Purpose To evaluate the in vitro efficacy of several anti-staphylococcal agents against a nationwide collection of contemporary Staphylococcus aureus clinical isolates from several healthcare centres in Greece. Methods Thirty hospitals throughout Greece (18 in Attica) provided all clinical isolates of S.aureus from April 2012 to May 2013 to a central lab to be re-submitted to susceptibility testing. The MICs were evaluated by Vitek® 2 with the exception of ceftaroline (OXOID M.I.C. Evaluator™). Vancomycin and daptomycin MICs were also evaluated by Etest®. Heterogeneously vancomycin-intermediate strains (hVISA) were detected by the Etest® GRD. VISA phenotype was confirmed by PAP-AUC. Results A total of 1005 isolates (39% MRSA) were studied. Susceptibility rates were: erythromycin 66.5%, clindamycin 79.2%, SXT 98.9%, rifampicin 97.3%, fusidic acid 67%, moxifloxacin 78.8%, vancomycin 99.9%, ceftaroline 92.9% and linezolid, tigecycline and daptomycin 100%. For mupirocin, high level resistance could be excluded for 98.9% of isolates. Vancomycin Etest® MIC_50/90 were 1.5/1.5 mg/L, 58.5% of isolates exhibited a MIC > 1 and 8.7% a MIC of 2 mg/L, while Vitek® MIC_50/90 were 1/1 and 3.1% showed MIC > 1 mg/L. One VISA strain was detected. Among the selected 175 isolates that were screened for hVISA phenotype, six (3.4%) were positive. In 315 bloodstream isolates, 64.1% had a vancomycin Etest® MIC > 1 mg/L. Conclusions This multi-centre surveillance study revealed that a significant percentage of contemporary S.aureus isolates from Greek patients have a vancomycin MIC (> 1 mg/L) that may compromise the clinical efficacy of the drug for the treatment of serious infections. The in vitro activity of SXT, rifampicin, mupirocin, linezolid, tigecycline, daptomycin and ceftaroline remains excellent.

Background: Carbapenemase-producing Enterobacterales (CPEs) represent a significant global health threat, particularly in the context of nosocomial infections. The current study constitutes a retrospective epidemiological survey that aimed to provide updated data on the prevalence and characteristics of carbapenemases among carbapenem-resistant Enterobacterales (CREs) in a Greek tertiary hospital in Athens during and after the COVID-19 pandemic. Results: A total of 2021 non-duplicate CPE clinical isolates were detected. A significant increase in the number of carbapenemase-positive Enterobacterales was revealed during the study period (p < 0.05). KPC remained the predominant carbapenemase type through all four years of the survey, representing 40.7%, 39.9%, 53.5%, and 45.7% of the CPE isolates, respectively. However, a rapid transition from VIM to NDM metal-β-lactamase types was revealed, changing the epidemiological image of carbapenemases in the hospital setting. Notably, among the CPEs, antimicrobial resistance rates were significantly raised in the post-COVID-19 period (2022 and 2023) compared to the first study year (2020) for almost all the tested antibiotics, including those characterized as last-resort antibiotics. Methods: CREs were identified and subjected to screening for the five most prevalent carbapenemase genes [Klebsiella pneumoniae carbapenemase (KPC), Verona integron-borne metallo-β-lactamase (VIM), New Delhi metallo-β-lactamase (NDM), imipenemase (IMP), and oxacillin-hydrolyzing (OXA-48)] using a lateral flow immunoassay, and the CREs recovered from blood cultures were analyzed using a FilmArray system. Their clinical and epidemiological characteristics, as well as their antimicrobial susceptibility profiles, were also subjected to analysis Conclusions: Given this alarming situation, which is exacerbated by the limited treatment options, the development of new, effective antimicrobial agents is needed. The continued monitoring of the changing epidemiology of carbapenemases is also imperative in order to undertake rational public health interventions.

Mucormycosis has emerged as a group of severe infections mainly in immunocompromised patients. We analysed the epidemiology of mucormycosis in Greece in a multicentre, nationwide prospective survey of patients of all ages, during 2005–2022. A total of 108 cases were recorded. The annual incidence declined after 2009 and appeared stable thereafter, at 0.54 cases/million population. The most common forms were rhinocerebral (51.8%), cutaneous (32.4%), and pulmonary (11.1%). Main underlying conditions were haematologic malignancy/neutropenia (29.9%), haematopoietic stem cell transplantation (4.7%), diabetes mellitus (DM) (15.9%), other immunodeficiencies (23.4%), while 22.4% of cases involved immunocompetent individuals with cutaneous/soft-tissue infections after motor vehicle accident, surgical/iatrogenic trauma, burns, and injuries associated with natural disasters. Additionally, DM or steroid-induced DM was reported as a comorbidity in 21.5% of cases with various main conditions. Rhizopus (mostly R. arrhizus) predominated (67.1%), followed by Lichtheimia (8.5%) and Mucor (6.1%). Antifungal treatment consisted mainly of liposomal amphotericin B (86.3%), median dose 7 mg/kg/day, range 3–10 mg/kg/day, with or without posaconazole. Crude mortality was 62.8% during 2005–2008 but decreased significantly after 2009, at 34.9% (p = 0.02), with four times fewer haematological cases, fewer iatrogenic infections, and fewer cases with advanced rhinocerebral form. The increased DM prevalence should alert clinicians for timely diagnosis of mucormycosis in this patient population.

Background: Macrophomina phaseolina is an important phytopathogenic fungus affecting over 500 plant species worldwide. However, this fungus rarely causes disease in humans. Methods: We reported the first case of endophthalmitis due to M. phaseolina, describing microbiological diagnostic approaches. Also, we performed a systematic review of human infections by this plant pathogen in literature. We searched PubMed, Scopus, and Web of Science databases from inception to 31 December 2024. Results: Our case involved a male patient who presented with photophobia and pain in his right eye. His recent medical history revealed a superficial corneal injury caused by a metal burr three months prior, managed unsuccessfully by topical treatment and subsequent conjunctival flap surgery two months later. Ophthalmological and microbiological investigations, including microscopic examination, cultures, and DNA sequencing of ocular specimens, revealed M. phaseolina endophthalmitis. Despite intravenous and intravitreal antifungal therapy, the patient’s condition continued to worsen, eventually leading to enucleation. Regarding the literature review, we identified 12 additional cases of M. phaseolina human infections previously reported in literature. Overall, M. phaseolina was primarily associated with ocular infections (76.9% of cases), followed by skin infections and combined skin–joint infections. The majority of patients with M. phaseolina infection (63.6%) had no known immunosuppressive factors. Clinical outcomes were unfavorable in 46.15% of cases. Conclusions: M. phaseolina is an emerging cause of human infections, even in immunocompetent hosts, with a predilection for ocular infections. Further research is warranted to elucidate the pathogenesis of fungal infections caused by plant pathogens in humans.

Background: Infections caused by carbapenemase-producing Pseudomonas aeruginosa (CPPA) isolates have become a worldwide clinical challenge for clinicians due to the limited treatment options. This study provides epidemiological data on CPPA clinical isolates recovered from one of the largest tertiary care hospitals in Athens, Greece, serving a diverse patient population during and after the COVID-19 pandemic. Materials and Methods: The study included all consecutive single-patient CPPA clinical isolates identified from January 2020 to December 2023 in the clinical laboratory. Identification and antimicrobial susceptibility testing were performed using the VITEK-2 automated system. A lateral flow immunoassay and the FilmArray system for blood cultures only were used for the detection of the five most prevalent carbapenemases. Their epidemiological and antimicrobial susceptibility trends were retrospectively analyzed. Results: During the study period, a total of 628 single-patient CPPA were identified among 902 carbapenem-resistant P. aeruginosa clinical isolates. An increasing number of CPPA was revealed during the survey, especially in the post-COVID period (rising from n = 102 in 2020, n = 105 in 2021, and n = 123 in 2022 to n = 298 in 2023; p < 0.05). Regarding the type of carbapenemase, VIM metallo-beta-lactamase was the only carbapenemase identified during the first two years of the study (2020 to 2021). In 2022, VIM- and NDM-producing isolates split almost evenly at proportions of 57% and 43%, respectively. In 2023, NDM-producing isolates seem to have surpassed VIM producers with rates of 54.4% and 45.6%, respectively. As far as antimicrobial resistance profiles, high rates of resistance were observed for most of the antipseudomonal drugs, exceeding 90% across all study years, with little significant variation. However, aztreonam exhibited moderate activity and colistin exhibited excellent activity, remaining the most viable drugs in this setting. Conclusions: Following the COVID-19 pandemic, an increase in CPPA pathogens was identified, while an epidemiological shift was also observed, with the carbapenemase NDM dominating over VIM since 2023. Continuous surveillance is required to track resistance patterns and guide empirical therapy. In this context, new antimicrobials and antimicrobial combinations are also urgently needed.

Background/Objectives: Neisseria meningitidis is a human-specific pathogen capable of causing life-threatening illnesses. Occasionally, it is recovered from unusual sites, other than the bloodstream or the central nervous system. Herein, we describe two rare manifestations due to N. meningitidis within a year (2024) in Greece. Methods: Atypical infection due to N. meningitidis was diagnosed in two different patients: Case-1 presented with an inflammatory swelling in the mid-line of the neck, and Case-2 presented with swelling of the left knee. Both patients had high fever and no neurological signs at admission; Case-2 progressed to meningoencephalitis. Phenotypic and genotypic identifications were carried out in both cases. Results: Case-1 and Case-2 isolates were identified as follows: MenX: 18, 25-44, F5-5, ST-823; 198cc and MenB: 7-1, 1, F3-3, ST-7460; 32cc for PorA, FetA and MLST, respectively. MenX was identified for the first time in Greece and finetyping revealed rare genotypic characteristics. Both isolates were susceptible to cefotaxime, ceftriaxone and rifampicin, while Case-2 isolate expressed reduced susceptibility to penicillin and resistance to ciprofloxacin. Both patients recovered fully. Conclusions: Although uncommon, N. meningitidis may be isolated from atypical sites and specimens. Clinicians and microbiologists should remain aware that meningococcus is a potential cause of infections beyond meningitis and septicaemia.