Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp . (20.3%), Escherichia coli (15.8%), and Pseudomonas spp . (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06944-2.

INTRODUCTION Proper understanding of the prevalence and determinants of nicotine dependence is crucial for developing and implementing effective tobacco control interventions. The aim of the study was to identify the intrinsic and extrinsic barriers to smoking cessation, and to assess the association between nicotine dependence with demographic variables in Malaysia. METHODS A cross-sectional survey based on the Challenges to Stopping Smoking Scale (CSS-21) and Fagerström test for nicotine dependence (FTND) was performed on smoking Malaysian citizens aged ≥18 years, from February to June 2021. RESULTS A total of 1026 parents responded to the survey. As for the smoking dependence based on FTND, 39.1% suffered low-moderate dependence, while about 33.6% suffered moderate dependence. Only 1.8% suffered high dependence. Considering the barriers of quitting smoking based on CSS-21, the mean score of the intrinsic barriers domain was 5.7 ± 2.9, and for the extrinsic domain was 7.4 ± 4.0. The most common barrier reported in the intrinsic domain was the easy availability of cigarettes (69.8%), followed by experiencing withdrawal symptoms (68.5%). On the other hand, the most common barrier reported in the extrinsic domain was the belief in the capability of stopping smoking in the future (72.8%), followed by the fear of having side effects after stopping smoking (63.2%). Gender, race, education level, occupation, marital status, place of residence, and monthly income were also significantly associated with the FTND nicotine dependence category (all p<0.05). Pearson correlation analysis reported a positive association between intrinsic score (r=0.38), extrinsic score (r=0.43) and FTND score (all p<0.001). CONCLUSIONS Barriers to stopping smoking should be taken into consideration in initiatives to decrease smoking-related mortality. Vulnerable populations that are susceptible to high nicotine dependence should be given particular attention.

Background: Hepatocellular carcinoma (HCC) is one of the very frequent malignancies that has poor prognosis. Chronic hepatitis B is the most important risk factor in the world particularly in developping countries. In developed world, HCC occurs in the background of chronic infection with HCV or alcohol abuse. Several factors affects the development of HCC in chronic hepatitis patients including viral genotype. Objectives: The aim of this study was to determine HCV and HBV viral profile in Egyptian and Yemeni HCC patients. Additionally, HCV and HBV were genotyped to investigate any possible correlation with HCC development. Methodology: Thirty HCC Egyptian patients admitted to the Hepatology Unit, Medical Research Institute, Alexandria University and thirty HCC Yemeni patients attending the oncology center in Al-Gomhory hospital in Sanaa have been enrolled in this study. Hepatitis B surface Ag (HBs-Ag) was not detected in Egyptian HCC patients but in 36.7% of Yemeni HCC patients. On the other hand, anti-HCV antibodies were detected in 93.3% of the Egyptian HCC patients and in 16.7% only in Yemeni patients. HBV genotyping by direct sequencing of pol gene showed 11 cases of genotype D and 1 case of genotype E among HCC Yemeni patients. HCV genotyping by sequencing of NS5b and 5'UTR showed 21 cases of genotype 4 and 2 cases of genotype 1 and genotype 2 among Egyptian HCC patients. Conclusion: From the current study HCC appears to be significantly associated with HBV and HCV chronic infections in Yemen and Egypt respectively. In Egypt, occult HBV co-infection might escalate the danger of HCC development among HCV patients.

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