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/Objectives: Infections due to multidrug-resistant (MDR) Acinetobacter baumannii represent a critical challenge in modern healthcare, with limited therapeutic options. Eravacycline, a novel fluorocycline antibiotic, demonstrates promising in vitro activity, but real-world clinical data for complex intra-abdominal infections (IAIs) are scarce. We present two cases of severe IAI caused by carbapenem-resistant A. baumannii (CRAB) successfully treated with eravacycline. Methods: We describe the clinical course, microbiological findings, and outcomes of two critically ill patients. Case 1 was a 75-year-old male with biliary peritonitis following an endoscopic procedure. Case 2 was a 64-year-old male with infected pancreatic walled-off necrosis. Both patients had cultures positive for CRAB and failed multiple prior antibiotic regimens. Results: In both cases, the initiation of intravenous eravacycline led to significant clinical improvement, including resolution of septic shock and defervescence. A marked reduction in inflammatory markers (C-reactive protein and procalcitonin) was observed, alongside microbiological clearance of CRAB. Eravacycline was well tolerated, with no significant adverse events. Conclusions: These case reports suggest that eravacycline can be an effective and safe salvage therapy for complex IAIs caused by CRAB, even in scenarios of partial source control. It represents a valuable addition to the antimicrobial armamentarium for managing infections caused by these extensively drug-resistant organisms.

Background: Clostridioides difficile infection (CDI) remains a challenging condition, particularly in severe or recurrent cases. This study aimed to identify factors associated with recurrent CDI (rCDI), severe disease (defined by ZAR score or ESCMID criteria), death during CDI, and bloodstream infections (BSI) or candidemia within 8 weeks of CDI onset. Methods: We conducted a prospective study at an Italian university hospital that included all adult CDI cases diagnosed between November 2022 and December 2024. Statistical analyses were performed with IBM SPSS Statistics. A p-value < 0.05 was considered statistically significant in univariate analyses. For the multivariable analysis, we selected the variables that were statistically significant in the univariate analysis and considered the most clinically relevant. Results: A total of 161 CDI cases were identified. Recurrence occurred in 13%, higher than the 4% reported in a previous retrospective cohort at the same center (2013–2022). In univariate analysis, independent predictors of recurrent CDI (rCDI) were therapeutic regimens including oral vancomycin (p = 0.008; OR 6.17; 95% CI 1.36–27.97), peripheral vascular disease (PVD) (p < 0.001; OR 5.92; 95% CI 2.07–16.94), and dysphagia (p = 0.034; OR 4.61; 95% CI 1.25–17.07), whereas fidaxomicin use was associated with a protective effect (p = 0.016; OR 0.17; 95% CI 0.04–0.78). In multivariable analysis, oral vancomycin use (p = 0.008; OR 15.03) and peripheral vascular disease (p = 0.002; OR 7.27) remained independently associated with rCDI. Overall, 15 of 161 patients (9.3%) died during the CDI episode (either presenting CDI or rCDI), with all deaths directly attributable to CDI. Mortality during CDI was associated with age > 77 years (median value of the study population), transfer from a nursing home or long-term care facility within the previous 3 months, lymphoma, hematological malignancy, peripheral vascular disease, connective tissue disease, immobilization syndrome, dysphagia, elevated lactate levels (>1 mmol/L), septic shock, severe or severe-complicated CDI according to ESCMID criteria, severe-complicated CDI according to ESCMID criteria, leukocytosis (WBC > 15,000/mm³) during CDI, ZAR score ≥ 2, concomitant BSI, and concomitant pneumonia. During follow-up, 11 of 127 (8.7%) patients developed a BSI. BSI was associated with corticosteroid use and osteomyelitis. Only four patients developed candidemia due to Candida albicans during follow-up. Conclusions: Our study confirms that Clostridioides difficile infection remains a major clinical challenge, particularly due to its high recurrence rate and the burden of severe forms. The evidence strongly supports the preferential use of fidaxomicin, which should now be regarded as the standard of reference in clinical practice.

Background: Lemierre syndrome is a rare and life-threatening disease. It is characterized by septic thrombophlebitis of the internal jugular vein, historically associated with Fusobacterium necrophorum infection. However, atypical cases and associations with other organisms have been reported. Methods: Here, we describe a challenging case of Lemierre syndrome in a 71-year-old woman caused by Streptococcus constellatus and review the related literature. Case: The patient experienced multiple hospital admissions due to misdiagnoses and developed thrombosis involving the internal jugular vein and transverse sinus bilaterally, pulmonary complications including the formation of a pseudoaneurysm, and occipital abscess. She presented with headaches, neck pain, and blindness. Prolonged antibiotic therapy was administered, leading to gradual improvement of symptoms, with partial resolution of blindness. Prophylaxis with intramuscular penicillin was prescribed at discharge. Conclusions: Our case underscores the importance of considering Lemierre syndrome in patients who present with multiple thrombotic events affecting the intracranial circulation and/or jugular veins, particularly in those already receiving anticoagulation therapy or with no identifiable cause for thrombosis, even in the absence of sore throat or fever.

Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a genetically distinct lineage from healthcare-associated MRSA (HA-MRSA), often producing Panton-Valentine leukocidin (PVL) and causing severe skin and soft tissue infections (SSTIs) in otherwise healthy individuals. Methods: We describe five cases of PVL-positive CA-MRSA SSTIs admitted to the Infectious Diseases Unit of the University Hospital “Paolo Giaccone,” Palermo, Italy, between 2024 and 2025. Case inclusion followed the CDC criteria for CA-MRSA. Microbiological identification was performed using MALDI-TOF mass spectrometry, and antimicrobial susceptibility testing followed EUCAST standards. PVL gene presence was confirmed by polymerase chain reaction. Results: Clinical management included surgical drainage, systemic antibiotic therapy, and decolonization of both patients and close contacts. Long-acting lipoglycopeptides (oritavancin or dalbavancin) were evaluated as therapeutic options to achieve clinical resolution. Conclusions: PVL-positive CA-MRSA infections are characterized by recurrence, intrafamilial clustering, and frequent therapeutic failure with standard oral agents. Effective management requires an integrated approach combining prompt surgical drainage; systemic therapy, preferably including long-acting lipoglycopeptides; and comprehensive decolonization of all close contacts.

Background/Objectives: Veillonella species are Gram-negative, non-motile, non-fermentative, obligate anaerobic cocci. They are typically considered commensals of the oral cavity, respiratory tract, genitourinary tract, and gastrointestinal tract. It may be a rare cause of dental infections and discitis/spondylodiscitis. Methods: We report the case of an 80-year-old patient diagnosed with discitis caused by Veillonella parvula, isolated from blood. In addition, we performed a comprehensive literature review summarizing all reported cases of discitis or spondylodiscitis caused by Veillonella species. Results: In our case, antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method. Based on the results, the patient was treated with amoxicillin/clavulanate, which led to a favourable clinical outcome. A review of the literature revealed that, to date, only 14 cases of spondylodiscitis or discitis caused by Veillonella spp. have been reported. Potential risk factors for Veillonella spp. bacteremia were identified in only 9 cases. The most commonly affected site was the lumbar or lumbosacral spine. Magnetic resonance imaging was consistently regarded as the diagnostic gold standard. Most patients presented with localized pain. The overall therapeutic approach generally consisted of an initial course of intravenous antibiotics, typically ceftriaxone administered either as monotherapy or in combination with metronidazole, followed by an oral regimen with amoxicillin/clavulanate, given alone or alongside metronidazole. Conclusions: Spondylodiscitis due to V. parvula remains extremely rare. Although antimicrobial susceptibility patterns remain heterogeneous, beta-lactams, particularly amoxicillin/clavulanate, appear effective in most cases, and treatment regimens typically involve an initial intravenous phase followed by oral therapy.