Greek Tertiary Hospital Research Articles

Clostridioides difficile infection epidemiology during the COVID-19 pandemic in Greece.

Aim: The aim was to highlight the incidence and epidemiology of C. difficile infections (CDI) in a tertiary Greek hospital during the COVID-19 pandemic.Methods: A single-center prospective observational cohort study was conducted (October 2021 until April 2022). 125 C. difficile isolates were cultured from hospitalized patients stool samples and screened by PCR for toxin A (tcdA), toxin B (tcdB), binary toxin (cdtA and cdtB) genes and the regulating gene of tcdC.Results: The incidence of CDI increased to 13.1 infections per 10,000bed days. The most common PCR ribotypes identified included hypervirulent RT027-related RT181 (73.6%), presumably hypervirulent RT126 (8.0%) and toxin A negative RT017 (7.2%).Conclusion: Although the incidence of CDI increased significantly, the CDI epidemiology remained stable.

Characteristics of the Genetic Spread of Carbapenem-Resistant Acinetobacter baumannii in a Tertiary Greek Hospital.

Acinetobacter baumannii (Ab) has increasingly been identified as a cause of hospital-acquired infections and epidemics. The rise of carbapenem-resistant Acinetobacter baumannii (CRAB) poses significant challenges in treatment. Nosocomial outbreaks linked to CRAΒ A. baumannii strains have been reported worldwide, including in Greece. This study aimed to analyze the molecular epidemiology trends of multidrug-resistant A. baumannii isolates in a tertiary hospital in Athens, Greece. A total of 43 clinical isolates of extensively drug-resistant (XDRAB), pan-drug-resistant (PDRAB), and CRAB were collected from patients suffering from blood infection, hospitalized between 2016 and 2020 at the internal medicine clinics and the ICU. A.baumannii isolates underwent testing for Ambler class B and D carbapenemases and the detection of ISAba1, and were typed, initially, using pulsed-field gel electrophoresis, and, subsequently, using sequence-based typing and multiplex PCR to determine European Clone lineages. The blaOXA-23 gene accompanied by ISAba1 was prevalent in nearly all A. baumannii isolates, except for one carrying blaOXA-58. The intrinsic blaOXA-51-like gene was found in all isolates. No Ambler class B carbapenemases (VIM, NDM) were detected. Isolates were grouped into four PF-clusters and no one-cluster spread was documented, consistent with the absence of outbreak. The study indicated that XDR/PDR-CRAB isolates predominantly produce OXA-23 carbapenemase and belong to European Clone II. Further research is needed to understand the distribution of resistant bacteria and develop effective prevention and control strategies.

Clinical Characteristics of Outpatient Adolescents Undergoing Ongoing Psychotherapy in a Greek Tertiary Hospital from June 2016 to December 2019

Background: Adolescents with mental disorders often have difficulty engaging in ongoing treatment. Dropout from treatment is common. Aim: This paper aims to explore the clinical characteristics of a cohort of adolescents with mental disorders who were stably and actively undergoing psychotherapy over a relatively long period of time (for at least four months). Method: A purposive single-center cross-sectional cohort survey was conducted from June 2016 to December 2019. The sample of the study (N=50) was recruited from the Child and Adolescent Psychiatry outpatient setting of a large tertiary hospital of Thessaloniki, the second largest city in Greece. An intelligence test (Wechsler Intelligence Scale for Children, WISC III) and a self-report measure of depression (Beck Depression Inventory, BDI II) were used. All the participants underwent a rigorous clinical assessment of their mental health status in both initial and ongoing psychotherapy. The initial diagnosis was reconfirmed during the course of therapy. Mental disorders were defined and diagnosed using the ICD-10 (1992) (International Classification of Diseases). Results: The largest percentage of adolescents (44.9%) were found to suffer from mood (affective) disorders, while 20.4% suffered from neurotic disorders. We also found high prevalence of pessimism (32.7%), reduction of energy (28.6%) and difficulty in concentration (32.7%). A total of 22.4% of adolescents reported sleep disorders. A limited interest in sex was noted, which was in contrast with international and Greek data, where interest and experimentation around sex seems to preoccupy a high percentage of adolescents. Furthermore, sleep disorders, either as a symptom of an underlying disease or as an independent clinical condition, seem to preoccupy adolescents, and this may be a motive for them to seek treatment. Conclusion: For the most part, the findings of this study were consistent with the findings of prior studies; however, previous studies did not exclusively include adolescents engaging in ongoing psychotherapy. As we identified some inconsistencies with prior studies related to interest in sex and sleep disorders, further research is recommended for the investigation of possible correlations between these findings and ongoing psychotherapy engagement rates. Note, however, that the findings in this study are not representative of adolescents in Greece due to the fact that the used sample was not representative.

RESISTANT HYPERTENSION AS A RISK FACTOR FOR CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTENSIVE CRISES AFTER 12-MONTH FOLLOW-UP: A GREEK REGISTRY

Objective: Currently, evidence on the prognosis of patients with hypertensive crises (HC) and resistant hypertension (RH) is limited. The purpose of our study was to register the prevalence, and clinical phenotype of patients with HC admitted to the emergency department (ED) and a 12-month follow-up to record cardiovascular outcomes in a Greek tertiary hospital. Design and method: The study population included patients visiting the ED with acute an increase in blood pressure (BP) (systolic BP > or = 180mmHg and/or diastolic BP > or = 120mmHg). HC patients were classified as hypertensive emergencies or urgencies depending on the presence or absence of acute hypertension-mediated organ damage, respectively. In all patients, the baseline characteristics were registered for 12 consecutive months. After stratification of the HC population by RH (excluding non-adherence to medication as a cause for HC), we created two subgroups, those with and without RH. Finally, we compared outcomes (composite endpoint of deaths or hospitalizations from cardiovascular causes) by RH during a 12-month follow-up. Results: Out of 38,589 patients assessed in the ED, 353(0.91%) had HC, of whom 256 had hypertensive urgencies, and 97 had emergencies. The clinical status of 81 patients was not available during follow-up. The mean age of the remaining HC patients was 68±13 years, 49.6% were males, and 80.3% had a history of hypertension (58 patients had RH). More patients with RH had composite events (27.6% vs. 12.8%, p<0.001), deaths (10.3% vs. 0.6%, p = 0.002), and hospitalizations (27.6% vs. 12.1%, p<0.001) from a cardiovascular cause. RH vs. non-RH phenotype was associated with OR 1.437 (95% CI 1.006-2.012) after adjustment for confounders. Conclusions: RH is an independent risk factor of increased cardiovascular risk in patients with HC.

Evaluation of Antibody Kinetics Following COVID-19 Vaccination in Greek SARS-CoV-2 Infected and Naïve Healthcare Workers.

We investigated the antibody kinetics after vaccination against COVID-19 in healthcare workers of a Greek tertiary hospital. Eight hundred and three subjects were included, of whom 758 (94.4%) received the BNT162b2 vaccine (Pfizer-BioNTech), eight (1%) mRNA-1273 (Moderna), 14 (1.7%) ChAdOx1 (Oxford-AstraZeneca) and 23 (2.9%) Ad26.COV2.S (Janssen). Before the second dose, at 2, 6 and 9 months after the second dose and at 2 and 6 months after the third dose, anti-spike IgG were quantified by the chemiluminescence microparticle immunoassay method. One hundred subjects were infected before vaccination (group A), 335 were infected after receiving at least one vaccine dose (group B), while 368 had never been infected (group C). Group A presented a greater number of hospitalizations and reinfections compared to group B (p < 0.05). By multivariate analysis, younger age was associated with an increased risk of reinfection (odds ratio: 0.956, p = 0.004). All subjects showed the highest antibody titers at 2 months after the second and third dose. Group A showed higher antibody titers pre-second dose, which remained elevated 6 months post-second dose compared to groups B and C (p < 0.05). Pre-vaccine infection leads to rapid development of high antibody titer and a slower decline. Vaccination is associated with fewer hospitalizations and fewer reinfections.

Implication of COVID-19 pandemic on the incidence of Clostridioides difficile infection in a Greek tertiary hospital.

Introduction. C. difficile infection (CDI) represents an important global threat. In the COVID-19 era, the multifactorial nature of CDI has emerged.Hypothesis - Aim. The aim was to assess the impact of COVID-19 pandemic on the incidence of CDI in a Greek hospital.Methodology. A retrospective study was performed throughout a 51 month period (January 2018 to March 2022), divided into two periods: pre-pandemic (January 2018 to February 2020) and COVID-19 pandemic (March 2020 to March 2022). The effects of the pandemic compared to the pre-pandemic period on the incidence of CDI [expressed as infections per 10 000 bed days (IBD)] were studied using interrupted time-series analysis.Results. Throughout the study, there was an increase in the monthly CDI incidence from 0.00 to 11.77 IBD (P<0.001). Interrupted time-series disclosed an increase in CDI incidence during the pre-pandemic period from 0.00 to 3.36 IBD (P<0.001). During the COVID-19 pandemic period the linear trend for monthly CDI rose from 2.65 to 13.93 IBD (P<0.001). The increase rate was higher during the COVID-19 pandemic period (r2 = +0.47) compared to the pre-pandemic period (r1 = +0.16).Conclusion. A significant increase of CDI incidence was observed, with the rate of the rise being more intense during the COVID-19 pandemic.

A carbapenem-focused antimicrobial stewardship programme implemented during the COVID-19 pandemic in a setting of high endemicity for multidrug-resistant Gram-negative bacteria.

Greece is among the countries characterized by high rates of antimicrobial resistance and high consumption of antibiotics, including carbapenems. To measure the impact of a carbapenem-focused antimicrobial stewardship programme (ASP) on the antibiotic consumption and patient outcomes in a Greek tertiary hospital during the COVID-19 pandemic. A quasi-experimental, before-after study, comparing a 12 month pre-intervention period with a 12 month intervention period in which a carbapenem-focused ASP was implemented. A total of 1268 patients were enrolled. The proportion of admitted patients who received carbapenems decreased from 4.1% (842 of 20 629) to 2.3% (426 of 18 245) (-1.8%; P < 0.001). A decrease of -4.9 DDD/100 patient-days (PD) (95% CI -7.3 to -2.6; P = 0.007) in carbapenem use and an increase in the use of piperacillin/tazobactam [+2.1 DDD/100 PD (95% CI 1.0-3.3; P = 0.010)] were observed. Thirty-day mortality following initiation of carbapenem treatment and all-cause in-hospital mortality remained unaltered after ASP implementation. In contrast, length of hospital stay increased (median 17.0 versus 19.0 days; P < 0.001), while the risk of infection-related readmission within 30 days of hospital discharge decreased (24.6% versus 16.8%; P = 0.007). In the post-implementation period, acceptance of the ASP intervention was associated with lower daily hazard of in-hospital death [cause-specific HR (csHR) 0.49; 95% CI 0.30-0.80], lower odds of 30 day mortality (OR 0.36; 95% CI 0.18-0.70) and higher rate of treatment success (csHR 2.45; 95% CI 1.59-3.77). Implementing and maintaining a carbapenem-focused ASP is feasible, effective and safe in settings with high rates of antimicrobial resistance, even during the COVID-19 pandemic.

PS-C01-1: CARDIOVASCULAR EVENTS PREDICTION RELATED TO AGE IN PATIENTS WITH HYPERTENSIVE CRISES IN 12-MONTHS FOLLOW-UP GREEK STUDY

Objective: Few data have been published regarding the long-term prognosis of patients with hypertensive crises (hC). The aim of our study was to record the prevalence and clinical phenotype of patients with hypertensive urgencies (hU) and emergencies (hE) assessed in the emergency department (ED) and during hospitalization and a 12-month follow-up to record new events in a Greek tertiary hospital. Design and method: The registry population consisted of patients admitted to the ED with acute increase in blood pressure (BP) (systolic BP &gt; or = 180mmHg and/or diastolic BP &gt; or = 120mmHg) and depending on the presence or absence of acute hypertension-mediated target organ damage they were divided into the HE and the HU group, respectively. In all patients the demographic and clinical parameters were recorded for 12 months and there was a 12-month follow-up for new end points. Results: Out of 38,589 patients assessed in the ED during a period of 12 months, 353(0.91%) had hC, out of whom 256(72.5%) had HU and 97(27.5%) had hE. The mean age of all patients was 67.4 ± 12.9 years, 49% were males and 80% had a history of hypertension. During the study period 81 patients were excluded for not completing the follow-up. We stratified the total population of hC by age separating patients into two groups, e.g. &gt; or = 65 and &lt; 65 years old, and analyzed the composite end point consisting of deaths or hospitalizations caused by cardiovascular disease. Patients &gt; or = 65years old presented more composite events (36 vs 8 events, p = 0.019, hR for patients &gt; or = 65years 2.68, 95% CI 1.18–6.12). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease and diabetes mellitus. Conclusions: Our study implies that age &gt; or = 65years is an independent risk factor for deaths or hospitalizations caused by cardiovascular disease in patients with hC. There is an arising necessity for more intensive follow-up of these patients and the need for further research in this setting.

PS-BPC03-3: CARDIOVASCULAR EVENTS PREDICTION RELATED TO GENDER IN PATIENTS WITH HYPERTENSIVE EMERGENCIES IN 12-MONTHS FOLLOW-UP GREEK STUDY

Objective: Currently, epidemiological data on prognosis of patients with hypertensive crises (hC) are limited. The purpose of our study was to register the prevalence and clinical characteristics of patients with hypertensive urgencies (hU) and emergencies (hE) admitting to the emergency department (ED) and during hospitalization and a 12-month follow-up to record new end points in a Greek tertiary hospital. Design and method: The study population included patients reporting to the ED with acute rise in blood pressure (BP) (systolic BP &gt;or = 180mmHg and/or diastolic BP &gt;or = 120mmHg), categorizing as hE and hU depending on the presence or absence of acute hypertension-mediated target organ damage, respectively. In all patients the demographic and clinical information were registered for 12 consecutive months. In addition, there was a 12-month follow-up for new events. Results: Out of 38,589 patients assessed in the ED during a period of 12 months, 353(0.91%) had HC, out of whom 256(72.5%) had hU and 97(27.5%) had hE. The mean age of the hE patients was 73 ± 12years, 51.5% were males and 86.4% had a history of hypertension. During the study period 3 hE patients did not complete the follow-up. After stratification of hE population by gender, we created two subgroups, males and females, and analyzed the composite end point involving deaths or hospitalizations by cardiovascular causality. Men reported more composite events than women (21 vs 11 events, p = 0.042, hR for males 2.2, 95% CI 1.03–4.6). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease and diabetes mellitus. Conclusions: The results indicate male gender as an independent risk factor for deaths or hospitalizations caused by cardiovascular disease in patients with hE. Our registry highlights the commitment for a more intensive follow-up of hE patients, especially for men, and underlines the need for further research in this pathological entity.

Antimicrobial Prescribing before and after the Implementation of a Carbapenem-Focused Antimicrobial Stewardship Program in a Greek Tertiary Hospital during the COVID-19 Pandemic.

Irrational use of antimicrobials poses a significant risk for public health by aggravating antimicrobial resistance. The aim of this repeated point prevalence survey (PPS) was to evaluate the impact of a carbapenem-focused antimicrobial stewardship program (ASP) on overall antimicrobial use and quality of antimicrobial prescribing during the COVID-19 pandemic. All adult inpatients in the University Hospital of Heraklion in Greece were audited twice, before and after the implementation of the ASP, in October 2019 and October 2020, respectively. Patient characteristics, indications and diagnoses for antimicrobial administration, antimicrobials prescribed, and compliance with treatment guidelines were recorded. Of 743 adult inpatients on the days of the two surveys, 398 (53.6%) were on antimicrobials for 437 diagnoses. Following implementation of the ASP, there was substantial decrease in the utilization of carbapenems (4.9% of all antibacterials prescribed in the second PPS compared to 10.3% in the first PPS). A significant improvement was observed for all indicators of the quality of antimicrobial prescribing. Our study demonstrated a positive impact of an ASP implementation during the first stages of the COVID-19 pandemic on reducing the use of last-line antimicrobials and improving overall quality of antimicrobial prescribing.

Spa diversity and genetic characterization of t127 methicillin-resistant Staphylococcus aureus in a tertiary Greek hospital

Methicillin-resistant Staphylococcus aureus (MRSA) causes severe community and hospital acquired infections. Identification of staphylococcal cassette chromosome mec (SCCmec), multilocus-sequence typing, and sequencing of S. aureus protein A (spa) gene are used for MRSA typing. The aim was to investigate the spa types of MRSA isolates in a tertiary hospital in Greece and analyse the whole genome sequences of two t127 MRSA isolates. Totally, 39 MRSA isolates collected from July2019 to June 2020 in "Georgios Gennimatas" General Hospital of Thessaloniki, Greece, were included in the study. Identification and antimicrobial susceptibility testing were performed using VITEKII automated system, and spa typing was performed. A minimum spanning tree was used to display the spa type frequencies and the genetic distances among them. Two t127-MRSA isolates (IM-MRSA and PD-MRSA) were selected for WGS. Six isolates (15.4%) were resistant to mupirocin, 18 (46.2%) to fusidic acid, three (7.7%) to vancomycin and two (5.1%) to teicoplanin. Twenty-two different spa types were detected, with t002, t003, and t422 being the most frequent (5/39, 12.8% each), followed by t1994 (4/39, 10.3%). The isolates presented high genetic diversity and, taking into account the time between hospital admission and sampling, intrahospital spread did not occur. Even the two t127 isolates were assigned to different sequence types, ST9-XII-t127 and ST1-IVa-t127. Plasmids and genes conferring antimicrobial resistance and virulence were also identified. Various spa types were identified and together with the information about the time between hospital admission and sampling supports polyclonal MRSA spread in the hospital excluding a nosocomial infection. WGS provides a more detailed analysis distinguishing even the isolates belonging to the same spa type.

Cataract Surgery during the COVID-19 Pandemic: Insights from a Greek Tertiary Hospital.

Background: COVID-19 has affected everyday clinical practice, having an impact on the quality of healthcare provided, even in eye clinic departments. The aim of this study is to evaluate the consequences of this worldwide pandemic on cataract surgery in a Greek tertiary university hospital. Methods: A total of 805 patients were included in this study. The number of cataract surgeries (CS), the type, the unilateral or bilateral appearance as well as the stage of cataract were recorded for the months between January and June 2019 (pre-COVID period) and compared with the same period in 2021 (during the pandemic outbreak) in the Department of Ophthalmology of Thessaloniki General Hospital G. Papanikolaou. Results: A significant reduction in the number of CS as well as a significant increase in advanced and/or bilateral cataracts in 2021 compared to the pre-COVID period were observed. Conclusions: The COVID-19 pandemic has affected equally the value of ophthalmic interventions as well as the patients’ quality of life, being a powerful reminder of the significant physical and psychological benefits of CS, especially for older adults and patients with comorbidities.

The Demographic and Social Characteristics of Patients with Ocular Foreign Bodies in a Greek Tertiary Hospital.

PurposeTo present the demographic and social characteristics of patients with ocular foreign bodies (OFB), who visit the Ophthalmological Outpatient Department of a tertiary hospital in Athens, Greece.Patients and MethodsDuring the period January-March 2019, 5181 patients presented to the Ophthalmological Outpatient Department of our hospital, and 543 of them were diagnosed with an ocular foreign body. Moreover, 106 of them were interviewed about their demographic and social factors, regarding among others data about their occupation, level of education, nationality, family, and insurance status.ResultsThe patients with ocular foreign bodies were significantly younger compared to the rest of the examined patients (49.5±13.9 vs 56.3±17 years, p<0.001). Moreover, the ocular foreign bodies were more frequent in men compared to women (15.5% vs 5.0%, p<0.001) and in non-Greek patients (23.7% vs 9.2%, p<0.001). Regarding the social characteristics of the patients with ocular foreign bodies, we found that the majority of them were married, employed, insured, while their educational status was middle and high school. Furthermore, the vast majority of the patients practiced manual professions (73.1% of them).ConclusionWe documented that the introduction of an ocular foreign body is frequently encountered in the Outpatient Department of our tertiary hospital in Athens, Greece. We also demonstrated that these patients are younger, while they are more frequently men, of non-Greek origin, with an educational status of middle and high school, and their occupation is associated with manual labour.

GENDER AS A RISK FACTOR FOR CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTENSIVE CRISES AFTER 12-MONTH FOLLOW-UP: A GREEK REGISTRY

Objective: Currently, epidemiological data on prognosis of patients with hypertensive crises (HC) are limited. The purpose of our study was to register the prevalence and clinical characteristics of patients with hypertensive urgencies (HU) and emergencies (HE) admitting to the emergency department (ED) and during hospitalization and a 12-month follow-up to record new end points in a Greek tertiary hospital. Design and method: The study population included patients reporting to the ED with acute rise in blood pressure (BP) (systolic BP&gt; or = 180mmHg and/or diastolic BP&gt; or = 120mmHg), categorizing as HE and HU depending on the presence or absence of acute hypertension-mediated target organ damage, respectively. In all patients the demographic and clinical information were registered for 12 consecutive months. In addition, there was a 12-month follow-up for new events. Results: Out of 38,589 patients assessed in the ED during a period of 12 months, 353(0.91%) had HC, out of whom 256(72.5%) had HU and 97(27.5%) had HE. The mean age of the HE patients was 73 ± 12years, 51.5% were males and 86.4% had a history of hypertension. During the study period 3 HE patients did not complete the follow-up. After stratification of HE population by gender, we created two subgroups, males and females, and analyzed the composite end point involving deaths or hospitalizations by cardiovascular causality. Men reported more composite events than women (21 vs 11 events, p = 0.042, HR for males 2.2, 95% CI 1.03–4.6). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease and diabetes mellitus. Conclusions: The results indicate male gender as an independent risk factor for deaths or hospitalizations caused by cardiovascular disease in patients with HE. Our registry highlights the commitment for a more intensive follow-up of HE patients, especially for men, and underlines the need for further research in this pathological entity.

AGE AS A RISK FACTOR FOR CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTENSIVE CRISES AFTER 12-MONTH FOLLOW-UP: A GREEK REGISTRY

Objective: Few data have been published regarding the long-term prognosis of patients with hypertensive crises (HC). The aim of our study was to record the prevalence and clinical phenotype of patients with hypertensive urgencies (HU) and emergencies (HE) assessed in the emergency department (ED) and during ospitalisation and a 12-month follow-up to record new events in a Greek tertiary hospital. Design and method: The registry population consisted of patients admitted to the ED with acute increase in blood pressure (BP) (systolic BP&gt; or = 180mmHg and/or diastolic BP &gt; or = 120mmHg) and depending on the presence or absence of acute hypertension-mediated target organ damage they were divided into the HE and the HU group, respectively. In all patients the demographic and clinical parameters were recorded for 12 months and there was a 12-month follow-up for new end points. Results: Out of 38,589 patients assessed in the ED during a period of 12 months, 353(0.91%) had HC, out of whom 256(72.5%) had HU and 97(27.5%) had HE. The mean age of all patients was 67.4 ± 12.9 years, 49% were males and 80% had a history of hypertension. During the study period 81 patients were excluded for not completing the follow-up. We stratified the total population of HC by age separating patients into two groups, e.g. &gt; or = 65 and &lt; 65 years old, and ospital the composite end point consisting of deaths or ospitalisations caused by cardiovascular disease. Patients &gt; or = 65years old presented more composite events (36 vs 8 events, p = 0.019, HR for patients &gt; or = 65years 2.68, 95% CI 1.18–6.12). Cox regression models were adjusted for age, gender, cardiovascular disease, chronic kidney disease and diabetes mellitus. Conclusions: Our study implies that age &gt; or = 65years is an independent risk factor for deaths or ospitalisations caused by cardiovascular disease in patients with HC. There is an arising necessity for more intensive follow-up of these patients and the need for further research in this setting.

Quality-adjusted life years in macular oedema due to age-related macular degeneration, diabetes and central retinal vein occlusion: the impact of anti-VEGF agents in a tertiary centre in Greece.

Neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DME), and macular oedema due to central retinal vein occlusion (CRVO) are leading causes of vision loss, currently managed with anti-vascular endothelial growth factor injections (anti-VEGF). The aim of this study was to calculate QALYs in patients with nAMD, DME, and CRVO treated with anti-VEGF agents (QALYs+) in a Greek tertiary hospital setting and compare them to theoretical QALYs that the patients would have without treatment (QALYs-). The study included 143 treatment-naive patients with macular oedema due to nAMD (n = 79), DME (n = 57), and CRVO (n = 7), who received anti-VEGF injections as monotherapy according to the Treat-and-Extend (T&E) protocol. The anti-VEGF agents were ranibizumab and aflibercept in equivalent fractions. QALYs where calculated by the formula QALY = Utility Value × Time, where "Time" refers to the follow-up period of the study. For QALYs-, we assumed that visual acuity remained unchanged during this period. Mean follow-up time was 1.3 ± 1.2years in the nAMD group, 1 ± 1.3years in the DME group, and 0.5 ± 1years in the CRVO group. There was no statistically significant difference between QALYs- and QALYs+ in all three ocular pathologies for the study period (p > 0.05 for each of the three statistical tests performed). Possible explanations for the lack of significant difference between QALYs - and QALYs + in nAMD, DME, and CRVO groups, may be the short time horizon used in this analysis, the inclusion of data from the better-seeing eye (BSE) and the specific socio-economic, geographical and health care characteristics of this rural Greek area.

Changes in molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in the intensive care units of a Greek hospital, 2018-2021.

The spread of multi-drug resistant (MDR) Gram-negative bacteria, including Klebsiella pneumoniae, constitutes a global threat. The most frequent mechanism of acquired carbapenem resistance is the production of carbapenemases, especially KPC, NDM, VIM, IMP and OXA-48. We analyzed the epidemiological trend of carbapenem resistance genes of carbapenem-resistant K. pneumoniae (CRKP) strains isolated from critically ill patients in a Greek tertiary hospital. The study included 150 CRKP isolates collected from 116 (77.4%) patients hospitalized in the adult ICU and 17 (11.3%) each in the pediatric and the two neonatal ICUs between March 2018 and March 2021. Identification and antimicrobial susceptibility testing were performed using VITEK-2. A multiplex lateral flow immunoassay was used for the detection of carbapenemases, while the detection of bla VIM, bla KPC, bla NDM, bla IMP and bla OXA-48-like genes was achieved by multiplex PCR. The bla NDM was mainly detected in adults (54/116, 46.9%), while in children the most often detected gene was bla KPC (24/34, 70.6%). The predominant carbapenem resistance gene during 2018-2019 was bla KPC alone or in combination with bla VIM, reaching 44.4% in 2019, while during 2020-2021 the detection of bla NDM prevailed significantly, reaching 45.5 and 60.7% for 2020 and 2021, respectively. A shift in the molecular epidemiology of CRKP was seen during 2018-2021, which is probably associated with the recent excessive empiric use of newer antimicrobials. Surveillance studies and proper and strict implementation of infection control measures are highly needed to decrease the spread of MDR bacteria, including CRKP.

Diabetic retinopathy in Greece: prevalence and risk factors studied in the medical retina clinic of a Greek tertiary hospital.

To determine the prevalence of diabetic retinopathy (DR) and diabetic macular edema (DME) in a cohort of Greek diabetic patients and identify possible risk factors. This is a non-interventional, cross-sectional study of 300 diabetic Greek patients attending the Ophthalmology Department of a tertiary hospital. Clinical and imaging data were recorded and statistical analysis was performed. Confidence intervals (CI) at 95% and statistically significant p values ≤ 0.05 were set. A total of 300 diabetic patients were included. Of these patients, 21 (7%) were diagnosed with diabetes mellitus (DM) type I and 279 (93%) with DM type II. The average duration of diabetes was 15 ± 9.4years (95% CI 13.9-16.1) and the mean level of HbA1c was 7.2 ± 1.3 (95% CI 7.1-7.4) overall.Prevalence of DR was 38.7% (116 patients), only 15 patients (5%) had proliferative DR and DME was detected in 19 patients (6.3%). In DM type I patients, 52.4% had DR and 9.5% had DME, while in the DM type II group, 37.6% had DR and 6.1% had DME. Binary logistic regression analysis identified duration of diabetes, increased HbA1c and hypertriglyceridemia as potential risk factors. This study is the first one to present the extent and severity of DR and DME in a Greek cohort of diabetic patients and also identify risk factors associated with these entities. Our findings highlight the significance of a properly organized national screening program for the early detection and management of the vision-threatening complications of DR.

Validation of the Trauma and Injury Severity Score for Prediction of Mortality in a Greek Trauma Population.

Although the Trauma and Injury Severity Score (TRISS) has been extensively used for mortality risk adjustment in trauma, its applicability in contemporary trauma populations is increasingly questioned. The study aimed to evaluate the predictive performance of the TRISS in its original and revised version and compare these with a recalibrated version, including current data from a Greek trauma population. This is a retrospective cohort study of admitted trauma patients conducted in two tertiary Greek hospitals from January 2016 to December 2018. The model algorithm was calculated based on the Major Trauma Outcome Study coefficients (TRISSMTOS), the National Trauma Data Bank coefficients (TRISSNTDB), and reweighted coefficients of logistic regression obtained from a Greek trauma dataset (TRISSGrTD). The primary endpoint was inhospital mortality. Models' prediction was performed using discrimination and calibration statistics. A total of 8,988 trauma patients were included, of whom 854 died (9.5%). The TRISSMTOS displayed excellent discrimination with an area under the curve (AUC) of 0.912 (95% CI 0.902-0.923) and comparable with TRISSNTDB (AUC = 0.908, 95% CI 0.897-0.919, p = .1195). Calibration of both models was poor (Hosmer-Lemeshow test p < .001), tending to underestimate the probability of mortality across almost all risk groups. The TRISSGrTD resulted in statistically significant improvement in discrimination (AUC = 0.927, 95% CI 0.918-0.936, p < .0001) and acceptable calibration (Hosmer-Lemeshow test p = .113). In this cohort of Greek trauma patients, the performance of the original TRISS was suboptimal, and there was no evidence that it has benefited from its latest revision. By contrast, a strong case exists for supporting a locally recalibrated version to render the TRISS applicable for mortality prediction and performance benchmarking.

Emergence of ST39 carbapenem-resistant Klebsiella pneumoniae producing VIM-1 and KPC-2

IntroductionCarbapenem-resistant Klebsiella pneumoniae (CRKP) causes life-threatening hospital-acquired infections. KPC and VIM carbapenemase production is the main molecular mechanism for carbapenem resistance. The aim of the current study was the genetic characterization of four ST39 CRKP isolates simultaneously producing VIM-1 and KPC-2, obtained in a Greek tertiary hospital. MethodsIdentification and antimicrobial susceptibility testing were performed through VITEK 2. Multiplex PCR, multiplex lateral flow immunoassay, phenotypic tests and next generation sequencing were applied. The sequence reads were de novo assembled and annotated, while antimicrobial resistance genes and plasmids were identified using bioinformatics software. Genomic comparison and core genome single-nucleotide polymorphism-based phylogenetic analysis were also performed. ResultsThree isolates were pandrug-resistant, and one was extensively drug-resistant; they all carried blaVIM-1 and blaKPC-2 genes and were assigned to ST39. BlaVIM-1 was integrated in a class 1 integron. They all harboured many antimicrobial resistance genes and various plasmids. The mgrB gene of all isolates was disrupted by an insertion sequence (ISKpn14). Genome comparison and phylogenetic analysis revealed that the isolates were closely related. ConclusionTo our knowledge this is the first report on detection of CRKP ST39 isolates simultaneously producing VIM-1 and KPC-2 in addition to colistin resistance. The knowledge of the clonal relatedness of the isolates can lead to the implementation of strict infection control measures absolutely needed to eliminate their spread.