Antimicrobial resistance (AMR) has emerged as one of the leading public health threats of the 21st century. New evidence underscores its significance in patients’ morbidity and mortality, length of stay, as well as healthcare costs. Globally, the factors that contribute to antimicrobial resistance include social and economic determinants, healthcare governance, and environmental interactions with impact on humans, plants, and animals. Antimicrobial stewardship (AS) programs have historically overlooked surgical teams as they considered them more difficult to engage. This review aims to summarize the evolution and significance of AS in surgical wards, including the surgical intensive care unit (SICU) and the role of diagnostic stewardship (DS). The contribution of AS team members is presented. The new diagnostic modalities and the new technologies including artificial intelligence (AI) are also reviewed.

Background: Limited data exist on the prevalence of myosteatosis (i.e., excess accumulation of fat in skeletal muscles) in hepatocellular carcinoma (HCC) patients, and no systematic review or meta-analysis has been conducted in this context. Methods: We searched for articles published from inception until November 2023 to assess the prevalence of myosteatosis in patients with HCC. Results: Ten studies with 3316 patients focusing on myosteatosis and HCC were included. The overall prevalence of myosteatosis in HCC patients was 50% [95% Confidence Interval (CI): 35–65%]. Using the body mass index-based criteria (two studies), the prevalence was 34%, while gender-based criteria (eight studies) yielded 54% (p = 0.31). In Asian studies (n = 8), the prevalence was 45%, compared to 69% in non-Asian countries (two studies) (p = 0.02). For viral-associated HCC (eight studies), the prevalence was 49%, rising to 65% in non-alcoholic fatty liver disease-associated cases (three studies) and 86% in alcoholic liver disease-associated cases (three studies) (p < 0.01). The prevalence of myosteatosis was higher in Child–Pugh class C (3 studies, 91%) than in A (7 studies, 73%) or B (6 studies, 50%) (p = 0.02), but with no difference between Barcelona Clinic Liver Cancer stage A (3 studies, 66%), B (4 studies, 44%) and C (3 studies, 62%) (p = 0.80). Patients with myosteatosis had a significantly higher mortality (six studies) (Relative Risk: 1.35 (95%CI: 1.13–1.62, p < 0.01). Conclusion: The prevalence of myosteatosis is high in HCC patients and is associated with more severe liver disease and higher mortality rates.

Background and Aims: Sarcopenia and frailty have been associated with hormonal dysregulation in non‐cirrhotic populations. The aim of the study was to evaluate hypothalamic–pituitary–adrenal and gonadal (HPA‐HPG) axes as well as growth hormone/insulin‐like growth factor‐1 (GH/IGF‐1) levels in patients with cirrhosis and their correlation with reduced muscle mass and frailty. Methods: One hundred twenty‐four patients with decompensated cirrhosis were prospectively included. Clinical and laboratory variables, including hormonal assessment, were evaluated. MELD‐Na and Child‐Turcotte‐Pugh scores were calculated. Muscle mass was estimated through mid‐arm muscle circumference and dual energy X‐ray absorptiometry. Short Physical Performance Battery (SPPB) and Liver Frailty Index (LFI) were also calculated. Results: Among the studied hormones, low DHEAS levels were the only independent factor associated with abnormal SPPB and LFI [Odds ratio (OR): 1.11, p = 0.019 and OR: 0.97, p = 0.005 respectively]. Separate analysis on the basis of gender revealed that DHEAS was independently associated with abnormal SPPB and LFI only in men. Δ4 androstenedione [Hazard Ratio (HR): 0.64, p = 0.038] and MELD‐Na score (HR: 1.108, p = 0.0057) were the only prognostic factors independently associated with mortality. MELD‐Na was significantly associated with the outcome in both male and female patients (HR: 1.052, p = 0.04 and HR: 1.22, p = 0.009, respectively), whereas Δ4 androstenedione was significantly associated only in men (HR: 0.47, p = 0.01). Conclusions: Our study is the first to evaluate HPA‐HPG and GH/IGF‐1 dysregulation in the same cohort of patients with decompensated cirrhosis. DHEAS was the only hormone correlated with frailty parameters and physical function, whereas low Δ4 androstenedione was associated with adverse outcomes in men.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to sarcopenia and frailty, but data on white populations remain limited. This study evaluated sarcopenia, physical performance and steroid hormone associations with frailty in European MASLD patients. A cross-sectional study included 245 white MASLD patients. Clinical, biochemical, hormonal and elastography data were collected. Sarcopenia was assessed using dual-energy X-ray absorptiometry alongside mid-arm muscle circumference (MAMC), while physical performance was assessed using the liver frailty index (LFI) and the short physical performance battery (SPPB). Mean age was 56.2 years, 45.7% were male, and median liver stiffness was 5.2 kPa; 76.3% and 33.9% of patients had low MAMC and Appendicular Lean Mass Index, while 13.5% had abnormal SPPB and 16% were frail (i.e., LFI > 4.4). Poor physical performance was linked to lower dehydroepiandrosterone sulfate (DHEAS) levels using both LFI (OR: 0.98, 95% C.I.: 0.96–0.99, p = 0.01) and SPPB (OR: 1.14, 95% C.I.: 1.003–1.22, p = 0.026). Frailty assessed by LFI was associated with increased liver stiffness (OR: 1.24, 95% C.I.: 1.047–1.482, p = 0.013). We concurrently evaluated muscle mass and frailty for the first time in a white MASLD cohort. Lower DHEAS levels were associated with impaired physical performance. Further studies are needed to confirm these findings and their possible therapeutic implications.

Background/Objectives: Regional adipose tissue has been studied as a prognostic factor in various extra-hepatic diseases, but data in the setting of cirrhosis is scarce. Our aim was to evaluate the association of regional adipose tissue indices with the severity of liver disease and its impact on the outcome of patients with cirrhosis. Methods: Three hundred and thirty-seven patients with cirrhosis were prospectively enrolled in the study. Clinical and laboratory data were recorded, and MELD-Na and Child-Turcotte-Pugh scores were calculated. Physical performance was evaluated with handgrip strength, the Short Physical Performance Battery test, and the Liver Frailty Index. Dual-energy X-ray absorptiometry was used for the evaluation of total and regional lean and fat mass. Results: A low trunk fat percentage was found to be independently associated with a MELD-Na score ≥ 15 (Odds Ratio: 0.92, p = 0.007). MELD-Na score and trunk fat percentage were the only factors independently associated with mortality [Hazard Ratio (HR): 1.078, p = 0.02 and HR: 0.95, p = 0.03, respectively], while a separate analysis based on gender confirmed this finding only in men. In the total cohort, patients with a trunk fat percentage < 27.5% had worse outcomes (log-rank 11.4; p < 0.001). Conclusions: This study marks the first effort to examine the association of indices related to regional adipose tissue distribution with the severity of liver disease and outcome. Trunk fat percentage was the only body composition parameter independently associated with advanced liver disease and prognosis in the total cohort specifically in men, but not in women. Further studies are needed to validate the predictive role of adipose tissue in patients with cirrhosis.