Background: Ceftobiprole is a fifth-generation cephalosporin that has been approved in Europe solely for the treatment of community-acquired and nosocomial pneumonia. The objective was to analyze the use of ceftobiprole medocaril (Cefto-M) in Spanish clinical practice in patients with infections in hospital or outpatient parenteral antimicrobial therapy (OPAT). Methods: This retrospective, observational, multicenter study included patients treated from 1 September 2021 to 31 December 2022. Results: A total of 249 individuals were enrolled, aged 66.6 ± 15.4 years, of whom 59.4% were male with a Charlson index of four (IQR 2–6), 13.7% had COVID-19, and 4.8% were in an intensive care unit (ICU). The most frequent type of infection was respiratory (55.8%), followed by skin and soft tissue infection (21.7%). Cefto-M was administered to 67.9% of the patients as an empirical treatment, in which was administered as monotherapy for 7 days (5–10) in 53.8% of cases. The infection-related mortality was 11.2%. The highest mortality rates were identified for ventilator-associated pneumonia (40%) and infections due to methicillin-resistant Staphylococus aureus (20.8%) and Pseudomonas aeruginosa (16.1%). The mortality-related factors were age (OR: 1.1, 95%CI (1.04–1.16)), ICU admission (OR: 42.02, 95%CI (4.49–393.4)), and sepsis/septic shock (OR: 2.94, 95%CI (1.01–8.54)). Conclusions: In real life, Cefto-M is a safe antibiotic, comprising only half of prescriptions for respiratory infections, that is mainly administered as rescue therapy in pluripathological patients with severe infectious diseases.

We evaluated in this randomised, double-blind clinical trial the efficacy of melatonin as a prophylactic treatment for prevention of SARS-CoV-2 infection among healthcare workers at high risk of SARS-CoV-2 exposure. Healthcare workers fulfilling inclusion criteria were recruited in five hospitals in Spain and were randomised 1:1 to receive melatonin 2 mg administered orally for 12 weeks or placebo. The main outcome was the number of SARS-CoV-2 infections. A total of 344 volunteers were screened, and 314 were randomised: 151 to placebo and 163 to melatonin; 308 received the study treatment (148 placebo; 160 melatonin). We detected 13 SARS-CoV-2 infections, 2.6% in the placebo arm and 5.5% in the melatonin arm (p = 0.200). A total of 294 adverse events were detected in 127 participants (139 in placebo; 155 in melatonin). We found a statistically significant difference in the incidence of adverse events related to treatment: 43 in the placebo arm and 67 in the melatonin arm (p = 0.040), and in the number of participants suffering from somnolence related to treatment: 8.8% (n = 14) in the melatonin versus 1.4% (n = 2) in the placebo arm (p = 0.008). No severe adverse events related to treatment were reported. We cannot confirm our hypothesis that administration of melatonin prevents the development of SARS-CoV-2 infection in healthcare workers.

Background: Ceftobiprole is a fifth-generation cephalosporin that has been approved in Europe solely for the treatment of community-acquired and nosocomial pneumonia. The objective was to analyze the use of ceftobiprole medocaril (Cefto-M) in Spanish clinical practice in patients with infection in hospital or outpatient parenteral antimicrobial therapy (OPAT). Methods: This retrospective, observational, multicenter study included patients treated from September 1, 2021 to December 31, 2022. Results: 249 individuals were enrolled, aged 66.6±15.4 years, 59.4% male, with Charlson index of 4 (IQR 2-6); 13.7% had COVID-19, and 4.8% were in intensive care unit (ICU). The most frequent type of infection was respiratory (55.8%), followed by skin and soft tissue infection (21.7%). Cefto-M was administered to 67.9% as empirical treatment, being in monotherapy for 7 days (5-10) in 53.8% of cases. The infection-related mortality was 11.2%.The highest mortality rates were for ventilator-associated pneumonia [40%], and infections due to methicillin-resistant S. aureus (20.8%) and Pseudomonas aeruginosa (16.1%). Mortality-related factors were age (OR: 1.1, 95%CI [1.04-1.16]), ICU admission (OR:42.02, 95%CI[4.49-393.4]), and sepsis/septic shock (OR:2.94, 95%CI [1.01-8.54]).Conclusions: In real life, Cefto-M is a safe antibiotic, with only half of prescriptions in respiratory infections, mainly administered as rescue therapy in pluripathological patients with severe infectious diseases.

Introduction The management of complicated Gram-positive bloodstream infections (cBSI) and infective endocarditis (IE) often requires prolonged intravenous therapy. Transition to oral therapy is frequently unfeasible because of resistance, drug interactions, or adherence concerns, increasing the risk of intravenous-related complications and healthcare burden. The pharmacokinetic profile and spectrum of oritavancin may enable effective treatment and early discharge. This study evaluated its effectiveness, safety, and impact on hospital resource use in patients with cBSI or IE. Methods We conducted a multicenter, retrospective, observational study across eight hospitals in Italy and Spain (April 2023–February 2025). Adult patients with Gram-positive cBSI (persistent/refractory BSI or prosthetic material) or IE (2023 modified Duke criteria) treated with ≥ 1 dose of oritavancin were included. Dosing was determined by the treating physicians. Data on outcomes, adverse events (AEs) and healthcare use were collected from medical records. Patients were followed for at least 6 months. Results Twenty-seven patients were included: 13 (48.1%) cBSI and 14 (51.9%) IE. Median age was 73 years (IQR 65–81); 18 out of 27 (66.7%) were male; Charlson Comorbidity Index 6 (IQR 4–7). In cBSI, oritavancin was first-line in 6/13 (46.2%) and given in multiple doses in 8/13 (61.6%), median of 2 doses (IQR 2–2.5). Clinical success was 100%, with no recurrence or BSI-related mortality. In IE, Staphylococcus aureus was identified in 5 of 14 cases (35.7%), of which 40% were methicillin-resistant. Native valves were involved in 6/14 (42.8%), prosthetic valves in 6/14 (42.8%), cardiac devices in 2/14 (14.3%). Clinical success was achieved in 85.7% of patients with IE (12/14). Two AEs occurred: nausea and a non-fatal acute coronary syndrome in a patient with pre-existing ischemic heart disease. Oritavancin use reduced 369 hospital days with potential savings of approximately €4235 per patient. Conclusions Oritavancin may represent a safe, effective treatment option for selected patients with cBSI or IE, with advantages in outcomes, reduced hospital stay, and cost containment.

Background: People with HIV (PWH) experience increased cardiovascular disease driven by chronic inflammation despite suppressive antiretroviral therapy. Circulating microRNAs (miRNAs) have emerged as potential biomarkers of cardiometabolic dysfunction, yet their relevance to HIV-associated atherosclerosis remains unclear. Methods: We analyzed PWH PBMC-derived miRNAs in two independent cohorts: the HUMT cohort (N = 185), characterized by carotid ultrasound assessment of atheroma plaque and carotid intima–media thickness (cIMT), and the CoRIS cohort (N = 119), stratified by cardiometabolic comorbidity burden (≥3 comorbidities vs none). An exploratory miRNA microarray comparing individuals with and without atheroma plaque (AP+ vs. AP−, N = 72) identified candidate miRNAs, a subset of which was selected for validation by RT-qPCR. Associations with atherosclerosis, cardiometabolic comorbidities and the HIV-adapted COMVIH-CoR clinical cardiovascular risk score were examined. Results: Forty-four miRNAs were differentially expressed in AP+ vs. AP– in the microarray. RT-qPCR validation showed sex-specific miRNA association with miR-638 was consistently downregulated in AP+ and pathological cIMT among men, while reduced expression of miR-27b-5p and miR-3613-5p was observed in women. Associations between miRNAs and cardiometabolic comorbidities differed by cohort: in HUMT, miR-638 was reduced in diabetes and obesity, while miR-140-5p and miR-27b-5p were decreased in smokers and individuals with low HDL. CoRIS participants with multiple comorbidities showed a generalized miRNAs upregulation. Notably, miR-140-5p was consistently elevated in individuals with high COMVIH-CoR scores across both cohorts. Conclusions: PBMC-derived miRNAs capture heterogeneous, context-dependent dimensions of cardiovascular risk in PWH, likely reflecting cumulative immune-metabolic stress rather than universal diagnostic markers of subclinical atherosclerosis and supporting a phenotype-specific role.