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Management of patients with infections caused by multidrug-resistant organisms is challenging and requires a multidisciplinary approach to achieve successful clinical outcomes. The aim of this paper is to provide recommendations for the diagnosis and optimal management of these infections, with a focus on targeted antibiotic therapy. The document was produced by a panel of experts nominated by the five endorsing Italian societies, namely the Italian Association of Clinical Microbiologists (AMCLI), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Society of Microbiology (SIM), the Italian Society of Infectious and Tropical Diseases (SIMIT) and the Italian Society of Anti-Infective Therapy (SITA). Population, Intervention, Comparison and Outcomes (PICO) questions about microbiological diagnosis, pharmacological strategies and targeted antibiotic therapy were addressed for the following pathogens: carbapenem-resistant Enterobacterales; carbapenem-resistant Pseudomonas aeruginosa; carbapenem-resistant Acinetobacter baumannii; and methicillin-resistant Staphylococcus aureus. A systematic review of the literature published from January 2011 to November 2020 was guided by the PICO strategy. As data from randomised controlled trials (RCTs) were expected to be limited, observational studies were also reviewed. The certainty of evidence was classified using the GRADE approach. Recommendations were classified as strong or conditional. Detailed recommendations were formulated for each pathogen. The majority of available RCTs have serious risk of bias, and many observational studies have several limitations, including small sample size, retrospective design and presence of confounders. Thus, some recommendations are based on low or very-low certainty of evidence. Importantly, these recommendations should be continually updated to reflect emerging evidence from clinical studies and real-world experience.

Acute bacterial skin and skin structure infections (ABSSSIs) are associated with considerable morbidity and a heavy healthcare burden. The primary objectives of this two-phase study were to determine the incidence of skin infections and ABSSSIs in hospitalized patients (Phase A), and to describe the characteristics and treatment of hospitalized patients with ABSSSIs (Phase B).This non-interventional, retrospective study was based on data collected from adult patients hospitalized for skin infections in six European countries (Czech Republic, Greece, Italy, Portugal, Russia and Spain) between January 2014 and June 2016.In Phase A, the total hospital incidence of skin infections and ABSSSIs was 2.4 and 1.8 per 1000 patient-days, respectively. Overall, 73.6% of 50,469 hospitalizations for skin infections were for ABSSSIs. Among the 750 patients with ABSSSIs included in Phase B, Gram-positive bacteria were isolated in 24.9%, most commonly methicillin-susceptible Staphylococcus aureus (11.5%). Empirical therapy was administered to 98.1% of patients, most often with a penicillin, with or without a β-lactamase inhibitor (42.1%). Complete cure was achieved in 46.5% and 34.5% of patients after initial treatment and treatment modification, respectively. Overall, 22.7% of patients had at least one additional ABSSSI-related hospitalization, 47.1% of patients visited the emergency room, 19.3% of patients visited primary care clinics, and 34.8% of patients visited a specialist.Treatment of ABSSSIs in Europe is associated with a heavy healthcare burden, highlighting the need for optimized management strategies that may reduce healthcare utilization.

Among the Gram-positive organisms, meticillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecium represent the biggest therapeutic hurdles. The evolution of MRSA exemplifies the genetic adaptation of an organism into a first-class multidrug-resistant pathogen. Glycopeptides such as vancomycin have been the treatment of choice for MRSA, but poor outcomes have frequently been reported, particularly among isolates with higher minimum inhibitory concentrations (MICs) within the susceptible range (< or =2 mg/L). Further more, vancomycin's limitations as an antibacterial agent include slow bactericidal activity and relatively poor tissue penetration. Inadequate dosing may, however, contribute to vancomycin's poor performance; the standard recommendation for trough concentrations of 5-10 mg/L is inadequate for serious infections such as bacteraemia and endocarditis. Trough levels of 15-20 mg/L are probably necessary; however they are often associated with increased nephrotoxicity. Despite the recent dramatic reduction in antibiotic research by pharmaceutical companies, a few compounds have been developed to treat Gram-positive infections. Quinupristin-dalfopristin, although shown to have in vitro activity against MRSA, is not approved by the US Food and Drug Administration for the treatment of MRSA, and cannot be recommended for the treatment of S. aureus bacteraemia, except under exceptional circumstances. Although linezolid and tigecycline may be useful in specific situations, they cannot be routinely recommended for the treatment of MRSA bacteraemia because of safety concerns and very limited available clinical data. Daptomycin has recently been proven to be effective and well tolerated for meticillin-sensitive S. aureus and MRSA bacteraemia, including right-sided endocarditis.

030 STREPTOCOCCUS BOVIS (SB) FECAL CARRIAGE (SBFC) AND COLONIC TUMORS IN FRANCE: AN UPDATE C. Chirouze1 *, G. Couetdic1, V. Baty2, X. Duval3, P. Tattevin4, T. Aparicio3, M. Pagenault4, F. Carbonnel1, I. Patry1, B. Hoen1. 1University hospital of Besancon, Dpt of Infectious Diseases, Besancon, France, 2Clinique mutualiste, Dpt of gastroenterolgy, Lyon, France, 3Groupe hospitalier Bichat Claude Bernard, Dpt of gastroenterolgy, Paris, France, 4University hospital Pontchaillou, Dpt of gastroenterolgy, Rennes, France