Multidrug-resistant Staphylococcus epidermidis (MDRSE) is responsible for difficult-to-treat infections in humans and hospital-acquired-infections. This review discusses the epidemiology, microbiology, diagnosis, and treatment of MDRSE infection and identifies knowledge gaps. By using the search term “pan resistant Staphylococcus epidermidis” OR “multi-drug resistant Staphylococcus epidermidis” OR “multidrug-resistant lineages of Staphylococcus epidermidis”, a total of 64 records have been identified from various previously published studies. The proportion of methicillin resistance in S. epidermidis has been reported to be as high as 92%. Several studies across the world have aimed to detect the main phylogenetic lineages and antibiotically resistant genes through culture, mass spectrometry, and genomic analysis. Molecular biology tools are now available for the identification of S. epidermidis and its drug resistance mechanisms, especially in blood cultures. However, understanding the distinction between a simple colonization and a bloodstream infection (BSI) caused by S. epidermidis is still a challenge for clinicians. Some important parameters to keep in mind are the number of positive samples, the symptoms and signs of the patient, the comorbidities of the patient, the presence of central venous catheter (CVC) or other medical device, and the resistance phenotype of the organism. The agent of choice for empiric parenteral therapy is vancomycin. Other treatment options, depending on different clinical settings, may include teicoplanin, daptomycin, oxazolidinones, long-acting lipoglycopeptides, and ceftaroline. For patients with S. epidermidis infections associated with the presence of an indwelling device, assessment regarding whether the device warrants removal is an important component of management. This study provides an overview of the MDRSE infection. Further studies are needed to explore and establish the most correct form of management of this infection.

Antibiotic resistance is one of the greatest growing public health threats and a worldwide priority. According to the WHO, drug-resistant diseases may cause 10 million deaths a year by 2050 and have a substantial impact on the global economy, driving up to 24 million people into poverty. The ongoing COVID-19 pandemic has exposed the fallacies and vulnerability of healthcare systems worldwide, displacing resources from existing programs and reducing funding for antimicrobial resistance (AMR) fighting efforts. Moreover, as already seen for other respiratory viruses, such as flu, COVID-19 is often associated with superinfections, prolonged hospital stays, and increased ICU admissions, further aggravating healthcare disruption. These events are accompanied by widespread antibiotic use, misuse, and inappropriate compliance with standard procedures with a potential long-term impact on AMR. Still, COVID-19-related measures such as increasing personal and environmental hygiene, social distancing, and decreasing hospital admissions could theoretically help the AMR cause. However, several reports have shown increased antimicrobial resistance during the COVID-19 pandemic. This narrative review focuses on this “twindemic”, assessing the current knowledge of antimicrobial resistance in the COVID-19 era with a focus on bloodstream infections and provides insights into the lessons learned in the COVID-19 field that could be applied to antimicrobial stewardship initiatives.

Oritavancin is emerging as a potential alternative to standard antibiotic regimens in the treatment of infective endocarditis caused by gram-positive bacteria, though evidence remains limited. We hereby report 7 cases of enterococcal endocarditis treated with oritavancin as consolidation therapy, resulting in 6 cures and 1 relapse.

Progressive Multifocal Leukoencephalopathy (PML) is a rare opportunistic infection of the central nervous system (CNS) caused by human polyomavirus JC virus, with high mortality rate in people living with HIV (PLWH), without an effective specific treatment beside combined antiretroviral therapy (cART). The use of Pembrolizumab, an inhibitor of the Programmed cell death protein 1 (PD-1) receptor on T cells, has been associated with decreased viral clearance. Aim of this study is to evaluate clinical course of PLWH affected by PML treated with pembrolizumab. We report four consecutive PLWH with clinical and radiological evidence of PML and JCV-DNA detection in cerebrospinal fluid (CSF). Pembrolizumab was administered to all four PLWH alongside cART. Radiological and laboratory follow-up were performed at the end of the medical protocol. Clinically, 3 out of 4 PLWH showed an improvement in neurological deficits, partially reacquiring the lost functions, and they are alive at 3.5 years, 14 months, and 9 months, respectively; the fourth patient died shortly after treatment due to worsening respiratory conditions. In all the PLWH completing treatment, a decrease of about 80–90% of the specific PD-1 activity was observed. Prolonged survival and stabilization of radiological findings have been observed, along with clinical improvement and partial recovery of acquired deficits in 3 out of 4 PLWH. In addition, a decrease in anti-PD-1 expression has also been observed, suggesting a link between the therapy and the success achieved. Given the small sample and conflicting evidence in the existing literature, further investigation is needed to assess its effectiveness.

Background and Objectives: The management of HIV patients presenting with fever in the Emergency Department (ED) remains a challenging clinical scenario. Accurate risk stratification and prognostic indicators are crucial for timely intervention and improved patient outcomes. Procalcitonin (PCT) has emerged as a promising biomarker for assessing the severity and prognosis of various infectious diseases. The study aimed to evaluate the prognostic value of procalcitonin (PCT) in HIV patients admitted to the Emergency Department for clinical suspicion of infection and assess its association with in-hospital mortality. Methods: A retrospective analysis was conducted on febrile HIV-positive patients admitted to the Emergency Department. Clinical data were collected from 2018 to 2022. Patients were categorized based on PCT levels (>0.5 ng/dL), clinical findings, comorbidities, and viro-immunological status. Results: We investigated data from 289 HIV-positive patients (74% male). The median age of the sample was 54 years [IQR: 42–62], 100 (35%) patients presented detectable viremia, and the median value of CD4+ T lymphocytes was 358 [IQR: 104–531]. Elevated PCT levels (≥0.5 ng/dL) were detected in 69 (23.8%) patients. A significant association was observed between elevated PCT and increased mortality risk (p < 0.05). The mortality rate among patients with detectable HIV viremia was higher compared to those with undetectable viremia (p = 0.02). Moreover, deceased patients had statistically lower CD4+ values compared to survivors (61 [IQR: 14–186] vs. 370 [IQR: 136–548], p < 0.001). Conclusions: In febrile HIV patients admitted to the Emergency Department, elevated procalcitonin levels, low CD4+, and detectable viremia are associated with an increased risk of in-hospital mortality.

Background: The comparative efficacy of ceftaroline and ceftobiprole against standard of care for Staphylococcus aureus infections, including methicillin-resistant S. aureus remains uncertain. Thus, we conducted a systematic review and Bayesian meta-analysis to assess the efficacy and safety of ceftaroline and ceftobiprole monotherapy for non-urinary S. aureus infections. Methods: We registered the protocol in PROSPERO. We searched PubMed, Embase, Scopus, and Web of Science. We included randomized controlled trials and comparative non-randomized studies reporting adjusted estimates, enrolling patients with non-urinary S. aureus infections. The primary analysis assessed clinical cure in randomized trials using a Bayesian random-effects model with a vague prior. For ceftaroline, we additionally conducted an exploratory analysis using an observationally informed prior derived from non-randomized studies with variance inflation. Risk of bias was assessed with RoB 2 and ROBINS-I and certainty of evidence with GRADE. Results: Sixteen studies met inclusion criteria [11 ceftaroline (1030 subjects); 5 ceftobiprole (1265 subjects)]. In the primary analysis, the pooled odds ratio for clinical cure was 1.38 (95% CrI 0.81–2.44) for ceftaroline and 0.99 (95% CrI 0.59–1.62) for ceftobiprole. The exploratory ceftaroline analysis using an observationally informed prior yielded an odds ratio of 1.45 (95% CrI 0.91–2.38). Adverse events and serious adverse events were similar between groups. Certainty of evidence was low for ceftaroline and moderate for ceftobiprole. Conclusions: Current evidence does not demonstrate superiority of ceftaroline or ceftobiprole over standard-of-care therapy for clinical cure in non-urinary S. aureus infections. Estimates remain imprecise and are largely driven by registrational trials and subgroup data. These findings support cautious, indication-specific interpretation rather than routine preference of these agents over established therapies.