Chronic osteomyelitis in adults is a complex condition that requires prolonged and intensive antimicrobial therapy, but evidence on optimal selection and duration of antibiotics is limited. A review of PubMed and Ovid Embase databases was conducted to identify systematic reviews, meta-analyses, retrospective and randomised controlled trials (RCTs) on antibiotic treatment outcomes in adults with chronic osteomyelitis. Three main areas of interest were investigated: short-term versus long-term antibiotic therapy, oral versus parenteral antibiotic therapy, and combination antibiotic therapy with rifampicin versus without rifampicin. A total of 36 articles were identified and findings were synthesised using a narrative review approach. The available literature suffers from limitations, including a lack of high-quality studies, inconsistent definitions, and varying inclusion/exclusion criteria among studies. Most studies are open-labelled and lack blinding. Limited high-quality evidence exists that oral therapy is non-inferior to parenteral therapy and that shorter antibiotic duration might be appropriate in low-risk patients. Studies on the impact of rifampicin are inconclusive. Further well-designed studies are needed to provide more robust evidence in these areas.

Atypical skull-base osteomyelitis is a rare but fatal disease that usually involves infection of the ethmoid, sphenoid, occipital, or temporal bones that form the skull base. Unlike typical (so-called otogenic), atypical skull-base osteomyelitis has no otogenic cause. Instead, some authors call atypical skull-base osteomyelitis sinonasal, since the infection most often originates from the nose and paranasal sinuses. Diagnosing and treating this disease is challenging. To assist in managing atypical skull-base osteomyelitis, a review of the most recent literature, with patient cases and multidisciplinary perspectives from otolaryngologists, neurosurgeons, radiologists, infectious disease specialists, pathologists, and clinical microbiologists, is provided in this paper.

Studies suggest that the incidence of coinfections in patients with the coronavirus disease 2019 (COVID-19) is low, but a large number of patients receive antimicrobials during hospitalisation. This may fuel a rise in antimicrobial resistance (AMR). We conducted a multicentre point-prevalence survey in seven tertiary university hospitals (in medical wards and intensive care units) in Croatia, Italy, Serbia and Slovenia. Of 988 COVID-19 patients, 521 were receiving antibiotics and/or antifungals (52.7%; range across hospitals: 32.9–85.6%) on the day of the study. Differences between hospitals were statistically significant (χ² (6, N = 988) = 192.57, p < 0.001). The majority of patients received antibiotics and/or antifungals within 48 h of admission (323/521, 62%; range across hospitals: 17.4–100%), their most common use was empirical (79.4% of prescriptions), and pneumonia was the main indication for starting the treatment (three-quarters of prescriptions). The majority of antibiotics prescribed (69.9%) belonged to the “Watch” group of the World Health Organization AWaRe classification. The pattern of antimicrobial use differed across hospitals. The data show that early empiric use of broad-spectrum antibiotics is common in COVID-19 patients, and that the pattern of antimicrobial use varies across hospitals. Judicious use of antimicrobials is warranted to prevent an increase in AMR.

Background/Objectives. Our study aimed to determine the development of antibiotic resistance during the peri-pandemic period in a regional secondary care hospital using an interrupted time series analysis. Methods. We analyzed data from seven years, accounting for 441,149 patient days. The incidence density of multidrug-resistant bacteria (MDR) burden and infection was reported per 1000 patient days. Results. During the COVID-19 period, a significant increase in the mean incidence density of the total MDR burden from 4.93 to 5.81 per 1000 patient days was observed (p = 0.007). On the other hand, the mean incidence density of MDR infections decreased from 1.61 to 1.29 per 1000 patient days (p = 0.019). Using the interrupted time series analysis, the same trends were observed, namely the overall increasing trend in MDR burden and the overall decreasing trend in MDR infections. This divergent trend is mainly due to similar trends in several Gram-negative MDR, namely ESBL-EC, ESBL-KP and CRE. Conclusions. Due to the increasing burden of MDR, it is necessary to strengthen AMR surveillance. In addition, strict infection prevention and control measures, and antimicrobial stewardship programs continue to be important components in the fight against resistant bacteria.

This position paper addresses the evolving care continuum for patients with respiratory viral infections in the context of the post–coronavirus disease 2019 pandemic phase. We emphasize the need to place the patient at the center of attention from the first signs of influenza-like illness to recovery. Current practices have revealed several deficiencies, such as timely access to healthcare, fragmentation of care, and inadequate follow-up instructions. This article proposes means to address these deficiencies and discusses diagnostic and management considerations for patients with suspected influenza infection.

Background/Objectives: Our study aimed to assess longitudinal trends in blood culture contamination in a regional secondary care teaching hospital before and after the COVID-19 pandemic and to evaluate differences in the interpretation of trends using two distinct quasi-experimental statistical methods, including interrupted time-series analysis. Methods: We analyzed data from a 10-year period spanning from 2015 to 2024, encompassing 147,733 admissions and 634,158 patient-days, as well as a total of 25,068 blood cultures. The (i) blood culture contamination rate, (ii) contaminant proportion, (iii) single blood culture rate, and (iv) first-to-second bottle contamination ratio were calculated. Results: The observed usage rate of blood cultures per 1000 patient-days was 38.9. The contamination rate of blood cultures increased from 0.9% to 1.5% (p = 0.001) in the post-COVID-19 period, accompanied by a rise in the proportion of contaminant bacteria from 9.8% to 14.2% (p = 0.016). Additionally, the proportion of single blood culture collections increased from 23.1% to 33.6% (p < 0.001). Finally, the overall first-to-second bottle contamination ratio was 1.54, while the ratio in the post-COVID-19 period was 1.92. Conclusions: In a low-COVID-19-burden secondary care teaching hospital setting, blood culture contamination rates have progressively increased over the past decade, irrespective of the pandemic. These findings underscore the importance of sustained vigilance in infection prevention and control practices, strict adherence to blood culture collection protocols, and the ongoing need for staff training.