Laboratory assessment of antimicrobial susceptibility is a prerequisite for adequate management of infections. The aim of this research was to evaluate the performance of the novel FASTinov^® kit for antimicrobial susceptibility testing (AST) of Gram negative bacilli directly on positive blood cultures. One hundred and two positive blood cultures from patients of a Portuguese University Hospital were included. AST were performed with routine method, Vitek2, with FASTinov^® kit, and with the gold standard microdilution. Bacteria directly extracted from blood cultures were used to inoculate the FASTinov^® kit. Time-to-result as well as the number of patients receiving initially inappropriate therapy (and those in whom de-escalation would have been done) and length of stay (LOS) was recorded. Seventy percent of patients were over 70 years old and 18.6% were admitted in intensive care units. Regarding the isolates, 88.2% were Enterobacteriaceae, 9.8% Pseudomonas spp. and 1% Acinetobacter spp. Extended spectrum β-lactamases producing-Enterobacteriaceae were found in 7.8% of cases and 10.8% were multi-drug resistant. Fifty-one hours was the mean of time-to-result for routine test (Vitek2) vs. 2 h response regarding Fastinov^® test. The overall agreement between FASTinov^® and the reference microdilution method was 98%. According to the susceptibility phenotype, 16.7% of patients received initially inappropriate therapy and the mean hospital LOS of these patients was significantly higher. FASTinov^® kit revealed an excellent correlation with the AST standard method and provided much earlier results than Vitek2.

Background: Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality worldwide. It remains unknown whether recently introduced prevention strategies, such as vaccination, may have impacted its mortality. Moreover, it is important to understand whether these trends are similar for all patients or if some groups may have different outcomes. Methods: We evaluated the CAP hospitalization data for adult patients, from the Portuguese mainland Hospital diagnosis database. We included all patients discharged with CAP between 2010 and 2019. We assessed Hospital mortality for the whole population and according to age and gender. We also examined the monthly number of admissions and mortality. Results: We identified 462,910 CAP admissions, of which 54% were male (mean age 76.8 ± 14.5years). We divided our population into 4 age groups: 18-40years (3.2% of episodes); 41-65years (14.9%); 66-80years (31.6%); >80 years (50.2%). Mortality increased sharply with age, to more than 40% in older patients, highlighting the disproportionate burden of respiratory diseases in this age group. Although CAP mortality remained stable until 2016 (roughly 23%), a slight decreasing trend was noted afterwards (from 23.1 to 21.8%). In hospitalized patients, the relative risk of dying with CAP, consistently decreased during this period, from odds ratio 5.5, 95% CI 5.4–5.7 to odds ratio 4.3, 95% CI 4.2–4.4. As much as 25% of deaths related to CAP occurred during the first 48 h after hospital admission. While CAP admissions peaked in January, mortality was higher during the summertime. Conclusions: Community-acquired pneumonia remains associated with a high risk of death. Mortality increased with age from 40 years onwards. However, the relative risk of dying with CAP in the Hospital decreased during this decade. Graphical

Mid-regional proadrenomedullin (MR-proADM) is a novel biomarker with potential prognostic utility in patients with community-acquired pneumonia (CAP). To evaluate the value of MR-proADM levels at ICU admission for further severity stratification and outcome prediction, and its kinetics as an early predictor of response in severe CAP (SCAP). Prospective, single-center, cohort study of 19 SCAP patients admitted to the ICU within 12h after the first antibiotic dose. At ICU admission median MR-proADM was 3.58nmol/l (IQR: 2.83-10.00). No significant association was found between its serum levels at admission and severity assessed by SAPS II (Spearman's correlation=0.24, p=0.31) or SOFA score (SOFA<10: <3.45nmol/l vs. SOFA≥10: 3.90nmol/l, p=0.74). Hospital and one-year mortality were 26% and 32%, respectively. No significant difference in median MR-proADM serum levels was found between survivors and non-survivors and its accuracy to predict hospital mortality was bad (aROC 0.53). After 48h of antibiotic therapy, MR-proADM decreased in all but 5 patients (median -20%; IQR -56% to +0.1%). Its kinetics measured by the percent change from baseline was a good predictor of clinical response (aROC 0.80). The best discrimination was achieved by classifying patients according to whether MR-proADM decreased or not within 48h. No decrease in MR-proADM serum levels significantly increased the chances of dying independently of general severity (SAPS II-adjusted OR 174; 95% CI 2-15,422; p=0.024). In SCAP patients, a decrease in MR-proADM serum levels in the first 48h after ICU admission was a good predictor of clinical response and better outcome.