Ceftazidime/avibactam in the era of carbapenemase-producing Klebsiella pneumoniae: experience from a national registry study.

BACKGROUND: Infections caused by KPC-producing Klebsiella pneumoniae (Kp) are associated with high mortality. Therefore, new treatment options are urgently required. OBJECTIVES: To assess the outcomes and predictors of mortality in patients with KPC- or OXA-48-Kp infections treated with ceftazidime/avibactam with an emphasis on KPC-Kp bloodstream infections (BSIs). METHODS: A multicentre prospective observational study was conducted between January 2018 and March 2019. Patients with KPC- or OXA-48-Kp infections treated with ceftazidime/avibactam were included in the analysis. The subgroup of patients with KPC-Kp BSIs treated with ceftazidime/avibactam was matched by propensity score with a cohort of patients whose KPC-Kp BSIs had been treated with agents other than ceftazidime/avibactam with in vitro activity. RESULTS: One hundred and forty-seven patients were identified; 140 were infected with KPC producers and 7 with OXA-48 producers. For targeted therapy, 68 (46.3%) patients received monotherapy with ceftazidime/avibactam and 79 (53.7%) patients received ceftazidime/avibactam in combination with at least another active agent. The 14 and 28 day mortality rates were 9% and 20%, respectively. The 28 day mortality among the 71 patients with KPC-Kp BSIs treated with ceftazidime/avibactam was significantly lower than that observed in the 71 matched patients, whose KPC-Kp BSIs had been treated with agents other than ceftazidime/avibactam (18.3% versus 40.8%; P = 0.005). In the Cox proportional hazards model, ultimately fatal disease, rapidly fatal disease and Charlson comorbidity index ≥2 were independent predictors of death, whereas treatment with ceftazidime/avibactam-containing regimens was the only independent predictor of survival. CONCLUSIONS: Ceftazidime/avibactam appears to be an effective treatment against serious infections caused by KPC-Kp.

Effect of genotype, gender and feed restriction on growth, meat quality and the occurrence of white striping and wooden breast in broiler chickens.

Due to their importance for the control of meat quality in broiler chickens, the present study aimed at identifying the factors associated with the occurrence of myopathies and characterizing the meat properties when affected by myopathies. To this aim, a total of 768 broiler chickens were reared until slaughter (46 d) to evaluate the effect of genotype, gender, and feeding regime (ad libitum vs. restricted rate, 80% from 13 to 21 d of age) on performance and meat quality. Standard broilers were heavier (3,270 vs. 3,139 g; P<0.001) and showed lower feed conversion (1.56 vs. 1.61; P<0.001) than the high-yield broilers. Males showed higher final live weight (3,492 vs. 2,845 g) and lower feed conversion (1.54 vs. 1.63) than females (P<0.001). Feed restriction decreased final live weight (3,194 vs. 3,142 g; P<0.01) and feed conversion (1.60 vs. 1.57; P<0.01) compared to ad libitum feeding. At gross examination, feed restriction tended to increase white-striped breasts (69.5 vs. 79.5%; P<0.10), whereas females showed less wooden breasts than males (8.0 vs. 16.3%; P<0.05). White-striped fillets had higher pHu (5.87 vs. 5.83), and lower a* (-0.81 vs. -0.59) and b* color indexes (13.7 vs. 14.5) (P<0.05), whereas wooden breast fillets exhibited higher cooking losses (25.6 vs. 22.1%) and AK-shear force (4.23 vs. 2.84 kg/g) compared with normal fillets (P<0.001). At histological examination, 3.1% of pectoralis major were normal, 26.6% mildly degenerated, 45.3% moderately degenerated, and 25.0% severely degenerated. In conclusion, genotype had a moderate effect on growth without modifying myopathy occurrence. In contrast, gender and feed restriction affected performance, meat quality, and breast abnormalities.

Effects of floor type, stocking density, slaughter age and gender on productive and qualitative traits of rabbits reared in collective pens.

At 34 days of age, 376 crossbred rabbits of both sexes were housed in 16 open-top collective pens (1.68 m2) according to a 2×2×2 factorial arrangement with two types of pen floor (plastic v. wooden slatted), two stocking densities (12 v. 16 animals/m2) and two slaughter ages (76 v. 83 days). The rabbits were examined for growth performance, slaughter results and meat quality. The effect of gender was also examined. The percentage of rabbits with wounds due to aggression varied with stocking density (8.2% v. 26.2% for 12 v. 16 animals/m2; P⩽0.001), slaughter age (15.0% v. 22.0% at 76 v. 83 days; P⩽0.10) and gender (11.3% v. 25.8% for females v. males; P⩽0.001). Rearing rabbits on a plastic rather than a wooden slatted floor promoted slaughter weight (2795 v. 2567 g; P⩽0.001), dressing percentage (61.4% v. 60.9%; P⩽0.01), dissectible fat (2.4% v. 2.0%; P⩽0.01) and hind leg muscle-to-bone ratio (5.81 v. 5.35; P⩽0.001). Increased stocking density impaired daily growth (38.5 v. 35.9 g/day; P⩽0.05) and feed intake (140 v. 134 g/day; P⩽0.01) during the second period (55 days to slaughter) and decreased slaughter weight (2725 v. 2637 g; P⩽0.01). At the older slaughter age, the feed conversion ratio was impaired (2.98 v. 3.18; P⩽0.001); the slaughter weight (2574 g v. 2788 g; P⩽0.001), dissectible fat (2.0% v. 2.4%; P⩽0.01) and hind leg muscle-to-bone ratio (5.41 v. 5.75; P⩽0.01) increased; meat thawing losses, cooking losses and shear force decreased (P⩽0.05). The main differences between the females and males were found in the slaughter for transport losses (2.6% v. 2.2%; P⩽0.01) and longissimus lumborum proportions (13.0% v. 12.4%; P⩽0.01). In conclusion, the growth performance of pen-housed rabbits was largely determined by the type of floor and less affected by stocking density. The meat quality depended on ontogenetic factors, such as slaughter age and gender, and not on housing conditions. The differences in the percentages of wounded animals owing to experimental factors deserve further investigation from the perspective of animal welfare issues.

Housing of growing rabbits in individual, bicellular and collective cages: fear level and behavioural patterns.

During growth (27 to 75 days of age), a total of 384 rabbits were kept in 72 individual cages, 48 bicellular cages (2 rabbits/cage) and 24 collective cages (9 rabbits/cage). To evaluate the effects of the housing system on the fear level and behavioural patterns of rabbits at the two ages (39 to 45 days and 66 to 73 days), a tonic immobility test and an open-field test were conducted and their behaviour was video recorded. In the tonic immobility test, the number of attempts to induce immobility (1.38) was lower, and the duration of immobility (47.8 s) was higher (0.05 < P < 0.01) in the rabbits housed in individual cages than in those kept in bicellular (1.72 attempts and 25.0 s of immobility) and collective cages (1.99 attempts and 25.0 s of immobility). During the open-field test, the rabbits from individual and bicellular cages showed higher latency (38.8 and 40.3 v. 27.0 s), a lower number of total (73.3 and 81.7 v. 91.9) and central displacements (3.6 and 2.8 v. 5.4) and a shorter running time (11.8 and 13.6 s v. 17.7 s) and the time biting the pen (5.5 and 9.1 s v. 28.2 s) compared with the rabbits kept in collective cages (0.05 < P < 0.001). During the 24-h video recording, the rabbits in individual and bicellular cages spent less time allogrooming (0.34% and 0.19% v. 1.44%), moving (0.74% and 0.60% v. 1.32%) and running (0.08% and 0.03% v. 0.21%) than the rabbits in the collective cages (0.01 < P < 0.001). The lowest numbers of alerts and hops were observed in the rabbits kept in bicellular cages. With increasing age, a lower number of rabbits were sensitive to the immobility test and more rabbits entered the pen spontaneously during the open-field test (P < 0.001). In conclusion, the rabbits in individual cages exhibited the highest fear level and incomplete behavioural patterns; the rabbits housed in collective cages showed the lowest fear levels and had the possibility of expressing a wider range of behaviour; and the rabbits in bicellular cages exhibited an inconsistent pattern of fear in the tonic immobility and open-field tests. Probably, these rabbits were in a less stressful condition compared with animals in individual cages because social contacts were allowed, even if freedom of movement was more limited.