Introduction: Late HIV diagnosis is associated with increased morbidity, mortality and risk of onward transmission. Increasing HIV early diagnosis is still a priority. In this observational study with historical control, we determined the impact of an opportunistic HIV screening strategy in the reduction of late diagnosis and missed opportunities for earlier diagnosis.Methods: The screening programme was implemented in the emergency department (ED) of the Hospital de Cascais between September 2018 and September 2021. Eligible patients were aged 18–64 years, with no known HIV diagnosis or antibody testing performed in the previous year, and who required blood work for any reason. Out of the 252 153 emergency visits to the ED, we identified 43 153 (17.1%) patients eligible for HIV testing. Among the total population eligible for the screening, 38 357 (88.9%) patients were ultimately tested for HIV. Impact of the ED screening was determined by analysing late diagnosis in the ED and missed opportunities at different healthcare settings 3 years before and 3 years after the start of the ED screening.Results: After 3 years of automated HIV ED testing, we found 69 newly diagnosed HIV cases (54% male, 39% Portuguese nationals, mean age 40.5 years). When comparing the characteristics of HIV diagnoses made in the ED, we observed a significant reduction in the number of people with late HIV diagnosis before and after implementation of the screening programme (78.4% vs. 39.1%, respectively; p = 0.0291). The mean number of missed opportunities for diagnosis also fell (2.6 vs. 1.5 annual encounters with the healthcare system per patient, p = 0.0997).Conclusions: People living with HIV in Cascais and their providers miss several opportunities for earlier diagnosis. Opportunistic screening strategies in settings previously deemed to be unconventional, such as EDs, are feasible and effective in mitigating missed opportunities for timely HIV diagnosis.

Third-generation cephalosporins are widely used due to the convenient spectrum of activity, safety, and posology. However, they are associated with the emergence of multidrug-resistant organisms, which makes them important targets for antimicrobial stewardship interventions. We aimed to assess the appropriateness of empirical prescriptions of ceftriaxone in a tertiary hospital. This cross-sectional study analysed empirical ceftriaxone prescriptions in January and June 2021. Patients under other antimicrobials 48 h before admission were excluded. The quality of ceftriaxone prescription was assessed regarding the initial appropriateness, duration of inappropriate ceftriaxone therapy, and missed opportunities for de-escalation. Of 465 prescriptions, 46.5% were inappropriate. The ceftriaxone prescription was inappropriate in 95.7% of lower respiratory tract infections (LRTI) globally and in nearly 40% of urinary tract infections (UTI) in medical and intensive care departments. Intensive care, internal medicine, and palliative care departments showed the highest number of inappropriate ceftriaxone prescriptions and longer length of inappropriate ceftriaxone prescriptions compared to the hospital’s average. Improvement of empirical ceftriaxone prescription in LRTI and urinary infections, adherence to local guidelines and de-escalation practices, and targeted interventions focusing on critical departments may significantly reduce the inappropriate empirical use of ceftriaxone.

Our hospital experienced an outbreak of OXA-48-producing Enterobacteriaceae, triggering this study. We aimed to describe the population with carbapenemase-producing Enterobacteriaceae (CPE) in our hospital from 2014 to 2018, the phenotypic and genotypic characteristics of isolates, and strategies to stop the outbreak. We performed a retrospective study, including every patient with CPE species in a clinical sample. Epidemiology, risk factors, treatment and outcomes were gathered from medical records. A total 113 patients were included, ranging from 5 in 2015 to 83 in 2018. In 2018 the number of CPE went from 4 in May to 20 in July. With the implemented measures, propagation stopped. Implantable devices were present in 36% of patients and open wounds in 34%. Antibiotics had been prescribed to 71% of patients in the prior 30 days and most of the patients had been hospitalized for more than 5 days prior to sample collection or had a hospital stay in the previous year. Klebsiella pneumoniae was the most common species (87%). OXA-48 (62%) and Klebsiella pneumoniae-carbapenemase (KPC) (15%) were the most common carbapenemases, with OXA-48 being implicated in the 2018 outbreak. The case fatality rate at 30 days was 32%. Combination therapy resulted in less mortality. While KPC is the most common carbapenemase in Europe and Portugal, we experienced an important OXA-48 outbreak. Surveillance should be in place as these isolates are probably spreading. Effective communication, multidisciplinary team work and proper infection control measures are some of the best strategies during outbreaks.

HIV-related stigma remains a barrier to well-being and long-term care despite effective antiretroviral therapy. We conducted a cross-sectional analysis using baseline data from a prospective real-world cohort of adults receiving routine HIV care in northern Portugal. Overall HIV stigma was the primary outcome, and associations with sociodemographic, clinical, laboratory, behavioral, and patient-reported variables were examined using univariable and multivariable linear regression. Among 467 participants, the median overall stigma score was 30 (Q1–Q3, 26–35), and disclosure concerns had the highest median subscale score. The multivariable model was statistically significant, F(7,429) = 10.254, p < 0.001, adjusted R² = 0.129. Higher overall stigma was independently associated with HIV-1 viral load ≥ 200 copies/mL (B = 4.489, 95% CI 0.660 to 8.318, t = 2.304, p = 0.022), anxiety symptoms (B = 0.318 per point, 95% CI 0.120 to 0.515, t = 3.166, p = 0.002), and depressive symptoms (B = 0.236 per point, 95% CI 0.031 to 0.441, t = 2.259, p = 0.024). A history of opportunistic infection was associated with lower stigma (B = -1.826, 95% CI -3.524 to -0.128, t = -2.114, p = 0.035). Higher quality-of-life scores were consistently associated with lower stigma (t values ranging from − 10.690 to -4.161, all p < 0.001). These findings support routine stigma-sensitive and psychologically informed HIV care to identify psychosocial needs and potentially improve well-being and treatment outcomes.

Background: Adherence to HIV care is pivotal for achieving viral suppression, preventing viral transmission, and improving health outcomes. Despite advancements in antiretroviral therapy, many people living with HIV (PLHIV) are disengaged from care, compromising treatment effectiveness. Methods: A retrospective cohort study was conducted on 81 episodes of care dropout at a Portuguese hospital between 2018 and 2024. A multidisciplinary team (physicians, nurses, social workers, and mental health professionals) implemented a structured program to reengage patients. Demographic, clinical, and socioeconomic data were collected at baseline and after 6 months. Results: 79% percent of the participants returned to care, with 68% resuming antiretroviral therapy. Although most patients achieved improved viral load suppression after returning, 27% were lost to follow-up after 6 months. Foreign-born individuals were associated with a lower likelihood of re-engagement. Common barriers include financial hardship, limited social support, and unaddressed mental health needs. Conclusions: A multidisciplinary approach effectively reconnected PLHIV to care and achieved enhanced virological outcomes. However, persistent socioeconomic and psychosocial challenges can lead to repeated disengagement. Long-term, targeted interventions, particularly for vulnerable groups, are required to sustain retention and ensure improved HIV management and overall patient well-being.

Purpose: Clostridium species are an under-recognized cause of severe infections with substantial mortality, yet national data remain limited. This study aimed to characterize the epidemiological, microbiological, clinical, and therapeutic features of clinically significant Clostridium spp. infections and to identify factors associated with 30-day mortality. Methods: We conducted a retrospective, single-centre cohort study at Unidade Local de Saúde de Gaia-Espinho (Portugal), including all patients with clinically significant Clostridium spp. isolates between 1 January 2020 and 30 March 2025. Demographic, clinical, microbiological, and therapeutic data were obtained from electronic medical and laboratory records. The primary outcome was 30-day all-cause mortality. Survivors and non-survivors were compared using univariate and multivariable logistic regression analyses. Results: A total of 119 patients were included (median age 68.9 years). Most infections were community-acquired (73.1%), and C. perfringens was the most frequently identified species (58.8%). Thirty-day mortality was 22.7%. In univariate analysis, mortality was associated with older age, thrombocytopenia, hepatic and renal dysfunction, bacteremia, sepsis or septic shock, inadequate antimicrobial therapy, and lack of source control. In Firth penalised logistic regression, age (OR 1.09/year, 95% CI 1.04–1.16), hepatic dysfunction (OR 6.74, 95% CI 2.05–25.87), and septic shock (OR 56.41, 95% CI 11.11–458.37) were associated with mortality; adequate antimicrobial therapy was protective (OR 0.09, 95% CI 0.02–0.37). Conclusion: Clostridium spp. infections were associated with high mortality. Age and organ dysfunction were key risk factors, whereas early appropriate antimicrobial therapy was the main modifiable protective factor. Prompt recognition, timely antibiotics, and adequate source control are essential.