Ceftazidime-Avibactam To Treat Life-Threatening Infections by Carbapenem-Resistant Pathogens in Critically Ill Mechanically Ventilated Patients.

Data on the effectiveness of ceftazidime-avibactam (CAZ-AVI) in critically ill, mechanically ventilated patients are limited. The present retrospective observational cohort study, which was conducted in two general intensive care units (ICUs) in central Greece, compared critically ill, mechanically ventilated patients suffering from carbapenem-resistant Enterobacteriaceae (CRE) infections receiving CAZ-AVI to patients who received appropriate available antibiotic therapy. Clinical and microbiological outcomes and safety issues were evaluated. A secondary analysis in patients with bloodstream infections (BSIs) was conducted. Forty-one patients that received CAZ-AVI (the CAZ-AVI group) were compared to 36 patients that received antibiotics other than CAZ-AVI (the control group). There was a significant improvement in the Sequential Organ Failure Assessment (SOFA) score on days 4 and 10 in the CAZ-AVI group compared to that in the control group (P = 0.006, and P = 0.003, respectively). Microbiological eradication was accomplished in 33/35 (94.3%) patients in the CAZ-AVI group and 21/31 (67.7%) patients in the control group (P = 0.021), and clinical cure was observed in 33/41 (80.5%) versus 19/36 (52.8%) patients (P = 0.010), respectively. The results were similar in the BSI subgroups for both outcomes (P = 0.038 and P = 0.014, respectively). The 28-day survival was 85.4% in the CAZ-AVI group and 61.1% in the control group (log-rank test = 0.035), while there were 2 and 12 relapses in the CAZ-AVI and control groups, respectively (P = 0.042). A CAZ-AVI-containing regime was an independent predictor of survival and clinical cure (odds ratio [OR] = 5.575 and P = 0.012 and OR = 5.125 and P = 0.004, respectively), as was illness severity. No significant side effects were recorded. In conclusion, a CAZ-AVI-containing regime was more effective than other available antibiotic agents for the treatment of CRE infections in the high-risk, mechanically ventilated ICU population evaluated.

Spondylodiscitis due to Stenotrophomonas maltophilia.

Stenotrophomonas maltophilia is an increasingly recognized cause of severe nosocomial infections, especially in immunocompromised patients. Community-acquired infections have also been reported. Spondylodiscitis due to S. maltophilia has only once before been described in the literature. We present a case of spondylodiscitis due to community-acquired S. maltophilia infection in a renal transplant recipient with liver cirrhosis.

Helicobacter pylori seroprevalence in patients with chronic bronchitis.

BACKGROUND: A high Helicobacter pylori seroprevalence has been found in many extragastrointestinal disorders. Moreover, it has been reported that the risk of chronic bronchitis may be increased in H. pylori-infected patients. The aim of this study was to assess the H. pylori seroprevalence in patients with chronic bronchitis. METHODS: We evaluated 144 patients with chronic bronchitis (81 men and 63 women, aged 53.2+/-12.7 years) and 120 age and sex-matched control subjects. All enrolled subjects (bronchitic patients and controls) underwent an enzyme-linked immunosorbent assay (ELISA) IgG serologic test for H. pylori diagnosis. RESULTS: A correlation between age and H. pylori IgG level was detected for both bronchitic patients (r = 0.42; P = 0.004) and controls (r = 0.44; P = 0.004). H. pylori seropositivity in the chronic bronchitis group was significantly higher than that in controls (83.3% vs 60%; P = 0.007). The mean serum concentration of IgG antibodies against H. pylori was also significantly higher in patients with chronic bronchitis than in the control subjects (38.7+/-24.1 U/ml vs 25.9+/-19.3 U/ml; P = 0.02). CONCLUSIONS: Helicobacter pylori infection may be associated with chronic bronchitis. Further studies should be undertaken to confirm our results and to clarify the potential underlying pathogenetic mechanisms.