Ioannis Chandroulis

The COVID-19 pandemic redirected infection control and antimicrobial stewardship towards SARS-CoV-2, potentially increasing multidrug-resistant (MDR) bloodstream infections (BSIs). We compared MDR BSI epidemiology and outcomes in a non-COVID intensive care unit (ICU) before and after the pandemic. The MATURATE ICU study retrospectively included adults with MDR BSIs admitted to a non-COVID ICU during the pre-COVID-19 (1 January 2017–1 January 2020) and post-COVID-19 (1 January 2022–1 January 2025) eras. Clinical, microbiological and outcome data were compared. Survival analyses and multivariable logistic regression identified predictors of ICU mortality. Overall, 146 patients were included (74 pre-COVID-19 and 72 post-COVID-19). Pre-COVID-19 patients were older and had higher comorbidity burden and severity indices (all p ≤ 0.023). ICU stay after the first positive blood culture was longer in the post-COVID-19 period (p = 0.003). New organ dysfunction, acute kidney injury, and septic shock were more frequent pre-COVID-19, whereas cardiovascular events were more frequent post-COVID-19. ICU mortality was higher pre-COVID-19 (p < 0.001). Competing-risk analysis, treating ICU discharge alive as a competing event, demonstrated a significantly lower cumulative incidence of ICU death in the post-COVID-19 era (adjusted sHR 0.20, 95% CI 0.11–0.35; p < 0.001). In multivariable analysis, post-COVID-19 era independently predicted lower 28-day ICU mortality (adjusted OR = 0.11, 95% CI 0.04–0.28, p < 0.001), whereas higher CCI (adjusted OR = 1.31, 95% CI 1.04–1.69, p = 0.027) and SOFA (adjusted OR = 1.22, 95% CI 1.07–1.40, p = 0.003) independently predicted increased mortality. Despite the persistently high burden of antimicrobial resistance, improved post-COVID-19 survival suggests that, advances in ICU care and healthcare system recovery may have contributed to better outcomes.

Background/Objectives: Venous thromboembolism (VTE) is the third most common cardiovascular condition, with higher rates among hospitalized patients. The limited efficacy of universal prophylaxis strategies has led to individual VTE risk assessments approaches. The main objective of this study was to assess outcomes in high-risk patients for VTE who receive prophylactic vs. intermediate, weight-adjusted doses of tinzaparin for thromboprophylaxis. Methods: This was a retrospective study assessing adult patients hospitalized with acute medical disease in a tertiary university hospital from January 2022–2024. Patients were included if found to be at high risk for VTE—as this reflected in Padua Prediction Score (PPS) ≥ 4—and received prophylactic versus intermediate dosage of tinzaparin. Data were collected from patients’ files and analyzed using appropriate statistical methods. Results: In total, 286 patients were included, of whom 160 received prophylactic and 126 intermediate tinzaparin dosage. The groups were comparable, except for arterial thrombosis history, central venous catheter presence, and median PPS. Patients receiving prophylactic doses exhibited significantly higher mortality rates (20.62 vs. 7.14, p = 0.002), increased length of stay (LOS) (6 vs. 4, p < 0.001), and prolonged treatment durations (5 vs. 3, p = 0.003) compared to patients receiving intermediate dosages. Univariate analysis revealed significant associations between mortality and tinzaparin dose (OR = 3.38, p = 0.002), age (OR = 1.03, p = 0.017), LOS (OR = 1.07, p = 0.001), PPS (OR = 1.62, p < 0.001), Charlson Comorbidity Index (CCI) (OR = 1.27, p < 0.001), and prior thrombotic events (OR = 2.27, p = 0.028). In multivariate analysis, tinzaparin dose (OR = 2.58, p = 0.035), age (OR = 1.04, p = 0.033), LOS (OR = 1.10, p < 0.001), and PPS (OR = 1.33, p = 0.038) remained independent predictors of mortality. Conclusions: These findings reveal that intermediate tinzaparin dosing is a more effective and safe approach in high-risk for VTE hospitalized patients, emphasizing the need for personalized VTE management.

Introduction: Candida auris (now Candidozyma auris) and multidrug-resistant (MDR) bacterial infections pose significant therapeutic challenges due to high antimicrobial resistance, increased mortality, and persistence in healthcare settings. In Greece, their rising prevalence is raising concerns regarding co-infection, yet comprehensive data remain limited. This study aims to investigate the epidemiology, risk factors, and clinical outcomes of MDR bacterial co-infection in patients with C. auris candidemia. Methods: This single-center, retrospective observational cohort study was conducted at a Greek tertiary university hospital and included adult patients with C. auris bloodstream infections from January 2019 to June 2024. The data were analyzed using appropriate statistical methodologies. Results: Among 96 patients, those with C. auris candidemia and MDR bacterial co-infection exhibited a significantly higher mortality rate (87.23% vs. 61.22%, p = 0.007). The presence of a central venous catheter was the only factor significantly associated with MDR co-infection (p = 0.030). In univariate analysis, MDR co-infection, a higher Charlson Comorbidity Index, and mechanical ventilation correlated with increased mortality. Multivariate analysis identified MDR co-infection (OR = 3.19, p = 0.045) and mechanical ventilation (OR = 7.07, p = 0.002) as independent mortality predictors. Conclusions: These findings underscore the need for enhanced surveillance, precise identification, and stringent infection control measures to prevent C. auris and MDR bacterial outbreaks in healthcare settings.

Bloodstream infections (BSIs) can be primary or secondary, with significant associated morbidity and mortality. Primary bloodstream infections (BSIs) are defined as infections where no clear infection source is identified, while secondary BSIs originate from a localized infection site. This study aims to compare patterns, outcomes, and medical costs between primary and secondary BSIs and identify associated factors. Conducted at the University Hospital of Patras, Greece, from May 2016 to May 2018, this single-center retrospective cohort study included 201 patients with confirmed BSIs based on positive blood cultures. Data on patient characteristics, clinical outcomes, hospitalization costs, and laboratory parameters were analyzed using appropriate statistical methods. Primary BSIs occurred in 22.89% (46 patients), while secondary BSIs occurred in 77.11% (155 patients). Primary BSI patients were younger and predominantly nosocomial, whereas secondary BSI was mostly community-acquired. Clinical severity scores (SOFA, APACHE II, SAPS, and qPitt) were significantly higher in primary compared to secondary BSI. The median hospital stay was longer for primary BSI (21 vs. 12 days, p < 0.001). Although not statistically significant, mortality rates were higher in primary BSI (43.24% vs. 26.09%). Total care costs were significantly higher for primary BSI (EUR 4388.3 vs. EUR 2530.25, p = 0.016), driven by longer hospital stays and increased antibiotic costs. This study underscores the distinct clinical and economic challenges of primary versus secondary BSI and emphasizes the need for prompt diagnosis and tailored antimicrobial therapy. Further research should focus on developing specific management guidelines for primary BSI and exploring interventions to reduce BSI burden across healthcare settings.