Introduction: Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivation are known complications in immunocompromised hosts, particularly transplant recipients. However, their occurrence and clinical implications in patients with solid tumors remain underexplored. The introduction of immune checkpoint inhibitors (ICIs) has transformed cancer therapy, but immune-related adverse events (irAEs), including colitis, are increasingly recognized. The potential role of viral reactivation in exacerbating these toxicities is not well established. Cases Presentation: We report two cases of patients with solid tumors treated with ICIs who developed severe, refractory immune-related colitis. Extensive evaluation revealed markedly elevated CMV and EBV viral loads in colonic biopsies, confirmed by histopathology. Both patients showed significant clinical and endoscopic improvement following antiviral therapy with ganciclovir, highlighting the role of CMV and EBV in modulating the severity of ICI-induced colitis. Conclusions: CMV and EBV reactivation may contribute to the persistence or worsening of ICI-induced colitis. Early recognition and treatment of viral reactivation in patients with irAEs may improve outcomes. Clinical judgment and serial viral monitoring are essential for guiding management decisions.

Clostridium cadaveris (C. cadaveris), a strict anaerobic gram-positive rod, is rarely reported in clinical specimens. Since its detection in 1899, it has always been linked to the decay of dead bodies. C. cadaveris is considered non-pathogenic to humans, however infrequently it can cause severe infections including bacteremia. The latter was typically associated with gastro-intestinal pathologies. We report the first case of C. cadaveris invasive infection at Sultanate Oman. The source was most probably an infected decubitus ulcer.

Candida species frequently cause bloodstream infections; however, there is a lack of epidemiological studies on candidemia in Oman. To address this, we conducted a retrospective study at Sultan Qaboos Comprehensive Cancer and Research Center from October 2021 to October 2023. Our study identified 27 episodes of candidemia among 26 patients with cancer, with an incidence of 4.9 per 1000 admissions. Non-albicans Candida (NAC) prevailed over C. albicans (70.37% vs 29.62%), with C. glabrata as the predominant NAC species (n = 10; 37%). The 30-day mortality rate was 40.7%, showing no significant difference between NAC and C. albicans but was notably higher in critically ill patients (P = 0.03). In Oman, NAC surpasses C. albicans as a causative pathogen for candidemia with a high mortality rate.

Objectives: This study aimed to delineate the characteristics and outcomes of gram-negative bacteremia (GNB) in oncology patients; analyze the risk factors for multi-drug–resistant (MDR) GNB; and assess its impact on the recurrence of bloodstream infection (BSI), hospital stay, and 30-day mortality. Methods: Data, including demographics, clinical features, common cancers, and microbiologic findings, were collected retrospectively from electronic medical records of patients admitted with solid tumors and BSI episodes between January and December 2022. Fisher's exact tests were used to determine the effect of MDR-GNB on 30-day mortality and BSI recurrence. The Wilcoxon rank-sum test assessed the differences in the length of hospital stay. Logistic regression models identified the risk factors for MDR-GNB. Results: Among 1074 patients, 77 episodes of GNB bacteremia occurred in 59 individuals (47% male, median age 57.4 years). Of these, 37 (48%) were MDR-GNB. Carbapenem resistance was noted in 9.1% of GNB episodes. Previous antibiotic use was significantly associated with MDR-GNB (odds ratio 7.82; 95% confidence interval 2.52-24). MDR-GNB was linked to longer hospital stays (median 23 vs 10.5 days, P = 0.003) and higher recurrence rates than non-MDR-GNB (35.13% vs 5.0%, P <0.001). However, 30-day mortality did not significantly differ between the groups (35.14% vs 32.5%, P = 0.81). Conclusion: Previous antibiotic use predicted MDR-GNB in patients with solid tumor. MDR-GNB bacteremia increased the length of hospital stay and risk of recurrence compared with non-MDR-GNB bacteremia.

Background: Dacryoadenitis is inflammation of the lacrimal gland, mainly caused by viral infection. It can also be caused by bacterial pathogens and non-infectious processes such as auto-immune diseases and malignancy. Chronic dacryoadenitis is rarely linked to SARS-CoV-2 infection, with only five reports in the literature. Report: A 26-year-old Arab woman experienced chronic inflammatory dacryoadenitis after a mild SARS-CoV-2 infection, which was successfully treated with oral prednisone. Conclusions: Dacryoadenitis can occur due to inflammation caused by either SARS-CoV-2 exposure. The treatment typically involves the administration of steroids, with duration to be decided based on clinical response.

Surgical antimicrobial prophylaxis (SAP) is essential for preventing surgical site infections (SSIs), particularly in oncology patients. However, adherence to SAP guidelines globally remains inconsistent. This study evaluated adherence to SAP protocols at a tertiary oncology center and assessed associated factors with non-adherence and SSI outcomes. A retrospective review was conducted at Sultan Qaboos Comprehensive Cancer and Research Center (SQCCCRC) from August 2022 to July 2023. SAP prescriptions were evaluated for four criteria: antibiotic choice, weight-based dosing, re-dosing, and duration. Non-adherence to any of the four components considered non-adherent. Demographics, cancer type, surgical procedure, wound classification, procedure duration, SSIs, and microbiology results were extracted from patient records. We used bivariate analysis and multivariable logistic regression model to identify factors associated with non-adherence. The cumulative incidence of SSIs was also calculated. Of the 261 surgeries reviewed, overall adherence to SAP protocols was 65%. Weight-based dosing adherence was highest (99.6%), while re-dosing adherence was lowest (80%). Univariate analyses showed non-adherence linked to higher patient weight (P = 0.041), male gender (P = 0.01), wound classification (P < 0.001) and longer surgery duration (P < 0.001), while breast surgery had better adherence (P = 0.0025). In the multivariable model, non-adherence was independently associated with gyne-oncology procedures (odds ratio [OR] = 7.76, 95% confidence interval [CI] = 2.13-30.86; P = 0.002) and longer surgery duration (OR = 1.35 per hour, 95% CI = 1.16-1.58; P = 0.0001). The cumulative incidence of SSIs was 8.4%, comprising 52% organ-spaced, 33.3% deep SSI, and 14% superficial SSIs. Non-adherent cases were more likely to have SSI compared to adherent (15.7% vs 4.7%, P = 0.004). The study found suboptimal overall adherence to SAP protocols, particularly in re-dosing practices. Targeted antimicrobial stewardship interventions are warranted to address these gaps and minimize infection risk, especially in high-risk oncology populations.