We reviewed the efficacy and safety of intravenous (IV) fosfomycin for the treatment of infections caused by Gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR). Data were retrospectively retrieved for all hospitalized patients who received IV fosfomycin for ≥48 h for the treatment of a DTR GNB between September 27, 2017 and January 31, 2020. A total of 30 patients were included, of which 63.3% were males, and the median age was 63.5 years (IQR 46-73). The median Charlson Comorbidity Score was 6 (IQR 3.8-9). The urinary tract (56.7%) was the most frequent site of infection, and the most frequent target organisms were Klebsiella pneumoniae (56.7%), and Escherichia coli (23.3%). The majority (76.%) received IV fosfomycin in combination with other antibacterial agents. Clinical improvement was observed in 22 (73.3%), eradication of baseline pathogens in 20 (66.7%), 30-day all-cause mortality in 7 (23.3%), and documented emergent resistance to fosfomycin in 5 (16.7%) patients. Treatment-related adverse events were infrequent and generally mild or moderate in severity. In conclusion, IV fosfomycin is a potentially efficacious and safe treatment option for the treatment of DTR GNB infections. Randomized trials are urgently required to confirm the utility of IV fosfomycin as monotherapy and in combination with other agents.

Burkholderia species infections are associated with diverse and challenging clinical presentations because of distinct virulence and antimicrobial resistance factors. The study aims to evaluate the epidemiology, microbiological, and clinical outcomes of Burkholderia cepacia complex (Bcc) infections in non-cystic fibrosis (CF) patients from Qatar. A retrospective study was conducted on adult patients across all hospitals at Hamad Medical Corporation between January 2012 and December 2018 to evaluate clinically relevant Bcc in non-CF adult patients. Over 7 years, 72 episodes of Burkholderia species infections were recorded, 64 were secondary to Bcc primarily affecting males (78.12%) with a mean age of 53 years, from the Middle and Southeastern region (92.2%) affected predominantly by diabetes mellitus (34.4%), chronic kidney (23.4%), coronary heart (20.3%), and hypertensive diseases (17.2%) while recent hospitalization and admission to critical care were evident in 45.3% and 93.8% of cases, respectively. Main infection sites were urinary (43.8%) and respiratory (29.7%) with associated bacteremia recorded in 26.6% of cases. Microbiological characteristics demonstrated high-level resistance profiles leading to delayed microbiological clearance in case of bacteremia (61%) and management with multiple therapeutic agents (range 4-6) resulting in disease resolution in 90.6% of cases with observed 30-day mortality of 7.8%. B. cepacia infections are infrequent, recorded mainly in middle-aged males with chronic comorbidities presenting as urinary, respiratory, and bacteremia associated with hospitalization, admission to critical care, and invasive procedures. High-level antimicrobial resistance is observed necessitating multiple therapeutic agents and suboptimal bacteriological clearance.

Coronary artery interventions are safe procedures yet have a risk of stent infection, bacteremia and sepsis, events that are rare but with high morbidity and mortality sequel. A few prior cases had reported post percutaneous coronary intervention (PCI) infections, abscesses and sepsis due to Staphylococcus aureus, followed by Pseudomonas aeruginosa. Cardiac Actinomyces infections are extremely rare. Here we report a case of a 50 year old patient who developed a post intervention Actinomyces oris epicardial abscess occluding right coronary artery with subsequent bacteremia eventually requiring open heart surgery. He was treated during and thereafter with IV penicillin and ceftriaxone for almost 8 weeks. We highlight during this review the available literature regarding risk factors, the possible theories of acquiring such bacterium at this unusual site as well as our patient’s course and treatment outcome.

Background: Worldwide, 5–10% of people with chronic hepatitis B virus infection are co-infected with hepatitis D virus. In Qatar, there are no data on hepatitis D virus infection among patients positive for hepatitis B surface antigen (HBsAg). Aims: To determine the seroprevalence of hepatitis D virus infection among patients with chronic hepatitis B virus infection in Qatar and assess the characteristics of these patients. Methods: This was a retrospective cohort study of all HBsAg-positive individuals tested for hepatitis D virus between 1 January 2010 and 29 December 2019 within the Hamad Medical Corporation. Data were retrieved from electronic records and included demographic and clinical information of the patients. Results: Of the 2348 HBsAg-positive patients, 125 were positive for hepatitis D virus (seroprevalence 5.3%). The median age of hepatitis D positive patients was significantly higher than for hepatitis D negative patients (P = 0.001). Most of the patients with hepatitis D had a hepatitis B viral load < 2000 IU/mL (53.6%) and were negative for hepatitis B e antigen (93.6%). A significantly greater proportion of hepatitis D positive patients than hepatitis D negative patients were infected with hepatitis C virus (P < 0.001), and had liver cirrhosis (P < 0.001) and hepatocellular carcinoma (P = 0.006). Conclusions: Hepatitis D virus infection is associated with lower hepatitis B virus viraemia and more advanced liver disease in the study population.

Echinocandins are recommended as initial treatment for candidemia. The safety and efficacy of both anidulafungin and caspofungin are well established, yet; no direct comparison was made pertaining to their efficacy and safety. This was a retrospective study to compare efficacy and safety of anidulafungin versus caspofungin in patients with candidemia. All adult patients with candidemia who were treated with either anidulafungin or caspofungin for ≥ 5 days, over a period of 6 years were retrospectively included. Baseline demographics, infection characteristics and patient courses were assessed. The primary end point was global response defined as clinical and microbiological success at the end of treatment duration. A total of 171 patients received either anidulafungin (n = 135) or caspofungin (n = 36) based on physician preference. The most common isolated candida species were candida glabrata (31.6%) followed by candida albicans (25.1%). Around 6% had chronic liver disease, and source control (mainly catheter removal) was achieved in 91.8%. Baseline characteristics were comparable between the two groups suggesting similar risks and treatment response. Response rates were similar among both groups with the primary outcome of global response being not significantly different (50% for caspofungin group vs 65.2% for anidulafungin, p=0.666). Similarly, no differences between the two groups were observed in terms of 90-day all-cause mortality (p=0.405) and hepatic safety profile defined as elevated liver function tests ≥ 3 times from baseline (p=0.521) Our data suggested that among patients with candidemia, there was no difference between anidulafungin and caspofungin for the primary endpoint of global response. Both studied echinocandins had similar rate of 90-day all-cause mortality and liver safety profile. All Authors: No reported disclosures

We investigated clinical outcomes of favipiravir in patients with COVID-19 pneumonia. Patients who between 23 May 2020 and 18 July 2020 received ≥24 hours of favipiravir were assigned to the favipiravir group, while those who did not formed the non-favipiravir group. The primary outcome was 28-day clinical improvement, defined as two-category improvement from baseline on an 8-point ordinal scale. Propensity scores (PS) for favipiravir therapy were used for 1:1 matching. Cox regression was used to examine associations with the primary endpoint. The unmatched cohort included 1,493 patients, of which 51.7% were in the favipiravir group, and 48.3% were not receiving supplemental oxygen at baseline (table 1). Favipiravir was started within a median of 5 days from symptoms onset. Significant baseline differences between the two unmatched groups existed, but not between the PSmatched groups (N = 774) (table 1). After PS-matching, there were no significant differences between the two groups in the proportion with 28-day clinical improvement (93.3% versus 92.8%, P 0.780), or 28-day all-cause mortality (2.1% versus 3.1%, P 0.360) (Table 2). Favipiravir was associated with more viral clearance by day 28 (79.8% versus 64.1%, P < 0.001) (table 2). In the adjusted Cox proportional hazards model, favipiravir therapy was not associated 28-day clinical improvement (adjusted hazard ratio 0.978, 95% confidence interval 0.862 –1.109, P 0.726) (Table 3). Favipiravir therapy for COVID-19 pneumonia is well tolerated but is not associated with an increased likelihood of clinical improvement or reduced all-cause mortality by 28 days. All Authors: No reported disclosures