Microbiological diagnosis by using commercial multiplex quantitative PCR systems provides great advantages over the conventional culture. In this work, the Biofire FilmArray Pneumonia Panel Plus (FAPP+) was used to test 144 low respiratory tract samples from 105 COVID-19 patients admitted to an Intensive Care Unit (ICU), detecting 78 pathogens in 59 (41%) samples. The molecular panel was evaluated by using the conventional culture (CC) as comparator, which isolated 42 pathogens in 40 (27.7%) samples. The overall percentage of agreement was 82.6%. Values of sensitivity (93%), specificity (62%), positive predictive value (50%), and negative predictive value (96%) were obtained. The mean time elapsed from sample extraction to modification of antibiotic treatment was 7.6 h. A change in antimicrobial treatment after the FAPP+ results was performed in 27% of patients. The FAPP+ is a highly sensitive diagnostic method that can be used to significantly reduce diagnostic time and that allows an early optimization of antimicrobial treatment.

Our study aims to assess the prevalence of CAPA (COVID-19-associated pulmonary aspergillosis) and describe the associated risk factors and their impact on mortality. A prospective study was conducted. We included patients with COVID-19 disease who were admitted to the ICU with a diagnosis of respiratory failur. Mycological culture and other biomarkers (calcofluor staining, LFD, LFA, PCR, GM, and B-D-glucan) were performed. A total of 300 patients were included in the study. Thirty-five patients were diagnosed with CAPA (prevalence 11.7%). During admission, 57 patients died (19%), and, in the group of CAPA patients, mortality was 31.4%. In multivariate analysis, independent risk factors associated with CAPA diagnosis were age (OR: 1.05; 95% CI 1.01–1.09; p = 0.037), chronic lung disease (OR: 3.85; 95% CI 1.02–14.9; p = 0.049) and treatment with tocilizumab during admission (OR: 14.5; 95% 6.1–34.9; p = 0.001). Factors independently associated with mortality were age (OR: 1.06; 95% CI 1.01–1.11; p = 0.014) and CAPA diagnosis during admission (OR: 3.34; 95% CI 1.38–8.08; p = 0.007). CAPA is an infection that appears in many patients with COVID-19 disease. CAPA is associated with high mortality rates, which may be reduced by early diagnosis and initiation of appropriate antifungal therapy, so screening of COVID-19 ARDS (acute respiratory distress syndrome) patients for CAPA is essential.

Background: The clinical and microbiological epidemiology of ventilator-associated pneumonia (VAP) is not well studied in intensive care units (ICUs) European wide. The European Clinical Research Alliance on Infectious Diseases (Ecraid), a warm-base clinical research network investigating infectious diseases, aimed to track the implementation of VAP prevention strategies and quantify the incidence, aetiology, and clinical outcome of VAP, across several European countries. Methods: Overall, 25 ICUs from 11 European countries participating in Ecraid’s perpetual observational study prospectively enrolled adult patients with an expected length of invasive mechanical ventilation (IMV) of at least 48 h, between August 2022 and September 2024. VAP was defined according to the US Food and Drug Administration guidelines. Patients were followed until ICU discharge or 28 days after VAP diagnosis. Routine clinical and microbiological data were prospectively collected. Mortality was calculated using cumulative incidence functions. Results: Of the 3,446 patients at-risk of VAP, 590 developed VAP (cumulative incidence: 17.1%, 95% CI 15.9%-18.4% and incidence rate per 1000 ventilator days: 18.6, 95% CI 17.1–20.1). Importantly, VAP cumulative incidence varied widely between countries recruiting at least 100 patients (range: 7.6% (Croatia)-29.6% (Romania)). Microbiological documentation was available for 359 (60.8%) VAP patients, predominantly showing Staphylococcus aureus (26.2%), Haemophilus influenzae (16.2%), and Pseudomonas aeruginosa (15.0%). Methicillin resistance was confirmed in 14 (18.2%) of 77 VAP cases due to S. aureus . Ceftazidime and carbapenem resistance for P. aeruginosa was reported in 10/46 (21.7%) and 8/47 (17.0%) cases, respectively. Cumulative incidence of ICU mortality was 34.2% (95% CI 30.4%-38.0%) among VAP patients versus 29.3% (95% CI 27.6%-30.9%) in non-VAP patients. The overall median IMV duration until first extubation was 17 days in VAP patients (including ventilation before and after diagnosis) versus 7 days for non-VAP patients. The most widely implemented VAP prevention measure was head-of-bed elevation (3207 patients, 93.1%); only 4 patients (0.1%) did not have any prevention measures implemented. Conclusion: In European ICUs, there is a considerable and heterogeneous incidence of VAP, with methicillin susceptible S. aureus most frequently identified as a causative pathogen. VAP is associated with poor clinical prognosis, highlighting the need for better VAP prevention and management strategies.

The present report describes an uncommon case of nosocomial pneumonia caused by Salmonellaenterica in an immunocompetent patient. The patient was admitted to ICU of a tertiary hospital due to low level of consciousness, aphasia and seizure episodes. Four days after hospitalization, he developed nosocomial pneumonia, which evolved into septic shock. Gram-negative bacilli were recovered from blood, tracheal aspirate and fecal samples of the patient. The isolates, which were identified as Salmonella enterica, proved to be resistant to ciprofloxacin, amoxicillin/clavulanic acid and piperacillin/tazobactam. Four months before, the same bacterial species was recovered from feces and blood cultures of the patient, admitted to the nephrology ward of the same hospital with diagnosis of gastroenteritis and acute renal failure. However, at that time, the isolates were susceptible to the above-mentioned antibiotics. Genome sequencing revealed that all isolates were closely related and belonged to the emergent ST34 monophasic variant of S. enterica serovar Typhimurium. Since the patient has received therapy with fluoroquinolones and amoxicillin/clavulanic acid, these results support treatment-associated selection of the acquired resistances. In conclusion, this case represents a paradigm of selective pressure leading to in vivo development of resistance to highly relevant antibiotics, including the piperacillin/tazobactam combination used for empirical management of severe infections at ICU.