Optimal duration of antifungal therapy in candidemia.

Purpose Of Review: In candidemia, the standard 14-day antifungal treatment after blood culture clearance has been long accepted, despite being based on limited and outdated evidence. This review discusses the rationale for re-evaluating treatment duration, in the context of growing interest in optimizing antifungal use.

Recent Findings: A small number of retrospective studies have explored shorter treatment courses in uncomplicated candidemia, suggesting similar outcomes in terms of mortality and recurrence compared to the traditional 14-day regimen.

Role of remdesivir for the treatment of COVID-19 in patients with hematologic malignancy-A narrative review and expert opinion.

Background: COVID-19 remains a potentially severe condition for immunocompromised individuals, such as patients with hematologic malignancy. These patients are at increased risk of progressing to severe-critical or prolonged COVID-19. Prompt treatment with antivirals has proven effective in preventing disease progression and is recommended by current guidelines.

Old Pathogens-New Patient Types: Infections in a CAR T-Cell Recipient. Could It Get Any More Complicated?

The case discussed involves a 41-year-old Italian man who was a candidate for chimeric antigen receptor T-cell therapy (CAR-T) for mediastinal diffuse large B-cell lymphoma. His CAR-T treatment was postponed several times due to prolonged relapsing COVID-19 and new onset of pulmonary Mycobacterium tuberculosis diseases. After 11 weeks of antimycobacterial treatment, CAR T-cell therapy was performed, but complicated by cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

Persistent candidemia caused by different Candida species: Data from a multicenter contemporary cohort.

Objectives: To explore persistent candidemia by different Candida spp.

Methods: Observational, retrospective, multicenter study including patients with candidemia (Jan 2018-Dec 2022) from 3 hospitals in Italy and Spain. The primary outcome was persistent candidemia, defined as positive blood culture (BC) yielding the same Candida spp≥5 days from the start of active antifungals.

Clinical impact of fluconazole-resistant : a narrative review.

Fluconazole resistance in is an increasing global concern, with resistance rates varying widely and reaching up to 80% in some regions. This trend has led to hospital outbreaks, primarily driven by mutations in the gene, especially the Y132F substitution. The clinical relevance of fluconazole resistance remains controversial, as studies have yielded conflicting results regarding its impact on mortality.

Can We Lower the Burden of Antimicrobial Resistance (AMR) in Heavily Immunocompromised Patients? A Narrative Review and Call to Action.

Effective antibiotics are a cornerstone of treatment for heavily immunocompromised patients such as those undergoing cancer treatment or transplantation procedures, as these patients are at particularly high risk of adverse outcomes from infections. However, rising antimicrobial resistance (AMR) threatens to undermine our ability to deliver modern treatments, and without action, recent advances in clinical care may be undone. In this narrative review, we examine the broad burdens of AMR for patients and healthcare systems, including excess mortality, underlying disease outcomes, economic costs and the damage to patients' quality of life.

Vaccine hesitancy in healthcare workers during COVID-19 pandemic: Draw on experience.

Objectives: The present study aimed to identify factors that affect healthcare workers' (HCWs) vaccine hesitancy and the subsequent changes in psychological well-being.

Study Design: 800 employees (207 M; 14 aged ≤ 25; 145 aged 26-35; 381 aged 36-55; 260 aged > 55 years) were recruited from the San Martino Hospital during the first months 2021.

Methods: HCWs were asked to fill in an online survey assessing (a) demographics, (b) having contracted COVID-19 infection, (c) vaccination history (against COVID-19 and influenza), (d) expected changes in psychological well-being, (e) vaccine hesitancy and (f) factors leading to a decision about the vaccine (Information Trust, Information Seeking, Fear for the Self, and Sense of Responsibility).

Cancer Awareness Among People Living with HIV (PLWH): Insights from an Italian Survey of Oncologists and Infectious Disease Specialists.

Introduction: Since the mid-1990s, the adoption of combined antiretroviral therapy (cART) has significantly reduced HIV-related mortality and morbidity. Nevertheless, cancer continues to be the leading cause of death in people living with HIV (PLWH). We conducted a survey to assess the knowledge and inter-disciplinarity among the Italian oncologists and infectious disease specialists in the cancer prevention and treatment of PLWH.

Role of artificial intelligence in ICU therapeutic decision-making for severe infections.

Purpose Of Review: To discuss current and future role of artificial intelligence in predicting severe infections and supporting decisions on antibiotic treatment in critically ill patients in intensive care units (ICU), focusing in particular on some relevant conceptual changes compared to classical clinical reasoning.

Recent Findings: Several studies have evaluated the ability of machine learning techniques for severe infection prediction, while other studies have explored the potential of large language models (LLM)-based tools to assist clinicians in deciding which antimicrobial agent(s) to prescribe to patients with severe infections.

Summary: The support of artificial intelligence for infection prediction and antimicrobial prescribing has shown the potential to improve the treatment of severe infections in ICU.

29-mRNA host response signatures for classification of bacterial infection, viral infection and disease progression in COVID-19 pneumonia: a post hoc analysis of the SAVE-MORE randomized clinical trial.

Background: Biomarkers based on host response signatures are currently under development for the critically ill. We applied a 29-mRNA classifier for the diagnosis and prognosis of suspected acute infection and sepsis (TriVerity, Inflammatix Inc.) in patients hospitalized with COVID-19.

Deep Learning for the Early Diagnosis of Candidemia.

Introduction: Candidemia carries a heavy burden in terms of mortality, especially when presenting as septic shock, and its early diagnosis remains crucial.

Methods: We assessed the performance of a deep learning model for the early differential diagnosis between candidemia and bacteremia. The model was trained on a large dataset of automatically extracted laboratory features.

Treatment of Stenotrophomonas malthophilia bloodstream infections from guidance to real life: multicenter retrospective cohort study.

Objectives: Infectious Diseases Society of America guidance recommend the use of combination therapy (CT) for the treatment of Stenotrophomonas maltophilia (SM) infections. The aims of our study are to describe therapeutical management of patients with SM bloodstream infections (SM-BSI) and to evaluate the impact of antibiotic CT compared to monotherapy (MT) on 30-days mortality.

Methods: Multicenter, retrospective study of patients with SM-BSI hospitalized in 14 centers between January 2021-December 2022.

Mortality of pneumonia in intensive care units: a post-hoc analysis of an international multicenter study by ESGCIP and EFISG.

Background: pneumonia (PJP) is a life-threatening disease. In the intensive care unit (ICU), PJP is most frequently observed among patients with several conditions not related to the human immunodeficiency virus (HIV) infection.

Methods: The primary objective of the present post-hoc analysis of a multicenter, multinational, retrospective study was to assess factors impacting prognosis in ICU patients with PJP through univariable and multivariable analyses.

Invasive in the abdomen: how to differentiate infection from colonization.

Introduction: Intra-abdominal candidiasis (IAC) is a serious complication in critically ill patients, particularly after abdominal surgery or trauma. Differentiating Candida colonization from invasive infection is crucial, as misdiagnosis can lead to inappropriate antifungal use, increased resistance, and worse outcomes. However, IAC remains underrecognized due to the limitations of conventional culture-based diagnostics.

Candida endocarditis: current perspectives on diagnosis and therapy.

Background: Candida infective endocarditis (CIE) is a rare but potentially devastating condition. Although it accounts for only 1-1.5% of infective endocarditis cases, CIE carries a high mortality rate (36-49%) and a substantial risk of relapse.

Three Cases of Human Babesiosis, Italy, 2017-2020.

We report 3 cases of babesiosis in Italy caused by Babesia species that are rarely reported in humans. The circulation of Babesia spp. among vectors, animals, and humans might be more common than previously thought, and babesiosis might be an underdiagnosed and emerging disease in Italy and Europe.

Pseudomonas aeruginosa bloodstream infections in internal medicine wards: A large Italian multicenter retrospective study.

Introduction: This large, multicenter, Italian retrospective study aimed to describe clinical characteristics and risk factors associated with 30-day mortality in patients with Pseudomonas aeruginosa bloodstream infections (PA-BSI) admitted to internal medicine wards (IMW). To enhance clinical decision-making, we also developed and internally validated a bedside prognostic model to predict the 30-day mortality risk.

Methods: We conducted a retrospective, multicenter cohort study across 14 public hospitals in Italy, analyzing all adult patients admitted to IMW with PA-BSI between 2021 and 2022.

Two-drug regimen with dolutegravir plus lamivudine for HIV treatment in children: a narrative review.

The treatment landscape for HIV is rapidly evolving, particularly with the advent of two-drug regimens (2DR). Traditionally, three-drug regimens (3DR) have been the standard, providing effective treatment but often at the cost of tolerability and increased pill burden. Recent studies demonstrate that 2DR can achieve non-inferior virological suppression compared to 3DR, while potentially offering enhanced safety and reduced long-term drug exposure.

Role of liposomal amphotericin B in intensive care unit: an expert opinion paper.

Introduction: Invasive fungal infections (IFI) are frequent in patients admitted to the intensive care unit (ICU). The use of first-line antifungals like triazoles or echinocandins may be limited by the global spread of multi-drug resistance species, drug-drug interactions, low organ penetration, and some safety concerns in case of multi-organ failure. Liposomal amphotericin B (L-AmB) is a polyene drug with a broad activity against mold and yeast and an acceptable safety profile.

Fine-tuning FUNDICU: imaging considerations for future research.

The FUNDICU consensus was conceived with the aim of developing a standard set of definitions for invasive fungal diseases in non-neutropenic, intensive care unit patients outside the classical immunocompromised patient populations, which could improve the generalizability and comparability of research findings. In this letter, we report the first results of an original study exploring as to whether some potential additional criteria could be consistent in terms of results and prognostic impact with those defining probable invasive pulmonary aspergillosis in the original FUNDICU consensus, focusing in particular on any possible role of chest X-ray.

Neural networks for the prediction of bacterial and fungal infections: current evidence and implications.

In the present narrative review, we discuss the use of artificial neural networks (ANNs) for predicting bacterial and fungal infections based on commonly available clinical and laboratory data, focusing on promises and challenges of these machine learning models. For predicting different bacterial or fungal infections from data commonly found in electronical medical records, ANN models may reach, based on current literature, an acceptable performance for discriminating between infected and non-infected patients, and outperformed other machine learning (ML)-based models in 38.3% of the retrieved studies evaluating at least another ML approach.

Meropenem-Vaborbactam for Treatment of Carbapenem-Resistant Enterobacterales: A Narrative Review of Clinical Practice Evidence.

Among drug-resistant bacteria, carbapenem-resistant Enterobacterales (CRE) are a major clinical challenge with limited options for treatment. In the last several years, new treatment options have emerged for CRE, including meropenem-vaborbactam (MVB). MVB was studied clinically in the TANGO-I and TANGO-II trials, which evaluated the combination in complicated urinary tract infections and in different types of CRE infections, respectively.