of a vaccination. Conclusion: There is an increasing awareness of the potential infectious complications of MS and of exposure to DMTs. The interaction between the MS neurologist and infectious disease specialist is fundamental to minimise the infectious risk related to the disease and to the DMTs, with a progressive shift from complication management to a broader prevention workup at the time of MS diagnosis, including both vaccination and prophylactic treatments.

Objectives To explore the real-life performance of meropenem/vaborbactam for treating serious KPC-producing Klebsiella pneumoniae infections, including those resistant to ceftazidime/avibactam. Methods A retrospective observational cohort study was conducted in 12 Italian hospitals. Enrolled patients had K. pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) infections (59.5% of which were ceftazidime/avibactam resistant). Patients who received ≥72 h of meropenem/vaborbactam therapy (with or without other antimicrobials) in a compassionate-use setting were included. Results The 37 infections (all hospital-acquired) were mainly bacteraemic (BSIs, n = 23) or lower respiratory tract infections (LRTIs, n = 10). Clinical cure was achieved in 28 (75.6%) cases and microbiologically confirmed in all 25 with follow-up cultures. Three (10.7%) of the 28 clinical cures (all BSIs, 2/3 microbiologically confirmed) were followed by in-hospital recurrences after meropenem/vaborbactam was discontinued (median interval: 18 days). All three recurrences were susceptible to meropenem/vaborbactam and successfully managed with meropenem/vaborbactam combined with colistin or fosfomycin. Nine patients (24.3%) (all with BSIs or LRTIs) died in hospital with persistent signs of infection. Most were aged over 60 years, with high comorbidity burdens and INCREMENT scores ≥8. Only one had received meropenem/vaborbactam monotherapy. Six began meropenem/vaborbactam therapy >48 h after infection onset. Outcomes were unrelated to the isolate’s ceftazidime/avibactam susceptibility status. The single adverse event observed consisted of severe leukopenia with thrombocytopenia. Conclusions With the well-known limitations of real-life retrospective studies, our results support previous findings indicating that meropenem/vaborbactam therapy will be a safe, effective tool for managing serious KPC-Kp infections, including the increasing proportion displaying resistance to ceftazidime/avibactam.

To explore the real-life performance of meropenem/vaborbactam for treating serious KPC-producingA retrospective observational cohort study was conducted in 12 Italian hospitals. Enrolled patients hadThe 37 infections (all hospital-acquired) were mainly bacteraemic (BSIs,With the well-known limitations of real-life retrospective studies, our results support previous findings indicating that meropenem/vaborbactam therapy will be a safe, effective tool for managing serious KPC

Background: Lung ultrasound (LUS) has been reported as a useful tool to intercept lung peripheral changes (LPC) in COVID-19 pneumonia. Viral pneumonia by Sars-Cov-2 is characterized by alveolar exudation and damage, interstitial thickening with patchy distribution with centrifugal extension and subpleural involvement. Methods: COVID-19 pneumonia patients underwent LUS using a standard sequence of scans in 14 landmarks. A score ranging from 0 to 3, according to Soldati’s proposal, was reported for each landmark. High-resolution CT-scan of the chest (HRCT) was performed within 48 hours prior to or after LUS. For each corresponding HRCT area, was reported a score (0 normal peripheral lung, 1 minimal LPC, 2 peripheral ground glass opacities (GGOs), 3 peripheral lung consolidations with or without GGOs) Results: Sixteen confirmed COVID-19 pneumonia underwent LUS. LUS showed sensitivity 92.1%, specificity 90%, PPV 96.8% to intercept any peripheral alterations on HRCT (both LUS and HRCT scores ≠0). Higher LUS scores (2-3), corresponding to worst changes, showed sensitivity 70.1%, specificity 84%, PPV 78.1% to intercept higher HRCT scores (2-3). The overall score, for both LUS and HRCT, over 14 landmarks, showed no significant differences (paired t-test p=0.055). An overall score ≥24 was reported in 5 cases by LUS and 6 cases by HRCT. No significant differences also for patients either with more than 3 landmarks with score 3 or with 8 landmarks out of 14 with score 2-3 (p=0.16). Conclusions: LUS showed good sensitivities and specificities compared to HRCT to intercept peripheral changes in COVID-19 pneumonia.

Background Hydroxychloroquine (HCQ) was proposed as potential treatment for COVID-19. Objective We set-up a multicenter Italian collaboration to investigate the relationship between HCQ therapy and COVID-19 in-hospital mortality. Methods In a retrospective observational study, 3,451 unselected patients hospitalized in 33 clinical centers in Italy, from February 19, 2020 to May 23, 2020, with laboratory-confirmed SARS-CoV-2 infection, were analyzed. The primary end-point in a time-to event analysis was in-hospital death, comparing patients who received HCQ with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores, with the addition of subgroup analyses. Results Out of 3,451 COVID-19 patients, 76.3% received HCQ. Death rates (per 1,000 person-days) for patients receiving or not HCQ were 8.9 and 15.7, respectively. After adjustment for propensity scores, we found 30% lower risk of death in patients receiving HCQ (HR=0.70; 95%CI: 0.59 to 0.84; E-value=1.67). Secondary analyses yielded similar results. The inverse association of HCQ with inpatient mortality was particularly evident in patients having elevated C-reactive protein at entry. Conclusions HCQ use was associated with a 30% lower risk of death in COVID-19 hospitalized patients. Within the limits of an observational study and awaiting results from randomized controlled trials, these data do not discourage the use of HCQ in inpatients with COVID-19.

Objectives The 2019 novel coronavirus (severe acute respiratory syndrome coronavirus 2) is causing cases of severe pneumonia. Lung ultrasound (LUS) could be a useful tool for physicians detecting a bilateral heterogeneous patchy distribution of pathologic findings in a symptomatic suggestive context. The aim of this study was to focus on the implications of limiting LUS examinations to specific regions of the chest. Methods Patients were evaluated with a standard sequence of LUS scans in 14 anatomic areas. A scoring system of LUS findings was reported, ranging from 0 to 3 (worst score, 3). The scores reported on anterior, lateral, and posterior landmarks were analyzed separately and compared with each other and with the global findings. Results Thirty-eight patients were enrolled. A higher prevalence of score 0 was observed in the anterior region (44.08%). On the contrary, 21.05% of posterior regions and 13.62% of lateral regions were evaluated as score 3, whereas only 5.92% of anterior regions were classified as score 3. Findings from chest computed tomography performed in 16 patients with coronavirus disease 2019 correlated with and matched the distribution of findings from LUS. Conclusions To assess the quantity and severity of lung disease, a comprehensive LUS examination is recommended. Omitting areas of the chest misses involved lung.

infections due to carbapenem-resistantThis article reviews the microbiological and pharmacological profile and current clinical experience and safety of M/V in the treatment of infections caused by CRE.M/V is a promising drug for the treatment of infections due to KPC-producing CRE (KPC-CRE). It exhibited an almost complete coverage of KPC-CRE isolates from large surveillance studies and a low propensity for resistance selection, retaining activity also against strains producing KPC mutants resistant to ceftazidime-avibactam. Both meropenem and vaborbactam have a favorable pharmacokinetic profile, with similar kinetic properties, a good intrapulmonary penetration, and are efficiently cleared during continuous venovenous hemofiltration (CVVH). According to available data, M/V monotherapy is associated with higher clinical cure rates and lower rates of adverse events, especially in terms of nephrotoxicity, if compared to 'older' combination therapies.

Lung ultrasound examination has been demonstrated to be an accurate imaging method to detect pulmonary and pleural conditions. During pregnancy, there is a need for rapid assessment of the maternal lung in patients with suspected coronavirus disease 2019. We report our experience on lung ultrasound examination in the diagnosis of coronavirus disease 2019 pneumonia in a pregnant woman. Typical ultrasound features of this pulmonary pathology, including diffuse hyperechoic vertical artifacts with thickened pleural line and "white lung" with patchy distribution, were observed. We suggest point-of-care lung ultrasound examination as a diagnostic imaging tool in pregnant women with suspected coronavirus disease 2019.

Despite being members of gut microbiota, Enterobacteriaceae are associated with many severe infections such as bloodstream infections. The β-lactam drugs have been the cornerstone of antibiotic therapy for such infections. However, the overuse of these antibiotics has contributed to select β-lactam-resistant Enterobacteriaceae isolates, so that β-lactam resistance is nowadays a major concern worldwide. The production of enzymes that inactivate β-lactams, mainly extended-spectrum β-lactamases and carbapenemases, can confer multidrug resistance patterns that seriously compromise therapeutic options. Further, β-lactam resistance may result in increases in the drug toxicity, mortality, and healthcare costs associated with Enterobacteriaceae infections. Here, we summarize the updated evidence about the molecular mechanisms and epidemiology of β-lactamase-mediated β-lactam resistance in Enterobacteriaceae, and their potential impact on clinical outcomes of β-lactam-resistant Enterobacteriaceae infections.

Objectives To analyze risk factors for early and late mortality in individuals aged 75 and older with Staphylococcus aureus bacteremia (SAB) in Italy. Design Four‐year retrospective observational study (January 2011‐December 2014). Setting Two tertiary care university hospitals in Italy (Santa Maria Misericordia Hospital in Udine, Policlinico Universitario Agostino Gemelli in Rome). Participants All adults consecutively admitted with SAB. Measurements Clinical presentation, infection characteristics, and clinical outcomes of individuals aged 75 and older were compared with those of individuals younger than 75. Results Three hundred thirty‐seven cases of SAB were diagnosed during the study period, 118 of which (35%) occurred in those aged 75 and older. Seven‐ (20.3% vs 9.2%) and 30‐day (35.7% vs 20.7%) mortality were significantly higher in elderly than younger adults. Clinical presentation with septic shock, adequacy of empiric antibiotic treatment, and liver cirrhosis were found to be predictors of 7‐day mortality in elderly adults with SAB. Risk factors independently associated with 30‐day mortality included isolation of methicillin‐resistant Staphylococcus aureus (MRSA) and not receiving an infectious disease consultation. Conclusion Mortality is significantly higher in elderly than in younger adults with SAB, particularly in those presenting with septic shock, liver cirrhosis, or SAB due to MRSA. Additional risk factors for mortality included inappropriate empiric antibiotic treatment and not receiving an infectious disease consultation.

Purpose of review Skin and soft tissue infections (SSTIs) with a wide spectrum of disease severity ranging from uncomplicated to potentially lethal are still a leading cause of morbidity and mortality. The burden of carbapenem-resistant gram-negative bacteria (CR-GNB) in SSTIs is increasing. Luckily, the armamentarium of drugs available is recently expanding as well. The present review looks at data on the role CR-GNB in SSTIs and on the old and new drugs available for the treatment of carbapenem-resistant Enterobacteriaceae (CRE), Pseudomonas, and Acinetobacter. Recent findings The most recent information concern the availability of new antibiotics that, even if no specific clinical trials on complicated SSTIs (cSSTIs) have been performed, may play a role in clinical practice also for the treatment of cSSTIs caused by CR-GNB. Ceftolozane-tazobactam has been found to be a good option for CR Pseudomonas infections including SSTIs. Ceftazidime-avibactam is approved for several indications, including aerobic GNB infections with limited treatment options. Meropenem-vaborbactam therapy has been associated with decreased mortality in infections caused by CRE. Eravacycline has the potential to become useful for the treatment of CR Acinetobacter for which the treatment options are limited. Summary In the carbapenem resistance era, the physicians goal should be to stratify patients according to risk factors for CR-GNB causing SSTIs in order to minimize inappropriate initial therapies. Some recently approved drugs seem destined to become the backbone of target therapy in patients with severe infections caused by susceptible CR-GNB strains. Prompt diagnosis of cSSTIs is crucial and, when feasible, surgical debridement as source control is essential as well.

Lung ultrasound (LUS) has been reported as a useful tool to intercept lung peripheral changes (LPC) in COVID-19 pneumonia. Sixteen confirmed COVID-19 pneumonia patients underwent LUS using a standard sequence of scans in 14 landmarks. A score ranging from 0 to 3, according to Soldati's proposal, was reported for each landmark. High-resolution CT-scan of the chest (HRCT) was performed within 48 h prior to or after LUS. For each corresponding HRCT area, was reported a score (0 normal peripheral lung, 1 minimal LPC, 2 peripheral ground glass opacities (GGOs), 3 peripheral lung consolidations with or without GGOs) LUS showed sensitivity 92.1%, specificity 90%, PPV 96.8% to intercept LPC on HRCT (scores ≠ 0). Higher LUS scores (2–3), corresponding to worst changes, showed sensitivity 70.1%, specificity 84%, PPV 78.1% to intercept higher HTCT scores (2–3). The overall score, for both LUS and HRCT, over 14 landmarks, showed no significant differences (paired t-test p = 0.055). An overall score ≥24 was reported in five cases by LUS and 6 cases by HRCT. No significant differences also for patients either with more than three landmarks with score 3 or with 8 landmarks out of 14 with score 2–3 (p = 0.16). LUS showed good sensitivities and specificities compared to HRCT.

Methicillin-resistant Staphylococcus aureus (MRSA) infections cause great concern in intensive care units (ICUs) [1]. Although strict infection control protocols have reduced staphylococcal colonization, the ICU still represents a reservoir for MRSA infections, playing a role in their circulation to multiple wards and hospitals [2–4]. In critically ill patients, lack of adequate treatment may lead to increased mortality [1]. For this reason, broad-spectrum antimicrobial therapy is often justified among critically ill patients. We retrospectively analyzed the characteristics of S. aureus bloodstream infections (SA-BSI) from two Italian University hospitals during 2010–2014. A total of 17/337 (5 %) were ICU patients; of these, 16 (94 %) had MRSA-BSI compared with 36 % (116/320) from other wards (P

We aimed to describe the characteristics of patients with Staphylococcus aureus bacteremia and to evaluate the risk factors associated with early (7-day) and late (30-day) mortality. We performed an observational study including all consecutive episodes of Staphylococcus aureus bacteremia diagnosed at two Italian university hospitals during 2010–2014. A total of 337 patients were included. Mean age was 69 years (range, 57–78) and 65% were males. Methicillin-resistant S. aureus (MRSA) was identified in 132/337 (39%)cases. Overall 7- and 30-day mortality were 13% and 26%, respectively. Early mortality was associated with increased Charlson scores (OR 1.3, 95% CI 1.1–1.5), MRSA bacteremia (OR 3.2, 95% CI 1.4–8.1), presentation with septic shock (OR 13.5, 95% CI 5.4–36.4), and occurrence of endocarditis (OR 4.5, 95%CI 1.4–14.6). Similar risk factors were identified for late mortality, including increased Charlson scores (OR 1.2, 95% CI 1.1–1.4), MRSA bacteremia (OR 2.1, 95% CI 1.2–3.9), presentation with septic shock (OR 4, 95%CI 1.7–9.7), occurrence of endocarditis (OR 3.8, 95% CI 1.4–10.2) as well as Child C cirrhosis (OR 3.9, 95% CI 1.1–14.4) and primary bacteremia (OR 2.5, 95%CI 1.3–5). Infectious disease consultation resulted in better outcomes both at 7 (OR 0.1, 95% CI 0.05–0.4) and at 30 days (OR 0.4, 95% CI 0.2–0.7). In conclusion, our study highlighted high rates of MRSA infection in nosocomial Staphylococcus aureus bacteremia. Multiple comorbidities, disease severity and methicillin-resistance are key factors for early and late mortality in this group. In patients with Staphylococcus aureus bacteremia, infectious disease consultation remains a valuable tool to improve clinical outcome.