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.

Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward

The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.

POSA394 Mortality Curves Analysis of COVID-19 Hospitalizations in Oncologic Patients of a Private Health Care Plan in Brazil

Objectives: Brazil emerged as an epicenter of the coronavirus pandemic with more than 12.8 million cases, including over 500,000 fatalities. Some private health plans implemented early assistance to cancer patients, due to be more susceptible to infections and complications. This study evaluates mortality curves rates of hospitalized cancer patients. Methods: Retrospective analysis from March 2020-May 2021 of 37,462 people administrative database. Mortality during and after hospital discharge studied into two groups: presence/absence of cancer prior to admission, with/without previous chemotherapy. Variables: In-hospital mortality (IHM) and after discharge or anytime death during the study. For survival analysis after discharge, we used the Kaplan-Meier method. Log-rank test was applied to compare curves. For statistical significance, Chi-square tests (Mantel-Haenszel and Fisher's Exact), when p <0.05. Confidence interval (CI) 95%. Results: Overall rate of oncologic patients from total was 2.7%. Among 916 COVID-19 admissions, 79 with cancer (8.6%;p< 0,001, hazard ratio 3.4). Mean age 69.1 (CI 68.1-70.1), 50% women (n=458) and 50% men (n=458). IHM 16.5% (n=13) in oncologic group and 11.2% (n=93) in non-oncologic patients (p=ns). Risk of death during hospitalization and follow-up (14 months) was significantly higher when presence of previous cancer (35.5%;n=28) than without cancer (24.35%;n=203), p=0.029. Mortality rate of cancer patients without COVID was 17.4% in the same period of follow up. Risk of death for oncologic patients was 3.8 higher if they had COVID (p< 0.001). Conclusions: COVID-19 hospitalization and death risk are significantly higher in patients with cancer, even with early strategies by the HC plan to reduce the risk. IHM wasn’t different from patients without cancer, but overall mortality was higher after discharge, comparing to cancer patients without COVID19. There is a crucial need to understand better and mitigate these excess hospitalization risks and higher mortality which may be revealed over the follow up.

Measuring breathability and bacterial filtration efficiency of face masks in the pandemic context: A round robin study with proficiency testing among non-accredited laboratories

Six Italian non-accredited laboratories participated to an interlaboratory study aimed at measuring Differential Pressure (DP) and Bacterial Filtration Efficiency (BFE) of three face-mask models using methods in-line with EN 14683 standard. Methodological non-conformities were annotated. Repeatability and reproducibility on quintuplicate samples were calculated according to ISO 5725-2. Sample stability was also assessed. Laboratories were ranked according to the total standard deviation over all samples and proficiency was evaluated using z-score according to ISO 13528. Although some non-conformities were present, performances for the DP measurements were always acceptable. One laboratory had to revise the bacterial suspension preparation for the BFE test. Overall, non-accredited laboratories working during pandemic emergency performed satisfactorily. Sample-to-sample variability impacted measurement repeatability. BFE values above 98% showed good repeatability (≤1.0%) and reproducibility (≤6.1%), but high BFE uncertainty was associated to community masks. Our findings suggest that relevant face-mask conformity standards should consider uncertainty of BFE and DP measurements. © 2021 The Authors

Women Tend to Perceive Greater Risks Associated with the COVID-19 Outbreak and Are More Likely to Follow Precautionary Measures

Background: The COVID-19 pandemic may have a different impact on men and women. Aim: This study aimed to investigate gender differences in risk perception, attitudes toward quarantine measures, and adoption of precautionary behaviors during the COVID-19 pandemic. Method: We employed a cross-sectional web-based survey design. The sample included 1,569 people living in Italy. The survey was conducted during the national lockdown in April 2020 when the Italian government extended the quarantine measures to the whole country. Results: Results showed that women reported higher scores on perceived severity, worry, precautionary behaviors, and attitudes toward quarantine restrictions. Gender differences in the perceived likelihood of infection with SARS-CoV-2 were not significant. Using mediation analysis, we found that the relationship between gender and precautionary behaviors was explained by attitudes toward quarantine restrictions, perceived severity, and worry. Limitations: The use of a cross-sectional design precludes causal inference. Conclusion: Our results point to the need to develop and implement interventions that address (1) the higher levels of risk perception of the COVID-19 outbreak among women and (2) the lower scores on risk perception, attitudes toward quarantine restrictions, and adoption of precautionary behaviors during the COVID-19 pandemic among men. © 2021 Hogrefe Publishing.

The pandemic and homeless people in the Turin area: the level of housing adequacy shapes experiences and well-being

Purpose Considering the case study presented, the purpose of this paper is to analyse the impact of the pandemic in local services for homeless people. Drawing from the concept of ontological security, it will be discussed how different services' levels of "housing adequacy" shaped remarkably different experiences of the pandemic for homeless people and social workers in terms of health protection and agency. Design/methodology/approach This paper focuses on a case study concerning homeless services for people during the COVID-19 pandemic in the metropolitan and suburban area of Turin, in Northern Italy. In-depth interviews with social workers and participant observation during online meetings of workers from the shelters constitute the empirical data that have been collected during the first wave of the pandemic in Italy. Findings According to the findings, the pandemic showed shelters as unsafe places that reduce homeless people's decision power and separate them from the rest of the citizenship. Instead, Housing First projects emerged as imore inclusive and safermore inclusive and safer spaces, able to enhance people's power over their own lives. The pandemic did not create emerging issues in the homeless services system or discontinuities: rather, it amplified pre-existing problematic aspects. Originality/value The case study presented provides empirical insights to recognise at the political and organisational level the importance of housing as a measure of individual and collective security, calling for an intervention to tackle homelessness in terms of housing policies rather than exclusively social and emergency treatment.

Computational modeling ofimmunologic response to immune checkpoint inhibitors inCOVID-19 patients with and without cancer

Cancer patients have an increased risk of severe COVID-19 infection due to the suppression of the immune systemand the development of cytokine release syndrome (CRS) that favor respiratory syndromes and interstitialpneumonia. However, substantial differences exist between patients treated with chemotherapy and patients treated with immune checkpoint inhibitors (ICIs), for which the risk of COVID-19 infection and the immunologic and cytokineprofile in case of infection have not yet been well characterized. The administration of ICIs for the treatment ofsevere COVID-19 infection has been recently suggested. However, no conclusive data have been generated on thismatter. To recognize the therapeutic potential of ICIs administration in COVID-19 patients with or without cancer, theUniversal Immune System Simulator (UISS) prediction model was used to simulate the immunologic response ofCOVID-19 patients after ICIs administration. Briefly, UISS represents an appropriate computational modelinginfrastructure able to simulate the dynamics of every single entity of the immune system after a stimulus or atherapeutic intervention by using an agent-based methodology. Therefore, the UISS platform, already used for theprediction of the efficacy of specific SARS-CoV-2 candidate vaccines, was here adopted to characterize theimmunologic behavior in both COVID-19 and cancer patients and to predict the effects of ICIs in these patients. Thecomputational results allowed us to identify key inflammatory and immune-related factors responsible for severerespiratory syndromes in COVID-19 infected patients with and without cancer. UISS results suggest that theadministration of ICIs modulates the immune system and the inflammatory status in both groups of patients withCOVID-19 infection, reducing the risk of severe symptoms. Although the results of the present study are still undervalidation in peripheral blood samples obtained from COVID-19 patients and from cancer patients after two cycles oftreatment with ICIs, we can speculate that ICIs may be a good therapeutic approach for the treatment of COVID-19severe respiratory syndrome even with a concomitant cancer diagnosis. If this is the case, the lower expressionlevels of inflammatory biomarkers can result in the drop-down of the viral load, assessed by droplet digital PCR inCOVID-19 patients.