Antimicrobial susceptibility testing (AST) is not routinely performed for C. difficile infection (CDI); however, reports of antimicrobial resistance to various antibiotics have increased. This study aimed to assess the rate of antimicrobial resistance to four antimicrobials (vancomycin, metronidazole, tigecycline, and ciprofloxacin) to assess risk factors for antimicrobial resistance and evaluate MIC variation in patients with recurrence. Data from consecutive patients with CDI admitted to our institution between 1 January 2022 and 30 April 2023 were collected. We performed AST with gradient diffusion and NAAT to evaluate the presumptive presence of R027/NAP1 and toxin production genes. Antimicrobial susceptibility testing was performed on 108 available isolates. We did not find any resistance to vancomycin (median MIC 0.5 μg/mL), metronidazole (median MIC 1 μg/mL), and tigecycline (median MIC 0.016 μg/mL), while resistance to ciprofloxacin was detected in all the samples. Among the recurrent isolates, 37.5% displayed a 2-fold MIC increase for vancomycin, 75% for metronidazole, and 37.5% for tigecycline. After stratifying clinical outcomes according to vancomycin MIC, patients with higher MIC experienced increased 28-day mortality (p value 0.009). Our results were concordant with European surveillance data. MIC increase in all tested antibiotics in patients with CDI warrants further research since decreased susceptibility has been associated with clinical failure.

Background: Double-valve infective endocarditis (DVIE) accounts for 15–20% of all endocarditis and represents a challenge due to the increased incidence of embolic events and congestive heart failure compared to infective endocarditis (IE) affecting one valve. This study aims to evaluate patients’ characteristics, surgical procedures, complications, and mortality associated with DVIE in our tertiary hospital in Italy. The Endocarditis Registry STEADY includes patients admitted with IE from January 2009 to March 2024 (n = 398). Sixty-three of them (16%) had DVIE. Methods: We conducted a retrospective single-center observational study, analyzing demographic, clinical, and microbiological data in DVIE patients, comparing those treated surgically (surgical group, SG) with those treated medically (non-surgical group, NSG). Results: The groups were homogeneous in age, microbiological yields, type of valve involved, and risk factors for infective endocarditis. The surgical group presented significantly more cancer history, intracardiac complications, and new-onset arrhythmias compared to the non-surgical group. Median hospital stay was similar in both groups. In SG, the most common postoperative complication was new rhythm disorders; other complications such as cardiac tamponade, pericardial effusion, and pneumothorax were rare. In-hospital mortality was similar between groups; however, one-year survival was higher in the surgical group (72% vs. 54%, p = 0.031). In our series, 16 patients were over 75 years old (25%), and 7 of them (44%) underwent cardiac surgery. One-year survival in the surgical group was also higher in this subgroup. Conclusions: Surgical treatment, when indicated, may improve the prognosis of patients with DVIE, including elderly patients.

We aimed to characterize suppressive antimicrobial treatment (SAT) for non-surgical candidate patients with prosthetic valve endocarditis (PVE). We systematically reviewed PubMed and Embase databases for studies reporting individual data on patients with PVE medically treated for longer than 8 weeks published until the 31^st of June 2024. The review protocol was registered on PROSPERO database [CRD42024529650]. One hundred seventy patients were retrieved from 91 studies. PVE-related death during follow-up occurred in 26 (15.57%) patients, being associated with coagulase-negative staphylococci PVE in multivariate Cox regression model (HR 3.40, 95% CI 1.06-10.97, P-value = 0.04). Relapse occurred in 15 (8.92%) patients and was similar according to SAT discontinuation (long-rank test P-value = 0.8). This was confirmed after performing landmark analysis to adjust for survival bias (HR 0.97; 95% CI 0.21-4.4, P-value = 0.98). SAT-related adverse events were reported in 15% of the patients. Supporting evidence for SAT is low and derived from case reports and case series. SAT seems well tolerated, but clinical effectiveness should be further evaluated due to the relevant mortality rate. In selected cases when SAT discontinuation is considered, close and long-term follow-up is crucial to prevent relapse.

Background: In 2018, Lombardy's Fight Against Sepsis in Obstetrics group developed a regional sepsis management bundle for obstetric patients. This study aimed to evaluate the impact of this bundle on maternal and neonatal clinical outcomes and on process measures. Methods: This multicenter, observational, retrospective study included data from pregnant and puerperal adult patients diagnosed with sepsis according to the Surviving Sepsis Campaign guidelines in 2 periods: May 2015 to May 2018 (prebundle) and July 2018 to January 2023 (postbundle). Results: Eighty women were included: 24 (30.0%) in the prebundle period and 56 (70.0%) in the postbundle period. The primary source of infection was urinary (40.0%), with Escherichia coli being the most common pathogen isolated from blood cultures. Regarding clinical outcomes, no deaths occurred in pre- and postbundle periods. For mothers, there was no significant difference in median length of stay between the groups, while neonatal intensive care unit admissions of neonates significantly decreased from 85.7% to 31.3% (P = .013). Regarding process measures, the only significant increase occurred in infectious disease specialist consultations in the postbundle period (75.0%) as compared with the prebundle period (50.0%, P = .029). Conclusions: The implementation of a regional maternal sepsis management bundle did not significantly alter maternal outcomes but was associated with a reduction in neonatal intensive care unit admissions, although what role bundle implementation had in this change remains uncertain. More infectious disease consultations postbundle highlight the potential role of the bundle increasing sepsis awareness among physicians dealing with these patients.

Background: Ocular tuberculosis (TB) is an uncommon yet potentially vision‐threatening manifestation of Mycobacterium tuberculosis , particularly difficult to diagnose in immunocompromised individuals. The increasing use of anti–tumor necrosis factor‐ α (anti–TNF‐ α ) agents has markedly heightened the risk of TB reactivation, often with disseminated or extrapulmonary involvement despite negative baseline screening. Case Presentation: We describe a 52‐year‐old woman with rheumatoid arthritis receiving long‐term adalimumab and methotrexate who developed disseminated TB with pulmonary, splenic, and ocular involvement after 12 years of anti–TNF‐ α therapy. Baseline screening had shown a negative tuberculin skin test and an indeterminate interferon‐ γ release assay. She presented with constitutional and respiratory symptoms, whereas chest computed tomography demonstrated diffuse micronodular infiltrates consistent with miliary TB. Microbiological confirmation was obtained via bronchoalveolar lavage. Ophthalmologic evaluation revealed bilateral choroidal granulomas with subretinal edema, leading to a diagnosis of ocular TB. Standard antitubercular therapy (ATT) was initiated but required modification due to drug‐induced liver injury. Adjunctive systemic corticosteroids were introduced after antimicrobial therapy and gradually tapered. The patient achieved progressive clinical, radiological, and ophthalmologic improvement, with gradual regression of choroidal lesions. Discussion: This case underscores the persistent long‐term risk of TB reactivation during prolonged anti–TNF‐ α therapy and highlights the limitations of current screening strategies in immunosuppressed patients. Ocular TB requires integration of systemic, clinical, and imaging findings; in this patient, microbiologically confirmed disseminated TB together with characteristic bilateral choroidal granulomas supported a definitive diagnosis. Management relies on prompt ATT, discontinuation of immunosuppression, and judicious use of adjunctive corticosteroids. Long‐term follow‐up is essential given the risk of persistent lesions and late recurrence. Reintroduction of biologic therapy may be feasible in selected cases but requires careful risk stratification. Conclusion: TB should remain a diagnostic consideration in patients receiving biologic therapy who develop compatible systemic or ocular manifestations, even after long‐term treatment and negative baseline screening. Close multidisciplinary collaboration is essential for the diagnosis and management of ocular TB in this population.