Background: Multidrug-resistant Acinetobacter baumannii (CRAB) infections are a serious problem in critical care. This study aims to develop an early prognostic score for immune paralysis, using practical and cost-effective parameters, to predict ICU mortality in patients with CRAB infections being treated with Cefiderocol. Methods: We carried out an observational pilot study on consecutive patients hospitalized in the ICU with ensuing septic Acinetobacter baumannii infections treated with Cefiderocol monotherapy or Cefiderocol including combinations. We investigated the predictive power of lymphocyte counts, lymphocyte subpopulations, serum cholinesterase levels, and reactivation of herpes viruses. Results: Overall, 36 of 39 patients entered in our analysis: 20 survivors and 16 deceased. A total of 12 patients developed bacteremia, 19 patients had HAP/VAP, and 5 patients had a soft tissue infection. Univariate analyses of factors associated with unfavorable outcome revealed a significant association for age (OR: 1.5, CI: 1.11–2.02), SAPS II (OR: 1.05, CI: 1.01–1.1), SOFA score (OR: 1.37, CI: 1.06–1.76), lymphocytopenia (OR: 32.5, CI: 3.45–306.4), viral reactivation (OR: 9.75, CI: 1.72–55.4), and cholinesterase drop <1600 U/L (OR: 39.7, CI: 5.8–271.6). At variance, monotherapy or associations with Cefiderocol were not associated. In the final multivariable model, the only independent predictors of death were age (OR: 1.42, CI: 0.98–2.05), lymphocytopenia (OR: 18.2, CI: 0.87–371), and cholinesterase drop to below 1600 U/L (OR: 9.7, CI: 0.77–123.7). Conclusions: Age, lymphocytopenia, and serum cholinesterase drops, which were nearly significantly associated with an unfavorable outcome, may help pinpoint patients with acute immune paralysis during sepsis. Knowledge of such an immune state may in turn directly influence patients’ care.

Background: Monitoring antibody response following SARS-CoV-2 vaccination is strategic, and neutralizing antibodies represent the gold standard. The neutralizing response to Beta and Omicron VOCs was evaluated versus the gold standard by a new commercial automated assay. Methods: Serum samples from 100 healthcare workers from the Fondazione Policlinico Universitario Campus Biomedico and the Pescara Hospital were collected. IgG levels were determined by chemiluminescent immunoassay (Abbott Laboratories, Wiesbaden, Germany) and serum neutralization assay as the gold standard. Moreover, a new commercial immunoassay, the PETIA test Nab (SGM, Rome, Italy), was used for neutralization evaluation. Statistical analysis was performed with R software, version 3.6.0. Results: Anti-SARS-CoV-2 IgG titers decayed during the first ninety days after the vaccine second dose. The following booster dose significantly (p < 0.001) increased IgG levels. A correlation between IgG expression and neutralizing activity modulation was found with a significant increase after the second and the third booster dose (p < 0.05. Compared to the Beta variant of the virus, the Omicron VOC was associated with a significantly larger quantity of IgG antibodies needed to achieve the same degree of neutralization. The best Nab test cutoff for high neutralization titer (≥1:80) was set for both Beta and Omicron variants. Conclusion: This study correlates vaccine-induced IgG expression and neutralizing activity using a new PETIA assay, suggesting its usefulness for SARS-CoV2 infection management.

This study investigated an increase in Bacillus cereus bacteraemia cases amongst hospitalized patients in Italy during the summer of 2023. To precisely characterize the outbreak, we performed extensive genomic investigation, including both short- and long-read sequencing technologies, combined with bioinformatics analysis. This genomic approach enabled us to identify the putative source of the outbreak and understand the transmission dynamics of this opportunistic pathogen within the hospital. Our investigation revealed a complex, polyclonal contamination pattern traced to contaminated hospital laundry. Whole-genome sequencing (WGS) analysis identified multiple B. cereus sequence types (STs) in both clinical and environmental samples, with three predominant STs (ST-2184, ST-163 and ST-365) found in both. These STs, previously implicated in bloodstream infection (BSI) outbreaks, raise concerns about their potential as healthcare-associated pathogens. SNP-based phylogenetic analysis provided strong evidence linking human and environmental isolates, with close genetic relatedness observed between isolates from patients and those from laundered scrubs, transport trucks and bed linens. The study highlights the potential for laundry-mediated pathogen transmission in healthcare settings and underscores the importance of stringent laundry hygiene practices. Improved laundry procedures successfully resolved the B. cereus bacteraemia outbreak. This study demonstrates the power of WGS-based methodologies for investigating and resolving outbreaks, informing targeted infection control measures and ultimately enhancing patient safety.

Trichophyton indotineae is an emerging dermatophyte associated with extensive, chronic, recalcitrant, and frequently terbinafine-resistant dermatophytosis worldwide. In this study, 30 T. indotineae strains isolated in Italy were investigated. The isolates were obtained from patients originating from Asian countries, from patients from other countries, and from Italian patients who reported no travel outside Italy in the preceding years. Clinical isolates were identified by internal transcribed spacer (ITS) sequencing and analyzed to assess the occurrence and molecular basis of terbinafine resistance. Terbinafine resistance was detected in 18 strains (60%) using a real-time PCR assay. Sequencing of the squalene epoxidase (SQLE) gene revealed mutations associated with resistance, including L393S in nine strains and F397L in another nine strains. NGS analysis confirmed two terbinafine-resistant strains carrying the L393S and F397L mutations, respectively, and detected the A448T mutation in one terbinafine-susceptible strain. These findings demonstrate the presence of terbinafine-resistant T. indotineae across five regions of Italy and confirm the occurrence of SQLE mutations previously linked to antifungal resistance. Data obtained also support a link with endemic Asian areas, other than suggesting the possible occurrence of autochthonous transmission in Italy.

Listeria monocytogenes (Lm) is a serious public health foodborne pathogen cause of listeriosis, usually in elderly, pregnant and immunocompromised people, linked to consumption of contaminated food, especially ready-to-eat (RTE) products. Different protocols can be used to detect Lm, and ISO11290-1:2017 is the reference method in Europe. Through molecular techniques such as whole genome sequencing (WGS) it is possible to discriminate between Lm strains, which are unequally distributed between clinical cases, food or food related environments, probably also due to enrichment step bias towards some Lm serogroup (IIa) compared to IVb. In the present work a set of Lm strains, detected in clinical cases and food, was investigated to define Lm strains growth ability after incubation in Half Fraser broth, and Genome Wide Association Studies (GWAS) applied to correlate the growth phenotype traits to presence of relevant genes. GWAS enabled the identification of a more relevant cassette of genes associated to a holin region of bacteriophage A118 and the determination of the distribution of relevant genes, highlighted from GWAS analysis within a population of Lm IVb and IIa.

Background: In Italy, seasonal flu vaccination was recommended for all children aged 6 months to 6 years, all adults aged ≥60 years and specific at-risk groups. Influenza vac-cine effectiveness (IVE) varies from season to season. It can be related to several factors: possible mismatches between circulating virus strains and vaccine composition, the host immune response and the interval between the vaccine administration and the epidemic peak. The present study aimed to estimate IVE against acute respiratory infections (ARIs) caused by influenza during the 2024/25 season in the Province of Pescara, Abruzzo Region, Southern Italy. Methods: A retrospective test-negative case–control study was conducted in the tertiary hospital of the province of Pescara, Abruzzo region, Southern Italy. The study considered all naso/oropharyngeal swabs performed between 15 October 2024 and 1 April 2025. Results: During the study period, 5452 tests were performed and met the inclusion criteria. Among them, 637 tested positive for influenza (11.68%) and 4815 (88.32%) were considered controls. The IVE estimated using the fully adjusted model showed an overall effectiveness of 41.36% (from 1.08 to 57.29%). Considering influenza type, IVE against influenza A was 37.23%, whereas IVE against influenza B was 77.28%. Conclusions: The 2024/2025 season was characterized in our Italian region by a delayed start in flu circulation, with a concomitant and prominent co-circulation of all virus types. Available vaccines provided a moderate protection against laboratory-confirmed influenza, with an estimated VE of 41%.