Surgical site infections persist as a substantial concern within the realm of hospital-acquired infections. This enduring issue is further compounded by the mounting challenge of antibiotic resistance, a surge in surgical interventions, and the presence of comorbidities among patients. Thus, a comprehensive exploration of all discernible risk factors, as well as proactive preventive and prophylactic strategies, becomes imperative. Moreover, the prevalence of multidrug-resistant microorganisms has reached alarming proportions. Consequently, there is an acute need to investigate and scrutinize all potential therapeutic interventions to counter this burgeoning threat. Consequently, the primary objective of this review is to meticulously assess the origins and risk elements intertwined with surgical site infections across a diverse spectrum of surgical procedures. As the medical landscape continues to evolve, this critical analysis seeks to provide a nuanced understanding of the multi-faceted factors contributing to surgical site infections, with the overarching aim of facilitating more effective management and mitigation strategies. By exploring these dimensions comprehensively, we endeavor to enhance patient safety and the quality of surgical care in this era of evolving healthcare challenges.

Antimicrobial resistance is increasingly concerning, causing millions of deaths and a high cost burden. Given that carbapenemase-producing Enterobacterales are particularly concerning due to their ability to develop structural modifications and produce antibiotic-degrading enzymes, leading to high resistance levels, we sought to summarize the available data on the efficacy and safety regarding the combination of meropenem-vaborbactam (MV) versus the best available therapy (BAT). Articles related to our objective were searched in the PubMed and Scopus databases inception to July 2024. To assess the quality of the studies, we used the Cochrane risk-of-bias tool, RoB2. The outcomes were pooled as a risk ratio (RR) and a 95% confidence interval (95%CI). A total of four published studies were involved: one retrospective cohort study and three phase 3 trials, including 432 patients treated with MV and 426 patients treated with BAT (mono/combination therapy with polymyxins, carbapenems, aminoglycosides, colistin, and tigecycline; or ceftazidime-avibactam; or piperacillin-tazobactam). No significant difference in the clinical response rate was observed between MV and the comparators at the TOC (RR = 1.29, 95%CI [0.92, 1.80], p = 0.14) and EOT (RR = 1.66, 95%CI [0.58, 4.76], p = 0.34) visits. MV was associated with a similar microbiological response as the comparators at TOC (RR = 1.63, 95%CI [0.85, 3.11], p = 0.14) and EOT assessment (RR = 1.16, 95%CI [0.88, 1.54], p = 0.14). In the pooled analysis of the four studies, 28-day all-cause mortality was lower for MV than the control groups (RR = 0.47, 95%CI [0.24, 0.92], p = 0.03). MV was associated with a similar risk of adverse events (AEs) as comparators (RR = 0.79, 95%CI [0.53, 1.17], p = 0.23). Additionally, MV was associated with fewer renal-related AEs than the comparators (RR = 0.32, 95%CI [0.15, 0.66], p = 0.002). MV was associated with a similar risk of treatment discontinuation due to AEs (RR = 0.76, 95%CI [0.38, 1.49], p = 0.42) or drug-related AEs (RR = 0.56, 95%CI [0.28, 1.10], p = 0.09) as the comparators. In conclusion, MV presents a promising therapeutic option for treating CRE infections, demonstrating similar clinical and microbiological responses as other comparators, with potential advantages in mortality outcomes and renal-related AEs.

Background and Clinical Significance: Acute pediatric rhinosinusitis is most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The involvement of Enterobacter species is rare and typically linked to chronic or nosocomial infections. Typical cases of acute rhinosinusitis in children present with abundant nasal discharge, headache, and fever and are generally managed with systemic antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), mucolytics, and topical intranasal treatment. Atypical presentations prompt heightened clinical attention, and depending on the symptoms and patient status, surgical interventions might be considered. Case Presentation: We report the case of a previously healthy 5-year-old boy presenting with painful unilateral palpebral edema, minimal ipsilateral nasal discharge, and persistent headache despite standard rhinosinusitis therapy. Imaging tests revealed complete right maxillary sinus opacification. As the clinical response to ceftriaxone and dexamethasone was minimal, we opted for endoscopic sinus surgery. A nasal swab culture identified Enterobacter spp. in the nasal discharge. Conclusions: Unusual pathogens like Enterobacter spp. can cause acute sinusitis in children without prior risk factors. Early surgical intervention and culture-adjusted antimicrobial therapy remain critical for favorable outcomes.

(1) Background: Chronic rhinosinusitis (CRS) with recurrent symptoms despite therapy raises concern for underlying antimicrobial resistance. While inflammation is central to disease pathophysiology, increasing evidence suggests that resistant bacterial populations within the sinonasal niche may contribute to treatment failure. This study aimed to characterize the molecular resistance profiles of bacterial isolates from refractory CRS patients and evaluate genotype–phenotype concordance and clinical resistance burden. (2) Methods: Our observational study includes 99 bacterial isolates obtained by endoscopically guided nasal swabs from adult CRS patients with recurrent disease. Species identification and antimicrobial susceptibility testing were performed using the VITEK^®2 system. Resistance genes were detected using multiplex-PCR. Statistical analyses included Mann–Whitney U tests for genotype–phenotype associations, Kruskal–Wallis testing across MDR categories, Spearman correlation between gene burden and clinical risk, and concordance metrics. (3) Results: Recognized sinonasal pathogens accounted for 46.5% of isolates, predominantly Staphylococcus aureus, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. β-lactamase genes (tem 25.3%, shv 9.1%, ctxM 8.1%) and macrolide resistance markers (ermB 20.2%) were most prevalent, while carbapenemase genes remained infrequent. Significant phenotype–genotype correlations were observed for mecA–oxacillin, sul1–TMP-SMX, KPC–meropenem, and tem–β-lactams (p < 0.01). Gene burden increased progressively across clinical risk categories (p < 0.001), with MDR/XDR isolates concentrated in patients with repeated antibiotic exposure. Molecular and phenotypic analyses demonstrated high concordance for selected gene–antibiotic pairs, supporting targeted molecular screening as an adjunct to culture-based diagnostics in refractory CRS.

Background/Objectives: Rapid molecular detection of antimicrobial resistance determinants has the potential to optimize antimicrobial therapy before conventional antimicrobial susceptibility testing becomes available. However, the clinical utility of these assays depends on the concordance between detected resistance genes and phenotypic susceptibility. This study aimed to evaluate the genotype–phenotype concordance of carbapenemase and β-lactamase genes detected by the Unyvero multiplex-PCR platform with minimum inhibitory concentration (MIC)-based susceptibility profiles obtained using the phenotypic AST comparator method in Gram-negative clinical isolates. Methods: A total of 117 non-duplicate Gram-negative clinical isolates recovered from hospitalized patients at a Romanian tertiary-care hospital were analyzed. Resistance determinants, including blaKPC, blaOXA-48, blaOXA-23, blaCTX-M, blaTEM, together with aminoglycoside, fluoroquinolone, and sulfonamide resistance markers, were identified using the Unyvero multiplex-PCR system. Phenotypic antimicrobial susceptibility testing was performed using the VITEK^®2 automated system according to EUCAST criteria. Genotype–phenotype concordance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen’s κ coefficient. Results: Overall, 78.8% (78/99) of isolates were classified as non-susceptible. blaOXA-48 was the most frequently detected carbapenemase gene (n = 12), followed by blaKPC (n = 9) and blaOXA-23 (n = 3). blaKPC demonstrated a sensitivity of 100% for predicting imipenem resistance in Enterobacterales, with moderate agreement (κ = 0.58), whereas blaOXA-23 showed complete diagnostic performance (100% sensitivity and PPV) for carbapenem resistance in Acinetobacter baumannii. In contrast, all blaOXA-48-positive Enterobacterales remained phenotypically susceptible to carbapenems, indicating poor genotype–phenotype concordance. Likewise, blaCTX-M, gyrA83/87, and qnrA/B/S showed limited diagnostic performance for corresponding phenotypic resistance. Conclusions: Phenotype–genotype concordance varies across resistance determinants and Gram-negative bacterial species. Detection of blaKPC and blaOXA-23 may support early optimization of antimicrobial therapy, whereas blaOXA-48 should be interpreted together with conventional phenotypic antimicrobial susceptibility testing. Integrating rapid molecular diagnostics with phenotypic susceptibility testing may improve antimicrobial stewardship and optimize the management of multidrug-resistant Gram-negative infections.

Introduction. Acute bacterial sinusitis in immuno­com­pe­tent adults is typically caused by Streptococcus pneumoniae, Hae­mo­phi­lus influenzae and Moraxella catarrhalis. En­te­ro­co­ccus faecalis is a rare etiologic agent in sinonasal in­fec­tions, being usually linked to nosocomial settings, im­mu­no­sup­pres­sion or chronic disease. Case presentation. We present the case of a previously healthy 27-year-old man with acute exacerbation of chronic rhinosinusitis, pre­sen­ting with severe unilateral head­ache, palpebral ne­cro­sis and purulent nasal discharge. The patient was ma­naged with broad-spectrum intravenous anti­bio­tics and under­went combined endoscopic sinus surgery and external fron­tal sinus drainage (modified Ogston-Luc pro­ce­dure). Cul­ture of the collected material identified En­te­ro­coc­cus fae­ca­lis as the primary pathogen. Discussion. This case high­lights an unusual presentation of acute complicated si­nu­si­tis caused by Enterococcus faecalis in an otherwise healthy young adult. While rarely implicated in community-ac­qui­red rhi­no­si­nu­sitis, its detection should prompt con­si­de­ra­tion of resistance mechanisms, biofilm formation and sub­opti­mal hygie­nic factors. Early surgical intervention and microbiological identification were essential in guiding the effective antibiotic therapy. Conclusions. Enterococcus fae­ca­lis may represent an emerging, atypical pathogen in sinus in­fec­tions even in low-risk individuals. Accurate diagnosis, prompt surgical management and culture-directed therapy are critical in avoiding com­pli­ca­tions and ensuring optimal cli­ni­cal outcomes.