The superiority of combination therapy for carbapenem-resistant Gram-negative bacilli (CR-GNB) infections remains controversial. In vitro models may predict the efficacy of antibiotic regimens against CR-GNB. A systematic review and meta-analysis was performed including pharmacokinetic/pharmacodynamic (PK/PD) and time-kill (TK) studies examining the in vitro efficacy of antibiotic combinations against CR-GNB [PROSPERO registration no. CRD42019128104]. The primary outcome was in vitro synergy based on the effect size (ES): high, ES ≥ 0.75, moderate, 0.35 < ES < 0.75; low, ES ≤ 0.35; and absent, ES = 0). A network meta-analysis assessed the bactericidal effect and re-growth rate (secondary outcomes). An adapted version of the ToxRTool was used for risk-of-bias assessment. Over 180 combination regimens from 136 studies were included. The most frequently analysed classes were polymyxins and carbapenems. Limited data were available for ceftazidime/avibactam, ceftolozane/tazobactam and imipenem/relebactam. High or moderate synergism was shown for polymyxin/rifampicin against Acinetobacter baumannii [ES = 0.91, 95% confidence interval (CI) 0.44-1.00], polymyxin/fosfomycin against Klebsiella pneumoniae (ES = 1.00, 95% CI 0.66-1.00) and imipenem/amikacin against Pseudomonas aeruginosa (ES = 1.00, 95% CI 0.21-1.00). Compared with monotherapy, increased bactericidal activity and lower re-growth rates were reported for colistin/fosfomycin and polymyxin/rifampicin in K. pneumoniae and for imipenem/amikacin or imipenem/tobramycin against P. aeruginosa. High quality was documented for 65% and 53% of PK/PD and TK studies, respectively. Well-designed in vitro studies should be encouraged to guide the selection of combination therapies in clinical trials and to improve the armamentarium against carbapenem-resistant bacteria.

Local transmission of dengue, chikungunya, and Zika infection is an emerging public health threat in Europe. Monitoring the epidemiological trends can help define the intervention strategy. The aim of this work was to analyse epidemiological characteristics of autochthonous transmission of Aedes-borne arboviruses in Europe. A systematic review of the literature published from January 1, 2007, to January 31, 2024, reporting autochthonous cases of dengue, chikungunya, and Zika detected in Europe was performed. We searched MEDLINE, EMBASE, and the ECDC reports. Descriptive statistics and a secondary analysis were used to summarize the epidemiological characteristics of local transmission events (LTEs), explore potential temporal trends and identify relevant associations between epidemiological variables. Time intervals between key events were analysed to identify potential delays in LTE identification and intervention. A total of 59 studies were included, describing 56 LTEs. The frequency of LTEs increased over time, with an average of 1.25 (95% CI: 1.17-1.35) times increment every year. While the highest number of dengue LTEs was reported in France (N = 37), Italy faced the largest number of cases detected in an LTE (N = 41). Considering all the arboviral LTEs, the median time between the symptom onset of the primary case and the diagnosis of the index case ("outbreak detection") was 35.5 days (range 23.0-76.0). Only for chikungunya, higher delays correlated with higher cumulative number of cases detected per LTE, though this may be biased due to the low sample size. We have observed a gradual increase of Aedes-borne arboviral LTEs in Europe over time, and a considerable delay in outbreak detection. Improving the timeliness of LTE identification is essential. This work was partly funded by the Italian Ministry of Health (Ricerca corrente) and by the European Union (Next Generation EU, Missione 4 Componente 1 CUP H93C22000640007).

During the current SARS-CoV-2 pandemic, a novel syndrome termed “multisystem inflammatory syndrome in children” (MIS-C) has emerged. MIS-C was linked to COVID-19 and shared some features with Kawasaki disease and Toxic Shock Syndrome, with a common pathogenetic substrate of hyperinflammation and cytokine storm. Lately, MIS was also described in adults (≥21 years of age) and named “MIS-A”. There is no consensus about the treatment of MIS-A; successful use of glucocorticoids and immunoglobulins has been reported in case series, but more solid evidence is lacking. Furthermore, the role of biologic agents with proven benefits against COVID-19, MIS-C, or Kawasaki disease is still unexplored. In this report, we detail the clinical picture and the diagnostic process that led to the diagnosis of MIS-A in a 27-year-old man, focusing on its treatment with anakinra and glucocorticoids, which resulted in full recovery. To our knowledge, this is the first report of the successful use of anakinra for MIS-A, a drug that has already proven useful in the treatment of refractive cases of MIS-C. Anakinra may also play a pivotal role for the treatment of MIS-A.

Purpose of Review: Antimicrobial resistance (AMR) is a significant global health challenge, especially for populations with limited access to healthcare services and poor living conditions. This narrative review focuses on the determinants and figures related to AMR in the context of migration. Recent Findings: Migrants face the risk of MDRO (multidrug resistant organisms) acquisition at every stage of their migration journey, from their country of origin to the transit centres and destination countries. While there is a lack of systematic data, the existing information justifies raising alertness among the global health community. Moreover, in recent years, a growing body of literature has reported that armed conflicts act as a magnifier of AMR spreading. Summary: Targeted interventions at each stage of migration are urgently needed to limit the spread of the AMR pandemic, particularly among this vulnerable population.

We aimed at estimating the frequency of local transmission of arboviral infections in Verona province, Italy, between June and September 2025. People presenting with acute fever and without recent travel history (and less than WBC 10,000 per µL, unless there was a history of tick bite) were screened for arboviruses following a multi-step protocol. Cases were confirmed by a molecular assay and/or virus-specific IgM antibodies, including rising antibody titre in a second serum sample collected 15-20 days later and a positive seroneutralization test. One hundred and two people were included. Of these, 29 out of 102 (28.4%, 95% CI 20.2-38.4%) demonstrated autochthonous arboviral infections. Specifically, three cases of West Nile fever, four cases of tick-borne encephalitis, and 22 cases of chikungunya infections were diagnosed. A large proportion of unexplained acute fever cases had arboviral infections from local transmission. Of note, the protocol permitted an early detection of a local outbreak of chikungunya. These findings support the importance of strengthening public health surveillance in southern Europe, for an early detection of transmission foci and to adapt screening protocols to the changing epidemiology of arboviral infections.