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Background Antimicrobial-resistant Gram-negative bacteria (AMR-GNB) have emerged as important health care-associated pathogens. Infections with AMR-GNB are associated with high patient morbidity and attributable mortality. Colonization is a prerequisite for infection, however the extent to which colonized patients develop infection is unclear. This systematic review explored the risk of developing infection during hospitalisation among AMR-GNB faecal carriers. Also, we investigated the acquisition rate for AMR-GNB colonization among patients not colonized at admission. Methods We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to April 2019. We included studies reporting on hospitalised patients ≥18 years old in high-income countries (excluding long-term care facilities). Results Out of 9496 articles, 55 studies fulfilled our inclusion criteria. Forty-two studies reported data from EU/EEA, 6 from USA and 7 from other regions. Almost all studies (n = 45) were conducted in university hospitals. Most studies (n = 41;74.5%) were performed in high-risk wards (ICU, haematology, burn units and transplant units). Out of 55 studies, 8 examined AMR-GNB, 27 Enterobacteriaceae, while the others investigated specific pathogens: Klebsiella spp. (n = 11), E. Coli (n = 2), A. Baumannii (n = 3) and P. Aeruginosa (n = 4). The rate of AMR-GNB carriage acquisition was 10.5% (n = 40 studies; 95% CI:8.2-13.1). The risk of progression to infection among patients colonized at hospital admission was 13.9% (n = 15; 5.4-24.9), while the infection rate in patients who acquired carriage during hospitalization was 23.0% (n = 7; 5.9-45.2). Patients with an undefined time of colonization presented an infection rate of 16.9% (n = 13; 11.2-23.4). Considering these three populations as a whole, the risk of developing infection was 16.0% (11.0-21.0). Conclusions Our results suggest that risk of progression to infection in AMR-GNB colonized patients in hospital setting is high. Key messages The aim of our study was to estimate the risk of progression to infection, during hospital stay, in patients colonized by AMR-GNB at hospital admission in high-income countries. Our results suggest that faecal colonization with AMR-GNB poses a 16.0% risk of subsequent AMR-GNB infection. This risk in higher (23.0%) in patients who acquired colonization during hospitalisation.

Objectives: The main objective was to determine the monthly average dose for biologic drugs used for psoriasis (PSO), psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Methods: A retrospective analysis of administrative databases of two regions and 1 local health unit was performed. All adult patients with a diagnosis of PSO, PsA or AS (identified byICD-9-CM/exemption code)between 01/01/2011 and 30/06/2017 (inclusion period) were screened. Only patients with biologic drugs were included. Date of first prescription of biologic drugs during inclusion period was defined index date(ID). Patients were followed-up for 6 months after ID. Monthly average dose(mg) and persistence to treatment were estimated after 6 months of follow-up. Results: Percentage(%) of patients in the 3 diseases treated with biologic drugs in each indication was: 1.1 in PSO, 37.4 in PsA and 17.8 in AS. 6179 patients were included: 2373 (mean age 50.2, 60.4% male) PSO-patients, 2756 (mean age 53.0, 50.6% male) PsA-patients, 1050 (mean age 47.0, 59.0% male) AS-patients. Results focused on subcutaneous biologic drugs frequently prescribed for the 3 diseases of interest. Etanercept monthly average dose was 152 for PSO, 155 for PsA and 147 for AS patients. For adalimumab, PSO-patients had a monthly average dose of 69, PsA-patients 73 and AS-patients 70. Monthly average dose for secukinumabtreated patients was 255 for PSO, 183 for PsA and 154 for AS. The percentage of patients persisting with treatment (6 months of follow up) was: for etanercept 77 for PSO, PsA and AS patients; for adalimumab, 76 for PSO, 78 for PsA and 74 for AS patients; for secukinumab 91 for PSO, 85 for PsA and 60 for AS. Conclusions: This cohort study described real-world dosing patterns of biologic drugs used by patients affected by PSO, PsA or AS, giving an insight into the everyday clinical practice.

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