In recent years, due to the dramatic increase in and global spread of bacterial resistance to a number of commonly used antibacterial agents, many studies have been directed at investigating drugs whose primary therapeutic purpose is not antimicrobial action. In an era where it is becoming increasingly difficult to find new antimicrobial drugs, it is important to understand these antimicrobial effects and their potential clinical implications. Numerous studies report the antibacterial activity of non-steroidal anti-inflammatory drugs, local anaesthetics, phenothiazines such as chlorpromazine, levomepromazine, promethazine, trifluoperazine, methdilazine and thioridazine, antidepressants, antiplatelets and statins. Several studies have explored a possible protective effect of statins inreducing the morbidity and mortality of many infectious diseases. Various non-antibiotic agents exhibit antimicrobial activity via multiple and different mechanisms of action. Further studies are required in the field to further investigate these antimicrobial properties in different populations. This is of paramount importance in the antimicrobial resistance era, where clinicians have limited therapeutic options to combat problematic infections.

Peripheral Inserted Central Catheter Use and Related Infections in Clinical Practice: A Literature Update

Background: The increased prevalence of antibiotic resistance among Gram-negative bacteria presents a severe public health challenge, leading to increased mortality rates, prolonged hospital stays, and higher medical costs. In Greece, the issue of multidrug-resistant Gram-negative bacteria is particularly alarming, exacerbated by overuse of antibiotics and inadequate infection control measures. This study aimed to detect the prevalence of extensively drug-resistant (XDR) Gram-negative bacteria in a tertiary hospital in Western Greece over the last eight years from 2016 to 2023. Materials and Methods: In the present study, all Carbapenem-resistant (CR) Acinetobacter baumannii, K. pneumoniae and Pseudomonas aeruginosa. bloodstream isolates from patients hospitalized in the University General Hospital of Patras in Western Greece, from January 2016 to December 2023, were recorded. XDR strains were defined as non-susceptible to at least one agent in all but two or fewer antimicrobial categories (i.e., bacterial isolates remain susceptible to only one or two categories). The prevalence and distribution of these pathogens across different hospital wards and their susceptibility patterns to key antibiotics (aminoglycosides, trimethoprim-sulfamethoxazole, tigecycline, colistin, ampicillin-sulbactam, ceftolozane-tazobactam and ceftazidime-avibactam) were recorded. Results: A total of 1142 blood cultures growing carbapenem-resistant Klebsiella pneumoniae (CRKp), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA) were studied. In the present study, we found an increased resistance of both A. baumannii and K. pneumoniae in colistin. Acinetobacter baumannii had colistin resistance rates between 8.4% and 49.3%, showing a stable increase during the study period. K. pneumoniae showed an increased colistin-resistance rate in 2022 and 2023 (46.8% and 31.2%, respectively) Regarding P. aeruginosa, amikacin was almost inactive with a rate 68.4% and 87.5% in 2020 and 2023, respectively. Of all CR isolates, 69.3% were extensively drug-resistant (XDR). Acinetobacter baumannii had the highest percentage of XDR isolates (34.3%), followed by K. pneumoniae (26.8%) and P. aeruginosa (8.1%). Most XDR pathogens were isolated from the ICU (73.4%), followed by the internal medicine units (64%) and surgical units (22%). Conclusions: The rate of antimicrobial resistance and extensive drug resistance is alarmingly high, which calls for strict surveillance, control measures, and antibiotic stewardship to prevent the development of further resistance.

Background: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. Methods: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. bla_KPC, bla_VIM, bla_NDM, and bla_OXA genes were detected by PCR. Results: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. bla_KPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. Conclusions: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.