Aims: To characterize patients hospitalized for COVID-19 in the three waves in Southern Italy. Methods: We conducted a multicenter observational cohort study involving seventeen COVID-19 Units in Campania, southern Italy: All adult (≥18 years) patients, hospitalized with a diagnosis of SARS-CoV-2 infection from 28 February 2020 to 31 May 2021, were enrolled. Results: Two thousand and fifteen COVID-19 hospitalized patients were enrolled; 392 (19%) in the first wave, 917 (45%) in the second and 706 (35%) in the third wave. Patients showed a less severe clinical outcome in the first wave than in the second and third waves (73%, 65% and 72%, respectively; p = 0.003), but hospitalization expressed in days was longer in the first wave [Median (Q1–Q3): 17 (13–25) v.s. 14 (9–21) and 14 (9–19), respectively, p = 0.001)] and also mortality during hospitalization was higher in the first wave than in the second and third waves: 16.6% v.s. 11.3% and 6.5%, respectively (p = 0.0001). Multivariate analysis showed that older age [OR: 1.069, CI (1046–1092); p = 0.001], a worse Charlson comorbidity index [OR: 1042, CI (1233–1594; p = 0.0001] and enrolment during the first-wave [OR: 1.917, CI (1.054–3.485; p = 0.033] were predictors of mortality in hospitalized patients. Conclusions: Improved organization of the healthcare facilities and the increase in knowledge of clinical and therapeutic management have contributed to a trend in the reduction in mortality during the three waves of COVID-19.

The availability of all oral direct acting antiviral agents (DAAs) has revolutionized the management of HCV infections in recent years, allowing to achieve a sustained virological response (SVR) in more than 95% of cases, irrespective of hepatitis C Virus (HCV) genotype or staging of liver disease. Although rare, the failure to the latest-generation regimens (grazoprevir/elbasvir, sofosbuvir/velpatasvir, pibrentasvir/glecaprevir) represents a serious clinical problem, since the data available in the literature on the virological characteristics and management of these patients are few. The aim of the present narrative review was to provide an overview of the impact of baseline RASs in patients treated with the latest-generation DAAs and to analyze the efficacy of the available retreatment strategies in those who have failed these regimens.

Background and Aim: PASC is a potentially debilitating clinical condition consisting of different general symptoms experienced by about 10% of patients with previous SARS-CoV-2 infection. Our study analyses a cohort of patients with a history of hospitalization for COVID-19 and aims to evaluate prognostic factors for experiencing PASC and to investigate the characteristics of patients experiencing PASC symptoms. Methods: This is an observational, monocentric retrospective study including all adult patients admitted to our COVID unit from 28 February 2020 to 30 April 2022, discharged alive, and having performed at least one follow-up visit at our post-COVID outpatient clinic after a minimum of three months from discharge. Patients who experienced persistent clinical manifestations or the development of new symptoms three months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least two months with no other explanation, were defined as having PASC. Results: A total of 429 patients were discharged alive from our COVID Unit and 244 patients performed at least one follow-up visit in our outpatient clinic. Of these, 134 patients did not experience PASC, while 110 patients experienced PASC. Long-COVID patients were more frequently female (43.6% vs. 31.3%, p = 0.048), more frequently presented throat pain and headache at hospital admission (respectively 8.9% vs. 2.5%, p = 0.041 and 15.8% vs. 5%, p = 0.007), and were more likely to have a history of type 2 diabetes mellitus (25.5% vs. 13%, p =0.013). At the multivariable analysis, female gender, type 2 diabetes, and headache at admission were factors associated with PASC. All 46 patients who performed at least two different admissions in our outpatient clinic were divided in two groups: the first including the 16 patients who experienced a reduction or a resolution of symptoms related to COVID-19, the second comprising the 30 patients who experienced clinical worsening or persisting symptoms. Smoking habit was more represented among patients with stable or worsening symptoms (42.3% vs. 7.7%, p = 0.042); myalgias at admission were more frequent in the clinical worsening group (27.6% vs. 0%, p= 0.039); and a larger amount of patients who reported neuropsychiatric symptoms and respiratory symptoms were in the stable or worsening PASC symptoms group. Discussion: In conclusion, this study underscores the complexity of PASC, identifying female sex, Type 2 diabetes, and certain acute COVID-19 symptoms as potential predisposing factors for its development. PASC still represents a substantial public health challenge, and ongoing efforts are essential to better understand its underlying mechanisms and improve patient outcomes.

Pseudomonas aeruginosa is a ubiquitous opportunistic pathogen and a leading cause of severe healthcare-associated infections, particularly ventilator-associated pneumonia (VAP) and bloodstream infections (BSIs) in critically ill patients. Its remarkable capacity for both intrinsic and acquired resistance leads to complex phenotypic profiles, culminating in difficult-to-treat resistant P. aeruginosa (DTR-PA). Managing DTR-PA presents a daunting clinical challenge characterised by a narrow therapeutic armamentarium, treatment delays, and high attributable mortality. To bridge the gap between complex molecular microbiology and bedside decision-making, this narrative review employs a pragmatic, clinical vignette-based approach. Through six representative fictional scenarios of pneumonia and BSI, we systematically dissect the underlying mechanisms of resistance and their direct therapeutic implications. The vignettes explore combinations of intrinsic adaptations—such as Pseudomonas-derived cephalosporinase (PDC/AmpC) hyperexpression, OprD porin loss, and efflux pump upregulation—as well as the acquisition of serine- (e.g., GES) and metallo-β-lactamases (e.g., VIM, NDM, IMP). Grounded in the updated 2026 Infectious Diseases Society of America (IDSA) guidelines, we evaluate the optimal deployment of newer β-lactam/β-lactamase inhibitor combinations. We highlight the specific preference for ceftolozane–tazobactam in pneumonia, the roles of ceftazidime–avibactam and imipenem–relebactam, and the critical use of cefiderocol for metallo-β-lactamase producers and highly resistant phenotypes. Furthermore, the review addresses pressing clinical controversies: the superiority of targeted monotherapy over historical, toxic combination regimens; the risks of unconditionally applying “shorter-is-better” duration paradigms to DTR-PA; and the alarming frequency of treatment-emergent cross-resistance among novel agents. We also clarify common clinical misconceptions, such as the limited utility of meropenem–vaborbactam and aztreonam–avibactam against specific pseudomonal mechanisms. Ultimately, effective DTR-PA management precludes class-based empirical assumptions. By providing a phenotype-driven bedside aide-mémoire, this review reinforces that rapid recognition, direct agent-specific antimicrobial susceptibility testing (AST), pharmacokinetic/pharmacodynamic (PK/PD)-optimised dosing, and prompt source control remain the absolute cornerstones of survival for patients afflicted by these formidable infections.