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We retrospectively analyzed the antimicrobial data of Enterobacter spp. strains isolated from hospitalized subjects and outpatients over 20 years (2000–2019). A total of 2277 non-duplicate Enterobacter spp. isolates, 1037 from outpatients (45%) and 1240 from hospitalized subjects (55%), were retrieved. Most of samples are infections of the urinary tract. Considering Enterobacter aerogenes, now classified as Klebsiella aerogenes, and Enterobacter cloacae, representing more than 90% of all isolates, except for aminoglycosides and fluroquinolones, which showed significant antibiotic decreasing trends (p < 0.01), none of the other antimicrobial agents tested showed significant changes in both groups (p > 0.05). Conversely, there was a significant increasing resistance trend for fosfomycin (p < 0.01), among both community and hospital-related subjects, most probably owing to uncontrolled and improper usage. Surveillance studies on antibiotic resistance at the local and regional level are required to detect new resistance mechanisms, reduce inappropriate antimicrobial consumption, and increase the focus on antimicrobial stewardship.

Background: Cefiderocol is a siderophore cephalosporin that exhibits antimicrobial activity against most multi-drug resistant Gram-negative bacteria, including Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia. Methods: A total of 20 multidrug-resistant A. baumannii strains were isolated from 2020 to 2021, molecularly characterized and tested to assess the in vitro antibacterial activity of cefiderocol. Thirteen strains were carbapenem-hydrolysing oxacillinase OXA-23-like producers, while seven were non-OXA-23-like producers. Minimum in-hibitory concentrations (MICs) were determined by broth microdilution, considered as the gold standard method. Disk diffusion test was also carried out using iron-depleted CAMHB plates for cefiderocol. Results: Cefiderocol MICs ranged from 0.5 to 1 mg/L for OXA-23-like non-producing A. baumannii strains and from 0.25 to >32 mg/L for OXA-23-like producers, using the broth microdi-lution method. Cefiderocol MIC90 was 8 mg/L. Diameter of inhibition zone of cefiderocol ranged from 18 to 25 mm for OXA-23-like non-producers and from 15 to 36 mm for OXA-23-like producers, using the diffusion disk method. A large variability and a low reproducibility were observed during the determination of diameter inhibition zone. Molecular characterization showed that all isolates presented the ISAba1 genetic element upstream the blaOXA-51. Among OXA-23-like non-producers, four were blaOXA-58 positive and two were negative for all the resistance determinants analyzed. Conclusions: Cefiderocol showed in vitro antimicrobial activity against both carbapenem-susceptible and non-susceptible A. baumannii strains, although some OXA-23-like producers were resistant. Further clinical studies are needed to consolidate the role of cefiderocol as an antibiotic against MDR A. baumannii.

STUDY QUESTION: Is there an association between 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure and fecundability and infertility among Seveso women and their daughters? SUMMARY ANSWER: TCDD exposure is associated with a decrease in fecundability and increased risk of infertility in women, as well as their daughters. WHAT IS KNOWN ALREADY: In animal studies, maternal exposure to TCDD is associated with decreased fertility in offspring. Effects of TCDD are mediated by activation of the aryl hydrocarbon receptor (AHR) pathway. STUDY DESIGN, SIZE, DURATION: The Seveso Women's Health Study (SWHS) has followed 981 women exposed to TCDD in a 1976 accident since 1996. In 2014, we initiated the Seveso Second Generation Study to follow-up their children. PARTICIPANTS/MATERIALS, SETTING, METHODS: We obtained information on pregnancy history including time of trying to conceive from SWHS women and their daughters who were 18 years or older. We considered TCDD exposure as initial 1976 serum TCDD concentration and estimated TCDD at pregnancy. We examined relationships of TCDD exposure with time to pregnancy (TTP, the monthly probability of conception within the first 12 months of trying) and infertility (≥12 months of trying to conceive). We also assessed contributions of polymorphisms in the AHR pathway via genetic risk score. MAIN RESULTS AND THE ROLE OF CHANCE: Among SWHS women (n = 446), median TTP was 3 months and 18% reported taking ≥12 months to conceive. Initial 1976 TCDD (log10) was associated with longer TTP (adjusted fecundability odds ratio = 0.82; 95% CI 0.68-0.98) and increased risk of infertility (adjusted relative risk = 1.35; 95% CI 1.01-1.79). TCDD at pregnancy yielded similar associations. Among SWHS daughters (n = 66), median TTP was 2 months and 11% reported taking ≥12 months to conceive. Daughters showed similar, but non-significant, associations with maternal TCDD exposure. LIMITATIONS, REASONS FOR CAUTION: A limitation of this study is time to pregnan

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Bacterial vaginosis (BV) is one of the most frequent causes of vaginal discharge in women during reproductive age worldwide. This disease is characterized by the replacement of the normal vaginal flora with an overgrowth of anaerobic bacteria most of them producing sialidase enzyme. BV is associated with an increased risk of adverse outcomes in pregnancy and susceptibility to several sexually transmitted diseases. In the present study, we evaluated the detection of sialidase activity by OSOM BVBlue test in association with routine microbial cultures and Nugent’s score, considered as the gold standard, for the diagnosis of bacterial vaginosis. Three vaginal swabs were collected from 352 women older than 12 years in age. A swab collected into Amies transport medium was employed for standard microbial cultures, a FLOQSwab for Gram stain, and a second FLOQSwab for the BVBlue test. According to Nugent’s score, BV frequency was 16.5 % (58 samples). The sensitivity of microbial culture and BVBlue test, when compared with Nugent’s score, was 69.8 % and 39.6 %, respectively. However, BVBlue test detected five cases with no bacterial growth in culture, whereas 14 samples with bacterial cultures positive for Gardnerella vaginalis showed a BVBlue test negative. The combination of microbial culture and BVBlue test increased the sensitivity to 75 % compared with Nugent’s score. In conclusion, BVBlue test alone appears not to be an efficient screening test, but, when associated with microbial cultures, can improve the diagnosis of BV