Effect of ceftazidime/avibactam plus fosfomycin combination on 30†day mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae: results from a multicentre retrospective study.

Introduction: The primary outcome of the study was to evaluate the effect on 30 day mortality of the combination ceftazidime/avibactam + fosfomycin in the treatment of bloodstream infections (BSIs) caused by KPC-producing Klebsiella pneumoniae (KPC-Kp). Materials and methods: From October 2018 to March 2021, a retrospective, two-centre study was performed on patients with KPC-Kp BSI hospitalized at Sapienza University (Rome) and ISMETT-IRCCS (Palermo) and treated with ceftazidime/avibactam-containing regimens. A matched cohort (1:1) analysis was performed. Cases were patients receiving ceftazidime/avibactam + fosfomycin and controls were patients receiving ceftazidime/avibactam alone or in combination with in vitro non-active drugs different from fosfomycin (ceftazidime/avibactam ±â€Šother). Patients were matched for age, Charlson comorbidity index, ward of isolation (ICU or non-ICU), source of infection and severity of BSI, expressed as INCREMENT carbapenemase-producing Enterobacteriaceae (CPE) score. Results: Overall, 221 patients were included in the study. Following the 1:1 match, 122 subjects were retrieved: 61 cases (ceftazidime/avibactam + fosfomycin) and 61 controls (ceftazidime/avibactam ±â€Šother). No difference in overall mortality emerged between cases and controls, whereas controls had more non-BSI KPC-Kp infections and a higher number of deaths attributable to secondary infections. Almost half of ceftazidime/avibactam + fosfomycin patients were prescribed fosfomycin without MIC fosfomycin availability. No difference in the outcome emerged after stratification for fosfomycin susceptibility availability and dosage. SARS-CoV-2 infection and ICS ≥ 8 independently predicted 30 day mortality, whereas an appropriate definitive therapy was protective. Conclusions: Our data show that fosfomycin was used in the treatment of KPC-Kp BSI independently from having its susceptibility testing available. Although no difference was found in 30 day overall mortality, ceftazidime/avibactam + fosfomycin was associated with a lower rate of subsequent KPC-Kp infections and secondary infections than other ceftazidime/avibactam-based regimens.

Framing Big Tech: News Media, Digital Capital and the Antitrust Movement

This article analyses US news media’s coverage of the collision between Google, Amazon, Facebook, and Apple, and an emergent antitrust movement aiming to break up or curb their powers. A study of over 700 articles from 2019 and 2020 shows how news media “frame” this controversy by their selection of storylines, subjects, sources, signs, and solutions. Many stories stress the benefits of Big Tech—the cheapness and convenience of products and services, its importance to the US economy and stock market, and its central role in the Covid-19 pandemic emergency. However, a preponderance of stories supportive of antitrust initiatives seeking to rein in digital monopolists;the narrative of an “antitrust bipartisan alliance” crossing the Republicans/Democrats polarity has become a dominant frame. Yet, the media focus on antitrust legislation and prosecution tends to marginalize more radical proposals for challenging digital corporate power, such as those from the Black Lives Matter movement. Our analysis relates the contested media framing of Big Tech both to inter-capitalist struggles within the communications industry and to a hegemonic crisis in US politics, as an entrenched neoliberalism faces populist challenges from both left and right. © The Author 2021