Cefiderocol is a new cephalosporin displaying against extensively resistant (XDR) Gram-negative bacteria. We report our experience with cefiderocol-based combination therapies as “rescue” treatments in immunocompromised or critically ill patients or in patients with post-surgical infections who had failed previous regimens. A total of 13 patients were treated from 1 September 2020 to 31 March 2021. In total, 5/13 (38%) patients were classified as critically ill, due to severe COVID-19 lung failure; 4/13 (31%) patients had post-surgical infections and 4/13 (31%) had severe infections in immunocompromised subjects due to solid organ transplantation (2/4) or hematological malignancy (2/4). Overall, 10/13 infections were caused by carbapenem-resistant Acinetobacter baumannii, one by KPC-positive ceftazidime/avibactam-resistant Klebsiella pneumonia and two by Pseudomonas aeruginosa XDR. Based on clinical, microbiological and hematobiochemical evaluation, cefiderocol was associated with different companion drugs, particularly with fosfomycin, high-dose tigecycline and/or colistin. Microbiological eradication was achieved in all cases and the 30-day survival rate was 10/13; two patients died due to SARS-CoV-2 lung failure, whereas one death was attributed to subsequent infections. No recurrent infections within 30 days were reported. Finally, we hereby discuss the therapeutic potential of cefiderocol and the possible place in the therapy of this novel drug.

The long-term consequences of the coronavirus disease 19 (COVID-19) are likely to be frequent but results hitherto are inconclusive. Therefore, we aimed to define the incidence of long-term COVID signs and symptoms as defined by the World Health Organization, using a systematic review and meta-analysis of observational studies. A systematic search in several databases was carried out up to 12 January 2022 for observational studies reporting the cumulative incidence of long COVID signs and symptoms divided according to body systems affected. Data are reported as incidence and 95% confidence intervals (CIs). Several sensitivity and meta-regression analyses were performed. Among 11,162 papers initially screened, 196 were included, consisting of 120,970 participants (mean age: 52.3 years; 48.8% females) who were followed-up for a median of six months. The incidence of any long COVID symptomatology was 56.9% (95% CI 52.2–61.6). General long COVID signs and symptoms were the most frequent (incidence of 31%) and digestive issues the least frequent (7.7%). The presence of any neurological, general and cardiovascular long COVID symptomatology was most frequent in females. Higher mean age was associated with higher incidence of psychiatric, respiratory, general, digestive and skin conditions. The incidence of long COVID symptomatology was different according to continent and follow-up length. Long COVID is a common condition in patients who have been infected with SARS-CoV-2, regardless of the severity of the acute illness, indicating the need for more cohort studies on this topic.

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Background The spectrum of clinical manifestations of CoronaVirus Disease-19 (COVID-19) is not yet completely known. In elderly, mortality and extra-pulmonary involvement appear to be more frequent than expected. Methods A multicentric-retrospective-case-series of patients hospitalized between March 1 st and June 15 th , 2020 with confirmed COVID-19 by RT-PCR testing on throat/nasopharyngeal swabs and age ≥65 years was analysed. Based on the “Clinical Frailty Scale” (CFS), patients were classified into three groups according to the resulting score: 1-3 (group A), 4-6 (group B), 7-9 (group C). Results Overall, 206 patients were included. Crude mortality was 27%. According to CFS, on admission, 60 patients (29%) were assigned to group A, 60 (29%) to group B, and 86 (42%) to group C. The following features were significantly more frequent among group C patients in comparison with groups B and A: mental confusion (65% vs 33% vs 7%, respectively, p < .001), kidney failure (39% vs 22% vs 20%, p = .019), dehydration syndrome (55% vs 27% vs 13%, p < .001), electrolyte imbalance (54% vs 32% vs 25%, p = .001), and diabetic decompensation (22% vs 12% vs 7%, p = .026). By multivariable logistic regression model, male sex (aOR = 2.87, 95%CI = 1.15–7.18), CFS between 7 and 9 (aOR = 9.97, 95%CI = 1.82–52.99), dehydration at admission (aOR = 4.27, 95%CI = 1.72–10.57), and non-invasive/invasive ventilation (aOR = 4.88, 95%CI = 1.94–12-26) were independent predictors of death. Conclusions Elderly with a high CFS showed frequent extrapulmonary signsat admission, even in absence of lung involvement. These findings, along with a high CFS, predicted a significant risk of mortality.

The early administration of anti-SARS-CoV-2 monoclonal antibodies (mAb) could decrease the risk of severe disease and the need of inpatients care. Herein, our clinical experience with Bamlanivimab/Etesevimab for the treatment of early SARS-CoV-2 infection through an outpatient service was described. Patients with confirmed COVID-19 were selected by General Practitioners (GPs) if eligible to mAb administration, according to manufacturer and AIFA (Agenzia-Italiana-del-Farmaco) criteria. If suitability was confirmed by the Multidisciplinary Team, the patient was evaluated within the next 48–72 hours. Then, all patients underwent a medical evaluation, followed by mAb infusion or hospitalization if the medical condition had worsened. Overall, from March 29th to June 4th, 2021, 106 patients with confirmed COVID-19 were identified by GPs; 26 were considered not eligible and then excluded, while 9 refused treatment. Among the 71 remaining, 6 were not treated because of worsening of symptoms soon after selection. Finally, 65 received mAb therapy. All treated patients survived. However, 2/65 developed adverse events (allergic reaction and atrial fibrillation, respectively) and 6/65 needed hospitalization. By performing univariate logistic regression analysis, diabetes was the only risk factor for hospitalization after mAb administration [aOR = 9.34, 95%CI = 1.31–66.49, p = .026]. Importantly, subjects who worsened awaiting mAb were more frequently obese (OR = 16.66, 95%CI = 1.80–153.9, p = .013) and received home corticosteroid therapy for COVID-19 (OR = 14.11, 95%CI = 1.53–129.6, p = .019). Establishing a network among GPs and COVID units could be an effective strategy to provide mAb treatment to patients with early SARS-CoV-2 infection to reduce hospitalizations and pressure on healthcare systems.