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: Antimicrobial resistance (AMR) is a significant global health concern, posing a critical challenge for the effective management of infectious diseases. This study aimed to compare the immunological response, clinical outcomes, and associated costs in patients with bacteremia due to antibiotic-resistant vs. susceptible bacterial microorganisms. Methods: This study was a single-center, prospective cohort study conducted from May 2017 to November 2019. The study population consisted of patients admitted with a confirmed diagnosis of bacteremia. Results: A total of 116 patients were included, with 53 (45.7%) harboring non-multidrug-resistant (non-MDR) bacterial isolates and 63 (54.3%) harboring multidrug-resistant (MDR) bacterial isolates. Patients with MDR bacteremia had more severe clinical presentations, as indicated by higher SOFA and APACHE II scores. Results revealed higher all-cause mortality rates (39.7% vs. 17%) and median healthcare costs (€4791 vs. €2843.5) in the MDR bacteremia group. Moreover, MDR bacteremia was linked to higher levels of TNF-a, indicating a differential immune response. Furthermore, MDR bacteremia was found to be an independent predictor of mortality (OR = 3.216, 95% CI: 1.338–7.730, p = 0.009) and increased healthcare costs (effect size of approximately 27.4%). Conclusion: These findings underscore the significant impact of antimicrobial resistance in healthcare settings, highlighting the urgency of addressing the challenges posed by MDR microorganisms.

Introduction: Candida auris (now Candidozyma auris) and multidrug-resistant (MDR) bacterial infections pose significant therapeutic challenges due to high antimicrobial resistance, increased mortality, and persistence in healthcare settings. In Greece, their rising prevalence is raising concerns regarding co-infection, yet comprehensive data remain limited. This study aims to investigate the epidemiology, risk factors, and clinical outcomes of MDR bacterial co-infection in patients with C. auris candidemia. Methods: This single-center, retrospective observational cohort study was conducted at a Greek tertiary university hospital and included adult patients with C. auris bloodstream infections from January 2019 to June 2024. The data were analyzed using appropriate statistical methodologies. Results: Among 96 patients, those with C. auris candidemia and MDR bacterial co-infection exhibited a significantly higher mortality rate (87.23% vs. 61.22%, p = 0.007). The presence of a central venous catheter was the only factor significantly associated with MDR co-infection (p = 0.030). In univariate analysis, MDR co-infection, a higher Charlson Comorbidity Index, and mechanical ventilation correlated with increased mortality. Multivariate analysis identified MDR co-infection (OR = 3.19, p = 0.045) and mechanical ventilation (OR = 7.07, p = 0.002) as independent mortality predictors. Conclusions: These findings underscore the need for enhanced surveillance, precise identification, and stringent infection control measures to prevent C. auris and MDR bacterial outbreaks in healthcare settings.

Infective endocarditis (IE) during pregnancy, while uncommon, is associated with substantial maternal and fetal morbidity and mortality due to the complex physiological adaptations of pregnancy. Hemodynamic alterations, including increased cardiac output and changes in vascular resistance, combined with immunological modulation, predispose pregnant individuals to increased risk of infection and associated complications. Predominant pathogens implicated in pregnancy-associated IE are Staphylococcus aureus, Streptococcus viridans, and Enterococcus faecalis, with S. aureus infections frequently leading to poorer clinical outcomes. Diagnosis remains challenging due to commonly atypical presentation and relies on microbiological identification via blood cultures in conjunction with imaging modalities such as transthoracic echocardiography. IE in pregnancy is associated with increased maternal mortality rates (5–17%) and adverse fetal outcomes, including preterm birth, intrauterine growth restriction (IUGR), and fetal loss. Management necessitates careful selection of antimicrobial therapy to ensure efficacy while minimizing fetal toxicity, especially in settings of increased antimicrobial resistance. Anticoagulation and surgical interventions must be judiciously considered, with surgical timing individualized based on the severity of heart failure and coordinated multidisciplinary care. In conclusion, IE during pregnancy constitutes a significant clinical challenge, underscoring the need for enhanced diagnostic strategies, optimized therapeutic protocols, and the development of pregnancy-specific management guidelines to improve maternal and fetal outcomes.