Data from the literature indicates that the human ocular surface is inhabited by diverse commensal microbial communities, crucial for maintaining the homeostasis of healthy eyes. The ocular surface microbiome (OSM) plays a protective immunoregulatory role against pathogenic species, and any dysbiosis may contribute to disease onset. Traditional culture methods, employed in both clinical and research settings, have limitations. Certain pathogens are challenging to grow under routine conditions, leading to lower bacterial detection compared to next-generation sequencing (NGS). Despite the extensive use of NGS in published studies, variable results are observed. This variability may be attributed to factors such as limited sample size, differences in analytical procedures (from sampling to sequencing platforms), age and gender variations in included populations, diverse inclusion criteria, and geographical differences. These factors collectively impact the generated genomic data. Moreover, consistent reports on diversity indices are lacking in various published studies, whereas these indices could enhance the definition of OSM changes in disease states. Therefore, this review emphasizes the current imperative to standardize OSM sample collection, preparation, and analysis. This standardization is vital for accurately defining the composition of OSM in both healthy and pathogenic conditions and facilitating meaningful comparisons among studies.

Beta-lactams are extensively used antibiotics known for their safety and effectiveness. The rise in patients who receive care in outpatient settings has increased the interest in subcutaneous administration (SA). The aim of the study is to assess the safety and pharmacokinetic (PK) profiles of SA of beta-lactams compared with other routes. The protocol was registered in the PROSPERO database and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Online databases were searched, and the quality of the eligible studies was assessed. The data extracted related to adverse events (AEs) and PK were summarised narratively. Sixteen studies were included. The reported AEs were generally mild, localised, and temporary. Although SA and intravenous administration had similar PK profiles, SA resulted in lower peak drug concentrations and slower absorption. Heterogeneity in the populations, medication delivery, outcome measures, and methodological quality emerged across the studies. The mild severity of AEs suggests that SA is a viable route. Additionally, SA appears to demonstrate effective PK profiles and delays drug release, with potential to reduce the dosing frequency and prolong the therapeutic effects. SA of beta-lactams is a promising viable alternative to intravenous administration, potentially enhancing treatment in the outpatient and long-term care settings.

Chlamydia pneumoniae is the etiologic agent of respiratory tract infections in humans, including community-acquired pneumonia, and has been associated with atherosclerotic cardiovascular diseases. The present systematic review of reviews aimed at answering important questions on the involvement of C. pneumoniae in the pathogenesis of atherosclerosis, its cellular and molecular mechanisms, and whether there is evidence of a causal relationship. The databases PubMed/Medline, Scopus, and Web of Science were searched for all review articles published from 2003 to the end of 2023. A total of 27 reviews, systematic reviews, and systematic reviews with metanalysis were included. Overall, current evidence suggests that C. pneumoniae is a biologically plausible candidate for the causation of atherosclerosis, albeit not all the 4 Koch postulates are fulfilled; oxidative stress and inflammation are the most likely pathogenic mechanisms mediated by C. pneumoniae. However, it is still unclear how the persistent form, responsible for chronic inflammation, fits into this etiopathogenetic scenario. In the future, the newly-designed transformation systems for the genomic manipulation of C. pneumoniae will surely help expand our knowledge on the role of this pathogen in atherogenesis.

Mycoplasma pneumoniae infection is a manifestation of pneumonia, which can be combined with multiple bacterial flora infection at the same time. This study explored the epidemiological characteristics and related risk factors of mixed infection in children with mycoplasma pneumonia (MP). 462 children with MP were enrolled and divided into simple infection and mixed infection groups. The mixed infection group was further divided into concurrent bacteria, virus, and chlamydia groups. Clinical data were collected to explore the epidemiological characteristics, and the related factors were analyzed by logistic regression. The co-infection rate was the highest in the mixed infection group (50.27%). Children under 1 year of age had the highest bacterial co-infection rate (40.95%). Children aged 1-5 years and >5 years had the highest viral co-infection rate (39.53%, 51.51%). Patients were more likely to be infected with virus from September to November (52.73%), and patients were more likely to be infected with bacteria from December to February (52.73%). The independent risk factors for concurrent viral, bacterial, and chlamydia infections were extrapulmonary complications, fever >10 days, high white blood cell count (WBC), and age, respectively. Conclusion: analysis of the epidemiological characteristics and risk factors of mixed infection in children with MP can provide guidance for clinicians to formulate a more reasonable diagnosis and treatment plan, reduce the occurrence of mixed infection, and improve the treatment effect.

Numerous drugs are known to alter the colour of human body fluids. Although drug-induced bronchial secretions staining is normally harmless, it may frighten the patient and could lead to unnecessary clinical inquiries. Cefiderocol is often removed renally as an unmodified drug; bronchial secretion staining has not been seen at doses used in clinical practice. We report a possible first case of bronchoalveolar lavage staining occurred during Cefiderocol treatment in a critical patient.

Pre-exposure prophylaxis for COVID-19 with Tixagevimab/Cilgavimab in immunocompromised patients has reduced the risk of breakthrough infection, disease, hospitalization, and COVID-19 related mortality. However, the advent of the Kraken variant (XBB.1.5) has limited the use of this monoclonal antibody, based on poor efficacy in in vitro studies The objective of the study was to evaluate the risk of breakthrough infection, symptomatic disease, hospitalization, intensive care admission, and COVID-19 related death in kidney transplant recipients receiving pre-exposure prophylaxis with Tixagevimab/Cilgavimab for COVID-19 in the era of the Kraken variant (XBB.1.5). In a prospective, observational study, we enrolled kidney transplant patients undergoing pre-exposure prophylaxis for COVID-19 with Tixagevimab/Cilgavimab at the Division of Infectious Diseases of Federico II University of Naples from February 2023 to August 2023. Each patient subsequently underwent a six-month follow-up with symptom monitoring and surveillance nasopharyngeal swab for SARS-CoV-2 RNA detection every 30 days, regardless of symptoms. Thirty-four kidney transplant patients were enrolled, and in the follow-up period only one tested positive for the nasopharyngeal swab for SARSCoV-2 research with asymptomatic infection and virological recovery on the eighth day after diagnosis of infection. Therefore, no patient developed disease, no patient needed hospitalization, and no death occurred. No adverse drug reaction to Tixagevimab/Cilgavimab occurred. Our data, although derived from a limited and uncontrolled sample, show the potential of Tixagevimab/Cilgavimab as a valid and viable therapeutic strategy in pre-exposure prophylaxis for immunocompromised patients. These findings highlight the importance of conducting clinical studies on this topic.

Some members of the Chlamydiales order, particularly Chlamydia, Waddlia, and Parachlamydia, have been associated with adverse pregnancy outcomes in humans and animals. Recently, the existence of another Chlamydia-like bacterium, namely Simkania, has been confirmed in the genitalia of adult females, but its possible pathogenic role has not yet been examined. In comparison to other members of Chlamydiales, the presence of Parachlamydia in the urogenitalia of human females and its involvement in obstetrical complications is less convincingly investigated and still a matter of debate. This study aims to examine the existence of Parachlamydia and to assess its prevalence in the genital and urinary tracts of a population of women by using the polymerase chain reaction (PCR)-based methodology. Endocervical and vaginal specimens were collected from 103 married females, while only 60 females agreed to give urine samples. Among the examined population, 29 women (about 28%) had experienced miscarriage. Clinical samples were tested for Parachlamydia DNA by species-specific PCR assay. Nucleic acids of P. acanthamoebae were not detected in any endocervical, vaginal, and urine specimens tested. This investigation could not bring evidence for the existence of Parachlamydia in the urogenitalia of the female cohort tested. The role of Parachlamydia as a probable emerging obstetrical agent remains to be explained in future controlled studies targeting a larger number of females with prior unsuccessful pregnancies.

The SARS-CoV-2 virus appeared and was discovered in the year 2019, marking its significance. The spread of the virus also had serious consequences for national safety; members of the Police and Fire Brigade contracted the infection and therefore the efficiency of their operational activity decreased. Since the beginning of 2020, the biological laboratory of the Chemical Biological Radiological Nuclear (CBRN) unit of Milan's Fire Brigade headquarters performed thousands of serological tests to monitor the health of the Fire Brigade and various branches of the Police Forces. The aim of this study is to evaluate the degree of concordance and interchangeability between a lateral flow immunochromatographic assay (LFIA) and an automated laboratory immunoassay with different viral targets by comparing the data gathered from a sample group of firemen and policemen participating in a serological screening campaign. The serological tests used in this study are the LYHER® Novel Coronavirus (2019-nCoV) IgM/IgG Antibody Combo Test Kit and the Elecsys® Anti-SARS-CoV-2. The degree of concordance was computed using Cohen's kappa, with a result of 0.78 (CI 95%, 0.661-0.898), which is equivalent to a substantial agreement measured between the two tests. Additionally, the sensitivity of both serological tests was found to be 97%.

The flu outbreak after the coronavirus disease 2019 (COVID-19) pandemic has put a heavy burden on the medical system. We aimed to investigate the infection indicators and risk factors for influenza A virus, with the intention of offering valuable insights for clinical diagnosis and treatment. A total of 1590 throat swabs were collected from patients with influenza-like illness admitted to our hospital for treatment in March 2023. Influenza virus in infected patients was detected by the rapid antigen method and qPCR. We used statistical methods to compare clinical manifestations and laboratory tests between positive and negative patients. Among the 1590 influenza-like illness patients, 1004 (63.1%) were infected with influenza A, mainly children aged 0-9 years (52.8%); more males than females were infected, and the main clinical symptoms were fever, cough, diarrhea, nausea and vomiting, and muscle soreness. The leukocyte (WBC), lymphocyte (LYM), eosinophil (EOS), platelet (PLT), C-reactive protein (CRP) and lymphocyte/monocyte (LMR) levels in the positive group were lower than those in the negative group, while the neutrophil (NEU) and monocyte (MON) levels were higher than those in the negative group (P<0.05). Multivariate logistic regression analysis showed that age 0-9 years, cough, antiviral treatment time>48 h, and reduced PLT and LMR levels were independent risk factors for influenza A patients.

Carbapenemase-producing Enterobacteriales (CPE) represent an emerging threat for global public health and a serious problem for clinicians due to the limited available treatment options. The emergence of CPE has been recently described worldwide by describing different antimicrobial mechanisms. Here, we describe a CPE carrying dual-carbapenemase isolated in Italy and we provide a deep characterization of the antimicrobial resistance genes, virulence-factors and prophage regions within the genome.

Only toxigenic serogroups O1 and O139 Vibrio cholerae have been associated with widespread cholera epidemics. Other serogroups (non-O1/non-O139 Vibrio cholerae or NOVC) most often cause sporadic gastrointestinal manifestations. Rarely, NOVC can result in severe extraintestinal manifestations in immunocompromised hosts. Although the presence of Vibrio cholerae is well documented in Mediterranean waters, it is not routinely tested in food sources in European countries. Here we report the case of a 46-year-old woman with a history of Von Hippel-Lindau syndrome who had previously undergone major hepatic and pancreatic surgeries and was on Everolimus, which caused neutropenia and mucositis. She was admitted to our emergency department with fever, chills, nausea, and abdominal pain, and was diagnosed with sepsis and acute cholangitis. Empiric piperacillin/ tazobactam was started, and blood cultures later identified non-O1/non-O139 Vibrio cholerae, linked to recent oyster consumption. The ongoing therapy resulted in initial clinical stabilization and microbiological clearance. However, fever persisted, along with the onset of diarrhoea (with negative stool cultures), leukopenia, thrombocytopenia, and elevated CRP levels. Ciprofloxacin was then added to the regimen, resulting in improved condition, fever resolution, normalization of bowel function, relief from abdominal pain, and radiological resolution of cholangitis. She was discharged in stable condition after 15 days of treatment. NOVC systemic infections are rising globally. Physicians should think of this pathogen in patients with risk factors, suggestive symptoms, and seafood ingestion. The literature shows significant heterogeneity in antimicrobial strategies, but association of beta-lactam antibiotic with ciprofloxacin proved to be an effective choice.

The time of re-implantation of removed CIED for local infection or endocarditis has been debated because no randomized studies are available. Many authors prefer to delay reimplantation to the time of blood culture negative or clinical stability. In this case report we describe the case of E. faecalis CIED endocarditis treated with the combination ampicillin plus ceftobiprole and one-stage removal and re-implantation with early follow-up without relapse of infection. In case of E. faecalis infection, we hypothesize that ampicillin plus ceftobiprole combination might have bactericidal and anti-biofilm activity, therefore allowing one state re-implantation without relapse.

Microbiota defines all microorganisms that are vital for our immunological, hormonal, and metabolic homeostasis by living symbiotically in different parts of our body. On the other hand, the microbiome is a collection of microorganisms that can be detected together. The lungs are constantly exposed to airborne microorganisms found in the upper respiratory tract. Until recently, the lower respiratory tract was considered sterile, as bacteria were rarely isolated from the lungs by conventional culture methods. Most chronic inflammatory lung diseases are caused by dysregulation of the lung microbiota, which has been discussed in many review papers. However, little is known whether microbiota dysymbiosis is a consequence or a cause of these diseases. In this review, we provide an overview of lung microbiota and lung immunity.

In this fast-evolving era of antiretroviral chemotherapy, the single-tablet regimen (STR) BIC/FTC/TAF, an oral regimen including a potent INSTI (strand-transfer integrase inhibitors) like Bictegravir plus two different NRTIs (Nucleoside Reverse Transcriptase Inhibitors), is increasingly challenged by new oral combinations. Furthermore, long-acting injectable drugs have also been developed and others are being under development. Notably, no new STR consisting of two NRTIs plus a 3rd drug like an INSTI are in the industrial pipeline. However, many People with HIV (PWH) still need potent multidrug regimens, especially those newly diagnosed with advanced HIV (defined late presenters), which represent over 50% of new infections. The asymmetrical comparison between a potent STR like BIC/FTC/TAF and new combinations is difficult to make. By comparing the STR BIC/FTC/TAF, the most representative of potent multi-drug regimens, with all approved new options, we can distinguish some features that are worthy of attention. The stronger genetic barrier and the better forgiveness resulting from BIC/FTC/TAF is self-evident, with the extra coverage here provided by the remarkable pharmacologic properties of TAF, consisting of great diffusion into target cells, long persistence at high concentration, and a much lower plasma exposure. On the pharmacokinetic side, the main difference is between oral and long-acting injectable regimens. Pk of long-acting injectables consists of a single peak (followed by a slow decrease in drug concentration), while with oral regimens daily C max - C trough fluctuations take place instead. The latter property of oral regimens should be taken into account whenever the Pk exposure is suboptimal, as it might allow inhibition of the growth of quasi-species that are less sensitive. The choice of the new combinations including long acting injectables instead of the STR BIC/FTC/TAF might be made for sure for several reasons, but compared to the past when combinations included TDF, toxicity by TAF is no longer an issue today. The size of the tablet and its net weight may be disproportional to the number of drugs, as there are multidrug regimens like the STR BIC/FTC/TAF whose weight may be lower than those of the new oral combinations INSTI-based for both naive and switching PWH. Although multi-drug regimens like the STR BIC/FTC/TAF are no longer in development, their use in clinical practice will still remain substantial for a long time and knowledge of their properties is necessary to properly select the most appropriate regimens for PWH.

Due to a limited range of effective treatment options, highly treatment-experienced (HTE) people with HIV (PWH) still struggle to maintain virological suppression and obtain an adequate immunological recovery. To increase the likelihood of virologic success, HTE PWH require an individualized treatment regimen based on cumulative genotypic resistance testing (GRT) data, potential drug-drug interactions, and adherence. From the PRESTIGIO Registry, we present a case of a 28-year-old man with vertically transmitted HIV-1 infection, on therapy with an ibalizumab-including regimen and desiring a treatment simplification. In January 2024, the patient was started on a lenacapavir-containing regimen along with optimized background therapy in an attempt to maintain sustained virological suppression, simplify antiretroviral regimen, and potentially increase CD4+ T-cell count. At six months follow-up evaluation, virological suppression was confirmed, and an increase in CD4+ T-cell count of 60 cells/μL was observed. Close follow-up of this patient is ongoing.

The study objective is to examine epidemiological and microbiological aspects of aerobic vaginitis in female patients admitted to University Hospital of Campania "L. Vanvitelli" over five years. The most represented strains were E. coli (n = 153), Citrobacter spp. increasing from 2020, E. faecalis (n = 149), S. haemolitycus (n = 61), and Candida albicans (n = 87). The susceptibility patterns of a selection of gram-negative and gram-positive representative bacterial isolates were examined. Carbapenems, aminoglycosides, and fosfomycin were most effective against gram-negative bacteria, whereas vancomycin, daptomycin, and linezolid exhibited greater efficacy against gram-positive bacteria. None of the E. coli and Citrobacter spp. isolates produced extended-spectrum beta-lactamases, and the S. haemolyticus strains were methicillin-resistant. In gram-positive isolates, gentamicin susceptibility increased in 2020 and 2021 compared to clindamycin; erythromycin showed high resistance rates in 2020. Our findings indicate that integrating proper microbiological cultures into clinical practice could improve the management of aerobic vaginitis. Moreover, they highlight the necessity of establishing a nationwide surveillance guideline to mitigate antimicrobial resistance. Improvement actions in antimicrobial diagnostic stewardship must be considered when seeking the appropriate diagnosis and treatment for aerobic vaginitis.

Italy is recognized as having the highest Hepatitis C virus (HCV) prevalence in Europe. The Tuscany region, where the prevalence of HCV infection is approximately 0.8%, implemented two programs for the control of chronic hepatitis C in Tuscany from 2018 to 2022. This retrospective study aims to investigate the incidence of HCV in a population screened in Southeastern Tuscany from 2013 to 2022. The study population included 246,137 patients from the provincial area of Arezzo and Grosseto, Tuscany, spanning from January 2013 to October 2022. Among the subjects included in the study, 3,190 (1.29%) tested positive for anti-HCV antibodies. Of this population, 2,119 patients (66.43%) also tested positive for HCV-RNA quantification, leading to their enrolment for subsequent viral genotyping. 1,106 patients had genotype (GT) 1 (52.2%), 484 had GT 3 (22.8%), 371 had GT 2 (17.5%), and 158 had GT 4 (7.5%). Our study underscores the prevalence of HCV GTs 1 and 3 as the most predominant GTs in the Southeast Tuscany region. We also observe a correlation between age, sex and HCV genotypic distribution.

The aim of this research was to define the prevalence of antibodies against hepatitis D virus (anti-HDV Ab) in a group of 26 outpatients with liver dysfunction in northeastern Bulgaria. Serum samples were obtained from April 2022 to December 2023 in the "Status" Medical Diagnostic Laboratory, Varna, Bulgaria. We found seroprevalence of anti-HDV Ab in 15.4% (CI: 4.3-34.8%) of the target population. Age and gender had no significant role in HDV seropositivity.

Staphylococcus aureus bacteremia presents clinical complexities, with prolonged duration associated with unfavorable outcomes. This research delves into unconventional treatments, such as combinations involving daptomycin, oxacillin, ceftaroline, and fosfomycin, with the aim of swiftly sterilizing bloodstream infection to reduce complications. Our examination of 30 MSSA bacteremia patients with infective endocarditis uncovers differing results between single-agent therapies (oxacillin or daptomycin) and combined treatment plans. Microbiologic clearance at the 72 hour mark demonstrates greater efficacy within the combination cohort (bacteremia persistence 29%) versus monotherapy (bacteremia persistence 78%). This limited case series suggests the potential superiority of combination therapy, prompting further investigations.

Stephanoascus ciferrii, a conditional pathogenic fungus prevalent in nature, is more frequently encountered in patients with compromised immunity. However, the literature rarely reports infections caused by Stephanoascus ciferrii in peritoneal dialysis patients. Here, we detail the case of a 66-year-old female suffering from renal failure who experienced catheter-related infection during peritoneal dialysis. Dialysate turbidity prompted the detection of Stephanoascus ciferrii in both peritoneal dialysate and tubes through microbiological cultures. Subsequent treatment involved antifungal drugs and a transition to hemodialysis, resulting in the disappearance of peritonitis symptoms and the patient's discharge. In recent years, fungal infections, particularly dialysis-related infections, are on the rise. This marks the first reported case of catheter-related peritonitis infection caused by Stephanoascus ciferrii. Compared to bacterial infections, fungal infections pose challenges due to limited drug options, significant side effects, and prolonged treatment durations. Hence, prompt pathogen diagnosis and drug sensitivity testing are crucial for effective clinical treatment. In essence, this scientific case report underscores the uncommon occurrence of catheter-related peritonitis attributed to Stephanoascus ciferrii in a peritoneal dialysis patient with renal failure, emphasizing the distinctive management challenges and underscoring the critical significance of prompt diagnosis and suitable intervention in such instances.

Non-O1 and non-O139 Vibrio cholerae (NOVC) are serogroups that do not produce cholera toxin and are not responsible for epidemics. Even though rarely encountered in clinical practice, they can cause a spectrum of different conditions ranging from mild gastrointestinal syndrome to extraintestinal diseases, of which bacteremia and wound infections are the most severe. Risk factors for severe disease are cirrhosis, neoplasms, and diabetes mellitus. The mortality rate of NOVC bacteremia in hospitalized patients ranges from 24 to 61.5%. Incidence of NOVC infections is still rare, and consensus recommendations on treatment are not available. We report a case of NOVC bacteremia associated with severe cellulitis in an immunocompetent 75-year-old man who had eaten raw seafood in a location by the northern Adriatic Sea (Italy). Twenty-four hours after intake, he developed a high fever and vomiting. Afterwards, he started noticing the appearance of cellulitis in his right leg, which worsened in a matter of hours. The patient had a history of compensated type 2 diabetes mellitus. NOVC was isolated from both blood cultures and the leg ulcer. The non-O1, non-O139 serogroup was confirmed, and the detection of the cholera toxin gene was negative. Both tests were performed by the Reference National Laboratory of Istituto Superiore di Sanità (ISS). Multiple antimicrobial regimens were administered, with complete recovery. In conclusion, considering the severity of NOVC-associated manifestations, it is of pivotal importance to reach etiological diagnosis for a target antimicrobial therapy and to consider V. cholerae infection in the differential diagnosis in the presence of risk factors and potential exposure.