Background and Objectives: Stenotrophomonas maltophilia is a ubiquitous, aerobic, Gram-negative bacillus causing increasing concern in patients affected by haematological malignancies. Materials and Methods: We report a case series from two centres in Northern Italy to describe the characteristics, outcome and microbiological response of S. maltophilia infections in patients with haematological malignancies and/or allogenic hematopoietic stem cell transplantation (aHSCT). Results: Ten patients were included. The median age was 67 years, and seven patients (70%) were males. The median Charlson Comorbidity Index was 6 (IQR: 4-8). The most frequent haematological comorbidities were acute myeloid leukaemia (AML; n = 3; 30%) and non-Hodgkin\'s lymphoma (n = 3; 30%). Three (30%) patients underwent aHSCT before infection, all for AML. All the patients had undergone a recent antibiotics course and had an indwelling central venous catheter before infection. The main clinical presentations were nosocomial pneumonia, with (2; 20%) or without (4; 40%) secondary bloodstream infection and CRBSI (3; 30%). Four patients were treated with cefiderocol in monotherapy or combinations therapy with cotrimoxazole. The rest of the patients were treated with cotrimoxazole or levofloxacin in monotherapy. Conclusions: Despite a high rate of clinical improvement (90%) after starting antimicrobial therapy, we faced high 30-day mortality (30%) and in-hospital mortality (50%) rates in a highly comorbid population.

We report a Russian case of a 61-year-old male patient with confirmed COVID-19 infection who developed nosocomial pneumonia complicated by lung abscess associated with multi-drug-resistant isolates of Klebsiella pneumoniae and Acinetobacter baumannii, which could have been provoked due to the immunosuppressive therapy. We discuss the existing literature highlighting the issue of the prudent balance between benefits and risks when prescribing immunomodulators to hospitalized patients with COVID-19 due to the risk of difficult-to-treat nosocomial infections caused by MDR Gram-negative bacterial pathogens. Currently, there is evidence of a substantial positive effect of dexamethasone on the course of COVID-19 in patients requiring supplemental oxygen or anti-interleukin-6 drugs in individuals with prominent systemic inflammation. However, it seems that in real clinical practice, the proposed criteria for initiating treatment with immunomodulators are interpreted arbitrarily, and the doses of dexamethasone can significantly exceed those recommended.

OBJECTIVE: To determine how clinical and laboratory factors were associated with nosocomial pneumonia in adult patients hospitalized in an internal medicine department.
METHODS: We conducted a retrospective unmatched case-control study. We recorded clinical and epidemiological data from patients discharged from an internal medicine department of a Peruvian reference hospital, the Hospital Nacional Arzobispo Loayza, between 2016 and 2018. Bivariate and multivariate analyses (using logistic regression models) were performed to obtain crude and adjusted odds ratios with 95% confidence intervals. A P value < 0.05 was considered significant. We calculated the population attributable fraction of the significant variables.
RESULTS: We analyzed 138 cases and 200 controls, with a mean age of 72.6 ± 17.8 years (21 to 104) for cases and 71.7 ± 15.3 years (19 to 98) for controls. The multivariate analysis indicated that severe anemia (adjusted odds ratio 9.0, confidence interval 95% 1.9 to 43.1, P = 0.01), severe hypoalbuminemia (adjusted odds ratio 4.0, confidence interval 95% 1.2 to 13.8, P = 0.03), altered state of consciousness (adjusted odds ratio 3.6, confidence interval 95% 1.6 to 8.2, P = 0.00), and prior use of antibiotics (adjusted odds ratio 6.3, confidence interval 95% 2.7 to 14.5, P = 0.00) were significantly associated with nosocomial pneumonia. The population attributable fraction found were 41.8% for altered state of consciousness, 33.2% for severe anemia, and 36.3% for severe hypoalbuminemia.
CONCLUSIONS: Clinical and laboratory risk factors associated with nosocomial pneumonia development in adult patients hospitalized in an internal medicine department were severe anemia, severe hypoalbuminemia, altered consciousness, and previous use of antibiotics.
UNASSIGNED: La neumonía nosocomial es la infección intrahospitalaria más frecuente y es responsable de alta morbimortalidad en todo el mundo, por lo que su estudio es muy importante.
OBJECTIVE: Determinar cómo los factores clínicos y de laboratorio se asociaron a neumonía nosocomial en pacientes adultos hospitalizados en un servicio de medicina interna.
UNASSIGNED: Se realizó un estudio retrospectivo de casos y controles no pareado. Se recolectaron los datos clínicos epidemiológicos de pacientes egresados del departamento de medicina interna durante el periodo 2016 a 2018 de un centro de referencia en Perú: el Hospital Nacional Arzobispo Loayza. Se realizó análisis bivariado y multivariado, usando el método de regresión logística, para obtener Odds ratio crudos y ajustados, con un intervalo de confianza de 95%. El valor p < 0,05 fue considerado significativo. Se calculó la fracción atribuible poblacional de las variables significativas.
RESULTS: Se analizaron 138 casos y 200 controles, la media de edad fue de 72,6 ± 17,8 años (21 a 104) para los casos y 71,7 ± 15,3 años (19 a 98) para los controles. En el análisis multivariado la anemia severa (Odds ratio ajustado: 9,0; intervalo de confianza 95%: 1,9 a 43,1; p = 0,01), hipoalbuminemia severa (Odds ratio ajustado: 4,0; intervalo de confianza 95%: 1,2 a 13,8; p = 0,03), trastorno de conciencia (Odds ratio ajustado: 3,6; intervalo de confianza 95%: 1,6 a 8,2; p = 0,00) y el uso previo de antibióticos (Odds ratio ajustado: 6,3; intervalo de confianza 95%: 2,7 a 14,5; p = 0,00) se asociaron independientemente con la neumonía nosocomial. La fracción atribuible poblacional encontrada fue 41,8% para trastorno de conciencia, 33,2% para anemia severa y 36,3% para hipoalbuminemia severa.
CONCLUSIONS: Los factores de riesgos clínicos y de laboratorio asociados al desarrollo de neumonía nosocomial en pacientes adultos hospitalizados fueron la anemia severa, la hipoalbuminemia severa, el trastorno de conciencia y el uso previo de antibióticos.

OBJECTIVE: Continuous renal replacement therapy (CRRT) is a specialized type of dialysis. However, the characteristics and factors associated with nosocomial pneumonia in patients undergoing CRRT have received little attention to date. Therefore, this study investigated the characteristics of and factors contributing to nosocomial pneumonia in patients receiving CRRT.
METHODS: The clinical data of 1160 patients undergoing CRRT during the period January 2008 to December 2015 were analyzed retrospectively. Of these 1160 cases, 145 (12.5%) were included in the nosocomial pneumonia group, while 1015 were included in the control group.
RESULTS: The primary pathogen in the 145 cases of nosocomial pneumonia in the CRRT patients was Staphylococcus aureus (58.57%); the morbidity rate was 12.5%. Multivariate logistic regression analysis revealed that age (odds ratio (OR) 2.209), initial curative time (OR 1.960), underlying diseases (OR 1.820), consciousness disorder (OR 1.616), organ failure (OR 2.154), the Acute Physiology and Chronic Health Evaluation II score (APACHE II) (OR 1.186), and the Charlson Comorbidity Index score (CCI) (OR 1.278) were risk factors for nosocomial pneumonia (all p<0.05). Conversely, the serum white blood cell count (OR 0.585), albumin (OR 0.673), and hemoglobin (OR 0.712) levels were protective factors (all p<0.05).
CONCLUSIONS: Results from this study indicate that by modifying risk factors, such as providing adequate nutrition, earlier treatment of underlying diseases, and controlling organ failure, the risks associated with nosocomial pneumonia may be reduced.

This case-report describes a patient with confirmed nosocomial Legionnaires\' disease, a diagnosis which should be suspected when pneumonia does not respond to empiric therapy with beta-lactam antibiotics, or develops in the presence of certain risk factors. Culture is currently the golden standard for diagnosis, although the use of more modern techniques, such as a combination of urinary antigen testing and polymerase chain reaction, are on the rise. Specific detection and eradication methods are discussed.

BACKGROUND: Hospital-acquired pneumonia (HAP) is one of the leading nosocomial infections and is associated with high morbidity and mortality. Numerous studies on HAP have been performed in intensive care units (ICUs), whereas very few have focused on patients in general wards. This study examined the incidence of, risk factors for, and outcomes of HAP outside the ICU.
METHODS: An incident case-control study was conducted in a 600-bed hospital between January 2006 and April 2008. Each case of HAP was randomly matched with 2 paired controls. Data on risk factors, patient characteristics, and outcomes were collected.
RESULTS: The study group comprised 119 patients with HAP and 238 controls. The incidence of HAP outside the ICU was 2.45 cases per 1,000 discharges. Multivariate analysis identified malnutrition, chronic renal failure, anemia, depression of consciousness, Charlson comorbidity index ≥3, previous hospitalization, and thoracic surgery as significant risk factors for HAP. Complications occurred in 57.1% patients. The mortality attributed to HAP was 27.7%.
CONCLUSIONS: HAP outside the ICU prevailed in patients with malnutrition, chronic renal failure, anemia, depression of consciousness, comorbidity, recent hospitalization, and thoracic surgery. HAP in general wards carries an elevated morbidity and mortality and is associated with increased length of hospital stay and increased rate of discharge to a skilled nursing facility.