Background: Antimicrobial resistance (AMR) is an escalating global health threat, projected to cause over 40 million deaths by 2050. ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) are major contributors to nosocomial infections and AMR. We evaluated the epidemiology and AMR prevalence of ESKAPE pathogens at the University Hospital in Palermo between January 2018 and July 2023, analyzing factors associated with mortality in patients with positive blood cultures. Methods: Microbiological data from all specimen types were collected using the Business Intelligence system Biwer, excluding duplicates. We assessed the prevalence and trends of ESKAPE isolates and AMR over time. Clinical data from hospital discharge forms were used to evaluate factors associated with mortality in patients with ESKAPE-positive blood cultures. Differences in AMR prevalence between blood and non-blood isolates were examined. Results: A total of 11,607 specimens from 4916 patients were analyzed. Most patients were admitted to Internal Medicine (19.4%), the ICU (13.2%), and General Surgery (9.9%). Additionally, 21.5% of the specimens were collected from ICU-admitted patients. Blood cultures accounted for 14.3% of the specimens, urine for 25.3%, respiratory secretions for 22.1%, and skin and mucosal swabs for 20.9%. The prevalence of all isolates increased progressively, peaking in 2021. The vancomycin-resistant E. faecium prevalence was 19.4%, with a significant upward trend, while oxacillin-resistant S. aureus prevalence was 35.0%, showing a significant decline. A. baumannii exhibited high resistance to all antibiotics tested except for colistin and cefiderocol. Carbapenemase resistance was 55.0% in K. pneumoniae, 20.4% in P. aeruginosa, and 4.6% in Enterobacter spp. P. aeruginosa showed a significant decrease in meropenem resistance. K. pneumoniae and A. baumannii bloodstream infections were linked to higher mortality risk.

Background: Bloodstream infections (BSIs) are both a primary cause and a severe complication of hospitalization. This retrospective study aims to analyze the epidemiology of BSIs at the University Hospital of Palermo from 2018 to 2024. Methods: We conducted a single-center, retrospective, observational study at the University Hospital Paolo Giaccone in Palermo, analyzing microbiological data from blood cultures collected between 1 January 2018 and 31 December 2024. Results: A total of 6345 blood culture isolates from 2967 patients were analyzed. Bacteremia-related mortality per 1000 patients rose from 5.1% in 2018 to 10.5% in 2024. The most isolated pathogens were non-aureus staphylococci (39.7%), followed by Klebsiella pneumoniae (12.1%) and Staphylococcus aureus (7.47%). Acinetobacter baumannii and Pseudomonas aeruginosa were more prevalent in ICUs. The number of K. pneumoniae, A. baumannii, S. aureus, and P. aeruginosa isolates per 1000 admitted patients increased significantly over time. Oxacillin resistance in S. aureus peaked at 49.0% in 2020 before declining, while among non-aureus staphylococci, it remained consistently high (>80%). Carbapenem-resistant K. pneumoniae peaked at 80% in 2022 before decreasing in 2024. Resistance to ceftazidime-avibactam and meropenem-vaborbactam was observed in 11.3% and 11.8% of K. pneumoniae, respectively. Multivariable analysis identified A. baumannii and K. pneumoniae BSIs as independent predictors of in-hospital mortality. Additionally, female sex, pneumonia, and central nervous system infections were significant risk factors for mortality. Conclusions: We observed an increasing trend in overall bacteremia-related mortality from 2018 to 2024. Microbiological data highlight the predominance of non-aureus staphylococci, K. pneumoniae, and S. aureus as leading pathogens of BSI, with A. baumannii emerging as a significant threat, particularly in ICUs. Rising antimicrobial resistance, especially among K. pneumoniae, underscores the urgent need for robust antimicrobial stewardship programs. K. pneumoniae and A. baumannii were associated with higher mortality.

Background/Objectives: Various factors associated with seasonality, including temperature, humidity, geographical composition, and seasonal fluctuations, can influence the trends of microbes responsible for hospital infections, such as Candida spp. This study evaluates the seasonal variability of Candida spp. bloodstream infections and antifungal resistance in hospitalized patients in Sicily. Methods: We retrospectively analyzed the demographic and epidemiological characteristics of 175 patients with blood cultures positive for Candida spp. Who were hospitalized at University Hospital Paolo Giaccone (A.U.O.P.), University of Palermo, Italy, from 1 January 2022 to 31 December 2024. Data on Candida species and antifungal resistance were also collected from the hospital’s database system to prevent and control hospital infections in A.U.O.P. Results: A total of 175 patients, 57.7% males, with a mean age of 68.3 years, were included in this study. Candida parapsilosis, Candida albicans, and Candida glabrata were more frequent in ICU (54.5%, p = 0.0001), medical (72.5%, p = 0.0003), and surgical settings (24%, p = 0.0161), respectively. C. parapsilosis was more frequent in dead patients (53.2%, p = 0.005). Among the seasons, we observed a significantly higher presence of C. glabrata in Autumn (20%, p = 0.0436). From the analysis of the seasons, C. parapsilosis and C. albicans were more frequent for each season, except in Spring, where the most frequent isolates were C. glabrata (5.1%, p = 0.0237) and C. parapsilosis (9.7%, p < 0.0001). The antifungal with the most resistance to Candida spp. was fluconazole in all seasons. Conclusions: Our study highlights the seasonal trends in Candida spp. and antifungal resistance, emphasizing climate change’s challenges on fungal diseases. These findings may contribute to improving prevention and treatment strategies for candidemia.

Bloodstream infections (BSIs) and sepsis are a major cause of morbidity and mortality. Appropriate early antibiotic therapy is crucial for improving the survival of patients with sepsis and septic shock. T2 magnetic resonance (T2MR^®) technology may enable fast and sensitive detection of ESKAPEc pathogens directly from whole-blood samples. We aimed to evaluate concordance between the T2Bacteria^® Panel and standard blood culture and its impact on antibiotic therapy decisions. We conducted a single-centre retrospective study on patients with sepsis-induced hypotension or septic shock admitted to general, post-operative/neurosurgical, and cardiothoracic Intensive Care Units who were tested with the T2Bacteria^® Panel from January 2021 to December 2022. Eighty-five consecutively admitted patients were included, for a total of 85 paired tests. A total of 48 ESKAPEc pathogens were identified by the T2Bacteria^® Panel. The concordance rate between the T2Bacteria^® Panel and blood cultures was 81% (69/85), with 20 concordant-positive and 49 concordant-negative cases. For the 25 microorganisms grown from accompanying blood cultures, blood pathogen coverage by the T2Bacteria^® Panel was 88%. In this cohort of severely ill septic patients, the T2Bacteria^® Panel was highly concordant and was able to detect more ESKAPEc pathogens, with a significantly shorter turn-around time compared to conventional blood cultures. The T2Bacteria^® Panel also significantly impacted decisions on antibiotic therapy.

Introduction Acinetobacter baumannii is recognized by the World Health Organization (WHO) as one of the ESKAPE priority pathogens because of its environmental persistence and ability to acquire antimicrobial resistance. Carbapenem-resistant A. baumannii (CRAb) has been included in the WHO Global Priority List of Antibiotic-Resistant Bacteria since 2017 and remains a critical threat. In Europe, CRAb is responsible for a substantial burden of healthcare-associated infections and mortality, particularly among critically ill patients. Objectives To evaluate temporal trends in antimicrobial resistance among clinical isolates of Acinetobacter baumannii collected at the Microbiology Laboratory of the University Hospital “Paolo Giaccone” of Palermo over a 13-year period (2013–2025). Methods A retrospective analysis was conducted on all clinical isolates of A. baumannii collected between 2013 and 2025 (N = 3,010). One isolate per patient was included. Data collected comprised year of isolation, patient demographics (age and sex), hospital ward (Intensive Care Unit/Emergency, Medical Area, Surgical Area), and biological sample type. Antimicrobial susceptibility testing was performed against polymyxins, fluoroquinolones, aminoglycosides, and carbapenems. Isolates were classified as multidrug-resistant (MDR) when resistant to at least three antimicrobial classes. Comparisons between MDR and non-MDR isolates were performed using chi-square or Fisher’s exact tests for categorical variables and the Kruskal–Wallis test for age. To identify independent predictors of MDR isolation and evaluate temporal variability, a mixed-effects logistic regression model was applied, with isolates nested within years. Age, sex, clinical area, and sample type were included as fixed effects, while year of isolation was modelled as a random effect. Results were reported as adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs). Results Among the 3,010 isolates analyzed, 2,727 (90.6%) were classified as MDR. Patients were predominantly male (60.3%), with a mean age of 71.0 ± 15.7 years; 71.4% were aged 65 years or older. Most isolates originated from Intensive Care/Emergency Units (43.8%), followed by Medical (33.9%) and Surgical Wards (21.0%). Resistance rates remained consistently high throughout the study period, reaching 95.8% for carbapenems, 95.1% for fluoroquinolones, and 91.0% for aminoglycosides. Polymyxin resistance remained low (1.6%). Univariable analyses did not identify significant associations between patient or clinical characteristics and MDR status. In the mixed-effects model, age emerged as the only independent predictor of MDR isolation (OR 1.01; 95% CI 1.00–1.02; p = 0.019). Significant between-year variability was observed (random intercept SD = 0.404; 95% CI 0.046–0.526). Year-specific analyses showed a significantly increased probability of MDR isolation in 2020, whereas significantly lower-than-expected odds were observed in 2022 and 2023. Conclusions The observed temporal variability suggests that healthcare-system factors, beyond individual patient characteristics, influenced MDR A. baumannii circulation. The increase observed in 2020 coincided with the COVID-19 pandemic, characterized by increased intensive care admissions, broad-spectrum antibiotic use, prolonged mechanical ventilation, and critical care overcrowding. Conversely, the reduction observed in 2022–2023 may reflect strengthened infection prevention and control measures and reduced antibiotic selective pressure associated with declining COVID-19-related critical care admissions.