Efficacy of cefiderocol- vs colistin-containing regimen for treatment of bacteraemic ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii in patients with COVID-19.

INTRODUCTION: Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) in patients hospitalized in intensive care units (ICUs) is an important and challenging complication, including in patients with coronavirus disease 2019 (COVID-19). Considering the poor lung penetration of most antibiotics, including intravenous colistin due to the poor pharmacokinetics/pharmacodynamics at the infection site, the choice of the best antibiotic regimen is still being debated. METHODS: This single-centre, observational study was conducted from March 2020 to August 2022, and included all patients hospitalized consecutively with VAP and concomitant bloodstream infection due to CRAB in the COVID-ICU. The main goal of the study was to evaluate risk factors associated with survival or death at 30 days from VAP onset. A propensity score for receiving therapy was added to the model. RESULTS: During the study period, 73 patients who developed VAP and concomitant positive blood cultures caused by CRAB were enrolled in the COVID-ICU. Of these patients, 67 (91.7%) developed septic shock, 42 (57.5%) had died at 14 days and 59 (80.8%) had died at 30 days. Overall, 54 (74%) patients were treated with a colistin-containing regimen and 19 (26%) were treated with a cefiderocol-containing regimen. Cox regression analysis showed that chronic obstructive pulmonary disease and age were independently associated with 30-day mortality. Conversely, cefiderocol-containing regimens and cefiderocol + fosfomycin in combination were independently associated with 30-day survival, as confirmed by propensity score analysis. CONCLUSIONS: This real-life study in patients with bacteraemic VAP caused by CRAB provides useful suggestions for clinicians, showing a possible benefit of cefiderocol and its association with fosfomycin.

Future perspectives of Italian cardiologists in training: A nationwide survey

Background. Adequate specialist training is the basis of a health system capable of supporting the continuous expansion of the population's demand for assistance. The continuous scientific advances, technological innovations, and the recent outbreak of a pandemic lead to a reshaping of training courses in order to guarantee a high standard of quality of care. Aims. Evaluating the feedback provided by Italian cardiologists in training about the current educational program and analyzing their perspectives about the future. Methods. We performed a 23-item national survey that has been delivered to 1443 Italian Fellow in Training (FITs), registered in the database of the Italian Society of Cardiology (ISC). The survey has been available online for 33 days (from 12 of June to 15 of July 2020). The impact of COVID-19 on medical education has been the original principal topic of the questionnaire, but we took advantage of this opportunity to investigate the perception of the trainees about their future work and training. Results. 633 cardiologists in training (44% of the FITs) participated to the survey. 45% of the participants affirmed to be completely satisfied by the current training program. 24% of respondents affirmed to have a totally inadequate or inadequate expertise on treating cardiovascular emergencies. 83% claimed to be interested in a working experience abroad but only 24% would remain lifelong in another Country. We asked the future cardiologists an opinion about the possibility of an early access to the world of work, starting from the third year of residency, provided from two recent Italian decrees ("Calabria" and "Milleproroghe"). 63% of the respondents believe that this chance does not represent an overall advantage and for 83% of them the early abandonment of the Universities could jeopardize a thorough cardiological training. Sub-specializations such as interventional cardiology and echocardiography emerged as the main topics of interest for the future careers of the FITs;however, general cardiology has been indicated as the third most requested area of interest, in contrast to the increasing tendency to sub-specializations. Only a few numbers of participants (<1%) expressed their interest in dedicating their future in the research field. Conclusions. Universities and politicians should make a great effort in the organization and re-organization of the teaching programs, taking into account the opinions of the cardiologists of tomorrow.

Epidemiological emergency, correct exercise of parental responsibility and protection of bigenitoriality

The essay analyses the effects of COVID-19 in relation to the correct exercise of parental responsibility. Particular attention is dedicated to the so−called right to bigenitoriality which, in this emergency phase, must be properly balanced with the right to health. © 2020 Ibero-American Law Institute. All rights reserved.