Cefiderocol for Severe Carbapenem-Resistant A. baumannii Pneumonia: Towards the Comprehension of Its Place in Therapy

Cefiderocol use in A. baumannii pneumonia still represents an important matter of debate. The aim of this study is to describe 13 cases of carbapenem-resistant A. baumannii (CRAB) pneumonia treated with cefiderocol in real-life practice. We retrospectively included patients with CRAB pneumonia hospitalized at Fondazione Policlinico Universitario Agostino Gemelli Hospital treated with cefiderocol either in the general ward or the intensive care unit. A total of 11 patients out of 13 had ventilator-associated pneumonia caused by CRAB, and 12/13 patients had polymicrobial infection. We found a 30-day success rate of 54%. Cefiderocol may have a role when facing severe XDR A. baumannii pneumonia. Future studies are warranted to better define its place in therapy in CRAB infections.

Microbiota markers level in the cerebrospinal fluid of patients with multiple sclerosis and radiologically isolated syndrome

According to numerous studies, gut microbiota plays a significant role in multiple sclerosis (MS) development. However, data on changes in the gut microbiota in MS is often contradictory. The most common approach in gut microbiota research is the 16S ribosomal RNA sequencing of fecal microbiota. However, such data do not reflect the composition of the entire body microbiota. There is also a lack of data on microbiota markers in the cerebrospinal fluid (CSF) of patients with MS and predisposing conditions.Objective: to assess the level of microbial markers in the CSF of patients with MS and radiologically isolated syndrome (RIS).Patients and methods. We used gas chromatography-mass spectrometry (GC-MS) to evaluate microbial markers levels in eight patients with MS, five patients with RIS, and seven controls.Results and discussion. We found an increase in microbial load in patients with MS, indicating a possible association of MS with polymicrobial infection. In particular, an increase in the content of Streptococcus markers was observed, as well as a tendency to a three-fold increase in the campesterol content (a marker of campesterol-producing microfungi) in the CSF of patients with MS, compared to the control group (diagnostic punctures, various diseases of the nervous system of a non-autoimmune or inflammatory nature, not acute states).Conclusion. GC-MS of microbial markers can be used to assess the presence of microbial markers in the CSF. The CSF of patients with MS contains an increased amount of various microbial markers, which may indicate a possible association of MS with polymicrobial infection.

Controlling Staphylococcus aureus by 2-[(Methylamino)methyl]phenol (2-MAMP) in a co-culture moderates the biofilm and virulence of Pseudomonas aeruginosa

Staphylococcus aureus and Pseudomonas aeruginosa are the most encountered organisms in a polymicrobial chronic wound infection. Production of multiple virulence factors by this duo delays wound healing process. Notably P. aeruginosa displays enhanced virulence in the presence of S. aureus by a peptidoglycan sensing mechanism. Thus novel therapies are imperative to address polymicrobial infections effectively. Previously, it has been suggested that targeting S. aureus might be a possible approach to reduce the severity of P. aeruginosa in a polymicrobial infection. In this aspect, we have used 2-[(Methylamino)methyl]phenol (2-MAMP), our previously reported QS inhibitor to target S. aureus and phenotypically determine the virulence factors of P. aeruginosa under this condition. Analysis of major virulence factors of Pseudomonas viz. biofilm, pyocyanin and pyoveridine showed a significant reduction. The competitive index (CI) and relative increase ratio (RIR) were determined to understand the organisms interaction in co-culture. Results indicated competitiveness among the strains and on increasing ratios of S. aureus cells, co-existence was noticed. Further as a sensible approach antibiotic anti-virulence drug combinations were tested on co-culture. Significant improvement in the growth inhibition was observed. Our preliminary results presented here would enable further research to address polymicrobial infection in a novel way.

Community-acquired pneumonia in HIV patients

The objective: to study the frequency and nature of community-acquired pneumonia (CAP) in HIV patients.Subjects and methods: The continuous longitudinal retrospective study of all cases of respiratory diseases among HIV patients (n = 185), who received in-patient treatment in the therapy department.Results. CAP was diagnosed in 38.4% (n = 71) of patients and it was the most frequent respiratory disease among HIV patients. The median CD4 count in CAP made 197.5 cells/μL, 9.1% of patients received antiretroviral therapy before hospital admission. 74.7% of CAP patients (n = 53) had lesions disseminated to several lobes. Laboratory parameters revealed in severe CAP (leukocytosis > 12 × 109/L, leukopenia < 4.0 × 109/L and thrombocytopenia < 100 × 1012/L) were associated with the degree of immunodeficiency and did not depend on the infiltration dissemination (p > 0.05). Bacteremia in CAP was detected in 20.8% of patients and it was associated with the failure of standard empiric antibiotic therapy (p < 0.05). 9.9% of CAP patients (n = 7) were diagnosed with polymicrobial infection. Lethal outcomes of CAP were recorded in 5.6% of cases (n = 4), all with severe immunosuppression (the median of CD4 count was 5 cells/μL), 2 cases had bilateral subtotal CAP and 2 suffered from polymicrobial infection.

Involvement of L5-S1 level as an independent risk factor for adverse outcomes after surgical treatment of lumbar pyogenic spondylitis: A multivariate analysis

Purpose: To identify the independent risk factors for adverse outcomes and determine the effect of L5-S1 involvement on the outcome of surgical treatment of lumbar pyogenic spondylitis (PS). Methods: A retrospective analysis was performed for all consecutive patients who underwent surgery for lumbar PS between November 2004 and June 2020 at a single institution. The patients were divided into two groups based on the outcomes: good and adverse (treatment failure, relapse, or death). Treatment failure was defined as persistent or worsening pain with C-reactive protein (CRP) reduction less than 25% from preoperative measurement or requiring additional debridement. Relapse was defined as the reappearance of symptoms and signs with an elevated white blood cell count, erythrocyte sedimentation rate, and CRP after the first period of treatment. Binary logistic regression analyses were performed to identify the independent risk factors for adverse outcomes. Results: Twenty-four (21.2%) of the 113 patients were classified as having adverse outcomes: treatment failure, relapse, and death occurred in 15, 7, and 2 patients, respectively. The involvement of L5-S1 (adjusted odds ratio [aOR] = 6.561, P = 0.004), Methicillin-resistant Staphylococcus aureus (MRSA) infection (aOR = 6.870, P = 0.008), polymicrobial infection (aOR = 12.210, P = 0.022), and Charlson comorbidity index (CCI; P = 0.005) were identified as significant risk factors for adverse outcomes. Conclusion: Involvement of L5-S1, MRSA, polymicrobial infection, and CCI were identified as independent risk factors for adverse outcomes after surgical treatment of lumbar PS. Because L5-S1 is anatomically demanding to access anteriorly, judicious access and thorough debridement are recommended in patients requiring anterior debridement of L5-S1.

Overview of Microbiological Profile of NOMA

Noma is a destructive gangrenous stomatitis and polymicrobial infection that generally affects children in developing countries. Our review listed the different microorganisms, in particular anaerobic bacteria found in the case of Noma.